Stage Blood Loss Research Articles

Placental Cord Drainage Versus Clamping for Prevention of Blood Loss in the Third Stage of Labour

Abstract Background: Third stage of labour may contribute greatly in postpartum haemorrhage and maternal mortality if not well conducted. Unclamping of the maternal side of the umbilical cord after cutting may allow the placental cord blood to release freely and minimize blood loss. Aim of Study: This study aimed to investigate the effect of placental cord drainage on outcome of the third stage of labour. Patients and Methods: A randomized controlled clinical trial was conducted at the Emergency Unit of Obstetrics and Gynecology department, Mansoura University Hospital, Egypt. This study comprised a random sample of 116 parturient women who were expected to have spontaneous vaginal delivery and at low risk for postpartum hemorrhage. Women were divided into two equal groups (n=58 per each); the control group received the conventional management of the third stage of labour, similarly the study group in addition to the placental cord blood drainage. Data were collected assess-ing the participants' baseline characteristics and the third stage outcome sheet was used to evaluate outcomes of the third stage of labour. Results: Showed that the 3rd stage blood loss was signif-icantly lower by 146.7 ml in the study group compared to the control group (143.1±56 vs. 289.8±114.5; 95% CI, 113.6- 179.9, p<0.001). The third stage length was shorter in the study group than the control group by 2.6 minutes (4.5±1.7 vs. 7.1±2.9; t=5.788, p<0.001). Conclusion: Placental cord drainage during the third stage of labour was an effective method in reducing the blood loss and duration of third stage of labour. Being a safe, costless, and effective method placental cord drainage should be encouraged.

Minimally invasive surgery for the severe degenerative lumbar scoliosis: two stage protocol

Objective: To investigate the surgical outcome of minimally invasive surgery(MIS) for severe degenerative lumbar scoliosis(DLS) and put forward a two-stage MIS surgical strategy. Methods: Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out, excluding the patients whose apex vertebrae of scoliosis was above L(1/2) level or whose facet joint got spontaneous fusion. Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment. Information was recorded, including gender, age, body mass index, follow-up period, pelvic incidence (PI), blood loss, operation time, visual analogue pain score (VAS), Oswestry disability index (ODI), complications in the perioperative period and follow-up period, and also the radiographic parameters such as scoliosis Cobb angle, the mismatch between pelvic incidence and lumbar lordosis (PI-LL), sagittalvertical axis (SVA), coronal balance (CB) before and after each stage of surgery or latest follow-up. The paired-samples t test was used to analyze the effectiveness of staging surgery. Results: Fifty-three patients (18 males and 35 females) were included in this study. All patients had completed clinical and the follow-up records, with an average follow-up period of 11.52 months (6-20 months). A total of 168 segments fusions were performed with CLIF, 113 segments were performed with anterior column realignment (ACR), the average correct angle was 15.6°±6.3°(7°-28°) in sagittal plane each level. After the stage Ⅰ surgery, lumbar scoliosis cobb had been corrected for 55.35%, after the stage Ⅱ surgery, rate of correction was 75.6%. PI-LL had been matched (-32.8°±14.9° to -2.5°±9.4°), SVA was changed from 5.7 cm to 0.6 cm, the stage Ⅰ rate of correction was 80.3 and stage Ⅱ was 88.8%, pelvic tilt (PT), lumbar lordosis (LL) and CB had been restored; 13 (24.5%) patients were performed paraspinal approach transforaminal decompression. The posterior minimally invasive fixation indexes: 11(20.8%) patients were performed paraspinal approach transforaminal multi-segment transforaminal osteotomy (TFO) and internal fixation; 36(67.92%) cases were performed paraspinal approach transforaminal multi-segment fixation; 6(11.33%) patients were treated with percutaneous pedicle screw fixation. The average fixed segments was 7.4±1.4 in each patient. The blood loss of stage Ⅰ and stage Ⅱ operation was (157±71) ml, (343±224)ml, respectively. The operation time was (214±60) min, (190±54)min respectively in the two stage operations. The low back pain and leg pain VAS score and ODI improved after the stage Ⅰ and Ⅱ surgery (t=17.948, 10.099, 14.619, all P<0.001). Conclusions: MIS for the severe degenerative lumbar scoliosis can achieve good clinical outcome and deformity correction. The two-stage protocol has the advantages of less complications and is well-tolerated.

