Cases Of Postpartum Hemorrhage Research Articles

Management and strategies utilized by nurses in the control of postpartum haemorrhage among pregnant women in UCTH

This study sought to investigate the management and strategies utilized by nurses in the control of postpartum hemorrhage among pregnant women in UCTH. In order to successfully carry out the study, the following research questions and hypotheses were formulated. What is the proportion, proper management strategies utilized and the causes of postpartum hemorrhage among pregnant women in UCTH? The research instruments used in collecting data for analysis was in parts, records from the hospital and a four point likert scale questionnaire which was administered on 57 nurses used as sample for the study. Their responses were analyzed using appropriate statistic and the following results were obtained. Only 12 cases of postpartum hemorrhage were recorded out of 1952 cases of labour registered in 2017 in UCTH. Management strategies utilized by the nurses in the control of postpartum haemorrhage in UCTH. Prolonged labour, disease conditions, multiparity with lax uterine muscles, retained product of conception and poor management of labour resulting in lacerations among others were identified as causes of postpartum haemorrhage.

275 Cost and Benefit Tradeoffs of Preconception Fibroid Treatment with Myomectomy on Obstetric Outcomes: A Cost-Effectiveness Analysis

OBJECTIVES/GOALS: Fibroids during pregnancy are associated with worse obstetric outcomes. However, theres no recommendation to guide counseling. We aimed to assess the cost-effectiveness of (1) treating prevalent fibroids before pregnancy and (2) screening and treatment of fibroids against the outcomes of postpartum hemorrhage (PPH) and fetal malpresentation. METHODS/STUDY POPULATION: A decision tree model was used to compare (1) preconception myomectomy for prevalent fibroids, without treatment and (2) preconception myomectomy for prevalent cases and universal ultrasound screening with subsequent myomectomy for incident cases. Probabilities and costs, calculated from the U.S. healthcare sectors perspective, were derived from the literature. Effectiveness was measured in incident PPH or malpresentation cases per 1,000 in the population. The incremental cost-effectiveness ratio (ICER) was measured in incremental cost per case averted. One-way and probabilistic sensitivity analyses were conducted to identify influential parameters and assess the impact of parameter uncertainty. RESULTS/ANTICIPATED RESULTS: Treating known fibroids prior to pregnancy averted 65.7 PPH cases at the cost of $8,773,094 and 91.08 malpresentations at the cost of $8,163,315 (ICERs, $133,532 vs $89,628 per case averted, respectively). Universal fibroid screening with treatment of incident and prevalent cases averted 7.34 PPH cases at the cost of $3,725,619 and 2.7 malpresentations at the cost of $3,477,033 (ICERs, US$507,450 vs US$1,335,771 per case averted, respectively). Sensitivity analyses showed cost-effectiveness improved with decreased cost of myomectomy and increased proportion of prevalent and incident cases. DISCUSSION/SIGNIFICANCE: Treatment alone costs $133,532 per PPH averted and $89,628 per malpresentation averted. Likewise, screening with treatment costs $507,450 per PPH averted and $1,335,771 per malpresentation averted. Additionally, ICERs may decrease when focusing on populations where fibroid incidence and prevalence is higher, for example, among Black women.

