Primary Postpartum Haemorrhage Research Articles

Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals.

To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. A secondary data analysis using a cross-sectional design. Referral-level hospitals (48 public and six private facilities). Women admitted for birth between 1 September 2019 and 31 August 2020. Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. Prevalence of PPH and maternal and neonatal outcomes. Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.

Prognostic Role of Initial Thromboelastography in Emergency Department Patients with Primary Postpartum Hemorrhage: Association with Massive Transfusion.

The early prediction of the need for massive transfusions (MTs) and the preparation of blood products are essential for managing patients with primary postpartum hemorrhage (PPH). Thromboelastography (TEG) enables a thorough evaluation of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. We investigated the role of TEG in predicting the need for MT in patients with primary PPH. A retrospective observational study was conducted in the emergency department (ED) of a university-affiliated, tertiary referral center between November 2015 and August 2023. TEG was performed upon admission. We defined MT as the requirement for transfusion of more than 10 units of packed red blood cells within the first 24 h. The primary outcome was the need for MT. Among the 184 patients with initial TEG, 34 (18.5%) required MT. Except for lysis after 30 min, the MT and non-MT groups had significantly different TEG values. Based on multivariate analysis, an angle < 60 was an independent predictor of MT (odds ratio (OR) 7.769; 95% confidence interval (CI), 2.736-22.062), along with lactate (OR, 1.674; 95% CI, 1.218-2.300) and shock index > 0.9 (OR, 4.638; 95% CI, 1.784-12.056). Alpha angle < 60 degrees indicated the need for MT with 73.5% sensitivity, 72.0% specificity, and 92.3% negative predictive value. Point-of-care testing of TEG has the potential to be a useful tool in accurately predicting the necessity for MT in ED patients with primary PPH at an early stage.

Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery

To compare the efficacy and safety of intrauterine balloon tamponade with uterovaginal roll gauze packing in patients presenting with primary postpartum hemorrhage after normal vaginal delivery. This randomized controlled trial, conducted at Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore, from December 2015 to November 2016. Two hundred and twelve patients presenting with primary postpartum hemorrhage who did not respond to medical treatment following normal vaginal delivery were included. They were randomly divided in two groups. The first group underwent balloon tamponade using condom and second group underwent intrauterine packing using roll gauze. Both interventions were removed after 24 hours. All females were kept under observation with antibiotic coverage in ward to prevent infection. If bleeding was stopped within 15 minutes and the patient remained hemodynamically stable, then efficacy was labeled and if no complications occur while applying or removing, safety was labeled. Mean age group of women using balloon tamponade and intrauterine packing was used was 28.25±4.672 and 28.30±4.613 years. The mean gestational age of patients using balloon tamponade and intrauterine packing was 38.57±1.36 and 38.63±0.62 years. Mean blood loss in patients using balloon tamponade and intrauterine packing was 600.28±25.338 and 699.21±70.176 ml. Efficacy of intrauterine packing was 94 (88.7%) and balloon tamponade was 104 (98.1%). Safety of intrauterine packing was 83 (78.3%) and that of balloon tamponade was 97 (91.5%). Thus, treatment of balloon tamponade was more effective and safer than intrauterine packing in female presenting with postpartum hemorrhage after normal vaginal delivery.

Association between Initial Fibrinogen Levels and the Need for Massive Transfusion in Emergency Department Patients with Primary Postpartum Hemorrhage: A Retrospective Study from a Single Center in Korea.

