Postpartum Hemorrhage Research Articles

Post-marketing quality evaluation of oxytocin injection and assessment of associated factors among selected health facilities in Addis Ababa, Ethiopia

Oxytocin is the principal drug and the primary choice for labor induction and postpartum hemorrhage prevention and treatment. The problems associated with oxytocin are not usually from its effectiveness, but they are from its compromised quality which may occur at the point of manufacturing, transportation, and storage. The main objective of this study was to assess the status of oxytocin injection quality and associated factors in the health facilities located in Addis Ababa city, Ethiopia. A laboratory based instrumental quality testing alongside a cross sectional study design was used to evaluate oxytocin injection quality in Addis Ababa city administration from January to June, 2022 according to United States Pharmacopeia (USP 20), and the World Health Organization guideline of post-market medicine quality assessment. Binary logistic regression and cross tabulation analysis were conducted using SPSS 26. Significance was considered at p ≤ 0.05. Out of 107 tested oxytocin injection samples, 92.5% met the limit for oxytocin content, 81.3% for sterility test, and 91.6% for pH value. Overall, quality failure rate was 23.4%, while sterility test failure rate was 18.7%. Lack of reliable refrigerated storage condition [(AOR = 5.62, 95% CI: (1.87, 16.88)], lack of effective cold chain system during distribution [(AOR = 5.5, 95% CI: (1.53, 19.74)], and weak national medicine regulatory system [(AOR = 3.23, 95% CI: (1.13, 9.23)] were among the significantly associated factors for the failure of some of the brands. The study demonstrated that oxytocin injection quality failure rate, failing to meet at least one quality test requirement, is demonstrated in the health facilities of Addis Ababa. The determinant factors for the reported failures are related to storage, distribution, and regulatory system. Hence, these should be addressed by strictly adhering in to the national regulation and providing a comprehensive health promotion on rational use of oxytocin injection should be implemented to assure its quality and safety.

If the first child is breech, overall outcomes for families with two children are similar regardless of the mode of the first birth

Cesarean section for breech presentation is often recommended. However, cesarean section affects future reproduction. The aim of this study was to assess the effect of mode of the first birth in breech on outcomes of the second birth and the two births together. This is a register-based nationwide cohort study including 23 062 women with a first singleton birth in breech ≥ 34 gestational weeks and a subsequent singleton birth in Sweden 2000–2019. Exposure was mode of first delivery. Main maternal outcome was a composite of fourth-degree perineal injury, postpartum hemorrhage requiring blood transfusion, hysterectomy, or death. Main infant outcome was a composite of stillbirth, extremely preterm birth (< 28 weeks), moderate to severe hypoxic ischemic encephalopathy, therapeutic hypothermia, or death. Outcomes were analyzed using multivariable logistic regression. In the first birth, the infant composite outcome affected < 1% in both groups but the risk was higher in the vaginal breech group (13/1525), compared with the breech CS group (27/21 537), aOR 7.06, 95% CI 2.91–17.1. In the second birth, the infant composite outcome affected < 1% in both groups but the risk was lower for the first vaginal breech group (3/1525) compared with the first breech CS group (152/21 537), aOR 0.26, 95% CI 0.08–0.84. There was no significant difference between the groups in risk of composite infant outcome in the two births assessed together, or in risk of composite maternal outcome. In total, the chance of a two-children family without maternal or infant severe adverse composite outcome was high and similar regardless mode of the breech first birth.

