Prevention Of Postpartum Hemorrhage Research Articles

The Adverse Effects of Carbetocin Administration in the Third Stage of Labor

Introduction: The pharmacologic agents currently used routinely to prevent postpartum hemorrhage are mainly oxytocin, syntometrine (a combination of oxytocin and ergometrine), and carbetocin. Syntometrine is associated with a statistically significant reduction in the risk of postpartum hemorrhage when compared with oxytocin alone. So, this study aimed to assess the adverse effects of carbetocin administration in the third stage of labor. This study aimed to analyze the adverse effects of carbetocin administration in the third stage of labor. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh. The study period was from May 2016 to October 2016. 100 women undergoing normal vaginal delivery were the study subject. A convenient sampling technique was used in this study. Necessary data was collected in the data collection sheet. Women received a bolus of 100 microgram carbetocin IV at delivery of the anterior shoulder. A standardized deliver mat (Quaiyum's mat) was used before placental removal for measuring blood loss. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 19.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The mean values were calculated by frequencies and percentages. Result: In this study, the majority (54, 54.0%) of patients belonged to age 20-25 years, followed by (30, 30.0%) >25 years. It was observed that the majority 93(93.0%) patients had regular menstrual history. Concerning the clinical indices, anaemia was found 69(69.0%), jaundice 08(8.0%) and edema 24(24.0%). Additional uterotonices was used in 15(15.0%) and blood transfusion 07(7.0%) patients. Mean blood loss before the use of the weight of Q-mat was found 74.81±1.23 gram, mean blood loss after the use of the weight of Q-mat was 246.28±99.98 gram, and mean net blood loss was 141.61±59.93 gram. Majority 61(61.0%) babies had birth weight ≥2.5 kg. Majority 68(68.0%) patients had Hb% <10.5. The mean Hb% before delivery was 10.3±0.47 gm/dl with a range from 9.40 to 11.20 gm/dl The mean birth weight was found 2.57±0.41 kg with a range from 2.3 to 3.10 kg. Conclusion: Carbetocin appears to be an effective new drug in the active management of third-stage labor. Carbetocin has associated with a lower risk of various adverse effects and preventing postpartum hemorrhage in women undergoing vaginal delivery.

Closed- or open-glottis pushing for vaginal delivery: a planned secondary analysis of the TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery study

The effect on obstetrical outcomes of closed- or open-glottis pushing is uncertain among both nulliparous and parous women. This study aimed to assess the association between open- or closed-glottis pushing and mode of delivery after an attempted singleton vaginal birth at or near term. This was an ancillary planned cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial, conducted in 15 French maternity units from 2015 to 2016 that enrolled women with an attempted singleton vaginal delivery after 35 weeks' gestation. After randomization, characteristics of labor and delivery were prospectively collected, with special attention to active second-stage pushing and a specific planned questionnaire completed immediately after birth by the attending care provider. The exposure was the mode of pushing, classified into 2 groups: closed- or open-glottis. The main endpoint was operative vaginal delivery. Secondary endpoints were items of maternal morbidity, including severe perineal laceration, episiotomy, postpartum hemorrhage, duration of the second stage of labor, and a composite severe neonatal morbidity outcome. We also assessed immediate maternal satisfaction, experience of delivery, and psychological status 2 months after delivery. The associations between mode of pushing and outcome were analyzed by multivariate logistic regression to control for confounding bias, with multilevel mixed-effects analysis, and a random intercept for center. Among 3041 women included in our main analysis, 2463 (81.0%) used closed-glottis pushing and 578 (19.0%) open-glottis pushing; their respective operative vaginal delivery rates were 19.1% (n=471; 95% confidence interval, 17.6-20.7) and 12.5% (n=72; 95% confidence interval, 9.9-15.4; P<.001). In an analysis stratified according to parity and after controlling for available confounders, the rate of operative vaginal delivery did not differ between the groups among nulliparous women: 28.7% (n=399) for the closed-glottis and 27.5% (n=64) for the open-glottis group (adjusted odds ratio, 0.93; 95% confidence interval, 0.65-1.33; P=.7). The operative vaginal delivery rate was significantly lower for women using open- compared with closed-glottis pushing in the parous population: 2.3% (n=8) for the open- and 6.7% (n=72) for the closed-glottis groups (adjusted odds ratio, 0.43; 95% confidence interval, 0.19-0.90; P=.03). Other maternal and neonatal outcomes did not differ between the 2 modes of pushing among either the nulliparous or parous groups. Among nulliparous women with singleton pregnancies at term, the risk of operative vaginal birth did not differ according to mode of pushing. These results will inform shared decision-making about the mode of pushing during the second stage of labor.