This study aimed to evaluate the association between initial fibrinogen levels and massive transfusion (MT) in emergency department (ED) patients with primary postpartum hemorrhage (PPH). This retrospective study was conducted in the ED of a university-affiliated, tertiary referral center from January 2004 to August 2023. Patients were divided into two groups: the MT group, which included those who received a transfusion of 10 or more units of packed red blood cells within the first 24 h, and the Non-MT group. Out of the 364 patients included in the study, 97 (26.6%) required MT. Fibrinogen, shock index, and lactate were independently associated with MT (odds ratio [OR] 0.987; 95% confidence interval [CI] 0.983-0.991; p < 0.001, OR 7.277; 95% CI 1.856-28.535; p = 0.004, and OR 1.261; 95% CI 1.021-1.557; p = 0.031, respectively). The area under the receiver operating characteristic curve for fibrinogen, shock index, and lactate in predicting MT was 0.871 (95% CI 0.832-0.904; p < 0.001), 0.821 (95% CI 0.778-0.859; p < 0.001), and 0.784 (95% CI 0.738-0.825; p < 0.001), respectively. When the cutoff value of fibrinogen was 400 mg/dL, both the sensitivity and negative predictive values for predicting MT were 100.0%. When the cutoff value of fibrinogen was 100 mg/dL, the specificity and positive predictive values were 91.8% and 70.7%, respectively. The initial fibrinogen levels were independently associated with the need for MT in ED patients with primary PPH.

Tranexamic acid versus oxytocin for primary postpartum Haemorrhage in the out-of-hospital setting: A systematic review with implications for rural practice.

Primary postpartum haemorrhage causes approximately 25% of global maternal deaths and accounts for significant maternal morbidity. While high certainty evidence demonstrates that tranexamic acid reduces comparative blood loss in postpartum haemorrhage in hospital settings, limited data exist on the specific pharmacological management of this condition in out-of-hospital settings, and the implications for rural communities. To determine the efficacy of oxytocin compared to tranexamic acid in women suffering postpartum haemorrhage in the out-of-hospital environment. A systematic review comparing evidence containing patients with postpartum haemorrhage in the out-of-hospital and/or rural setting, in which oxytocin/tranexamic acid were used. Outcome measures were comparative blood loss/haemorrhagic shock, the need for further interventions and maternal/neonatal morbidity/mortality. No randomised control trials have been conducted in an out-of-hospital environment in relation to oxytocin/tranexamic acid. In this setting, there is no difference in outcome measures when using oxytocin compared to no intervention, or oxytocin compared to standard care. Data are lacking on the effect of tranexamic acid on the same outcome measures. Rural and out-of-hospital management of postpartum haemorrhage is limited by resource availability and practitioner availability, capacity and experience. In-hospital evidence may lack transferability, therefore direct evidence on the efficacy of pharmacological management in these contexts is scant and requires redress. There is no difference in blood loss, neonatal or maternal mortality or morbidity, or need for further interventions, when using oxytocin or TXA compared to no intervention, or compared to standard care, for PPH. Further studies are needed on the efficacy of these drugs, and alternate or co-drug therapies, for PPH in the out-of-hospital environment and rural clinical practice.

Safety and efficacy of pelvic arterial embolization for primary postpartum hemorrhage in hemodynamically stable and hemodynamically unstable patients: Is it “time” for a paradigm change?

