Postpartum Blood Loss Research Articles

Emerging trend in the etiology of postpartum hemorrhage in a low resource setting

Background: While rates of postpartum hemorrhage (PPH) have continued to rise, it is not clear if the etiology and patterns have changed over time. Anecdotal reports have shown that, other than uterine atony, genital tract laceration is emerging as the chief causes of PPH. Objectives: This was to determine the changing trend in the prevalence, causes and maternal mortality associated with PPH in a low resource setting. Methods: A retrospective cohort study of all parturients that had PPH at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 1st, 2006 to December 31st, 2015 was conducted. Post-partum blood loss was calculated by estimating blood losses in graduated containers and in bed lines and gauze packs. Results: During the period under review, a total of 10,502 deliveries were conducted, out of which 119 women were managed for PPH, giving a prevalence of 1.13%. Sixty-nine (58.0%) had primary PPH and 50 (42.0%) had secondary PPH. The overall leading cause of PPH was retained product of conception in 51 (42.9%). The commonest cause of primary PPH was genital tract laceration in 24 (34.8%) followed by uterine atony in 21 (30.4%). The leading cause of secondary PPH was retained products of conception in 37 (74.0%) cases, whereas its least causes were uterine sub-involution and gestational trophoblastic diseases in 1(2.0%) patient each. There was a significant association between the types of PPH and their risk factors/causes (genital tract laceration, uterine atony, retained product of conception, endometritis and coagulopathy; p<0.05 for all). The majority of the cases of primary PPH (94.6%) survived the condition and 5.4% died. Conclusion: Genital tract laceration has emerged as commonest cause of primary PPH followed by uterine atony, while the leading cause of secondary PPH was retained products of conception. This new trend in etiology warrants further investigation in other regions.

Per-Partum Anaemia and Missed Post-Partum Haemorrhage in Low Resources Settings

Background: Post-partum haemorrhage is the leading cause of maternal death throughout the world, and anaemia is one of its indirect causes. Anaemia during labour increases the risk of PPH and may lead to maternal mortality even after moderate PPH. Undiagnosed PPH and post-partum anaemia increases the risk of late maternal death in the community. The aim of this study was to assess the prevalence of anaemia on admission for labour, the occult early post-partum haemorrhage and the magnitude of post-partum anaemia in a low resource setting. Methods: This was a longitudinal study. We included pregnant women in labour. Haemoglobin concentration was measured on admission (H0), then 24 hours (H24) and 48 (H48) hours later. The post-partum blood loss was estimated by delta haemoglobin, using the criteria of M. Driessen et al. Results: We recruited 245 pregnant women. The mean age was 27.0 ± 6.0 years. The mean hemoglobin concentration was 11.7 ± 1.9 g/dl, the frequency of anaemia was 30.6% and was related to ethnicity (P = 0.042) gestational age (p < 0.001) marital status (p = 0.014) and the inter pregnancy time space (p = 0.001). Twenty-two-point two percent had post-partum haemorrhage among which 40% were undiagnosed. The mean blood loss was 375 ml and post-partum anaemia rate was 44.5%. Conclusion: Anaemia on admission was related to socio-demographic characteristics. The frequencies of anaemia during labour, missed PPH and undiagnosed post-partum anaemia were high. Haemoglobin concentration on admission for labour and after delivery, reliable method to assess PPH should be mandatory, to better identify per and post-partum anemia, and the management of PPH, in low income environments.

Postpartum Blood Loss Measurement Using Digital Image Processing

Most of maternal mortality is directly caused by obstetric hemorrhage and almost three-quarters of it take place in postpartum period. The risk of maternal death due to hemorrhage can be reduced with prompt and proper care that in turn relates to the blood loss measurement method used. Unfortunately, the most commonly practiced method is not yet accurate enough. This research proposes a postpartum blood loss measurement method using digital image processing. Initially, characterization is carried out to find out blood absorbance against digital image area and blood volume in the underpad. Results of this characterization then serve as the basis for blood loss measurement using digital image processing. This measurement basis is validated by measuring blood volume lost during delivery care. Results show that the area and volume of blood absorbed in the underpad has significant linear relation (R = 0.9734). Digital image processing can be used to measure postpartum blood loss with a high accuracy up to 83.7%. The use of this method is therefore an accurate and objective alternative to the other available method. Nonetheless, the use of this new method must also adhere to standard guidelines in delivery care as to ensure the utmost outcomes.

