Obstetric Hemorrhage Research Articles

Trends in Maternal Mortality From Obstetric Hemorrhage in France: 15 Years of Confidential Enquiry Into Maternal Deaths.

The aim of this study was to assess temporal trends in incidence and underlying causes of maternal deaths from obstetric hemorrhage in France and to describe clinical care before and after implementation of the first national guidelines published in 2004 and updated in 2014. Data from all hemorrhage-related maternal deaths between 2001 and 2015 were extracted from the French Confidential Enquiry into Maternal Deaths. We compared the maternal mortality ratio (MMR), cause of obstetric hemorrhage, and death preventability by triennium. Critical care, transfusion, and obstetric management among women who died were described for 2001 to 2003 and 2013 to 2015. The MMR from obstetric hemorrhage significantly decreased over time from 2.3 of 100,000 livebirths (54 of 2,391,551) in 2001 to 2003 to 0.8 of 100,000 livebirths (19 of 2,412,720) in 2013 to 2015. In 2001 to 2003, uterine atony accounted for 50% (27 of 54) of maternal deaths vs 21% (4 of 19) in 2013 to 2015. As compared to 2001 to 2003, an increased proportion of women had hemodynamic continuous monitoring in 2013 to 2015 (30%, 9 of 30, vs 47%, 8 of 18) and received vasopressor infusion therapy (57%, 17 of 30, vs 72%, 13 of 18), and a smaller proportion was extubated during active hemorrhage (17%, 5 of 30, vs 0 of 18). Transfusion therapy was initiated more frequently and earlier in 2013 to 2015 (71 vs 58 minutes). In 2013 to 2015, 88% of maternal deaths due to hemorrhage remained preventable. The main identified improvable care factors were related to delays in diagnosis and surgical management, particularly after cesarean delivery. Maternal mortality by obstetric hemorrhage decreased dramatically in France between 2001 and 2015, particularly mortality due to uterine atony. Among women who died, we detected fewer instances of substandard transfusion management or critical care. Nevertheless, opportunities for improvement were observed in most of the recent cases.

#2977 Pregnancy-related acute kidney injury in a second level care hospital in Merida, Yucatan, Mexico

Abstract Background and Aims Pregnancy-related acute kidney injury (PRAKI) is a public health problem associated with an increased risk of adverse maternal and fetal outcomes. The causes of PRAKI varies according to the age of gestation. Mexico lacks a national acute kidney injury (AKI) registry, and the access to AKI treatment is limited due to lack of financial coverage, lack of nephrologists, and poor infrastructure. The General Hospital Dr. Agustín O'Horán is a second level unit that attends to the uninsured pregnant population from the southeast of Mexico. The aim of this study was to investigate the prevalence, clinical characteristics, and outcomes of PRAKI in a Mexican population. Method This was a retrospective study in an obstetric intensive care unit (OICU) in the General Hospital Dr. Agustín O'Horán in Merida, Yucatan, Mexico. Women during pregnancy and postpartum periods admitted to the OICU between January to December 2023 were included. Demographical, clinical and laboratory data were collected from medical records, and AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. We evaluated the prevalence, clinical characteristics, and outcomes of PRAKI. Results During the study period, 188 women were admitted to the OICU, and the mean age was 24.9 years. Eight women presented in the first trimester, 19 in the second trimester, 21 in the third trimester, and 140 in the postpartum period. Fifty-five women met AKI creatinine criteria: 31 (56.3%) had stage 1, 15 (27.3%) had stage 2, and 9 (16.4%) had stage 3. The most common causes of PRAKI were obstetric hemorrhage (27.3%), eclampsia (21.8%), and preeclampsia (18.2%) (Table 1). There was no difference in vital signs on admission and baseline creatinine level between both groups. Women who developed PRAKI had a longer stay in the OICU (4.2 days vs 2.3 days, p < 0.001), and greater use of vasopressor (30.9% vs 9.0%, p < 0.001), and mechanical ventilation (34.5% vs 11.3%, p < 0.001). Women with AKI had higher mortality (9.1% vs 1.5%, p = 0.012), and perinatal mortality (9.1% vs 2.3%, p = 0.035) (Table 2). Conclusion Women during pregnancy and postpartum periods who developed PRAKI had more adverse clinical and obstetric outcomes (maternal and perinatal mortality). Hence, women in pregnancy and postpartum periods admitted to an intensive care unit should be closely monitored and implement strategies for early diagnosis and aggressive therapy of PRAKI regardless of KDIGO stage.

Pregnancy and childbirth in patients with Glanzmann Thrombasthenia.

