Prevention Of Postpartum Hemorrhage Research Articles

Oxytocin before versus after placenta delivery for postpartum hemorrhage prevention: meta-analysis of randomized controlled trials

Oxytocin before versus after placenta delivery for postpartum hemorrhage prevention: meta-analysis of randomized controlled trials

Intravenous versus Intramuscular Oxytocin in the Prevention of Atonic Post-Partum Hemorrhage after Vaginal Delivery

Intravenous versus Intramuscular Oxytocin in the Prevention of Atonic Post-Partum Hemorrhage after Vaginal Delivery

Tranexamic acid for the prevention of postpartum hemorrhage and decreasing blood loss after vaginal delivery in high-risky parturient: A double-blind randomized controlled trial

Background and objective: The purpose of this study was to examine the effectiveness of Tranexamic acid administered in the third stage of labor to reduce vaginal blood loss and prevent postpartum hemorrhage in women with high-risk factors for postpartum Hemorrhage. Methods: A double-blind randomized placebo-controlled trial with two parallel groups was conducted in women scheduled to undergo vaginal delivery at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq. The women were randomly assigned to receive tranexamic acid (97 women) or placebo (99 women) immediately after fetal delivery in the third stage of labor. The vaginal blood loss and the time from fetal to placental delivery were measured. Results: The mean blood loss in the placebo group (Group 1) was 354.5 gram, which was considerably greater than the mean blood loss in the tranexamic group (Group 2), which was 284.4 gram. The incidence of postpartum hemorrhage (blood loss of ≥500 ml.) and (blood loss of ≥250 ml.) was significantly higher in G1 than G2. The length of the third stage of labor lasted 10.28 minutes in G1, which was longer than in G2, which lasted 7.82 minutes. Oxytocin was given to both groups as an active management of the third stage of labor. Conclusion: In this single-center study, women with risk factors for postpartum hemorrhage who received tranexamic acid had lower postpartum blood loss and a shorter time for placental delivery than those women who received placebo. Larger multicenter randomized clinical trials are needed to generalize these findings.

Cost-effectiveness analysis of carbetocin for prevention of postpartum hemorrhage in a low-burden high-resource city of China.

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity, and oxytocin is the first-line uterotonic agent for PPH prevention. Clinical findings have reported carbetocin to reduce PPH risk without increasing risk of important side effects. Hong Kong is a low PPH burden and high-resource city in China. We aimed to examine the cost-effectiveness of PPH prevention with carbetocin from the perspective of Hong Kong public healthcare provider. A decision-analytic model was developed to simulate clinical and economic outcomes of carbetocin and oxytocin for PPH prevention in a hypothetical cohort of women at the third stage of labor following vaginal birth or Caesarean section (C-section). The model inputs were retrieved from literature and public data. Base-case analysis and sensitivity analysis were performed. The model time horizon was the postpartum hospitalization period. Primary model outcomes included PPH-related direct medical cost, PPH, hysterectomy, maternal death, and quality-adjusted life-year (QALY) loss. In base-case analysis, carbetocin (versus oxytocin) reduced PPH-related cost (by USD29 per birth), PPH ≥500 mL and ≥1,500 mL (by 13.7 and 1.9 per 1,000 births), hysterectomy (by 0.15 per 1,000 births), maternal death (by 0.02 per 1,000 births), and saved 0.00059 QALY per birth. Relative risk of PPH ≥500 mL with carbetocin versus oxytocin, and proportion of child births by C-section were two influential parameters identified in deterministic sensitivity analysis. In probabilistic sensitivity analysis, carbetocin was accepted as cost-effective in >99.7% of the 10,000 Monte Carlo simulations at a willingness-to-pay threshold of zero USD/QALY. PPH prevention with carbetocin appeared to reduce major unfavorable outcomes, and save cost and QALYs.

