Prevention Of Postpartum Hemorrhage Research Articles

The prevalence of blood product transfusion after the implementation of a postpartum hemorrhage bundle: a retrospective cohort at a single safety net academic institution

Postpartum hemorrhage, defined as blood loss of ≥1000 mL within 24 hours after birth, is a leading cause of maternal morbidity and is associated with substantial financial and emotional burden. Based on societal and regulatory guidelines, in 2019, our institution adopted a postpartum hemorrhage prevention and management bundle based on the California Maternal Quality Care Collaborative initiatives. The study aimed to compare the prevalence of maternal blood product transfusion before and after the implementation of the bundle. This was a retrospective cohort study comparing the prevalence of blood product transfusion before and after the implementation of a California Maternal Quality Care Collaborative-based postpartum hemorrhage management bundle at a single safety net teaching hospital between October 2017 and December 2019 excluding a 4-month rollout period between September 2018 and December 2018. The study included all patients ≥18 years of age and at >20 weeks' gestation. Exclusion criteria were out-born deliveries, delivery at time of significant nonobstetrical trauma, and refusal of blood transfusion. The primary outcome was the frequency of any blood product transfusion in the pre- and postbundle implementation cohorts. Secondary outcomes included blood product transfusion type and amount, maternal death, intrauterine balloon placement, uterine artery embolization, unplanned peripartum hysterectomy, intensive care admission, and length of stay among all deliveries complicated by postpartum hemorrhage. We further evaluated compliance with bundle measures for all postpartum hemorrhage cases. Cohort characteristics were compared using chi-square tests or Fisher exact tests for categorical data and Satterthwaite or Wilcoxon 2-sample tests for continuous variables based on data distributions. The proportion of blood product transfusion were evaluated using a chi-square test. A total of 6744 deliveries were included with 3310 in the pre- and 3425 in the postbundle cohort. The prevalence of any blood product transfusion was similar between the pre- and postbundle cohorts (3.41%; 113/3310 vs 3.47%; 119/3425; P=.892). The prevalence of postpartum hemorrhage was 7.05% (233/3310) in the prebundle cohort and 10.34% (354/3434) in the postbundle cohort (P<.001). Among women with postpartum hemorrhage, those in the prebundle cohort had a higher rate of blood product transfusion than those in the postbundle cohort (36.05%; 84/233 vs 26.84%; 95/354; P=.018). Compared with the prebundle counterparts, patients with postpartum hemorrhage in the postbundle cohort had higher rates of utilization of intrauterine balloon placement (10.30%; 24/233 vs 16.95%; 60/354; P=.024). There were no significant differences among other secondary outcomes. The overall compliance with the bundle among those with blood loss ≥1000 mL was 92.1%. The implementation of the postpartum hemorrhage bundle did not decrease the overall prevalence of blood product transfusion and may have led to higher rates of utilization of resources.

Comparison of Sublingual &amp; Per Rectal Misoprostol versus Oxytocin in the Prevention of Postpartum Hemorrhage

Abstract: &#x0D; Background: Postpartum Hemorrhage (PPH) is the most common reason of maternal death globally. Misoprostol and oxytocin are two first line and effective management protocols. But controversies exist in literature. For that matter, this study was conducted.&#x0D; Objectives: To compare the frequency of postpartum hemorrhage with per rectal misoprostol in relation to intramuscular oxytocin in females undergoing normal vaginal delivery at term.&#x0D; Methods: This randomized controlled trial was conducted in Department of Obstetrics &amp; Gynaecology, Sheikh Zayed Hospital, Lahore from 01-01-2019 to 01-12-2019. Patients were divided randomly into equal halves through the lottery method. Group A received Misoprostol and group B received Oxytocin. Medications were administered within one minute of clamping and the cutting of cord. During 24 hours, soaked pads were evaluated for blood loss and total blood loss was calculated. If blood loss&gt;500ml, then PPH was labeled.&#x0D; Results: Mean age of women in Group A and in Group-B were 29.11±6.67 and 29.23±6.70 years. The mean gestational age for Group A came as 39.60±1.78 weeks and for Group-B, it was 39.53±1.72. In Group-A 24(15.7%) and in Group-B 59(38.6%) women suffered from PPH. PPH was significantly lower in comparison to the women in Group-B. Pvalue=0.000.&#x0D; Conclusion: Results of this study showed that use of per rectal Misoprostol is more suitable and effective in the prevention of Post-partum hemorrhages compared to oxytocin in females undergoing normal vaginal delivery at term.

