PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “HEMORRHAGE, POSTPARTUM”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2003

Successful treatment of life-threatening postpartum hemorrhage with recombinant activated factor VII.

BACKGROUND: Postpartum hemorrhage is one of the most common causes of maternal mortality and morbidity worldwide. The aims of treatment are to maintain the circulation and to stop the bleeding. The latter is achieved by either medical or surgical management. In intractable bleeding, emergency hysterectomy is usually required. CASE: A 30-year-old nullipara presented with major postpartum hemorrhage due to uterine atony and vaginal lacerations. The patient developed hemorrhagic shock, resulting in prolonged prothrombin time, prolonged activated partial thromboplastin time, and low levels of factor VIII and fibrinogen. Treatments with uterotonic drugs, suturing, ligation of internal iliac arteries, subtotal hysterectomy, packing of the pelvis, and blood transfusion failed to control diffuse pelvic and vaginal bleeding. Recombinant activated factor VIIa (60-microg/kg intravenous bolus injection) was given as a final attempt to control the bleeding. The bleeding was successfully controlled within 10 minutes after administration. No side effects were noted. CONCLUSION: Recombinant factor VIIa may be an alternative hemostatic agent in a patient with life-threatening postpartum hemorrhage unresponsive to conventional therapy.

Adult↗
PubMedDate not supplied

Maternal and perinatal outcome of massive postpartum hemorrhage: a review of 33 cases.

BACKGROUND: Postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. PATIENTS AND METHODS: We evaluated maternal and perinatal outcome of primary massive postpartum hemorrhage. In a restrospective case analysis of 33 women with intractable postpartum hemorrhage initially managed either by hysterectomy or a conservative approach in a tertiary referral center between January 1, 1991 to December 30, 1998, we reviewed the procedures used as a primary or secondary attempt to arrest the hemorrhage. RESULTS: Medical and surgical measures were successful in controlling hemorrhage in 21 (63.6%) of the 33 women. Hemorrhage was successfully arrested by conservative surgery in 13 cases, and by medical management in 8 cases. Emergency hysterectomy was performed in 12 cases (0.7 per 1000 deliveries) No maternal deaths occurred, but there were 2 early neonatal deaths (6.1 %). Atony of the uterus was the main cause of hemorrhage (n=15). Genital tract laceration was associated with a worse prognosis, but the time lapse between delivery and surgery appears to be the main prognostic factor. CONCLUSION: Uterine atony and morbid adherent placenta are major causes of massive obstetric hemorrhage. In our series, morbidity was high, but there was no mortality. Obstetricians should identify women at risk which is especially associated with a prior cesarean delivery, a current placenta previa and high parity. Early intervention and proper procedure could minimize the complications.

Journal Article↗
PubMed1975

Postpartum hemorrhage and reevaluation of uterine packing.

Postpartum hemorrhage, occurring in 153 patients, is categorized according to etiology, predisposing conditions, and severity. Ruptured uterus is considered as a cause of postpartum hemorrhage, with an incidence of 7.1% overall and 11.9% in patients with severe hemorrhage. The effectiveness and complications of the uterine pack, used in 33 patients, are evaluated.

Adult↗
PubMed2003

[Application of emergency hysterectomy on severe postpartum hemorrhage].

OBJECTIVE: To investigate the value of emergency hysterectomy on arresting severe postpartum hemorrhage. METHODS: A retrospective analysis was performed on 10 cases of hysterectomy by reason of postpartum hemorrhage between Jan 1990 and Dec 2000. RESULTS: All the patients were severe postpartum hemorrhage that couldn't be controlled by conservative treatment. Among them, there were 5 cases of DIC, 2 cases of placental adherence, 1 case each of uterine atony, uterine rupture and infection of uterine incision. Blood loss averaged 2,427 ml. All the 10 patients were recovered. Emergency hysterectomy was related to times of gestation and delivery and also to delivery pattern. CONCLUSION: Emergency hysterectomy is one of the effective methods on arresting severe postpartum hemorrhage.

Emergencies↗
PubMed2005

Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review.