Expression of Concern: Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section

Expression of Concern: Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section

Expression of Concern: Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women

This article refers to:Carbetocin versus oxytocin for prevention of postpartum hemorrhage after vaginal delivery in high risk women

The Effect of Anemia in Pregnancy on Postpartum Hemorrhage

Eighty percent of maternal deaths are caused by complications during pregnancy and childbirth. Furthermore, twenty-five percent of maternal deaths is affected by postpartum hemorrhage which is estimated 100,000 deaths annually. Indonesia places at the second ranks of the highest maternal deaths country after Laos. The cause of death in Indonesia is 28% by hemorrhage. The hemorrhage in maternity is due to anemia in pregnancy. It occurs because when the mother gives birth, there will be adequate uterine contractions so that the hemorrhage is inevitable. The objective of the study is to identify the effect of anemia in pregnancy on the incidence of postpartum hemorrhage. The type of research employed is an analytic survey with a retrospective design. The research location was at Juata Tarakan Health Center. The population in this study were all pregnant women who visited the obstetrics and gynecology polyclinic in 2020 which was obtained from secondary data, the patient's medical record book at the Juata Public Health Center with a sample of 271 on June 23 to August 31, 2021. Sampling employed a non-probability sampling technique, total sampling, and the data analysis was administered univariately, and bivariate with chi-square test. The incidence of postpartum hemorrhage in women giving birth in the working area of the Juata Tarakan Health Center is 12.9%. Anemia in pregnancy possesses a significant effect on the risk of postpartum hemorrhage with p value (OR=11,253, 95%CI 5,120-24,732). Meanwhile, parity, age, type of delivery did not possess significant effect on postpartum hemorrhage. Mothers with anemia in pregnancy own a higher risk of postpartum hemorrhage which was 11.253 times greater than mothers who were not anemic in pregnancy. Therefore, it is necessary to perform proper handling of anemia in pregnant women to prevent postpartum hemorrhage.

Role of Carbetocin over Oxytocin Followed by Caesarian Section

Introduction: Prevention of post-partum hemorrhage (PPH) is a major issue due to its impact on maternal mortality and morbidity. Primary post-partum hemorrhage (PPH) is the leading cause of maternal mortality in low- income countries and the primary cause of nearly one quarter of all maternal deaths globally. Aim of the Study: The aim of this study was to assess the effect of carbetocin over oxytocin in consequence of PPH. Methods: This was a cross- sectional study conducted in the Department of Obstetrics and Gynecology at Chattogram Medical College Hospital (CMCH), Chittagong, Bangladesh during the period from March 2018 to February 2019.Study population was the patient (n=100) with the risk of develops primary PPH following cesarean section. Women fulfilling inclusion criteria was included in the study and divided into 2 groups- Experimental group (n=50 cases) received 100μg of IV carbetocin through intravenous route; Control group (n= 50 cases) received 10 IU oxytocin through intravenous route. Data collection was done by the researcher after taking the written consent. Statistical analyses were done by SPSS 23. Result: In total 100 patients from both the groups completed the study. In our study we found the mean age was 25.20±5.43 years in carbetocin group and 25.90±5.83 years in oxytocin group. Regarding obstetric indications in carbetocin group majority (28.0%) patients had prolonged labour, 13 (26.0%) P/H/O C/S, 9 (18.0%) obstructed labour. In oxytocin group majority (38.0%) patients had P/H/O C/S, 14 (28.0%) had obstructed labour and 8 (16.0%) had prolonged labour. In 2 hours post-operative mean pulse was found 71.6±7.3 beats/min in carbetocin group and 68.9±5.9 beats/min in oxytocin group. Conclusion: In our study, it can be concluded that Carbetocin is as effective and safe as Oxytocin in the prevention of PPH following caesarean section. Carbetocin is more heat stable than oxytocin which is of crucial importance to resource poor settings like us. .......