Role of intravenous tranexamic acid on cesarean blood loss: A prospective randomized study

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality globally. Tranexamic acid, an anti‑fibrinolytic agent, is a novel approach to prevent this dreadful complication. This study aims to document the efficacy of intravenous (IV) tranexamic acid in reducing blood loss during and after cesarean section (CS).Materials and Methods: In this prospective, randomized, placebo‑controlled, open‑label study, 100 mothers scheduled for elective CS were randomly selected and divided into two groups (study and control) of 50 each. The study group received 1 g IV tranexamic acid and the control group received IV placebo. Following delivery, all mothers received 10 units of oxytocin in 500 mL of normal saline.Results: The mean intraoperative and postpartum blood loss were significantly lower in the study group than the control group: 499.11 ± 111.2 ml and 59.93 ± 12.5 ml versus 690.85 ± 198.41 ml and 110.06 ± 13.47ml, respectively (P < 0.001). Total blood loss was 30% less in the study group (P < 0.001). Six mothers had PPH in the control group while none in the study group had PPH. The difference between the preoperative and postoperative hemoglobin values was significantly less in the study group than the control group, 0.26 ± 0.22 g% versus 0.99 ± 0.48 g% (P < 0.001).There was no significant difference with respect to other hematologic parameters. There was no added adverse effect or need for NICU admission in the study group.Conclusion: Preoperative IV tranexamic acid significantly reduced blood loss during elective CS without any significant adverse effects.Keywords: Anti‑fibrinolytics; blood‑loss; cesarean delivery; postpartum hemorrhage; Tranexamic acid

162: A comparison of estimated blood loss and quantitative blood loss as predictors of peripartum hemoglobin change

Evaluation of post-partum blood loss has traditionally depended on visual estimation of blood loss (EBL). Multiple studies have identified the limitations and inaccuracy of this approach. Quantitative measurement of blood loss (QBL) during delivery using a gravimetric weighing scheme has been proposed to improve identification of life-threatening hemorrhage and facilitate earlier intervention. However, lack of validation has limited its wide applicability. Our objective in this study was to determine if QBL was more effective than EBL in predicting changes in hemoglobin (Hgb) associated with delivery. We conducted a retrospective study of women aged 13-60 (n=258) admitted to RWJUH for either vaginal (n=114) or cesarean delivery (n=144) during the time period of August 1st 2015 to December 31st 2016. QBL was calculated using weight differences in under buttocks drapes, flat and fitted sheets, lap pads and chux towels. Nursing estimated amniotic fluid in under buttocks drapes in vaginal deliveries, and irrigation and amniotic fluid in the suction canister during cesarean deliveries. EBL assigned by the physician, admission and at least 8 hour post-delivery Hgb (g/dl) were recorded. SigmaPlot was used for data analysis using descriptive measures and linear regression. P values of <0.05 were considered statistically significant. Mean change in Hgb was 1.5 g/dl [11.9 to 10.3, 375mL] for vaginal deliveries and 1.9 g/dl [11.7 to 9.9, 475mL] for cesarean deliveries. Median EBL for vaginal deliveries was 300 mL [300-362] compared to median QBL of 502 mL [246-845]. Median EBL for cesarean deliveries was 800 [700-1000] mL compared to median QBL of 1005 [581-1466] mL. Poorly correlative but significant linear regressions were observed for EBL (vaginal r2 0.0745, p 0.003; cesarean r2 0.0470, p 0.009) and QBL (vaginal r2 0.154, p<0.001; cesarean r2 0.0975, p<0.001). Our study found QBL has a wider variance, and is a more accurate predictor of postpartum Hgb values compared to EBL in both vaginal and cesarean deliveries. However, neither method of blood loss assessment closely approximated change in Hgb. Although QBL assessment offers the possibility for earlier recognition of accurate blood loss measurements during delivery, visual estimations of amniotic fluid may continue to limit accuracy.

Effectiveness of Tranexamic Acid for Reducing Postpartum Blood Loss in the First Two Hours after Vaginal Delivery: A Randomised Controlled Trial

Effectiveness of Tranexamic Acid for Reducing Postpartum Blood Loss in the First Two Hours after Vaginal Delivery: A Randomised Controlled Trial

Peran Penambahan Misoprostol pada Penatalaksanaan Aktif Kala Tiga dalam Menurunkan Perdarahan Pasca Persalinan

