Obstetric Emergencies Research Articles

Develop a web-based system using the Naïve Bayes algorithm to predict asphyxia neonatal

Introduction: Most cases of perinatal asphyxia are caused by conditions unrelated to labor. When asphyxia occurs during childbirth, it is usually caused by an obstetric emergency that was not detected during pregnancy. It is essential to prevent asphyxia by identifying the incidence of asphyxia during pregnancy. Several studies have been conducted to identify asphyxia problems developing by predictive models. However, there has been no development of a system for predicting birth asphyxia during pregnancy and carried out in primary health facilities.Purpose: Develop a web-based system using the Naïve Bayes (NB) algorithm to predict asphyxia neonatal using a dataset of antepartum risk factors in primary health facilities.Methods: This study employed research and development, which consists of 4 stages, namely literature study, development stage, expert validity, and trial.Results: A system that health workers in primary health facilities can use to predict asphyxia neonatal and recommend referrals for determining the place of childbirth has been successfully created. The system performance test predicted asphyxia neonatal with all NB evaluation values reaching more than 98%, and the prediction accuracy in the respondent test included in the High Accuracy category (MAPE value 9.06%).Conclusion: The development of a web-based system using the NB algorithm has been proven to be able to predict asphyxia neonatal and can be implemented for health workers as an effort to anticipate delays in handling cases of asphyxia neonatal because of the predicted results along with recommendations for focusing mothers with the risk of babies born asphyxia to find out possible childbirth places.

The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571

INTRODUCTION: Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia. METHODS: Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome. RESULTS: A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived. CONCLUSION: This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.

A Quality Improvement Intervention to Improve the Management of Obstetric Hypertensive Emergency during Pregnancy and Postpartum

A Quality Improvement Intervention to Improve the Management of Obstetric Hypertensive Emergency during Pregnancy and Postpartum

A Model for Interprofessional, Multisituational, High-Intensity Simulations of Obstetrical and Neonatal Emergencies Involving Residents and Nursing Students.

A Model for Interprofessional, Multisituational, High-Intensity Simulations of Obstetrical and Neonatal Emergencies Involving Residents and Nursing Students.

Embarazo crítico en la altitud: una mirada en América Latina

Critical pregnancy at high altitudes increases morbidity and mortality from 2,500 meters above sea level. In addition to altitude, there are other influential factors such as social inequalities, cultural, prehospital barriers, and lack the appropriate development of healthcare infrastructure. The most frequent causes of critical pregnancy leading to admission to Intensive Care Units are pregnancy hypertensive disorders (native residents seem to be more protected), hemorrhages and infection/sepsis. In Latin America, there are 32 Intensive Care Units above 2,500 meters above sea level. Arterial blood gases at altitude are affected by changes in barometric pressure. The analysis of their values provides very useful information for the management of obstetric emergencies at very high altitude, especially respiratory and metabolic pathologies.

Determinants of Mortality in Primigravida in Peoples Medical College Nawabshah.

Objective: To determine the determinants of maternal mortality in primigravida. Methodology: This cross-sectional, descriptive study was conducted from June 2023 to Dec 2023 at the department of Gynecology and Obstetrics of Peoples University of Medical & Health Sciences for women, Nawabshah; a tertiary care center. We studied overall causes of death (direct and indirect) during pregnancy, delivery, and puerperium. Those patients who died after admission were included and analyzed on specially designed proforma. Information collected from hospital records/patient attendants. The reason for admission, status at arrival, cause of death, and potential variables answerable for death were recognized. Data including age, booking status, parity, gestational age, and relevant variables from the current pregnancy, along with the traveling distance from the clinic, was recorded on Performa, and analyses were done on SPSS adaptation 25. Results: During study period 43 maternal deaths occurred in their first pregnancy. The live birth rate was 10020. MMR counted to 429 per lac live birth. Most frequent death occurs at 19 years of age, from the rural population (62%), the majority un-booked (72%), history of domestic violence (48%) was not uncommon. Among these primigravida; 60% having no formal education, 65% were referral cases presented with obstetrical complication and in labor (34.9%). Almost all deaths were due to direct causes (99%). The highest contribution was by hemorrhage 39.5% (PPH=27.9%+ APH 11.6%), followed by sepsis (27.9%), pre-eclampsia/ eclampsia (18.6%), pulmonary embolism (7%), while 4.7% deaths due to unsafe abortion in early pregnancy complications. We found only 2.3% of deaths due to indirect causes. CONCLUSION: It is crucial to highlight that tackling maternal mortality requires a comprehensive strategy, which encompasses enhancing healthcare infrastructure, guaranteeing access to high-quality prenatal and obstetric care, advocating for education and awareness, and tackling social determinants of health. Recognizing and dealing with these factors can help decrease maternal mortality rates for all expectant mothers, including primigravidae. Key words: Primigravida, Maternal Mortality Rate, antenatal care, Obstetric emergency.