A study to evaluate the effectiveness of simple technique of placental drainage in control of third stage blood loss

A study to evaluate the effectiveness of simple technique of placental drainage in control of third stage blood loss

Intravenous carbetocin shot is superior to oxytocin infusion for placental delivery in second trimester abortion: a pilot randomized controlled trial

Objective: To study the efficacy of 100 μg intravenous shot of carbetocin compared to 20 IU oxytocin intravenous infusion to prevent placental retention in second trimester medical termination of pregnancy.Methods: A double-blinded randomized controlled trial was conducted at Ain Shams University Maternity Hospital from 1 April 2013 to 30 November 2013. A total of 132 women between 14 and 24 weeks gestation indicated for termination were randomized to receive either 20 IU oxytocin infusion (n = 66) or 100 μg carbetocin shot (n = 66) after fetal expulsion. Patients were observed for time elapsed between fetal and placental expulsion, presence of placental retention and blood loss.Results: Third stage was 33.4 ± 20.4 min in oxytocin group & 23.1 ± 16.8 min in carbetocin group (p = 0.002). Eight patients (12.1%) in oxytocin group had complete placental retention versus two patients (3.0%) in carbetocin group (p = 0.05). Eight patients (13.8%) received oxytocin had remnants of placenta compared to four patients (6.2%) received carbetocin (p = 0.04). Sixteen patients (24.2%) received oxytocin and six patients (9%) received carbetocin needed surgical curettage (p = 0.04). Third stage blood loss was 87.2 ± 33.7 ml in carbetocin and 206.9 ± 35.2 ml in oxytocin groups (p = 0.001).Conclusion: Carbetocin is superior to oxytocin infusion for management of placental delivery in second trimester abortion.

Role of Oral Misoprostol 600 mcg versus Inj. Syntometrinein the Active Management of Third Stage of Labour

Postpartum haemorrhage is the leading cause of direct maternal death in developing countries. The incidence of PPH may vary from less than 5% to more than 10%. About 30% of maternal deaths in India occur due to massive haemorrhage. Normal blood loss in a vaginal delivery may exceed 500 ml and can range from 500 to 1000 ml. A decline in hematocrit is a more reliable estimation of blood loss. Active management had definitely reduced third stage blood loss. World Health Organisation (WHO) recommends Intra muscular oxytocin in the third stage oflabour. Misoprostol PGE1 is a potent uterotonic agent. Ergometrine is also an effective oxytocic. This study has been conducted to compare the efficacy and safety of oral misoprostol 600 mcg with parenteral syntometrine in the active management of third stage of labour in 100 pregnant women of low risk pregnancies by objective assessment of the difference in pre- and post-delivery haemoglobin values. This study concludes that misoprostol has the potential of an effective, stable oral oxytocic with rapid onset of action. Though this study was limited to low risk patients, misoprostol has scope for use even in high risk patients of bronchial asthma, gestational hypertension, pre-eclampsia and Rhesus (Rh) negative groups where syntometrine is contraindicated. Thus, misoprostol may be used as an alternative to IM syntometrine in the active treatment of third stage of labour.

Comparison of Blood Loss in Induced vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag.

To compare third stage blood loss in induced vs. spontaneous vaginal deliveries and to correlate the amount of blood loss with the decrease in haemoglobin following deliveries. Department of Obstetrics and Gynaecology, Kasturba Hospital Manipal, Karnataka, India. Blood loss following placental deliveries was measured by using special collection bags in 150 pregnant ladies who delivered vaginally by labour induction and it was compared with that of another 50 women who had spontaneous vaginal deliveries. Haemoglobin values were recorded for each patient prior to labour and after delivery of child. The mean blood loss in induced group was 30 mL more than that in spontaneous group (202 ± 117 mL vs. 172 ± 114 mL), but this was not statistically significant (p=0.12). However, when different methods of induction were compared, oxytocin group was found to have significantly higher blood loss (327 ± 140 mL) as compared to that in other types of labour inductions as well as spontaneous deliveries. Labour induction using prostaglandins did not produce more blood loss as compared that produced by spontaneous deliveries. Both induced and spontaneous delivery groups showed statistically significant drops in post-delivery haemoglobin values, but the drop was relatively more in induced group as compared to that in spontaneous vaginal delivery group (0.96gm/dL vs. 0.56gm/dL), which appeared to be statistically significant (p=0.002). Labour induction using prostaglandins is safe as compared to oxytocin usage. Accurate estimation of blood loss is important in all types of deliveries, in order to detect postpartum haemorrhage early, so that appropriate measures can be undertaken.

The BLEED study: Testing an innovative drape that measures third stage blood loss

