Occurrence Of Postpartum Hemorrhage Research Articles

HUBUNGAN INISIASI MENYUSUI DINI (IMD) DENGAN KEJADIAN PERDARAHAN POST PARTUM DI PUSKESMAS ONAN HASANG TAHUN 2023

The Ministry of Health (2008) states that IMD involves pressing the newborn up against the mother's chest or stomach, let him to wiggle about in search of the nipple, and then nursing him until he is full. At least the first hour following the baby's birth is dedicated to this procedure. This kind of study uses a cross-sectional design and is descriptive correlative in nature. It measures both the independent and dependent research variables concurrently throughout the course of one time period. The purpose of this study is to examine the correlation between the occurrence of postpartum hemorrhage at the Onan Hasang Community Health Center in 2023 and the Early Breastfeeding Initiation (IMD). There were 26 persons (81.3%) postpartum. Respondents who did not initiate early breastfeeding (IMD) represented the minority with postpartum hemorrhage, i.e. 3 (9.4%). Based on the study results obtained, there is a relationship between early initiation of breastfeeding (IMD) and the incidence of postpartum bleeding at Onan Hasang Community Health Center in 2023, which from the main trial Fisher's exact test, the obtained p value is 0.008, which is less than 0.05. This means that the earlier you start breastfeeding (IMD), the less postpartum bleeding you will have. We note that the majority of respondents who completed Early Initiation of Breastfeeding (IMD) did not experience postpartum bleeding, i.e. 26 (81.3%). The majority of respondents who did not initiate early breastfeeding (IMD) had postpartum hemorrhage, i.e. 3 (9.4%). Fisher's exact test results showed a p-value of 0.008 < 0.05. This means that the alternative hypothesis (Ha) of this study is accepted, i.e. there is an association between early initiation of breastfeeding (IMD) and the incidence of postpartum hemorrhage at community health centers. Onan Hasang coin in 2023.

The optimal dosage of aspirin for preventing preeclampsia in high-risk pregnant women: A network meta-analysis of 23 randomized controlled trials.

This study aimed to assess the effectiveness and optimal dosage of aspirin in preventing preeclampsia in high-risk pregnant women. Traditional and network meta-analyses were conducted on data from 23 randomized controlled trials involving 10547 pregnant women. The findings demonstrated that aspirin significantly reduced the incidence of preeclampsia (OR=0.66, 95%CI [0.58, 0.75]), with the best preventive effect observed at a dosage of 80-100mg/day (OR=0.51, 95%CI [0.36, 0.72]). No significant differences were found in the occurrence of postpartum hemorrhage (OR=1.03, 95%CI [0.79, 1.33]), small for gestational age (OR=0.83, 95%CI [0.50, 1.35]), placental abruption (OR=0.96, 95%CI [0.53, 1.73]), and intrauterine growth restriction (OR=0.63, 95%CI [0.45, 1.86]) between women taking aspirin and those taking placebos. Different doses of aspirin showed a reduction in preeclampsia incidence, but there was no significant difference in efficacy between the dosage groups. Side effects did not significantly differ between placebo and different aspirin dosage groups. SUCRA analysis suggested that 80-100mg/day may be the optimal dosage, prioritizing both effectiveness and minimizing side effects. Sensitivity analysis confirmed the robustness of the findings. However, improvements are needed in addressing issues like loss to follow-up, reporting bias, and publication bias. In conclusion, a dosage of 80-100mg/day is recommended for preventing preeclampsia in high-risk pregnant women, although individual circumstances should be considered for optimizing the balance between effectiveness and safety.

Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study

BackgroundMost previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results.ObjectivesWe examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria.MethodsThis was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors.ResultsOf the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05–1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99–1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131).ConclusionOur study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.

Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence.

Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.