Background: Postpartum haemorrhage is the leading cause of maternal mortality in both developed and developing countries, which is almost 80 % due to the failure of the uterus to contract. Misoprostol is a powerful uterotonic agent used as an alternative in preventing postpartum haemorrhage. Objective: The purpose of this study was to determine whether administration of misoprostol adjunctive therapy in active management of the third stage of labor influenced postpartum blood loss. Method: This study was a non-blinding randomized controlled trial that divided subjects into two groups. The treatment group was the group who received misoprostol 600 mcg orally for adjunctive treatment in active management of the third stage of labor and the control group did not receive misoprostol, each group also got routine oxytocin 10 IU intramuscularly. Both group were assessed of the number of blood loss in the fourth stage of labor, decreased levels of hemoglobin and hematocrit within 24 hours after delivery. Chi square test was conducted to determine the strength of the relationship between the two groups. Result and Discussion: The study recruited 104 subjects, there were significant difference for the mean number of blood loss in the fourth stage of labor and the decrease in hemoglobin levels within 24 hours of postpartum between treatment and control group (OR 2.45; 95% CI 1.05-5.71, p=0.04), (OR 2.99; 95% CI 1.26-7.11, p=0.01). The mean of the decreasing hematocrit levels was statistically not significant between the two groups (OR 0.87; 95% CI 0.38-1.99, p=0.75). Conclusion: The addition of misoprostol to the routine active management of the third stage of labor was statistically significant to decrease amount of postpartum blood loss. Keywords: misoprostol, active management of the third stage of labor, postpartum blood loss, postpartum hemorrhage.

Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial

ObjectiveHyoscine butyl bromide (HBB) is known for its antispasmodic action and has been in use for over five decades, there is however no consensus on its effectiveness in the labor process. The aim of this study was to determine the effect of HBB on the duration of the active phase of labor. Materials and methodsA randomized double-blind placebo-controlled clinical trial involving 160 parturient who received either intravenous Hyoscine butyl-bromide (20 mg in 1 ml; n = 80) or intravenous normal saline (1 ml, n = 80). The mean duration of active phase of labor was compared between the two groups. ResultsThe observed mean duration of the active phase of labor was significantly shorter (P = 0.001) in the Hyoscine butyl-bromide group (365.11 ± 37.32 min, range = 280–490) than in the Placebo group (388.46 ± 51.65 min, range = 280–525). There was no significant difference between the two groups in the mean duration of the second and third stages of labor (20.46 ± 10.46 vs. 23.38 ± 18.95 min, P = 0.43 and 8.96 ± 4.34 vs. 9.23 ± 5.92 min, P = 0.75, respectively). The mean 1-min APGAR scores were also comparable (8.08 ± 1.54 vs. 7.64 ± 1.60, P = 0.08). The mean postpartum blood loss was significantly less in the Hyoscine butyl-bromide group (303 ± 96.52 vs. 368 ± 264.19 ml, P = 0.04). ConclusionHyoscine butyl-bromide was effective in shortening the duration of the active phase of labor. It was also associated with significantly less postpartum blood loss.

Development and validation of a predictive model for excessive postpartum blood loss: A retrospective, cohort study

Backgroundpostpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. Despite the use of uterotonics agents as preventive measure, it remains a challenge to identify those women who are at increased risk of postpartum bleeding. Objectiveto develop and to validate a predictive model to assess the risk of excessive bleeding in women with vaginal birth. Designretrospective cohorts study. Setting“Mancha-Centro Hospital” (Spain). Participantsthe elaboration of the predictive model was based on a derivation cohort consisting of 2336 women between 2009 and 2011. For validation purposes, a prospective cohort of 953 women between 2013 and 2014 were employed. Women with antenatal fetal demise, multiple pregnancies and gestations under 35 weeks were excluded Methodswe used a multivariate analysis with binary logistic regression, Ridge Regression and areas under the Receiver Operating Characteristic curves to determine the predictive ability of the proposed model. Resultsthere was 197 (8.43%) women with excessive bleeding in the derivation cohort and 63 (6.61%) women in the validation cohort. Predictive factors in the final model were: maternal age, primiparity, duration of the first and second stages of labour, neonatal birth weight and antepartum haemoglobin levels. Accordingly, the predictive ability of this model in the derivation cohort was 0.90 (95% CI: 0.85–0.93), while it remained 0.83 (95% CI: 0.74–0.92) in the validation cohort. Conclusionsthis predictive model is proved to have an excellent predictive ability in the derivation cohort, and its validation in a latter population equally shows a good ability for prediction. This model can be employed to identify women with a higher risk of postpartum haemorrhage.