A Rare Case of Spontaneous Stump Ectopic Pregnancy after Adnexectomy

Abstract Ectopic pregnancy is an obstetric emergency associated with morbidity. The commonest site for an ectopic pregnancy is the fallopian tube. Occurrence of ectopic in a remnant of tubal stump is a rare form which is not yet classified. Here we present a case of spontaneous stump ectopic pregnancy in a patient who had an adnexectomy. The ruptured remnant end was excised. There is a need to emphasise that the tube should be excised till the cornual end when performing salpingectomy to avoid recanalisation or fistulae formation and stump ectopics.

Utilization of technology to provide on-the-job trainings on Emergency Obstetric and Neonatal Care: Perspectives of nurses and midwives working in Rwanda's remote health facilities.

One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context. The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data. Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC. Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC.

Mechanical Birth Injuries: A Comprehensive Five-Year Analysis From a Tertiary Care Hospital.

Birth injury or birth trauma refers to physical damage or trauma that occurs to a newborn during the birthing process. To ensure continuous care and improve neonatal outcomes, it is crucial to know the incidence, types, relation to the mode of delivery, and their management. This is a retrospective cohort study conducted at Aga Khan University Hospital, Pakistan from January 2018 to December 2022. Neonates aged from birth to 28 days of life identified to sustain any form of mechanical birth injuries were included. Data analysis was done using SPSS version 19 (IBM Corp., Armonk, NY). In the last five years, 51 mechanical birth injuries were found among 27,854 deliveries, which accounts for one in 546 births with an overall prevalence of 0.001%. Out of the total mechanical birth injuries, 12 (23.5%) were noticed in spontaneous vaginal delivery, six (11.8%) had instrumental delivery, and 33 (64.7%) patients had cesarean sections. More birth injuries were noticed in emergency cesarean section as compared to vaginal deliveries. There were 40 babies (78%) with soft tissue injuries, seven (14%) had musculoskeletal injuries/fractures, two (4%) babies had intracranial bleeding, andtwo (4%) had fractures along with intracranial bleeding. There was no mortality reported among these neonates. The overall rate of birth injuries was significantly lower as compared to other low and middle-income countries. Most of the birth injuries were soft tissue injuries in patients with cesarean sections. The rate of birth injury did not show any association with the time of delivery. More frequent obstetric emergency drills would improve complications associated with shoulder dystocia.

Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial.

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

THE EVALUATION OF INDONESIA'S BASIC EMERGENCY OBSTETRIC CARE PROGRAM

THE EVALUATION OF INDONESIA'S BASIC EMERGENCY OBSTETRIC CARE PROGRAM

Obstetric Emergency Supply Chain Dynamics and Information Flow Among Obstetric Emergency Supply Chain Employees: Key Informant Interview Study.

