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Kurakazu M, Kurakazu M, Kiyoshima C, Shigekawa K, Hirakawa T, Yoshikawa K, Ito T, Urushiyama D, Miyata K, Yotsumoto F. Clinical Prediction of Retained Products of Conception: Combining Obstetric History and Ultrasound for Improved Accuracy in Severe Postpartum Hemorrhage. Cureus 2024; 16:e53651. [PMID: 38449994 PMCID: PMC10917468 DOI: 10.7759/cureus.53651] [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] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Background The current challenge is how to improve the management of postpartum hemorrhage (PPH) to reduce the maternal mortality rate further. This study aimed to investigate whether a combined specific obstetric history and ultrasonographic findings can improve the predictive accuracy of retained products of conception (RPOC) with severe PPH. Methods This retrospective study included 56 patients who were diagnosed with RPOC. We extracted the following clinical data: obstetric history of second-trimester miscarriage, the time at which there was clinical suspicion of RPOC after the previous pregnancy (TIME), grayscale ultrasonographic finding (RPOC long-axis length [SIZE]), and color Doppler ultrasonographic finding based on the Gutenberg classification (RPOC hypervascularity). In this study, we defined cases requiring blood transfusion therapy or transcatheter arterial embolization as severe PPH. The patients were divided into two groups according to the presence or absence of severe PPH. The predictors of severe PPH were evaluated using logistic regression models. Model A comprised a combination of second-trimester miscarriage and TIME, Model B comprised a combination of Model A and long-axis SIZE, and Model C comprised a combination of Model B and RPOC hypervascularity. Results The multivariable analysis showed that long-axis SIZE was the only significant predictor of severe PPH (odds ratio [OR], 10.38; 95% confidence interval [CI], 2.06-63.86) independent of second-trimester miscarriage, TIME, and RPOC hypervascularity. The c-statistic was higher in Model C (OR, 0.863; 95% CI, 0.731-0.936) than in Model A (OR, 0.723; 95% CI, 0.551-0.847) and Model B (OR, 0.834; 95% CI, 0.677-0.923). Conclusion Combining a specific obstetric history (second-trimester miscarriage and TIME) and ultrasonographic findings (long-axis SIZE and RPOC hypervascularity) improves the predictive accuracy of RPOC with severe PPH. This prediction model may be a useful clinical screening tool for RPOC with severe PPH.
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Affiliation(s)
- Mariko Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Koichiro Shigekawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Toyofumi Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kenichi Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Tomohiro Ito
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Daichi Urushiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kohei Miyata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
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Doğru Ş, Akkuş F, Atci AA, Metin ÜS, Uyar M, Acar A. Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries. Obstet Gynecol Sci 2024; 67:58-66. [PMID: 38044617 DOI: 10.5468/ogs.23154] [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: 06/10/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP). METHODS Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared. RESULTS A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037). CONCLUSION Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.
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Affiliation(s)
- Şükran Doğru
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Fatih Akkuş
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Aslı Altinordu Atci
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ülfet Sena Metin
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Mehmet Uyar
- Department of public health, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ali Acar
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
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Yi J, Chen L, Meng X, Chen Y. The infection, cervical and perineal lacerations in relation to postpartum hemorrhage following vaginal delivery induced by Cook balloon catheter. Arch Gynecol Obstet 2024; 309:159-166. [PMID: 36607435 DOI: 10.1007/s00404-022-06861-1] [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: 07/15/2022] [Accepted: 11/12/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To identify whether infection, cervical laceration and perineal laceration are associated with postpartum hemorrhage in the setting of vaginal delivery induced by Cook balloon catheter. MATERIALS AND METHODS The retrospective study included 362 women who gave birth vaginally at or beyond 37 weeks of gestation with a diagnosis of postpartum hemorrhage between February 2021 to May 2022, of which including 216 women with induction of labor (Cook balloon catheter followed by oxytocin or oxytocin) and 146 women with spontaneous delivery. Risk factors for postpartum hemorrhage were collected and compared. RESULTS 362 women were divided into three groups, group 1 with spontaneous delivery, group 2 with oxytocin, group 3 with Cook balloon catheter followed by oxytocin. There was no significant difference in incidence of infection within three groups (P > 0.05). The rate of cervical laceration and perineal laceration was significantly higher in group 3 compared with groups 2 and 1 (P < 0.05); Multivariate logistic regression analysis found that compared with group 1, either group 3 or group 2 was associated with increased risks of cervical laceration and perineal laceration (P < 0.05), and compared with group 2, group 3 was not associated with increased risks of cervical laceration and perineal laceration (P > 0.05). CONCLUSION Infection, cervical laceration and perineal laceration are identified not to be independent risk factors for postpartum hemorrhage for women undergoing labor with Cook balloon catheter; Cervical laceration and perineal laceration increase the risk of postpartum hemorrhage in women with labor induction.
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Affiliation(s)
- Jiao Yi
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China.
| | - Lei Chen
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
| | - Xianglian Meng
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
| | - Yi Chen
- Department of Obstetrics and Gynecology, Maternal and Child health care hospital affiliated With Anhui Medical University, Anhui Maternal and Child health care Hospital, NO 15 Yimin Street, Hefei, 230000, China
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Patek K, Friedman P. Postpartum Hemorrhage-Epidemiology, Risk Factors, and Causes. Clin Obstet Gynecol 2023; 66:344-356. [PMID: 37130373 DOI: 10.1097/grf.0000000000000782] [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: 05/04/2023]
Abstract
The incidence of postpartum hemorrhage (PPH) is increasing worldwide and in the United States. Coinciding, is the increased rate of severe maternal morbidity with blood transfusion in the United States over the past 2 decades. Consequences of PPH can be life-threatening and carry significant cost burden to the health care system. This review will discuss the current trends, distribution, and risk factors for PPH. Causes of PPH will be explored in detail.
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Affiliation(s)
- Kara Patek
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
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Akter S, Forbes G, Miller S, Galadanci H, Qureshi Z, Fawcus S, Justus Hofmeyr G, Moran N, Singata-Madliki M, Amole TG, Gwako G, Osoti A, Thomas E, Gallos I, Mammoliti KM, Coomarasamy A, Althabe F, Lorencatto F, Bohren MA. Detection and management of postpartum haemorrhage: Qualitative evidence on healthcare providers' knowledge and practices in Kenya, Nigeria, and South Africa. Front Glob Womens Health 2022; 3:1020163. [PMID: 36467287 PMCID: PMC9715762 DOI: 10.3389/fgwh.2022.1020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Postpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management; however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE. Methods Between July 2020-June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used. Results Four key themes were identified, which varied across contexts: in-service training on emergency obstetric care; limited knowledge about PPH; current approaches to PPH detection; and current PPH management and associated challenges. PPH was recognised as an emergency but understanding of PPH varied. Early PPH detection was limited by the subjective nature of visual estimation of blood loss. Lack of expertise on PPH detection and using visual estimation can result in delays in initiation of PPH management. Shortages of trained staff and essential resources, and late inter-hospital referrals were common barriers to PPH management. Conclusion There are critical needs to address context-specific barriers to early and timely detection and management of PPH in hospital settings. These findings will be used to develop evidence-informed implementation strategies, such as improved in-service training, and objective measurement of blood loss, which are key components of the E-MOTIVE trial (Trial registration: ClinicalTrials.gov: NCT04341662).