Carbetocin: The New Preferred Treatment For Partum Hemorrhage

Background: Postpartum hemorrhage defined as the condition blood loss more than 500 mL from the female genital tract after vaginal delivery of the fetus (or >1000 mL after cesarean section). Case Presentation: Mrs. FA 31 year’s old G2P1A0 40 weeks age gestation preeclampsia with main complaints dyspnea and swollen legs. Physical examination showed decreased saturation, increase blood pressure, rhonci, and pitting edema of the pedal. Cardiomegaly with pulmonary edema on x-ray, elevated liver enzymes, LEA value +3, perfectly compensated respiratory alkalosis and electrolyte imbalance on laboratory test. Four-hour post C-section she got postpartum hemorrhagic and given oxytocin due to maximizing use of uterotonic agent, MgSO4 stopped and patient reported with postpartum eclampsia. Conclusion: Many studies discus other drugs to replace oxytocin, considering side effects to prevent postpartum hemorrhage. Carbetocin could be one potent agent of uterotonic agents with lower side effect.

Efficacy and Safety of Misoprostol Administered Rectally Compared with Oxytocin for the Prevention of Postpartum Hemorrhage

Background: The foremost cause of maternal morbidity and mortality in third-world countries is Post-Partum Hemorrhage (PPH). To prevent PPH, often Misoprostol is used. This study aimed to find out the efficacy and safety profile of Misoprostol when administered rectally in comparison to oxytocin, to avoid the incidence of PPH. Methods: This quasi-experimental study on n=72 patients were performed at Ziauddin University and Hospital Karachi for 6 months (2021). The patients were divided into two groups. Oxytocin (10 IU) was administered intramuscularly to Group A(n=36) while 400ug of Misoprostol was given to group B(n=36) rectally, at the time of delivery. The level of hemoglobin was checked at the time of admission and 24 hours after delivery and side effects were also monitored. Chi-square and t-test were applied between both groups and a p-value <0.05 was taken as significant. Results: The average duration of the third stage of labor in the Misoprostol group was 5.3 minutes versus the Oxytocin (Syntocinon) group 3.75 minutes (p= 0.012). The decrease in the level of hemoglobin and the blood loss quantity was not significantly different in both groups (p=0.766, 0.203) respectively. The side effect of shivering was seen in group B in 4(11.1%) of the patients (p=0.04) and hyperthermia was observed in 2 (5.6%) (p=0.151). Conclusion: Misoprostol proved to be efficacious oxytocin in PPH prevention. Therefore, Misoprostol can likely be of help during the third stage of labor, especially in countries with developing healthcare setups. Keywords: Misoprostol; Postpartum Hemorrhage; Oxytocin; Maternal Mortality; Uterotonic.

Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. The most common cause of maternal death in Korea is complications related to the postpartum period (obstetric embolism), accounting for 37.5%, while complications of labor and delivery (uterine atony, PPH, etc.) were the second most common cause, accouning for 21.9%. The effective treatment of PPH often requires multidisciplinary intervention. When managing PPH, multiple interventions (medical, mechanical, invasive, and nonsurgical and surgical procedures), which require different levels of skill and technical expertise, may be used to control bleeding. The healthcare provider needs to begin resuscitative efforts quickly, establish the cause of the hemorrhage, and possibly enroll the assistance of other care providers, such as an obstetrician, anesthetist or radiologist. Avoiding delays in diagnosis and treatment will have a significantly impact on sequelae and chances of survival. This review discusses the causes, identification, management, prevention and prediction of PPH.

Carbetocin versus Oxytocin: A Comparative Study to Prevent Postpartum Hemorrhage in Pre-eclamptic Women Delivered by Caesarean Section

Carbetocin versus Oxytocin: A Comparative Study to Prevent Postpartum Hemorrhage in Pre-eclamptic Women Delivered by Caesarean Section

Comparison of Oral Misoprostol with Intravenous Oxtocin in the Prevention of Primary Postpartum Haemorrhage in ESUT Teaching Hospital: A Randomized Controlled Trial