In Australia, postpartum haemorrhage (PPH) occurs in 6.8–9.2% of all births, with variation between states. Australian and overseas data suggest the rates of PPH and associated morbidity are increasing, and that further research and improved management of the third stage of labour, including estimation of blood loss, are required. Australian clinicians tend to estimate third stage blood loss visually, which under estimates blood loss which can lead to an under-diagnosis of PPH and poor identification of women at risk of complications from anaemia. Anaemia associated with third stage blood loss significantly contributes to serious postnatal health complications and maternal mortality. A calibrated blood collection drape has been found to be more accurate for measuring third stage blood loss when compared to the visual method and this has led to World Health Organisation endorsement. The acceptability of the blood collection drape however has not been tested, nor has the accuracy of Australian midwives visual estimations of blood loss when compared to the drape measurement. We are testing the accuracy and acceptability of a calibrated blood collection drape in the Australian setting. Data will be collected in the birth suite setting using blood loss estimates from 75 vaginal births. During phase one of the study (50 births), the drape will be placed under the woman by the midwife researcher and blinded to the midwife. The drape measurement will be recorded bythe researcher. The blood in the drape will then be estimated by the midwife using standard methods; either visual or weighing after the bloodhas been removed from thedrape.Midwives’ estimations will be compared to the drape measurements via statistical analysis, measuring interclass correlation and Kappa statistics. During phase two of the study (25 births) midwives will be asked to use the drape and complete a survey focussing on acceptability. Study results will be presented at the conference.

Five years follow-up of the Ready for Child trial

In Australia, postpartum haemorrhage (PPH) occurs in 6.8–9.2% of all births, with variation between states. Australian and overseas data suggest the rates of PPH and associated morbidity are increasing, and that further research and improved management of the third stage of labour, including estimation of blood loss, are required. Australian clinicians tend to estimate third stage blood loss visually, which under estimates blood loss which can lead to an under-diagnosis of PPH and poor identification of women at risk of complications from anaemia. Anaemia associated with third stage blood loss significantly contributes to serious postnatal health complications and maternal mortality. A calibrated blood collection drape has been found to be more accurate for measuring third stage blood loss when compared to the visual method and this has led to World Health Organisation endorsement. The acceptability of the blood collection drape however has not been tested, nor has the accuracy of Australian midwives visual estimations of blood loss when compared to the drape measurement. We are testing the accuracy and acceptability of a calibrated blood collection drape in the Australian setting. Data will be collected in the birth suite setting using blood loss estimates from 75 vaginal births. During phase one of the study (50 births), the drape will be placed under the woman by the midwife researcher and blinded to the midwife. The drape measurement will be recorded bythe researcher. The blood in the drape will then be estimated by the midwife using standard methods; either visual or weighing after the bloodhas been removed from thedrape.Midwives’ estimations will be compared to the drape measurements via statistical analysis, measuring interclass correlation and Kappa statistics. During phase two of the study (25 births) midwives will be asked to use the drape and complete a survey focussing on acceptability. Study results will be presented at the conference.

Programmed Labor—Indegenous Protocol to Optimize Labor Outcome

ABSTRACT Objective To Asses and develop an indigenous protocol to optimize labour outcome, as Programmed Labor. Design Open, prospective (Between January 2000 to December 2007), randomized, parallel group, monocentric, comparative matching trial. Settings Labor rooms at Nowrosjee Wadia Maternity, Mumbai. Selection criteria 200 patients in each group, aged between 21-30, as low-risk parturient. Intervention Partography, Oxytocin, Primiprost, Pentazocin, Dizepam, Tramadol, Drotin, Ketamine. Outcome parameters Satisfactory obstetric outcome, progressive labor of shorter duration, less blood loss and pain relief. Results Study group had mean shorter duration of active labor as 3.5 hrs compared to controls of 5.2 hrs. Excellant pain relief was of 24 and 62% of substantial relief in comparison to 32% only in other group with no patient falling in excellent group. Second stage of labor was reduced by half (26 to 48 meters) and lesser third stage blood loss. Conclusions Programmed labor with indigenous protocol developed and practiced, results in progressive, shorter, and comfortable labors with lesser blood loss.

Active management of third stage of labour: comparison between prophylactic intramuscular methylergometrine and intramuscular oxytocin

Aim: Aimed at comparing the efficacy of prophylactic intramuscular methylergometrine with intramuscular oxytocin in reducing blood loss in the third stage of labour (TSL). Methods: This is a randomized, comparative, clinical trial to compare the efficacy of intramuscular methylergometrine with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage Two hundred women undergoing normal vaginal delivery were recruited, 100 in each group- Group A receiving .2mg methylergometrine intramuscularly and Group B receiving 10U oxytocin intramuscularly immediately after the delivery of the anterior shoulder of the baby. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in haemoglobin (Hb) and haematocrit (Hct) level from before delivery to 24 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Intramuscular methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post partum haemorrhage (PPH) [defined as fall in Hb and /or Hct level³ 10% from before delivery to 24 hours after delivery]. There was no difference in the risk of prolonged third stage, need for additional uterotonic agents, need for exploration and uterine evacuation and need for blood transfusion in the two groups. The side effects were all mild in nature and the overall incidence was too low for statistical significance to be elicited. Conclusion: Intramuscular methylergometrine is as efficacious as intramuscular oxytocin in the prevention of third stage blood loss with comparable side effects. Keywords: Third stage of labour, postpartum hemorrhage, methylergometrine, oxytocin. doi:10.3126/njog.v2i2.1451 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 24 - 28