THE ROLE OF TRANEXAMIC ACID IN REDUCING BLOOD LOSS DURING ELECTIVE CAESAREAN SECTION IN A TERTIARY CARE CENTRE

Introduction: The reduction of maternal mortality is one of the indicators under Goal 3- Ensure healthy lives and promote well-being for all at all ages of Sustainable Development Goals. It seeks to reduce global MMR to less than 70 per 100 000 live births by 2030. A leading cause of maternal mortality is Post-partum Haemorrhage (PPH). Hence, it is imperative that any improvement in maternal mortality rate must address the issue of Post-partum Haemorrhage. Post-partum Haemorrhage (PPH) is dened as the amount of blood loss in excess of 500 ml following the birth of the baby (World Health Organization). The clinical denition, which is more practical, states, any amount of bleeding from or into the genital tract following the birth of the baby up to the end of the puerperium, which adversely affects the general condition of the patient evidenced by the rise in pulse rate and falling blood pressure, is called Post-partum Haemorrhage. Aim: The present study is aimed to determine the clinical efcacy of tranexamic acid in reducing blood loss during elective caesarean section in Patna Medical College and Hospital, Patna. Type of study: Prospective study Study period: 1 year (January 2020 to December 2020) Materials and Methods: This is a prospective study conducted in Obstetrics and Gynaecology department at Patna Medical College and Hospital, Patna. 100 female patients scheduled for elective caesarean section are enrolled for the present prospective study, which was carried out from January 2020 to December 2020. The patients were randomly divided into 2 groups. 50 patients received 1g intravenous tranexamic acid 10 rd minutes before skin incision in addition to active management of 3 stage of labour and the other 50 patients were kept under the active rd management of 3 stage of labour only. Result: In the present study, the amount of blood loss was found to be signicantly low (mean 537 ml) in the tranexamic acid group as compared to the control group (608 ml), the difference was statistically signicant (p-value 0.001). The mean fall in haemoglobin level was also less (0.61 mg/dl) in the group which received the tranexamic acid as compared to the control group (1.07 mg/dl), the difference was statistically signicant (p- value 0.001). Postpartum haemorrhage (blood loss more than 1000 ml) was observed in 1 patient in the control group and no case of PPH was observed in the study group. Conclusion: To reduce blood loss following caesarean section, TXAmay be safely recommended in addition to Oxytocin.

Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria

IntroductionPrimary postpartum haemorrhage (PPH) is the leading cause of Nigeria’s high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH...

Analysis of the effect of the covid-19 pandemic on maternal care at the Acobamba hospital - Huancavelica, Perú 2020

o determine the effect of the COVID-19 pandemic on maternal care in the Hospital of Acobamba - Huancavelica, 2020. Methodology: The research was observational, retrospective, and longitudinal with the population being consisted of 27 and 29 pregnant women, 53 and 60 deliveries, 27 and 29 postpartum women during the second trimester of the year 2019 and 2020, respectively. Results: Analysis with pandemic (2020) and without pandemic (2019), pregnant women attended 86.6% and 114.8%; pregnant women controlled (6APN) 62.1% and 88.9%; with full laboratory set 44.8% and 88.9%. During the pandemic, each pregnant woman received 1.8 visits and 3.9 telephone follow-ups, compared to 0.9 visits and no telephone follow-ups. During the pandemic, delivery care reached 236.7% since deliveries from other jurisdictions and by returning migrants were attended and there were 5% of home deliveries, while during the non-pandemic 86.8% and no home deliveries were attended. The first puerperal check-up reached 162.1%, 137.9% compared to 66.7% and 59.3%; visits to puerperal women reached 117.2% compared to 74.1% non-pandemic. The causes of the main emergencies were abortion (22.2%), hypertensive disease of pregnancy (15.3%), fetal distress (8.3%) and hemorrhage during pregnancy (8.3%). Conclusion: COVID-19 pandemic reduced APN, increased delivery and puerperium care, strengthened follow-up of pregnant and puerperal women, increased emergencies and reduced cases of postpartum hemorrhage. The health team responded to the situation with commitment and responsibility). Keywords: COVID - 19, Maternal care, Women health, Pandemic, Pre-natal.

Comparison of haematological indices and transfusion management in severe and massive postpartum haemorrhage: analysis of a two-year national prospective observational study

