Reduce Postpartum Hemorrhage Research Articles

Sublingual Misoprostol in Active Management of the third Stage: Maternal Outcome

Background: The use of uterotonic agents in active management of the third stage of labor has been shown to reduce postpartum hemorrhage. Although intramuscular oxytocin remains the uterotonic of choice, others such as intravenous oxytocin, ergometrine, carboprost, and misoprostol can be used. Sublingual misoprostol has been shown to have the greatest bioavailability, achieving the highest plasma concentration in the shortest time when compared to other routes at equal dose. Objective: To evaluate whether the addition of sublingual misoprostol to intramuscular oxytocin in active management of the third stage of labor is beneficial. Methodology: This was a randomized controlled trial that involved all women planned for vaginal delivery who presented in labor. After consenting, these women were randomly assigned and received either 600µg of sublingual misoprostol and 10IU of intramuscular oxytocin or 10IU of intramuscular oxytocin alone. Following delivery of the placenta, blood loss was assessed by the gravimetric method. The data obtained was analyzed and compared between the two groups. Results: Three hundred and six women were randomized in this study, one hundred and fifty-three women into each group. Baseline characteristics and risk factors for postpartum hemorrhage were similar for both groups except for parity, maternal weight, and cervical laceration. When these were subjected to logistic regression, they were not found to significantly predict the occurrence of postpartum hemorrhage. Sublingual misoprostol in addition to IM oxytocin significantly reduced postpartum hemorrhage, duration of the third stage, blood transfusion, and need for additional uterotonics as compared to IM oxytocin alone. Fever and shivering occurred more in the misoprostol group, but only shivering was statistically significant. All side effects were transient and self-limiting. Conclusion: The addition of sublingual misoprostol to IM oxytocin has statistical significance in reducing primary postpartum hemorrhage, duration of the third stage of labor, blood transfusion, and need for additional oxytocics.

Effectiveness of Telemedicine and Remote Monitoring in Reducing Postpartum Hemorrhage Rates: A Meta-Analysis

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited access to healthcare. Telemedicine and remote monitoring technologies offer potential solutions for early detection and management of PPH. This meta-analysis aimed to evaluate the effectiveness of these technologies in reducing PPH rates. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published between 2013 and 2024 investigating the impact of telemedicine and remote monitoring interventions on PPH rates. Randomized controlled trials (RCTs) and observational studies with a control group were included. The primary outcome was the incidence of PPH (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after cesarean delivery). Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Publication bias was assessed using funnel plot asymmetry and Egger's test. Six studies involving 4200 women met the inclusion criteria. The pooled analysis demonstrated a statistically significant reduction in PPH rates in the intervention groups compared to the control groups (RR 0.56; 95% CI 0.47-0.67; p<0.00001). The funnel plot was symmetrical, and Egger's test was not statistically significant (p=0.45), suggesting no evidence of publication bias. Telemedicine and remote monitoring interventions are associated with a significant reduction in PPH rates. These findings support the integration of these technologies into postpartum care to improve maternal outcomes, particularly in resource-constrained settings.

Comparative Clinical Study for Uterotonic Drugs Used in Reducing Postpartum Haemorrhage for Risky Patients in Caesarean Section

Comparative Clinical Study for Uterotonic Drugs Used in Reducing Postpartum Haemorrhage for Risky Patients in Caesarean Section

Misoprostol versus oxytocin in reducing postpartum hemorrhage after labor induction

Misoprostol versus oxytocin in reducing postpartum hemorrhage after labor induction

Factors associated with postpartum hemorrhage in selected Southern Oromia hospitals, Ethiopia, 2021: an unmatched case-control study.