For the past several decades, the Ethiopian Ministry of Health has worked to decrease the maternal mortality ratio (MMR)-the number of pregnant women dying per 100,000 live births. However, with the most recently reported MMR of 267, Ethiopia still ranks high in the MMR globally and needs additional interventions to lower the MMR to achieve the sustainable development goal of 70. One factor contributing to the current MMR is the frequent stockouts of critical medications and supplies needed to treat obstetric emergencies. This study describes the obstetric emergency supply chain (OESC) dynamics and information flow in Amhara, Ethiopia, as a crucial first step in closing stockouts and gaps in supply availability. Applying qualitative descriptive methodology, the research team performed 17 semistructured interviews with employees of the OESC at the federal, regional, and facility level to describe and gain an understanding of the system in the region, communication flow, and current barriers and facilitators to consistent emergency supply availability. The team performed inductive and deductive analysis and used the "Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems" to guide the deductive portion. The interviews identified several locations within the OESC where barriers could be addressed to improve overall facility-level readiness, such as gaps in communication about supply needs and availability in health care facilities and regional supply hubs and a lack of data transparency at the facility level. Ordering supplies through the integrated pharmaceutical logistics system was a well-established process and a frequently noted strength. Furthermore, having inventory data in one place was a benefit to pharmacists and supply managers who would need to use the data to determine their historic consumption. The greatest concern related to the workflow and communication of the OESC was an inability to accurately forecast future supply needs. This is a critical issue because inaccurate forecasting can lead to undersupplying and stockouts or oversupplying and waste of medication due to expiration. As a result of these interviews, we gained a nuanced understanding of the information needs for various levels of the health system to maintain a consistent supply of obstetric emergency resources and ultimately increase maternal survival. This study's findings will inform future work to create customized strategies that increase supply availability in facilities and the region overall, specifically the development of electronic dashboards to increase data availability at the regional and facility levels. Without comprehensive and timely data about the OESC, facilities will continue to remain in the dark about their true readiness to manage basic obstetric emergencies, and the central Ethiopian Pharmaceutical Supply Service and regional hubs will not have the necessary information to provide essential emergency supplies prospectively before stockouts and maternal deaths occur.

Nursing interventions in patients with Hysterectomy due to Uterine Atony

Uterine Atony is an inability of the uterine muscle to perform contractions, due to various factors, it is considered a more common obstetric emergency and is related to the presence of unstable hemodynamics and hypovolemic shock, which can lead to a hysterectomy, it is a surgical procedure where the uterus and cervix are removed through an abdominal incision, this procedure is performed to safeguard the patient's quality of life. To describe the nursing intervention in a post-operated user of hysterectomy due to uterine atony in the Gynecology service of a hospital in Ayacucho. A qualitative study was carried out, with a single clinical case design that is recorded in the Nursing Care Process (PAE) method, applying the Marjory Gordon functional pattern assessment record to a 31-year-old user as an instrument. The clinical characteristics of the patient corresponding to uterine atony and the risk factors that increase possible complications of hysterectomy were identified. For this reason, it is important to apply effective preventive measures and care against the risk of transvaginal hemorrhage in post-operated hysterectomy users for uterine atony. All framed in the nursing process that identified the main problems and risks in an individualized care plan that allowed providing timely and quality care that improved the patient's Meath status.

Identifying Barriers to Utilization of Basic Emergency Obstetric and NewBorn Care Services in Jigawa State, North-western Nigeria: A Qualitative Study

Background: Maternal mortality has remained high in northern Nigeria despite decades of effort aimed at reducing it. The number of women who deliver in Emergency Obstetric Care (EmONC) facilities is low. This study explored the barriers to utilizing Basic EmONC services in Jigawa State.&#x0D; Methods: A qualitative study was conducted among mothers of children under five years through 12 Focus Group Discussions. A purposive sampling technique was used to select participants who were categorized based on age (below 35 years, 35 years and above) and prior utilization of EmONC services. Content analysis along thematic lines was done and the findings were reported in narrative form.&#x0D; Results: The mean age of participants was 31 ± 6 years. The majority of participants had primary education and most were unemployed. Most of the participants identified obstetric danger signs, however, they opine that medical attention should be sought only when complications become serious. Participants in all groups unanimously said decision-making for seeking medical care rests with the husband and occasionally the mother-in-law. Barriers to seeking care identified by participants include lack of money, distance to the nearest health facility, fear of embarrassment by healthcare workers, and insecurity among others.&#x0D; Conclusion: Most participants were knowledgeable of obstetric danger signs, but with low risk-perception towards obstetric complications. The Jigawa State government should engage in a robust education campaign on the need for early decision-making to seek care as well as strengthen its women empowerment programs to overcome barriers to seeking care for obstetric complications.