Background: Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality globally. About 14 million patients suffer from postpartum haemorrhage annually worldwide, of which about 140,000 die. The active management of third stage of labour with the use of uterotonic drugs has reduced the risk of postpartum haemorrhage significantly. The most common uterotonic drug currently in use is oxytocin but the problem of insufficient skilled manpower for its administration, inadequacy of electric power supply to ensure the stability of the drug at appropriate temperature, and its high cost have made widespread use of oxytocin difficult in the resource-poor countries. This has made the search for an effective, affordable, stable and available alternative necessary. Misoprostol, an analogue of prostaglandin-E1, has a good uterotonic activity, is highly affordable, does not require specialized skill to administer and is very stable at room temperature. It also has multiple routes of administration, which makes its use in resource-poor countries indispensable. Aim: To determine if there is any difference in the efficacy of intravenous oxytocin over oral misoprostol in the prevention of primary postpartum haemorrhage. Study Design: This was a prospective, double-blinded, randomized study of uncomplicated pregnant women who had vaginal delivery in ESUT Teaching Hospital, Enugu. Sample Size: Two hundred (200) pregnant women who satisfied the inclusion criteria were recruited in this study with each arm of the study accommodating 100 participants. Methodology: The eligible women were recruited on presentation to the labour ward after giving their consent. They were randomly allocated into 2 groups: A and B. Group A received 2 tablets (400mcg) of oral misoprostol and 1mililtre (ml) of sterile water intravenously while group B received 2 tablets of white vitamin c and 1ml (10iu) of intravenous oxytocin immediately after cord clamping and cutting following the delivery of the baby. Pre-weighed delivery mats and vulval pads were used to collect the blood at delivery and for the first 24 hours for weighing and estimation of blood loss. A proforma was used to record the necessary data. Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software version 20.0 for windows. Statistical analysis was both descriptive and inferential at 95% confidence level. The socio-demographic variables were used to categorize the data and this was subjected to comparative statistical evaluation to yield frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P<0.05 at one degree of freedom (df=1) was considered statistically significant. Results: Two hundred pregnant women were recruited into the study with 100 women on each arm and all completed the study. The amounts of blood loss (in mililitre) in the misoprostol and oxytocin arms were 339.36 ± 122.28 and 378.52 ± 148.24, respectively. Forty-three women had PPH (blood loss ≥ 500ml) but there was no significant difference in the amount of blood loss and occurrence of PPH on both arms of the study. Conclusion: There was no difference in the efficacy of oxytocin over misoprostol in the management of the 3rd stage of labour for preventing PPH. We therefore, recommend that misoprostol can be adopted as an alternative/substitute to oxytocin in the management of the third stage of labour especially in the developing countries for prevention of PPH.

Comparison the Effectiveness of Oxytocin and Misoprostol in Prevention of Primary Post-Partum Haemorrhage

Introduction: Postpartum haemorrhage is one of the leading causes of maternal mortality. Maternal Mortality globally is estimated as 599.00 deaths per year, a ratio of 400 maternal deaths per 10,000 live births. The aim of this study was to compare the effectiveness of oxytocin and misoprostol in prevention of primary post-partum haemorrhage Material and Method: It was Randomized Controlled Trial, which was conducted in the department of Obstetrics and Gynaecology, Hospital, Peshawar, between 14th March 2020 to 22 April 2022). The sample size was 100(50 in each group) Using 4% of PPH in misoprostol group, 24% of PPH in oxytocin group, 95% confidence level and 90% power of test under WHO software for sample size determination. Results: A total of 100 patients of primary post-partum haemorrhage were observed, which were divided in two equal groups A & B. Patients in Group A were managed with misoprostol while patients in group B will be subjected to oxytocin. Gravida wise distribution shows that out of 50 patients 22(44%) were gravid less than or equal to one,18(36) patient have 2-5 and 10(20%) were more than 5 while group B contains 25(50%) less than or equal to one, 17(34%) patients 2-5 and 8(16%) have gravid more than 5. Gravida distribution among the groups was insignificant with p-value=0.802. Average age was 27.82 years+4.56SD with range of 20-36 years. Group A contained 13(26%) patients in less than or equal to 25 years, 30(60%) patients 26-35 years and 7(14%) patients having ages of more than 35 years. While group B contained 18(36%) patients in less than or equal to 25 years, 28(56%) in 26-35 years and 4(8%) patients with age more than 35 years. The age distribution among the group was also insignificant with p-value 0.429. Efficacy wise distribution was significant with p-value = 0.021. Group A showed 47(94%) efficacy while non-effective in 3(6%) patients. Similarly, Group B showed 39 (78%) efficacy while non effective in 11(22%) patients. The misoprostol has greater efficacy than oxytocin. Age wise distribution of drug-efficacy shows that efficacy was almost same in all age groups. The patients having less than or equal to 25 years of age have shown efficacy in 12(92.3%) patients while 1(7.7%) patients being non-effective. Patients with 26-35 years of age have shown efficacy in 28(93.3%) of patients and 2(6.7%) have shown no efficacy. Similarly, 7(100%) patients have shown efficacy and no patients have no efficacy, with age more than 36 years of age. The same pattern was followed in group B, although age wise efficacy was insignificant in both the groups with p-value=0.765 and 0.987 respectively. The prevention of PPH, particularly in resource poor settings, where PPH is the leading cause of maternal mortality The enormity of postpartum haemorrhage and the limitations in the use of oxytocin for the adequate preventive therapy were the basic rationales behind this study. Secondarily, our cultural setups of home deliveries have a marked role in grave morbidity as well as lack a consensus protocol for the choice of adequate preventive treatment of haemorrhage. Keeping in view the above mentioned factors, this study was conducted to compare the effectiveness of the per rectal misoprostol medication to the intramuscular oxytocin to control the blood loss as adequate preventive therapy. Conclusion: Misoprostol is more effective as compared to oxytocin in prevention of primary postpartum hemorrhage. Keywords: Primary Postpartum haemorrhage, Cervical tears, Vaginal tears, oxytocin, Misoprostol, efficacy