Engaging National Professional Society to Combat Postpartum Hemorrhage Using Bundle Approach - A FIGO-SAFOG-OGSB-MGH Project: Experience of Implementation in Bangladesh

Objective: To reduce the incidence and death due to post-partum Hemorrhage (PPH) and capacity building of health service providers by using PPH Emergency response using Bundle Approach. Method: Planning and implementation of WHO formulated PPH Bundles [Active Management of Third Stage of Labour (AMTSL), First response Bundle and Refractory PPH Bundle] by Obstetrical and Gynaecological Society of Bangladesh (OGSB) in 14 different levels of public and private hospitals in Bangladesh. After discussion with International Federation of Gynaecology and Obstetrics (FIGO) and South Asian Federation of Obstetrics and Gynaecology (SAFOG) team, a Memorandum of understanding (MOU) was signed; permission from Ministry of Health and Family welfare (MOHFW) was obtained through Directorate General of Health Services (DGHS) and also from all the institutions. The project period was from November 2019 to September 2022 in a spoke-and-hub fashion. A group of master trainers and a technical advisory group were developed comprising of senior obstetricians and gynecologist of Bangladesh. Data were obtained through record keeping of the respective hospitals and Management Information System (MIS) of DGHS, monitoring was done by OGSB and Massachusetts General Hospital (MGH)-FIGO team. Results: Consultative and planning meetings were organized among OGSB, FIGO, SAFOG and MGH: 16 master trainers, 74 trainers were produced and 740 health service providers (Doctor, Nurses, midwives) and 450 non clinical staffs were trained. All clinical and nonclinical bundles were implemented in 14 facilities in spoke-and-hub fashion. Occurrence of PPH, detection rate of PPH, filling up PPH checklist and debrief forms were improved. Data collection system, understanding about data improved a lot. Facility readiness, team work, data monitoring & supervision, network integration and leadership skills were instituted and shown excellent positive changes. Regular simulations were continued which helped old & new service providers to learn and continue proper use of the clinical and non-clinical interventions. Scale up was planned and continued. Conclusion: PPH emergency response using bundle approach was found to be an important practical way to reduce occurrence, death and disability related to PPH. Needs for surgery has reduced also. Quality of services improved in terms of providing standard care, record keeping and reporting. Regular supervision and monitoring; data management and personal motivation are the challenges. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 98-108

Major Placenta Previa in Advanced Age Among Nulliparous With Cesarean Section: A Cross-Sectional Study

INTRODUCTION:Major placenta previa with advanced maternal age (AMA) is a significant risk factor for obstetric hemorrhage and associated maternal and neonatal complications.OBJECTIVE:The objective was to study major placenta previa in advanced age among nulliparous with cesarean section.METHODS:This prospective cross-sectional study analyzes 78 pregnant women of advanced age with major placenta previa under a cesarean section. Data were collected using interview questionnaires between January 2019 and June 2020.RESULTS:The mean gestational age at delivery was 35.7 ± 3 years. Antepartum hemorrhage, premature membrane rupture, and placenta accreta occurred in 15.4%, 35.9%, and 15.4% of cases, respectively. About 12.8% of women were at risk of post-traumatic stress disorder symptoms. Fetal distress, postpartum hemorrhage (PPH), and cesarean hysterectomy occurred in 37.2%, 46.2%, and 15.4% of patients. Mean Apgar scores in the first and fifth minutes were 7.0 ± 0.90 and 8.0 ± 0.82, respectively. The mean birth weight was 2.7 ± 0.14823. Of neonates, 37.2% were premature, 37.2% required resuscitation, less than half (44.9%) were admitted to the neonatal intensive care unit, and 37.2% had respiratory distress syndrome. Moreover, there is a statistically significant relationship between placenta accreta and cesarean hysterectomies and the occurrence of PPH. Also, a highly significant association was observed between the use of antenatal steroids, fetal distress, Apgar score <3 at 1 minute, and neonatal respiratory distress syndrome.CONCLUSION:Major placenta previa with AMA significantly influences pregnancy outcomes and is considered an obstetric emergency. Therefore, early detection of major placenta previa and proper management during clinical care is essential.

Prediction of postpartum hemorrhage (PPH) using machine learning algorithms in a Kenyan population.

Postpartum hemorrhage (PPH) is a significant cause of maternal mortality worldwide, particularly in low- and middle-income countries. It is essential to develop effective prediction models to identify women at risk of PPH and implement appropriate interventions to reduce maternal morbidity and mortality. This study aims to predict the occurrence of postpartum hemorrhage using machine learning models based on antenatal, intrapartum, and postnatal visit data obtained from the Kenya Antenatal and Postnatal Care Research Collective cohort. Four machine learning models - logistic regression, naïve Bayes, decision tree, and random forest - were constructed using 67% training data (1,056/1,576). The training data was further split into 67% for model building and 33% cross validation. Once the models are built, the remaining 33% (520/1,576) independent test data was used for external validation to confirm the models' performance. Models were fine-tuned using feature selection through extra tree classifier technique. Model performance was assessed using accuracy, sensitivity, and area under the curve (AUC) of the receiver operating characteristics (ROC) curve. The naïve Bayes model performed best with 0.95 accuracy, 0.97 specificity, and 0.76 AUC. Seven factors (anemia, limited prenatal care, hemoglobin concentrations, signs of pallor at intrapartum, intrapartum systolic blood pressure, intrapartum diastolic blood pressure, and intrapartum respiratory rate) were associated with PPH prediction in Kenyan population. This study demonstrates the potential of machine learning models in predicting PPH in the Kenyan population. Future studies with larger datasets and more PPH cases should be conducted to improve prediction performance of machine learning model. Such prediction algorithms would immensely help to construct a personalized obstetric path for each pregnant patient, improve resource allocation, and reduce maternal mortality and morbidity.