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Affiliation(s)
- Shahinoor Akter
- Gender and Women’s Health Unit, Centre for Health Equity, University of Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - Gillian Forbes
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Suellen Miller
- Department of Obstetrics, and Reproductive Sciences, School of Medicine, University of California, San Francisco, United States
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano, Kano, Nigeria
| | - Zahida Qureshi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Sue Fawcus
- Department of Obstetrics and Gynaecology, University Cape Town, Cape Town, South Africa
| | - G. Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Universities of Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Neil Moran
- KwaZulu-Natal Department of Health, and Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mandisa Singata-Madliki
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Universities of Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Taiwo Gboluwaga Amole
- Africa Center of Excellence for Population Health and Policy, Bayero University Kano and Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - George Gwako
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Global Health University of Washington, United States
| | - Eleanor Thomas
- WHO Collaborating Centre on Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, London, United Kingdom
| | - Ioannis Gallos
- WHO Collaborating Centre on Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, London, United Kingdom
| | - Kristie-Marie Mammoliti
- WHO Collaborating Centre on Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, London, United Kingdom
| | - Arri Coomarasamy
- WHO Collaborating Centre on Global Women’s Health, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, London, United Kingdom
| | - 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, World Health Organization, Geneva, Switzerland
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Centre for Health Equity, University of Melbourne School of Population and Global Health, Carlton, VIC, Australia
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Sano Y, Kasai M, Shinoda S, Miyagi E, Aoki S. The indicators for early blood transfusion in patients with placental abruption with intrauterine fetal death: a retrospective review. BMC Pregnancy Childbirth 2022; 22:847. [PMID: 36397012 PMCID: PMC9670574 DOI: 10.1186/s12884-022-05187-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Placental abruption (PA) with intrauterine fetal death (IUFD) is associated with a high risk of postpartum hemorrhage (PPH) resulting from severe disseminated intravascular coagulation (DIC). Therefore, blood products that are sufficient for coagulation factor replacement must be prepared, and delivery should occur at referral medical institutions that are equipped with sufficient blood products and emergency transfusion protocols. We retrospectively reviewed the records of patients with PA and IUFD (PA-IUFD) to identify possible factors that may indicate the need for early blood transfusion and investigated whether the Japanese scoring system for PPH can be applied in such cases.
Methods
We used a database of 16,058 pregnant patients who delivered at Yokohama City University Medical Center between January 2000 and February 2016. Thirty-three patients were diagnosed with PA-IUFD before delivery and categorized into two groups–blood transfusion and non-transfusion–to compare the maternal characteristics and pregnancy outcomes.
Results
In patients with PA-IUFD, the transfusion group exhibited significantly more blood loss; lower fibrinogen levels and platelet counts; higher levels of fibrin degradation products (FDP), D-dimer, and prothrombin time; and a tendency for tachycardia on admission, compared to the non-transfusion group. Many patients in the transfusion group had normal fibrinogen levels on admission but later displayed markedly decreased fibrinogen levels. The Japan Society of Obstetrics and Gynecology (JSOG) DIC score was significantly higher in the transfusion than in the non-transfusion group.
Conclusions
In PA-IUFD, the fibrinogen level, platelet count, D-dimer, FDP, heart rate, and JSOG DIC score on admission may indicate the need for blood transfusion. However, even with normal fibrinogen levels on admission, continuous monitoring is indispensable for identifying progressive fibrinogen reductions in patients with PA-IUFD.
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Kuba K, Estrada-Trejo F, Lambert C, Vani K, Eisenberg R, Nathan L, Bernstein P, Hughes F. Novel Evidence-Based Labor Induction Algorithm Associated with Increased Vaginal Delivery within 24 Hours. Am J Perinatol 2022; 39:1622-1632. [PMID: 35709742 DOI: 10.1055/a-1877-8996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to assess whether concordance with our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours. STUDY DESIGN We conducted a retrospective review of 287 induction of labors (IOLs) at a single urban, tertiary, academic medical center which took place before we created an evidence-based IOL algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 years or over with a singleton, cephalic pregnancy of 366/7 to 420/7 weeks' gestation were included. Patients were excluded with a Bishop's score >6, contraindication to misoprostol or cervical Foley catheter, major fetal anomalies, or intrauterine fetal death. Patients with 100% concordance were compared with <100% concordant patients, and patients with ≥80% concordance were compared with <80% concordant patients. Adjusted hazard ratios (AHRs) were calculated for rate of vaginal delivery within 24 hours, our primary outcome. Competing risk's analysis was conducted for concordant versus nonconcordant groups, using vaginal delivery as the outcome of interest, with cesarean delivery (CD) as a competing event. RESULTS Patients with 100% concordance were more likely to have a vaginal delivery within 24 hours, n = 66 of 77 or 85.7% versus n = 120 of 210 or 57.1% (p < 0.0001), with an AHR of 2.72 (1.98, 3.75, p < 0.0001) after adjusting for delivery indication and scheduled status. Patients with 100% concordance also had shorter time from first intervention to delivery (11.9 vs. 19.4 hours). Patients with ≥80% concordance had a lower rate of CD (11/96, 11.5%) compared with those with <80% concordance (43/191 = 22.5%; p = 0.0238). There were no differences in neonatal outcomes assessed. CONCLUSION Our IOL algorithm may offer an opportunity to standardize care, improve the rate of vaginal delivery within 24 hours, shorten time to delivery, and reduce the CD rate for patients undergoing IOL. KEY POINTS · Studies on IOL have focused on individual steps. A labor induction algorithm allows for standardization.. · Algorithm concordance is associated with decreased time to delivery.. · Algorithm concordance is associated with decreased CD rate..
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Affiliation(s)
- Kfier Kuba
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Fatima Estrada-Trejo
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Calvin Lambert
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Kavita Vani
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Ruth Eisenberg
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Lisa Nathan
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Peter Bernstein
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Francine Hughes
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Faria I, Thivalapill N, Makin J, Puyana JC, Raykar N. Bleeding, Hemorrhagic Shock, and the Global Blood Supply. Crit Care Clin 2022; 38:775-793. [PMID: 36162910 DOI: 10.1016/j.ccc.2022.06.013] [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] [Indexed: 11/18/2022]
Abstract
Hemorrhage is responsible for at least 40% of deaths after trauma and 27% of maternal deaths worldwide. Patients with hemorrhagic shock require attentive critical care and transfusion of blood products. Access to a safe and affordable blood supply is critical to providing safe surgical care. Traumatic injury, obstetric hemorrhage, and upper gastrointestinal bleed are the main causes of severe bleeding requiring transfusion. This article discusses the presentation and management of these causes across the world and provides a brief overview of the current challenges in maintaining a global blood supply.