BackgroundPelvic artery embolization (PAE) is an effective and safe technique for treating postpartum hemorrhage (PPH) with hemodynamic stability. However, its use in hemodynamically unstable patients remains controversial. PurposeTo determine the safety and efficacy of pelvic arterial embolization (PAE) according to the hemodynamic state of primary postpartum hemorrhage (PPH) patients. MethodsThis cohort study was conducted retrospectively, using data from January 2004 to December 2021, in a resource-rich setting at a tertiary Level 1 trauma academic center. A total of 437 patients were diagnosed with PPH during the study period. Of these 437 patients, 161 with primary PPH who underwent PAE were enrolled in the study. The outcomes assessed included the clinical success rate, mortality, the overall success rate, predictive factors for failed PAE, and time-dependent changes in hemodynamic parameters, such as systolic blood pressure (SBP), heart rate (HR), and shock index (SI). Propensity score (PS) matching analysis was performed to assess the influence of specific variables or conditions on the outcomes. ResultsOf the 161 patients who underwent PAE for primary PPH (mean age, 32.9 ± 4.3 [SD]), 85 were retrospectively categorized as having hemodynamic stability (mean age, 32.6 ± 4.1 [SD]), while 76 were categorized as having hemodynamic instability (mean age, 33.3 ± 4.4 [SD]). This study showed PAE for primary PPH had a success rate of 91.9 %, with no significant difference in mortality rates between the groups. The clinical success rate was 98.8 % for patients with hemodynamic stability and 84.2 % for those with hemodynamic instability (p < .001). The overall success rate was 98.8 % for hemodynamic stability and 89.5 % for hemodynamic instability (p = .014). After propensity score matching, the clinical success rate was higher in hemodynamically stable patients than in unstable ones (100 % vs. 86.3 %, p = .013). However, there was no significant difference in the overall success rate (100 % vs. 90.2 %, p = .056). Among the PS-matched population, predictive factors for the failed PAE in primary PPH were hemodynamic instability (adjusted odds ratio [aOR] 21.22, 95 % CI 1.27-355.76; p = .034) and emergency Cesarean delivery with accompanying hemorrhag (aOR 54.00, 95 % CI 11.93-244.56; p = .008). In three groups within a PS-matched population — hemodynamically stable, unstable with successful outcomes, and unstable with unsuccessful outcomes, a generalized linear mixed model (GLMM) analysis for time-dependent changes in hemodynamic parameters revealed a statistically significant difference in SBP, HR, and SI at various time points. ConclusionPelvic arterial embolization of primary postpartum bleeding in hemodynamic instability has been identified as an alternative, safe, and effective life-saving procedure for multidisciplinary treatment in resource-rich environments even after the baseline characteristics are balanced by the PS matching, suggesting it is a primary care option.

Comparison of Modified Shock Index and Shock Index for Predicting Massive Transfusion in Women with Primary Postpartum Hemorrhage: A Retrospective Study.

BACKGROUND The modified shock index (MSI) is calculated as the ratio of heart rate (HR) to mean arterial pressure (MAP) and has been used to predict the need for massive transfusion (MT) in trauma patients. This retrospective study from a single center aimed to compare the MSI with the traditional shock index (SI) to predict the need for MT in 612 women diagnosed with primary postpartum hemorrhage (PPH) at the Emergency Department (ED) between January 2004 and August 2023. MATERIAL AND METHODS The patients were divided into the MT group and the non-MT group. The predictive power of MSI and SI was compared using the areas under the receiver operating characteristic curve (AUC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated. RESULTS Out of 612 patients, 105 (17.2%) required MT. The MT group had higher median values than the non-MT group for MSI (1.58 vs 1.07, P<0.001) and SI (1.22 vs 0.80, P<0.001). The AUC for MSI, with a value of 0.811 (95% confidence interval [CI], 0.778-0.841), did not demonstrate a significant difference compared to the AUC for SI, which was 0.829 (95% CI, 0.797-0.858) (P=0.066). The optimal cutoff values for MSI and SI were 1.34 and 1.07, respectively. The specificity and PPV for MT were 77.1% and 40.2% for MSI, and 83.2% and 45.9% for SI. CONCLUSIONS Both MSI and SI were effective in predicting MT in patients with primary PPH. However, MSI did not demonstrate superior performance to SI.

Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial.

To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.

Relationship between Maternal Vitamin-D deficiency and serum Calcium level with Primary Caesarean Section and Postpartum Hemorrhage

Relationship between Maternal Vitamin-D deficiency and serum Calcium level with Primary Caesarean Section and Postpartum Hemorrhage

Intrauterine Misoprostol plus Oxytocin versus Oxytocin only in Prevention of Primary Postpartum Hemorrhage: Randomized Controlled Trial

Intrauterine Misoprostol plus Oxytocin versus Oxytocin only in Prevention of Primary Postpartum Hemorrhage: Randomized Controlled Trial

Comparison of tranexamic acid plus intramuscular oxytocin with intramuscular oxytocin alone for prophylaxis of primary postpartum haemorrhage in vaginal delivery