The authors describe three patients who developed massive primary postpartum hemorrhage and review the case reports. In two patients, primary postpartum hemorrhage was due to uterine atony, and in one patient it was due to atony and thrombophilia. In all three patients, excellent effect was achieved with hemorrhage reduction by a compression B-Lynch suture alone, with bimanual compression following medicamentous uterotonic therapy. B-Lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. In our opinion, the method should be included in the algorithm of primary postpartum hemorrhage management at all obstetric departments.

Adult↗
PubMed2001

Misoprostol in the prevention of postpartum hemorrhage.

OBJECTIVE: To evaluate the data regarding the use of misoprostol in the prevention of postpartum hemorrhage. DATA SOURCES: Pertinent literature was identified through a MEDLINE search (1966-January 2001) and through other secondary literature databases and/or bibliographies of pertinent articles. DATA SYNTHESIS: New strategies in the prevention of postpartum hemorrhage are being evaluated due to the obstacles surrounding conventional therapies. One therapeutic option is the use of misoprostol. This literature review evaluates the published clinical data involving misoprostol in the prevention of postpartum hemorrhage. Current data suggest that the use of misoprostol for the prevention of postpartum hemorrhage reduces mean estimated blood loss compared with placebo. However, no clinical trials have detected a statistically significant decrease in the incidence of postpartum hemorrhage in misoprostol-treated subjects. There is conflicting evidence regarding the efficacy of misoprostol compared with conventional uterotonics, such as oxytocin or Syntometrine. CONCLUSIONS: In situations where conventional oxytocics are not readily available, storage requirements for oxytocics cannot be met, or the equipment for parenteral administration is not obtainable, misoprostol may be an acceptable prophylactic option.

Clinical Trials as Topic↗
PubMedDate not supplied

A randomized controlled trial of oxytocin administered at the end of the second stage of labor versus oxytocin administered at the end of the third stage of labor in the prevention of postpartum hemorrhage.

The general objective was to determine the incidence of postpartum hemorrhage when oxytocin was administered at the end of the second stage of labor compared to when oxytocin was administered at the end of the third stage. The specific objectives were to determine the mean amount of blood loss, duration of the third stage of labor, need for additional uterotonics and blood transfusion, incidence of hypotension and retained placenta, and mean difference in hemoglobin levels. A randomized controlled trial was conducted in a tertiary care training hospital. 130 women with term, singleton, live pregnancies in cephalic presentation who delivered vaginally were included. Patients were randomly allocated to receive oxytocin after the second stage or after the third stage of labor. Oxytocin was administered as a continuous intravenous infusion. The placenta was delivered by controlled cord traction after placental separation. Blood loss was measured by weight, and the corresponding volume was computed. Relative risk was calculated. Incidence of postpartum hemorrhage, volume of blood loss, duration of the third stage of labor, need for additional uterotonics and blood transfusion, incidence of hypotension and retained placenta, and difference in hemoglobin levels were the main outcome measures. There was a decreased incidence of postpartum hemorrhage (39.66% vs. 48.61%, relative risk [RR] = 0.82, 95% confidence interval [CI] = 0.55-1.21) and less amount of blood loss (557.93 ml vs. 636.84 ml, p = 0.352) when oxytocin was administered at the end of the second stage of labor. There was less need for additional uterotonics (12.07% vs. 13.89%, RR = 0.87, 95% CI = 0.35-2.14), and blood transfusion (5.17% vs. 5.56%, RR = 0.87, 95% CI = 0.22-3.99). There was a smaller mean difference in hemoglobin (16.20 g/dl vs. 20.29 g/dl, p = 0.145). Mean duration of the third stage of labor were comparable (7.93 minutes vs. 7.96 minutes, p = 0.863). However, more patients developed hypotension (3.45% vs. 1.39%, RR = 2.48, 95% CI = 0.23-26.70). All results were not statistically significant. There was no incidence of retained placenta. There is a trend towards a reduction of the risk of postpartum hemorrhage when oxytocin is administered at the end of the second stage of labor. This is not accompanied by an increased risk for any morbidity.