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Affiliation(s)
- Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Hungtington Avenue, Boston, MA 02115, USA; Faculdade de Medicina da Universidade Federal de Minas Gerais, 190 Avenida Professor Alfredo Balena, Belo Horizonte, MG 31130450, Brazil
| | - Neil Thivalapill
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago IL 60611, USA
| | - Jennifer Makin
- Department of Obstetrics, Gynecology and Reproductive Science, The University of Pittsburgh Medical Center Magee - Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Juan Carlos Puyana
- Critical Care Medicine, and Clinical Translational Science, Pittsburgh, PA 15213, USA; University of Pittsburgh, UPMC Presbyterian, F1263, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Nakul Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Hungtington Avenue, Boston, MA 02115, USA; Division of Trauma & Emergency Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, USA.
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Hews-Girard JC, Galica J, Goldie C, James P, Tranmer J. Determining the incidence of postpartum haemorrhage among Ontario women with and without inherited bleeding disorders: A population-based cohort study. Haemophilia 2022; 28:832-841. [PMID: 35665573 DOI: 10.1111/hae.14594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/02/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION At a population level, there is a poor understanding of the incidence and pre-disposing risk factors of postpartum haemorrhage (PPH) among women with inherited bleeding disorders (IBD). AIM To determine the incidence of PPH, and identify maternal factors associated with risk of PPH among women with IBD. METHODS We conducted a retrospective cohort study using data housed within ICES (formerly known as the Institute for Clinical Evaluative Sciences). The cohort included women with an in-hospital, live or stillborn delivery, between January 2014 and December 2019. The primary outcome was PPH (identified by ICD-10 code O72). PPH incidence and risk factors were compared between women with and without IBD. Temporal trends were assessed using the Cochrane-Armitage test. Between group differences were assessed using standardised differences (std. difference). RESULTS Total 601,773 women were included; 2002 (.33%) had an IBD diagnosis. PPH incidence was 1.5 times higher (7.3 vs. 4.9 cases/100 deliveries, std. difference .1) among women with IBD compared to women without. Women with IBD were slightly older (31.7 vs. 30.7 years), had higher rates of hypertension, previous PPH, and induction of labour. Women with IBD were more frequently diagnosed with anaemia (4.8% vs. 1.8%; std difference .17) and had lower haemoglobin levels at admission for delivery compared to women without IBD. CONCLUSIONS This study contributes to the literature regarding obstetric bleeding among women with IBD, showing that anaemia at delivery may be an important risk factor for PPH. Given their predisposition to anaemia, clarifying this relationship will optimise management and outcomes.
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Affiliation(s)
| | | | - Catherine Goldie
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Paula James
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Ahmad N, Ramlan N, Ganeshan M, Bhaskaran KS, Ismail F, Razak T, Hassan A, Amin N. Massive transfusion protocol for postpartum hemorrhage case management in Hospital Kuala Lumpur; Five years implementation and outcome. Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang Y, He J, Deng N. Factors Associated with Primary Postpartum Hemorrhage in Elderly Women Undergoing Repeated Cesarean Deliveries. Int J Womens Health 2021; 13:1261-1267. [PMID: 35002333 PMCID: PMC8721015 DOI: 10.2147/ijwh.s332020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to analyze the risk factors for primary postpartum hemorrhage in elderly parturients undergoing repeated cesarean delivery (PHEPWRCD). Participants and Methods The clinical data of 1675 elderly parturients who underwent repeated cesarean delivery in our hospital from May 2011 to March 2020 were retrospectively collected for analysis. The women were divided into a postpartum hemorrhage group (116 individuals) and a nonpostpartum hemorrhage group (1559 individuals). We analyzed the association of maternal age, maternal history, pregnancy complications, placenta and other factors with postpartum hemorrhage in elderly women who underwent repeated cesarean delivery and screened out independent risk factors by multivariate logistic regression analysis. Results The incidence rate of PHEPWRCD was 6.92% (116/1675). Using single-factor analysis of variance, we found that maternal age (p=0.012), the number of pregnancies (p=0.007), the number of cesarean deliveries (p<0.001), fetal position (p<0.001), fetal macrosomiaren (p<0.001), placental attachment position (p<0.001), placenta previa (p<0.001), and placental implantation (p<0.001) were significantly associated with PHEPWRCD. Multivariate logistic regression analysis showed that the number of cesarean deliveries (OR=2.457, 95% CI=1.453–4.540, P=0.013), placenta previa (OR=11.741, 95% CI=5.874–26.078, P<0.001), placenta implantation (OR=6.844, 95% CI=3.514–14.873, P<0.001), placental attachment position (OR=2.421, 95% CI=1.275–3.917, P=0.009) and fetal position (OR=5.722, 95% CI=3.817–16.577, P<0.001) were independent risk factors for PHEPWRCD. Conclusion This study found that the number of cesarean deliveries, placental attachment, placental previa, and placental implantation are independent risk factors for PHEPWRCD.
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Affiliation(s)
- Yan Yang
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
- Correspondence: Yan Yang Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of ChinaTel/Fax +86 23-85653335 Email
| | - Jiajia He
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
| | - Na Deng
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
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Knoll W, Phelan R, Hopman WM, Ho AMH, Cenkowski M, Mizubuti GB, Ghasemlou N, Klar G. Retrospective review of time to uterotonic administration and maternal outcomes following post-partum hemorrhage. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:490-495. [PMID: 34844004 DOI: 10.1016/j.jogc.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Despite advances in health care and ample resources, post-partum hemorrhage (PPH) rates are increasing in high income countries. Although guidelines recommend therapeutic uterotonics, timing of administration is open to judgement and most often based on (inherently inaccurate) visual estimates of blood loss. With severe hemorrhage, every minute of delay can have significant consequences. Our objective was to examine the timing of uterotonic administration and its impact upon maternal outcomes. We hypothesized that increased time to uterotonic administration following the identification of PPH, would be associated with a greater decline in hemoglobin (Hb) and higher odds of hypotension and transfusion. METHODS We reviewed all cases of PPH that occurred at an academic centre between June 2015 and September 2017. All cases of primary PPH (i.e., those declared within 24 h of delivery with estimated blood loss [EBL] >500 mL for vaginal and >1000 mL for cesarean deliveries) were analyzed. Patient records were excluded if they were missing information regarding time of PPH declaration, uterotonic administration, and/or Hb measures, or if a pre-existing medical condition could have contributed to PPH. RESULTS Of 4397 births, there were 259 (5.9%) cases of primary PPH, of which 128 were included in this analysis. For these patients, each 5-minute delay in uterotonic treatment was associated with 26% higher odds of hypotension following delivery of any type. For vaginal deliveries (n = 86), each 5-minute delay was associated with 31% and 34% higher odds of hypotension and transfusion, respectively. CONCLUSION In this study, delay in administration of therapeutic uterotonics was associated with a higher incidence of hypotension and transfusion in primary PPH patients.
