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Dueckelmann AM, Hermann P, Biele C, Leichtle C, Waldner C, Braun T, Henrich W. Short and long-term menstrual, reproductive, and mental health outcomes after the intrauterine use of chitosan tamponade or the Bakri balloon for severe postpartum hemorrhage: an observational study. J Matern Fetal Neonatal Med 2024; 37:2354382. [PMID: 38782738 DOI: 10.1080/14767058.2024.2354382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This retrospective follow-up study analyzes the effect of intrauterine postpartum hemorrhage (PPH) therapy on menstrual, reproductive, and mental health outcomes. METHODS All women who delivered at a university hospital between 2016 and 2021 with PPH and who needed intrauterine therapy were included. A questionnaire on well-being, menses, fertility, and reproductive outcomes was mailed to the patients. Those who did not reply were surveyed by telephone. RESULTS A total of 214 women treated with chitosan-covered gauze (group A) and 46 women treated with a balloon tamponade (group B) were recruited, and their short-term courses were analyzed. For long-term follow-up, 71 women of group A (33%) and 21 women of group B (46%) could be reached. A total of 89% of group A and 95% of group B had regular menstrual bleeding in the most recent 12 months; 27% (group A) and 29% (group B) were trying to conceive again, and all of them did so successfully. There were 12 deliveries, 3 ongoing pregnancies, 3 miscarriages, and 2 terminations of pregnancies (TOP) in group A and 4 deliveries, 1 miscarriage, and 2 TOPs in group B. More than half of our study participants was sorted into grade II or III of the Impact of Events Scale, indicating they experienced clinical impacts in the form of psychological sequelae. One-quarter of patients had symptoms of post-traumatic stress disorder. CONCLUSION Chitosan gauze as well as balloon tamponade appear to have few adverse effects on subsequent menstrual and reproductive function. Women after PPH are at increased risk of long-term adverse psychological outcomes.
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Affiliation(s)
- Anna M Dueckelmann
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Paulina Hermann
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Carolin Biele
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Clara Leichtle
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Charlotte Waldner
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
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Neef V, Meybohm P, Zacharowski K, Kranke P. Current concepts in the use of cell salvage in obstetrics. Curr Opin Anaesthesiol 2024; 37:213-218. [PMID: 38391030 PMCID: PMC11062610 DOI: 10.1097/aco.0000000000001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. RECENT FINDINGS Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. SUMMARY Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Peter Kranke
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
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Cravassac L, Hamadmad R, Crequit S, Redel D, Yakhou L, Verton C, Haddad B, Lecarpentier E. Clinical and biological factors associated with red blood cell transfusion during severe postpartum haemorrhage - A single-center retrospective cohort study. J Gynecol Obstet Hum Reprod 2024; 53:102774. [PMID: 38521407 DOI: 10.1016/j.jogoh.2024.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Red blood cell (RBC) transfusions are of utmost importance in the management of severe post-partum haemorrhage. Although the recommendations for blood transfusion protocols are regularly issued, there are significant differences in management depending on the context and the medical teams involved. OBJECTIVE To determine during the first 24 h, the clinical and biological factors associated with the decision for RBC transfusion during severe PPH (≥1000 mL) for vaginal and caesarean deliveries. STUDY DESIGN Monocentric retrospective study conducted in a tertiary care university maternity unit (CHI-Creteil) including all parturients from November 23th 2018 to 31th December 2020 with severe PPH (≥1000 mL). RESULTS Over the study period, we reported 7103 deliveries, out of which 682 were complicated by PPH (9.6 %) with 200 cases of PPH ≥1000 mL (2.8 %). In our study, 40 % of patients (80/200) required a RBC transfusion". After multivariate analysis, severe PPH caused by placental abruption, uterine rupture or placental implantation disorders (aOR = 3.48 IC95 [1.27-9.52], p < 0.001), estimated blood loss ≥1500 mL (aOR = 9.60 IC95 [3.69-24.95], p < 0. 001), invasive measures such as uterine balloon tamponade, arterial ligation and uterine packing (aOR = 4.15 IC95 [1.80-9.61], p < 0.001), pre-labor hemoglobin <10 g/dL (aOR =4.88 IC95 [1.57-15.15], p < 0.001) or abnormal biological results in the acute phase (including hemoglobin <7.0 g/dL and/or fibrinogen <2 g/L and/or platelets <100 G/L) (aOR =356 IC95 [1,05-12,10], p < 0.001) were significantly and independently associated with the decision to initiate RBC transfusions. CONCLUSIONS In a monocentric retrospective study including 200 consecutive cases of severe PPH (≥1000 mL) we identified groups of clinical and biological factors directly accessible to clinicians, significantly and independently associated with RBC transfusion in the first 24 h of management.
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Affiliation(s)
- Lauren Cravassac
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Rayan Hamadmad
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Simon Crequit
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Diane Redel
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Leila Yakhou
- Service d'Anesthésie Réanimation, Centre Hospitalier Intercommunal de Créteil, France
| | - Caroline Verton
- Service d'Anesthésie Réanimation, Centre Hospitalier Intercommunal de Créteil, France
| | - Bassam Haddad
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Université Paris-Est Créteil, France
| | - Edouard Lecarpentier
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Université Paris-Est Créteil, France; Équipe Biologie du Trophoblaste et Pathologies Vasculaires Placentaires, INSERM, CNRS, UPC, Institut Cochin, France.
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Howe-Heyman A. Systematic Reviews to Inform Practice, May/June, 2024. J Midwifery Womens Health 2024. [PMID: 38768070 DOI: 10.1111/jmwh.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Abby Howe-Heyman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Wang T, Li H, Liu Y, Min X. Quantitative blood loss measurement methods for early detection of primary postpartum haemorrhage following vaginal birth: A scoping review. J Clin Nurs 2024. [PMID: 38764248 DOI: 10.1111/jocn.17216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/09/2024] [Accepted: 05/07/2024] [Indexed: 05/21/2024]
Abstract
AIM To map the commonly used quantitative blood loss measurement methods in clinical practice and provide a solid foundation for future studies. DESIGN AND METHOD This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. We conducted a literature search using five databases to retrieve articles published between January 2012 and September 2022. The search was repeated on 29 February 2024. Data extraction and verification were carried out by two independent researchers using a self-designed data extraction form. RESULTS Ultimately, 26 studies published between 2012 and 2024 were considered eligible for inclusion. Six categories of methods were identified from the 26 articles. Among the included studies, only two involved randomized controlled trials, with the majority being observational studies. The World Health Organization (2012) version of the postpartum haemorrhage diagnostic criteria was predominantly used in most studies. Gravimetric and volumetric methods emerged as the most commonly used methods for quantifying postpartum haemorrhages. The timing of blood collection was inconsistent among the included studies. Only 12 studies mentioned measures for the management of amniotic fluid. CONCLUSIONS This scoping review supports the replacement of the visual estimation of blood loss with quantitative assessment methods. Supporting a specific assessment approach is not feasible due to the variability of the study. Future research should focus on establishing the best practices for specific quantitative methods to standardize the management of postpartum haemorrhage and reduce the incidence of postpartum haemorrhage-related adverse outcomes. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals need to acknowledge the low accuracy of visual estimation methods and implement quantitative methods to assess postpartum blood loss. Given the limitations inherent in each assessment method, quantification of blood loss should be combined with assessment of maternal vital signs, physiologic indicators and other factors.
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Affiliation(s)
- Tong Wang
- Department of Nursing, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Li
- Department of Nursing, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Liu
- Delivery Unit, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China
| | - Xiongkuo Min
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Araki H, Sekino M, Hasegawa Y, Kurobe M, Motokawa T, Tanigawa A, Egashira T, Iwasaki N, Suzumura M, Yano R, Matsumoto S, Ichinomiya T, Higashijima U, Kanayama N, Miura K, Hara T. Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review. Medicine (Baltimore) 2024; 103:e38176. [PMID: 38758915 PMCID: PMC11098262 DOI: 10.1097/md.0000000000038176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
RATIONALE Amniotic fluid embolism (AFE) is a fatal obstetric condition that often rapidly leads to severe respiratory and circulatory failure. It is complicated by obstetric disseminated intravascular coagulation (DIC) with bleeding tendency; therefore, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is challenging. We report the case of a patient with AFE requiring massive blood transfusion, rescued using VA-ECMO without initial anticoagulation. PATIENTS CONCERNS A 39-year-old pregnant patient was admitted with a complaint of abdominal pain. An emergency cesarean section was performed because a sudden decrease in fetal heart rate was detected in addition to DIC with hyperfibrinolysis. Intra- and post-operatively, the patient had a bleeding tendency and required massive blood transfusions. After surgery, the patient developed lethal respiratory and circulatory failure, and VA-ECMO was introduced. DIAGNOSIS Based on the course of the illness and imaging findings, the patient was diagnosed with AFE. INTERVENTIONS By controlling the bleeding tendency with a massive transfusion and tranexamic acid administration, using an antithrombotic ECMO circuit, and delaying the initiation of anticoagulation and anti-DIC medication until the bleeding tendency settled, the patient was managed safely on ECMO without complications. OUTCOMES By day 5, both respiration and circulation were stable, and the patient was weaned off VA-ECMO. Mechanical ventilation was discontinued on day 6. Finally, she was discharged home without sequelae. LESSONS VA-ECMO may be effective to save the lives of patients who have AFE with lethal circulatory and respiratory failure. For safe management without bleeding complications, it is important to start VA-ECMO without initial anticoagulants and to administer anticoagulants and anti-DIC drugs after the bleeding tendency has resolved.
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Affiliation(s)
- Hiroshi Araki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motohiro Sekino
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuri Hasegawa
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaya Kurobe
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsufumi Motokawa
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Takashi Egashira
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Iwasaki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Miki Suzumura
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rintaro Yano
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sojiro Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Ichinomiya
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ushio Higashijima
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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7
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Ács N, Korte WC, von Heymann CC, Windyga J, Blatný J. Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage. J Clin Med 2024; 13:2928. [PMID: 38792469 PMCID: PMC11122570 DOI: 10.3390/jcm13102928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Severe post-partum hemorrhage (PPH) is a major cause of maternal mortality worldwide. Recombinant activated factor VII (rFVIIa) has recently been approved by the European Medicines Agency for the treatment of severe PPH if uterotonics fail to achieve hemostasis. Although large randomized controlled trials are lacking, accumulated evidence from smaller studies and international registries supports the efficacy of rFVIIa alongside extended standard treatment to control severe PPH. Because rFVIIa neither substitutes the activity of a missing coagulation factor nor bypasses a coagulation defect in this population, it is not immediately evident how it exerts its beneficial effect. Here, we discuss possible mechanistic explanations for the efficacy of rFVIIa and the published evidence in patients with severe PPH. Recombinant FVIIa may not primarily increase systemic thrombin generation, but may promote local thrombin generation through binding to activated platelets at the site of vascular wall injury. This explanation may also address safety concerns that have been raised over the administration of a procoagulant molecule in a background of increased thromboembolic risk due to both pregnancy-related hemostatic changes and the hemorrhagic state. However, the available safety data for this and other indications are reassuring and the rates of thromboembolic events do not appear to be increased in women with severe PPH treated with rFVIIa. We recommend that the administration of rFVIIa be considered before dilutional coagulopathy develops and used to support the current standard treatment in certain patients with severe PPH.