Mortalité maternelle par hémorragie, résultats de l’ENCMM, France 2010–2012

Haemorrhage is the first cause of maternal mortality and morbidity in France and a quality of care marker. Haemorrhage rate in France is around 5 to 10% of deliveries. PPH is defined as a post-partum blood loss≥500mL whatever the delivery route and sometime blood can be concealed inside the pelvis. Between 2010 and 2012 in France, 29 deaths were related to haemorrhage giving a maternal mortality ratio of 1.2/100,000 live births (CI 95% 0.8–1.7). Haemorrhage cases decreased from last triennium (2007–2009) especially for uterine atony cases (12/29) but remains the first leading cause of direct maternal death. Patients with previous cesarean birth were more represented than in general obstetrical population (11/23). Substandard care were mainly due to delays in diagnosis of hemoperitoneum, delays in adequate resuscitation because of reassuring vital signs (normal blood pressure or normal hematocrite at the initial stage of bleeding) or organisational mistakes.

Cooling the lower abdomen to reduce postpartum blood loss: A randomized controlled trial

BackgroundCooling the lower abdomen is one of the Japanese traditional non-pharmacological prophylactic managements for postpartum hemorrhage. This study aimed to evaluate the effectiveness of cooling the lower abdomen in reducing postpartum blood loss compared with no intervention. In both cases, women delivered vaginally without prophylactic oxytocin in the third stage of labor.MethodsIn this randomized controlled trial, the lower abdomen was cooled by placement of an 8.6°C icepack during the first 2 h after placental delivery. The primary outcome was measured as the total blood loss within 2 h after delivery. This study had 80% power at the two tails of 5% significance level to detect the mean difference (MD, 70 g) in total blood loss within 2 h after delivery between the two groups. The sample size was calculated as 144 women (72 women per group).ResultsBetween January and May 2016, 160 women were randomly assigned to the intervention group (cooling the lower abdomen, n = 81) or the control group (n = 79). Baseline characteristics were similar between groups, with the exception of mean blood loss during the third stage of labor. The primary outcome was not reduced by cooling, compared with no intervention (mean blood loss, 513.3 vs. 478.1 g, respectively; MD = 35.2 g; 95% confidence interval = −65.3–135.7). No adverse events occurred; however, seven (8.7%) women in the intervention group declined to continue cooling the lower abdomen because of discomfort.ConclusionCompared with the control group, cooling the lower abdomen did not reduce the total amount of blood loss up to 2 h after delivery.Trial registrationUMIN-CTR UMIN000019834

A Single Large Dose of Tranexamic Acid before Vaginal Delivery : Is It Beneficial ?

Background: many factors are attributed in the management of postpartum hemorrhage after vaginal delivery Objective: to assess the efficacy and safety of a single large dose of intravenous tranexamic acid in reducing postpartum blood loss after vaginal delivery. Subjects and Methods: this is a multicentric prospective randomized double blind placebo controlled trial. 240 pregnant women were randomized to receive either 60 mg/kg of TA (n=120) or placebo (n=120) intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from placental delivery to 2 hours postpartum and adverse effects of were observed. Results: the mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group (241.5 ± 82.7 versus 322.8 ± 127.4, respectively; p < 0.001), and the proportion of women in the tranexamic acid group who had an estimated blood loss ≥ 500 mL was significantly lower than in the placebo group ( 5 [4.2%] versus 18 [15%], relative risk [RR]=0.30; 95% confidence interval [CI] 0.11 to 0.78; P<0.05). Maternal and neonatal outcomes did not differ significantly between both groups. Conclusion: A single large dose of tranexamic acid administrated intravenously before vaginal delivery significantly reduces the amount of postpartum blood loss and contributes to prevention of PPH. Adverse effects were only mild and transient. Thus, tranexamic acid can be used safely and effectively to reduce bleeding after vaginal delivery.

Misoprostol rectal u oxitocina intramuscular en el manejo de la tercera fase del parto

ObjectiveTo compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the management of the third phase of labour. Materials and methodPatients to be treated with rectal misoprostol (group A) or intramuscular oxytocin (group B) were selected and randomised to attend delivery at the Central Hospital ‘Dr. Urquinaona’, Maracaibo, Venezuela. An evaluation was made of the general characteristics, changes in haemoglobin and haematocrit values, post-partum blood loss, and adverse effects. ResultsComplete data were obtained from 392 patients (195 from Group A and 197 from Group B), who were included in the final analysis. No significant differences were found between the groups with respect to the general characteristics (P=ns). No statistically significant differences were found in the mean values of haemoglobin and pre- and post-partum haematocrit (P=ns). There was a significant decrease in the duration of the third phase of labour in Group A compared to patients in Group B (P<.001). The estimated blood loss in patients in Group A was significantly lower (P<.05). It was observed that the patients in Group A had a tendency to a lower use of additional uterotonics (P<.05). Patients in Group A presented with a higher frequency of headache and shivering compared to patients in Group B (P<.05). ConclusionsMisoprostol administered rectally is effective in minimising blood loss and duration of the third phase of labour.