IntroductionThis two-year prospective cohort study compared the management of women experiencing severe or massive postpartum haemorrhage (PPH) to explore the impact of targeted blood product administration on reducing PPH progression (from >1500 mL to ≥2500 mL blood loss). During the study, viscoelastic haemostatic assays (VHA) guided blood product transfusion. MethodsAll women experiencing blood loss after PPH >1000 mL were included in a national database. Haematological indices, transfusion and PPH aetiology were analysed in severe (>1500 mL blood loss or transfusion of any blood product) and massive PPH (≥2500 mL blood loss or transfusion ≥5 units red blood cells). ResultsOf the 61 094 maternities in Wales (2017 to 2018), 2111 had severe and 349 massive PPH. Red blood cells were transfused to 42.5% severe and 80.6% massive PPH cases. Hypofibrinogenaemia (fibrinogen <2 g/L and/or Fibtem A5 <12 mm) was the most frequent coagulation abnormality, occurring in 5.4% severe and 17.0% massive PPH, with blood coagulation products (fresh frozen plasma, platelets, cryoprecipitate and/or fibrinogen concentrate) administered to 3.6% and 22.9%. Women with hypofibrinogenaemia received targeted fibrinogen replacement in 97.8% severe and 93.6% massive PPH. The only aetiology with similar rates of hypofibrinogenaemia in severe and massive PPH was abruption (40.0% and 36.8%). ConclusionHypofibrinogenaemia was less frequent in severe PPH, although coagulopathy was observed across a range of PPH aetiologies, highlighting the importance of coagulation testing for all. Cases of abruption in severe and massive PPH had similar rates of hypofibrinogenaemia. Early VHA-guided fibrinogen replacement may reduce PPH progression in abruption and requires further evaluation.

Narrow distance inter-pregnancies increase the incidence of Post-Partum hemorrhage

Background and Aims. Maternal Mortality Rate (MMR) is the parameters of women's health status in community. The single most common cause of maternal mortality is obstetric haemorrhage, generally occurring postpartum. Most postpartum haemorrhage cases are caused by uterus atony, myometrium tonus loss, placenta retention, and clotting disorders. Short pregnancy intervals can cause threefolds of anaemia than normal pregnancy intervals. Pregnant women who suffer from anaemia has the possibility experiencing a postpartum bleeding caused by atonia uteri. This research aims to acknowledge the effect of narrow distance interpregnancy on a postpartum haemorrhage.&#x0D; Methods. This study uses an observational analytic study with a cross"‘sectional design. The data used is secondary data of pregnant women based on medical record to calculate the distance of interpregnancy with the incidence of postpartum bleeding during childbirth at Budhi Asih General Hospital of East Jakarta. The inclusion criteria are women who underwent childbirth during 2017"‘2018, multiparity, and postpartum women between 20"‘35 years old. The exclusion criteria are women with a history of postpartum haemorrhages caused by placental retention, tear of the reproductive tract or blood coagulation), gemelli parturition, macrosomia, assisted childbirth, grande multiparity, induction childbirth, and dystocia.&#x0D; Results. The number of samples used in this study amounted to 111 people. Postpartum haemorrhage are significantly associated with short interpregnancy intervals (p=0,000).&#x0D; Conclusion. Narrower pregnancy interval will leads to postpartum haemorrhage. To prevent this, it is important to consider contraception utilization, to improve iron consumption for pregnant women, and to provide decent antenatal care.

Novel intrauterine vacuum induced haemorrhage control device; a favourable alternative treatment of postpartum haemorrhage.

Maternal mortality is a serious health concern, with casualties amounting to 295,000 in 2017.[1] As of present, about 25% of all maternal deaths fall under a condition known as postpartum haemorrhage (PPH), which is defined as abnormal bleeding of more than 500 – ml post child birth; 80% of all PPH cases are attributed to an atonic uterus. Consequently, a stepwise progression is observed to achieve haemostasis, starting from compression therapy to uterotonics like oxytocin followed by uterine balloon tamponade and even surgical intervention as the last line of treatment.[2] In their study, Dalton et al. introduce The Jada System, a novel intrauterine vacuum induced haemorrhage control device and evaluate its safety and effectiveness. [3] This novel innovation uses low- level intrauterine vacuum to assist physiological forces, collapse the uterine cavity and occlude blood vessels to control excessive bleeding. Moreover, the study showcased successful definitive treatment in 94% of the patients within an average of 3 minutes, minimal low-grade adversities, 98% investigators deeming it easy to use and majority recommending it for future treatment.[3] The Jada System’s rapid and early use renders it an exceptional treatment to PPH in comparison with alternatives like balloon tamponade that can only be used after a significant blood loss. Furthermore, with a success rate of 87%, the balloon tamponade can take up to 24 hours to control bleeding and carries numerous risks like rupture of the overfilled balloon, infections, cervical tears and vaginal lacerations. [4] While tackling maternal mortality with the help of The Jada System, it is imperative to recognize that 94% of all maternal deaths occur in low and lower middle-income countries, therefore coherent and competent approaches to maternal health care must be introduced to developing countries around the world.[1] Pakistan is one such low-middle income country that reported a Maternal Mortality Rate (MMR) of 140 per 100000 deaths in 2017.[1] Additionally, in a 2002 study, Jafarey outlined lack of management, scarcity of medications, services, skills and blood banks to accommodate excessive blood loss as the major causes of continued maternal deaths due to PPH (52.9%) in the country.[5] Considering The Jada System's high success rate in managing PPH, low - middle income countries like Pakistan can invest in the local production of this device in a cost- efficient manner. Such an incentive can prove to be a feasible and swift solution to obstetric emergencies in the region.

