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Germano C, Girlando F, Carosso AR, Messina A, Parpinel G, Leo L, Attini R, Revelli A, Masturzo B. Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study. J Clin Med 2024; 13:2632. [PMID: 38731162 PMCID: PMC11084657 DOI: 10.3390/jcm13092632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/15/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.
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Affiliation(s)
- Chiara Germano
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Flavia Girlando
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Andrea Roberto Carosso
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Alessandro Messina
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Giulia Parpinel
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Livio Leo
- Department of Obstetrics and Gynecology, Beauregard Hospital, 11100 Aosta, Italy;
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
| | - Alberto Revelli
- SCDU2, Department of Surgical Sciences, Sant’Anna Hospital, University of Turin, 10126 Turin, Italy; (F.G.); (A.R.C.); (A.M.); (A.R.)
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Nuovo Ospedale degli Infermi, 13875 Biella, Italy; (G.P.); (R.A.); (B.M.)
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Zhang R, Cao X, Feng H, Liu Y, Cui P, Jiang H. Review of clinical practice guidelines for postpartum hemorrhage according to AGREE II. Midwifery 2023; 121:103659. [PMID: 36989879 DOI: 10.1016/j.midw.2023.103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Clinical practice guidelines for postpartum hemorrhage (PPH) are available worldwide, but no review has assessed the quality of these guidelines. Poor-quality guidelines for PPH may lead clinicians to follow incorrect approaches. OBJECTIVES High-quality guidelines for PPH are important in guiding the clinical diagnosis and treatment of PPH and decreasing maternal mortality. The aim of this study was to assess the quality of clinical guidelines for PPH. METHODS We collected studies from different countries through a literature search including PubMed (MEDLINE), Web of Science, the Cochrane library, websites of health institutions from multiple countries, and search sites, according to the criterion of clinical guidelines for treatment of PPH published between inception and October 2022. Four independent reviewers assessed the eligible guidelines by using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Agreement among reviewers of the guidelines was measured with the intra-class correlation coefficient (ICC). The number of recommendations, strength of recommendations, and level of evidence were determined. RESULTS Seven sets of PPH guidelines published from 2007 to 2022 were identified. An overall high agreement among reviewers in each domain was observed (ICC 0.74 to 0.95). The median scores and ranges for each AGREE II domain were as follows: (i) scope and purpose (median = 86.51%, range: 61.11%-94.44%); (ii) stakeholder involvement (median = 73.02%, range: 52.78%-90.28%); (iii) rigor of development (median = 76.49%, range: 66.15%-97.92%); (iv) clarity and presentation (median = 88.49%, range: 68.06%-100.00%); (v) applicability (median = 73.36%, range: 53.13%-93.75%); and (vi) editorial independence (median = 84.52%, range: 60.42%-95.83%). Three sets of PPH guidelines scored high in all domains and were classified as recommended for clinical practice. The other guidelines were classified as recommended with modifications. CONCLUSION The methodological and reporting quality of the guidelines for PPH included in this review was generally good, but the strength of the recommendations and the quality of the evidence varied, thus potentially leading to confusion among clinicians applying the guidelines. An urgent need exists for rigorous studies to close important evidence gaps to support the development of guidelines for PPH.
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Affiliation(s)
- Rongli Zhang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
| | - Xiao Cao
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou 73000, China
| | - Haoxue Feng
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Ying Liu
- Delivery Room, Shanghai First Maternity and Infant Hospital, Shanghai 201204, China
| | - Ping Cui
- Delivery Room, Shanghai First Maternity and Infant Hospital, Shanghai 201204, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, Shanghai 201204, China.
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Abstract
Patient blood management (PBM) aims to reduce red blood cell transfusion, minimize preoperative anemia, reduce intraoperative blood loss as well as optimize hemostasis, and individually manage postoperative anemia. Benefits include improved clinical outcome with a reduction in patient morbidity and mortality, but also lower hospital costs and shorter hospital length of stay. To date, it has been successfully implemented in several medical specialties, such as cardiac, trauma and orthopedic surgery. In obstetrics, postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. PBM has the potential to improve outcome of mother and child. However, pregnancy and childbirth pose a special challenge to PBM, and several adaptations compared to PBM in elective surgery are necessary. To date, awareness of the clinical advantages of PBM among obstetricians and midwifes regarding PBM and its concept in PPH is limited. In the following review, we therefore aim to present the current status quo in PBM in obstetrics and its challenges in the clinical routine.