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Affiliation(s)
- Nándor Ács
- Department of Obstetrics and Gynaecology, Semmelweis University, H-1082 Budapest, Hungary
| | - Wolfgang C. Korte
- Centre for Laboratory Medicine, Haemostasis and Haemophilia Centre, CH-9001 St. Gallen, Switzerland
| | - Christian C. von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum in Friedrichshain, DE-10249 Berlin, Germany
| | - Jerzy Windyga
- Department of Haemostasis Disorders and Internal Medicine, Laboratory of Haemostasis and Metabolic Diseases, Institute of Haematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Jan Blatný
- Department of Paediatric Oncology, University Hospital Brno, and Masaryk University, 613 00 Brno, Czech Republic
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8
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Pingray V, Williams CR, Al-Beity FMA, Abalos E, Arulkumaran S, Blumenfeld A, Carvalho B, Deneux-Tharaux C, Downe S, Dumont A, Escobar MF, Evans C, Fawcus S, Galadanci HS, Hoang DTT, Hofmeyr GJ, Homer C, Lewis AG, Liabsuetrakul T, Lumbiganon P, Main EK, Maua J, Muriithi FG, Nabhan AF, Nunes I, Ortega V, Phan TNQ, Qureshi ZP, Sosa C, Varallo J, Weeks AD, Widmer M, Oladapo OT, Gallos I, Coomarasamy A, Miller S, Althabe F. Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus. BMJ Open 2024; 14:e079713. [PMID: 38719306 PMCID: PMC11086283 DOI: 10.1136/bmjopen-2023-079713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/19/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE There are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert's consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth. DESIGN Systematic review and three-stage modified Delphi expert consensus. SETTING International. POPULATION Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance. OUTCOME MEASURES Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth. RESULTS Experts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman's haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman's haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach. CONCLUSION These agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.
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Affiliation(s)
- Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Caitlin R Williams
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics & Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Edgardo Abalos
- Maternidad Martin, Secretaría de Salud Pública de la Municipalidad de Rosario, Rosario, Santa Fe, Argentina
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | | | - Alejandro Blumenfeld
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Public Health, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Brendan Carvalho
- Stanford University School of Medicine, Stanford, California, USA
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research team, Centre for Research in Statistics and Epidemiology (CRESS) Université Paris Cité INSERM, Paris, France
| | - Soo Downe
- Research in Childbirth and Health, University of Central Lancashire, Preston, UK
- THRIVE Centre, School of Heath and Community Studies, University of Central Lancashire, Preston, UK
| | | | - Maria Fernanda Escobar
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Cherrie Evans
- Technical Leadership & Innovations Office, Jhpiego/USA, Baltimore, Maryland, USA
| | - Sue Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Rondebosch, South Africa
| | - Hadiza S Galadanci
- Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano, Kano, Nigeria
| | | | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- Effective Care Research Unit, University of the Witwatersrand, Johannesburg and Walter Sisulu University, Mthatha, South Africa
| | | | | | - Tippawan Liabsuetrakul
- Department of Epidemiology, Prince of Songkla University, Hat Yai, Thailand
- Department of Obstetrics & Gynecology, Prince of Songkla University, Hat Yai, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Elliott K Main
- Department of Obstetrics & Gynecology-Maternal Fetal Medicine, Stanford University, Stanford, California, USA
- California Maternal Quality Care Collaborative, Standford, California, USA
| | - Judith Maua
- Liverpool School of Tropical Medicine, Nairobi, Kenya
| | - Francis G Muriithi
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Ashraf Fawzy Nabhan
- Department of Obstetrics & Gynecology, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Inês Nunes
- Department of Obstetrics and Gynaecology, Gaia/ Espinho Local Health Unit, Vila Nova de Gaia, Portugal
- RISE-HEALTH - CINTESIS-Center for Health Technology and Services Research, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vanesa Ortega
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Thuan N Q Phan
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Department of Delivery, Tu Du Hospital, Ho Chi Minh City, Viet Nam
| | - Zahida P Qureshi
- University of Nairobi Department of Obstetrics and Gynecology, Nairobi, Kenya
| | - Claudio Sosa
- Woman and Reproduction Health Unit at Maternal Health at the Latin American Center of Perinatology (CLAP/WR), Pan American Health Organization, Montevideo, District of Columbia, USA
- Department of Obstetrics and Gynecology, School of Medicine, Universidad de la República Uruguay, Montevideo, Uruguay
| | - John Varallo
- Women's Health, Global Surgery Foundation, Washington, District of Columbia, USA
| | - Andrew D Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital, Liverpool, UK
| | - Mariana Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Suellen Miller
- Bixby Center for Global reproductive Health, University of California San Francisco, San Francisco, California, USA
| | - Fernando Althabe
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Hu Y, Cui L, Zhang C, Chen F. Timely use of Bakri intrauterine balloon tamponade contributes to the effectiveness in controlling severe postpartum hemorrhage. Exp Ther Med 2024; 27:177. [PMID: 38515648 PMCID: PMC10952343 DOI: 10.3892/etm.2024.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
The aim of the present study was to explore the effectiveness of Bakri intrauterine balloon tamponade (IUBT) in treating severe postpartum hemorrhage (SPPH). A cohort of 198 women with SPPH using IUBT were retrospectively selected. The baseline and maternal outcome characteristics were examined. The results demonstrated that women with SPPH had a high proportion of placenta accrete (53.0%). Bakri IUBT demonstrated a global effectiveness of 84.5% in SPPH treatment, accounting for 82.9% in women with placenta accrete. Compared with women with Bakri failure, women who experienced Bakri success had reduced rates of less use of pre-/post-IUBT intervention, blood transfusion, lower genital tract trauma, estimated blood loss (EBL), and a longer indwelling duration (P<0.05). Logistic regression revealed that the pre-IUBT intervention (OR=3.910; 95% CI: 1.684-9.079; P=0.002) was positively associated with hemostasis success, while lower genital tract trauma was negatively associated with Bakri success (OR=0.091; 95% CI: 0.009-0.894; P=0.040). Moreover, women diagnosed with placenta accrete underwent a greater number of transabdominal placed Bakri IUBT and pre-IUBT interventions than those without placenta accrete (P<0.05). No significant differences were observed in Bakri success, total EBL, pre-/post-IUBT EBL, infused volume of IUBT, IUBT indwelling duration, even the rate of hemostasis, lower genital tract trauma, blood transfusion, post-IUBT intervention, and puerperal fever between women with and without placenta accrete (P>0.05). In conclusion, placenta accrete may be the leading cause of SPPH. Bakri IUBT is an effective and safe measure for SPPH. Pre-IUBT intervention may be predictive of Bakri's success. The timely use of IUBT during labor may mitigate the impact of risk factors identified on PPH.
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Affiliation(s)
- Yaping Hu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Lingjie Cui
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Chong Zhang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
| | - Feifei Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430070, P.R. China
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Sambo AA, Ijaiya MA, Nwachukwu D, Nwosu IC, Idris H, Abdullateef RM, Adewale FB. A randomized controlled study comparing oral misoprostol with intramuscular oxytocin in active management of third stage of labour. Obstet Gynecol Sci 2024; 67:279-285. [PMID: 38409787 PMCID: PMC11099097 DOI: 10.5468/ogs.23128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/28/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE The study aimed to compare the effectiveness and side effects of 600 μg of oral Misoprostol with 10 international units (IU) intramuscular oxytocin in managing the third stage of labor. METHODS This open-label, randomized controlled trial included 260 low-risk women in the second stage of labor with anticipated vaginal delivery. They were randomly assigned, to receive either 600 μg of misoprostol orally or 10 IU of oxytocin intramuscularly. The primary outcomes were blood loss during delivery and incidence of postpartum hemorrhage, evaluated using intention-to-treat analysis. Significance was set at P≤0.05. RESULTS Baseline characteristics were similar in both groups (P>0.05). The misoprostol group had a significantly lower blood loss than that of the oxytocin group (306.57±176.44 mL vs. 349.37±135.50 mL; relative difference, -12.251 [95% confidence intervals [CI], -22.528 to -1.575]; P=0.012). Incidence of postpartum hemorrhage was similar in both the groups (relative risk [RR], 0.952 [95% CI, 0.543 to 0.671]; P=0.865). Additional oxytocic therapy requirement was also comparable (RR, 1.143 [95% CI, 0.671 to 1.947]; P=0.623). Nausea, shivering, and mean increase in temperature were significantly more common in the misoprostol group than in the oxytocin-parturient group. CONCLUSION In this study, 600 μg oral misoprostol was superior to intramuscular 10 IU oxytocin in reducing blood loss at birth, and equally effective in preventing postpartum hemorrhage. However, misoprostol exhibited more side effects compared to that of oxytocin.
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Affiliation(s)
| | - Munir’deen Aderemi Ijaiya
- Department of Obstetrics and Gynecology, University of Ilorin Teaching Hospital, University of Ilorin, Ilorin,
Nigeria
| | - Duum Nwachukwu
- Department of Obstetrics and Gynecology, Maitama District Hospital, Federal Capital Territory Administration, Abuja,
Nigeria
| | | | - Haruna Idris
- Department of Obstetrics and Gynecology, Federal Medical Centre, Bida, Niger State,
Nigeria
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11
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Vuong ADB, Pham TH, Pham XTT, Truong DP, Nguyen XT, Trinh NB, Nguyen DV, Nguyen YON, Nguyen TNTN, Ho QN, Nguyen PN. Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single-center retrospective analysis based on 619 Vietnamese pregnant women. Int J Gynaecol Obstet 2024; 165:723-736. [PMID: 38009657 DOI: 10.1002/ijgo.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal outcome measures in surgical management of placenta accreta spectrum (PAS)-the modified one-step conservative uterine surgery (MOSCUS), a new approach at Tu Du Hospital in Vietnam, versus cesarean hysterectomy, and to identify factors that appear to contribute to the successful outcome of the MOSCUS. METHODS This retrospective study was conducted at Tu Du Hospital in southern Vietnam between January 2019 and December 2020. The study enrolled all pregnant women at more than 28 weeks of pregnancy with a diagnosis of PAS who underwent either a cesarean hysterectomy or a uterus-preserving approach using the MOSCUS method. RESULTS The prevalence of PAS at our single tertiary referral hospital was 0.4% (619 PAS cases/132 518 births) in 2 years. Among 296 patients, the surgical time duration, estimated blood loss, and red blood cell transfusion in the MOSCUS group (n = 217) were all significantly less than in the cesarean hysterectomy group (n = 79) (152.72 ± 42.23 vs 185.13 ± 58.22 min, 1000 vs 1500 mL, and 500 vs 710 mL, respectively). Intraoperatively, the rate of visceral injuries in the hysterectomy group was higher than that in the MOSCUS group (P < 0.001). However, the rate of postoperative infection was higher in the MOSCUS group than in the cesarean hysterectomy group (P = 0.012). Of a total of 217 cases managed using the MOSCUS management, 24 required a secondary hysterectomy; the success rate was 88.9% (95% confidence interval [CI] 84.3%-93.1%). Some of the primary factors associated with the success of MOSCUS included maternal age less than 35 years, planned surgery, severity of PAS, and estimated blood loss during surgery (odds ratio [OR] 5.16, 95% CI 1.96-13.59; OR 3.05, 95% CI 1.08-8.62; OR 3.62, 95% CI 1.19-10.98; and OR 49.66, 95% CI 11.16-221.02, respectively; P < 0.05). CONCLUSION MOSCUS is an acceptable alternative to cesarean hysterectomy in many patients diagnosed with PAS. This new surgical management of PAS resulted in the preservation of the uterus, and a favorable outcome in nearly 9 out of 10 pregnant women. We believe that MOSCUS can be safely offered for the management of PAS in referral hospital settings.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Thi Pham
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Diem Phuong Truong
- Department of Obstetrics Bloc M, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Dinh Vinh Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | | | | | - Quang Nhat Ho
- Department of Postoperative Care Bloc A, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
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12
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Mizutani H, Ushida T, Ozeki K, Tano S, Iitani Y, Imai K, Nishiwaki K, Kajiyama H, Kotani T. Predictive performance of Shock Index for postpartum hemorrhage during cesarean delivery. Int J Obstet Anesth 2024; 58:103957. [PMID: 38071128 DOI: 10.1016/j.ijoa.2023.103957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/05/2023] [Accepted: 11/15/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND The Shock Index (SI), defined as heart rate divided by systolic blood pressure, is reportedly an early surrogate indicator for postpartum hemorrhage (PPH). However, most previous studies have used clinical data of women who delivered vaginally. Therefore, we aimed to evaluate the SI pattern during cesarean delivery and determine its usefulness in detecting PPH. METHODS This was a single-center retrospective study using the clinical data of women (n = 331) who underwent cesarean delivery under spinal anesthesia at term between 2018 and 2021. We assessed the SI pattern stratified by total blood loss and evaluated the predictive performance of each vital sign in detecting PPH (total blood loss ≥1000 mL) based on the area under the receiver operating characteristic curve (AUROC). RESULTS At 10-15 min after delivery, the mean SI peaked between 0.84 and 0.90 and then decreased to a level between 0.72 and 0.77, which was similar to that upon entering the operating room. Among 331 women, 91 (27.5%) were diagnosed with PPH. There was no correlation between SI and total blood loss (rs = 0.02). The SI had low ability to detect PPH (AUROC 0.54, 95% confidence interval 0.47 to 0.61), which was similar to other vital signs (AUROCs 0.53-0.56). CONCLUSION We determined the pattern of SI during cesarean delivery. We found no correlation between SI and total blood loss. Unlike in vaginal delivery, the prognostic accuracy of SI for PPH detection in cesarean delivery was low.