Machine learning-based prediction of postpartum hemorrhage after vaginal delivery: combining bleeding high risk factors and uterine contraction curve.

This work used a machine learning model to improve the accuracy of predicting postpartum hemorrhage in vaginal delivery. Among the 25,098 deliveries in the obstetrics department of the First Hospital of Jinan University recorded from 2016 to 2020, 10,520 were vaginal deliveries with complete study data. Further review selected 850 cases of postpartum hemorrhage (amount of bleeding > 500mL) and 54 cases of severe postpartum hemorrhage (amount of bleeding > 1000mL). Indicators of clinical risk factors for postpartum hemorrhage were retrieved from electronic medical records. Features of the uterine contraction curve were extracted 2h prior to vaginal delivery and modeled using a 49-variable machine learning with 90% of study cases used in the training set and 10% of study cases used in the test set. Accuracy was compared among the assessment table, classical statistical models, and machine learning models used to predict postpartum hemorrhage to assess their clinical use. The assessment table contained 16 high-risk factor scores to predict postpartum hemorrhage. The classical statistical model used was Logistic Regression (LR). The machine learning models were Random Forest (RF), K Nearest Neighbor (KNN), and the one integrated with Lightgbm (LGB) and LR. The effect of model prediction was evaluated by area under the receiver operating characteristic curve (AUC), namely, C-static, calibration curve Brier score, decision curve, F-measure, sensitivity (SE), and specificity (SP). 1:Among the tested tools, the machine learning model LGB + LR has the best performance in predicting postpartum hemorrhage. Its Brier, AUC, and F-measure scores are better than those of other models in each group, and its SE and SP reach 0.694 and 0.800, respectively. The predictive performance of the classical statistical model LR is AUC: 0.729, 95%CI [0.702-0.756]). 2: Verification on the testing set reveals that the features of uterine contraction contribute to the improved accuracy of the model prediction. 3: LGB + LR model suggested that among the 49 indicators for predicting severe postpartum hemorrhage, the importance of the first 10 characteristics in descending order is as follows: hematocrit (%), shock index, frequency of contractions (min-1), white blood cell count, gestational hypertension, neonatal weight (kg), time of second labor (min), mean area of contractions (mmHgs), total amniotic fluid (mL), and body mass index (BMI). The prediction effect is close to that of the model after training with all 49 features. The predictive effect was close to that of the model after training using all 49 features. 4: Contraction frequency and intensity Mean_Area (representing effective contractions) have a high predictive value for severe postpartum hemorrhage. 5: Blood loss amount within 2h has a high warning effect on postpartum hemorrhage, and the increase in AUC to 0.95 indicates that postpartum bleeding mostly occurs within 2h after delivery. Machine learning models incorporated with uterine contraction features can further improve the accuracy of postpartum hemorrhage prediction in vaginal delivery and provide a reference for clinicians to intervene early and reduce adverse pregnancy outcomes.

Risk factors for postpartum haemorrhage in the Northern Province of Rwanda: A case control study.