Glanzmann thrombasthenia (GT) is a rare inherited platelet bleeding disorder caused by a quantitative and/or qualitative defect of the αIIbβ3 integrin. Pregnancy and delivery pose special challenges as they entail increased risks of both maternal and foetal bleeding that may be life-threatening. Multidisciplinary management throughout the preconception, intrapartum and peripartum periods is vital to optimize pregnancy outcomes. This Nutshell review focuses on the challenging management of pregnancy and childbirth in patients with GT.

Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa.

The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.

Risk Assessment of Critical Obstetric Bleeding With Low-Molecular-Weight Heparin.

Use of unfractionated heparin (UFH) during the peripartum period is considered to be a higher risk of critical obstetric bleeding compared to low-molecular-weight heparin (LMWH). However, the evidence for the safety of using LMWH during the peripartum period is currently lacking. This study retrospectively investigated a nationwide medical database to clarify the safety of using LMWH during childbirth. The Japanese Nationwide Diagnosis Procedure Combination database was retrospectively reviewed, and data from women with childbirth between 2018 and 2022 were collected. Among the overall 354,299 women with childbirth, 3,099 were with obstetric disseminated intravascular coagulation (DIC), 484 were with critical obstetric bleeding requiring massive red blood cell (RBC) transfusion ≥4,000 cc, and 38 were with maternal death. Among the overall women, each of the anticoagulants other than LMWH was associated with critical obstetrical bleeding with an adjusted odds ratio (aOR) greater than 1.0, while LMWH was not associated with critical obstetrical bleeding (aOR, 0.54 (95% confidence interval, 0.11-2.71)). This finding did not change in subgroup analyses among those with Cesarean section. Furthermore, UFH was associated with critical bleeding among the 3,099 women with obstetrical DIC (aOR, 3.91 (2.83-5.46)), while LMWH was not (aOR, 0.26 (0.03-1.37)). The use of UFH was significantly associated with an increased critical obstetric hemorrhage requiring massive RBC transfusion or total hysterectomy. Meanwhile, the use of LMWH was not associated with increased critical obstetric bleeding. LMWH would be safer than UFH to be used for women during childbirth.

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Long-term outcomes of uterine artery embolization in patients with early hypotonic postpartum hemorrhage

Introduction. Obstetric haemorrhage remains the number one cause of maternal death globally. Today, the frequency of hypotonic postpartum hemorrhage (PPH) reaches 80% in the obstetric hemorrhage profile.Objective. To evaluate the long-term outcomes of uterine artery embolization (UAE) for the treatment of early hypotonic postpartum hemorrhage (PPH).Material and methods. 136 patients were examined 2–8 years after UAE performed for early hypotonic postpartum hemorrhage. A survey was conducted for everyone. Ultrasound of the pelvic organs on the 5th–7th day of the menstrual cycle with an assessment of endometrial thickness, ovarian volume, number of antral follicles, and also Dopplerography were performed in 34 patients. Hormonal status was studied in 34 patients, that were examined in the first phase of the menstrual cycle, with an assessment of serum levels of anti-Mullerian hormone (AMH), follicle-stimulating (FSH) and luteinizing (LH) hormones.Results. 19.1% (26/136) of patients planned pregnancy. Pregnancy occurred in 61.5% (16/26). Term delivery occurred in 38.5% (10/26), PPH recurrence occurred in 30% (3/10), placenta accretion was not detected. 23.1% (6/26) patients were pregnant at the time of the survey. Neither morphological nor functional changes of the ovaries were detected in patients 2–8 years after UAE.Conclusions. Uterine artery embolization is a safe method of therapy of early hypotonic postpartum hemorrhage.

The Effect of Bilateral Uterine Artery Ligation after Intrapartum or Postpartum Hemorrhage on Ovarian Reserve Markers and Pregnancy Outcome

The Effect of Bilateral Uterine Artery Ligation after Intrapartum or Postpartum Hemorrhage on Ovarian Reserve Markers and Pregnancy Outcome

Intravenous Iron Supplementation Timing in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683470

INTRODUCTION: Intravenous iron supplementation (IVFe) for pregnant patients with iron deficiency anemia improves hemoglobin (Hb) levels in the peripartum period. Optimal timing of this therapy, however, is unknown. We analyzed the effects of IVFe as part of an institution-based protocol on maternal Hb levels, stratifying by gestational age (GA). METHODS: We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by gestational age (<34 or ≥34 weeks) at time of IVFe. We excluded patients with known antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software. RESULTS: Of 295 patients who met inclusion criteria, maternal age, body mass index, nulliparity, and ferritin levels were similar in both groups. Mean GA for the cohorts at time of IV iron transfusion were 29.6 ± 4.9 weeks (early third trimester) and 36.6 ± 2.4 weeks (late third trimester), respectively (P<.0001). Higher delta Hb (2.5 g/dL at <34 weeks versus 1.3 g/dL at ≥34 weeks) and improved mean pre-delivery Hb were seen when IV iron was given in the early third trimester (P<.0001). CONCLUSION: Early third-trimester IVFe improves maternal pre-delivery Hb levels and may reduce significant maternal morbidity hemorrhage complications.