TRANEXAMIC ACID PLUS OXYTOCIN PROPHYLAXIS IN REDUCING BLOOD LOSS AND PREVENTING POSTPARTUM HEMORRHAGE DURING CESAREAN SECTION

Objective: To find the efficacy of prophylactic tranexamic acid and Oxytocin in preventing postpartum hemorrhage during cesarean section as compared to uterotonic alone. Materials and Methods: A randomized clinical trial that was single-center, double-blind placebo-controlled was conducted in the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, between 1st July 2021 to 31st December 2021. A total of 280 patients undergoing cesarean section were randomized to group A receiving tranexamic acid and uterotonic (oxytocin) and control group B having placebo and uterotonic(oxytocin) within three minutes of delivery of the baby. Blood loss after the cesarean section was calculated from blood volume and pre and post-operative hematocrit. The main outcome of the study was to establish the efficacy of tranexamic acid in decreasing the number of women with calculated estimated blood loss&gt; 1000 ml. Secondary outcomes included differences in mean calculated blood loss, peripartum change in hematocrit, and postoperative blood transfusion in both groups. Data was analyzed by statistical package for social sciences(SPSS) version 23.0. Mean and standard deviation were calculated for numerical data and percentages, and frequencies for categorical variables. To see the effects of modifiers, post stratified t-test was used. P-value &lt;0.05 was considered statistically significant. Results: Both the groups were comparable for maternal age (28.4±4.5, 28.8±4.9) gestational age (37.71±1.61, 37.70±1.56), and parity (1.79±1.5, 2±1.6). Tranexamic acid significantly reduced the number of women with estimated calculated blood loss of &gt; 1000 ml in group A to 10%(n=14) as compared to 18.6%(n=26) in group B (p-value&lt;0.005). Secondary outcomes like mean calculated blood loss and postoperative blood transfusion were statistically insignificant between the two groups. Conclusion: Pregnant women who received prophylactic uterotonic agents and tranexamic acid treatment within three minutes of cesarean delivery, resulted in a lesser number of women with calculated estimated blood loss &gt; 1000 ml than placebo. Key Words: Primary postpartum hemorrhage, Tranexamic acid, Cesarean section, Blood loss.

Exploring Cardiac Effects After Oxytocin 2.5 I U or Carbetocin 100 μg: A Randomised Controlled Trial in Women Undergoing Planned Caesarean Delivery

(Eur J Anaesthesiol. 2022;39:928–938) While oxytocin can be cardioprotective at physiologic levels, higher concentrations are used to prevent postpartum hemorrhage (PPH) and can induce hypotension, ST-depression, tachycardia, arrhythmias, and prolongation of the QTc interval. Further cardiovascular (CV) effects caused directly by oxytocin can result in fatalities in patients with underlying myocardial disease. Such acute risk for susceptible patients warrants characterization of CV changes induced by intravenous oxytocin and its commonly used analog carbetocin as administered to prevent PPH. While carbetocin has demonstrated comparable or improved effect for stimulating uterine contractions and has similar hemodynamic effects to oxytocin, the comparative prevalence of adverse cardiac events is unknown. Myocardial distress can be measured by the release of circulating troponin I (cTnI) and troponin T (cTnT), which are considered indirect indicators of ischemic heart damage. This exploratory Phase 4 randomized trial queried the difference in troponin release following oxytocin or carbetocin administration to approximate the incidence of cardiac adverse events when used to prevent PPH in women undergoing planned cesarean delivery (CD).

Tranexamic Acid for the Prevention of Blood Loss After Cesarean Among Women With Twins: A Secondary Analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery Randomized Clinical Trial

(Am J Obstet Gynecol 2022;227:889e1–17) Tranexamic acid (TXA) has been proposed as a preventive medication in obstetrics to reduce the risk of postpartum hemorrhage (PPH). However, previous research has not shown TXA to be clinically beneficial for vaginal or cesarean delivery among a general obstetric population. Information is lacking on whether TXA might be more effective for women who are at increased risk of PPH. This study aimed to evaluate the effectiveness of prophylactic TXA in one group of women at high risk for PPH—those with multiple gestation. The purpose of this study was to examine the effect of TXA and a uterotonic agent compared with the uterotonic agent alone on the risk of PPH. The primary outcome was the incidence of calculated estimated blood loss of more than 1000 mL or a red blood cell transfusion by day 2 after delivery. Secondary outcomes included clinical and laboratory measurements of postpartum blood loss, adverse effects related to TXA, and maternal satisfaction.