In contemporary obstetrics, postpartum hemorrhage is one of the primary causes of maternal mortality. Postpartum hemorrhage is defined as blood loss of more than 500 mL within the first 24 hours of birth. The term, late postpartum hemorrhage is used when the bleeding lasts more than 24 hours. Due to the physiological changes that occur during pregnancy, the body may sustain a 500 mL blood loss without experiencing any severe negative consequences. However, even a modest amount of blood loss might be harmful in cases of comorbidities like anemia. However, even a modest amount of blood loss might be harmful in cases of comorbidities like anemia. Postpartum hemorrhage poses a double threat because it decreases the mother's strength and immunity, leaving her more vulnerable to puerperal illnesses. Second, the loss of blood could be fatal. Maternal death occurs gradually as a result of constant trickle-like blood loss. There are predictors which may help us in scrutinizing patients to be labeled as high risk for postpartum hemorrhage, however, there are no formulized criteria for postpartum hemorrhage. The active management of the third stage of labor is a management protocol made to prevent as well as manage this potentially life-threatening condition. It has significantly led to a reduction in maternal mortality rates. However, with more permutation - combinations of medical management and using different pharmacological agents we can devise a better algorithm for further deduction in the mortality rates. Here we propose to randomly allocate and administer an additional drug, tranexamic acid, in addition to uterotonics prophylactically given during the active management of the third stage of labor in vaginal deliveries. In doing so we compare the differences between groups in which only oxytocin was given and in which oxytocin plus tranexamic acid was given.

Tranexamic Acid to reduce post-partum blood loss after a vaginal delivery: a double-blinded randomized controlled trial.

To assess the effect of intravenous tranexamic acid (1 g) in reducing blood loss during the 3rd and 4th stages of labor following vaginal delivery, in addition to active management of the third stage of labor. This double-blinded randomized controlled trial included 650 women with singleton pregnancies of ≥ 34 weeks gestation undergoing vaginal delivery. Eligible women were randomly assigned to receive 1 g of tranexamic acid or placebo intravenously in addition to active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the 3rd and 4th stages of labor. Out of 886 expectant women who were approached, 650 instances that met the study's inclusion criteria were enrolled and a total of 320 women in group A and 321 in group B were analyzed. Maternal characteristics did not differ between the two groups. Mean blood loss did not differ significantly among the intervention and placebo groups (378.5±261.2 ml vs. 383±258.9 ml; p = 0.93). The incidence of primary postpartum hemorrhage was comparable in both groups (Group A: 15.9%, Group B: 15.3%, p = 0.814). The median fall in haemoglobin within 12-24 hours following delivery in both groups was comparable (group A: 0.60 g% with interquartile range (IQR) 0.4-0.9 g %; group B: 0.6 g% with IQR 0.4-0.8 g %; p = 0.95). The most common adverse effect reported was dizziness. No thromboembolic events were reported at the follow-up of three months in both groups. Prophylactic use of tranexamic acid in addition to active management of the third stage of labor does not help further reduce postpartum blood loss following vaginal delivery.

Hemophilia A Research Program (HARP): A Novel Study Design for a Multicenter and Decentralized Prospective Observational Longitudinal Cohort Study in Hemophilia A