HIF-1α is essential for the augmentation of myometrial contractility during labor†.

Uterine contraction is crucial for a successful labor and the prevention of postpartum hemorrhage. It is enhanced by hypoxia; however, its underlying mechanisms are yet to be elucidated. In this study, transcriptomes revealed that hypoxia-inducible factor-1alpha was upregulated in laboring myometrial biopsies, while blockade of hypoxia-inducible factor-1alpha decreased the contractility of the myometrium and myocytes in vitro via small interfering RNA and the inhibitor, 2-methoxyestradiol. Chromatin immunoprecipitation sequencing revealed that hypoxia-inducible factor-1alpha directly binds to the genome of contraction-associated proteins: the promoter of Gja1 and Ptgs2, and the intron of Oxtr. Silencing the hypoxia-inducible factor-1alpha reduced the expression of Ptgs2, Gja1, and Oxtr. Furthermore, blockade of Gja1 or Ptgs2 led to a significant decrease in myometrial contractions in the hypoxic tissue model, whereas atosiban did not remarkably influence contractility. Our study demonstrates that hypoxia-inducible factor-1alpha is essential for promoting myometrial contractility under hypoxia by directly targeting Gja1 and Ptgs2, but not Oxtr. These findings help us to better understand the regulation of myometrial contractions under hypoxia and provide a promising strategy for labor management and postpartum hemorrhage treatment.

Prostaglandin E1 Analog: Comparison between Two Different Routes of Administration for the Prevention of Post-Partum Hemorrhage

Prostaglandin E1 Analog: Comparison between Two Different Routes of Administration for the Prevention of Post-Partum Hemorrhage

Carbetocin versus oxytocin combined with misoprostol for prevention of postpartum hemorrhage in patients with severe pre-eclampsia: A randomized control trial

Carbetocin versus oxytocin combined with misoprostol for prevention of postpartum hemorrhage in patients with severe pre-eclampsia: A randomized control trial

Labor progression characteristics of primiparous term singleton pregnant women complicated with adenomyosis