Magnitude and Determinants of Postpartum Hemorrhage in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background: Maternal mortality remains a major challenge in sub-Saharan Africa (SSA), accounting for 70% of world's maternal deaths. Hemorrhage is the leading direct cause of maternal mortality worldwide, with postpartum hemorrhage (PPH) responsible for more than two-thirds of hemorrhage-related deaths. This systematic review and meta-analysis integrated data from studies conducted in SSA to provide an accurate estimation of the prevalence of PPH and to identify regional risk variables. Methods: We conducted a search across multiple databases for peer-reviewed articles published between 2013 and 2023. This study included quantitative research employing cross-sectional, case-control, or cohort designs, regardless of sample size, and published in English. This review excluded literature reviews, meta-syntheses, qualitative studies, editorials, systematic reviews, and meta-analyses. We used MetaXL to estimate the pooled magnitude of PPH in SSA, and employed the Q test, I2 statistic, and funnel plots to assess statistical heterogeneity. Furthermore, we used MetaXL to perform subgroup and sensitivity analyses. Finally, we used IBM SPSS Statistics for Windows (Version 29.0.2.0 Armonk, NY, USA), to estimate the pooled effect size of the factors associated with PPH. Results: 26 methodologically rigorous articles were included in this review and meta-analysis. The pooled magnitude of PPH in SSA was 8.6%. The studies exhibited significant heterogeneity. Individual factors associated with PPH include the woman's age (crude odds ratio [OR] = 4.37, 95% confidence interval [95% CI] = 3.03–6.29), place of residence (OR = 2.06, 95% CI = 1.51–2.82), and parity (OR = 3.13, 95% CI = 1.38–7.11). Antenatal factors include antenatal care (ANC) attendance (OR = 3.43, 95% CI = 1.12–10.05), antepartum hemorrhage (APH) (OR = 6.83, 95% CI = 3.64–12.80), and twin pregnancy (OR = 8.25, 95% CI = 3.80–17.92). Intrapartum factors include induction of labor (OR = 4.39, 95% CI = 2.01–9.61), and mode of delivery (OR = 2.61, 95% CI = 1.80–3.78). Postpartum factors include previous history of PPH (OR = 10.86, 95% CI = 3.71–31.84), and oxytocin use after delivery (OR = 0.17, 95% CI = 0.09–0.32). Conclusions: The pooled magnitude of PPH in SSA in this study was considerably higher than that in other regions. Therefore, there is a need to strengthen strategies aimed at improving ANC attendance in SSA to ultimately reduce PPH. Additionally, close monitoring of women with risk factors for PPH and the careful use of oxytocin for labor induction are strategies that can also be used to reduce PPH in SSA.

Risk factors of severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta: a retrospective cohort study

BackgroundThe severe postpartum hemorrhage (SPPH) leads to dangerous maternal conditions, and its rate is still increasing and the trend in related risk factors is changing. Placenta-related problems remain the high-risk factor for SPPH. The object is to investigate the prevalence and the risk factors of the severe postpartum hemorrhage in pregnant women with placenta previa or low-lying placenta.MethodA retrospective analysis of pregnant women with placenta previa or low-lying placenta after 28 weeks gestation from May 2018 to May 2023 in the Peking Union Medical College Hospital was conducted. The primary outcome was severe postpartum hemorrhage defined as blood loss ≥ 1000 mL within 24 h of childbirth, or with signs or symptoms of low blood volume requiring transfusion of ≥ 4U of red blood cells. Univariate and multivariate logistic regression were used to identify potential risk factors of severe postpartum hemorrhage and receiver operating curve to evaluate the prediction performance.ResultsOf the 14,964 women, 201 met the inclusive criteria. SPPH rate was 1.3% overall and 18.9% in women with placenta previa or low-lying placenta. Weight (aOR = 0.93, 95%CI 0.87–0.99), increta or percreta placenta (aOR = 7.93, 95%CI 2.53–24.77) were the risk factors. The area under the ROC curve was 0.69(95%CI 0.59–0.80) for increta or percreta placenta alone, and 0.72(95%CI 0.62–0.82) for the combination of times of cesarean sections and anterior placenta.ConclusionsPlacenta accreta spectrum was the key independent risk factor of SPPH in women with placenta previa or low-lying placenta. Antenatal risk assessment of SPPH in these population is highly desirable and optimal intervention could be planned.