Carbetocin Versus Oxytocin And Ergometrine for Prevention of Postpartum Hemorrhage in Women With Twin Pregnancy Undergoing Elective Cesarean Delivery: A Randomized Controlled Trial

Carbetocin Versus Oxytocin And Ergometrine for Prevention of Postpartum Hemorrhage in Women With Twin Pregnancy Undergoing Elective Cesarean Delivery: A Randomized Controlled Trial

Effect of Carica papaya raw fruit extract using in vitro rat uterus preparations

Background: Uterine stimulants are medications used to induce/augment labor, induce abortion, and to prevent postpartum hemorrhage. Currently, available drugs carrying adverse effects, hence the present study is designed to study the effect of Carica papaya raw fruits extract in comparison with oxytocin using in vitro rat uterus preparations. Aims and Objectives: Primary and secondary aims of the present study were to evaluate the uterine stimulant effect and also the potency of C. papaya fruit extract using in vitro rat uterus preparations in comparison with oxytocin. Materials and Methods: A total of 6 female rats were taken and anesthetized with ether. By giving midline incision at abdomen from pubic symphysis, two horns of uterus were identified and collected from each rat. Uterus of each rat was subjected to Oxytocin 0.32 IU (standard), alcoholic extract of C. papaya 0.32 mg (AECP), and combination of various doses of AECP (0.64 mg, 1.28 mg, and 2.56 mg) and a fixed dose of Oxytocin (0.32 IU). Using Sherrington’s kymograph, the uterine responses of each drug and combinations were studied in terms of height of the graph. Results: The mean contraction of uterus was 6.55mm and 2.26 cm, when Oxytocin (0.32 UI) and AECP (0.32 mg) injected, respectively. When combination of Oxytocin and different doses of AECP was injected, the uterus has shown dose-dependent response, i.e., 7.13 cm (Oxytocin 0.32 IU +AECP 3.2 mg), 8.08 cm (Oxytocin 0.32 IU + AECP 6.4 mg), and 9.01 cm (Oxytocin 0.32 IU + AECP 12.8 mg). Conclusion: AECP has shown dose-dependent uterine stimulant effect. Further studies are required to find out the possible mechanism behind the uterine stimulant activity of AECP.

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. PPH-preventing interventions need to be prioritized and can be integrated with conventional methods of PPH prevention. The introduction of negative intrauterine pressure using a suction cannula can be one of the cheapest modalities to decrease PPH secondary to uterine atonicity. This method has brought a renaissance to practical obstetrics in low-middle income countries (LMIC), where the cost and availability of uterotonics are major health issues. It was a prospective quality improvement (QI) study conducted in the labor and delivery wards of a tertiary care medical institute and teaching center over the duration of one year. We aimed to assess the decrease in the incidence of atonic PPH with a negative intrauterine pressure suction device (NIPSD) integrated with active management of the third stage of labor (AMTSL) in the prevention of atonic PPH following normal vaginal delivery in low-risk antenatal women. In the initial six months, routine AMTSL was instituted for all consenting women (group 1). In the next six months, NIPSD was integrated with AMTSL (group 2). Data pertaining to the amount of blood loss, the incidence of primary PPH, uterine tone, fall in hemoglobin and hematocrit levels post-delivery, need for blood transfusion, and doctor and patient satisfaction were tabulated for all patients. A total of 1324 consenting women were eligible for enrollment during the study time frame. In the initial six months (baseline period, group 1), 715 participants were subjected to routine AMTSL in the third stage of labor. During the intervention phase (group 2), 609 parturient women were recruited. There was no significant difference in baseline parameters between the two groups. With the introduction of NIPSD to routine AMTSL, there was a significant decrease in the average volume of blood loss during vaginal delivery (group 1 = 389.45+65.42 ml, group 2 = 216.66+34.27 ml; p-value = 0.012). The incidence of atonic PPH was reduced by more than 75% (group 1 = 13 women, group 2 = 3 women; p-value = 0.001) after the introduction of NIPSD complementing routine AMTSL. The introduction of NIPSD has also been instrumental in reducing the cost burden on patient and hospital expenditures. The net benefit of its introduction resulted in a reduction of the overall cost burden of blood transfusions by around 70%. PPH is a public health problem, and measures to reduce PPH must be implemented to decrease this health burden. In countries with low resources, complementing routine AMTSL with NIPSD can be instrumental in decreasing the incidence of PPH. Considering its cost-effectiveness and reusability, LMIC can adopt NIPSD as a routine measure in all vaginal deliveries.