Background: Hemophilia A is a rare X-linked bleeding disorder caused by factor VIII (FVIII) deficiency. There is a compelling need in hemophilia to better understand the causes of bleeding in females and the factors underlying FVIII inhibitor development. To meet this need we are establishing a new NHLBI funded Hemophilia A Analytical Cohort Research Program (HARP) as part of a public-private partnership to support an Intergenerational Precision Medicine Program for the study of factor VIII (FVIII) immunogenicity in severe hemophilia A (Harpf8.org). The HARP objectives are: 1) Longitudinal assessment of bleeding in females with a severe hemophilia A genotype beginning in pregnancy; 2) Longitudinal assessment of anti-FVIII antibody formation in severe hemophilia A from birth through at least the first 2 years of life; 3) Studies of causes of bleeding in females with a severe hemophilia A genotype; 4) Studies of the immune response to FVIII in severe hemophilia A; 5) Development of a well-curated annotated data set of genetic, hemophilia, immune, environmental, psychosocial, and quality of life metrics; 6) Development of a multi-omics and immunologic biospecimen resource; and 7) Development of the hemophilia analytical Portal (F8portal.org). Study design: The HARP is a multicenter and decentralized prospective observational longitudinal cohort study beginning in pregnancy. It will follow 50 mother-baby pairs where the babies have severe hemophilia A and the mothers have a severe hemophilia A genotype. The private Clinical Consortium (CC) will oversee the study throughout the U.S., including sites that care for the mothers (up to 200 sites) and sites that care for the child (up to 70 sites). The CC will also conduct decentralized aspects of the study including collection of patient reported outcomes and local sample collection. The primary maternal endpoint is primary postpartum hemorrhage; the primary pediatric endpoint is rate of development of humoral immune response to FVIII and proportion that progress to clinical inhibitors. Mother and child secondary endpoints reflect the diverse research the HARP resource will support. Inclusion criteria for the pregnant person are: Pregnant and prior to 37 weeks gestation, known or at-risk to have a severe hemophilia A genotype, pregnant with a fetus at-risk for severe hemophilia A, ability to give informed consent, and &amp;gt; 18 years old. Inclusion criteria for the child are: severe hemophilia A, born to a person in the study. Exclusion/discontinuation criteria are: Presence of another significant bleeding disorder in mother or child; mother age &amp;lt;18 years; no fetus is at-risk to inherit severe hemophilia A; the child does not have severe hemophilia A; the child has a severe immune disorder; the mother or child participates in another study with blood collection volumes that exceed safety limits; mother's or child's healthcare will be outside the U.S.; the mother is a prisoner; any other reason that in the opinion of the investigator a subject is unsuitable for the study Summary: The HARP innovates in multiple areas of clinical study design to conduct a national prospective longitudinal intergenerational study in a rare disorder beginning in pregnancy. The structure includes a new multidisciplinary CC, systematic inclusion of Lived Experience Experts, strategies for broad community engagement, recruitment, and retention, and decentralized operations. This cohort will enable deep characterization, including genomics and other -omics, on pregnancy-associated bleeding and drivers of FVIII inhibitors in hemophilia A. The HARP Shareable Resource will be comprised of well annotated data and biological samples accessible to researchers through a portal, F8portal.org, and a linked biorepository.

Pregnancy and Delivery Outcome Among Ladies with Glanzmann Thrombasthenia: A Report from Glanzmann Thrombasthenia Registry of Al-Madinah, Saudi Arabia