Latest advances in postpartum hemorrhage management.

Hemorrhage is the leading cause of maternal mortality worldwide. A maternal health priority is improving how healthcare providers prevent and manage postpartum hemorrhage (PPH). Because anesthesiologists can help facilitate how hospitals develop approaches for PPH prevention and anticipatory planning, we review the potential utility of PPH risk-assessment tools, bundles, and protocols. Anesthesiologists rely on clinical and diagnostic information for initiating and evaluating medical management. Therefore, we review modalities for measuring blood loss after delivery, which includes visual, volumetric, gravimetric, and colorimetric approaches. Point-of-care technologies for assessing changes in central hemodynamics (ultrasonography) and coagulation profiles (rotational thromboelastometry and thromboelastography) are also discussed. Anesthesiologists play a critical role in the medical and transfusion management of PPH. Therefore, we review blood ordering and massive transfusion protocols, fixed-ratio vs. goal-directed transfusion approaches, coagulation changes during PPH, and the potential clinical utility of the pharmacological adjuncts, tranexamic acid, and fibrinogen concentrate.

Comparison of Clinical Efficacy and Safety between Misoprostol and Oxytocin in the Prevention of Postpartum Hemorrhage: A Meta-Analysis.

In order to systematically evaluate the clinical efficacy and safety of misoprostol versus oxytocin in the prevention of postpartum hemorrhage, this paper provides evidence-based reference for clinical medication, computerized retrieval of Chinese biomedical literature database (CBM), PubMed, Embase, Cochrane Library, and clinical trials. The retrieval period is from the establishment of each database to October 1, 2021. Published randomized controlled trials (RCTS) are included in this study. The literature is screened and evaluated according to inclusion and exclusion criteria, and meta-analysis is performed using RevMan 5.3 software. A total of 13 RCTS are included, with a total of 24754 parturients. The meta-analysis shows the average blood loss (SMD = 0.10, 95% CI (−0.11, 0.32), P=0.35), the time of the third stage of labor (SMD = 0, 95% CI (−0.07, 0.08), P=0.95), and blood transfusion rate (RR = 0.80, 95% CI (0.63, 1.02), P=0.07). However, the incidences of shivering (RR = 2.61, 95% CI (1.79, 0.81), P < 0.00001) and vomiting (RR = 2.78, 95% CI (1.85, 4.18), P < 0.00001) are significantly higher than those in oxytocin group. The effect of misoprostol on preventing postpartum hemorrhage is similar to that of oxytocin, but the incidence of adverse reactions is high, and the occurrence of adverse reactions should be closely watched in the use process. Due to the limitations of the included studies, multicenter, large-sample, and high-quality RCTS are still needed in the future to further verify this conclusion.

Comparison between Oxytocin Bolus Versus Bolus Plus Infusion in Prevention of Postpartum Hemorrhage During Elective Cesarean Section

Comparison between Oxytocin Bolus Versus Bolus Plus Infusion in Prevention of Postpartum Hemorrhage During Elective Cesarean Section

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...

Role of tranexamic acid in the prevention of primary postpartum haemorrhage.