Preterm Birth Outcomes during the War in El-Obeid, Western Sudan

Background: Premature birth is the leading cause of newborn morbidity and mortality. This study sought to evaluate the outcomes of preterm delivery in El-Obeid, Sudan. Methodology: A prospective descriptive study was conducted in the Obstetrics and Gynecology Hospital in El-Obeid, North Kordofan State, Sudan, from January 2023 to December 2024. The study encompassed approximately 106 hospitalized women with a gestational age below 37 weeks. Results: The largest G.A. at risk were 34 weeks, followed by 35 weeks, with figures of 26/106 (24.5%) and 20/106 (19%). The majority of deaths occurred at 30 G.A. (27%). The most common risk factor was premature rupture of membranes (PPROM), followed by postpartum hemorrhage (PPH), which accounted for 45% and 39%, respectively. Antepartum hemorrhage caused the majority of deaths (49%) in Sudan. Conclusion: Preterm birth is widespread in Sudan, with severe consequences, the most common being death. Although postpartum hemorrhage is the most common risk factor, antepartum hemorrhage is becoming more closely associated with death.

Safety of the use of dinoprostone gel and vaginal insert for induction of labor: A multicenter retrospective cohort study.

To assess adverse obstetric and neonatal outcomes associated with the use of dinoprostone for induction of labor, with particular attention on categories for which caution is recommended by the Italian Medicines Agency and the European Medicine Agency. A retrospective multicenter observational study was conducted on a population of 1687 patients undergoing induction of labor with vaginal dinoprostone (gel or insert) between August 2019 and June 2022. Patients were subdivided based on maternal age, gestational age, and obstetric disorders. Data regarding the mode of delivery, the incidence of tachysystole, and the obstetric and perinatal outcomes were collected. The main adverse event associated with the use of dinoprostone was tachysystole. However, tachysystole was not associated with an increased risk of cesarean section (CS), neonatal intensive care (NICU) admission, low 1-min Apgar, or umbilical cord acidosis. Maternal age greater than 35 years, gestational age greater than 40 weeks, and obstetric disorders were not associated with an increased rate of tachysystole, NICU admission, low 1- and 5-min Apgar scores, and cord acidosis. The only associated adverse outcomes in those categories were postpartum hemorrhage with age greater than 35 years and tachysystole with gestational diabetes mellitus and hypertensive disorders. Not a single case of severe outcome (disseminated intravascular coagulation, uterine rupture, maternal and fetal death) was reported in the cohort. Providing there is adequate maternal and fetal surveillance, in an inpatient setting, dinoprostone could be safely administered for the induction of labor and considered appropriate in high-risk pregnancies. Tachysystole can be self-identified by the patient and effectively managed.

High-risk pregnancy and risk of breastfeeding failure

BackgroundThere is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure.AimTo compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes.MethodsA prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support.ResultsDelivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother’s illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037).ConclusionsWomen with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers’ health.

The Association of Serum Fibrinogen Levels With the Severity of Primary Postpartum Hemorrhage: A Prospective Study.

Postpartum hemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. Coagulation disorders are a major risk factor for PPH that have not been studied adequately. Fibrinogen, a plasma glycoprotein, is integral to hemostasis and is involved in the final process of the coagulation cascade. Fibrinogen levels increase with advancing pregnancy probably because of an increase in estrogen levels and reach a peak (~5g/L) in the third trimester of pregnancy. However, in the postpartum period, the fibrinogen concentration shows a decreasing trend. The purpose of the study was to study the serum fibrinogen levelin patients with PPH and to find its association with the severity of primary postpartum hemorrhage. Methodology: Patients were selected according to inclusion and exclusion criteria. Written and informed consents were taken. Routine investigations were done on admission and special investigations like red blood cell count, prothrombin time, international normalized ratio,activated partial thromboplastin time, and serum fibrinogen were done later when the patient developed PPH. Serial samples of all PPH patients for serum fibrinogen levels at0, 1, 2, 4, and 24 hours were taken to study the serum fibrinogen levels and data were analyzed. Result: The mean fibrinogen level on admission was 3.92 ± 0.92 g/lin non-severe PPH and 2.03 ± 0.97 g/l in the severe PPH group.Fibrinogen levels in the non-severe group remained < 4.46 g/l at 0, 1, 2, 4, and 24 hours. In the severe group, fibrinogen levels were < 2.89 g/l at 0, 1, 2, and 4 hours and it was 2.44 ± 1.06g/l in the 24-hour samples. Statistical significance was found in all the fibrinogen values among the two study groups (p = 0.001). Our results showed that zero-hour fibrinogen levels correlate significantly with the aggravation of PPH and levels <2 g/L can serve as a predictor for progression to severe PPH.