Prophylactic Tranexamic Acid Prevents Postpartum Hemorrhage and Transfusions in Cesarean Deliveries: A Systematic Review and Meta-analysis.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and PPH resulting in transfusion is the most common maternal morbidity in the United States. Literature demonstrates that tranexamic acid (TXA) can reduce blood loss in cesarean deliveries; however, there is little consensus on the impact on major morbidities like PPH and transfusions. We conducted a systematic review/meta-analysis of randomized controlled trials (RCTs) to evaluate if administration of prophylactic intravenous (IV) TXA prevents PPH and/or transfusions following low-risk cesarean delivery. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. Five databases were searched: Cochrane, EBSCO, Ovid, PubMed, and ClinicalKey. RCTs published in English between January 2000 and December 2021 were included. Studies compared PPH and transfusions in cesarean deliveries between prophylactic IV TXA and control (placebo or no placebo). The primary outcome was PPH, and the secondary outcome was transfusions. Random effects models were used to calculate effect size (ES) of exposure in Mantel-Haenszel risk ratios (RR). All analysis was done at a confidence level (CI) of α = 0.5. Modeling showed that TXA led to significantly less risk of PPH than control (RR: 0.43; 95% CI: 0.28-0.67). The effect on transfusion was comparable (RR: 0.39; 95% CI: 0.21-0.73). Heterogeneity was minimal (I 2 = 0%). Due to the large sample sizes needed, many RCTs are not powered to interpret TXA's effect on PPH and transfusions. Pooling these studies in a meta-analysis allows for more power and analysis but is limited by the heterogeneity of studies. Our results minimize heterogeneity while demonstrating that prophylactic TXA can lower PPH occurrence and reduce the need for blood transfusion. We suggest considering prophylactic IV TXA as the standard of care in low-risk cesarean deliveries. KEY POINTS: · Consider TXA prior to incision for singleton, term pregnancies undergoing elective cesarean.. · Prophylactic TXA is effective in preventing PPH and blood transfusions.. · Routine use of TXA has the potential to decrease transfusion-related complications and costs..

Oxytocin versus carbetocin for prevention of postpartum hemorrhage in high risk cases: Randomized controlled trial

Oxytocin versus carbetocin for prevention of postpartum hemorrhage in high risk cases: Randomized controlled trial

Contribution of Carboprost in the Prevention of Postpartum Haemorrhage in Vaginal Delivery with Haemorrhagic Risk Factors: Experience of the Teaching Hospital of Angre, Abidjan, Côte D’ivoire

Objective: To evaluate the contribution of carboprost in the prevention of postpartum haemorrhage in patients with haemorrhagic risk factors. Patients and Method: We conducted an analytical study at the Teaching Hospital of Angré (January 1, 2020-December 31, 2022) on vaginal births with one or more of the following bleeding risk factors: age ≥ 35 years, multiparity, overdistension uterine. Group 1 consisted of postpartum patients who received only oxytocin. Those in group 2 received oxytocin and another uterotonic: carboprost. Blood loss was quantified postpartum. The chi 2 statistical test was used to compare the 2 groups at the threshold α = 5%. Results: We identified 4,203 vaginal deliveries including 823 hemorrhagic risk factors meeting the study criteria. Blood loss was greater in patients who had received only oxytocin, particularly the risk factors for multiparity and uterine overdistension [age 35 years (17.46% versus 8.89% p=0.11); multiparous (14.15% against 5.56% p=0.003); patients with uterine overdistension (23.71% versus 9.67% p=0.00001)]. Conclusion: The synergy of 2 utero tonics, namely oxytocin and carboprost, in patients with hemorrhagic risk factors, in particular multiparity and uterine overdistension, contributes to reducing postpartum bleeding. Adding carboprost is a good alternative to preventing postpartum hemorrhage in parturients at higher risk.