Objectives: To determine the role of TRANEXAMIC ACID in prevention of primary postpartum haemorrhage in women. Study Design: Observational Retrospective Cohort Design. Settings: DHQ Hospital, Gujranwala. Period: April 2016 to July 2018. Material &amp; Methods: The data of 110 women who suffered postpartum haemorrhage was retrieved from the hospital records. Exclusion criteria included all the females who were below and equal to 18 years of age. Patients suffering from acute respiratory distress syndrome (ARDS), on long-term anti-inflammatory and steroid therapy were also excluded. Whereas all the women who had experienced postpartum haemorrhage after birth were included. Results: We retrieved data of 110 women who had experienced postpartum haemorrhage after birth. The age of participants was averaged 28.95 + 7.6 years. The group I was named as early treatment group and contained 35 women whereas the group II (late treatment or without TRANEXAMIC ACID) had 75 women. The mean age of women is higher in the group I i.e. 30.2 +6.8 than 27.7+8.4. The TRANEXAMIC ACID was given intravenously with an average dose of 1 gram (0.1-3.0 grams) 1.5 hours after the birth. This was an average time for all cases in group I. The average time was 4.6 hours in group II. Conclusion: We concluded that use of intravenous TRANEXAMIC ACID in postpartum haemorrhage is associated with reduced haemorrhage but a low dose at early treatment may not yield good results.

Implementing Heat-Stable Carbetocin for Postpartum Haemorrhage Prevention in Low-Resource Settings: A Rapid Scoping Review.

Heat-stable carbetocin (HSC), a long-acting oxytocin analogue that does not require cold-chain transportation and storage, is effective in preventing postpartum haemorrhage (PPH) in vaginal and caesarean deliveries in tertiary-care settings. We aimed to identify literature documenting how it is implemented in resource-limited and lower-level maternity care settings to inform policies and practices that enable its introduction in these contexts. A rapid scoping review was conducted with an 8-week timeframe by two reviewers. MEDLINE, EMBASE, Emcare, the Joanna Briggs Institute Evidence-Based Practice Database, the Maternity and Infant Care Database, and the Cochrane Library were searched for publications in English, French, and Spanish from January 2011 to September 2021. Randomized and non-randomized studies examining the feasibility, acceptability, and health system considerations in low-income and lower-middle-income countries were included. Relevant data were extracted using pretested forms, and results were synthesized descriptively. The search identified 62 citations, of which 12 met the eligibility criteria. The review did not retrieve studies focusing on acceptability and health system considerations to inform HSC implementation in low-resource settings. There were no studies located in rural or lower-level maternity settings. Two economic evaluations concluded that HSC is not feasible in terms of cost-effectiveness in lower-middle-income economies with private sector pricing, and a third one found superior care costs in births with PPH than without. The other nine studies focused on demonstrating HSC effectiveness for PPH prevention in tertiary hospital settings. There is a lack of evidence on the feasibility (beyond cost-effectiveness), acceptability, and health system considerations related to implementing HSC in resource-constrained and lower-level maternity facilities. Further implementation research is needed to help decision-makers and practitioners offer an HSC-inclusive intervention package to prevent excessive bleeding among pregnant women living in settings where oxytocin is not available or of dubious quality.

Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section

Background: postpartum haemorrhage is one of the major contributors to maternal mortality and morbidity worldwide. There are many pharmacological options for the management of postpartum hemorrhage, oxytocin being the first line choice of treatment.Carbetocin, a long acting oxytocin agonist, appears to be a promising agent for the prevention of PPH. This comparative study was between Carbetocin Versus Oxytocin for the Prevention of Postpartum Haemorrhage in Caesarean Section&#x0D; Objective: To determine the safety and effectiveness of carbetocin and oxytocin for the prevention of post-partum haemorrhage in caesarean section.&#x0D; Methods: Randomized controlled clinical trial was done in the department of Obstetrics and Gynaecology of Sir Salimullah Medical College Mitford Hospital, Dhaka, between February to July 2015. Study population were 64 pregnant women admitted for delivery and underwent caesarean section, who were randomly selected. Women in the intervention group (group I) received injection carbetocin a bolus of 100 mgm IV; women in the standard treatment group (group II) received 10 IU of oxytocin in IV.Both administered immediately after chiidbirth.This trial was registered in SSMC MH with reference no-SSMC/2014/76.&#x0D; Result: Difference of mean age,mean gestational age and indication of C/S were not statistically significant between two groups.Regarding haemodynamic effect,both drugs were almost similar.There was no significant difference in per-operetive blood loss,uterine tone, level of uterine fundus, urine output in urobag and hemoglobin level. Need for additional oxytocics required 0(0.0%) vs 5(16.7%) patients in group I and group II respectively and was found statistically significant.Blood transfusion needed was 0(0.0%) vs 3(10.0%) patients and primary PPH 0(0.0%) vs 3(9.4%),though both were not statistically significant. No significant difference regarding side effects and total expense was found.&#x0D; Conclusion: Administration of single bolus dose of carbetocin (100 μgIV) after delivery of the baby in caesarean section immediately reduces the need for additional oxytocics, occurrence of primary PPH and further blood transfusion. Side effects are mild and similar in both the groups.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 63-67