Hubungan Umur Paritas dan Anemia dengan Kejadian Perdarahan Postpartum di Rumah Sakit Bhayangkara Palembang Tahun 2021

Post-partum by WHO as a state of blood loss > 500 ml in 24 hours after delivery. Age is a factor in the occurrence of postpartum hemorrhage. Women who give birth to children at the age of more than 35 years is a predisposing factor for postpartum hemorrhage which can lead to maternal death. This study aims to determine the relationship between age, parity and anemia with the incidence of postpartum hemorrhage at Bhayangkara Hospital Palembang. This study used an analytical survey with a Cross Sectional design. as many as 73 (100%) samples obtained there are 4 patients who have an age with a risk of 5% while patients whose age is not dangerous are 69 patients or 95%. from a total of 73 (100%) samples. There were more patients with high parity than those with low parity. There were 42 patients or 58% who had high parity while there were 31 patients who had low parity, namely 42%. From the total sample of 73 patients, there were 15% or 11 who suffered from anemia while those who did not suffer from anemia were 62 patients with a percentage of 85%. There was a significant relationship between age and the incidence of bleeding at Bhayangkara Hospital Palembang in 2021. From the results of statistical tests with a p value = 0.003 or p < 0.05. There is no significant relationship between parity and the incidence of bleeding at Bhayangkara Hospital Palembang in 2021. This is based on the results of statistical tests with p value = 0.716 or p> 0.05. There is a significant relationship between anemia with bleeding events at Bhayangkara Hospital. This is based on the results of statistical tests with p value = 0.000 or p < 0.05.

Prevention of Post-Partum Hemorrhage: Comparison of Oxytocin and Misoprostol. A Two center study in the Bamenda and Nkwen Health Districts

Background: Postpartum hemorrhage is one of the most common obstetrical complications affecting up to 18% of deliveries. Globally, it is responsible for 35 – 55% of peripartum maternal deaths. In Cameroon, the maternal mortality rate is at 406 maternal death per 100,000 live births, with PPH being the leading cause accounting for about 25%. This study aimed to compare the efficacy and safety of misoprostol versus oxytocin in the prevention of postpartum hemorrhage in the Bamenda Health District and Nkwen Health District. Methods: This was a hospital-based randomized clinical trial study in the Bamenda Regional Hospital and Nkwen District Hospital. The study was conducted from March 1st to May 31st 2021 including pregnant women who delivered at the maternity at these two hospitals. All their pregnancy was singleton gestation at term and haven given their informed consent. Women with known history of cardiac, renal, hepatic diseases or any coagulopathy, Cesarean delivery were excluded. We randomized 308 participants in a 1:1 ratio to receive 800 μg of oral misoprostol or 10IU of oxytocin intramuscularly during the active management of third stage of labor (AMSTL). The Hemoglobin (Hb) concentration and hematocrit (HCT) of the participants were measured before and 24hrs after delivery. Our primary outcome of interest was (Post-Partum Hemorrhage) PPH, defined as Hb change ≥ 1g/dl within 24hrs of delivery. Secondary outcomes included; mean Hb change, Hb change ≥2g/dl (severe PPH). Dichotomous outcomes between study groups were compared by estimating crude relative risks (RRs) with 95% confidence intervals. Logistic regression (the chi-square test) was done to determine the factors associated with the occurrence of postpartum hemorrhage, with a level of significance at 5%. Results: After 24hrs, Postpartum hemorrhage (PPH) occurred in 41 (26.6%) and 47 (30.5%) participants in the misoprostol and oxytocin groups respectively (RR= 0.87, 95% C.I= 0.61 - 1.24, p=0.449). Severe postpartum hemorrhage occurred in 3 (1.9%) and 5 (3.2%) participants in the misoprostol and oxytocin groups respectively (RR= 0.6, 95% C.I=0.15 - 2.47, p=0.723). Past history of PPH (aOR=10.1 (3.5 – 28.6), p<0.0001), augmentation of labor (aOR=3.4 (1.6 – 7.1), p=0.0011), fetal birth weight ≥3.5Kg (aOR=2.5 (1.3 – 4.8), p=0.0074) and retained products (aOR= 8.4 (4.2 – 16.7), p<0.0001) were risk factors of PPH. Participants in the misoprostol group more commonly experienced shivering (RR 3.2, 95% CI 2.0 - 5.1, p<0.0001) and nausea/vomiting (RR 35.5, 95% CI 8.9 – 142.2, p<0.0001). Conclusion: Oral misoprostol at the dose of 800μg is as effective as 10 IU IM Oxytocin in the prevention of PPH and is a potent alternative to oxytocin. Most common risk factors of PPH are past history of PPH, augmentation of labor, fetal weight ≥ 3.5kg and retained products. Side effects were mostly associated with 800μg of oral Misoprostol.

Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece.

Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.

Descriptive statistical study of the most important possible causes of obstetric and postpartum hemorrhage in Thi-Qar province

The aim of the study is to describe and analyze the most important causes that lead to postpartum hemorrhage. This research was carried out at The Bent al-Huda Hospital for Maternity and Children's Hospital in Nasiriyah, where the study included (63) cases of women with postpartum hemorrhage from the reviews of the hospital for the period from February 2020 to December 2020 as shown in the hospital records, and collected information for the study through a simple questionnaire, including information: age of women, place of residence, place of birth, type of birth and causes of hemorrhage. Age groups between (40-44) accounted for (22?), (35-39), which are the highest age groups at risk of postpartum hemorrhage. The most frequent deliveries take place in the hospital, because natural or cesarean deliveries increase in this percentage. The results of the current study also show that there is no difference between natural childbirth and caesarean section with the occurrence of postpartum hemorrhage , that the condition of non-constriction of the uterus (inertia of uterus) constitutes (30%) and is considered the highest percentage among the causes of hemorrhage after birth, and then the causes such as the remnants of part of the placenta and the frequency of caesarean section by (16%), the use of accelerated medicines for childbirth and by percentage (14%) while the other causes came in low rates of cases postpartum hemorrhage.&#x0D;

FACTORS AFFECTING POSTPARTUM HAEMORRHAGE ON POSTPARTUM MOTHER

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postpartum haemorrhage in general is defined as blood loss from the body in the amount of 500 ml after vaginal delivery or 1000 ml after cesarian section. Every year it is estimated that there are 140.000 mother’s death caused by PPH or every 4 minutes 1 death occurs worldwide caused by PPH. According to WHO 99% of all maternal deaths occur in developing countries due to postpartum hemorrhage. Based on data obtained in 2020, the MMR in Indonesia is 305 per 100,000 live births.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;to find out the factors affecting haemorrhage occurrence on postpartum mother based on the results of previous research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Scoping review using databases: Google Schoolar, PubMed, and ProQuest. The keywords used in the literature search are “Factor”, “Postpartum haemorrhage”, “maternity”. The searching results were 7 articles which fulfilled the criteria. The 7 articles then were analyzed by using The Joana Briggs Institute and synthesis method using PEOS modification&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 99 articles with relevant title and abstract, obtained 7 articles which fulfilled the inclusion and exclusion criteria. Four factors were found, which are; perineal tear, anemia, placental complications, and uterine atony which affects the haemorrhage on postpartum mother.&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There are four most frequent factors occurring which affect the occurrence of postpartum haemorrhage namely birth canal tear, anemia factor, placental complication, and uterine atony. Those factors can cause and continuously increase haemorrhage which can lead to maternal mortality rate.&lt;div&gt; &lt;/div&gt;

Occurrence of post-partum hemorrhage in spontaneous versus induced labor in primigravida at term in a tertiary care hospital of Peshawar