Asia↗
PubMed1980

Embolization of pelvic arteries for control of postpartum hemorrhage.

Two cases are presented in which postpartum hemorrhage was controlled by Gelfoam embolization via an angiographic catheter. The advantages of embolization over surgery are discussed. It is suggested that an attempt be made to control severe postpartum hemorrhage by this means before resorting to surgery.

Adult↗
PubMed2001

[Transcatheter arterial embolization in intractable postpartum hemorrhage].

OBJECTIVE: To asses the value of transcatheter arterial embolization treatment in intractable postpartum hemorrhage. METHODS: Fourteen patients of postpartum hemorrhage failed to the drugs treatment were performed transcatheter arterial embolization (TAE). Superselective catheterization to the bilateral uterial arteries or anterior branches of internal iliac arteries was carried out after intubation to single-side femoral artery by Seldinger's technique. When the catheter tip was proved in right place by digital substraction angiography (DSA) techniques, antibiotic solution was poured into arteries and then the arterial embolization with gelfoam particles was followed. RESULTS: All the patients were performed TAE successfully. The duration of TAE was 30-50 minutes [mean (41.8 +/- 6.4) minutes]. Bleeding was found in DSA mostly as diffuse intrauterine flow outward sign from one side or both side of uterial artery branches. After one time of TAE, the vaginal bleeding of all patients was stopped in 3-10 minutes [mean (6.1 +/- 3.6) minutes]. The follow-up showed that all patients had normal menstrual periods in 2-60 months and no serious complications were found. CONCLUSION: With the characteristic of fast homeostasis and less complications, TAE was proved to be an effective method for intractable postpartum hemorrhage.

Adult↗
PubMed2002

[Use of the B-Lynch suture technique in postpartum hemorrhage].

BACKGROUND: Serious postpartum haemorrhage occurs in approximately 1.4% of all deliveries in Norway and may result in hysterectomy. Stepwise devascularisation and hysterectomy are technically difficult and time consuming. A simple suture technique, B-Lynch suture, has recently been introduced, by which atonic postpartum haemorrhage may be controlled and hysterectomy avoided. MATERIAL, METHODS AND RESULTS: We have used the B-Lynch technique in five patients with serious postpartum uterine atonia and haemorrhage. In all patients serious bleeding and hysterectomy were avoided. Three of the patients are described in detail, one with failed induction of labour resulting in Caesarean section, one with placenta previa, and one with prolonged normal vaginal delivery. INTERPRETATION: If performed early, the B-Lynch suture technique is less mutilating to the woman; it may prevent excessive blood loss and is probably beneficial for the patient's future fertility. It is easy to perform in Caesarean sections and can be adopted in vaginal deliveries.

Adult↗
PubMed2004

[Postpartum hemorrhage: frequency, consequences in terms of health status, and risk factors before delivery].

In the developing countries, postpartum hemorrhage is the leading cause of maternal death and affects approximately 1% of pregnant women. In developed countries like ours, maternal mortality is one hundred fold lower but remains the cause of maternal death for about 10 women per 100,000 births. In the last decade, French confidential inquiries show that the number of maternal deaths by postpartum hemorrhage are probably the double of the number in nearby countries, whereas hemorrhage should no longer be the leading cause of maternal death in our countries. Postpartum hemorrhage is defined as the loss of 500 ml or more blood in the 24 hours following delivery (5% of deliveries), but maternal tolerance is really threatened starting from 1,000 ml (1% of the women approximately). "Life-threatening" situations concern approximately one patient in one thousand so that obstetricians are rarely faced with this situation. For maternal morbidity or mortality, the risk factors of postpartum hemorrhage are nearly the same: maternal age, multiple pregnancies, uterine scars, abruptio placentae, cesarean section, poor social condition and absence of prenatal care constitute the main risk factors of postpartum hemorrhage. Maternal age must be kept in mind because it is the most related to mortality by hemorrhage, even if prevention is difficult. However, progress in delivery care which are applied to all the patients could make it possible to limit the harmful effects of this risk factor. A recent study showed that organizational factors also part of the factors of risk of maternal morbidity/mortality and could be studied for intervention.