The Impact of Labor Oxytocin Use on Newborn Liver Enzymes.

Oxytocin is commonly used during labor and delivery for induction of labor and prevention of postpartum hemorrhage. While previous studies have explored the effects of labor oxytocin use on maternal and neonatal outcomes, there is a paucity of research on its impact on newborn liver enzyme function. This study aimed to assess the effects of labor oxytocin use on liver enzyme function in newborns. A case-control study was conducted. The case group consisted of 70 newborns whose mothers received oxytocin during labor, while the control group consisted of 70 newborns whose mothers did not receive oxytocin. Complete blood count (CBC), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total and indirect bilirubin levels were measured in all newborns on the second day of life. The levels of AST and total and indirect bilirubin were found to be higher in the case group than in the control group (51 vs. 42, 7.8 vs. 4.6, and 7.4 vs. 4, respectively; p < 0.005). The levels of CPK and LDH were also higher in the case group (p < 0.005). However, the difference in ALT levels was not significant between the study groups. The observed increase in liver enzymes in this study can indicate the effect of maternal oxytocin on the newborn's liver function. While the changes in liver enzyme levels due to oxytocin use were not found to be high enough to cause liver damage, the increase in CPK and LDH levels could potentially elevate bilirubin levels due to hemolysis. Further research is needed to confirm these findings and explore the underlying mechanisms.

Mapping the scientific literature on obstetric and perinatal health among sexual and gender minoritized (SGM) childbearing people and their infants: a scoping review

BackgroundEvidence suggests sexual and gender minoritized (SGM) childbearing individuals and their infants experience more adverse obstetric and perinatal outcomes compared to their cisgender, heterosexual counterparts. This study aimed to comprehensively map obstetric and perinatal physical health literature among SGM populations and their infants and identify knowledge gaps.MethodsPubMed, Embase, CINAHL, and Web of Science Core Collection were systematically searched to identify published studies reporting obstetric and perinatal outcomes in SGM individuals or their infants. Study characteristics, sample characteristics, and outcome findings were systematically extracted and analyzed.ResultsOur search yielded 8,740 records; 55 studies (1981–2023) were included. Sexual orientation was measured by self-identification (72%), behavior (55%), and attraction (9%). Only one study captured all three dimensions. Inconsistent measures of sexual orientation and gender identity (SOGI) were common, and 68% conflated sex and gender. Most (85%) focused on sexual minorities, while 31% addressed gender minorities. Demographic measures employed varied widely and were inconsistent; 35% lacked race/ethnicity data, and 44% lacked socioeconomic data. Most studies (78%) examined outcomes among SGM individuals, primarily focusing on morbidity and pregnancy outcomes. Pregnancy termination was most frequently studied, while pregnancy and childbirth complications (e.g., gestational hypertension, postpartum hemorrhage) were rarely examined. Evidence of disparities were mixed. Infant outcomes were investigated in 60% of the studies, focusing on preterm birth and low birthweight. Disparities were noted among different sexual orientation and racial/ethnic groups. Qualitative insights highlighted how stigma and discriminatory care settings can lead to adverse pregnancy and birth outcomes.ConclusionsFrequent conflation of sex and gender and a lack of standardized SOGI measures hinder the comparison and synthesis of existing evidence. Nuanced sociodemographic data should be collected to understand the implications of intersecting identities. Findings on perinatal health disparities were mixed, highlighting the need for standardized SOGI measures and comprehensive sociodemographic data. The impact of stigma and discriminatory care on adverse outcomes underscores the need for inclusive healthcare environments. Future research should address these gaps; research on SGM perinatal outcomes remains urgently lacking.Trial registrationThe review protocol was developed a priori in February 2023, registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/5DQV4) and published in BMJ Open (https://bmjopen.bmj.com/content/13/11/e075443).