Around one-fourth of maternal deaths worldwide are attributed to hemorrhage. One of the prevalent types of maternal hemorrhage is postpartum hemorrhage. In spite of this, there is very little data on postpartum hemorrhage. Thus, the intention of this study was to determine factors associated with postpartum hemorrhage among mothers who gave birth in the selected Southern Oromia hospitals in Ethiopia. An institutional-based, unmatched case-control study was employed on a sample of 333 (83 cases and 250 controls) mothers who gave birth from March 1-30, 2021. Standardized and pretested check-lists were used to retrieve data from patients' cards, delivery registration, and operation registration logbooks. Epi Data Version 3.1 was used to enter data, while SPSS Version 25 was used for analysis. Multi-variable logistic regressions were used to identify the determinants of postpartum haemorrhage with a 95% confidence interval and p-value less than 0.05. Mothers who have no antenatal care follow-up (AOR = 1.94, 95% CI = 1.03, 3.64), had pre-partum anemia (AOR = 5.68, 95% CI = 3.13, 10.32), hypertensive disorder during pregnancy (AOR = 3.3, 95% CI = 1.13, 9.64), intrauterine fetal death (AOR = 4.21, 95% CI = 1.68, 10.58), and genital tract trauma during delivery (AOR = 3.23, 95% CI = 1.52, 6.89) were found as determinants of postpartum haemorrhage. The study showed that factors such as lack of antenatal care, pre-partum anemia, pregnancy-related hypertension, intrauterine fetal death and genital tract trauma during delivery were responsible for postpartum hemorrhage. The early introduction of antenatal care services for all mothers plays a crucial role in reducing postpartum hemorrhage.

Analysis of the Role of the Comprehensive Guided Labor Nursing Intervention in Improving Maternal Adverse Emotions

Objective: To analyze the application value of the comprehensive guided labor nursing model in improving maternal negative emotions. Methods: Eighty cases of mothers admitted to the hospital from June 2022 to June 2023 were sampled and randomly grouped, with comprehensive guided labor nursing intervention included in Group A and conventional care included in Group B. Emotion scores, labor and delivery, pregnancy outcomes, and nursing satisfaction were compared. Results: Maternal self-rating anxiety (SAS) and depression (SDS) scale scores were lower in Group A than in Group B (P < 0.05). Maternal visual analog scores (VAS) and postpartum hemorrhage were lower in Group A than in Group B (P < 0.05). Additionally, the duration of each stage of labor was shorter than in Group B (P < 0.05). The incidence of adverse pregnancy outcomes was lower in Group A than in Group B, and the rate of spontaneous deliveries was higher in Group A compared to Group B (P < 0.05). Furthermore, nursing care satisfaction was higher in Group A than in Group B (P < 0.05). Overall, Group A had a higher rate of maternal nursing satisfaction than Group B (P < 0.05). Conclusion: Comprehensive guided labor nursing can shorten the duration of labor, reduce postpartum hemorrhage, and decrease the rate of adverse pregnancy outcomes, thereby contributing to the improvement of maternal mood. This approach proves to be efficient and feasible in clinical practice.

EFFICACY OF UTERINE PACKING AND INTRAUTERINE BALLOON TAMPONADE IN ATONIC POSTPARTUM HEMORRHAGE COMPARISON

A randomized controlled trial was conducted between March 1, 2023, and September 1, 2023, at the Gynae unit of the Mardan Hospital complex in Mardan. The study aimed to evaluate the effectiveness of two strategies in treating postpartum hemorrhage caused by atony. The two strategies evaluated were uterine gauze packing and uterine balloon tamponade. A total of 168 women who had experienced postpartum hemorrhage due to uterine atony after a vaginal birth were enrolled in the study through non-probability sampling. Patients with clotting disorders, trauma-related hemorrhage, and those who had undergone cesarean deliveries were excluded from the study. The study had two groups of patients, with 84 patients enrolled in group A and 84 in group B. The study aimed to compare the effectiveness of the two strategies in minimizing blood loss in the first 24 hours following birth. The study found that uterine balloon tamponade was more effective in reducing postpartum hemorrhage caused by uterine atony than uterine gauze packing. Specifically, 75 (89.3%) patients in group A reported the effectiveness of uterine balloon tamponade, while uterine gauze packing was reported in 61 (72.6%) patients in group B. This difference in effectiveness was statistically significant (P=0.006). The Chi-square test was used to compare the two groups, with a P value of 0.05 considered significant. In conclusion, the study suggests that uterine balloon tamponade is more effective in reducing postpartum hemorrhage caused by uterine atony than uterine gauze packing.

Clinical study on the combination of misoprostol and oxytocin to prevent and reduce postpartum hemorrhage.

Clinical study on the combination of misoprostol and oxytocin to prevent and reduce postpartum hemorrhage.