Effects of Motherwort Injection Versus Intramuscular Oxytocin for Preventing Postpartum Hemorrhage Among Women Who Underwent Cesarean Section.

Objectives: Subject to ethical constraints, real-world data are an important resource for evaluating treatment effects of medication use during pregnancy and the postpartum period. This study investigated whether motherwort injection, a traditional Chinese medicine preparation, was more effective than intramuscular (IM) oxytocin for preventing postpartum hemorrhage (PPH) in a real-world setting when intravenous (IV) oxytocin is administered. Methods: We conducted an active-controlled, propensity-score matched cohort study using an established pregnancy registry database. Women who underwent cesarean section and received IV oxytocin at the third stage of labor were included. We used an active-comparator design to minimize indication bias, in which we compared IM motherwort injection in the uterus versus IM oxytocin, both on top of IV oxytocin use. We applied 1:1 propensity-score matching (PSM) to balance patient baseline characteristics and used a logistic regression model to estimate treatment effect (i.e., risk difference (RD) and odds ratio (OR)) by using the counterfactual framework. The outcomes of interest were blood loss over 500 ml within 2 h after delivery (PPH, primary) and blood loss over 1,000 ml (severe PPH, secondary). We conducted four sensitivity analyses to examine the robustness of the results. Results: A total of 22,519 pregnant women underwent cesarean sections, among which 4,081 (18.12%) PPH and 480 (2.13%) severe PPH occurred. Among included women, 586 (2.60%) were administrated with IM motherwort injection, and 21,933 (97.40%) used IM oxytocin. After PSM, patient baseline characteristics were well balanced. Compared with IM oxytocin, the use of IM motherwort injection was associated with significantly lower risk of PPH (RD −25.26%, 95% CI −30.04% to −20.47%, p < 0.001; OR 0.25, 95% CI 0.18 to 0.32, p < 0.001) and severe PPH (RD −3.58%, 95% CI −5.87% to −1.30%, p < 0.001; OR 0.39, 95% CI 0.20 to 0.71, p < 0.002). Sensitivity analyses showed that the results were similar. Conclusion: With the use of data from a real-world setting, the findings consistently showed that among women undergoing cesarean section who had received IV oxytocin, the additional use of IM motherwort injection could achieve a lower risk of PPH as compared to the additional use of IM oxytocin. Our study suggested a paradigm for investigating the treatment effect of Chinese herbal medicine in the real-world practice setting.

Comparative Study between Oxytocin and Carbetocin for the prevention of Primary Postpartum Hemorrhage following Caesarean Section