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Affiliation(s)
- William Knoll
- Queen's University School of Medicine, Department of Anesthesiology and Perioperative Medicine, Department of Molecular and Biological Sciences, Queen's University, Botterell Hall, 18 Stuart Street, Kingston ON K7L 3N6 Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston ON K7L 2V7 Canada
| | - Wilma M Hopman
- Kingston Health Sciences Research Institute, KGHRI, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Marta Cenkowski
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Nader Ghasemlou
- Department of Molecular and Biological Sciences, Department of Anesthesiology and Perioperative Medicine, ueen's University, Botterell Hall, 18 Stuart Street, Kingston ON K7L 3N6 Canada
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada.
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Risk factors and clinical outcomes for placenta accreta spectrum with or without placenta previa. Arch Gynecol Obstet 2021; 305:607-615. [PMID: 34448037 DOI: 10.1007/s00404-021-06189-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa. METHODS We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted. RESULTS There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70-7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5-23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50-5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks. CONCLUSION The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.
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Guarga Montori M, Álvarez Martínez A, Luna Álvarez C, Abadía Cuchí N, Mateo Alcalá P, Ruiz-Martínez S. Advanced maternal age and adverse pregnancy outcomes: A cohort study. Taiwan J Obstet Gynecol 2021; 60:119-124. [PMID: 33494983 DOI: 10.1016/j.tjog.2020.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies. MATERIALS AND METHODS A cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (<35 years (n = 19,429; 70.7%), 35-40 years (n = 7189; 26.2%), and >40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis. RESULTS The mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score <7 at 5 min after birth, threatened preterm labour, preterm rupture of membranes, or high-grade perineal tear. The analyses found statistically significant increases in the rates of hypertensive disorders, diabetes mellitus, induction of labour, and caesarean section, after 35 years of age. The risks of fetal death, neonatal admission, small for gestational age, placenta previa, instrument delivery, maternal ICU admission, and postpartum haemorrhage were greater after 40 years of age. CONCLUSIONS The results of our study indicated that women >35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.
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Affiliation(s)
- M Guarga Montori
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain.
| | - A Álvarez Martínez
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain
| | - C Luna Álvarez
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain
| | - N Abadía Cuchí
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain
| | - P Mateo Alcalá
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain
| | - S Ruiz-Martínez
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Spain; Aragon Institute of Health Research (IIS Aragón), Spain
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Levine EM, Delfinado LN, Locher S, Ginsberg NA. Reducing the cesarean delivery rate. Eur J Obstet Gynecol Reprod Biol 2021; 262:155-159. [PMID: 34022593 DOI: 10.1016/j.ejogrb.2021.05.023] [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: 04/12/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The cesarean delivery rate has been rising in recent years, having associated maternal morbidities. Elective induction of labor has also been seen to rise during this same time period. OBJECTIVE This current study investigated the difference in the cesarean delivery rate between induction of labor and spontaneous labor among nulliparous, term, singleton, and vertex-presenting women. STUDY DESIGN A retrospective cohort in a single institution over a seven-year period was used for this analysis, observing the difference in cesarean delivery rate at different term gestational ages and neonatal morbidity using the 5-minute Apgar score < 5. RESULTS A statistically significant difference was found in cesarean delivery rate between those women whose labor was induced and those whose labor began spontaneously, at each term gestational age of labor initiation (P < 0.001). The proportion of indications for induction was described (i.e. elective vs. medically-indicated), and no difference was found for neonatal morbidity between the groups analyzed, using the 5-minute Apgar score as the perinatal outcome measure. CONCLUSION A comparison was made between spontaneous and induced labor regarding the resultant cesarean delivery rate, and a significant difference was found favoring spontaneous labor. This should be considered when electing to deliver using an induction methodology for nulliparous women, especially when there are no medical indications for it.
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Affiliation(s)
- Elliot M Levine
- University of Illinois at Chicago, Chicago, IL, USA; Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
| | | | | | - Norman A Ginsberg
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Northwestern University Medical Center, Chicago, IL, USA.
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Pan Q, Huang Y, Dong Y, Shi GG, Wang YH. 3D Cu(II) Cluster-Based Coordination Polymer: Increasing the Activity of Prothrombin and Preventing Postpartum Hemorrhage. J CLUST SCI 2021. [DOI: 10.1007/s10876-021-02044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Riazanova OV, Reva VA, Fox KA, Romanova LA, Kulemin ES, Riazanov AD, Ioscovich A. Open versus endovascular REBOA control of blood loss during cesarean delivery in the placenta accreta spectrum: A single-center retrospective case control study. Eur J Obstet Gynecol Reprod Biol 2021; 258:23-28. [PMID: 33388487 DOI: 10.1016/j.ejogrb.2020.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare two vascular control options for blood loss prevention and hysterectomy during cesarean delivery (CD2): endovascular balloon occlusion of the aorta (REBOA3) and open bilateral common iliac artery occlusion (CIAO4) in women with extensive placenta accreta spectrum (PAS5). STUDY DESIGN This was retrospective comparison of cases of PAS using either CIAO (October 2017 through October 2018) or REBOA (November 2018 through November 2019) to prevent pathologic hemorrhage during scheduled CD. Women with confirmed placenta increta/percreta underwent either CD then intraoperative post-delivery, pre-hysterectomy open vascular control of both CIA6 (CIAO group) or pre-operative, ultrasound-guided, fluoroscopy-free REBOA followed by standard CD and balloon inflation after fetal delivery (REBOA group). Intraoperative blood loss, transfusion volumes, surgical time, blood pressure, maternal and neonatal outcomes, hospitalization length and postoperative complications were compared. RESULTS The REBOA and CIAO groups included 12 and 16 women, respectively, with similar median age of 35 years and gestational age of 34-35 weeks. All REBOA catheters were successfully placed into aortic zone three under ultrasound guidance. The quantitated median intraoperative blood loss was significantly lower for the REBOA group, (541 [IQR 300-750] mL) compared to the CIAO group (3331 [IQR 1150-4750] mL (P = 0.001). As a result, the total volume of fluid and blood replacement therapy was significantly lower in the REBOA group (P < 0.05). Median surgical time in the REBOA group was less than half as long: 76 [IQR 64-89] minutes compared to 168 [IQR 90-222] minutes in the CIAO group (P = 0.001). None of the women with REBOA required hysterectomy, while 8/16 women in the CIAO group did (P = 0.008). Furthermore, the post-anesthesia recovery and hospital discharge times in the REBOA-group were shorter (P < 0.05). One thromboembolic complication occurred in each group. The only REBOA-associated complication was non-occlusive femoral artery thrombosis, with no surgical management required. No maternal or neonatal deaths occurred in either group. CONCLUSION Fluoroscopy-free REBOA for women with PAS is associated with improved vascular control, perioperative blood loss, the need for transfusion and hysterectomy and reduces surgical time when compared to bilateral CIAO.