Introduction: Occurrence of post-partum hemorrhage (PPH) is a serious life-threatening complication of delivery and can occur with both normal vaginal delivery as well as induced labor. It is important to define the extent of blood loss after either procedure to adopt the safer method, particularly in complicated deliveries.&#x0D; Objective: To compare the occurrence of post-partum hemorrhage in spontaneous and induced labor in primigravida at term at a tertiary care hospital of Peshawar.&#x0D; Materials &amp; Methods: This descriptive cross-sectional study was performed in Obstetrics and Gynecology Department (Gynae B unit), Lady Reading Hospital, Peshawar from 31/5/2019 to 31/11/2019. Total patients observed were 134. All women were subjected to complete history taking and detailed examination. Brief obstetrical history, period of gestation, mode of onset of labor and frequency of post-partum hemorrhage (more than 500 ml after vaginal delivery) were noted. Women were induced with prostaglandin E2 gel only. The second gel was repeated after 6 hours if first attempt was failed. No more than three gels were used. Women were excluded from the study if they failed to go into labor even after the third gel. After vaginal delivery sanitary pads were used for blood loss estimation. They were weighed beforehand and after being soaked with blood, they were again weighed and the difference was noted as 1gm = 1ml. Descriptive statistics were done by SPSS 21.&#x0D; Results: The mean age of subjects was 32 ± 3.90 years Forty two percent patients had BMI ≤25 and 58% patients had BMI &gt;25. Seventy two percent of patients were having spontaneous labor and 28% were having induced labor. Twenty percent of patients had post-partum hemorrhage, 7% in spontaneous labor while 44% in induced labor, showing significant difference (p=0.03).&#x0D; Conclusion: Post-partum hemorrhage occurred significantly more frequently in primigravid women at term undergoing induction of labor as compared to spontaneous labor.

FAKTOR?FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN PERDARAHAN POSTPARTUM

Postpartum hemorrhage is bleeding more than 500-600 ml for 24 hours after the child is born (Mochtar, 2015). Based on the time of occurrence of postpartum hemorrhage can be divided into primary bleeding and secondary bleeding. Postpartum hemorrhage is the most common cause of all deaths from obstetric hemorrhage. Postpartum hemorrhage is bleeding that exceeds 500 ml after the baby is born with vaginal delivery and exceeds 1000 ml at cesarean section (Chunningham, 2012). The sample in this study was 90 people using a systematic random sampling technique. From the results of the analysis, it is known that there is a relationship between uterine atony (p-value 0.029), retained placenta (p-value 0.002), and multiple pregnancies (p-value 0.007), with the incidence of postpartum hemorrhage. In 2020. It is recommended to be an input for the health services that have been provided to improve the quality of services to maternity mothers, especially those experiencing postpartum hemorrhage.&#x0D; &#x0D;

High prevalence of postpartum hemorrhage in women with rare bleeding disorders in the Netherlands: retrospective data from the RBiN study

BackgroundWomen with rare bleeding disorders (RBDs), including coagulation factor deficiencies and fibrinolytic disorders, may have a higher risk of postpartum hemorrhage (PPH). Information on this patient category is lacking in the existing PPH guidelines because data on PPH in patients with RBDs are scarce. ObjectiveTo describe the prevalence of PPH in women with an RBD and evaluate the use of peripartum hemostatic prophylaxis. MethodsIn the Rare Bleeding Disorders in the Netherlands (RBiN) study, patients with RBDs (n = 263) were included from all 6 Dutch hemophilia treatment centers. Patient–reported information on delivery, peripartum hemostatic prophylaxis, and occurrence of PPH was collected retrospectively. If available, information about the precise volume of postpartum blood loss was extracted from electronic patient files. PPH was defined as blood loss ≥500 mL (World Health Organization guideline). ResultsA total of 244 pregnancies, including 193 livebirths, were reported by 85 women. A considerable proportion of these women experienced PPH, ranging from 30% in factor V deficiency to 100% in hyperfibrinolysis. Overall, PPH was reported in 44% of deliveries performed with and 53% of deliveries performed without administration of peripartum hemostatic prophylaxis. Blood loss was significantly higher in deliveries without administration of hemostatic prophylaxis (median 1000 mL) compared to deliveries with administration of prophylaxis (median 400 mL) (p = 0.011). Patients with relatively mild deficiencies also frequently experienced PPH when peripartum hemostatic prophylaxis was omitted. ConclusionPPH is common in rare coagulation factor deficiencies, both severe and mild, and fibrinolytic disorders, especially when peripartum prophylactic hemostatic treatment was not administered. The use of prophylactic hemostatic treatment was associated with less postpartum blood loss.