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Affiliation(s)
- Jarmila A Zdanowicz
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, Bern, Switzerland.
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Tabl S, Balki M, Downey K, Tomlinson G, Farine D, Seaward G, Carvalho JCA. Uterotonics in elective caesarean delivery: a randomised non-inferiority study comparing carbetocin 20 μg and 100 μg. Anaesthesia 2018; 74:190-196. [DOI: 10.1111/anae.14480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- S. Tabl
- Department of Anaesthesia and Pain Management; Mount Sinai Hospital; University of Toronto; ON Canada
| | - M. Balki
- Department of Anaesthesia and Pain Management; Mount Sinai Hospital; University of Toronto; ON Canada
| | - K. Downey
- Department of Anaesthesia and Pain Management; Mount Sinai Hospital; University of Toronto; ON Canada
| | - G. Tomlinson
- Biostatistics; Institute of Health Policy, Management and Evaluation; Dalla Lana Faculty of Public Health; University of Toronto; ON Canada
| | - D. Farine
- Department of Obstetrics and Gynecology; Mount Sinai Hospital; University of Toronto; ON Canada
| | - G. Seaward
- Department of Obstetrics and Gynecology; Mount Sinai Hospital; University of Toronto; ON Canada
| | - J. C. A. Carvalho
- Department of Anaesthesia and Pain Management; Mount Sinai Hospital; University of Toronto; ON Canada
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Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, Miller S, El Ayadi AM, Souza JP, Durocher J, Blumenthal PD, Winikoff B. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol 2018; 219:162-168. [PMID: 29660298 DOI: 10.1016/j.ajog.2018.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/23/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
The current definition of is inadequate for early recognition of this important cause of maternal death that is responsible for >80,000 deaths worldwide in 2015. A stronger definition of postpartum hemorrhage should include both blood loss and clinical signs of cardiovascular changes after delivery, which would help providers to identify postpartum hemorrhage more promptly and accurately. Along with the amount of blood loss, clinical signs, and specifically the shock index (heart rate divided by systolic blood pressure) appear to aid in more accurate diagnosis of postpartum hemorrhage.
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Affiliation(s)
- A Borovac-Pinheiro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - R C Pacagnella
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
| | - J G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - S Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - A M El Ayadi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - J P Souza
- Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | | | - P D Blumenthal
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning Services and Research, Stanford University, Stanford, CA
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De Tina A, Zhou J. Abruptio Placenta and Placenta Previa. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Quibel T, Ghout I, Goffinet F, Salomon LJ, Fort J, Javoise S, Bussieres L, Aegerter P, Rozenberg P; for the Groupe de Recherche en Obstétrique et Gynécologie (GROG). Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage: A Randomized Controlled Trial. Obstet Gynecol 2016; 128:805-11. [DOI: 10.1097/aog.0000000000001626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sathe NA, Likis FE, Young JL, Morgans A, Carlson-bremer D, Andrews J. Procedures and Uterine-Sparing Surgeries for Managing Postpartum Hemorrhage: A Systematic Review. Obstet Gynecol Surv 2016; 71:99-113. [DOI: 10.1097/ogx.0000000000000273] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ferrazzani S, Iadarola R, Perrelli A, Botta A, Moresi S, Salvi S, Santucci S, Degennaro VA, De Carolis S. Use of an intrauterine inflated catheter balloon in massive post-partum hemorrhage: a series of 52 cases. J Obstet Gynaecol Res 2015; 40:1603-10. [PMID: 24888923 DOI: 10.1111/jog.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022]
Abstract
AIM Massive post-partum hemorrhage (PPH) is an important cause of maternal death that occurs as a complication of delivery. We report a large case series to evaluate the efficacy of uterine balloon tamponade to treat PPH avoiding hysterectomy. MATERIAL AND METHODS This prospective study was conducted in two Italian hospitals (from December 2002 to July 2012). Fifty-two patients with PPH not responsive to uterotonics were treated by Rusch balloon. A follow-up was conducted among the study population to assess the subsequent fertility. RESULTS The most frequent cause of PPH was atony (59.6%), followed by placenta previa (21.2%), placenta accreta (9.6%), and placenta previa and accreta (9.6%). The balloon success rate to control hemorrhage was 75%. From the sample of 52 patients, 13 patients needed additional procedures. In three failure cases, other conservative techniques were used and the overall effectiveness of them was 80.7%. The follow-up group consisted of 31 women. Of these women, 24 women (77.4%) had no further pregnancies, but only one due to sterility. Four of seven patients with subsequent pregnancies made it to term without complications. CONCLUSIONS The Rusch balloon is effective in controlling non-traumatic PPH in 75% of cases. It is simple to use, readily available and cheap. If necessary, this technique does not exclude other procedures. We suggest that this balloon should be included routinely in the PPH protocol.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart