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Affiliation(s)
- Oksana V Riazanova
- D.O. Ott Research Institute of Obstetrics and Gynecology, Saint-Petersburg, Russian Federation
| | - Viktor A Reva
- Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
| | - Karin A Fox
- Baylor College of Medicine, Houston, TX, USA
| | - Larisa A Romanova
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
| | - Evgeniy S Kulemin
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
| | - Artem D Riazanov
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
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Cole NM, Abushoshah I, Fields KG, Carusi DA, Robinson JN, Bateman BT, Farber MK. The interrater reliability and agreement of a 0 to 10 uterine tone score in cesarean delivery. Am J Obstet Gynecol MFM 2021; 3:100342. [PMID: 33652161 DOI: 10.1016/j.ajogmf.2021.100342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postpartum hemorrhage is a leading source of maternal morbidity and mortality worldwide with uterine atony identified as the underlying cause in up to 80% of cases. Several measures have been utilized to report uterine tone. The most commonly reported measure is a 0 to 10 numeric rating scale, but this scale has not been tested for reliability or agreement between different raters. OBJECTIVE The primary purpose of this study was to evaluate the interrater reliability and agreement of the 0 to 10 visual numeric rating scale of uterine tone during cesarean delivery. A secondary purpose was to obtain estimates of scale responsiveness and minimal clinically important difference. STUDY DESIGN Between August and November of 2018, obstetricians used a 0 to 10 numeric rating score to independently rate uterine tone at 3 and 10 minutes after cesarean delivery by palpation of the uterus. Of note, "0" represented "no tone" and "10" represented excellent tone. Each obstetrician independently and blinded to the other's score pointed to a numeric rating scale held by the anesthesiologist through a clear sterile drape. Intraclass correlation coefficients and Bland-Altman analysis were used to assess interrater reliability and agreement, respectively. Standardized response mean and standard error of measurement were used to obtain estimates of responsiveness and minimal clinically important difference, respectively. RESULTS A total of 82 and 84 pairs of scores were collected at 3 and 10 minutes, respectively, from pairs of 62 unique obstetricians. The mean±standard deviation difference in scores between rater 1 and rater 2 was 0.4±1.4 at 3 minutes and 0.1±1.1 at 10 minutes. Intraclass correlation coefficients for a future single rater (intraclass correlation coefficient [1, 1]) at 3 and 10 minutes were 0.67 (95% confidence interval, 0.53-0.77) and 0.61 (95% confidence interval, 0.46-0.73), and for the average between 2 future raters (intraclass correlation coefficient [1, 2]), they were 0.80 (95% confidence interval, 0.71-0.87) and 0.76 (95% confidence interval, 0.63-0.84), indicating good and excellent reliability, respectively. Bland-Altman analysis estimated 95% limit of agreement between raters of -2.4 (95% confidence interval, -3.0 to -1.9) to 3.1 (95% confidence interval, 2.6-3.7) at 3 minutes and -2.1 (95% confidence interval, -2.5 to -1.7) to 2.4 (95% confidence interval, 2.0-2.8) at 10 minutes, consistent with good interrater agreement at both time points. The standardized response mean from 3 to 10 minutes after delivery was 1.1 (n=81). Standard error of measurement was 1.0 (95% confidence interval, 0.9-1.1) at 3 minutes and 0.8 (95% confidence interval, 0.7-0.9) at 10 minutes. CONCLUSION The 0 to 10 numeric rating scale for uterine tone demonstrated good to excellent interrater reliability with 1 and 2 raters, respectively, and good interrater agreement. The scale was responsive to within-parturient change in tone, and preliminary estimates of the minimal clinically important difference were obtained. The 0 to 10 numeric rating scale for uterine tone may be a reliable, standardized tool for future research in reporting degree of uterotonic contraction during cesarean delivery.
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Affiliation(s)
- Naida M Cole
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber).
| | - Ibrahim Abushoshah
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber); Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddhah, Saudi Arabia (Dr Abushoshah)
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber)
| | | | - Julian N Robinson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (Dr Robinson)
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber); Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (Dr Bateman), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michaela K Farber
- Department of Anesthesiology, Perioperative and Pain Medicine (Drs Cole and Abushoshah, Ms Fields, and Drs Bateman and Farber)
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Berdzuli N, Lomia N, Staff AC, Lazdane G, Pestvenidze E, Jacobsen AF. Audit of Early and Late Maternal Deaths in Georgia: Potential for Improving Substandard Obstetric Care. Int J Womens Health 2021; 13:205-219. [PMID: 33628061 PMCID: PMC7899038 DOI: 10.2147/ijwh.s288763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Quality of care is an important factor in reducing preventable maternal deaths, yet it is a significant challenge in many countries. Substandard and poor quality of care is the leading factor in two-thirds of maternal deaths in European countries. Our study investigated the deaths of all women of reproductive age in 2012 in Georgia. The aim was to define the underlying causes of maternal deaths and to identify the factors in women’s care which contributed to the fatal outcomes. Methods A national Reproductive Age Mortality Survey was conducted in Georgia in 2014–15. Data from multiple sources was triangulated to identify all deaths of women of reproductive age. This was followed by verbal autopsy diagnoses. Each case of early and late maternal death was investigated through interviews and medical record reviews at the last medical facility providing care for the deceased woman. A specialist panel reviewed and assigned underlying causes of death, assessed the management of each woman’s condition, and identified elements of suboptimal care. Results We identified a total of 23 maternal deaths, including 15 (65%) early and eight (35%) late deaths. The maternal mortality ratio was 26.3 per 100 000 live births. The four leading causes of early maternal deaths were: sepsis, hemorrhage, embolism, and pregnancy-induced hypertension. Embolism and sepsis were the direct causes of the eight late maternal deaths. Cancer, tuberculosis, and postpartum suicide constituted the indirect causes of death. Improvements in care which would have made a difference to the outcomes were identified in 87% of early maternal deaths and 67% of late maternal deaths due to direct obstetric causes. Discussion Delayed recognition and inappropriate management of maternal complications were common across almost all cases studied. The findings from Georgia highlight the conclusion that most maternal deaths were preventable and that improvement in obstetric care is urgently required.
