[On the etiology of early and late postpartum hemorrhages].
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Female↗
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Results for “HEMORRHAGE, POSTPARTUM”
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[ABORTION AND POSTPARTUM HEMORRHAGE].
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Abortion, Induced↗
[PREVENTION AND TREATMENT OF ATONIC POSTPARTUM HEMORRHAGES].
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Biomedical Research↗
Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study.
OBJECTIVE: To investigate whether rectally administered misoprostol is an effective treatment for postpartum hemorrhage unresponsive to conventional first-line management. METHODS: We studied 14 women with postpartum hemorrhage unresponsive to oxytocin and ergometrine (n = 10) or, when ergometrine was contraindicated, oxytocin alone (n = 4). While awaiting carboprost, misoprostol 1000 microg (five tablets) was administered rectally. RESULTS: In all 14 women, the hemorrhage was controlled, and sustained uterine contraction produced within three minutes of administration of misoprostol. CONCLUSION: Misoprostol appears to be absorbed effectively from rectal as well as oral and vaginal mucosa. Rectally administered misoprostol appears to be an effective treatment for postpartum hemorrhage unresponsive to oxytocin and ergometrine; therefore, it might be an alternative to parenteral prostaglandins or at least minimize the number of women requiring this invasive treatment. Given that it is an inexpensive and stable drug, misoprostol has considerable potential to reduce maternal mortality from postpartum hemorrhage in developing countries.
Administration, Rectal↗
Prevention of postpartum hemorrhage, safety and efficacy.
OBJECTIVE: This study was carried out to describe the safety and efficacy of intramuscular syntometrine (oxytocin plus ergometrine) compared to intravenous oxytocin for prevention of postpartum hemorrhage, and the difference between administration at the end of the 2nd stage of labor compared with that after delivery of the placenta. METHODS: A prospective study was carried out at Prince Zaid Ben Al-Hussein Hospital, Tafilah, Jordan. Two thousand one hundred and sixty one women delivering singletons during 12 consecutive months were included in our study. Women received either intramuscular syntometrine (oxytocin plus ergometrine) or oxytocin alone. The drugs were used either before or after the 3rd stage of labor, in order to compare their safety and efficacy in prevention of postpartum hemorrhage. RESULTS: There was no significant difference in the rate of postpartum hemorrhage for syntometrine compared with oxytocin, when used at the end of the 2nd stage of labor (odds ratio 1.08, 95% confidence interval 0.72-1.63) or after the 3rd stage (odds ratio 0.93, 95% confidence interval 0.65-1.34). The patients receiving oxytocics at the end of the 2nd stage of labor had significantly lower rates of postpartum hemorrhage, for both syntometrine (odds ratio 0.86, 95% confidence interval 0.59-0.1.12) and Oxytocin (odds ratio 0.59, 95% confidence interval 0.39-0.88), compared with those treated after the 3rd stage. CONCLUSION: Oxytocin alone is as effective as the use of syntometrine (ergometrine plus oxytocin) in the prevention of postpartum hemorrhage, but associated with significantly fewer maternal side effects. Oxytocics administered after the 2nd stage of labor compared with after the 3rd stage of labor (placental expulsion) are associated with a significantly fewer rate of postpartum bleeding.
Adult↗
Delayed postpartum hemorrhage: a morphologic study of causes and their relation to other pregnancy disorders.
OBJECTIVES: To ascertain the various causes of delayed postpartum hemorrhage and to test whether subinvolution of the placental bed is associated with other pregnancy disorders for which defective maternal-fetal interaction has been implicated pathogenetically. METHODS: In a group of women presenting with postpartum hemorrhage following singleton pregnancies, tissue that had been submitted for histopathologic examination was reviewed morphologically to delineate the various causes of delayed postpartum hemorrhage. The stratified groups were analyzed for relationship to preeclampsia, fetal growth retardation (FGR), spontaneous abortion, placenta accreta, and retained placental fragments in previous pregnancies. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each association. RESULTS: One hundred sixty-nine cases were identified. Tissue obtained at curettage or, rarely, at hysterectomy could be categorized into seven pathologic groups: involution of the placental bed, subinvolution of the placental bed, retained placental fragments, endometritis, normal endometrium, normal decidua, or nondiagnostic tissue. Hyalinized fragments of uteroplacental (spiral) arteries that were either collapsed or completely thrombosed were seen in involution of the placental bed. Subinvolution of the placental bed was characterized by widely distended and patent residua of uteroplacental arteries with only partial occlusion by thrombosis. Women with retained placental fragments (OR 3.93, 95% CI 1.51-10.47), but not women with an involuted placental bed (OR 2.40, 95% CI 0.68-8.54) or subinvolution of the placental bed (OR 1.52, 95% CI 0.51-4.57), had increased incidences of preeclampsia, FGR, spontaneous abortion, or retained placenta in previous pregnancies when compared to women with endometritis, endometrium only, decidua only, or nondiagnostic tissue. CONCLUSION: Retained placental fragments, reflecting placenta accreta, and subinvolution of the placental bed are important causes of delayed postpartum hemorrhage. The former is associated with an increased incidence, in prior pregnancies, of pregnancy complications that probably reflect aberrant maternal-trophoblastic interaction.