Intravenous Iron Supplementation in Pregnancy: Comparisons of Dosage and Latency of Infusion Based on a Quality Improvement Project on Maternal Transfusion Reduction [ID 2683380

INTRODUCTION: Optimal dosing of intravenous iron supplementation (IVFe) and latency of the infusion for pregnant patients with iron deficiency anemia has been minimally evaluated. We analyzed the effects of specific IVFe dosage parameters as part of an institution-based protocol on maternal peripartum hemoglobin (Hb) levels stratifying by time of infusion to delivery. METHODS: We reviewed average changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by IVFe dosage forms (800 mg) and infusion latency (by 2-week increments). We excluded patients with known antepartum blood transfusion. Maternal demographics and all comparison groups were analyzed among each other using GraphPad Prism software. RESULTS: Two hundred ninety-five patients met inclusion criteria. Demographics of maternal age, body mass index (BMI), nulliparity, and ferritin levels were similar in all groups. We found a statistically significant difference in improved pre-delivery Hb with larger IVFe doses (P=.002) and longer infusion-delivery periods (P=.049). A Tukey post-hoc test revealed that the highest yield on mean delta Hb was after 6–8 weeks or longer of latency with doses greater than 800 mg versus less than 2 weeks at doses of 800 mg or lower (2.6–3.1 g/dL; P<.0001). CONCLUSION: Latency periods of at least 6 weeks with IVFe dosages of 800 mg or greater, regardless of maternal BMI or starting ferritin, may markedly improve pre-delivery Hb levels and ultimately reduce maternal morbidity hemorrhage complications.

6301352 Thromboelastography (TEG) in Major Obstetric Haemorrhage: Assessment of Use during Major Haemorrhage and Healthcare Professional Awareness of TEG

6301352 Thromboelastography (TEG) in Major Obstetric Haemorrhage: Assessment of Use during Major Haemorrhage and Healthcare Professional Awareness of TEG

Seven-year review of emergency peripartum hysterectomy in a tertiary hospital in northern Nigeria

Background: Emergency peripartum hysterectomy (EPH) is surgical removal of the uterus during childbirth or within its immediate 24 hours, a lifesaving procedure done as the last resort to control obstetric haemorrhage. Objectives: To determine the incidence, indications, and complications of peripartum hysterectomy. Methods: The study is a retrospective review of emergency peripartum hysterectomies performed at the Centre from 1st January, 2015 to 31st December, 2021. The patients’ case folders were retrieved from the medical records department and relevant information obtained using a structured data extraction format. The data was analyzed using SPSS version 26. Means, frequency, and percentages were used to present the significance of the results. Results: A total of 46 EPH were performed between January 2015 and December 2021 out of 20,832 deliveries within the same period, giving an incidence of 0.22% (2.2 per thousand deliveries). Indications were uterine rupture (78.2%), uterine atony (10.9%), abruptio placentae (4.3%), placenta previa (4.3%) and placenta accreta spectrum (2.2%). Subtotal hysterectomy was performed in most cases (39/46; 84.8%). The most common complication was intraoperative haemorrhage requiring blood transfusion (100%). Other complications included severe post-operative anaemia, wound sepsis, paralytic ileus and enterocutaneous fistula. The maternal case fatality was 4 (8.7%) and all the mortality cases were unbooked patients. Conclusion: The incidence of emergency peripartum hysterectomy is relatively low in our study and uterine rupture is the most common indication. EPH is associated with significant maternal morbidity and mortality, and this is related to booking status. Hence, enlightening women on antenatal care and hospital delivery will help in reducing maternal morbidity and mortality.

Cost analysis of care and blood transfusions in patients with Major Obstetric Haemorrhage in Ireland.