Postpartum haemorrhage (PPH) remains a major global burden contributing to high maternal mortality and morbidity rates. Assessment of PPH risk factors should be undertaken during antenatal, intrapartum and postpartum periods for timely prevention of maternal morbidity and mortality associated with PPH. The aim of this study is to investigate and model risk factors for primary PPH in Rwanda. We conducted an observational case-control study of 430 (108 cases: 322 controls) pregnant women with gestational age of 32 weeks and above who gave birth in five selected health facilities of Rwanda between January and June 2020. By visual estimation of blood loss, cases of Primary PPH were women who changed the blood-soaked vaginal pads 2 times or more within the first hour after birth, or women requiring a blood transfusion for excessive bleeding after birth. Controls were randomly selected from all deliveries without primary PPH from the same source population. Poisson regression, a generalized linear model with a log link and a Poisson distribution was used to estimate the risk ratio of factors associated with PPH. The overall prevalence of primary PPH was 25.2%. Our findings for the following risk factors were: antepartum haemorrhage (RR 3.36, 95% CI 1.80-6.26, P<0.001); multiple pregnancy (RR 1.83; 95% CI 1.11-3.01, P = 0.02) and haemoglobin level <11 gr/dL (RR 1.51, 95% CI 1.00-2.30, P = 0.05). During the intrapartum and immediate postpartum period, the main causes of primary PPH were: uterine atony (RR 6.70, 95% CI 4.78-9.38, P<0.001), retained tissues (RR 4.32, 95% CI 2.87-6.51, P<0.001); and lacerations of genital organs after birth (RR 2.14, 95% CI 1.49-3.09, P<0.001). Coagulopathy was not prevalent in primary PPH. Based on our findings, uterine atony remains the foremost cause of primary PPH. As well as other established risk factors for PPH, antepartum haemorrhage and intra uterine fetal death should be included as risk factors in the development and validation of prediction models for PPH. Large scale studies are needed to investigate further potential PPH risk factors.

The effect of a decision-support mHealth application on maternal and neonatal outcomes in two district hospitals in Rwanda: pre \u2013 post intervention study

BackgroundGlobally, mobile health (mHealth) applications are known for their potential to improve healthcare providers’ access to relevant and reliable health information. Besides, electronic decision support tools, such as the Safe Delivery mHealth Application (SDA), may help to reduce clinical errors and to ensure quality care at the point of service delivery. The current study investigated the use of the SDA and its relationship to basic emergency obstetric and newborn care (BEmONC) outcomes for the most frequent complications in Rwanda; post-partum haemorrhage (PPH) and newborn asphyxia.MethodsThe study adopted a pre–post intervention design. A pre-intervention record review of BEmONC outcomes: Apgar score and PPH progressions, was conducted for 6 months’ period (February 2019 - July 2019). The intervention took place in two district hospitals in Rwanda and entails the implementation of the SDA for 6 months (October 2019- March 2020), and included 54 nurses and midwives using the SDA to manage PPH and neonatal resuscitation. Six months’ post-SDA intervention, the effect of the SDA on BEmONC outcomes was evaluated. The study included 327 participants (114 cases of PPH and 213 cases of neonatal complications). The analysis compared the outcome variables between the baseline and the endline data. Fisher’s exact test was used to compare the proportions and test between-group differences and significance level set at p < 0.05.ResultsUnstable newborn outcomes following neonatal resuscitation were recorded in 62% newborns cases at baseline and 28% newborns cases at endline, P-value = 0.000. Unstable maternal outcomes following PPH management were recorded in 19% maternal cases at baseline and 6% maternal cases at endline, P-value = 0.048. There was a significant association between the SDA intervention and newborns’ and maternal’ outcomes following neonatal resuscitation and PPH management, 6 months after baseline.ConclusionThe use of the SDA supported nurses and midwives in the management of PPH and neonatal resuscitation which may have contributed to improved maternal and neonatal outcomes during 6 months of the SDA intervention. The findings of this study are promising as they contribute to a broader knowledge about the effectiveness of SDA in low and middle income hospital settings.