Introduction Glanzmann's thrombasthenia (GT) is an autosomal recessive bleeding disorder due to functional platelet defects impairing platelet aggregation. AlMadinah has reported the highest prevalence of GT globally, with a prevalence of 1:10,000. Pregnancy had been reported among ladies with GT with different outcomes. As a bleeding disorder, Pregnancy among ladies with GT carries a higher risk for bleeding either during pregnancy or intra and postpartum. Neonates have an increased risk for hemorrhage, either due to alloimmunization or they may carry the gene of GT. Many GT ladies got pregnant earlier when GT diagnosis was difficult, and they did not know their diagnosis; even after the diagnosis was possible, ceasing the menstrual cycle was not culturally acceptable. In this study, we are describing the pregnancies among GT ladies and their outcomes. Methods This is a report from the AlMadinah GT registry in the Madinah Hemophilia Comprehensive Care Center. The registry covers a period of 20 years and includes all patients with a confirmed diagnosis of GT. 136 GT patients were identified. 11 patients had no data available. A spreadsheet designed to collect detailed data about pregnancy, delivery, and neonates. Electronic and hard copy medical records have been accessed to collect data. Data was analyzed by the statistical package of social sciences (SPSS) version 23. The research and ethical committee approved the study. Results Twenty-eight pregnancies have been identified. The median age of mothers at the time of pregnancy was 30 ± 5.7 years (20 - 42 years). Mothers' Gravidity was 1-7 (median 2.5 ± 1.6), and parity was 1-6 (median 2 ±1.4). Five miscarriages (18%) identified occurred at the 17 th, 11 th, 13 th and 15 th gestational weeks. In contrast, 5 th one is not on record. Three miscarriages took place after moderate to severe vaginal bleeding. Mild to severe post-abortion bleeding was controlled with platelets transfusion, activated human recombinant factor 7 (rFVIIa), and tranexamic acid. Thirty-two bleeding episodes occurred during 16 pregnancies, with 1-5 bleeding episodes per pregnancy (Median of 2 episodes). Seven (22%) bleeding episodes were vaginal bleeds, while 25 (78%) were GT-related bleeds such as gum bleeding or epistaxis. Two patients must undergo plasma exchange and be on steroids due to alloimmunization development during pregnancy. Delivery occurred at the gestational age of 34-40 weeks (median 38 ± 2 weeks). Sixteen (70%) deliveries were vaginal, and 7(30%) were cesarean sections. The indications for cesarean sections were family request in 4 cases, fetal distress in two instances, and precautional section in one case. Prophylactic platelets transfusion had given pre-delivery on four occasions, rFVIIa on 4, and a combination of rFVIIa and platelets transfusion on six occasions. Tranexamic acid was used in all cases. Ten deliveries were conducted with no prophylaxis. Post-partum hemorrhage (PPH) occurred in 18 (64%) cases, 13 (72%) cases of primary PPH, and 5 (28%) cases of secondary PPH. We could not find a correlation between pre-delivery prophylaxes and PPH (P=0.2). PPH had controlled successfully with platelets transfusion and rFVIIa though red blood cell transfusion was needed on eight occasions. Twenty-eight pregnancies produced 24 babies (13 girls and 11 boys). Four babies had bleeding (2 intracranial hemorrhages, one subdural hematoma, and one gum oozing), and 9 had alloimmunization with mild to severe thrombocytopenia. Of all babies tested for GT, 6 of them were GT. Conclusions Pregnancy among ladies with GT carries a higher risk of bleeding. Management of pregnancy in women with GT has to be in a Multidisciplinary approach. The high rate of PPH among GT ladies makes it essential to treat it promptly. Pregnancy among ladies with GT should be studied in multi-centers sitting to learn more about clinical courses and management.

What is the Role of Tranexamic Acid in the Management of Postpartum Haemorrhage? State of Art and Perspectives

Abstract: Primary postpartum haemorrhage (PPH) complicates the postpartum up to 11% of deliveries with different incidences based on geographical regions and is the first cause of maternal deaths, accounting for 25% of cases. Tranexamic acid may play a role in the delicate postpartum balance in case of PPH, inhibiting the conversion of plasminogen to plasmin and reducing the degradation of fibrin. We analyze literature evidence and the possible role of tranexamic acid in clinical practice and future scenarios.

Causes and outcome of pregnancy related acute kidney injury.

To determine frequencies of causes and renal outcomes of pregnancy related acute kidney injury. This descriptive case series study was conducted in Nephrology unit of a tertiary care hospital of Peshawar, from 1st August 2021 to 31st July 2022.A total of 100 patients with acute kidney injury secondary to obstetric conditions were enrolled via non-probability consecutive sampling technique. While patients with pre-existing renal disease, those with renal stones, or having bilateral small kidneys on ultrasound were excluded from the study. Patients were followed till 12 weeks postpartum period. Underlying obstetrical causes and outcome at 12 weeks postnatal period were determined. The mean age of sample of 100 cases was 29.29 ± 6.45. Mean serum creatinine at presentation was 6.5± 3.13. Majority of patient, 89% were multigravidas. Seventy eight percent patients required hemodialysis. Primary postpartum hemorrhage remained the commonest underlying cause of pregnancy related acute kidney injury in this study. The frequency of persistent renal failure in Pr-AKI (pregnancy related acute kidney injury) in this study was 14%. In about 66% of cases complete recovery occurred. All the underlying obstetrical causes, when adjusted for age, gravidity, place and mode of delivery, had no association with persistent renal failure. Primary postpartum hemorrhage is the predominant cause of pregnancy related acute kidney injury. By the end of 12 weeks postpartum, two third patients recover completely from pregnancy related acute renal injury.