Quantifying the Accuracy of Clinician Risk Assessment for Postpartum Hemorrhage

Abstract Objective To measure the accuracy of postpartum hemorrhage (PPH) risk assessment performed by unaided individual clinicians, to inform future comparison to alternative risk assessment methods. Methods Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States (Vanderbilt University Medical Center, Brigham and Women’s Hospital) from January 2022 to January 2023, following written informed consent from the providers. The data included a cohort of both vaginal and cesarean deliveries (CD). For each assessment, the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100% and rated their confidence in these assessments using a 5-point Likert scale, ranging from ‘not at all confident’ to ‘completely confident’. Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH, defined as blood loss ≥1000 mL. The accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve (AUC). Results Of 271 patients, 32 (11.8%) experienced PPH, accounting for 11.4% (104/915) of assessments. The overall AUC was 0.64 (95% confidence interval (CI): 0.58–0.71). Prediction accuracy was higher for CD than for vaginal deliveries, with AUCs of 0.82 (95% CI: 0.72–0.91) and 0.56 (95% CI: 0.48–0.63), respectively. No significant differences in the accuracy of assessments were observed according to physician specialty, physician experience level, or confidence level of the assessment. Conclusion Overall unaided clinician performance in predicting PPH was moderate, with an AUC of 0.64. Predictions were more accurate for patients undergoing CD. Further study is needed to understand how clinician performance compares to other modalities of risk prediction.

Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges

Abstract Objective To describe the challenges in diagnosing concealed postpartum bleeding, a rare but potentially life-threatening condition, and to highlight key factors in identifying and managing this condition. Methods We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected, focusing on the role of imaging, serologic markers, and angiography. We examined instances of hemodynamic instability, the utility of pelvic space analysis via computed tomography, and the limitations of digital angiography, particularly in identifying bleeding sources in the posterior iliac internal artery division. Results Concealed postpartum bleeding often originates from venous damage or, less commonly, arterial injury. Hemodynamic instability was noted to occur periodically, despite negative findings on vaginal examination and ultrasound, leading to diagnostic delays. Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery. Bleeding typically arises from damage to the vaginal muscular layer or levator ani muscle, both supplied by branches of the internal pudendal artery (posterior iliac division). In some cases, laparotomy also failed to locate the source due to the bleeding being in the subperitoneal spaces. Conclusion Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results. A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are crucial. Advanced expertise, along with serologic markers of hidden bleeding, is essential for timely diagnosis and management.

Risks Associated with Prolonged Latent Phase of Labor.