Cause of Death↗
PubMed2002

Major postpartum hemorrhage: survey of maternity units in the United Kingdom.

BACKGROUND: To determine current clinical practice among different maternity units in the United Kingdom for the management of major postpartum hemorrhage. METHODS: A postal questionnaire was sent to 258 maternity units in the UK. It was developed to identify the definition of major postpartum hemorrhage, and to identify the medical and surgical interventions used for postpartum hemorrhage, as considered by each unit, and the type and use of thromboprophylaxis following surgery for major hemorrhage after delivery. RESULTS: A total of 212 (82%) returned the questionnaire, but 13 units indicated that the questionnaire was not applicable to them, leaving 199 (82%) for analysis. There was a lack of agreement between the different units regarding the definition and interventions for major postpartum hemorrhage. The majority of the units use oxytocin, ergometrine and carboprost as a 'first-line' for the treatment of postpartum hemorrhage. Hysterectomy was the most common surgical procedure (89% of units had performed at least one hysterectomy for major hemorrhage in the last 5 years). There was a lack of agreement regarding the use and choice of thromboprophylaxis following surgery for major hemorrhage. CONCLUSIONS: Current management of major postpartum hemorrhage varies considerably. There is an urgent need to identify protocols that will reduce the need for hysterectomy in women with major hemorrhage who are unresponsive to conventional medical therapy.

Adult↗
PubMedDate not supplied

Anterior pituitary function in women with postpartum hemorrhage.

Thirteen asymptomatic women with postpartum blood loss of at least 500 cc were evaluated for anterior pituitary endocrine function. Insulin tolerance tests and TRH stimulation tests were done and determinations made for serum growth hormone, cortisol, thyrotropin, and prolactin. There was no laboratory evidence of pituitary dysfunction in this group of 13 patients. Subclinical hypopituitarism in women with previous postpartum hemorrhage would appear to be uncommon.

Adult↗
PubMed1999

Treatment of severe postpartum hemorrhage by rectally administered gemeprost pessaries.

OBJECTIVE: To assess the efficacy of rectally administered gemeprost pessaries in the treatment of severe postpartum hemorrhage. DESIGN: Retrospective analysis of a twelve month period in which all patients having postpartum hemorrhage treated with rectal gemeprost were analyzed. SETTING: Royal Darwin Hospital, Northern Territory, Australia. POPULATION: Fourteen women with established postpartum hemorrhage not responding to oxytocine and ergometrine regimens, or not responsive to oxytocine and having contraindications to ergometrine. MAIN OUTCOME MEASURES: Per vaginum bleeding with continued postpartum hemorrhage; adverse patient reactions to gemeprost; need for operative intervention. RESULTS: All patients who were treated with rectally administered gemeprost pessaries had cessation of bleeding per vaginum. There were no adverse side effects noted from the medication and no patient required surgical treatment. CONCLUSIONS: Rectally administered gemeprost administered pessaries appear to be safe and effective method of treating severe postpartum hemorrhage in those patients in whom the standard oxytocic regimens fail. This form of treatment may avoid the need for parenteral prostaglandins or surgical intervention.

Administration, Rectal↗
PubMed2006

Extracorporeal membrane oxygenation therapy for circulatory arrest due to postpartum hemorrhage.

BACKGROUND: Cardiac arrest after postpartum hemorrhage may not respond to advanced life support. Various resuscitation methods have been proposed, including sternotomy and direct cardiac massage. Extracorporeal membrane oxygenation (ECMO) might be an alternative. CASE: We report the case of a woman who suffered atonic uterine hemorrhage perioperatively after cesarean delivery of twins. During initial conservative treatment using prostaglandin analog (sulprostone), cardiac decompensation developed and was followed by cardiopulmonary arrest. Circulatory failure remained unresponsive after 2 hours of resuscitation, when ECMO was initiated. The ensuing recovery was favorable. CONCLUSION: Aggressive mechanical circulatory support, such as ECMO, should be considered in a case of potentially reversible cardiocirculatory failure in a young obstetric patient.

Adult↗