Background &amp; objective: Of the many pharmacological options for the management of postpartum hemorrhage, oxytocin is the first line of treatment. The newer drug carbetocin is getting popularity among obstetricians, although there is as yet not enough evidence about its safety and efficacy. The present study attempted to compare oxytocin with carbetocin for the routine prevention of postpartum hemorrhage (PPH) following caesarean section.&#x0D; Methods: The present comparative clinical trial was conducted in the Department of Obstetrics and Gynaecology in Rajshahi Medical College Hospital (RMCH), Rajshahi over a period of one year between March 2017 to February 2018. Pregnant women undergoing cesarean section under regional anaesthesia and do not have known hypersensitivity to oxytocin and carbetocin and known bleeding disorders were included in the study. A total of 96 such subjects were consecutively included and were randomly assigned to either Oxytocin (n = 48) and Carbetocin (n = 48) Groups. The outcome was evaluated in terms of incidence of PPH (loss of blood &gt; 1000 ml), blood transfusion needed to compensate for lost blood, additional oxytocics needed to manage PPH and adverse effects encountered by the subjects.&#x0D; Result: The mean age of the subjects was around 25 years and the age distribution between the study groups was almost similar. In terms of obstetric characteristics multigravida was predominant in the Oxytocin group than that in the Carbetocin group. The current pregnancy profile like gestational age, ANC received, number of foetus in utero and placental position all were comparable between the groups. Antenatal conditions/diseases deemed to have influence on PPH were no different between the study groups. Past history of caesarean section was higher in Oxytocin group (43.8%) than that in the Carbetocin group (22.9%). There were negligible incidences of past PPH and myomectomy in either group. The mean haemoglobin level in the former and the latter groups were 9.5 and 10 gm/dl respectively with majority of the subjects being mildly anaemic. More than 80% of the subjects in either group underwent emergency caesarean section. The outcome showed that 83% in the Oxytocin group and 90% in the Carbetocin group did not develop PPH, but the difference was not significant. The mean blood lost was somewhat lower in the carbetocin group (630 ml) than that in the Oxytocin group (685 ml). The number of patients needed to be transfused and the mean amount of blood transfused to them in each group was fairly comparable. Oxytocin group received additional oxytocic drugs, such as, Metherspan and Misoprostol more frequently than the Carbetocin group did, but the differences did not turn significant. A few patients in both groups developed adverse effects but they were comparable. The mean 24-hours urine output was &gt; 2000 ml in either group).&#x0D; Conclusion: The study concluded that the incidence of PPH, the amount of blood lost, number of patients transfused, amount of blood transfused and the additional amount of oxytocics required for the prevention and treatment of PPH were broadly comparable between the two study groups.&#x0D; Ibrahim Card Med J 2021; 11 (1): 71-78

Effectiveness and safety of carboxytocin versus oxytocin in preventing postpartum hemorrhage: A systematic review and meta-analysis.

This study compared the effectiveness and safety of carbetocin and oxytocin in preventing postpartum hemorrhage (PPH). A systematic literature search was performed on PubMed, Embase, and the Cochrane Library for relevant studies published up to February 2019. Next, two independent reviewers screened the studies according to the selection criteria as well as the strategies recommended by the Cochrane Collaboration. Data were then extracted and evaluated. All statistical analyses were performed using RevMan 5.1. A total of 24 studies involving 37 383 patients were included for analysis. For cesarean section patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contraction (odds ratio [OR]=0.48, 95% confidence interval [CI] [0.35, 0.65], p < 0.00001), PPH (OR=0.70, 95% CI [0.51, 0.95], p=0.02), blood loss (mean [MD]=-64.36, 95% CI [-107.78, -20.93], p=0.004), and transfusion (OR=0.59, 95% CI [0.42, 0.82], p=0.002), and there was no significant difference in severe PPH (OR=0.84, 95% CI [0.66, 1.090], p=0.19). For vaginal delivery patients, carbetocin was superior to oxytocin in reduction of the need for additional uterine contractions (OR=0.48, 95% CI [0.25, 0.93], p=0.03), PPH (OR=0.28, 95% CI [0.09, 0.91], p=0.03), and blood loss (MD=-63.52, 95% CI [-113.43, -13.60], p=0.01), and there were no significant differences in severe PPH (OR=0.82, 95% CI [0.40, 1.69], p=0.59) and transfusion (OR=0.60, 95% CI [0.22, 1.61], p=0.31). With regard to safety, for cesarean section patients, carbetocin was superior to oxytocin in reduction of the incidence of headache (OR=0.72, [0.55, 0.95], p=0.02), and there were no significant differences in nausea, vomiting, abdominal pain, flushing, tremors, itching, dizziness, and fever. For vaginal delivery patients, there were no significant differences in nausea, vomiting, headache, abdominal pain, flushing, tremors, itching, dizziness, and fever between the two drugs. For patients undergoing cesarean section and vaginal delivery, carbetocin was superior to oxytocin in effectiveness and similar in safety. Therefore, carbetocin is expected to be an alternative uterine contraction agent for preventing PPH.