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Ekelund K, Hanke G, Stensballe J, Wikkelsøe A, Albrechtsen CK, Afshari A. Hemostatic resuscitation in postpartum hemorrhage - a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94:680-692. [PMID: 25660118 DOI: 10.1111/aogs.12607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/14/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a potentially life-threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost-effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. OBJECTIVE This review summarizes the background, current evidence and recommendations with regard to the role of fibrinogen, tranexamic acid, prothrombin complex concentrate, desmopressin, and recombinant factor VIIa in the treatment of patients with postpartum hemorrhage. The benefits and evidence behind traditional standard laboratory tests and viscoelastic hemostatic assays, i.e. thromboelastography TEG(®) and thromboelastometry ROTEM(®) , are discussed. In addition we assess and elaborate on the current paradigm and evidence for transfusion of these patients. DATA SOURCES Publications between 1994 and 2014 were identified from PubMed, EMBASE, Cochrane Library databases, and ClinicalTrial.gov. RESULTS Viscoelastic hemostatic assays were found to provide a real-time continuum of coagulation and fibrinolysis when introduced as a supplement in transfusion management of postpartum hemorrhage. Fibrinogen should be considered when hypofibrinogenemia is identified. Early administration of 1-2 g tranexamic acid is recommended, followed by an additional dose in cases of ongoing bleeding. Uncontrolled hemorrhage requires early balanced transfusion. CONCLUSION Despite the lack of conclusive evidence for optimal hemostatic resuscitation in postpartum hemorrhage, the use of viscoelastic hemostatic assays, fibrinogen, tranexamic acid and balanced transfusion therapy may prove to be potentially pivotal in the treatment of postpartum hemorrhage.
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Affiliation(s)
- Kim Ekelund
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gabriele Hanke
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Stensballe
- Department of Anesthesia, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Wikkelsøe
- Department of Anesthesiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | - Charlotte Krebs Albrechtsen
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Arash Afshari
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Boere I, Smit M, Roest AAW, Lopriore E, van Lith JMM, te Pas AB. Current practice of cord clamping in the Netherlands: a questionnaire study. Neonatology 2015; 107:50-5. [PMID: 25377126 DOI: 10.1159/000365836] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent meta-analyses recommend delayed cord clamping (DCC) after uncomplicated births as well as preterm births, but there is no clear definition of timing and uniform national guidelines are lacking. OBJECTIVE We aimed to investigate if guidelines for the timing of cord clamping (CC) are followed and what the national practice entails. METHODS A postal questionnaire concerning CC after uncomplicated vaginal, Caesarean term and preterm deliveries was sent to all midwifery practices (n = 526) and obstetrical departments (n = 94) in the Netherlands. RESULTS The response rate was 81% (500/620). CC protocols were present in 16 and 38% of midwifery and obstetric practices, respectively. Early cord clamping (ECC) was recommended in 54%, DCC in 33%, 6% indicated a specific time point and 7% did not specify. In current practice, DCC was applied after uncomplicated vaginal term deliveries in 90% and ECC in 6%, and no timing was specified in 4%. Midwives used DCC more often than obstetricians (97 vs. 75%). Cessation of cord pulsations was often (54%) used as a time point, 40% used a fixed time point, 2% waited for placental expulsion and 4% did not specify. ECC was preferred in obstetric practices after Caesarean deliveries (in 81%). In preterm births, ECC was practised by 36%, DCC by 54 and 10% did not specify. CONCLUSION In the Netherlands, although often not protocolized, DCC is widely used after uncomplicated vaginal term and preterm deliveries, but not after Caesareans. Cessation of cord pulsation is often used as the time point for CC.