We sought to assess the impact of a prolonged latent phase (PLP) on maternal and neonatal morbidity. This is a secondary analysis of a prospective cohort study conducted 2010 to 2015 that included all term gravidas who reached active labor (6 cm). Primary outcomes were composite maternal morbidity (maternal fever, postpartum hemorrhage, transfusion, endometritis, and severe perineal lacerations) and composite neonatal morbidity (respiratory distress syndrome, mechanical ventilation, birth injury, seizures, hypoxic ischemic encephalopathy, therapeutic hypothermia, or umbilical artery pH ≤ 7.1). Outcomes were compared between patients with and without PLP, defined as ≥90th percentile of labor duration between admission and active phase. Results were stratified by induction of labor (IOL) versus spontaneous labor. A stratified analysis was performed by mode of delivery. Multivariable logistic regression was used to adjust for confounders. In this cohort of 6,509 patients, 51% underwent IOL. A total of 650 patients had a PLP with a median length of 8.5 hours in spontaneous labor and 18.8 hours in IOL. Among patients with PLP, there was a significant increase in composite maternal morbidity with both IOL (adjusted odds ratio [aOR]: 1.36, 95% confidence interval [CI]: 1.01, 1.84) and spontaneous labor (aOR: 1.49, 95% CI: 1.09, 2.04) and an increase in composite neonatal morbidity with spontaneous labor only (aOR: 1.57, 95% CI: 1.01, 2.45). Cesarean delivery occurred more often in PLP group (14.0 vs. 25.1%). Among patients who underwent cesarean delivery, PLP remained associated with increased odds of maternal morbidity compared with those with normal latent phase. PLP at or above the 90th percentile in patients who reach active labor is associated with increased risk of maternal morbidity that is not mediated by cesarean delivery. PLP in spontaneous labor is associated with increased neonatal morbidity. These data suggest that further research is needed to establish latent phase cutoffs that may be incorporated into labor management guidelines. · Latent labor ≥90th percentile is associated with increased maternal morbidity in induced and spontaneous labor.. · Latent labor ≥90th percentile in spontaneous but not induced labor is associated with increased neonatal morbidity.. · Cesarean delivery alone does not explain this increased maternal morbidity..

Exploring the Father's Role in Determining Neonatal Birth Weight: A Narrative Review.

Birth weight, which exhibits variability across different populations, is influenced by a mix of genetic, environmental, and dietary factors originating from both the mother and father. Maternal characteristics, including age, socioeconomic status, prior pregnancies, weight, height, and weight increase throughout pregnancy, have a substantial influence on fetal growth and the health of the infant. On the other hand, the influence of paternal characteristics on the weight of newborns is still not fully comprehended in a consistent manner. Birth weight is an important factor that can help predict various maternal complications, such as the probability of having a C-section, experiencing postpartum hemorrhage or infections. It can also indicate future health challenges like asthma, cognitive impairment, and chronic diseases such as hypertension and diabetes. Nineteen publications were found through a thorough search of the Medline, PubMed, and Scopus databases, which provide insights into how paternal variables contribute to variations in birth weight. Significantly, the age of the father was found to be associated with higher chances of preterm birth and having a smaller size for gestational age in premature infants, while full-term children were more likely to have a larger size for gestational age. In addition, there is a constant correlation between the height of the father and the birth weight of the child. Taller dads are more likely to have babies with a higher birth weight and a lower likelihood of being small for gestational age (SGA). Although there were some discrepancies in the data about the weight and BMI of fathers, it was found that the height of fathers played a significant role in determining the size of the fetus and the weight of the newborn. While there may be differences in the conducted studies, these findings provide valuable insights into the complex connection between parental characteristics and fetal development. This data can be utilized to enhance clinical treatment strategies and enhance our comprehension of outcomes for neonates. Further homogeneous investigations are required to conclusively validate and build upon these findings.

Concordance Between Actual and Estimated Blood Loss: A Bleeding Calculation Simulation Exercise

Introduction: Historically, visual estimation of blood loss during and after delivery has been the primary method for determining obstetric blood loss. This method is quick, easy, and cost-free, and it allows for the prompt identification of suspected postpartum hemorrhage. However, the majority of clinical studies concur that this method is imprecise and may underestimate the extent of bleeding produced during vaginal delivery. Objectives: The objective of this study was to compare the concordance between the estimated blood loss observed visually by physicians and residents of Gynecology and Obstetrics and the actual bleeding observed in a simulation exercise, with the aim of calculating the bleeding. terial and methods: A quasi-experimental study was conducted through the use of a simulation model at the General Hospital of Zone 20 of the IMSS in Puebla. A visual estimation was conducted between physicians and residents using surgical material (compresses and gauze) with a certain amount of blood. The evaluation of the estimate was carried out in three stations with different bleeding levels. The estimation of total bleeding was counted in milliliters using the visual method. A comparison of means was conducted using the ANOVA statistical test to evaluate the bleeding calculation. The relative error was calculated in order to determine the extent of agreement between the estimated and actual blood values for each station. Results: A total of 94 physicians, including residents in training in the specialty of Gynecology and Obstetrics, enrolled in the study. The discrepancy between the actual and estimated blood loss in a simulation exercise among affiliated obstetrician-gynecologists was 65.3%, while in the group of resident physicians it was 145.6%. It was determined that there was an 84% overestimation of bleeding. The relative error percentage for "Scenario A" was 141%, "Scenario C" yielded a result of 85%, and "Scenario B" produced a result of 74%. Conclusion: The agreement between the actual and estimated blood loss performed by obstetrician-gynecologists assigned to a bleeding calculation simulation exercise is slightly superior to that obtained by resident physicians. The lowest percentages of relative error were obtained by fourth- and third-year residents.