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Affiliation(s)
- H Mizutani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - K Ozeki
- Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada; Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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13
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Nivatpumin P, Nithi-Uthai J, Lertbunnaphong T, Sukcharoen N, Soponsiripakdee T, Yonphan P. Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study. PLoS One 2024; 19:e0300620. [PMID: 38626161 PMCID: PMC11020384 DOI: 10.1371/journal.pone.0300620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/03/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND This study aimed to identify the characteristics, causes, perioperative anesthetic, and obstetric outcomes of patients experiencing postpartum hemorrhage (PPH) after cesarean delivery. METHODS We retrospectively analyzed patients who underwent cesarean delivery at the largest university hospital in Bangkok, Thailand, during a 5-year period (January 1, 2016-December 31, 2020). PPH was defined as an estimated blood loss (EBL) of ≥ 1000 ml within 24 hours postpartum. RESULTS Of 17 187 cesarean deliveries during the study period, 649 patients were included for analysis. The mean EBL was 1774.3 ± 1564.4 ml (range: 1000-26 000 ml). Among the patients, 166 (25.6%) experienced massive PPH (blood loss > 2000 ml). Intraoperative blood transfusions were necessary for 264 patients (40.7%), while 504 individuals (77.7%) needed intraoperative vasopressors. The analysis revealed uterine atony as the leading cause of PPH in 62.7% (n = 407) of the patients, with abnormal placentation following at 29.3% (n = 190). Abnormal placentation was associated with a significantly higher mean EBL of 2345.0 ± 2303.9 ml compared to uterine atony, which had a mean EBL of 1504.0 ± 820.7 ml (P < 0.001). Abnormal placentation also significantly increased the likelihood of blood transfusions and hysterectomies (P < 0.001 for both) and led to more intensive care unit admissions (P = 0.032). The risk of EBL exceeding 2000 ml was markedly higher in patients with abnormal placentation (odds ratio [OR] 5.12, 95% confidence interval [CI] 3.45-7.57, P < 0.001) and in cases involving trauma to the internal organs (OR 2.33, 95% CI 1.16-4.71, P = 0.018) than in patients with uterine atony. The study documented three instances of perioperative cardiac arrest, one of which was fatal. CONCLUSIONS These findings highlight the importance of comprehensive perioperative management strategies, including the ready availability of adequate blood and blood products, particularly in scenarios predisposed to significant hemorrhage. TRIAL REGISTRATION Clinical trial registration: Clinicaltrial.gov registration number NCT04833556 (April 6, 2021).
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Affiliation(s)
- Patchareya Nivatpumin
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Jitsupa Nithi-Uthai
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Tripop Lertbunnaphong
- Faculty of Medicine Siriraj Hospital, Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Nattapon Sukcharoen
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Thanyarat Soponsiripakdee
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
| | - Pawana Yonphan
- Faculty of Medicine Siriraj Hospital, Department of Anesthesiology, Mahidol University, Bangkok, Thailand
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14
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Weerasingha TK, Ratnayake C, Abeyrathne R, Tennakoon SU. Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka. Heliyon 2024; 10:e28517. [PMID: 38571647 PMCID: PMC10988013 DOI: 10.1016/j.heliyon.2024.e28517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Evidence-based practice (EBP) is an effective approach to improve maternal and newborn outcomes at birth. Objective This study aimed to assess the current intrapartum practices of a tertiary care hospital in Central Province, Sri Lanka, during vaginal births. The benchmark for this assessment was the World Health Organisation's (WHO) recommendations on intrapartum care for a positive childbirth experience. Methods An observational study was conducted at the delivery room of Teaching Hospital, Peradeniya with the participation of 196 labouring women who were selected using systematic random sampling. A non-participant observation checklist covering labour room admission procedures, management of the first, second, and third stages of labour, and immediate care of the newborn and postpartum mother was used for the data collection. The care interventions implemented throughout labour and childbirth were observed and recorded. The data analysis was done using SPSS version 22. Results WHO-recommended practices such as providing privacy (33.2%), offering oral fluids (39.3%), and opioids for pain relief (48.5%) were found to be infrequent. Encouraging correct pushing techniques (77.6%), early breastfeeding (83.2%), regular assessment of vaginal bleeding (91.3%), skin-to-skin contact (93.4%), and using prophylactic uterotonics (100.0%) were found to be frequent. However, labour companionship, use of upright positions during labour, women's choice of birth position, and use of manual or relaxation techniques for pain relief were not observed in hospital intrapartum care. Conclusion The findings of the study indicate that additional attention and monitoring are required to align the current intrapartum care practices with the WHO recommendations. Moreover, the adoption of evidence-based intrapartum care should be encouraged by conveying the standard evidence-based intrapartum care guidelines to the grassroots level healthcare workers to avoid intrapartum interventions.
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Affiliation(s)
| | - Chathura Ratnayake
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - R.M. Abeyrathne
- Department of Sociology, Faculty of Arts, University of Peradeniya, Sri Lanka
| | - Sampath U.B. Tennakoon
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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15
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Okunade KS, Adejimi AA, Olumodeji AM, Olowe A, Oyedeji OA, Ademuyiwa IY, Adelabu H, Toks-Omage E, Okoro AC, Davies N, Adenekan MA, Ojo T, Rabiu KA, Oshodi YA, Ugwu AO, Olowoselu FO, Akinmola OO, Olamijulo JA, Oluwole AA. Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study. BMC Public Health 2024; 24:1028. [PMID: 38609913 PMCID: PMC11015669 DOI: 10.1186/s12889-024-18446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria.
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.
- Centre for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.
| | - Adebola A Adejimi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Ayokunle M Olumodeji
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Atinuke Olowe
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Olufemi A Oyedeji
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Hameed Adelabu
- Centre for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Eselobu Toks-Omage
- Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Austin C Okoro
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nosimot Davies
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics & Gynaecology, Lagos Island Maternity Hospital, Lagos Island, Nigeria
| | - Temitope Ojo
- Department of Obstetrics & Gynaecology, Federal Medical Center, Ebute-Meta, Lagos, Nigeria
| | - Kabiru A Rabiu
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics & Gynaecology, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria
| | - Festus O Olowoselu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olukayode O Akinmola
- Department of Chemical Pathology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Joseph A Olamijulo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Yang Y, Shao Y, Chen H, Guo X, Liang Y, Wang Y, Zhao Y. Characteristics and treatment for severe postpartum haemorrhage in different midwifery hospitals in one district of Beijing in China: an institution-based, retrospective cohort study. BMJ Open 2024; 14:e077709. [PMID: 38569676 DOI: 10.1136/bmjopen-2023-077709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To identify the characteristics and treatment approaches for patients with severe postpartum haemorrhage (SPPH) in various midwifery institutions in one district in Beijing, especially those without identifiable antenatal PPH high-risk factors, to improve regional SPPH rescue capacity. DESIGN Retrospective cohort study. SETTING This study was conducted at 9 tertiary-level hospitals and 10 secondary-level hospitals in Haidian district of Beijing from January 2019 to December 2022. PARTICIPANTS The major inclusion criterion was SPPH with blood loss ≥1500 mL or needing a packed blood product transfusion ≥1000 mL within 24 hours after birth. A total of 324 mothers with SPPH were reported to the Regional Obstetric Quality Control Office from 19 midwifery hospitals. OUTCOME MEASURES The pregnancy characteristics collected included age at delivery, gestational weeks at delivery, height, parity, delivery mode, antenatal PPH high-risk factors, aetiology of PPH, bleeding amount, PPH complications, transfusion volume and PPH management. SPPH characteristics were compared between two levels of midwifery hospitals and their association with antenatal PPH high-risk factors was determined. RESULTS SPPH was observed in 324 mothers out of 106 697 mothers in the 4 years. There were 74.4% and 23.9% cases of SPPH without detectable antenatal PPH high-risk factors in secondary and tertiary midwifery hospitals, respectively. Primary uterine atony was the leading cause of SPPH in secondary midwifery hospitals, whereas placental-associated disorders were the leading causes in tertiary institutions. Rates of red blood cell transfusion over 10 units, unscheduled returns to the operating room and adverse PPH complications were higher in patients without antenatal PPH high-risk factors. Secondary hospitals had significantly higher rates of trauma compared with tertiary institutions. CONCLUSION Examining SPPH cases at various institutional levels offers a more comprehensive view of regional SPPH management and enhances targeted training in this area.
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Affiliation(s)
- Yike Yang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Centre for Obstetrics and Gynecology, Beijing, China
| | - Yu Shao
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Huan Chen
- Peking University Health Science Center, Beijing, Beijing, China
| | - Xiaoyue Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yingzhi Liang
- Haidian Maternal and Child Health Hospital, Beijing, Beijing, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
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17
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Provinciatto H, Barbalho ME, da Câmara PM, Donadon IB, Fonseca LM, Bertani MS, Marinho AD, Sirena E, Provinciatto A, Amaral S. Prophylactic tranexamic acid in Cesarean delivery: an updated meta-analysis with a trial sequential analysis. Can J Anaesth 2024; 71:465-478. [PMID: 38453797 DOI: 10.1007/s12630-024-02715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Although several studies on the prophylactic use of tranexamic acid (TXA) in parturients undergoing Cesarean delivery have been published, conflicting results raise questions regarding its use. Thus, we aimed to investigate the safety and efficacy of PPH prophylaxis with TXA. SOURCE We searched PubMed®, Embase, Cochrane Central, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing prophylactic TXA with placebo or no treatment in parturients undergoing Cesarean delivery. Our main outcomes were PPH, any blood transfusion, need for additional uterotonics, and adverse events. We performed a trial sequential analysis (TSA) of all outcomes to investigate the reliability and conclusiveness of findings. PRINCIPAL FINDINGS We included 38 RCTs including 22,940 parturients, 11,535 (50%) of whom were randomized to receive prophylactic TXA. Patients treated with TXA had significantly fewer cases of PPH (risk ratio [RR], 0.51; 95% confidence interval [CI], 0.38 to 0.69; P < 0.001); less blood transfusion (RR, 0.43; 95% CI, 0.30 to 0.61; P < 0.001), and less use of additional uterotonics (RR, 0.52; 95% CI, 0.40 to 0.68; P < 0.001). No significant differences were found between the groups in terms of adverse effects and thromboembolic events. CONCLUSION Prophylactic TXA administration for parturients undergoing Cesarean delivery significantly reduced blood loss, without increasing adverse events, supporting its use as a safe and effective strategy for reducing PPH in this population. STUDY REGISTRATION PROSPERO (CRD42023422188); first submitted 27 April 2023.
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Affiliation(s)
- Henrique Provinciatto
- Barao de Maua University Center, Avenida Portugal, 2433, Ribeirao Preto, SP, Brazil.
| | | | | | | | - Luiza M Fonseca
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
| | | | - Alice D Marinho
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Sara Amaral
- Regional Hospital Deputado Afonso Guizzo, Araranguá, Brazil
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18
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Kowalczyk JJ, Cecconi M, Butwick AJ. Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage. Curr Opin Obstet Gynecol 2024; 36:88-96. [PMID: 38170626 DOI: 10.1097/gco.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Tranexamic acid (TXA) has emerged as a promising pharmacological adjunct to treat and prevent postpartum hemorrhage (PPH). We provide an overview of TXA, including its pharmacology, key findings of randomized trials and observational studies, and critical patient safety information. RECENT FINDINGS Pharmacokinetic data indicate that TXA infusions result in peak plasma concentration within 3 min (range: 1-6.6 min). Ex-vivo pharmacodynamic data suggest that low-dose TXA (5 mg/kg) inhibits maximum lysis for at least 1 h. In predominantly developing countries, TXA has demonstrated a 19% reduction in the risk of bleeding-related death among patients with PPH. Based on high-quality randomized trials, TXA prophylaxis does not effectively reduce the risk of PPH during vaginal delivery and is likely ineffective in reducing the PPH risk during cesarean delivery. TXA exposure does not increase the risk of maternal thrombotic events. Maternal deaths have occurred from accidental intrathecal TXA injection from look-alike medication errors. SUMMARY TXA has shown promise as an important adjunct for PPH treatment, especially in low-resource settings. However, TXA is not recommended as PPH prophylaxis during vaginal or cesarean delivery. Patient safety initiatives should be prioritized to prevent maternal death from accidental intrathecal TXA injection.