Cost Implications of Using Carbetocin Injection to Prevent Postpartum Hemorrhage in a Canadian Urban Hospital.

Recent World Health Organization (WHO) recommendations regarding uterotonics for the prevention of postpartum hemorrhage (PPH) state that carbetocin should be considered a first-line prophylactic agent for all births where its cost is comparable to other effective uterotonics. This study evaluated whether a room temperature stable formulation of carbetocin met this recommendation in a Canadian urban hospital setting. A decision tree model was developed to assess the financial implications of replacing oxytocin with carbetocin as a first-line prophylactic agent for PPH prevention in a Greater Toronto Area (GTA) hospital. The analysis accounted for the mode of delivery, efficacies of carbetocin and oxytocin in PPH prevention, occurrence of PPH-related health outcomes, and health care resource costs for PPH interventions. This study found that a GTA hospital, with 3242 deliveries per year, could save over CAD $349000 annually by switching to room temperature stable carbetocin for PPH prevention. Carbetocin was able to lower institution costs by reducing the use of health care resources for PPH management in low-risk and high-risk PPH patients. The cost-saving potential of carbetocin relative to oxytocin was largely attributed to its greater efficacy in preventing the consequences of PPH. The use of room temperature stable carbetocin as a first-line prophylactic agent for PPH prevention meets WHO recommendations regarding uterotonics for PPH in a GTA hospital. The model from this study can be used to determine the financial impact of switching from oxytocin to carbetocin in other jurisdictions while diversifying a hospital's pool of PPH prophylactic agents.

Multicenter, Randomized, Double-Blind, and Positive Drug-Controlled Clinical Trial on Prevention of Postpartum Hemorrhage after Vaginal Delivery with Ergometrine Maleate

To evaluate the safety and efficacy of using ergometrine maleate injection combined with oxytocin injection, with oxytocin injection as the control, to prevent postpartum hemorrhage after vaginal delivery. A total of 305 cases who underwent vaginal delivery between December 2018 and November 2019 in 16 hospitals across China were enrolled and included in the full analysis set (FAS) and the safety analysis set (SS). Among the 299 subjects who completed the trial, 277 were included in the per protocol set (PPS). The subjects were randomly assigned by 1∶1 ratio to two groups, 152 cases in Group A, the experimental group receiving oxytocin injection plus ergometrine injection, and 153 cases in Group B, the control group, receiving oxytocin injection. The difference in total bleeding volume at 2 h, 6 h and 24 h postpartum in the two groups was documented and compared. Other measures were also compared between the two groups, including the proportion of additional use of uterotonics and hemostatic drugs or other hemostatic measures 2 h and 24 h postpartum, the proportion of subjects needing blood transfusion, the time of placenta retention, proportion of subjects with prolonged hospital stay due to uterine asthenia, the vital signs, lab test indicators and the incidence of adverse reactions in the two groups. The total bleeding volume at 2 h, 6 h and 24 h after delivery was significantly lower in the experimental group (P<0.05). There was no significant difference between the two groups in the proportion of additional use of uterotonics and hemostatic drugs or other hemostatic measures 2 h and 24 h postpartum, the proportion of subjects needing blood transfusion and the time of placenta retention, heart rate, respiration, lab test indicators, or the incidence of adverse reaction (P>0.05). Ergometrine maleate injection showed evident therapeutic efficacy in preventing hemorrhage after vaginal delivery, causing fewer adverse reactions and ensuring greater safety, and therefore, presenting promising prospects for clinical application.