Geographical distribution of emergency obstetric and neonatal care signal functions in Ethiopian health facilities: 2021–2022 Ethiopian service Provision Assessment (SPA)

BackgroundThe maternal mortality ratio in Ethiopia is still high, with an estimate of 412 deaths per 100,000 live births in 2016. Signal functions for emergency obstetric and neonatal care must be accessible and usable in order to successfully prevent maternal deaths. It is an important strategy to reduce maternal and newborn morbidity and mortality in countries with limited resources. Hence, an assessment of the availability of fully functioning EmONC services and their coverage per 500,000 people in Ethiopia is crucial.MethodsThis study is a retrospective analysis of data from the Ethiopian Service Provision Assessment Survey (ESPA), a national-level survey data source. Data collection for the survey took place from August 11, 2021, to February 4, 2022. For this investigation, 905 healthcare facilities in total were evaluated for the availability of emergency obstetric and new-born care (EmONC) services at all hospitals, selected health centers, and private clinics were evaluated. Descriptive data analysis was done by the using statistical package for social science version 26 (SPSS) to run frequency and cross-tabs. Global Positioning System (GPS) (arc map 10.8) Software was used for spatial distribution in order to locate the physical accessibility of EmONC providing health facilities on flat map surfaces. It was projected based on Ethiopia’s geographic coordinate system at Adindan UTM zone 370N.ResultsOf 905 health facilities, only 442 (49%) could provide fully functioning BEmONC, and 250 (27.6%) health facilities have been providing fully functioning CEmONC. The overall coverage of BEmONC ratios in Ethiopia is 1.5–3.77 per 500,000 population and CEmONC (0.83–2.1) per 500,000 populations. Regions such as Amhara, SNNPR and Addis Ababa had found to have high BEmONC ratio. The geographical distribution of the EmONC showed that the central areas of the country, such as southwest Shewa and east Shewa, the Oromia region, the northern areas of the South Nation, nationalities, and peoples regions (SNNPR), including the Gurage zone and the Wolaita-Soddo zone, and the middle areas in the Amhara region (west Gojjam or around Bahir Dar town), and the southern areas, Debra Tabor and Debre Birhane zones, all had greater access to facilities offering complete EmONC services.ConclusionComprehensive emergency obstetrics and neonatal care (CEmONC) in Ethiopia met WHO recommendations, despite basic emergency obstetric and neonatal care (BEmONC) falling below those standards in Ethiopia. There are extremely large disparities in the accessibility of both basic and comprehensive emergency obstetrics and neonatal care in Ethiopia. Thus, Strategic planning is needed to improve infrastructures and inputs for EmONC services, particularly in remote areas of the country. Additionally, private facilities ought to place a priority on the provision of these services.

Successful Management of a Case with Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) is an obstetric emergency with high maternal and fetal mortality and morbidity. The most important factor in determining the prognosis is early diagnosis and treatment. We present a case of amniotic fluid embolism that was successfully treated with early diagnosis and intime management.&#x0D; Respiratory arrest developed during labor in a 20-year-old patient who underwent urinoma drainage and cordocentesis for fetal renal anomaly 10 days ago and then profuse bleeding occurred approximately 90 minutes after vaginal delivery. With our definition of AFE, massive blood transfusion, fibrinogen replacement and intrauterine balloon were applied quickly. The diagnosis of AFE was made clinically and excluding differential diagnoses. She was discharged without complications.