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Affiliation(s)
- John J Kowalczyk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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19
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Hargett SE, Leslie EF, Chapa HO, Gaharwar AK. Animal models of postpartum hemorrhage. Lab Anim (NY) 2024; 53:93-106. [PMID: 38528231 DOI: 10.1038/s41684-024-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
Postpartum hemorrhage (PPH)-heavy bleeding following childbirth-is a leading cause of morbidity and mortality worldwide. PPH can affect individuals regardless of risks factors and its incidence has been increasing in high-income countries including the United States. The high incidence and severity of this childbirth complication has propelled research into advanced treatments and alternative solutions for patients facing PPH; however, the development of novel treatments is limited by the absence of a common, well-established and well-validated animal model of PPH. A variety of animals have been used for in vivo studies of novel therapeutic materials; however, each of these animals differs considerably from the anatomy and physiology of a postpartum woman, and the methods used for achieving a postpartum hemorrhagic condition vary widely. Here we critically evaluate the various animal models of PPH presented in the literature and propose additional and alternative methods for modeling PPH in in vivo studies. We highlight how current animal models successfully or unsuccessfully mimic the anatomy and physiology of a postpartum woman and how this may impact treatment development. We aim to equip researchers with the necessary background information to select appropriate animal models for their research related to PPH solutions, while supporting the goals of refinement, reduction and replacement (3Rs) in preclinical animal studies.
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Affiliation(s)
- Sarah E Hargett
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA
| | - Elaine F Leslie
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA
| | - Hector O Chapa
- Medical Education, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Akhilesh K Gaharwar
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA.
- Interdisciplinary Program in Genetics and Genomics, Texas A&M University, College Station, TX, USA.
- Department of Material Science and Engineering, College of Engineering, Texas A&M University, College Station, TX, USA.
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, USA.
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20
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McQuilten ZK, Wood EM, Medcalf RL. When to use tranexamic acid for the treatment of major bleeding? J Thromb Haemost 2024; 22:581-593. [PMID: 37827378 DOI: 10.1016/j.jtha.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/15/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent originally developed for the management of bleeding in the setting of postpartum hemorrhage (PPH). Over the last 15 years, there has been accumulating evidence on the use of TXA for the treatment of active bleeding in a variety of clinical contexts. Clinical trials have shown that the efficacy and safety of TXA for the treatment of bleeding differ according to the clinical context in which it is being administered, timing of administration, and dose. Early administration is important for efficacy, particularly in trauma and PPH. Further studies are needed to understand the mechanisms by which TXA provides benefit, optimal modes of administration and dosing, and its effect in some clinical settings, such as spontaneous intracerebral hemorrhage. There is no evidence that TXA increases the risk of thrombotic events in patients with major bleeding overall. However, there is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding. There is also evidence of increased risk of seizures with the use of higher doses. This review summarizes the current evidence for the use of TXA for patients with active bleeding and highlights the importance of generating evidence of efficacy and safety of hemostatic interventions specific to the bleeding contexts-as findings from 1 clinical setting may not be generalizable to other contexts-and that of individual patient assessment for bleeding, thrombotic, and other risks, as well as important logistical and other practical considerations, to optimize care and outcomes in these settings.
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Affiliation(s)
- Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Haematology, Monash Health, Melbourne, Victoria, Australia.
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Robert L Medcalf
- Central Clinical School, Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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21
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Hersh AR, Carroli G, Hofmeyr GJ, Garg B, Gülmezoglu M, Lumbiganon P, De Mucio B, Saleem S, Festin MPR, Mittal S, Rubio-Romero JA, Chipato T, Valencia C, Tolosa JE. Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes. Am J Obstet Gynecol 2024; 230:S1046-S1060.e1. [PMID: 38462248 DOI: 10.1016/j.ajog.2022.11.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 03/12/2024]
Abstract
The third stage of labor is defined as the time period between delivery of the fetus through delivery of the placenta. During a normal third stage, uterine contractions lead to separation and expulsion of the placenta from the uterus. Postpartum hemorrhage is a relatively common complication of the third stage of labor. Strategies have been studied to mitigate the risk of postpartum hemorrhage, leading to the widespread implementation of active management of the third stage of labor. Initially, active management of the third stage of labor consisted of a bundle of interventions including administration of a uterotonic agent, early cord clamping, controlled cord traction, and external uterine massage. However, the effectiveness of these interventions as a bundle has been questioned, leading to abandonment of some components in recent years. Despite this, upon review of selected international guidelines, we found that the term "active management of the third stage of labor" was still used, but recommendations for and against individual interventions were variable and not necessarily supported by current evidence. In this review, we: (1) examine the physiology of the third stage of labor, (2) present evidence related to interventions that prevent postpartum hemorrhage and promote maternal and neonatal health, (3) review current global guidelines and recommendations for practice, and (4) propose future areas of investigation. The interventions in this review include pharmacologic agents to prevent postpartum hemorrhage, cord clamping, cord milking, cord traction, cord drainage, early skin-to-skin contact, and nipple stimulation. Treatment of complications of the third stage of labor is outside of the scope of this review. We conclude that current evidence supports the use of effective pharmacologic postpartum hemorrhage prophylaxis, delayed cord clamping, early skin-to-skin contact, and controlled cord traction at delivery when feasible. The most effective uterotonic regimens for preventing postpartum hemorrhage after vaginal delivery include oxytocin plus ergometrine; oxytocin plus misoprostol; or carbetocin. After cesarean delivery, carbetocin or oxytocin as a bolus are the most effective regimens. There is inconsistent evidence regarding the use of tranexamic acid in addition to a uterotonic compared with a uterotonic alone for postpartum hemorrhage prevention after all deliveries. Because of differences in patient comorbidities, costs, and availability of resources and staff, decisions to use specific prevention strategies are dependent on patient- and system-level factors. We recommend that the term "active management of the third stage of labor" as a combined intervention no longer be used. Instead, we recommend that "third stage care" be adopted, which promotes the implementation of evidence-based interventions that incorporate practices that are safe and beneficial for both the woman and neonate.
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Affiliation(s)
- Alyssa R Hersh
- Oregon Health & Science University, Portland, OR; FUNDARED-MATERNA, Bogotá, Colombia.
| | | | - G Justus Hofmeyr
- University of Botswana, Gaborone, Botswana; University of the Witwatersrand, Johannesburg, Johannesburg, South Africa; Walter Sisulu University, Mthatha, South Africa
| | - Bharti Garg
- Oregon Health & Science University, Portland, OR
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health, Montevideo, Uruguay
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mario Philip R Festin
- Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines, Manila, Philippines
| | | | | | - Tsungai Chipato
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
| | - Catalina Valencia
- FUNDARED-MATERNA, Bogotá, Colombia; Medicina Fetal SAS, Medellin, Colombia
| | - Jorge E Tolosa
- Oregon Health & Science University, Portland, OR; FUNDARED-MATERNA, Bogotá, Colombia; St. Luke's University Health Network, Bethlehem, PA
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22
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Nabhan A, Stringer E, Topçu G. Contemporary Issues in Women's Health. Int J Gynaecol Obstet 2024; 164:807-810. [PMID: 37083102 DOI: 10.1002/ijgo.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Elizabeth Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
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23
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Okaforcha EI, Eleje GU, Ikechebelu JI, Ezeama CO, Igbodike EP, Ugwu EO, Okpala BC, Mbachu II, Umeononihu OS, Ogabido CA, Onwusulu DN, Oguejiofor CB, Okafor CC, Olisa CL, Ikwuka DC, Ofor IJ, Okafor CG. Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial. SAGE Open Med 2024; 12:20503121241230484. [PMID: 38406581 PMCID: PMC10894536 DOI: 10.1177/20503121241230484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/18/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. Methods A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. Results The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Conclusion Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.
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Affiliation(s)
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chukwuemeka Okwudili Ezeama
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Emmanuel Onyebuchi Ugwu
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Boniface Chukwuneme Okpala
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ikechukwu Innocent Mbachu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Osita Samuel Umeononihu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Chukwudi Anthony Ogabido
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Daniel Nnaemeka Onwusulu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Charlotte Blanche Oguejiofor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Chinedu Lawrence Olisa
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - David Chibuike Ikwuka
- Department of Medical Physiology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | | | - Chigozie Geoffrey Okafor
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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24
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Alonso-Burgos A, Díaz-Lorenzo I, Muñoz-Saá L, Gallardo G, Castellanos T, Cardenas R, Chiva de Agustín L. Primary and secondary postpartum haemorrhage: a review for a rationale endovascular approach. CVIR Endovasc 2024; 7:17. [PMID: 38349501 PMCID: PMC10864234 DOI: 10.1186/s42155-024-00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Postpartum haemorrhage (PPH) is a significant cause of maternal mortality globally, necessitating prompt and efficient management. This review provides a comprehensive exploration of endovascular treatment dimensions for both primary and secondary PPH, with a focus on uterine atony, trauma, placenta accreta spectrum (PAS), and retained products of conception (RPOC). Primary PPH, occurring within 24 h, often results from uterine atony in 70% of causes, but also from trauma, or PAS. Uterine atony involves inadequate myometrial contraction, addressed through uterine massage, oxytocin, and, if needed, mechanical modalities like balloon tamponade. Trauma-related PPH may stem from perineal injuries or pseudoaneurysm rupture, while PAS involves abnormal placental adherence. PAS demands early detection due to associated life-threatening bleeding during delivery. Secondary PPH, occurring within 24 h to 6 weeks postpartum, frequently arises from RPOC. Medical management may include uterine contraction drugs and hemostatic agents, but invasive procedures like dilation and curettage (D&C) or hysteroscopic resection may be required.Imaging assessments, particularly through ultrasound (US), play a crucial role in the diagnosis and treatment planning of postpartum haemorrhage (PPH), except for uterine atony, where imaging techniques prove to be of limited utility in its management. Computed tomography play an important role in evaluation of trauma related PPH cases and MRI is essential in diagnosing and treatment planning of PAS and RPOC.Uterine artery embolization (UAE) has become a standard intervention for refractory PPH, offering a rapid, effective, and safe alternative to surgery with a success rate exceeding 85% (Rand T. et al. CVIR Endovasc 3:1-12, 2020). The technical approach involves non-selective uterine artery embolization with resorbable gelatine sponge (GS) in semi-liquid or torpedo presentation as the most extended embolic or calibrated microspheres. Selective embolization is warranted in cases with identifiable bleeding points or RPOC with AVM-like angiographic patterns and liquid embolics could be a good option in this scenario. UAE in PAS requires a tailored approach, considering the degree of placental invasion. A thorough understanding of female pelvis vascular anatomy and collateral pathways is essential for accurate and safe UAE.In conclusion, integrating interventional radiology techniques into clinical guidelines for primary and secondary PPH management and co-working during labour is crucial.