Study of the Role of Conservative Surgical Methods During Cesarean Section to Reduce Postpartum Hemorrhage

Study of the Role of Conservative Surgical Methods During Cesarean Section to Reduce Postpartum Hemorrhage

Prophylactic radiologic interventions to reduce postpartum hemorrhage in women with risk factors for placenta accreta spectrum disorder: a nationwide cohort study

Objective To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS) Methods We conducted a retrospective nationwide cohort study of women with risk factors for placenta accreta spectrum disorder who underwent planned cesarean section in 69 Dutch hospitals between 2008 and 2013. All women had two risk factors for PAS: placenta previa/anterior low-lying placenta and a history of cesarean section(s). Women with and without ultrasonographic signs of PAS were studied as two separate groups. We compared the total blood loss of women with prophylactic radiologic interventions, defined as preoperative placement of balloon catheters or sheaths in the internal iliac or uterine arteries, with that of a control group consisting of women without prophylactic radiologic interventions using multivariable regression. We evaluated maternal morbidity by the number of red blood cell (RBC) units transfused within 24 h following childbirth (categories: 0, 1–3, >4), duration of hospital admission, and need for intensive care unit (ICU) admission. Results A total of 350 women with placenta previa/anterior low-lying placenta and history of cesarean section(s) were included: 289 with normal ultrasonography, of whom 21 received prophylactic radiologic intervention, and 61 had abnormal ultrasonography, of whom 22 received prophylactic intervention. Among women with normal ultrasonography without prophylactic intervention (n = 268), the median blood loss was 725 mL (interquartile range (IQR) 500–1500) vs. 1000 mL (IQR 550–1750) in women with intervention (n = 21); the adjusted difference in blood loss was 9 mL (95% confidence interval (CI) −315–513), p = .97). Among women with abnormal ultrasonography, those without prophylactic intervention (n = 39) had a median blood loss of 2500 mL (IQR 1200–5000) vs. 1750 mL (IQR 775–4000) in women with intervention (n = 22); the adjusted difference in blood loss was −1141 mL (95% CI −1694– −219, p = .02). Results of outcomes on maternal morbidity were comparable among women with and without prophylactic intervention. Conclusion These findings suggest that prophylactic radiologic interventions prior to planned cesarean section may help to limit perioperative blood loss in women with clear signs of placenta accreta spectrum disorder on ultrasonography, but there was no evidence of a difference within the subgroup without such ultrasonographic signs. The use of these interventions should be discussed in a multidisciplinary shared decision-making process, including discussions of potential benefits and possible complications. Trial registration Netherlands Trial Registry, https://onderzoekmetmensen.nl/en/trial/28238, identifier NL4210 (NTR4363)

Tranexamic Acid Administered During Cesarean Delivery in High-risk Patients: Maternal Pharmacokinetics, Pharmacodynamics, and Coagulation Status

(Am J Obstet Gynecol. 2022;S0002-9378(22)00441-0) Tranexamic acid (TXA) is often used to prevent or reduce postpartum hemorrhage (PPH), reducing the risk of maternal mortality and decreasing the blood transfusion rate. TXA is widely used in clinical practice, but dosing and covariates that affect the effectiveness of the drug have yet to be studied in the obstetric population. The purpose of this study was to evaluate the pharmacokinetics and pharmacodynamics of the current recommended 1 g intravenous dosage of TXA typically administered during cesarean delivery, and in conjunction use rotational thromboelastometry to assess clot formation and fibrinolysis in patients with high risk of PPH. The primary aim was to evaluate the central tendency and variability of TXA plasma concentrations in high-risk patients after the standard dose up to 5 hours after delivery. Secondary aims were to estimate the correlation between TXA plasma concentrations and body mass index, assess coagulation measurements using rotational thromboelastometry, and other outcomes related to PPH, such as changes in hemoglobin and the requirement of blood transfusions.

Penyuluhan tentang Manfaat Kurma (Phoenix dactylifera L.) sebagai Upaya Memperlancar Persalinan

Fluid and nutritional needs are physiological needs that must be properly met by the mother during the birth process. Dates are rich in carbohydrates as a source of energy, influencing the progress of labor, spontaneity in labor and reducing postpartum hemorrhage. Carbohydrates as amplifiers are sugars that are absorbed and used by the body's cells shortly after consumption. Dates also contain B vitamins, minerals, iron, calcium, magnesium, potassium, saturated fatty acids and unsaturated fatty acids. Fatty acids besides providing energy also help provide prostaglandins. Fatty acids can help store energy and strengthen the uterine muscles. Dates also contain hormones that can stretch the uterus when approaching the birth of a baby. Therefore it is necessary to do counseling about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate labor. The activity of providing counseling about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate childbirth was carried out in Jempong Baru Village, Sekarbela District, Mataram City and was attended by 20 pregnant women. The results of the pretest and posttest showed an increase in pregnant women's knowledge about the benefits of dates (Phoenix dactylifera L.) as an effort to facilitate labor.