Postpartum hemorrhage: clinical features and management in a tertiary care center of Nepal

Introduction: Obstetric haemorrhage continues to account for a substantial proportion of maternal deaths in Nepal, despite implementation of different strategies. The most common type of obstetric haemorrhage is postpartum hemorrhage (PPH), mainly primary. Understanding its burden in the health care setting was the objective of this study by assessing its prevalence, associated factors and management. Method: This was a retrospective study conducted at Patan Academy of Health Sciences from Mar 2019 to Mar 2022. Demographic, obstetrical, medical factors and management of primary PPH was collected from medical record. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS-20). Results were expressed using frequencies, tables and figures. Result: From a total 17,770 deliveries, primary PPH was seen in 84(0.47%). Most of them 49(58.3%) were multipara. The frequency and impact of PPH can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased caesarean section rate which was 48(57.1%) among primary PPH. Other associated risk factors were induction of labor 32(38.1%), pre-existing medical diseases 32(38.1%), history of antepartum hemorrhage 15(17.9%), previous caesarean section 19(22.6%). Uterine atony 43(51.2%), abnormal placentation disorder 16(19%), genital trauma 9(10.71%), retained tissue 5(5.95%) were the leading causes of PPH. PPH in morbidly adherent placenta like placenta accreta spectrum was 8(9.5%) and placenta increta 1(1.2%). PPH was controlled by conservative management in 24(28.6%). Surgical intervention was required in 34(40.5%) including hysterectomy in 14(16.7%). Conclusion: PPH can be minimized by extra vigilance and planned conjoined management.

Effect of Tranexamic Acid on Primary Postpartum Haemorrhage in at Risk Women at Abuth, Zaria: A Randomized Controlled Study

Background: Postpartum haemorrhage is an obstetric nightmare. Although it may occur in women with no identified risk, women with certain risk profiles are at increased risk PPH. Tranexamic acid has been shown to be effective in low risk women. Aim: To compare the effectiveness of Tranexamic acid to placebo in preventing PPH in at-risk women following vaginal delivery. Research Methods: The study was a randomized controlled trial at ABUTH, Zaria, in which 334 women identified as being at risk for PPH, were sequentially randomized into Tranexamic and placebo groups of 167 each. The Tranexamic acid group received intravenous 1g Tranexamic acid made up to 20ml with 0.9% Normal saline, while the placebo group received 20ml 0.9% Normal saline at delivery. Both groups received I.M 10IU oxytocin as part of AMTSL protocol. Blood loss was collected objectively in a blood collection drape at delivery.

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.

Incidence, Risk Factors, and Aetiologies of Primary Postpartum Haemorrhage After Vaginal Delivery in Kasr Al Ainy University Hospital: A Cross-Sectional Study

Background: Approximately 15% of all pregnancies (about 20 million) suffer from acute severe obstetric complications. The first 24 hours postpartum represent the period with the highest chance of mortality. The most evident complication is haemorrhage, solely accounting for 27% of all maternal deaths worldwide. Haemorrhage occurring postpartum accounts for 73% of all cases. Primary postpartum haemorrhage (PPH) is defined as the loss of at least 500 mL of blood after vaginal delivery or 1,000 mL of blood after Caesarean section within 24 hours of delivery. Aim: This cross-sectional study aims to evaluate the incidence and determine risk factors of PPH after vaginal delivery in Kasr Al Ainy University Hospital, Cairo, Egypt. Methodology: The study is a multivariate cross-sectional study. Single population proportion formula was used to determine the sample size in accordance with inclusion and exclusion criteria. Data was collected via assisted questionnaires, and results were statistically interpreted with a confidence interval of 95% to gather the odds ratio (OR) of significant risk factors of PPH. The SPSS® (IBM, Armonk, New York, USA) statistical package was used. Results: PPH incidence in Kasr Al Ainy in the period of this study was 8.1%. Atonic factors were implicated in 67% of all PPH after vaginal delivery. Most evident risk factors were prolonged labour (OR: 5.1), history of previous PPH (OR: 4.25), hypertension (OR: 2.53), and age ≥35 years (OR: 2.29), respectively. Conclusion: The authors’ research concluded that most cases of PPH were mainly of atonic causes, with prolonged labour being the most evident risk factor.