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Affiliation(s)
- Alberto Alonso-Burgos
- Radiology Department, Vascular Surgery and Interventional Radiology Unit, University Clinic of Navarra, Clínica Universidad de Navarra, Marquesado de Santa Marta 1, 28027, Madrid, Spain.
| | - Ignacio Díaz-Lorenzo
- Radiology Department, Interventional Radiology Unit, University Hospital La Princesa, Madrid, Spain
| | - Laura Muñoz-Saá
- Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | | | | | - Regina Cardenas
- Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
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Vogel JP, Nguyen PY, Ramson J, De Silva MS, Pham MD, Sultana S, McDonald S, Adu-Bonsaffoh K, McDougall ARA. Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: a systematic review. Am J Obstet Gynecol 2024:S0002-9378(24)00042-5. [PMID: 38336124 DOI: 10.1016/j.ajog.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment. DATA SOURCES We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles. STUDY ELIGIBILITY CRITERIA Peer-reviewed studies evaluating postpartum hemorrhage-related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible. METHODS Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively. RESULTS Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32-0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57-0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution. CONCLUSION The E-MOTIVE intervention improves postpartum hemorrhage-related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Phi-Yen Nguyen
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jen Ramson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Manarangi S De Silva
- Department of Obstetrics, Gynaecology and Newborn Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Minh D Pham
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saima Sultana
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Annie R A McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
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26
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Al-Khatib A, Sagot P, Cottenet J, Aroun M, Quantin C, Desplanches T. Major postpartum haemorrhage after frozen embryo transfer: A population-based study. BJOG 2024; 131:300-308. [PMID: 37550089 DOI: 10.1111/1471-0528.17625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To investigate the effect on major postpartum haemorrhage (PPH) of mode of conception, differentiating between naturally conceived pregnancies, fresh embryo in vitro fertilisation (fresh-IVF) and frozen embryo transfer (frozen-IVF). DESIGN Retrospective cohort study. SETTING The French Burgundy Perinatal Network database, including all deliveries from 2006 to 2020, was linked to the regional blood centre database. POPULATION OR SAMPLE In all, 244 336 women were included, of whom 240 259 (98.3%) were singleton pregnancies. METHODS The main analyses were conducted in singleton pregnancies, including 237 608 naturally conceived, 1773 fresh-IVF and 878 frozen-IVF pregnancies. Multivariate logistic regression models adjusted on maternal age, body mass index, smoking, parity, induction of labour, hypertensive disorders, diabetes, placenta praevia and/or accreta, history of caesarean section, mode of delivery, birthweight, birth place and year of delivery, were used. MAIN OUTCOME MEASURES Major PPH was defined as PPH requiring blood transfusion and/or emergency surgery and/or interventional radiology. RESULTS The prevalence of major PPH was 0.74% (n = 1749) in naturally conceived pregnancies, 1.92% (n = 34) in fresh-IVF pregnancies, and 3.30% (n = 29) in frozen-IVF pregnancies. The risk of major PPH was higher in frozen-IVF pregnancies than in both naturally conceived pregnancies (adjusted odds ratio [aOR] 2.63, 95% CI 1.68-4.10) and fresh-IVF pregnancies (aOR 2.78, 95% CI 1.44-5.35). CONCLUSIONS We found that frozen-IVF pregnancies have a higher risk of major PPH and they should be subject to increased vigilance in the delivery room.
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Affiliation(s)
- Amélie Al-Khatib
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Paul Sagot
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
| | - Massinissa Aroun
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Service de Biostatistique et d'Informatique Médicale (DIM), Dijon University Hospital, Dijon, France
- Clinical Epidemiology Unit, Inserm, CIC 1432, Dijon, France
- Clinical Investigation Centre, Dijon University Hospital, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Thomas Desplanches
- Pôle de Gynécologie-Obstétrique et Biologie de la Reproduction, Dijon University Hospital, Dijon, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Nieto-Calvache AJ, Otero AF, Nieto-Calvache AS, Aryananda R, Ortiz-Lizcano EI, Meade-Triviño P, Maya J, Sarria-Ortiz D, Muñoz-Córdoba L, Yanque-Robles O, Posadas A, Zea-Prado F, Burgos-Luna JM, Vasco M, Messa-Bryon A. Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation. Int J Gynaecol Obstet 2024; 164:763-769. [PMID: 37872710 DOI: 10.1002/ijgo.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. METHODS An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. RESULTS Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. CONCLUSION We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.
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Affiliation(s)
| | | | | | - Rozi Aryananda
- Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Juliana Maya
- Facultad de Ciencias de la Salud, Programa de Medicina, Universidad Icesi, Cali, Colombia
| | | | - Laura Muñoz-Córdoba
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
| | | | - Alejandro Posadas
- Centro de Entrenamiento Quirúrgico en Obstetricia y Ginecología (CEQOG), México City, Mexico
| | | | | | - Mauricio Vasco
- Director simulación clínica, Facultad de medicina, Universidad CES, Medellín, Colombia
| | - Adriana Messa-Bryon
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia
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Madar H, Deneux-Tharaux C, Sentilhes L. Shock index as a predictor of postpartum haemorrhage after vaginal delivery: Secondary analysis of a multicentre randomised controlled trial. BJOG 2024; 131:343-352. [PMID: 37555480 DOI: 10.1111/1471-0528.17634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To describe the shock index (SI) distribution during the first 2 hours after delivery and to evaluate its performance when measured 15 and 30 minutes after delivery for predicting postpartum haemorrhage (PPH) occurrence in the general population of parturients after vaginal delivery. DESIGN Secondary analysis of a multicentre randomised controlled trial testing prophylactic administration of tranexamic acid versus placebo in addition to prophylactic oxytocin to prevent PPH. SETTING 15 French maternity units in 2015-2016. SAMPLE 3891 women with a singleton live fetus ≥35 weeks, born vaginally. METHODS For each PPH-related predicted outcome, we calculated the area under the receiver operating characteristic curve (AUROC) values of the SI at 15 and 30 minutes after delivery and its predictive performance for SI cut-off values of 0.7, 0.9 and 1.1. MAIN OUTCOME MEASURES Quantitative blood loss ≥1000 ml (QBL ≥1000 ml) measured in a graduated collector bag and provider-assessed clinically significant PPH (cPPH). RESULTS Prevalence of QBL ≥1000 ml and cPPH was respectively 2.7% (104/3839) and 9.1% (354/3891). The distributions of the SI at 15 and 30 minutes after delivery were similar with a median value of 0.73 and 97th percentile of 1.11 for both. The AUROC values of the 15-minute SI for discriminating QBL ≥1000 ml and cPPH were respectively 0.66 (lower limit of the 95% confidence interval [LCI] 0.60) and 0.56 (LCI 0.52); and for the 30-minute SI 0.68 (LCI 0.61) and 0.49 (LCI 0.43). CONCLUSIONS The shock index at 15 and 30 minutes after delivery did not satisfactorily predict either QBL ≥1000 ml or clinical PPH.
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Affiliation(s)
- Hugo Madar
- Université Paris Cité, Women's Health IHM, U1153, Centre of Research In Epidemiology and Statistics, Obstetrical, Perinatal and Paediatric Epidemiology EPOPé Research Team, INSERM, INRAE, Paris, France
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Women's Health IHM, U1153, Centre of Research In Epidemiology and Statistics, Obstetrical, Perinatal and Paediatric Epidemiology EPOPé Research Team, INSERM, INRAE, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
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Harzif AK, Nurbaeti P, Andyra AF, Wiweko B. Challenges and diagnosis in therapy of secondary amenorrhoea in caesarean section patient with postpartum haemorrhage B-lynch sutures: a case report. Ann Med Surg (Lond) 2024; 86:1106-1111. [PMID: 38333262 PMCID: PMC10849346 DOI: 10.1097/ms9.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance International Federation of Gynecology and Obstetrics (FIGO) and WHO report the incidence of postpartum haemorrhage (PPH) reaches 1-10% and contributes to an increase in postpartum maternal mortality with uterine atony as the most common cause. B-Lynch method is a suturing technique to overcome PPH. Although this method has proven useful as an emergency life-saving measure, the post-procedure complications are still able to occur. Presentation of case The patient was not menstruating for 14 months after giving birth through caesarean section with B-Lynch due to PPH. Before pregnancy, she had regular menstruation cycle and normal menstrual duration. Her general and gynaecological status were normal. Ultrasound showed the impression of uterine hypoplasia and endometrium that were difficult to assess while both ovaries were normal. Diagnostic hysteroscopy showed a severe degree of Asherman's syndrome. The results of FSH, LH and estradiol were normal. Discussion B-lynch suture is performed as a method to stop PPH in uterine atony. Secondary amenorrhoea occurs as a complication of B-lynch. Compression action of B-lynch can cause progressive myometrium necrosis resulting in synechiae and blockade of uterine blood flow. This will interfere with the development of the uterus. Intrauterine adhesions and amenorrhoea with normal levels of FSH, LH, and estradiol support the diagnosis of Asherman's syndrome. Conclusion This case shows that the B-Lynch procedure, which is the worldwide recommended method for treating postpartum haemorrhage due to its high success rate, can cause complications of Asherman's syndrome and cause secondary amenorrhoea.
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Affiliation(s)
- Achmad Kemal Harzif
- Department of Obstetrics and Gynaecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Elfors FB, Widarsson M, Velandia M. Midwives' experiences of postpartum haemorrhage: A web-based survey in Sweden. Midwifery 2024; 129:103902. [PMID: 38064780 DOI: 10.1016/j.midw.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE The objective was to describe midwives' experiences of postpartum haemorrhage (PPH) >1000 ml in connection with childbirth. DESIGN A qualitative web-based survey with open-ended questions was used and the results were analysed with content analysis. SETTING Participants were recruited through convenience sampling from a national Facebook group for midwives. PARTICIPANTS The study sample included 24 midwives with varying work experience at different maternity units in Sweden, all of whom had experience of postpartum haemorrhage >1000 ml. FINDINGS The midwives described that the treatment of PPH is limited by a lack of cooperation, knowledge, and assistance, as well as by staff inexperience. They also described how a high-pressure work environment contributed to feelings of inadequacy. Good cooperation, team training, having colleagues present, embodied knowledge, and good working conditions, led to successful handling of such situations, which contributed to feeling at ease with what had happened. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Good working conditions related to external contextual factors such as total load and support, as well as internal factors such as self-efficacy, can help midwives manage PPH while providing patient-safe care and feeling confident in their ability and at ease with the events. Therefore, midwives need to be given opportunities for emotional support, education, and team-based training to maintain the quality of midwifery care and avoid negative long-term effects for both midwives and patients.