UTEROTONIC USE IN THE ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL): SYSTEMATIC REVIEW

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Maternal mortality rate in Indonesia has decreased from 184/100,000 live birth (LB) (2016) to 177/100,000 LB (2017), but this number is still high enough than SDGs target of 70/100,000 LB. The one of direct cause of maternal death is hemorrhage, especially postpartum hemorrhage (PPH). Causes of PPH are uterine atony, laceration of birth canal, resistant placenta and uterine inversion. PPH prevention method is Active Management of Third Stage of Labor (AMTSL). The objective of this systematic review is to analyze the use of uterotonics in AMTSL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This systematic review used the PRISMA protocol, articles taken from Google Scholar, Science Direct, and Pub Med. The time span of the research article was 2010 to 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; The results of the study describe that the use of uterotonics in single use or combination in third stage of labor can reduce the risk of PPH and shorten the time of the stage. The side effects were reported in misoprostol and methyl ergometrine than oxytocin. In addition, combination therapy with oxytocin and misoprostol can reduce the length of the third stage and the potential for a decrease in hemoglobin within 24 hours of delivery. In Indonesia, if oxytocin is not available, maternal nipple stimulation is performed as nonpharmacological therapy or ergometrine 0.2 mg is given to patients without complications of high blood pressure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The use of uterotonics is adjusted to its cost-effectiveness, ability to store and refrigerate also the benefits compare to the side effects to the patients.&lt;/p&gt;

The Effect of Carbetocin Dose on Transmural Dispersion of Myocardial Repolarization in Healthy Parturients Scheduled for Elective Cesarean Delivery Under Spinal Anesthesia: A Prospective, Randomized Clinical Trial

(Anesth Analg. 2021;132:485–492) Transmural dispersion of myocardial repolarization (TDR) is the interval between the peak of the T wave and end of the TV wave (Tp-e). Increased TDR is a more reliable predictor of drug torsadogenicity than prolonged QT interval. Carbetocin, a synthetic analog of oxytocin, is used to prevent postpartum hemorrhage (PPH) following cesarean delivery (CD), though the effect dose varies. Carbetocin has been shown to increase mean correct QT, but there is a paucity of information on the effects of carbetocin of TDR. This study examined the effects of carbetocin dose on TDR in patients undergoing CD under spinal anesthesia.

Early post-partum hemorrhage after spontaneous vaginal delivery: prevention and management done by midwives at butare university teaching hospital

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal death in low-income countries and is the primary cause of approximately one-quarter of global maternal deaths. The purpose of this paper is to assess the prevention and management of early postpartum hemorrhage (PPH) after spontaneous vaginal delivery at Butare University Teaching Hospital. Methods: Quantitative prospective observational study, 31 women in labor from the end of the second stage of labor to the end of early postpartum after spontaneous vaginal delivery during data collection period (From March 20th to April 2, 2015). The participant involved in this Evidence Based Practice was observed after getting and signing consent form. Patient’s files, data correction form was used to correct data. All processes were done after getting approval from ethical committee and Butare University Teaching Hospital research committee permission to conduct the project. The data were entered in SPSS version 16 for being analyzed; Microsoft word for text elaboration and Microsoft excel was used for making tables. Results: Active management of the third stage of labor is considered the “gold standard” strategy for reducing the incidence of PPH. It combines nondrug interventions (controlled cord trac­tion and cord clamping) with the administration of an uterotonics drug, Unfortunately, Oxytocin is used in majority of cases(93.5%:n=29) followed by uterine massage (67,7%:n=21), but the controlled cord traction is the last one with (54,8%:n=17).For management vital signs are taken at 100% (n=6),estimated blood loss done at 66.7% (n=4) differently, establish intravenous access and prevention of shock are done at (83.3%: n=5). Transfusion done at 50% (n=3) and catheterized bladder not done at 83.3% (n=5). Conclusion: As the main cause of maternal mortality worldwide, PPH prevention interventions need to be prioritized. Increased access to prophylactic uterotonics, regardless of where deliveries occur, should be the primary means of reducing the complication of PPH.