Effect of Educational Program on Nurses' Performance regarding Obstetrical Emergencies during Pregnancy

Effect of Educational Program on Nurses' Performance regarding Obstetrical Emergencies during Pregnancy

Septic Abortion Complicated by Disseminated Intravascular Coagulation.

This scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: septic abortion and disseminated intravascular coagulation (DIC). Patients with an abortion (spontaneous or induced) of less than twenty weeks gestation may present with concurrent uterine infection, also known as septic abortion. One of the complications of septic abortion is DIC. Early management of both underlying etiology (septic abortion) and subsequent complications (DIC) is crucial to minimize morbidity and mortality. At the conclusion of the simulation session, learners will be able to: 1) Obtain a relevant focused history including pregnancy history, medication use, and past medical history. 2) Develop a differential for fever and vaginal bleeding in a pregnant patient. 3) Discuss management of septic abortion, including empiric broad-spectrum antibiotics and obstetric consultation for source control with dilation and curettage (D&C). 4) Discuss expected laboratory findings of disseminated intravascular coagulation (DIC). 5) Discuss management of DIC, including identification of underlying etiology and supportive resuscitation with blood products. 6) Review the components of blood products. 7) Identify appropriate disposition of the patient to the intensive care unit (ICU). This session was conducted using high-fidelity simulation followed by a debriefing session and discussion about the diagnosis, differential, and management of both septic abortion and DIC. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitator described something they observed in the case, outlined their reasoning as a facilitator why this observation was important or why they had questions, and then asked the learners to share their frame of reference at the time. An example: "I heard the team leader state that the platelets were normal, but then another resident disagreed. No one paused to come to a consensus. I'm wondering why this wasn't explored further in real time. Tell me more." This scenario may also be run as an oral boards case or adapted for other learners such as critical care fellows. Our residents were provided a survey at the completion of the debriefing session so they could rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form,1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Thirteen learners completed a feedback form out of seventeen participants. This session received all six and seven scores (consistently effective/very good and extremely effective/outstanding, respectively) other than two isolated 4 scores. This is a cost-effective method for reviewing septic abortion and DIC. The case may be modified for appropriate audiences, such as simplifying the case to septic abortion without DIC. You can also consider not showing an initial temperature with the initial set of vitals unless it is specifically asked for by the participants. We encourage readers to utilize bleeding moulage techniques as a visual stimulus to increase psychological buy-in. Medical simulation, septic abortion, pregnancy complications, hematology emergencies, obstetric emergencies, disseminated intravascular coagulation, emergency medicine.

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.

Низько розташована голівка плода під час кесаревого розтину: поширеність, фактори ризику, методи профілактики та менеджмент (огляд літератури)

Under certain circumstances, the fetal head may stop descending into the vagina during the second stage of labor, having its largest circumference into the pelvic cavity, while conservative methods of treatment may not be effective, and the clinical situation may require an emergency cesarean section with a "the deeply impacted fetal head" in the pelvic cavity. This is a technically complex method of delivery in this clinical situation, associated with serious risks for both the woman and the child. There are a number of approaches to prevent these complications and techniques for removing the fetus in this situation, however, there is currently no consensus on which of these approaches is best for this type of cesarean section. The aim - to investigate the main current data on possible techniques for fetal extraction with impacted fetal head during cesarean section and to compare their safety and effectiveness. A review of the literature on the definition of the concept of «impacted fetal head» during cesarean section, the distribution and risk factors of this complication, the study of possible complications for the mother and the fetus, techniques for preventing the occurrence of this condition, methods of removing the fetus with impacted head during cesarean section, as well as promising management methods. A comprehensive study of this obstetric emergency remains relevant for modern science, because it requires special techniques and skills of an obstetrician-gynecologist to prevent injuries to the mother and child, bleeding and other life-threatening conditions. There is a need to standardize the definition of terminology, improve the skills of doctors through simulation training and conduct large randomised trials to determine the best approaches and provide highly skilled care to mothers and children in situations that can potentially result in severe trauma. No conflict of interests was declared by the authors.