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Affiliation(s)
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Marianne Velandia
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Okunade KS, Ugwu AO, Adenekan MA, Olumodeji A, Oshodi YA, Ojo T, Adejimi AA, Ademuyiwa IY, Adaramoye V, Okoro AC, Olowe A, Akinmola OO, John-Olabode SO, Adelabu H, Henriquez R, Decroo T, Lynen L. Development of antepartum risk prediction model for postpartum hemorrhage in Lagos, Nigeria: A prospective cohort study (Predict-PPH study). Int J Gynaecol Obstet 2024. [PMID: 38234155 DOI: 10.1002/ijgo.15364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES There is currently a limited ability to accurately identify women at risk of postpartum hemorrhage (PPH). We conducted the "Predict-PPH" study to develop and evaluate an antepartum prediction model and its derived risk-scoring system. METHODS This was a prospective cohort study of healthy pregnant women who registered and gave birth in five hospitals in Lagos, Nigeria, from January to June 2023. Maternal antepartum characteristics were compared between women with and without PPH. A predictive multivariable model was estimated using binary logistic regression with a backward stepwise approach eliminating variables when P was greater than 0.10. Statistically significant associations in the final model were reported when P was less than 0.05. RESULTS The prevalence of PPH in the enrolled cohort was 37.1%. Independent predictors of PPH such as maternal obesity (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 2.47-4.26), maternal anemia (aOR 1.32, 95% CI 1.02-1.72), previous history of cesarean delivery (aOR 4.24, 95% CI 3.13-5.73), and previous PPH (aOR 2.65, 95% CI 1.07-6.56) were incorporated to develop a risk-scoring system. The area under the receiver operating characteristic curve (AUROC) for the prediction model and risk scoring system was 0.72 (95% CI 0.69-0.75). CONCLUSION We recorded a relatively high prevalence of PPH. Our model performance was satisfactory in identifying women at risk of PPH. Therefore, the derived risk-scoring system could be a useful tool to screen and identify pregnant women at risk of PPH during their routine antenatal assessment for birth preparedness and complication readiness.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics and Gynaecology, Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics and Gynaecology, Lagos Island Maternity Hospital, Lagos Island, Lagos, Nigeria
| | - Ayokunle Olumodeji
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Temitope Ojo
- Department of Obstetrics and Gynaecology, Federal Medical Center, Ebute-Meta, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Victoria Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Austin C Okoro
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Atinuke Olowe
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Olukayode O Akinmola
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Sarah O John-Olabode
- Department of Chemical Pathology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Hameed Adelabu
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Rodrigo Henriquez
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Lackovic M, Jankovic M, Mihajlovic S, Milovanovic Z, Rovcanin M, Mitic N, Nikolic D. Gestational Weight Gain, Pregnancy Related Complications and the Short-Term Risks for the Offspring. J Clin Med 2024; 13:445. [PMID: 38256578 PMCID: PMC10816050 DOI: 10.3390/jcm13020445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Maternal obesity influences pregnancy course in several different manners, and imbalanced nutrition during pregnancy may lead to various adverse pregnancy outcomes. Additionally, nutritional status during pregnancy may have implications for the health of the offspring and may possibly influence early motor development in children. The aim of this study was to assess the impact of excessive gestational weight gain (EGWG) on pregnancy outcomes and infant's motor development within the first twelve months of life. MATERIALS AND METHODS The study included 200 participants divided in two groups based on their gestational weight gain. Maternal, perinatal, and neonatal factors were analyzed, and early motor development was assessed using the Alberta infant motor scale (AIMS). RESULTS EGWG was significantly associated with: pre-pregnancy BMI (p < 0.001), family history for cardiovascular diseases (p = 0.013) and diabetes mellitus (p = 0.045), hypertensive disorder of pregnancy (p = 0.003), gestational diabetes mellitus (p < 0.001), gestational anemia (p = 0.001), vitamin D deficiency (p = 0.001), metformin use (p = 0.045), pre-labor premature rupture of membranes (p = 0.031), amniotic fluid index (p = 0.047), and APGAR score in the first five min of life (p = 0.007). Scored by AIMS, EGWG was significantly associated with parameters of early motor development at the age of three AIMS total (p < 0.001), six AIMS total (p < 0.001), nine AIMS total (p < 0.001), and twelve AIMS total (p < 0.001) months of infant's life. CONCLUSIONS The link between EGWG and adverse neurodevelopmental outcomes in offspring is a complex and multifaceted issue. Our results imply significant alterations in early motor development in the group of infants born from mothers who gained weight excessively during pregnancy. Further studies are needed to unravel the intricacies of this relationship and inform strategies for preventive interventions and supportive care during pregnancy and infancy.
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Affiliation(s)
- Milan Lackovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.)
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (D.N.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sladjana Mihajlovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (D.N.)
| | - Zagorka Milovanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (D.N.)
- Clinic for Gynecology and Obstetrics “Narodni Front”, 11000 Belgrade, Serbia
| | - Marija Rovcanin
- Clinic for Gynecology and Obstetrics “Narodni Front”, 11000 Belgrade, Serbia
| | - Nikola Mitic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.)
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia (D.N.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
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Nakamura Y, Maruyama J, Umemura T, Hoshino K, Irie Y, Morimoto S, Izutani Y, Ishikura H. CG02N Analyzer Accurately Measures Fibrinogen Level in Whole Blood in the Presence of Low- or High-Dose Heparin. Indian J Hematol Blood Transfus 2024; 40:161-165. [PMID: 38312190 PMCID: PMC10831028 DOI: 10.1007/s12288-023-01659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/17/2023] [Indexed: 02/06/2024] Open
Abstract
Rapid fibrinogen (Fbg) evaluation is important in patients with massive bleeding during severe trauma and those undergoing major surgery. However, there are only a few studies on the point-of-care Fbg analyzer. In this study, we aimed to investigate the accuracy of Fbg level measured using CG02N, with whole blood contained in lithium-heparinized syringes with two different concentrations of heparin. Blood samples were collected in lithium-heparinized tubes, namely PREZA-PAK®II (low-dose heparin group [LG], 7 IU/mL) and Pro-Vent® Plus (high-dose heparin group [HG], 70.5 IU/mL). The Fbg levels in LG and HG were compared with those of citrated plasma Fbg (standard-Fbg). Strong correlations with respect to the Fbg level were observed between standard-Fbg and LG or HG (r = 0.968, p < 0.0001; r = 0.970, p < 0.0001, respectively). We demonstrated that the Fbg level in whole-blood samples was accurately assessed by CG02N and not affected by low- or high-dose heparin.
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Affiliation(s)
- Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Junichi Maruyama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Takehiro Umemura
- Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
| | - Kota Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Yuhei Irie
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Shinichi Morimoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Yoshito Izutani
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, 814-0180 Japan
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Ghosh R, Owa O, Santos N, Butrick E, Piaggio G, Widmer M, Althabe F, Qureshi Z, Lumbiganon P, Katageri G, Walker D. Heat stable carbetocin or oxytocin for prevention of postpartum hemorrhage among women at risk: A secondary analysis of the CHAMPION trial. Int J Gynaecol Obstet 2024; 164:124-130. [PMID: 37357606 DOI: 10.1002/ijgo.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine whether the observed non-inferiority of heat-stable carbetocin (HSC), compared with oxytocin, was influenced by biologic (macrosomia, parity 3 or more, or history of postpartum hemorrhage [PPH]) and/or pharmacologic (induction or augmentation) risk factors for PPH. METHODS The present study is a secondary analysis of the CHAMPION non-inferiority randomized trial-a two-arm, double-blind, active-controlled study conducted at 23 hospitals in 10 countries, between July 2015 and January 2018. Women with singleton pregnancies, expected to deliver vaginally with cervical dilatation up to 6 cm were eligible. Randomization was stratified by country, with 1:1 assignment. Women in the intervention and control groups received a single intramuscular injection of 100 μg of HSC or 10 IU of oxytocin, respectively. The drugs were administered immediately after birth, and the third stage of labor was managed according to the WHO guidelines. Blood was collected using a plastic drape. For this analysis, we defined a woman as being at risk if she had any one or more of the biologic or pharmacologic risk factor(s). RESULTS The HSC and oxytocin arms contained 14 770 and 14 768 women, respectively. The risk ratios (RR) for PPH were 1.29 (95% confidence interval [CI] 1.08-1.53) or 1.73 (95% CI 1.51-1.98) for those with only biologic (macrosomia, parity 3 or more, and PPH in the previous pregnancy) or only pharmacologic (induced or augmented) risk factors, respectively, compared with those with neither risk factors. CONCLUSIONS Findings reinforce previous evidence that macrosomia, high parity, history of PPH, and induction/augmentation are risk factors for PPH. We did not find a difference in effects between HSC and oxytocin for PPH among women who were neither induced nor augmented or among those who were induced or augmented.
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Affiliation(s)
- Rakesh Ghosh
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Olorunfemi Owa
- Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure, Nigeria
| | - Nicole Santos
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Elizabeth Butrick
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | | | - Mariana Widmer
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Zahaida Qureshi
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Khon Kaen University, Bangkok, Thailand
| | | | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
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Mitoma T, Maki J, Suemori A, Kuriyama C, Hayata K, Masuyama H. Crucial factors for implementing treatment strategies in intractable atonic postpartum haemorrhage: early phase contrast medium extravasation on dynamic CT. Clin Radiol 2024; 79:73-79. [PMID: 37926646 DOI: 10.1016/j.crad.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
AIM To identify the relationship between contrast medium extravasation (CME) on dynamic contrast-enhanced computed tomography (DCT) and clinical information in intractable atonic postpartum haemorrhage (PPH) and its relevance to treatment with uterine artery embolisation (UAE). MATERIALS AND METHODS Of 90 patients who underwent DCT to diagnose PPH, 60 diagnosed with intractable atonic PPH were investigated retrospectively. Maternal background and clinical indicators were analysed to compare the positive and negative factors of early phase CME. Regression analysis was used to investigate the factors associated with CME. The sensitivity, specificity, and positive and negative predictive values of early phase CME for predicting UAE were calculated. Clinical outcomes were compared between the two groups according to the timing of the decision to undergo UAE. RESULTS Of the 60 patients with intractable atonic PPH, 21 underwent UAE, 20 of whom had early phase CME on DCT. Pre-DCT clinical parameters and clinical indices were not significantly different in presence of early phase CME. Early phase CME was associated with UAE performance, with a sensitivity of 95%, specificity of 87%, positive predictive value of 80%, and negative predictive value of 97%. In cases where UAE was performed after conservative management, there was a significant increase in blood loss and transfusion volume. CONCLUSION Early phase CME is not indicated by background factors or clinical findings. UAE is not required when CME cannot be detected in the uterine cavity. If early phase CME is present, UAE should be considered immediately.
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Affiliation(s)
- T Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - A Suemori
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - C Kuriyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Hayata
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - H Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Kostov S, Kornovski Y, Watrowski R, Slavchev S, Ivanova Y, Yordanov A. Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations. Clin Pract 2023; 14:32-51. [PMID: 38248429 PMCID: PMC10801552 DOI: 10.3390/clinpract14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.
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Affiliation(s)
- Stoyan Kostov
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria;
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yavor Kornovski
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Rafał Watrowski
- Department of Obstetrics and Gynecology, Helios Hospital Müllheim, 79379 Müllheim, Germany;
- Faculty Associate, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Stanislav Slavchev
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Yonka Ivanova
- Department of Gynecology, Hospital “Saint Anna”, Medical University, 9002 Varna, Bulgaria (S.S.); (Y.I.)
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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Lv X, Gao K, Nie J, Zhang X, Zhang S, Ren Y, Sun X, Li Q, Huang J, Liu L, Zhang X, Zhang W, Liu X. Structures of human prostaglandin F 2α receptor reveal the mechanism of ligand and G protein selectivity. Nat Commun 2023; 14:8136. [PMID: 38065938 PMCID: PMC10709307 DOI: 10.1038/s41467-023-43922-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Prostaglandins and their receptors regulate various physiological processes. Carboprost, an analog of prostaglandin F2α and an agonist for the prostaglandin F2-alpha receptor (FP receptor), is clinically used to treat postpartum hemorrhage (PPH). However, off-target activation of closely related receptors such as the prostaglandin E receptor subtype EP3 (EP3 receptor) by carboprost results in side effects and limits the clinical application. Meanwhile, the FP receptor selective agonist latanoprost is not suitable to treat PPH due to its poor solubility and fast clearance. Here, we present two cryo-EM structures of the FP receptor bound to carboprost and latanoprost-FA (the free acid form of latanoprost) at 2.7 Å and 3.2 Å resolution, respectively. The structures reveal the molecular mechanism of FP receptor selectivity for both endogenous prostaglandins and clinical drugs, as well as the molecular mechanism of G protein coupling preference by the prostaglandin receptors. The structural information may guide the development of better prostaglandin drugs.
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Affiliation(s)
- Xiuqing Lv
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Kaixuan Gao
- State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China
| | - Jia Nie
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Xin Zhang
- State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China
| | - Shuhao Zhang
- State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China
| | - Yinhang Ren
- State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China
| | - Xiaoou Sun
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Qi Li
- Reproductive Medicine Center, Xiangya Hospital Central South University, Changsha, China
| | - Jingrui Huang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Lijuan Liu
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Xiaowen Zhang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China.
- Hunan Engineering Research Center of Early Life Development and Disease Prevention, Changsha, China.
| | - Xiangyu Liu
- State Key Laboratory of Membrane Biology, Tsinghua-Peking Center for Life Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.
- Beijing Frontier Research Center for Biological Structure, Beijing Advanced Innovation Center for Structural Biology, Tsinghua University, Beijing, China.
- Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University, Beijing, China.
