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Results for “HEMORRHAGE, POSTPARTUM”

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PubMed2006

[Clinical value of adjuvant therapy with estrogen for postpartum hemorrhage].

OBJECTIVE: To investigate the clinical efficacy of estrogen in management of postpartum hemorrhage due to uterine atony. METHODS: Totalling 112 puerperants with postpartum hemorrhage due to uterine atony were randomly assigned into 2 groups and received routine managements for uterine atony such as uterine massage and uterotonics administration. The puerperants in one group (n=52) was treated with 4 mg estradiol benzoate injected intramuscularly, and the amount of blood loss 2 h after delivery and between 2 and 24 h after delivery was recorded. RESULTS: There were significant differences in vaginal blood loss at 2 h after delivery between the 2 groups (P<0.05). The puerperants with estrodiol benzoate treatment had blood loss of 589.6-/+226.4 ml at 2 h and 110.8-/+76.2 ml within 2-24 h after delivery, which were both less than those in the control group (864.5-/+359.5 ml and 161.5-/+98.3 ml, respectively). Postpartum hysterectomy was performed in 3 cases of the control group while none in estradiol benzoate-treated group. In the mothers and neonates, no major adverse effects were observed. CONCLUSION: Estrogen shows cooperative efficacy with uterotonics in stimulating uterine contraction for managements of postpartum hemorrhage due to uterine atony, and can be of value in clinical application.

Adult↗

PubMed1991

[Application of polychotomous logistic regression in the study of risk factors predisposed to postpartum hemorrhage].

To determine the role of history of induced abortion and pregnancy induced hypertension in postpartum hemorrhage, a polychotomous logistic regression method was introduced to analyze the data gathered in an investigation of blood loss among 933 parturients in some counties of Sichuan and Ningxia provinces. The results show that postpartum hemorrhage caused by placenta factors is related to a history of induced abortion and pregnancy induced hypertension with relative risks 2.55 (95% confidence interval = 1.2-5.3) and 4.94 (95% confidence interval = 1.8-13.2), respectively. An increased risk was noted for postpartum hemorrhage associated with pregnancy induced hypertension (relative risk = 2.58, 95% confidence interval = 1.3-5.2), but not with induced abortion. Suggestions were made for prevention of postpartum hemorrhage.

Abortion, Induced↗

PubMed2005

Postpartum hemorrhage and transfusion of blood and blood components.

UNLABELLED: Postpartum hemorrhage (PPH) is one of the top 5 causes of maternal mortality in developed and developing countries. The incidence of PPH is 40% after vaginal delivery and 30% after cesarean section. Criteria for PPH are based on the amount of blood loss. In clinical obstetrics, exact measurement of blood loss is often difficult. The most important treatment of PPH is red blood cell (RBC) transfusion. In the past few years, increasing concern has arisen about this treatment. Despite the introduction of several new guidelines, transfusion criteria still vary widely between clinicians. The decision whether to prescribe RBC transfusion is mostly based on postpartum hemoglobin (Hb) values. RBC transfusion should be aimed to reduce morbidity and especially to improve health-related quality of life (HRQoL). In this review, etiology, epidemiology, treatment, and prevention of postpartum hemorrhage are described. Special attention is given to the role of RBC transfusion in the treatment of PPH and the effects of RBC transfusion on HRQoL. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the new guidelines related to transfusion criteria, explain the importance of reducing morbidity related to improving quality of life issues, and list infectious and noninfectious complications of a red blood cell transfusion.

Blood Transfusion↗

PubMed1991

Factors associated with postpartum hemorrhage with vaginal birth.