Arteries↗
Infant insufficient milk syndrome associated with maternal postpartum hemorrhage.
Insufficient milk syndrome is defined as failure to thrive in infants due to insufficient daily breastmilk intake. This discussion examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. Ten consecutive cases of insufficient milk syndrome associated with maternal postpartum hemorrhage were identified. The mothers presented between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from 500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was noted as 400++ and 200++, respectively. Six mothers experienced a drop of hemoglobin by > 30g/L; two had a drop in blood pressure > 30mmHg for > 20 minutes. All infants were failing to thrive. Five infants suffered hypernatremic dehydration with serum sodium levels ranging from 148-166mmol/L. Breastmilk electrolytes were measured in six cases, and elevated sodium levels, ranging from 21-100mmol/L, in five cases. These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breastfeeding mothers and infants is strongly encouraged.
Adult↗
[Analysis of risk factors of postpartum hemorrhage in rural women].
Sixty variables during pregnancy, labor and delivery of 951 rural women were analyzed to identify the risk factors of postpartum hemorrhage. The result showed that uterine atony (RR = 13.30, 95% CI = 8.23-21.50) and its related factors were the major risk factors of postpartum hemorrhage. The related factors included prolonged labor (3.49, 1.98-6.15), prolonged second stage of labor (2.72, 1.54-4.78), pregnancy induced hypertension (mild 2.35, 1.11-4.99; > or = moderate 3.04, 1.38-6.70), neonatal weight > or = 3.500 g (2.55, 1.66-3.91). Another category of postpartum hemorrhage risk factors were placental factors (6.32, 2.35-17.01), the third stage of labor > or = 10 minutes (2.65, 1.74-4.01), parity > or = 2 (2.61, 1.69-4.01) and maternal age > or = 30 (2.19, 1.13-4.24). The authors recommends that the stress should be put on the management of labor and delivery, to prevent and management of postpartum hemorrhage, through training the birth attendants to promote their ability to prevent and manage uterine atony and correct management of labor and delivery.
Adult↗
Control of intractable atonic postpartum hemorrhage by 15-methyl prostaglandin F2 alpha.
Severe intractable atonic postpartum hemorrhage can be treated by either uterine packing or surgical techniques. However, certain prostaglandins possess properties of potential value for the control of postpartum uterine atony. Two hundred fifty micrograms 15-methyl prostaglandin F2 alpha (15-methyl PGF2 alpha) was given intramuscularly to 16 subjects for whom a uterine pack of operative management was the only other alternative. Fifteen patients responded satisfactorily following a mean of 1.75 injections (437.5 microgram); only 1 patient required hysterectomy. The latter had a case of severe intrauterine infection. The incidence of side effects was very low. The use of intramuscularly administered 15-methyl PGF2 alpha in uncontrollable atonic postpartum hemorrhage appears to be a valuable lifesaving medical tool in critical cases.
Diarrhea↗
[Management of blood products in the event of postpartum hemorrhage].
Transfusion during the treatment of postpartum hemorrhages is rare. It always occurs in complex situations: failure of the initial manipulations or cataclysmic bleeding. Its management is multidisciplinary and should aim at obtaining blood products within thirty minutes while preventing any risk of alloimmunization detrimental to the obstetrical future of the patient. Upstream process management is essential. The following points will be described: Within the legal bounds, the different options for blood products supply; the best practices procedures that every maternity hospital should set up and formalize; the immunohematologic documents to be used for transfusions, their validity and the criteria for the prescription of irregular antibody testing; the rules for antenatal management to anticipate the transfusion difficulties; the blood products available and their constraints of use to optimize the prescription. Effective management can be achieved only through the strict respect of procedures at every stage. These procedures should be written in conjunction with all actors, issued and regularly assessed.
Blood Transfusion↗
Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006.
Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.
Balloon Occlusion↗
Management of massive postpartum hemorrhage by "B-Lynch" brace suture.
Two cases of intractable postpartum hemorrhage managed by the B-Lynch Brace suture, a new technique for control of massive postpartum hemorrhage, are presented. Because of its simplicity and capability of preserving uterus, this procedure may be considered as first line surgical treatment before considering hysterectomy.
Adult↗
Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage?
OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of selective arterial embolization to control severe postpartum hemorrhage. MATERIALS AND METHODS: Twenty-five women with intractable postpartum hemorrhage underwent uterine embolization in our institution during a 6-year period. RESULTS: Angiography revealed arterial extravasation in 13 patients (52%). Sixty-nine arteries were embolized. External bleeding resolved immediately or was markedly decreased in 24 women. In one patient, embolization failed to control the bleeding, and surgical treatment was required. No major complication of embolization therapy was observed. Ten women were followed up for an average of 2 years. Menstruation resumed in all patients, and one woman became pregnant. CONCLUSION: Embolization of acute postpartum hemorrhage is a safe and effective alternative to hysterectomy.
Adult↗
A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage.
OBJECTIVE: To determine if the timing of the administration of prophylactic oxytocin influences the incidence of postpartum hemorrhage caused by uterine atony, retained placenta, and third-stage duration. STUDY DESIGN: Parturients who presented for vaginal delivery were randomized in a double-blinded fashion to receive oxytocin, 20 units in a 500-mL crystalloid intravenous bolus, beginning upon delivery of either the fetal anterior shoulder or placenta. For all patients, the third stage of labor was managed with controlled cord traction until placental expulsion, followed by at least 15 seconds of fundal massage. Patients were excluded if they had a previous cesarean section, multiple gestation, antepartum hemorrhage, or bleeding disorder. RESULTS: A total of 1486 patients were enrolled: 745 in the before-placenta group and 741 in the after-placenta group. The groups were similar with respect to gestational age, fetal weight, labor duration, maternal age, parity, and ethnicity. The incidence of postpartum hemorrhage did not differ significantly between the two groups (5.4% vs 5.8%; crude OR, 0.92; 95% CI, 0.59 to 1.43). There were no significant differences between the two groups with respect to incidence of retained placenta (2.4% vs 1.6%; OR, 1.49; 95% CI, 0.72 to 3.08), or third-stage duration (7.7 minutes vs 8.1 minutes; P =.23). CONCLUSIONS: The administration of prophylactic oxytocin before placental delivery does not reduce the incidence of postpartum hemorrhage or third-stage duration, when compared with giving oxytocin after placental delivery. Early administration, however, does not increase the incidence of retained placenta.
Adolescent↗
ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage.
Severe bleeding is the single most significant cause of maternal death world-wide. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. It is estimated that worldwide, 140,000 women die of postpartum hemorrhage each year-one every 4 minutes (1). In addition to death, serious morbidity may follow postpartum hemorrhage. Sequelae include adult respiratory distress syndrome, coagulopathy, shock, loss of fertility, and pituitary necrosis (Sheehan syndrome). Although many risk factors have been associated with postpartum hemorrhage, it often occurs without warning. All obstetric units and practitioners must have the facilities, personnel, and equipment in place to manage this emergency properly. Clinical drills to enhance the management of maternal hemorrhage have been recommended by the Joint Commission on Accreditation of Healthcare Organizations (2). The purpose of this bulletin is to review the etiology, evaluation, and management of postpartum hemorrhage.
Blood Transfusion↗
Postpartum hemorrhage and intrauterine balloon tamponade. A report of three cases.
BACKGROUND: Postpartum hemorrhage can become rapidly catastrophic. If medical management fails, then, according to recent reports, the use of an intrauterine inflated Foley catheter balloon for tamponade gives excellent results and can help avoid invasive procedures. CASE: We present one case of profuse hemorrhage following evacuation of the fetus after intrauterine fetal death at 17 weeks' gestation controlled with intrauterine balloon tamponade and two cases of severe postpartum hemorrhage (one immediate and one late) following normal vaginal deliveries, both controlled with Foley catheters. In either case the patient required no blood transfusions, and major surgery was avoided. CONCLUSION: Intrauterine balloon tamponade is highly effective. The catheter is readily available, is not expensive, does not require special training for insertion and, extremely important, can avoid major surgery.
Adult↗
Successful term pregnancy after bilateral uterine artery embolization for postpartum hemorrhage.
BACKGROUND: Selective bilateral uterine artery embolization has been used since the 1970s for the conservative treatment of postpartum hemorrhage. The fertility rate after the embolization procedure is yet to be determined. CASE: A 30-year-old woman presented with placental abruption and subsequently delivered preterm at 29 weeks' gestation. Her delivery was complicated by postpartum hemorrhage, for which selective bilateral uterine artery embolization was performed with successful cessation of the hemorrhage. Three months later, the patient presented with a spontaneous pregnancy. Her pregnancy resulted in an appropriately grown fetus delivered at 39 weeks' gestation. CONCLUSION: This is one of the earliest reported successful pregnancies after a bilateral uterine artery embolization procedure performed for postpartum hemorrhage. This case adds to a growing literature demonstrating that pregnancy after embolization is possible, and can occur soon after the procedure.
Abruptio Placentae↗
Ultrasound finding of an echogenic mass in women with secondary postpartum hemorrhage is associated with retained placental tissue.
OBJECTIVES: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium. METHODS: This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population. RESULTS: The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90(th) percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped. CONCLUSION: This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.
Adult↗