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de Vries PLM, Deneux-Tharaux C, Baud D, Chen KK, Donati S, Goffinet F, Knight M, D'Souzah R, Sueters M, van den Akker T. Postpartum haemorrhage in high-resource settings: Variations in clinical management and future research directions based on a comparative study of national guidelines. BJOG 2023; 130:1639-1652. [PMID: 37259184 DOI: 10.1111/1471-0528.17551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/15/2023] [Accepted: 05/04/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare guidelines from eight high-income countries on prevention and management of postpartum haemorrhage (PPH), with a particular focus on severe PPH. DESIGN Comparative study. SETTING High-resource countries. POPULATION Women with PPH. METHODS Systematic comparison of guidance on PPH from eight high-income countries. MAIN OUTCOME MEASURES Definition of PPH, prophylactic management, measurement of blood loss, initial PPH-management, second-line uterotonics, non-pharmacological management, resuscitation/transfusion management, organisation of care, quality/methodological rigour. CONCLUSIONS Our study highlights areas where strong evidence is lacking. There is need for a universal definition of (severe) PPH. Consensus is required on how and when to quantify blood loss to identify PPH promptly. Future research may focus on timing and sequence of second-line uterotonics and non-pharmacological interventions and how these impact maternal outcome. Until more data are available, different transfusion strategies will be applied. The use of clear transfusion-protocols are nonetheless recommended to reduce delays in initiation. There is a need for a collaborative effort to develop standardised, evidence-based PPH guidelines. RESULTS Definitions of (severe) PPH varied as to the applied cut-off of blood loss and incorporation of clinical parameters. Dose and mode of administration of prophylactic uterotonics and methods of blood loss measurement were heterogeneous. Recommendations on second-line uterotonics differed as to type and dose. Obstetric management diverged particularly regarding procedures for uterine atony. Recommendations on transfusion approaches varied with different thresholds for blood transfusion and supplementation of haemostatic agents. Quality of guidelines varied considerably.
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Affiliation(s)
- Pauline L M de Vries
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS, Paris, France
| | - David Baud
- Department of Gynaecology and Obstetrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kenneth K Chen
- Departments of Medicine & ObGyn, Brown University, Providence, Rhode Island, USA
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy
| | - Francois Goffinet
- Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rohan D'Souzah
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Departments of Obstetrics & Gynaecology and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Obstetrics and Gynaecology, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marieke Sueters
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
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Nakajima K, Fujii T, Iriyama T, Ichinose M, Toshimitsu M, Sayama S, Seyama T, Kumasawa K, Ikeda T, Osuga Y. Efficacy of prompt administration of cryoprecipitate in severe postpartum hemorrhage of preeclampsia patients. J Obstet Gynaecol Res 2023; 49:2811-2816. [PMID: 37723942 DOI: 10.1111/jog.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/01/2023] [Indexed: 09/20/2023]
Abstract
AIM Cryoprecipitate (CRYO) is a concentrated preparation of coagulation factors formulated from fresh frozen plasma (FFP), which can replenish coagulation factors rapidly. Preeclampsia (PE) is frequently associated with postpartum hemorrhage (PPH), and the rapid replenishment of coagulation factors is vital in the management. We conducted a retrospective cohort study to determine the efficacy of administering CRYO irrespective of fibrinogen levels in patients with PE who experienced severe PPH. METHODS Patients with PPH accompanied by PE and those who required red blood cell (RBC) transfusion were included. Cases were divided into two groups: those treated with CRYO (N = 16) and those not treated with CRYO (N = 10). The total transfusion volume, blood loss before and after transfusion initiation, duration of hospitalization, presence of pulmonary edema, and performance of either interventional radiology or hysterectomy were compared. RESULTS The median fibrinogen levels before transfusion were 2.24 and 2.34 g/L in the CRYO group and the not using group, respectively. Although blood loss before transfusion was comparable between the two groups, blood loss after transfusion was significantly less in the CRYO group (median: 520 vs. 2352 mL, p = 0.015), as well as the total blood loss (median: 2285 vs. 3825 mL, p = 0.005) and total transfusion volume (median: RBC 6 vs. 16 U, p = 0.01, FFP 10 vs. 20 U, p = 0.017). CONCLUSION Prompt replenishment of coagulation factors using CRYO to patients with PE who experience severe PPH could decrease further bleeding.
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Affiliation(s)
- Keisuke Nakajima
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Ichinose
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatake Toshimitsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Ikeda
- Department of Blood Transfusion, The University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Polzin A, Smith K, Rumpza T. Whole Blood Administration for Obstetric-Related Hemorrhage During Prehospital Transport. Obstet Gynecol 2023; 142:1248-1251. [PMID: 37562035 DOI: 10.1097/aog.0000000000005320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Whole blood transfusion has been used for resuscitation in trauma patients; however, case reports of whole blood transfusion for obstetric-related hemorrhage are limited. Whole blood transfusion typically is accomplished with low titer O-positive whole blood, and, despite success in trauma, use in persons with childbearing potential is of concern due to risk of alloimmunization. CASE We present a case series of patients who received low titer O-positive whole blood for obstetric hemorrhage. One patient was Rh-negative and received immune globulin treatment after whole blood transfusion. All patients survived to hospital discharge. None experienced transfusion-related complications. CONCLUSION Whole blood can be successfully administered both in and out of the hospital setting, even for obstetric hemorrhage. The benefits of easily administered balanced resuscitation, limited donor exposure, and improved patient outcomes likely outweigh potential alloimmunization, especially in resource-limited settings. Addressing concerns of alloimmunization cannot be accomplished without more research, and we encourage others to investigate using whole blood in this population.
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Affiliation(s)
- Abigail Polzin
- Department of Emergency Medicine and the University of South Dakota Sanford School of Medicine, Sanford Health, Sioux Falls, South Dakota; and Sanford Health, Bismarck, North Dakota
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Kasoha M, Nigdelis MP, Bishara L, Wagenpfeil G, Solomayer EF, Haj Hamoud B. Obstetric practice differences between Syrian refugees and non-Syrian nonrefugee gravidae: A retrospective cross-sectional study. Int J Gynaecol Obstet 2023; 163:430-437. [PMID: 37605949 DOI: 10.1002/ijgo.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To assess differences in obstetric practices between Syrian war refugees (SRs) and non-Syrian nonrefugees (NSRs) in a tertiary care provider in Germany. METHODS This was a retrospective study of SRs (n = 356) and NSRs (n = 5836) giving birth between January 2015 and December 2018. Data on medical history, birth mode, complications, and neonatal parameters was extracted. Group differences were evaluated using Mann-Whitney and χ2 test. Logistic regression models were fitted to investigate the association of refugee status with mode of birth in conditions associated with increased risk of cesarean section (CS). RESULTS SRs had higher rates of adolescent pregnancies (1.7% versus 0.6%, P = 0.020) but fewer maternal diseases compared with NSRs (1.7% versus 3.9%, P = 0.035). The rate of CS was higher in the NSR group (43.9% versus 36%, P = 0.003), as well as the rates of premature rupture of membranes (P = 0.006) and steroid administration for lung maturation (P = 0.012). Cases of umbilical artery pH ≤7.0 were more common in SRs (0.4% versus 1.1%, P = 0.027). Women with previous CS had similar odds of CS in the current pregnancy irrespective of study group (odds ratio, 0.94 [95% confidence interval, 0.50-1.75]). CONCLUSION SR women had lower rates of CS but higher rates of adolescent pregnancies and neonatal pH ≤7.0 at birth compared with NSR women.
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Affiliation(s)
- Mariz Kasoha
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Meletios P Nigdelis
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Leila Bishara
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Saarbrücken, Saarland, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
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Torloni MR, Betran AP, Vazquez Corona M, Bohren M, Widmer M. What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review. BMJ Open 2023; 13:e068442. [PMID: 37899165 PMCID: PMC10618966 DOI: 10.1136/bmjopen-2022-068442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES To synthesise evidence on the perceptions of healthcare providers (HCPs) about the quality of oxytocin and misoprostol available in their settings, and their actions as a result of these perceptions. DESIGN Mixed-methods systematic review. ELIGIBILITY CRITERIA We included quantitative and qualitative studies reporting HCPs' perceptions about oxytocin or misoprostol quality. DATA SOURCES We searched CINAHL, Cochrane Library, Ebscohost, Embase, PubMed, Global Index Medicus, Portal regional BVS, PsycNET, Scopus and Web of Science from inception to 31 March 2022 and grey literature. RISK OF BIAS We used the Center for Evidence-Based Management critical appraisal tool for surveys. For qualitative studies, we used the Critical Appraisal Skills Programme tool. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed study selection, data extraction and quality assessment. We conducted separate quantitative and qualitative syntheses and integrated the evidence into a narrative synthesis (convergent segregated review design). RESULTS We included five (three quantitative and two qualitative) studies, of moderate or high quality, conducted in low-income and middle-income countries (LMICs). In the three quantitative studies (N=7065 participants), 8.2-21.3% of HCPs had experienced problems due to known/suspected low-quality oxytocin and 3.3% due to low-quality misoprostol. In the two qualitative studies, perception of oxytocin quality varied. In quantitative studies, when confronted with suspected/known low-quality oxytocin, 29-78% of HCPs would inform a supervisor, 62% would document this in writing, 45-54% would change to another drug and 5-37% would double the dose of oxytocin. Qualitative evidence suggests that many HCPs do not formally report suspected low-quality oxytocin or misoprostol, and use higher doses or additional uterotonics. CONCLUSIONS A proportion of HCPs from LMICs perceive oxytocin to be of low quality. There is very limited evidence on their perceptions about misoprostol. Many HCPs do not report suspected low-quality uterotonics but change to another medicine or double the dose of oxytocin. PROSPERO REGISTRATION NUMBER CRD42022323812.
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Affiliation(s)
- Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meghan Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mariana Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Zomer PML, van Teeffelen MPA, Otterspoor LC, Kamps MJA. Postpartum cardiogenic shock due to coronary artery spasm after methylergometrine and sulprostone administration. Neth Heart J 2023; 31:408-409. [PMID: 37682458 PMCID: PMC10516809 DOI: 10.1007/s12471-023-01805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Pim M L Zomer
- Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
| | | | - Luuk C Otterspoor
- Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
| | - Marlijn J A Kamps
- Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands
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Riascos N, Loaiza-Osorio S, Monroy A, Barona JS, Carvajal J, Echavarria MP, Nasner D, Escobar MF. Effect of the postpartum hemorrhage intervention package implementation in a fourth-level hospital in Latin America. Int J Gynaecol Obstet 2023; 163:291-301. [PMID: 37269178 DOI: 10.1002/ijgo.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the implementation of intervention packages for postpartum hemorrhage (PPH) management in pregnant women hospitalized in a High Obstetric Complexity Unit in a Latin American country. METHODS Retrospective cohort study including pregnant women with PPH attended between January 2011 to December 2019. Three periods of time were defined according to management strategies We performed univariate and multivariate robust Poisson regression logistic models for each of the outcomes derived from each period. RESULTS We included 602 patients. There was a reduction in period 3 of the incidence of massive PPH (16% versus 12% P < 0.001, relative risk [RR] 0.61, 95% confidence interval [CI] 0.44-0.85; P = 0.003), major surgery (24%, 13%, 11%, P = 0.002, RR 0.54, 95% CI 0.33-0.883; P = 0.014), and admission to the intensive care unit (ICU) (14%, 7%, 6.1%, P = 0.0, RR 0.40, 95% CI 0.17-0.96 P = 0.00). CONCLUSION The implementation of PPH intervention packages in a hospital in a middle-income country from Latin America, led to a significant decrease in the incidence of massive bleeding, the rate of major surgery, and the ICU stay of pregnant women affected by this condition.
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Affiliation(s)
- Natalia Riascos
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza-Osorio
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Angelica Monroy
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan Sebastián Barona
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - María Fernanda Escobar
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
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Barnea ER, Muller M, Di Simone N, Inversetti A, Pacagnella R, Borovac-Pinheiro A, Nicholson W. Prep-for-Labor: Overview of FIGO's labor and delivery triage bundles of care to optimize maternal and newborn outcomes. Int J Gynaecol Obstet 2023; 163 Suppl 2:34-39. [PMID: 37807589 DOI: 10.1002/ijgo.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Childbirth is an intense event in which decisions may need to be made in seconds to guarantee the health of both mother and newborn. Despite health systems and care approaches varying widely according to real-life scenarios, availability of facilities, beliefs, resources, staff, and geography, among others, optimal outcomes should be ensured worldwide. Triaging low-risk pregnancies from high-risk pregnancies is the first step to ensure proper allocation of resources. From this need, we developed FIGO's Prep-For-Labor triage methods, a series of 2-minute labor and delivery bundles of care, with special regard given to low- and middle-income countries and rural settings. Around 80% of women, once properly triaged, can pursue vaginal delivery with minimal intervention, while those at risk can either be managed on site or transferred promptly to an advanced care site. FIGO's bundles of care and good practice recommendations for labor and delivery and immediate newborn triage cover four clinical scenarios: (1) preterm labor; (2) induced or spontaneous labor at term; (3) cesarean delivery; and (4) newborn care. From rapid triage of the mother (low vs high risk) to the list of required equipment, description of skilled staff, and coordination of resources, the recommendations for care are introduced across these four areas in this overview article. Implementing the proposed management steps described in each summary can improve maternal and neonatal outcomes.