A case-control study was performed to study risk factors for postpartum hemorrhage. Cases of hemorrhage were defined by a hematocrit decrease of 10 points or more between admission and post-delivery or by the need for red-cell transfusion. Patients with antenatal bleeding were excluded. Among 9598 vaginal deliveries, postpartum hemorrhage occurred in 374 cases (3.9%). Three controls were matched to each case and multiple logistic regression was used to control for covariance among predictor variables. Factors having a significant association with hemorrhage were prolonged third stage of labor (adjusted odds ratio 7.56), preeclampsia (odds ratio 5.02), mediolateral episiotomy (4.67), previous postpartum hemorrhage (3.55), twins (3.31), arrest of descent (2.91), soft-tissue lacerations (2.05), augmented labor (1.66), forceps or vacuum delivery (1.66), Asian (1.73) or Hispanic (1.66) ethnicity, midline episiotomy (1.58), and nulliparity (1.45). These data may help predict postpartum hemorrhage and may be useful in counseling patients about the advisability of home delivery, intravenous access in labor, or autologous blood donation.

Case-Control Studies↗

PubMed2004

Criteria for transfusion in severe postpartum hemorrhage: analysis of practice and risk factors.

OBJECTIVE: To analyze the accuracy of postpartum hemorrhage risk factors to determine patients at risk of severe postpartum hemorrhage and transfusion. POPULATION AND METHODS: Retrospective cohort study from a database in one high-risk obstetric unit over a 7-year period. RESULTS: In a cohort of 19,204 deliveries, 44 patients were transfused of whom five were given frozen fresh plasma only. Of the 39 who received red blood cells, 35 received at least three units. Multivariate analysis of postpartum hemorrhage risk factors revealed a significant role of placenta previa/accreta, cesarean section, multiple pregnancy, prematurity and vascular disease. Nevertheless 28% of women transfused had none of these risk factors. CONCLUSION: The percentage of patients transfused has probably decreased markedly with improved prevention, surveillance and treatment. This study emphasizes that the transfusion risk in the presence of anomalous placental insertion justifies special obstetrical and anesthetic management.

Adult↗

PubMed1985

Retardation in gonadotropin-secreting function of the pituitary during the early puerperium in women with postpartum hemorrhage but without circulatory collapse.

Recovery of gonadotropin-secreting function of the pituitary during the early puerperium has been studied in women with postpartum hemorrhage of 500 g and more during the first 2 h after expulsion of the placenta but without circulatory collapse. On day 4 postpartum, the concentrations of erythrocytes, hemoglobin, and hematocrit were significantly lower in puerperal women with postpartum hemorrhage than in normal puerperal women. On day 20 postpartum, administration of 100 micrograms synthetic luteinizing hormone-releasing hormone (LHRH) significantly increased serum follicle-stimulating hormone (FSH), but not luteinizing hormone, in puerperal women with severe postpartum hemorrhage of more than 1,000 g, but the FSH response to LHRH was significantly lower in these women than in normal women on the same postpartum day. All puerperal women were lactating and there was no significant difference in serum prolactin levels between normal puerperal women and puerperal women with postpartum hemorrhage. These results indicate that blood loss in the amount of more than 1,000 g during the first 2 h after expulsion of the placenta may cause perturbation to some extent in recovery of gonadotropin-secreting function of the pituitary during the early puerperium, even if there are no complications by circulatory collapse and disabled lactation.

Adult↗

PubMedDate not supplied

Prevention and treatment of postpartum hemorrhage: new advances for low-resource settings.

Postpartum hemorrhage due to uterine atony is the primary direct cause of maternal mortality globally. Management strategies in developed countries involve crystalloid fluid replacement, blood transfusions, and surgery. These definitive therapies are often not accessible in developing countries. Long transports from home or primary health care facilities, a dearth of skilled providers, and lack of intravenous fluids and/or a safe blood supply often create long delays in instituting appropriate treatment. We review the evidence for active management of third-stage labor and for the use of specific uterotonics. New strategies to prevent and manage postpartum hemorrhage in developing countries, such as community-based use of misoprostol, oxytocin in the Uniject delivery system, the non-inflatable antishock garment to stabilize and resuscitate hypovolemic shock, and the balloon condom catheter to treat intractable uterine bleeding are reviewed. New directions for clinical and operations research are suggested.

Developing Countries↗

PubMed1962