Lessons Learned about High-Risk Pregnancy on the Frequency of Antenatal Care at the Cilodong Community Health Center Depok City

Most of the deaths of pregnant women are caused by obstetric complications, which are often unpredictable during pregnancy or childbirth. The high maternal mortality rate in Indonesia is mostly caused by bleeding, eclampsia, infection, abortion, or obstructed labor. Very few maternal deaths are caused by diseases that worsen with pregnancy, such as heart disease and chronic infections. The thing that is very concerning is that out of the total cases of postpartum hemorrhage, only 7 people perform ANC regularly. The purpose of this study was to determine the relationship between the frequency of ANC and the knowledge of pregnant women about high-risk pregnancies at the Cilodong Health Center in Depok City in 2020. This research is a type of analytical research with a cross-sectional approach. The results of the analysis using the SPSS 12.0 program obtained a chi square value of 18.633 with a probability of 0.000, while the Chi square table at df = 3 was 7.81. The frequency of ANC has a significant relationship with knowledge about high-risk pregnancies at the Cilodong Community Health Center, Depok City, in 2018.

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data.

BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal mortality and the risk factors for PPH differ among studies. In this large-scale study, we investigated whether the anesthetic method used was associated with PPH after cesarean section.MethodsWe extracted data on cesarean sections performed between January 2008 and June 2013 from the National Health Insurance Service database. The anesthetic methods were categorized into general, spinal and epidural anesthesia. To compare the likelihood of PPH among deliveries using different anesthetic methods, crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression analysis.ResultsData from 330,324 cesarean sections were analyzed, and 21,636 cases of PPH were identified. Univariate analysis showed that general and epidural anesthesia increased the risk of PPH compared to spinal anesthesia. The OR for PPH was highest for morbidly adherent placenta, followed by placenta previa, placental abruption, and hypertension. When other clinical covariates were controlled for, general and epidural anesthesia still remained significant risk factors for PPH compared to spinal anesthesia.ConclusionsThis study showed that general and epidural anesthesia elevated the risk of PPH compared to spinal anesthesia during cesarean section. Since we could not consider the potential bias of group differences in indications, more in-depth clinical trials are needed to validate our findings. Obstetric factors such as placental abnormalities had high odds ratios and thus are more important than the choice of anesthetic method, which should be based on the patient’s clinical condition and institutional resources.

Recurrence of postpartum hemorrhage, maternal and paternal contribution, and the effect of offspring birthweight and sex: a population-based cohort study

PurposeThis study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight.MethodsWe studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight.ResultsMothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9–3.0 and 6.0; 5.5–6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases.ConclusionA history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak.

Singleton placentas with abnormal shape: a clinicopathological analysis of 130 cases

Objective: To investigate the pathological characteristics of singleton placenta with abnormal shape and its influence on the outcome of maternal-fetal pregnancy. Methods: The clinicopathological data of singleton placentas with abnormal shape from January 2014 to December 2020 in the Department of Pathology, Haidian Maternal and Children Health Hospital were analyzed retrospectively. Results: There were 130 singleton placentas with abnormal shape in this cohort, including 48 succenturiate placentas, 12 bilobed placentas, 50 marginate placentas, 13 circumvallate placentas, 3 annular placentas, 2 membranous placentas and 2 fenestrated placentas. Gestational age ranged from 29+5 to 40+4 weeks. There were 51 cases of premature rupture of membranes, 11 cases of placenta previa, 5 cases of placental abruption, 15 cases of placental adhesion/implantation and 27 cases of postpartum hemorrhage. There were 46 preterm fetuses,28 fetuses with fetal growth restriction, 22 fetuses with intrauterine distress, and 1 fetus with intrauterine death. Grossly, the placental lobules of succenturiate placentas had apparent size difference, while two lobules of bilobate placenta were more consistent. The chorionic plate size was smaller than the bottom plate of circumvallate placenta, the folded fetal membrane in the rim of placenta was thickened (termed marginate placenta if there was no thickening). The membranous placenta was characterized by a thin, large membrane-like shape. Annular placenta showed characteristic hollow cylinder, ring or horseshoe-shape. Fenestrated placenta was characterized by tissue defects near central area. Microscopically, functional/morphologic changes were the main manifestations of inadequate maternal-fetal perfusion, including villous infarction, distal villous dysplasia and excessive villous maturation. Conclusions: The abnormal shaped singleton placentas showed variable extent of inadequate maternal-fetal perfusion, which may lead to adverse pregnancy outcomes such as premature delivery, fetal growth restriction, intrauterine distress or fetal death.