Postpartum Hemorrhage Prevention Quality Improvement Initiatives and Blood Transfusion Utilization [ID: 1378079

INTRODUCTION: The universal implementation of active management of the third stage of labor, quantitative assessment of blood loss, and hemorrhage risk assessment on admission is recommended to reduce the incidence and morbidity of postpartum hemorrhage. We evaluated the effect of these quality improvement (QI) initiatives, in addition to an active management protocol for iron deficiency anemia antepartum, on the use of blood transfusion during delivery hospitalization. METHODS: We obtained blood transfusion data for the obstetric service at a tertiary care university hospital from January 1, 2017 to July 13, 2022, as well as data for every delivery during that time period (N=11,101). Institutional review board approval was obtained for the study. Patients whose transfusions were administered for nonobstetric indications were excluded. We compared the frequency of blood transfusions and number of units transfused per patient before and after the implementation of QI initiatives. RESULTS: There was a significant downward trend in the frequency of blood transfusions (P=.003) and the number of units transfused per patient (P=.000006) during the study period. The transfusion rate was 3.3% in the year prior to any intervention and 1.78% after implementation of all QI initiatives. No differences were observed in the characteristics of the patient population relevant to hemorrhage risk during the study period. CONCLUSION: This study provides evidence that in addition to reducing postpartum hemorrhage and its morbidity, these QI initiatives also help reduce blood transfusion utilization.

Efficacy and Safety of Carbetocin Versus Misoprostol in Cesarean Section: A Systematic Review and Meta-Analysis.

In the absence of comprehensive data investigating carbetocin versus misoprostol for reducing postpartum hemorrhage (PPH) during cesarean section (CS), we performed this investigation to compare the efficiency and side events of carbetocin versus misoprostol in the protection and reduction of PPH for women who underwent CS. Frominception to September 2022, we depended on searching through various databases for eligible trials involving Cochrane, Web of Science, PubMed, Scopus, and Google Scholar. From the efficacy prospect, we found that carbetocin substantially decreased intraoperative blood loss (p<0.001), hemoglobin/hematocrit levels (p<0.001), and the need for blood transfusion (p=0.002)/additional surgical interventions (p=0.003) than misoprostol. However, we revealed no substantial variation between both drugs for the need for additional uterotonic agents (p=0.08). From the safety prospect, we found that incidences of fever (p=0.002), heat sensation (p=0.007), metallic taste (p=0.01), and shivering (p=0.0002) were lower incarbetocin administration than in misoprostol. However, headache (p=0.34) and palpitation (p=0.11) incidences revealed no substantial variation between both drugs. In conclusion, from the efficacy and safety prospect, for women who underwent CS, carbetocin is more effective and safer in preventing and reducing PPH than misoprostol.

Does prophylactic tranexamic acid reduce postpartum hemorrhage in vaginal deliveries?

Does prophylactic tranexamic acid reduce postpartum hemorrhage in vaginal deliveries?

Impact of non pneumatic anti shock garment in reducing postpartum haemorrhage - a tertiary centre experience

Impact of non pneumatic anti shock garment in reducing postpartum haemorrhage - a tertiary centre experience

Date Juice Accelerates Labor in the First Stage

Labor is a normal process characterized by uterine contractions that cause significant cervical dilatation accompanied by expulsion of the fetus and placenta from the woman's body. The progress of labor in the first stage is the most tiring, strenuous, and most mothers begin to feel pain or pain, in this phase most mothers feel severe pain because uterine activities begin to be more active. The active phase of the first stage of labor involves a lot of energy, so the nutritional needs of the first stage need special attention from the labor manager. One of the fruits that contain considerable energy is the date palm which contains fructose and glucose, all of which are energy sources that are easily absorbed by the body. Dates contain lots of carbohydrates, affect the progress and spontaneity of labor and reduce postpartum hemorrhage. Dates contain saturated and unsaturated fatty acids such as oleic, linoleic, and linolenic acids. Fatty acids in addition to providing and ordering energy, contribute to the delivery of prostaglandins. Therefore, dates can help in saving energy and strengthening the uterine muscles.

Effects of Misoprostol on Induction of Labour in Patients with Hypertensive Disorders of Pregnancy: A Meta-Analysis.