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Affiliation(s)
- Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Gunta Lazdane
- Department of Obstetrics and Gynaecology, Riga Stradins University, Riga, Latvia
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Greene RA, McKernan J, Manning E, Corcoran P, Byrne B, Cooley S, Daly D, Fallon A, Higgins M, Jones C, Kinsella I, Murphy C, Murphy J, Bhuinneain MN. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257:114-120. [DOI: 10.1016/j.ejogrb.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
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Borovac-Pinheiro A, Ribeiro FM, Pacagnella RC. Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively - A Prospective Cohort Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:113-118. [PMID: 33511619 PMCID: PMC10183850 DOI: 10.1055/s-0040-1718439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To identify risk factors related to postpartum hemorrhage (PPH) and severe PPH with blood loss quantified objectively. METHODS This is a complementary analysis of a prospective cohort study that included pregnant women delivering vaginally. The total blood loss was obtained through the sum of the volume collected from the drape with the weight of gauzes, compresses and pads used by women within 2 hours. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. The risk factors for postpartum bleeding were evaluated using linear and logistic regression. RESULTS We included 270 women. The mean blood loss at 120 minutes was 427.49 mL (±335.57 mL). Thirty-one percent (84 women) bled > 500 mL and 8.2% (22 women) bled > 1,000 mL within 2 hours. Episiotomy, longer second stage of labor and forceps delivery were related to blood loss > 500 mL within 2 hours, in the univariate analysis. In the multivariate analysis, only forceps remained associated with bleeding > 500 mL within 2 hours (odds ratio [OR] = 9.5 [2.85-31.53]). Previous anemia and episiotomy were also related to blood loss > 1,000mL. CONCLUSION Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.
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Affiliation(s)
| | - Filipe Moraes Ribeiro
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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22
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The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage. NURSING REPORTS 2020; 11:1-11. [PMID: 34968307 PMCID: PMC8608112 DOI: 10.3390/nursrep11010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009–2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.
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Basil-Kway V, Castillo-Reyther R, Domínguez-Salgado LA, Espinosa-Tanguma R, Medina Ú, Gordillo-Moscoso A. Early prognostic capacity of serum lactate for severe postpartum hemorrhage. Int J Gynaecol Obstet 2020; 153:483-488. [PMID: 33119891 DOI: 10.1002/ijgo.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/23/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). METHODS A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non-SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. RESULTS SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7-16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55-0.98); specificity was 0.76 (95% CI 0.50-0.93). CONCLUSION Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.
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Affiliation(s)
- Venance Basil-Kway
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Roberto Castillo-Reyther
- Department of Obstetrics and Gynecology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico.,School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - L Andrés Domínguez-Salgado
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Ricardo Espinosa-Tanguma
- Department of Physiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Úrsula Medina
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico.,Department of Pharmacology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Antonio Gordillo-Moscoso
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
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Hacker FM, Linkov F, Serra AE, Petticord V, Zabielski MT, Simhan HN, Sakamoto SB. Lessons Learned From a Gap Analysis of Obstetric Hemorrhage Protocols across a Health System. Matern Child Health J 2020; 25:59-65. [PMID: 33244679 DOI: 10.1007/s10995-020-03050-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The United States has experienced a rising incidence of maternal deaths, including those attributable to obstetric hemorrhage (OBH). In response, the National Partnership for Maternal Safety developed a standardized OBH Consensus Bundle with the goal of universal adoption. In 2016 a large western Pennsylvania health system adopted the OBH Consensus Bundle across its 8 obstetrical units, with the goal to improve maternal outcomes. METHODS Gap analysis was used to identify differences between existing OBH protocols and the OBH Consensus Bundle from January to June 2016. Identified gaps as well as existing practices of success were used to systematically develop and implement a standardized system-wide OBH improvement initiative. Hospitals were then categorized by annual birth volume as high (> 2000), medium (500-2000), and low (< 500) with analysis performed across these groups to identify potential trends. RESULTS All hospitals had individual successes as well as gaps that were used to direct the system-wide OBH improvement initiative. In some cases, individual plans were tailored to meet hospital resources. When hospitals were compared by annual birth volume, variation existed in their preparedness for, and management of OBH, with the single low-volume hospital having the most gaps. DISCUSSION This gap analysis identified areas for improvement among all hospitals in a health system regardless of annual birth volume. This systematic approach of evaluation of current protocols and identification of improvement targets with implementation strategies may improve maternity outcomes. Additionally, these lessons described may provide a useful framework for other hospitals and health systems as they implement their own safety bundles.
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Affiliation(s)
- Francis M Hacker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Faina Linkov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA.,Department of Health Administration and Public Health, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Allison E Serra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vivian Petticord
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary T Zabielski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Sara B Sakamoto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abera SF, Kantelhardt EJ, Bezabih AM, Tsadik M, Lauvai J, Ejeta G, Wienke A, Frank J, Scherbaum V. What factors are associated with maternal undernutrition in eastern zone of Tigray, Ethiopia? Evidence for nutritional well-being of lactating mothers. BMC Public Health 2020; 20:1214. [PMID: 32770979 PMCID: PMC7414570 DOI: 10.1186/s12889-020-09313-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background Maternal undernutrition is a pervasive health problem among Ethiopian mothers. This study aims at identifying the level of maternal undernutrition and its associated factors in Kilte Awaleo-Health and Demographic Surveillance Site (KA-HDSS), Tigray region, Ethiopia. Methods Nutritional status of 2260 lactating mothers was evaluated using the mid-upper-arm circumference (MUAC). Data from the vital events and verbal autopsy databases were linked to the survey and baseline recensus data to investigate the association of adult mortality from chronic causes of death (CoD) on maternal undernutrition. We employed a generalized log-binomial model to estimate the independent effects of the fitted covariates. Results The overall prevalence of maternal undernutrition based on MUAC < 23 cm was 38% (95% CI: 36.1, 40.1%). Recent occurrence of household morbidity (adjusted prevalence ratio (adjPR) = 1.49; 95%CI: 1.22, 1.81) was associated with increased risk of maternal undernutrition. In addition, there was a 28% higher risk (adjPR = 1.28; 95%CI: 0.98, 1.67) of maternal undernutrition for those mothers who lived in households with history of adult mortality from chronic diseases. Especially, its association with severe maternal undernutrition was strong (adjusted OR = 3.27; 95%CI: 1.48, 7.22). In contrast, good maternal health-seeking practice (adjPR = 0.86; 95%CI: 0.77, 0.96) and production of diverse food crops (adjPR = 0.72; 95%CI: 0.64, 0.81) were associated with a lower risk of maternal undernutrition. Relative to mothers with low scores of housing and environmental factors index (HAEFI), those with medium and higher scores of HAEFI had 0.81 (adjPR = 0.81; 95%CI: 0.69, 0.95) and 0.82 (adjPR = 0.82; 95%CI: 0.72, 0.95) times lower risk of maternal undernutrition, respectively. Conclusions Efforts to ameliorate maternal undernutrition need to consider the influence of the rising epidemiology of adult mortality from chronic diseases. Our data clearly indicate the need for channeling the integrated intervention power of nutrition-sensitive development programs with that of nutrition-specific sectoral services.