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

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

Apgar Score and the Amount of Blood of Mother in Labour in Delayed Cord Clamping Period

A delay in cutting the umbilical cord in infants can increase the Apgar score in infants who experience asphyxia. Besides that, it can prevent postpartum hemorrhage from occurring. Most deaths from postpartum hemorrhage occur during the first 24 hours after delivery. This increase in the Apgar value proves that the longer the delay in the umbilical cord is carried out, even until it doesn't pulsate, the better the baby's body will be, which results in an increase in hemoglobin in the baby's body. The population in this study were all mothers in the 3-4 stage of labor in the city area. Bandar Lampung. The sample is part of the number and characteristics possessed by the population with 120 maternal. It is known the length of time delayed cord Clamping is performed on babies born (&lt;30 seconds) as many as 3 (2.5%) respondents, while umbilical cord clamping is delayed for 30-180 seconds as many as 117 (97.5%) respondents, the Apgar score in newborns in the category of mild asphyxia - not asphyxia as much as 100%, the amount of blood that came out &lt;250 grams was 93 (77.5% ) respondents and the amount of blood that came out 250 grams were 27 (22.5%) respondents. Delayed cord clamping does not increase the incidence of asphyxia and bleeding in laboring mothers, so immediate umbilical cord clamping can be performed by observing the baby's birth condition.

Heat stable carbetocin or oxytocin for prevention of postpartum hemorrhage among women at risk: A secondary analysis of the CHAMPION trial.

To examine whether the observed non-inferiority of heat-stable carbetocin (HSC), compared with oxytocin, was influenced by biologic (macrosomia, parity 3 or more, or history of postpartum hemorrhage [PPH]) and/or pharmacologic (induction or augmentation) risk factors for PPH. The present study is a secondary analysis of the CHAMPION non-inferiority randomized trial-a two-arm, double-blind, active-controlled study conducted at 23 hospitals in 10 countries, between July 2015 and January 2018. Women with singleton pregnancies, expected to deliver vaginally with cervical dilatation up to 6 cm were eligible. Randomization was stratified by country, with 1:1 assignment. Women in the intervention and control groups received a single intramuscular injection of 100 μg of HSC or 10 IU of oxytocin, respectively. The drugs were administered immediately after birth, and the third stage of labor was managed according to the WHO guidelines. Blood was collected using a plastic drape. For this analysis, we defined a woman as being at risk if she had any one or more of the biologic or pharmacologic risk factor(s). The HSC and oxytocin arms contained 14 770 and 14 768 women, respectively. The risk ratios (RR) for PPH were 1.29 (95% confidence interval [CI] 1.08-1.53) or 1.73 (95% CI 1.51-1.98) for those with only biologic (macrosomia, parity 3 or more, and PPH in the previous pregnancy) or only pharmacologic (induced or augmented) risk factors, respectively, compared with those with neither risk factors. Findings reinforce previous evidence that macrosomia, high parity, history of PPH, and induction/augmentation are risk factors for PPH. We did not find a difference in effects between HSC and oxytocin for PPH among women who were neither induced nor augmented or among those who were induced or augmented.

Guidelines for prevention and treatment of postpartum hemorrhage (2023)

Guidelines for prevention and treatment of postpartum hemorrhage (2023)

Carbetocin Use during Caesarean Deliveries in Preventing Postpartum Haemorrhage (PPH) In Enugu: A 15-Case Series and Review of Literature

Background: The news of pregnancy is usually a happy one in a family and the birth of a new baby marks the peak of the experience. However, many times this happy beginning is clouded by pain and sorrow when serious maternal morbidity or mortality occurs. The major cause of maternal death is Primary postpartum haemorrhage. The introduction of active management of the third stage of labour has significantly reduced the incidence of maternal mortality but the risk of PPH is not entirely eliminated, hence, the need for a near ideal uterotonic agent that will better prevent or control PPH. Carbetocin promises to be a veritable tool in this regard and this case series was designed to showcase our experience with the drug. Aim: The aim was to analyze our experiences with Carbetocin during caesarean section in preventing PPH. Methodology: This was a case series of 15 women who had caesarean delivery in 3 different hospitals in Enugu under cover of Carbetocin. An extensive literature search was also done to unravel the extent of use and reported efficacy or otherwise of Carbetocin compared with our own experience. Relevant data was collated using a proforma and the result was analyzed using SPSS version 25.0 Results: The result from the study showed that out of the fifteen subjects analyzed, 5(33.3%) were less than 30 years while 10(66.7%) were more than 30 years and that 14(93.3%) of them were Igbo, whereas only 1(6.7%) was Yoruba. Seven of them (46.7%) were primipara, 1(6.7%) was para-4 or more and the rest were either between para-2 or para-3. Intra-operatively 12(80%) had no uterine fibroid and 3(20%) had one or more uterine fibroids. It also revealed that 6(40%) were delivered at a gestational age of 38 weeks, 3(20%) at 37 weeks and 1(6.7%) each at 35 weeks and 40 weeks. Only 1(6.7%) had need for additional uterotonics whereas the remaining 14(93.3%) had no need for additional uterotonics during and after the surgery. There was no record of any side-effects in any of the subjects. Prolonged labour and placenta previa with previous caesarean delivery topped the list of indications each having 3(20%) whereas breech presentation and previous caesarean deliveries were 2(13.3%) each; the others constituted the remaining 5(33.3%) each. The mean estimated blood loss was 335.33ml±140.80 (p-value= 0.001 and CI= 4.68-8.26), the average pre-operative packed cell volume (PCV), 34.2%±2.73 whereas the mean post-operative PCV was 30.93%±2.21(p-value = 0.001 and CI= 2.55-3.90). There were no side-effects recorded in any of the subjects. Conclusion: Carbetocin is an efficacious uterotonic agent and is very effective in preventing uterine atony and PPH during caesarean deliveries with minimal and tolerable side-effects.