Objective: To analyze the labor progression characteristics of primiparous term singleton pregnant women with adenomyosis. Methods: From April 2014 to May 2021, pregnant women underwent regular antenatal examination in Peking University Third Hospital were enrolled in this retrospective study, 109 primiparous term pregnant women with adenomyosis who underwent singleton, primipara, cephalic and vaginal delivery were referred as the adenomyosis group, while 109 pregnant women without adenomyosis primiparous term pregnant women at the same time were referred as the control group. The general clinical information, labor process intervention, pregnancy outcomes and labor course time of the two groups were analyzed. Results: (1) General clinical conditions: the pre-pregnancy uterine volume of the adenomyosis group was larger than that of the control group [(66.8±23.7) vs (41.4±13.1) cm3, P<0.05]. The proportion of assisted reproductive pregnancy and endometriosis in the adenomyosis group were higher than those in the control group [31.2% (34/109) vs 7.3% (8/109); 31.2% (34/109) vs 5.5% (6/109); all P<0.05]. There were no significant differences in maternal age, gestational age at delivery, pre-pregnancy body mass index, gestational weight gain, gravidity, incidence of pregnancy complications (gestational diabetes mellitus, pre-eclampsia and thyroid diseases) and premature rupture of membranes between the two groups (all P>0.05). (2) Labor process intervention and maternal and fetal outcomes: postpartum hemorrhage was higher in the adenomyosis group than the control group (median: 300 vs 260 ml, P=0.018). There were no significant differences in the proportion of labor onset, use of oxytocin, artificial rupture of membranes, perineal laceration Ⅲ and above, episiotomy, newborn weight and 1-minute Apgar score between the two groups (all P>0.05). (3) Time of labor process: there were no significant differences between the two groups in the time required for the first stage, third stage, total stage and cervical dilation 0-1, 1-2, 2-3, 3-4, 4-5, 5-6, 6-7 cm (all P>0.05). The time required for cervical dilation 7-8, 8-9, 9-10 cm and the second stage of labor in adenomyosis group (median: 20, 18, 15 and 12 minutes, respectively) were shorter than those of the control group (median: 23, 23, 23 and 26 minutes, respectively), and the differences were statistically significant (all P<0.05). (4) The effect of endometriosis on labor: there was no significant difference in the effect of endometriosis on labor in adenomyosis group (P>0.05). Conclusions: The labor process of primiparous term pregnant women with adenomyosis is significantly accelerated after the cervical dilatation for 7 cm, which should be closely observed. The third stage of labor course is managed aggressively with drugs to prevent postpartum hemorrhage.

Oxytocin: At Birth and Beyond. A Systematic Review of the Long-term Effects of Peripartum Oxytocin

(Anaesthesia. 2021;76:1526–1537) In obstetrics, oxytocin is used to augment labor and to prevent postpartum hemorrhage. However, recent research points to its important effects in social behavioral traits, including compassion, empathy, and trust. This study looked at long-term consequences of peripartum oxytocin administration on mothers and infants.

Intraoperative Blood Loss Reduction During Caesarean Delivery- Rectal Misoprostol Versus Oxytocin Infusion- A Randomized Controlled Trial

The first drug of choice recommended by the World Health Organization (WHO) for the prevention of primary postpartum haemorrhage during caesarean section is oxytocin. However, when oxytocin’s efficacy is questionable due to poor transportation, suboptimal storage and or adulteration as seen in developing countries, an adjunctive, synergistic and cheaper as well as temperature-stable, uterotonic such as misoprostol would be needed. The study was aimed at comparing the effectiveness of rectal misoprostol with that of oxytocin infusion in intraoperative blood loss reduction during caesarean section. The trial involved one hundred and forty pregnant women who had unequivocal indications for caesarean section and had risk factors for primary postpartum haemorrhage were randomized equally into two study groups, after informed consent. One study arm received adjunctive 40 IU of oxytocin infusion and the other arm received adjunctive 600 ug of rectally administered misoprostol, after clamping of the edges of the uterine wound with Green-Armytage forceps at caesarean section. The primary outcome measure was intraoperative blood during caesarean section. The statistical significance was set at p-value of 0.05. There was no statistically significant difference between the study groups in reduction of intraoperative blood loss during caesarean section (603.5 ± 153.8 ml vs 597.4 ± 200.9 ml, p= 0.839). It was concluded that rectally administered 600 ug misoprostol is an effective, non-inferior adjunctive uterotonic comparable to 40 IU oxytocin infusion in reducing intraoperative blood loss during caesarean section.