Comparison of Oral Misoprostol with Intravenous Oxtocin in the Prevention of Primary Postpartum Haemorrhage in ESUT Teaching Hospital: A Randomized Controlled Trial

Background: Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality globally. About 14 million patients suffer from postpartum haemorrhage annually worldwide, of which about 140,000 die. The active management of third stage of labour with the use of uterotonic drugs has reduced the risk of postpartum haemorrhage significantly. The most common uterotonic drug currently in use is oxytocin but the problem of insufficient skilled manpower for its administration, inadequacy of electric power supply to ensure the stability of the drug at appropriate temperature, and its high cost have made widespread use of oxytocin difficult in the resource-poor countries. This has made the search for an effective, affordable, stable and available alternative necessary. Misoprostol, an analogue of prostaglandin-E1, has a good uterotonic activity, is highly affordable, does not require specialized skill to administer and is very stable at room temperature. It also has multiple routes of administration, which makes its use in resource-poor countries indispensable. Aim: To determine if there is any difference in the efficacy of intravenous oxytocin over oral misoprostol in the prevention of primary postpartum haemorrhage. Study Design: This was a prospective, double-blinded, randomized study of uncomplicated pregnant women who had vaginal delivery in ESUT Teaching Hospital, Enugu. Sample Size: Two hundred (200) pregnant women who satisfied the inclusion criteria were recruited in this study with each arm of the study accommodating 100 participants. Methodology: The eligible women were recruited on presentation to the labour ward after giving their consent. They were randomly allocated into 2 groups: A and B. Group A received 2 tablets (400mcg) of oral misoprostol and 1mililtre (ml) of sterile water intravenously while group B received 2 tablets of white vitamin c and 1ml (10iu) of intravenous oxytocin immediately after cord clamping and cutting following the delivery of the baby. Pre-weighed delivery mats and vulval pads were used to collect the blood at delivery and for the first 24 hours for weighing and estimation of blood loss. A proforma was used to record the necessary data. Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software version 20.0 for windows. Statistical analysis was both descriptive and inferential at 95% confidence level. The socio-demographic variables were used to categorize the data and this was subjected to comparative statistical evaluation to yield frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P&lt;0.05 at one degree of freedom (df=1) was considered statistically significant. Results: Two hundred pregnant women were recruited into the study with 100 women on each arm and all completed the study. The amounts of blood loss (in mililitre) in the misoprostol and oxytocin arms were 339.36 ± 122.28 and 378.52 ± 148.24, respectively. Forty-three women had PPH (blood loss ≥ 500ml) but there was no significant difference in the amount of blood loss and occurrence of PPH on both arms of the study. Conclusion: There was no difference in the efficacy of oxytocin over misoprostol in the management of the 3rd stage of labour for preventing PPH. We therefore, recommend that misoprostol can be adopted as an alternative/substitute to oxytocin in the management of the third stage of labour especially in the developing countries for prevention of PPH.

The Correlation of High-Risk Age on Women of Reproductive Age and Post Partum Bleeding Case

During the post partum there are physiological changes such as uterine involution and lochia expenditure. Excess lochea discharge to more than 500 cc after delivery is called postpartum hemorrhage. The purpose of this study was to analyze the correlation of high-risk age and the incidence of postpartum hemorrhage in the maternity room of Syuhada Haji Hospital, Blitar City. The type of the study was analytic with a cross sectional approach. The population was all postpartum mothers who gave birth in the maternity room of Syuhada Haji Hospital, Blitar City on January – December 2018. The poplation was 672 respondents and the sample was 97. The sample was taken systematically by random sampling. The measuring instrument used documentation guidelines. The study was carried out by Chi-Square test. It was obtained that X2 count (0.00) was less than á (0.05), then H0 was rejected and H1 was accepted. In conclusion there was a correlation between highrisk age and postpartum hemorrhage incidence. It is expected that the research area will pay more attention in the handling and care of pregnant women of reproductive age so that at the age that is slightly at risk for the occurrence of postpartum hemorrhage, they will not experience postpartum hemorrhage. And women of high-risk age should be able to give birth at hospital in order to reduce complications.