Carbetocin Use during Caesarean Deliveries in Preventing Postpartum Haemorrhage (PPH) In Enugu: A 15-Case Series and Review of Literature

Carbetocin Use during Caesarean Deliveries in Preventing Postpartum Haemorrhage (PPH) In Enugu: A 15-Case Series and Review of Literature

Practices and factors associated with active management of the third stage of labor in East Africa: systematic review and meta-analysis

BackgroundActive management of the third stage of labor involves prophylactic uterotonics, early cord clamping, and controlled cord traction to deliver the placenta. It is designed to facilitate the delivery of the placenta by increasing uterine contractions during the third stage of labor. It is also used to prevent postpartum hemorrhage by averting uterine atony.This systematic review and meta-analysis’s emphasis was on the practice and factors associated with active management of the third stage of labor in East Africa.MethodsPubMed, Web of Science, Science Direct (Scopus), Google Scholar, African Journals Online, and the Cochrane Library electronic databases were used. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. A p-value of 0.05 is regarded to indicate potential publication bias: the funnel plot, Begg, and Egger’s regression test were used to examine publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. Pooled analysis was carried out. By country, a subgroup analysis was conducted.ResultsThirteen studies were included in this systematic review and meta-analysis. The pooled prevalence of the practice of active management of the third stage of labor in East Africa was 34.42%. Received training (OR = 6.25, 95%CI = 3.69, 10.58), years of experience (OR = 3.66, 95%CI = 2.35, 5.71), and good knowledge (OR = 3.66, 95%CI = 2.35, 5.71) were statically associated with the practice of active management of third stage of labor.ConclusionThe pooled prevalence of practice for active management of the third stage of labor in East Africa was low. Factors that were statistically associated with the practice were received training, years of experience, and good knowledge. Obstetric care providers should continue to receive training in all components of active management of the third stage of labor through training and education programs.

Clinical outcome analysis of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy: a retrospective study

ObjectiveTo explore the efficacy of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy.MethodsThis retrospective analysis covers the clinical data of 40 women with postpartum haemorrhage caused by uterine inertia during caesarean section in women with twin pregnancy in our hospital from January 2018 to May 2022. These women were divided into the group with modified B-Lynch sutures at the fundus and part of the corpus uteri (Group A, 20 patients) and the group with classic B-Lynch sutures (Group B, 20 patients) according to the treatment received. The treatment effect and safety of the two uterine compression sutures were compared.ResultsIn this study, no statistically significant differences were found in the outcomes of haemostasis or intraoperative and 24-h postoperative blood loss between the two uterine compression suture groups (P > 0.05). Compared to Group B, Group A showed a significantly reduced operative time, postoperative hospital stay, puerperal morbidity rate, pain score and duration of lochia.ConclusionModified B-Lynch sutures at the fundus and part of the corpus uteri can achieve a haemostatic effect similar to that of the classic B-Lynch suture, while it allows for a shortened operative time and reduced postoperative complications. Modified B-Lynch sutures can serve as a safe, rapid and effective haemostatic method for the prevention and treatment of postpartum haemorrhage during caesarean section in women with twin pregnancy, showing certain validity for promotion in clinics.

Role of Tranexamic Acid for Prevention of Postpartum Hemorrhage in Cesareans

Role of Tranexamic Acid for Prevention of Postpartum Hemorrhage in Cesareans