Fetomaternal Outcome in Pregnancy with Gestational Thrombocytopenia

Introduction: Gestational thrombocytopenia, a common hematological disorder in pregnancy, poses risks to both maternal and neonatal health. This study aims to evaluate the fetomaternal outcomes in pregnancies complicated by gestational thrombocytopenia compared to those with normal platelet counts. Methods: This prospective cohort study was conducted over 12 months at Jalalabad Ragib-Rabeya Medical college hospital sylhet Bangladesh. It included 100 pregnant women diagnosed with gestational thrombocytopenia (platelet count &lt;150,000/µL after 20 weeks of gestation) and 100 matched controls with normal platelet counts. Maternal data included demographic information, obstetric and medical history, mode of delivery, incidence of pre-eclampsia, postpartum hemorrhage, and need for platelet transfusions. Fetal outcomes assessed were birth weight, Apgar scores, preterm birth rates, NICU admissions, and neonatal thrombocytopenia. Data were analyzed using t-tests for continuous variables and chi-square tests for categorical variables, with multivariate logistic regression to identify predictors of adverse outcomes. Result: The gestational thrombocytopenia group showed higher, though not statistically significant, rates of cesarean delivery (30% vs. 25%, p=0.453), pre-eclampsia (15% vs. 12%, p=0.540), and postpartum hemorrhage (18% vs. 10%, p=0.110). Platelet transfusions were required more frequently in the gestational thrombocytopenia group (8% vs. 2%, p=0.052). Fetal outcomes revealed lower mean birth weight (2950g vs. 3050g, p=0.145), higher preterm birth rates (14% vs. 10%, p=0.371), and more NICU admissions (20% vs. 12%, p=0.132) in the gestational thrombocytopenia group. Notably, neonatal thrombocytopenia was significantly more prevalent in the gestational thrombocytopenia group (10% vs. 2%, p=0.017). Conclusion: Gestational thrombocytopenia is associated with increased risks of certain maternal and neonatal complications. Vigilant monitoring and management are essential to improve outcomes in affected pregnancies. Further research is needed to develop targeted interventions and improve antenatal care practices.

Associations Between Non-communicable Diseases and Obstetric Complications: A Retrospective Records Review at a Tertiary Referral Hospital in Uganda.