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Affiliation(s)
- Semaw Ferede Abera
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany. .,Food Security Center, University of Hohenheim, Stuttgart, Germany. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany.,Department of Gynaecology, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mache Tsadik
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Judith Lauvai
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
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Downe S, Calleja Agius J, Balaam MC, Frith L. Understanding childbirth as a complex salutogenic phenomenon: The EU COST BIRTH Action Special Collection. PLoS One 2020; 15:e0236722. [PMID: 32756586 PMCID: PMC7406045 DOI: 10.1371/journal.pone.0236722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In 2014, the EU funded a four-year European Cooperation in Science and Technology (COST) Action to address the topic of childbirth. The COST Birth Action was a cross-European network, that brought together over 120 scientists, practitioners, activists and policy makers from 34 countries to work on intrapartum care. The central aim was to advance the state of research and practice in a specific area of great clinical and social importance, intrapartum care. The Action used inter and trans-disciplinary approaches to address birth from multiple perspectives and drew on complexity theory and the concept of salutogenesis (wellbeing). This special collection presents six papers produced from the Action and gives a sense of the range and depth of the work conducted. The Collection illustrates the knowledge that can be generated when a diverse group of people come together with a similar goals and perspectives.
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Affiliation(s)
- Soo Downe
- ReaCH Group, UCLan, Lancashire, United Kingdom
| | - Jean Calleja Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | | | - Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Althabe F, Therrien MNS, Pingray V, Hermida J, Gülmezoglu AM, Armbruster D, Singh N, Guha M, Garg LF, Souza JP, Smith JM, Winikoff B, Thapa K, Hébert E, Liljestrand J, Downe S, Garcia Elorrio E, Arulkumaran S, Byaruhanga EK, Lissauer DM, Oguttu M, Dumont A, Escobar MF, Fuchtner C, Lumbiganon P, Burke TF, Miller S. Postpartum hemorrhage care bundles to improve adherence to guidelines: A WHO technical consultation. Int J Gynaecol Obstet 2019; 148:290-299. [PMID: 31709527 PMCID: PMC7064978 DOI: 10.1002/ijgo.13028] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/16/2019] [Accepted: 11/08/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To systematically develop evidence-based bundles for care of postpartum hemorrhage (PPH). METHODS An international technical consultation was conducted in 2017 to develop draft bundles of clinical interventions for PPH taken from the WHO's 2012 and 2017 PPH recommendations and based on the validated "GRADE Evidence-to-Decision" framework. Twenty-three global maternal-health experts participated in the development process, which was informed by a systematic literature search on bundle definitions, designs, and implementation experiences. Over a 6-month period, the expert panel met online and via teleconferences, culminating in a 2-day in-person meeting. RESULTS The consultation led to the definition of two care bundles for facility implementation. The "first response to PPH bundle" comprises uterotonics, isotonic crystalloids, tranexamic acid, and uterine massage. The "response to refractory PPH bundle" comprises compressive measures (aortic or bimanual uterine compression), the non-pneumatic antishock garment, and intrauterine balloon tamponade (IBT). Advocacy, training, teamwork, communication, and use of best clinical practices were defined as PPH bundle supporting elements. CONCLUSION For the first response bundle, further research should assess its feasibility, acceptability, and effectiveness; and identify optimal implementation strategies. For the response to refractory bundle, further research should address pending controversies, including the operational definition of refractory PPH and effectiveness of IBT devices.
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Affiliation(s)
- Fernando Althabe
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Michelle N S Therrien
- Safe Motherhood Program, University of California, San Francisco, CA, USA.,HERHealthEQ, New York, NY, USA
| | - Veronica Pingray
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jorge Hermida
- Quality Performance Institute, University Research Co., LLC, Chevy Chase, MD, USA
| | - Ahmet M Gülmezoglu
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Deborah Armbruster
- Maternal and Newborn Division, USAID, Global Health Bureau, Washington, DC, USA
| | - Neelima Singh
- Department of Mother and Child Welfare, Indian Institute of Health and Family Welfare, Hyderabad, India
| | - Moytrayee Guha
- Division of Global Health and Human Rights, Massachusetts General Hospital, Boston, MA, USA
| | - Lorraine F Garg
- Division of Global Health and Human Rights, Massachusetts General Hospital, Boston, MA, USA
| | - Joao P Souza
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland.,Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Kusum Thapa
- Maternal Child Survival Program and Maternal Health, Jhpiego, Washington, DC, USA
| | | | | | - Soo Downe
- Research in Childbirth and Health Group, University of Central Lancashire, Preston, UK
| | - Ezequiel Garcia Elorrio
- Department of Quality and Safety in Healthcare, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Emmanuel K Byaruhanga
- Department of Obstetrics & Gynecology, Martyr's Hospital, Ministry of Health, Ibanda, Uganda
| | - David M Lissauer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Alexandre Dumont
- Research Institute for Sustainable Development, CEPED, Paris, France
| | - Maria F Escobar
- Department of Gynecology and Obstetrics, Fundacion Valle del Lili, Cali, Colombia
| | | | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thomas F Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Boston, MA, USA.,T.H. Chan School of Public Health, and HSPH Department of Global Health and Population, Harvard Boston, MA, USA
| | - Suellen Miller
- Safe Motherhood Program, University of California, San Francisco, CA, USA.,Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health and Policy University of California, San Francisco (UCSF), San Francisco, CA, USA
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Boyd SC, O'Connor AD, Horan MA, Dicker P, Manning C, Lynch C, Regan C, Ryan K, Tan T, Byrne BM. Analgesia, anaesthesia and obstetric outcome in women with inherited bleeding disorders. Eur J Obstet Gynecol Reprod Biol 2019; 239:60-63. [PMID: 31185377 DOI: 10.1016/j.ejogrb.2019.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Vertebral canal haematoma (VCH) complicates 1 in 168,000 obstetric epidurals (Ruppen et al., 2006). This risk is increased in women with inherited bleeding disorders (IBD). The impact of a contraindication to regional anaesthesia on pain management and obstetric outcome in these women is unknown. The purpose of this study was to determine anaesthetic use and obstetric outcomes in a cohort of women with IBD. STUDY DESIGN 97 women with IBD that delivered 130 babies at the CWIUH from Jan 2011 to Dec 2016 were identified from a maternal medicine database. Multidisciplinary planning of peripartum care was communicated to labour ward staff using a simple checklist. The primary bleeding disorders were: Von Willebrands disease (VWD) Type 1 27 (27.8%); VWD Type 2A 3 (3.8%); Low VWF 3 (3.8%); Bleeding disorder of unknown aetiology (BDUA) 19 (19.6%); deficiency of Factors VII, VIII, IX, X, and XI 13 (13.4%); Carriers of Factor VIII, IX, X, XIII deficiency 17 (17.5%); 5 had combined deficiencies (5.2%) and there was one platelet function defect. 9 had a family history of a bleeding disorder (9.3%). Haemostatic support, analgesia, mode of delivery and maternal and fetal outcomes were compared between pregnancies where regional anaesthesia was permitted and those that were not using the Chi-squared test. RESULTS When pregnancies where regional anaesthesia was not recommended (49) were compared with pregnancies where regional anaesthesia was considered safe (81), the women were more likely to see an anaesthetist before labour 46 (94%) vs 46 (61%): p < 0.001; to require prophylactic haemostatic support for delivery 30 (61%) vs 1 (1%): p < 0.001; to use a remifentanil infusion 15 (31%) vs 0: p < 0.001, and have general anaesthesia for Caesarean Section (CS) 10 (20%) vs 1(1%): p < 0.001. Vaginal birth 35 (71%) vs 53(65%): p = 0.4 and CS rates 14 (29%) vs 26 (32%) p = 0.28 were similar. Postpartum haemorrhage (PPH) was more common 11 (24%) vs 9(12%) vs p = 0.07 but not statistically so. There were no cases of neonatal bleeding or VCH. CONCLUSION Contraindication to neuraxial blockade in labouring women with IBD does not influence mode of delivery. This information is reassuring to these women who may be anxious about delivery without regional anaesthesia.