The Windmill technique avoids manual removal of the retained placenta—A new solution for an old problem

ObjectiveThe primary objective is to assess the reduction in manual removal of placenta with the Windmill technique of placenta delivery in patients with retained placenta. DesignThe Windmill technique involves the application of continuous 360° umbilical cord traction and rotation in such a manner as to be perpendicular to the direction of the birth canal at the level of the introitus. This rotation through 360° is repeated slowly with movement akin to the motion of the blades of a windmill.We performed a 3-year retrospective case-control study at the Charité University Hospital in Berlin. Patients with a retained placenta more than 30min following failed traditional interventions were consented and offered the Windmill technique of placenta delivery. Study cases were compared to controls where an operative manual removal of placenta was performed. Patients with suspected placenta implantation problems, uterine atony, bleeding due to vaginal tract injury and coagulation disturbances were excluded. ResultsOver the study period 14 patients were recruited to the study arm and 17 patients were in the control group. With the Windmill technique for retained placenta, 86% (12/14, p<0.001) of patients avoided invasive operative manual removal of the placenta in theatre.There was a statistically significant reduction in mean blood loss (429ml vs 724ml, p=0.001) and mean postoperative fall in hemoglobin values (1.3g/dl vs 2.5g/dl, p=0.04). There was a reduction in the time to delivery of the placenta, antibiotic prophylaxis and use of general anesthesia. ConclusionThe Windmill technique for the delivery of the retained placenta is a simple, safe, effective and easy to teach technique that reduces invasive operative manual removal of the placenta, postpartum blood loss and delay in the placenta delivery. This innovative technique can also be a lifesaving intervention especially in areas with limited or no access to operative facilities.

Use of a Visual Aid in addition to a Collector Bag to Evaluate Postpartum Blood loss: A Prospective Simulation Study

Postpartum hemorrhage (PPH) is one of the most common causes of mortality in obstetrics worldwide. The accuracy of estimated blood loss is a priority in determining appropriate treatment. Will the additional use of a visual aid improve physicians’ accuracy in estimating blood loss compared to the use of a collector bag and baby scale alone? Simulation training sessions created three vaginal delivery scenarios for participants to estimate volumes of blood loss: firstly, using only a collector bag and a baby weight scale and secondly, adding a visual aid depicting known volumes of blood. The primary endpoint was to determine if participants could accurately evaluate blood loss within a 20% error margin. The addition of the visual estimator resulted in overestimation of blood loss. The rates of participants’ estimations were significantly more accurate when using the collector bag with the baby weight scale without the addition of the visual aid; 85.5% versus 33.3% (p < 0.01) for 350 mL, 88.4% versus 50.7% (p < 0.01) for 1100 mL and 88.4% versus 78.3% (p < 0.01) for 2500 mL, respectively. Additional use of a visual aid with a collector bag does not seem to be useful in improving the accuracy in the estimation of blood loss.

The association between the time from oxytocin cessation during labour to Cesarean delivery and postpartum blood loss: a retrospective cohort study.

Prolonged exposure to oxytocin during augmentation of labour is associated with uterine atony and an increased risk of postpartum hemorrhage (PPH) due to oxytocin receptor desensitization. Cessation of oxytocin infusion during labour may facilitate recovery of oxytocin receptor function, which then helps to restore myometrial contractility and decrease postpartum blood loss. We examined the association between oxytocin recovery interval, i.e., the time from discontinuing oxytocin to Cesarean delivery (CD) for labour arrest, and blood loss. This retrospective cohort study included women who underwent CD for labour arrest following oxytocin-augmented labour from July 1, 2013 to July 19, 2015 at our institution. Data were collected on patient demographics, labour and delivery characteristics, oxytocin induction and augmentation, recovery interval, and PPH risk factors. The primary outcome was estimated blood loss (EBL), calculated using the hematocrit variation method. Data on 490 women were analyzed. The mean (standard deviation) EBL was 1,341 (577) mL; the amount of oxytocin administered during labour was 6,447 (6,868) mU, and the oxytocin recovery interval was 99 (65) min. Every ten-minute increase in the recovery interval was associated with a 10-mL decrease in EBL (95% confidence interval [CI], -18 to -3; P=0.009). Morbidly obese women had a significantly higher EBL than those with a body mass index < 40 kg·m-2 (mean difference, 572 mL; 95% CI, 382 to 762; P < 0.001). The amount and duration of oxytocin administered during labour, but not the oxytocin recovery interval, was associated with the use of additional interventions to control PPH (P=0.005). Our study shows that an increase in the oxytocin recovery interval is associated with a decrease in blood loss at CD in women with oxytocin augmented labour. These data support discontinuing the oxytocin infusion as soon as the decision is made to proceed with CD for labour arrest, particularly in morbidly obese women.