Knowledge and skills on active management of third stage of labor for prevention of post-partum haemorrhage among health care providers in Lake Zone, Tanzania: a cross sectional study

BackgroundHealth care providers (HCPs) knowledge and skills are both crucial in saving the lives of mothers and their newborns during childbirth. This study aimed to assess the knowledge and skills of HCPs on active management of third stage of labor (AMTSL) for prevention of PPH in Lake Zone Tanzania.MethodsA cross-sectional analytical hospital-based study which included 340 HCPs who were randomly selected, the study was conducted from March to May 2019 in lake zone, Tanzania. Data were collected using standardized questionnaire and observational checklist. Predictors of knowledge and skills on AMTSL were determined using binary logistic regression under multivariable analysis using SPSS version 23.0. p-value less than 0.05 was considered significant.ResultsMost 200 (58.8%) of the participants were aged between 25 and 34 years with mean age 31.4 ± 6.26 years. Majority 240 (67.6%) were females. Of all HCPs, 171 (50.3%) had adequate knowledge whereas 153 (45.0%) had adequate skills on AMTSL. Males (AOR = 1.96, 95% CI 1.18–3.26), HCPs with University education (AOR = 3.29, 95% CI 1.19–9.13) and previous BEmONC training (AOR = 2.20, 95% CI 1.24–3.91) were found to be the predictors of adequate knowledge on AMTSL. HCPs aged ≥ 45 years (AOR = 9.35, 95% CI 1.74–10.28) and HCPs working at a hospital (AOR = 1.78, 95% CI 1.12–2.82) were associated with having adequate skills on AMTSL.ConclusionHCPs included in this study demonstrated low skills on AMTSL as compared to knowledge which needs immediate attention. We recommend continuous in-service training and supportive supervision among HCPs working in labour wards for improving their knowledge and skills on AMTSL. This will help to reduce maternal morbidity and mortality related to PPH.

Role of Community mobilization as improving maternal health and proposed strategies in low-income countries: Narrative Review

Poor maternal outcome is one of the significant public health concerns globally. More than 295,000 women died in 2017, with 94% of deaths occurring in developing countries. There is a general lack of awareness about pregnancy-related issues. The current narrative review was planned to highlight the role of community mobilization in improving maternal health. Literature suggested five principal community mobilization strategies: improving home-based issues, such as the provision of and accessibility to healthcare facilities; community health education, including nutrition awareness; reducing the risk of maternal mortality; emergency care provision, like the uptake of misoprostol to prevent postpartum hemorrhage; and decision-making regarding birth preparedness. In Pakistan, there is a lack of evidence about the integration mode of community mobilization. It is necessary to determine how community mobilization integration helps reduce maternal mortality and its efficacy. Keywords: Maternal Health, LMICs, Community Mobilization, Developing countries, maternal care

Efficacy and Safety of Misoprostol for Prevention of Post-Partum Haemorrhage: A Comparative Study

Background: Post-partum haemorrhage condition is a serious condition after delivery.&#x0D; Objective: The purpose of the present study was to see the efficacy and safety of misoprostol for the prevention of post-partum haemorrhage.&#x0D; Methodology: This analytic cross-sectional study was carried out in the Department of Gynaecology and Obstetrics at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2006 to June 2006 for a period of six months. Pregnant women who were admitted in MMCH during the above period and were expected to have vaginal delivery and women at term with singleton pregnancy were included as study population. Women were divided into 2 groups. Women were in the group A who were treated with misoprostol and women who were treated with oxytocin were in group B. Blood loss during delivery was estimated subjectively by the attending obstetrician.&#x0D; Results: A total number of 100 women were recruited for this study of which 50 women were in the group A and the rest of 50 women were in group B. In this study majority of the patients were belonged to age group 20 to 25 years in both the groups. In oxytocin group 2.0% have developed nausea, 4.0% patients have developed shivering. None have developed vomiting, diarrhoea, temperature. In misoprostol group 10.0% patients have developed nausea, 18.0% patients have developed shivering, 4.0% patients have developed rise of temperature, none have developed diarrhoea, vomiting. The differences were statistically significant. In this study 4.0% patients from oxytocin group and 2.0% patient from misoprostol group required blood transfusion.&#x0D; Conclusion: In conclusion less amount of blood loss is found in misoprostol group than oxytocin group.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 152-155