Influence of previous laparoscopic surgical and pathological diagnosis of endometriosis on pregnancy outcomes in women with adenomyosis

ObjectivesPrevious studies demonstrated that endometriosis and adenomyosis are closely linked to lots of adverse pregnancy outcomes while the role of endometriosis in pregnant women with adenomyosis has not been explored yet. The present study aimed to evaluate the influence of previous laparoscopic surgical and pathological diagnosis of endometriosis on pregnancy outcomes in women with adenomyosis. MethodsA total of 60 pregnant women who were diagnosed with adenomyosis before or during pregnancy were included in this study. Among them, 8 were also diagnosed with endometriosis by previous laparoscopic surgery. The demographic characteristics and pregnancy outcomes were compared between women with adenomyosis only and those with the surgical history of endometriosis. ResultsCompared with women with adenomyosis only, those concomitant with the surgical history of endometriosis had significantly higher age at delivery [37.5(36.25–39.75) vs. 35(33.25–37), P ​= ​0.016] and an increased risk of postpartum hemorrhage (PPH) (adjusted OR: 5.992, 95% CI: 1.03–34.857, P ​= ​0.046) while no significant differences were found in other adverse pregnancy outcomes between these two groups. Then we further detected the risk factor of PPH in women with adenomyosis and found that the surgical history of endometriosis (OR: 6.995, 95% CI: 1.16–42.171, P ​= ​0.034) and assisted reproductive technology (ART) (OR: 5.062, 95% CI: 1.494–17.146, P ​= ​0.009) were the parameters closely associated with the occurrence of PPH. ConclusionsThe history of previous laparoscopic surgical and pathological diagnosis of endometriosis in pregnant women with adenomyosis may increase the risk of PPH, which still needs to be verified by future studies with a large sample size. Besides, pregnancy through ART is also an increased risk factor for PPH in women with adenomyosis. Pregnant women with adenomyosis who conceived with the surgical history of endometriosis or by ART should be closely monitored for the reason of being at high risk of PPH.

Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage.

Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide. Throughout the years, there have not been many studies looking into the association of race and ethnicity with the occurrence of PPH. The goal of this study was to assess race and ethnicity as risk factors in the development of PPH in pregnant women. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and conducted a literature search using Google Scholar and PubMed. After applying our inclusion and exclusion criteria, the search technique yielded a total of eight articles. The analysis included seven observational studies and one randomized controlled trial. The incidence of PPH was chosen as the major outcome measure. An evaluation of eight studies revealed that although Hispanics, Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have a higher chance of developing PPH caused by uterine atony, Caucasians had a greater rate of transfusion than the other groups. In addition, compared to Caucasians, African Americans or African descendants had a lower risk of atonic PPH but increased odds of atonic PPH requiring interventions. On the other hand, compared to non-native groups, Native Americans had increased odds of uterine atony. The results showed that, in contrast to other races/ethnicities, Caucasians had the lowest risk of PPH. Additionally, it was shown that African Americans or those descended from Africans had a higher chance of PPH but a lower risk of atonic PPH.

Impact of Obstetric Cholestasis on Fetomaternal Outcome

Objective: To evaluate the impact of obstetric cholestasis on maternal and fetal outcomes.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from Jan to Dec 2019.&#x0D; Methodology: All pregnant women with no comorbid and ladies with symptoms and signs of obstetric cholestasis were included during the study period. Antenatal complications and perinatal outcomes of women having obstetric cholestasis were compared with those of pregnant ladies having no comorbid.&#x0D; Results: Out of 6932 obstetric patients, 90 (1.29%) had obstetric cholestasis. The cholestatic group had significantly high levels of aminotransferases and alkaline phosphatase. There was higher occurrence of preterm prelabour rupture of membrane (11.11% vs 3.33%, p=0.044), preterm delivery (26.66% vs 4.44%, p&lt;0.001), prelabor rupture of membrane (31.11% vs 13.33%, p=0.004) and emergency cesarean section (16.66% vs 4.44%, p=0.008) in obstetric cholestatic group as compared to control. No difference in the occurrence of postpartum haemorrhage was observed in both groups. Meconium stained amniotic fluid (42.22% vs 8.88%, p&lt;0.001) and neonatal intensive care unit admission (23.33% vs 7.77%, p=0.004) were significantly high in the study group as compared to the control. Whereas occurrences of abnormal cardiotocography, APGAR score at 5 minutes, and intrauterine growth restriction in both groups had no significant difference.&#x0D; Conclusion: Women with obstetric cholestasis are at increased risk of preterm labour, PPROM, emergency LSCS, and poor neonatal outcome (low APGAR, macrosomia, NICU admission), burdening the health care system; hence early diagnosis with careful clinical examination...