Non-communicable diseases (NCDs) increasingly contribute to maternal morbidity and mortality. We determined the association between NCDs and obstetric complications at Mbarara Regional Referral Hospital(MRRH) in southwestern Uganda. In this retrospectiverecords review, we randomly selected records of women admitted for delivery at MRRH each month from January to December 2022,and extracted their socio-demographicand clinical histories. We defined a history of NCDs aschronic hypertension, pre-gestational diabetes, cardiac disease, anemia, or asthma. We performeda multivariaterobust Poisson regression analysis to assess the association between NCDs and obstetric complications, including preeclampsia, gestational diabetes, venous thromboembolic disease, obstetric hemorrhage, and preterm labor. Models were adjusted for maternal age, gravidity, referral status, employment status, andhumanimmunodeficiencyvirus (HIV) serostatus. Weextracteddata for 2,336 women with a mean age of 26±5.9 years. At least one NCD was present in 6.4% (n=149) of the patients,includinganemia (n=77, 3.3%), chronic hypertension (n=35, 1.5%), pre-gestational diabetes (n=16, 0.7%), asthma (n=9, 0.4%), and cardiac disease (n=6, 0.3%). Overall, 542 (23.2%) women had obstetric complications, including preeclampsia (n=265, 11.3%), preterm labor (n=67, 2.9%), placental abruption (n=29, 1.2%), postpartum hemorrhage (PPH) (n=54, 2.3%), and gestational diabetes (n=5, 0.2%). Women with NCDs had an increased likelihood of having an obstetric complication compared to women without (overall proportion 33.6% vs 22.5% respectively); adjusted prevalence ratio (aPR) was 1.8 (95% CI: 1.4-2.3) overall, 1.8 (95%CI: 1.2-2.8) for preeclampsia, 12.0 (95%CI: 2.0-72.7) for gestational diabetes, 6.0 (95%CI: 1.3-27.1) for deep venous thrombosis, 4.4 (95%CI: 1.5-12.6) for placenta abruption, and 4.3 (95%CI: 2.2-8.3) for PPH. We found that NCDs were associated with a nearly two-fold increase in the risk of obstetric complications. Our findings highlight the need for further research to understand the impact of this risk, particularly on maternal and fetal outcomes. Additionally, these findings suggest strengthened NCD surveillance, as a means of increasing preparedness, and management of potential obstetric complications among pregnant women in Uganda.

Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

Association of intra-operative red blood cell transfusion on the systemic immune index and recovery in patients undergoing cesarean section: a large propensity score-matched study.

Post-partum hemorrhage (PPH) is a leading cause of maternal death worldwide. However, the effect of blood transfusion in patients undergoing cesarean section remains unclear. The analysis was based on the retrospective evaluation of the pre- and post-operative data for 1231 patients who underwent a cesarean section at our hospital between January 2016 and June 2020. Patients were classified into the blood transfusion group (BT) and the no blood transfusion group (NBT) based on their intra-operative blood transfusion status. After propensity score matching, 322 patients were included in both groups and between-group differences in length of hospital stay (LOS), perioperative systemic inflammation indicators, and post-operative complications were evaluated. The LOS was longer in the BT (median, 6.6days) than the NBT (median, 4.2days) group (P = 0.026). The post-operative complication rate was higher for the BT than NBT group, as follows: vomiting, 3.2% vs. 4.9%, P = 0.032; fever, 5.41% vs. 2.24%, P = 0.032; wound complications, 15.44% vs. 10.45%, P = 0.028; and intestinal obstructions, 5.88% vs. 2.75%, P = 0.034. Systemic inflammation indicators increased significantly, from the pre-operative baseline, for both groups at post-operative day (POD) 1 and POD3. On multivariate analysis, intra-operative blood transfusion was associated with a longer LOS (hazard ratio, 1.52; 95% confidence interval, 1.07-2.25). Intraoperative blood transfusion for cesarean section was associated with increased levels of systemic inflammation indicators, higher post-operative complication rates, and prolonged hospital stay.

Modern ideas about the predictions of postpartum hemorrhage

Postpartum hemorrhage is currently a pressing problem. Its increasing incidence over time is observed not only in developing countries but also in countries with high levels of income and resources that significantly contribute to the development and functioning of the health system, which is the cause of scientific debate worldwide. The risk factors of postpartum hemorrhage include low hemoglobin level before birth, older maternal age, first birth, prolonged duration of the first and second stages of labor, high birth weight of the newborn, abnormal placentation, surgical vaginal birth, cesarean section, episiotomy, and placental defects. This review outlines the main risk factors of postpartum hemorrhage, displays new data on the relationship between types of assisted reproductive technologies and postpartum hemorrhage, and discusses prospects for research regarding the problem. A link between assisted reproductive technologies and postpartum hemorrhage elucidates the increase in the incidence of postpartum hemorrhage in developed countries. It is crucial to further research on obstetric risks following the use of assisted reproductive technologies and identify additional risk categories for complications to provide quality medical care and reduce maternal and perinatal losses.