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Affiliation(s)
- Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Department of Obstetrics Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Martin Muller
- Department of Obstetrics and Gynecology, Lindenhofgruppe, Bern, Switzerland
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Pacagnella
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Wanda Nicholson
- The George Washington Milken Institute of Public Health, Washington, District of Columbia, USA
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Cetin C, Tanoglu FB, Hanligil E, Gokce A, Pasin O, Ozcan P. Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial. Gynecol Obstet Invest 2023; 88:366-374. [PMID: 37778349 DOI: 10.1159/000534375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. DESIGN A multicentric randomized controlled trial. PARTICIPANTS/MATERIALS, SETTING, AND METHODS This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75). RESULTS The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6). LIMITATIONS The most important limitation of the study is a relatively small number of participants. CONCLUSION In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.
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Affiliation(s)
- Caglar Cetin
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Fatma Basak Tanoglu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Erhan Hanligil
- Department of Obstetrics and Gynecology, Van Research and Training Hospital, Van, Turkey
| | - Ali Gokce
- Department of Obstetrics and Gynecology, Ankara University Medical School, Ankara, Turkey
| | - Ozge Pasin
- Faculty of Medicine, Department of Basic Medical Sciences, Department of Biostatistics and Medical Informatics, Bezmialem Vakif University, Istanbul, Turkey
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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Park CH, Bae JG, Lee JW. Successful perioperative management with damage control surgery following cardiac arrest due to massive postpartum hemorrhage: A case report. Medicine (Baltimore) 2023; 102:e35450. [PMID: 37773834 PMCID: PMC10545379 DOI: 10.1097/md.0000000000035450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Although declining, maternal mortality due to postpartum hemorrhage (PPH) remains significant. Here we report the case of a 31-year-old primipara patient admitted with cardiac arrest due to PPH. CASE PRESENTATION Labor was induced at gestational week 39, and the infant was delivered rapidly. Cardiac arrest due to PPH occurred during the transfer to our hospital, and the patient underwent cardiopulmonary resuscitation upon arrival to the emergency room. On admission, her hemoglobin level was 0.7 g/dL and she was in hypovolemic shock. Resuscitation and hysterectomy were performed immediately, including damage control surgery and gauze packing, to control the diffuse oozing bleeding due to severe disseminated intravascular coagulation. Relaparotomy for hemostasis was subsequently performed because of a decrease in hemoglobin level and blood pressure, and gauze packing was reinserted with temporary abdominal closure. Two days later, the abdominal wall was closed after confirming the absence of bleeding and the patient recovered well without further intervention. CONCLUSION A prompt and assertive intensive response through collaborative efforts, utilizing feasible damage control surgery, can elegantly salvage uncontrolled bleeding in PPH patients with disseminated intravascular coagulation.
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Affiliation(s)
- Chan Hee Park
- Department of Surgery, School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin Gon Bae
- Department of Obstetrics and Gynecology, School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong Woo Lee
- Department of Surgery, School of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
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Ruiz-Labarta FJ, Aracil Rodríguez R, Sáez Prat A, Pérez Burrel L, Pina Moreno JM, Sánchez Rodríguez M, Pintado Recarte MP, García-Honduvilla N, Ortega MA, Anguita Velasco J, Pérez Corral A, Bravo C, De León-Luis JA. Red Blood Cell Transfusion after Postpartum Hemorrhage: Clinical Variables Associated with Lack of Postpartum Hemorrhage Etiology Identification. J Clin Med 2023; 12:6175. [PMID: 37834817 PMCID: PMC10573897 DOI: 10.3390/jcm12196175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Postpartum hemorrhage (PPH) remains a significant obstetric emergency worldwide and a leading cause of maternal death. However, it is commonly underreported, which can represent a major concern for maternal morbidity and mortality. This retrospective case series study analyzed patients with red blood cell transfusion (RBCt) in the postpartum period over a four-year interval at a specific center. A total of 18,674 patients delivered between January 2018 and December 2021. Patients with postpartum RBCt were classified into two groups: those with identified PPH (i-PPH) and those without (non-i-PPH). Clinical variables, delivery details, blood loss data, and treatment information were collected. Statistical analysis involved a comparison of variables between the i-PPH and non-i-PPH groups. Univariate and multivariate analyses were performed, aiming to identify significant associations between the clinical variables and a lack of PPH identification. The incidence of RBCt was 1.26% (236 cases). Patients receiving RBCt had higher rates of cesarean delivery, twin pregnancy, labor induction, and previous cesarean section. Among patients with postpartum RBCt, 34.3% lacked an identified PPH. The rarity of postpartum RBCt contrasts with the increasing rates of PPH, highlighting the importance of diagnosing PPH and postpartum anemia. A strategy of systematic quantification of blood loss during delivery could help detect PPH and anemia before adverse consequences occur.
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Affiliation(s)
- Francisco Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Rocío Aracil Rodríguez
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
| | - Ainoa Sáez Prat
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Laura Pérez Burrel
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Juan Manuel Pina Moreno
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Mercedes Sánchez Rodríguez
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - María Pilar Pintado Recarte
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
- University Center for the Defense of Madrid (CUD-ACD), 28047 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Ramón y Cajal Institute of Healthcare Research (IRYCIS), 28034 Madrid, Spain
| | - Javier Anguita Velasco
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Department of Haematology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ana Pérez Corral
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Department of Haematology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, Faculty of Medicine and Health Science, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.J.R.-L.); (R.A.R.); (A.S.P.); (L.P.B.); (J.M.P.M.); (M.S.R.); (M.P.P.R.); (C.B.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain; (J.A.V.); (A.P.C.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
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Anouilh F, de Moreuil C, Trémouilhac C, Jacquot M, Salnelle G, Bellec V, Touffet N, Cornec C, Muller M, Dupré PF, Bellot C, Morcel K, Joliff DL, Drugmanne G, Gelebart E, Lucier S, Nowak E, Bihan L, Couturaud F, Tromeur C, Moigne EL, Pan-Petesch B. Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter Haemorrhages and Thromboembolic Venous Disease of the Postpartum cohort study. Am J Obstet Gynecol MFM 2023; 5:101062. [PMID: 37343695 DOI: 10.1016/j.ajogmf.2023.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a major component of perinatal morbidity and mortality that affects young women worldwide and is still often unpredictable. Reducing the incidence of postpartum hemorrhage is a major health issue and identifying women at risk for postpartum hemorrhage is a key element in preventing this complication. OBJECTIVE This study aimed to estimate postpartum hemorrhage prevalence after vaginal delivery and to identify postpartum hemorrhage risk factors. STUDY DESIGN Unselected pregnant women ≥16 years of age admitted to 1 of 6 maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective, multicenter cohort study between June 1, 2015, and January 31, 2019. Postpartum hemorrhage was defined as blood loss ≥500 mL in the 24 hours following delivery. Independent risk factors for postpartum hemorrhage were determined using logistic regression. Missing data were imputed using the Multivariate Imputation by Chained Equations method. RESULTS Among 16,382 included women, the postpartum hemorrhage prevalence was 5.37%. A first-degree family history of postpartum hemorrhage (adjusted odds ratio, 1.63; 95% confidence interval, 1.24-2.14) and a personal transfusion history (adjusted odds ratio, 1.90; 95% confidence interval, 1.23-2.92) were significantly associated with postpartum hemorrhage. The use of oxytocin during labor was also a risk factor for postpartum hemorrhage (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk for postpartum hemorrhage (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.91, and 0.34; 95% confidence interval, 0.13-0.87, respectively). CONCLUSION In addition to classical risk factors, this study identified a family history of postpartum hemorrhage and personal transfusion history as new characteristics associated with postpartum hemorrhage after vaginal delivery. The association of postpartum hemorrhage with a family history of postpartum hemorrhage suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for postpartum hemorrhage is a key element of being prepared for this complication.
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Affiliation(s)
- François Anouilh
- Ecole Universitaire de Maïeutique de Brest, UFR Santé - Brest, Brest, France (Mr Anouilh); UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch)
| | - Claire de Moreuil
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne).
| | - Christophe Trémouilhac
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Jacquot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Gilles Salnelle
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Violaine Bellec
- Service de Gynécologie Obstétrique, Centre Hospitalier Privé de Brest - Keraudren, Brest, France (Dr Bellec)
| | - Nathalie Touffet
- Service de Gynécologie Obstétrique, CH de Landerneau, Landerneau, France (Dr Touffet)
| | - Caroline Cornec
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Matthieu Muller
- Service de Gynécologie Obstétrique, CH des Pays de Morlaix, Morlaix, France (Drs Salnelle and Muller)
| | - Pierre-François Dupré
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Charles Bellot
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Karine Morcel
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire Brest, Brest, France (Dr Trémouilhac, Ms Cornec, and Drs Dupré and Morcel)
| | - Delphine Le Joliff
- Service de Gynécologie Obstétrique, CHIC de Quimper, Quimper, France (Drs Jacquot, Bellot, and Le Joliff)
| | - Guillaume Drugmanne
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Elodie Gelebart
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Sandy Lucier
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Emmanuel Nowak
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Line Bihan
- CIC1412, Institut National de la Sante et de la Recherche Medicale, Brest, France (Mr Drugmanne, Ms Gelebart, Ms Lucier, Dr Nowak, and Ms Bihan)
| | - Francis Couturaud
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Cécile Tromeur
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Emmanuelle Le Moigne
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Département de Médecine Interne, Médecine Vasculaire et Pneumologie, Centre Hospitalier Universitaire Brest, Brest, France (Drs Moreuil, Couturaud, Tromeur, and Le Moigne)
| | - Brigitte Pan-Petesch
- UMR 1304, GETBO, Université de Bretagne Occidentale - Brest (France), Brest, France (Mr Anouilh, Drs de Moreuil, Trémouilhac, Morcel, Couturaud, Tromeur, Le Moigne, and Pan-Petesch); Centre de Ressources et de Compétence des Maladies Hémorragiques, Centre de Ressources et de Compétence des Maladies Hémorragiques, Hémostase, Service Hématologie, Centre Hospitalier Universitaire Brest, Brest, France (Dr Pan-Petesch)
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Staniczek J, Manasar-Dyrbuś M, Winkowska E, Skowronek K, Stojko R. Foley Catheter as a Tourniquet for Hemorrhage Prevention during Peripartum Hysterectomy in Patients with Placenta Accreta Spectrum (PAS)-A Hospital-Based Study. Life (Basel) 2023; 13:1774. [PMID: 37629631 PMCID: PMC10455697 DOI: 10.3390/life13081774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a clinical entity significantly increasing the risk of a peripartum hemorrhage. Various surgical methods have been described in the literature, which aim to reduce the risk of bleeding, although they often lack reproducibility and have been performed on low numbers of patients. The aim of this study was to evaluate the use of the Foley catheter as a cervical tourniquet during cesarean sections, in patients with PAS. METHODS All patients who underwent peripartum hysterectomy due to PAS in a large single-center registry were included in the present analysis. The general demographics and clinical characteristics of all participants, including blood loss, and maternal and fetal outcomes, were collected and analyzed. RESULTS Twelve participants were included. The mean blood loss was 1200 ± 760 ml during operation and the mean ± SD procedural duration was 89 ± 17 min. The median (Q1-Q3) length of hospital stay post-procedurally was 5 (4-6) days. None of the patients required subsequent urgent surgical procedures after hysterectomy. The median (Q1-Q3) packed red blood cell units transfused in our cohort was 2 (0-3). CONCLUSION Using the Foley catheter as a tourniquet might be an effective method of excessive bleeding prevention in patients with PAS during peripartum hysterectomy.
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