Objective Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for clinical decisions, we systematically reviewed the effects of misoprostol on induction of labour in HDP patients. Methods PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for relevant literature from 2010 to 2020. Subsequently, a meta-analysis was performed to compare the effective rate of induction of labour and reducing postpartum hemorrhage (PPH) between the intervention group (n = 544, misoprostol) and the control group (n = 543, oxytocin). Results A total of 10 studies with 1087 patients were included. The 10 studies compared the effective rate of induction of labour between the two groups and confirmed that the effective rate in the intervention group was significantly higher than that in the control group (OR = 4.37; 95% CI: 2.73, 7.00). Seven studies compared PPH between the groups and showed that it was significantly reduced in the intervention group compared to the control group (SMD = −1.32; 95% CI: −2.05, −0.59; P < 0.0001). Conclusion Misoprostol has a high effective rate of induction of labour in HDP patients and is an effective uterotonic agent in reducing PPH. This meta-analysis provides clinicians with meaningful information to help them make evidence-based decisions.

Oxytocin in Women's Health and Disease.

Oxytocin (OT) is a nonapeptide mainly produced in the supraoptic and paraventricular nuclei. OT in the brain and blood has extensive functions in both mental and physical activities. These functions are mediated by OT receptors (OTRs) that are distributed in a broad spectrum of tissues with dramatic sexual dimorphism. In both sexes, OT generally facilitates social cognition and behaviors, facilitates parental behavior and sexual activity and inhibits feeding and pain perception. However, there are significant differences in OT levels and distribution of OTRs in men from women. Thus, many OT functions in men are different from women, particularly in the reproduction. In men, the reproductive functions are relatively simple. In women, the reproductive functions involve menstrual cycle, pregnancy, parturition, lactation, and menopause. These functions make OT regulation of women’s health and disease a unique topic of physiological and pathological studies. In menstruation, pre-ovulatory increase in OT secretion in the hypothalamus and the ovary can promote the secretion of gonadotropin-releasing hormone and facilitate ovulation. During pregnancy, increased OT synthesis and preterm release endow OT system the ability to promote maternal behavior and lactation. In parturition, cervix expansion-elicited pulse OT secretion and uterine OT release accelerate the expelling of fetus and reduce postpartum hemorrhage. During lactation, intermittent pulsatile OT secretion is necessary for the milk-ejection reflex and maternal behavior. Disorders in OT secretion can account for maternal depression and hypogalactia. In menopause, the reduction of OT secretion accounts for many menopausal symptoms and diseases. These issues are reviewed in this work.

Comparison of Postpartum Hemoglobin and Hematocrit Levels In Conventional and Physiological Delivery in Iran: A Quasi-Experimental Study

Background: Despite the great importance of controlling and preventing postpartum hemorrhage, no evidence has been provided to reduce postpartum hemorrhage physiologically compared to conventional vaginal delivery. While it is claimed that physiological delivery can be better than conventional delivery, in many ways, there is insufficient available information about the effect of the delivery method on postpartum hemoglobin and hematocrit levels. Objective: The current study aimed to compare postpartum hemoglobin and hematocrit levels in conventional and physiological delivery methods in Fatemieh Hospital of Hamedan. Methods: This quasi-experimental study was conducted on 400 pregnant women candidates for physiological delivery and 400 pregnant women for conventional vaginal delivery in 2019. Mothers in the physiological delivery group were provided with the necessary training. In the conventional vaginal delivery group, the mother went through the usual procedures upon hospitalization. All mothers' venous blood samples were analyzed for hemoglobin and hematocrit levels at the time of hospitalization and six hours after delivery. The significance level was considered at p = 0.05. Results: The outcomes indicated that by controlling the confounding variables, the mean of hemoglobin in the physiologic delivery group was significantly higher than conventional vaginal delivery, 11.93 (1.20) and 11.64 (1.20) respectively (P &lt;0.001), but the Cohen's d value of 0.25 indicated a weak relationship between the mean of hemoglobin level six hours after delivery and the type of delivery. The results also indicated that by controlling the effect of confounding variables, the mean of hematocrit in the physiological group was significantly more than conventional vaginal delivery (36.53 (3.33) and 35.50 (3.33) respectively) (p &lt;0.001) but the Cohen's d value of 0.31 indicates a weak relationship between mean hematocrit 6 hours after delivery and the type of delivery. Conclusions: The results indicated that physiologic delivery did not show a valuable/considerable or the expected effect on improving postpartum maternal hemoglobin and hematocrit levels comparing to conventional delivery.