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Affiliation(s)
- Sean C Boyd
- University College Dublin, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - Anna D O'Connor
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Maebh A Horan
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Pat Dicker
- Department of Epidemiology Royal College of Surgeons, Ireland
| | - Catherine Manning
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - C Lynch
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - C Regan
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - K Ryan
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - T Tan
- Perioperative Medicine Service, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - B M Byrne
- Maternal Medicine, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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Abstract
Postpartum hemorrhage is an important contributor to maternal morbidity, and is one of the most common worldwide causes of preventable maternal mortality. Preventing significant morbidity and mortality from postpartum hemorrhage necessitates preparedness on both a unit and patient level. Our objectives are to define a bundle, to review the elements of the Council on Patient Safety in Women's Healthcare Obstetric Hemorrhage Bundle and to highlight simulation-based training opportunities, focusing on readiness for this significant obstetric emergency.
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Affiliation(s)
- Jessica Spiegelman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, United States.
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Dena Goffman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, United States
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Interdisciplinary Skills Review Program to Improve Team Responses During Postpartum Hemorrhage. J Obstet Gynecol Neonatal Nurs 2017; 47:254-263. [PMID: 29080398 DOI: 10.1016/j.jogn.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH). DESIGN Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations. SETTING/LOCAL PROBLEM The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting. PARTICIPANTS The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program. INTERVENTION/MEASUREMENTS The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program. RESULTS Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program. CONCLUSION An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH.
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Innovation in the Delivery of Perinatal Health Care. J Obstet Gynecol Neonatal Nurs 2017; 47:243-244. [PMID: 29174539 DOI: 10.1016/j.jogn.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 10/18/2022] Open
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Marshall AL, Durani U, Bartley A, Hagen CE, Ashrani A, Rose C, Go RS, Pruthi RK. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol 2017; 217:344.e1-344.e6. [PMID: 28502758 DOI: 10.1016/j.ajog.2017.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postpartum hemorrhage is a major cause of maternal morbidity and mortality, but the association between postpartum hemorrhage and hospital length of stay has not been rigorously investigated. OBJECTIVE We explored the impact of postpartum hemorrhage on hospital length of stay and inpatient mortality, as these outcomes have both clinical and economic significance. STUDY DESIGN We performed a retrospective analysis using data from the National Inpatient Sample database during the 2012 through 2013 time period. Deliveries were classified as postpartum hemorrhage due to uterine atony, nonatonic postpartum hemorrhage, or not complicated by postpartum hemorrhage (nonpostpartum hemorrhage). Average length of stay and inpatient mortality rates were compared between groups. RESULTS Over the study interval, postpartum hemorrhage occurred in 3% of deliveries. Among deliveries complicated by postpartum hemorrhage, 76.6% were attributed to uterine atony and 23.4% were nonatonic. Women with nonatonic postpartum hemorrhage had the highest average length of stay (3.67 days) followed by atonic postpartum hemorrhage (2.98 days) and nonpostpartum hemorrhage (2.63 days); P < .001, all comparisons. Inpatient mortality rate of nonatonic postpartum hemorrhage over the entire study period was 104 per 100,000 compared to 019 per 100,000 for atonic postpartum hemorrhage and 3 per 100,000 for nonpostpartum hemorrhage deliveries (P < .001). CONCLUSION From 2012 through 2013, women with postpartum hemorrhage experienced significantly longer length of stay and higher inpatient mortality rates than women without postpartum hemorrhage, largely attributable to nonatonic causes of postpartum hemorrhage. As hospital length of stay and inpatient mortality are important outcomes from both clinical and societal perspectives, interventions to reduce morbidity and mortality related to postpartum hemorrhage may simultaneously facilitate delivery of more cost-effective care and improve both maternal and population health.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
| | - Urshila Durani
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Adam Bartley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Clinton E Hagen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Aneel Ashrani
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Carl Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rajiv K Pruthi
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Schaap T, Bloemenkamp K, Deneux-Tharaux C, Knight M, Langhoff-Roos J, Sullivan E, van den Akker T. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity. BJOG 2017; 126:394-401. [PMID: 28755459 DOI: 10.1111/1471-0528.14833] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN Electronic Delphi study. SETTING International. POPULATION Eight expert panels. METHODS All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES Definitions with a rate of agreement of more than 70%. RESULTS The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
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Affiliation(s)
- T Schaap
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Bloemenkamp
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - C Deneux-Tharaux
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - E Sullivan
- Australian Centre for Public and Population Health Research Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - T van den Akker
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.,Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
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Cheng W, Wang Q, Zhang Z. Application effect of sterile normal saline ice for post-partum hemorrhage at the time of cesarean delivery: A retrospective review. J Obstet Gynaecol Res 2016; 42:1286-1289. [PMID: 27279562 DOI: 10.1111/jog.13047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/11/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Abstract
AIM Post-partum hemorrhage (PPH) is a common complication of cesarean sections (CS) and affects maternal and newborn health. We used a new method to control bleeding and compared its efficacy with conventional methods. METHODS Eighty-six women who experienced PPH with volume of bleeding over 1000 mL in CS between January 2008 and January 2012 were chosen as samples. Thirty-three underwent the new method in which normal saline ice blocks are placed in the uterus, and 53 underwent the conventional method. We evaluated blood loss, volume of transfusion and complications. RESULTS Patients who were treated with ice blocks had better hemostatic efficacy than those who underwent the conventional method (1450 ± 251.9 mL vs 1800 ± 278.9 mL; P < 0.001); they also had less blood transfusion (806.1 ± 242.3 mL vs 1222.6 ± 308.0 mL; P < 0.001), lower rate of hysterectomy and infection (3.03% vs 5.66%; P = 0.971; 0% vs 7.55%; P = 0.276), and shorter duration of hospital stay (5.3 ± 0.5 days vs 7.6 ± 3.0 days; P < 0.001). CONCLUSION PPH in CS can be treated with peeled sterile normal saline ice blocks, a simple and reliable method for stopping bleeding. Nonetheless, there needs to be a large randomized control trial for confirmation.
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Affiliation(s)
- Wenjing Cheng
- Department of Obstetrics and Gynecology, Ordos Central Hospital, Ordos, China
| | - Qiushi Wang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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