Management of Disseminated Intravascular Coagulation Following PPH: A Case Report

Disseminated intravascular coagulation is a life threatening complications of severe post-partum hemorrhage. That is the end point of a pathologically activated cascade leading to excessive consumption of platelets culminating bleeding. It results from washing out of all important procoagulants. A case of post-partum hemorrhage following caesarean section is reported. She was treated by emergency peripartum hysterectomy and aggressive blood and blood component therapy.

A Case of Recurrent Massive Secondary Postpartum Haemorrhage following Caesarean Section Due to the Eroded Left Uterine Artery Sealed by Laparoscopic Bipolar Coagulation

Background: Recurrent massive secondary postpartum haemorrhage (PPH) due to uterine wound dehiscence with uterine artery erosion following LSCS causes management challenges.

POSC50 Cost-Effectiveness of Addition of Intravenous Tranexamic Acid to Management of Primary Post-Partum Haemorrhage in Indian Public Health Settings

Obstetric haemorrhage, especially post-partum haemorrhage is the leading direct cause of maternal mortality worldwide. The WHO has updated its guidance in 2017 to recommend addition of intravenous tranexamic acid, an anti-fibrinolytic drug to standard care treatment for clinically diagnosed post-partum haemorrhage cases. This study aims to assess cost-effectiveness of addition of tranexamic acid for PPH management in the Indian public health context

CHARACTERISTICS OF WOMEN WHO EXPERIENCE ANTEPARTUM HAEMORRHAGE AND POSPARTUM HAEMORRHAGE AT EFARINA ETAHAM HOSPITAL BERASTAGI KARO

Antepartum bleeding is vaginal bleeding in pregnancy over 28 weeks or more. Because antepartum bleeding occurs at gestational age above 28 weeks, it is often called or classified as bleeding in the third trimester (Manuaba, 2007) while postpartum hemorrhage according to the World Health Organization (WHO) in 2006, namely partly puerperal blood loss of 500 ml or more that occurs after the child is born. The purpose of this study was to find out the characteristics of mothers who experienced antepartum bleeding and postpartum hemorrhage at Efarina Etaham Berastagi Hospital in the 2013-2016 period. The type of research used in this study is a retrospective descriptive study. The population in this study were medical records of mothers who experienced antepartum and postpartum hemorrhage at Efarina Etaham Berastagi Hospital, Karo District in 2013 - 2016. The number of medical records of mothers who experienced antepartum hemorrhage was 17 cases of antepartum and 25 cases of postpartum hemorrhage. From the results of a study on the characteristics of mothers who experienced antepartum and postpartum hemorrhage which was conducted at Efarina Etaham Berastagi Hospital, bleeding data was obtained based on antepartum age 5 35 years 8 people (47.1%), postpartum age 20 years 17 people (68.0%) , 8 people (47.1%) high school antepartum education, 13 high school postpartum education people (52.0), and antepartum family income « ​​Rp. 1200,000 9 people (52.9%), postpartum family income « ​​Rp. 1200,000 13 people (52.0%), Based on the results of the study, 10 people (58.6%) had multiparous antepartum bleeding, 9 people (52.9%) -28 weeks of gestation, 11 people (64.7%) had a history of prenatal bleeding, 15 people had a history of prenatal bleeding. (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital. the cause of placenta previa bleeding was 11 people (64.7%), history of prenatal illness in 15 people (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital. the cause of placenta previa bleeding was 11 people (64.7%), history of prenatal illness in 15 people (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital.

Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study

PurposeTo identify differences in mortality or length of hospital stay for mothers treated with uterine artery embolization (UAE) or hysterectomy for severe postpartum hemorrhage (PPH), as well as to analyze whether geographic or clinical determinants affected the type of therapy received. Materials and MethodsThis National Inpatient Sample study from 2005 to 2017 included all patients with live-birth deliveries. Severe PPH was defined as PPH that required transfusion, hysterectomy, or UAE. Propensity score weighting–adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. ResultsOf 9.8 million identified live births, PPH occurred in 31.0 per 1,000 cases. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000 cases). The following factors predicted that hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension during pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all P < .001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included postterm pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all P < .001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (P < .001). ConclusionsDespite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.