Duration of labor and the risk of severe postpartum hemorrhage: A case-control study.

ObjectiveOur main objective was to investigate the association between duration of active labor and severe postpartum hemorrhage. We examined the effect of the total duration of active labor, the effect of each stage of active labor, and the gradient effect of duration of labor on severe postpartum hemorrhage.MethodsA case-control study was generated from a source population of all women admitted for delivery at Oslo University Hospital and Drammen Hospital in Buskerud municipality during the time period January 1, 2008 to December 31, 2011. The study population included all cases of severe postpartum hemorrhage (n = 859) and a random sample of controls (n = 1755). Severe postpartum hemorrhage was defined as postpartum blood loss ≥1500 mL or need for blood transfusion. Prolonged labor was defined as duration of active labor >12 hours according to the definition of the World Health Organization. We used logistic multivariable regression in the analysis.ResultsWe observed a significantly longer mean duration of labor in women who experienced severe postpartum hemorrhage compared to controls (5.4 versus 3.8 hours, p<0.001). Women with severe postpartum hemorrhage also had a longer duration of all stages of active labor compared to controls. The association between the duration of active labor and severe postpartum changed from a linear dose-response association to a threshold association after adjusting for augmentation with oxytocin, induction of labor, primiparity, and fever during labor. Compared to controls, women with severe postpartum hemorrhage were more likely to have a prolonged labor >12 hours (adjusted odds ratio = 2.44, 95% confidence interval: 1.69–3.53, p< 0.001).ConclusionProlonged active labor (duration >12 hours) was associated with severe postpartum hemorrhage. Increased vigilance seems required when the labor is prolonged to reduce the risk of severe postpartum hemorrhage.

Rentgenoehndovaskuljarnaja occlusion of blood vessels in the treatment and prevention of massive obstetric hemorrhage

The objective: to analyze the effectiveness of these methods for endovascular occlusion of blood vessels in reducing postpartum blood loss and postoperative patients with placenta previa patients.Patients and methods. A search for publications that reflect the role and efficacy of prophylactic use of uterine artery embolization and temporary balloon occlusion of the iliac arteries in patients with pla1 centa previa and ingrowth, who may be massive bleeding.Results. According to the opinion of some researchers, prophylactic catheterization and embolization of pelvic arteries in women with pla1 centa rotation is considered a safe and effective method in the preven1 tion of hysterectomy, and should be used in patients who wish to pre1 serve future fertility.Conclusion. The results of the survey illustrate the safety and efficacy of endovascular occlusion of the uterine arteries and iliac based on individual clinical observations and non1randomized studies with small sample of cases, in connection with which to obtain further evi1 dence expedient conduct large multicentre randomized trials.

Postpartum Vaginal Blood Loss following Two Different Methods of Cervical Ripening.

Eighty women undergoing induction of labor at the University of Calabar Teaching Hospital were recruited and randomly allocated into two treatment groups (40 each), to receive either serial 50 µg doses of misoprostol or intracervical Foley catheter. Vaginal blood loss was collected and measured using an under buttocks plastic collection bag and by perineal pad weighing up to 6 hours postpartum. There were no significant differences between the two groups with respect to sociodemographic and obstetric characteristics. Comparison of blood loss in vaginal deliveries between the two groups revealed that subjects in the misoprostol group had significantly higher blood loss than subjects in the Foley catheter group (488 ± 222 versus 326 ± 106, p<0.05). In both groups, there was strong and statistically significant positive correlation between postpartum blood loss and induction delivery interval (r=0.75, p<0.0001; r=0.77, p<0.0001). There were no significant differences in maternal outcomes. In view of this, further study is required to ascertain if lower doses of misoprostol for induction of labor may result in lesser blood loss. This trial is registered with ISRCTN14479515.

A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound

The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time–intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time–intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.