Obstetric haemorrhage is the leading cause of maternal morbidity and mortality worldwide. We aimed to estimate the economic cost of Major Obstetric Haemorrhage (MOH) and the cost of therapeutic blood components used in the management of MOH in Ireland. We performed a nationwide cross-sectional study utilising top-down and bottom-up costing methods on women who experienced MOH during the years 2011-2013. Women with MOH were allocated to Diagnostic Related Groups (DRGs) based on the approach to MOH management (MOH group). The total number of blood components used for MOH treatment and the corresponding costs were recorded. A control group representative of a MOH-free maternity population was designed with predicted costs. All costs were expressed in Euro (€) using 2022 prices and the incremental cost of MOH to maternity costs was calculated. Cost contributions are expressed as percentages from the estimated total cost. A total of 447 MOH cases were suitable for sorting into DRGs. The estimated total cost of managing women who experienced MOH is approximately €3.2 million. The incremental cost of MOH is estimated as €1.87 million. The estimated total cost of blood components used in MOH management was €1.08 million and was based on an estimated total of 3997 products transfused. Red blood cell transfusions accounted for the highest contribution (20.22%) to MOH total cost estimates compared to other blood components. The total cost of caring for women with MOH in Ireland was approximately €3.2 million with blood component transfusions accounting for between one third and one half of the cost.

The magnitude and associated factors of immediate postpartum anemia among women who gave birth in Ethiopia: systematic review and meta-analysis, 2023

BackgroundThe immediate postpartum period is a very crucial phase for both the life of the mother and her newborn baby. Anemia is the most indirect leading cause of maternal mortality. However, anemia in the immediate postpartum period is a neglected public health problem in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of immediate postpartum anemia and the pooled effect size of associated factors in Ethiopia.MethodsSearching of published studies done through PubMed, Medline, Cochrane, African index Medicus, List of Reference Index, Hinari, and Google Scholar. This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) godliness. The quality of studies was assessed by using a Newcastle- Ottawa Scale (NOS) assessment tool. Analysis was performed using a random effect model by using STATA 17 version software. Egger’s weighted regression and I2 test were used to evaluate publication bias and heterogeneity respectively.ResultsIn this systematic review and meta-analysis, a total of 6 studies were included. The pooled magnitude of immediate postpartum anemia in Ethiopia was 27% (95%CI: 22, 32). Instrumental mode of delivery (OR = 3.14, 95%CI: 2.03, 4.24), mid-upper arm circumference (MUAC) measurement < 23 cm (OR = 3.19, 95%CI: 1.35, 5.03), Antepartum Hemorrhage (OR = 4.75, 95%CI: 2.46, 7.03), postpartum hemorrhage (OR = 4.67, 95%CI: 2.80, 6.55), and no iron/foliate supplementation (OR = 2.72, 95%CI: 1.85, 3.60) were the identified factors associated with developing anemia in the immediate postpartum period.ConclusionThe overall pooled magnitude of anemia in the immediate postpartum period among Ethiopian women was still a moderate public health problem. Instrumental mode of delivery, mid upper arm circumference (MUAC) measurement < 23 cm, antepartum hemorrhage, postpartum hemorrhage, and no iron/foliate supplementation were the identified factors associated with higher odds of developing anemia among immediate postpartum women in Ethiopia. Therefore, midwives, and doctors, shall focus on prevention of maternal hemorrhage, nutritional advice and counseling including iron /foliate supplementation, and avoid unnecessary instrumental delivery to prevent and reduce anemia related maternal mortality and morbidity in Ethiopia.PROSPERO registrationCRD42023437414 with registration date on 02/08/2023.

Feto-Maternal Outcome in Patients with Placenta Previa at Aljala Maternity Hospital, Tripoli, Libya

To assess maternal and fetal morbidity associated with placenta previa. All patients with placenta previa who delivered in services hospital, Aljala Maternity hospital during the years 2020 to 2022 were involved. This study designed as descriptive retrospective cross-sectional study. Total number of 55 patients having placenta previa during the study period, 52.07% of patients were in age group 31-40 years while 15.5% of patients with placenta previa were less than 30 years (p&lt;0.05). Regarding the gestational age, the current study showed that the mean gestational age for the patients who had PP was 37.19 weeks. The result was statistically insignificant with p value of 0.618. Most of the patients had H/O previous cesarean section (15 previous I C/S, 26 previous II C/S, 3 previous III C/S, 2 previous IV C/S, and 1 previous V C/S) which accounts 86.1% of the participated patients. Increased number of caesarean sections significantly associated with PP (p=0.0001). Around two third of women underwent urgent C/S (66%), and the rest of them (34%) had elective type. One third of the patients came with H/O vaginal bleeding. 21% of the patients had a complain of pain (most of them lower abdominal pain). 12.7% of the patients came shocked. Four percent of the participated women underwent hysterectomy, one of them had elective cesarean section. 15% of the patients had intrapartum bleeding, and 24% of the participated women had blood transfusion which reach 6 units in one case. With regard the birth weight, most of the neonates had average birth weight (80.4%). The percentage of low birth weight (LBW) was 9.4%. On the other hand, the percentage of macrosomia (birth weight is above 4.5kg) was 10.2% for the P value 0.737. 41.5% of the neonates had H/O admission to the neonatal intensive care unit. The most of the neonates were with mother (58.5%). There was one neonatal death during the admission in NICU. Placenta previa is danger to both the mother and the baby with high maternal morbidity and adverse perinatal outcome. Regular antenatal care with adequate arrangement of blood transfusion and multidisciplinary approach can reduce maternal morbidity and mortality.

Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease

Background and objectivescardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. Materials and methodsCross-sectional and retrospective study, which included the 2017–2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. Results112 patients with a median age of 28 years (range 15−44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk.Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5−10, p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6−194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3−84, p = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5−616, p = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2–16, p = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4−68, p = 0.021). Conclusionssevere complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.

Invited Commentary: Obstetric Hemorrhage: Imaging for Prevention of Maternal and Perinatal Mortality.

Invited Commentary: Obstetric Hemorrhage: Imaging for Prevention of Maternal and Perinatal Mortality.

Imaging of Antepartum and Postpartum Hemorrhage.

Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.

IJCM_80A: A Study on Risk factors and outcome of post partum hemorrhage among postnatal mothers attending a tertiary care hospital in Guntur District

Background: Post Partum Haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. PPH is the most common form of major obstetric haemorrhage. Majority of deaths due to PPH are reported to be in developing countries and the major factors responsible were attributed to lack of access to reproductive health services, availability of skilled health personnel, timely intervention of obstetric emergencies and others such as appropriate equipment and supplies. With increase in rate of institutional deliveries and improvement in quality of services MMR can further be reduced with focus on the factors responsible for maternal deaths. Objective: The study was aimed to identify risk factors of postpartum hemorrhage among postnatal mothers and to analyze various factors and determinants that influence the outcome among mothers with PPH. Methodology: This was a descriptive observational retrospective study conducted in Department of obstetrics and Gynecology, government general hospital, Guntur. The target population included 50 postnatal mothers diagnosed as having PPH. Other causes of hemorrhage not related to delivery such as accidents and women with preexisting medical and other conditions were excluded. Data was collected from the available medical records Results: The prevalence of PPH was 0.96%. The causative factors identified were atonic uterus (80%), traumatic delivery (17.5%) and retained bits (1.7%). Induced labor (16%), prolonged labor (11.1%) and preeclampsia (3.4%) were the risk factors that lead to PPH. The mortality was 4% (2) and the cause of death in the 2 patients was due to shock. Conclusion: In the present study, the prevalence of postpartum hemorrhage (PPH) was recorded at 0.96%. Uterine atony emerged as the primary contributing factor, with induced labor identified as the leading risk factor associated with an increased predisposition to PPH. Shock stood out as the predominant cause of mortality.

Tranexamic Acid Use in Obstetric Hemorrhage: Knowledge and Attitude Among Jordanian Obstetricians and Gynecologists.

Tranexamic acid (TXA) use in obstetric hemorrhage has been shown to decrease both maternal mortality and morbidity. This study aimed to explore the knowledge and attitudes of Jordanian obstetricians and gynecologists regarding the use of TXA in obstetric bleeding cases, as well as to identify factors that affect decision-making processes and emphasize the significance of TXA in enhancing maternal health outcomes. This study used a cross-sectional design and a structured questionnaire to gather data from a convenience sample of 1000 Jordanian obstetricians. Most participants used TXA to address obstetric hemorrhage, with medical training being the primary source of knowledge about TXA for(113/166) 68.1% of respondents. Awareness of TXA's potential benefits was highbut some misconceptions existed. Approximately(96/166) 57.8% of the participants were aware of the recommended dosage regimen, and (61/166) 36.7% emphasized the importance of timing of administration. Knowledge of potential side effects was notable, with (55/166) 33.1% aware of life-threatening side effects, such as pulmonary embolism and deep vein thrombosis. Concerns regarding barriers to implementation included the absence of strict guidelines (54.8%) and drug availability( 91/166;54.8%). However,(64/166) 38.6% expressed confidence in the effective use of TXA for obstetric hemorrhage treatment. The majority of respondents(154/166; 92.8%) considered additional education and training on TXA use to be important in managing obstetric hemorrhage. Jordanian obstetricians have used TXA in cases of obstetric hemorrhagedespite their experience and knowledge based only on limited resources; the need for national guidelines on when and how to use TXA in obstetric practice is of great importance and got vast support from the Jordanian obstetricians.