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Affiliation(s)
- Isabelle Boere
- Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
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Ruangkit C, Moroney V, Viswanathan S, Bhola M. Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study. J Neonatal Perinatal Med 2015; 8:393-402. [PMID: 26757008 DOI: 10.3233/npm-15915043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of a quality improvement (QI) program of delayed umbilical cord clamping (DCC) in multiple and singleton preterm infants born at our center. METHODS After DCC protocol implementation, compliance and success rate were assessed. Clinical outcomes of selected 150 preterm infants <34 weeks gestation born in 2014 after protocol implementation (Epoch II) were compared to those of preterm infants born in 2013 before protocol implementation (Epoch I). RESULTS Overall protocol compliance rate was 92% (246/267). DCC was successfully performed in 77% (205/267) after protocol implementation. There were higher multiple births in Epoch II compared to Epoch I (27.3 vs. 15.3% , p < 0.01). At birth, infants in Epoch II had significantly decreased need for intubation in delivery room (23.3 vs. 39.3% , p < 0.01), had higher hematocrit (46.4±7.3 vs. 44.0±7.1% , p < 0.01) and less metabolic acidosis (base excess -4.1±2.7 vs. -5.3±4.2 mmol/L, p < 0.01) compared to those born in Epoch I. During hospital stay, fewer infants in Epoch II received rescue surfactant therapy (45.3 vs. 56.7% , p = 0.05), medical treatment for PDA (6.7 vs. 16.6% , p = 0.04%) and red blood cell transfusions (20.7 VS. 32.0% , p < 0.01) compared to Epoch I. CONCLUSIONS Protocol-guided practice of DCC for 30 seconds can be safely performed in multiple and singleton preterm infants. In addition to higher initial hematocrit, infants in our QI project had lower need for delivery room resuscitation and less metabolic acidosis at birth. We also observed decreased need for rescue surfactant therapy, medical treatment for PDA and red blood cell transfusions after DCC protocol implementation.
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Bohlmann MK, Rath W. Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines. Arch Gynecol Obstet 2014; 289:555-67. [DOI: 10.1007/s00404-013-3016-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Abstract
Sulprostone, a synthetic prostaglandin analogue with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case of cardiac arrest in a parturient after Caesarean section during continuous infusion of intravenous sulprostone administered for atonic post-partum haemorrhage. She had cardiopulmonary resuscitation for 25 min before spontaneous circulation returned. The sequence of events, the results of investigations carried out during the intensive care unit stay, and the presence of multiple cardiovascular risk factors, suggest that sulprostone caused coronary spasm, bradycardia, and subsequent asystole, similar to other cases described in the literature.
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Affiliation(s)
- L. LAMPATI
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
| | - L. B. COLANTONIO
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
| | - E. CALDERINI
- Dipartimento di Anestesia; Terapia Intensiva e Terapia del Dolore; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano; Italy
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Gülmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, Carroli G, Qureshi Z, Souza JP, Bergel E, Piaggio G, Goudar SS, Yeh J, Armbruster D, Singata M, Pelaez-Crisologo C, Althabe F, Sekweyama P, Hofmeyr J, Stanton ME, Derman R, Elbourne D. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet 2012; 379:1721-7. [PMID: 22398174 DOI: 10.1016/s0140-6736(12)60206-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Active management of the third stage of labour reduces the risk of post-partum haemorrhage. We aimed to assess whether controlled cord traction can be omitted from active management of this stage without increasing the risk of severe haemorrhage. METHODS We did a multicentre, non-inferiority, randomised controlled trial in 16 hospitals and two primary health-care centres in Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. Women expecting to deliver singleton babies vaginally (ie, not planned caesarean section) were randomly assigned (in a 1:1 ratio) with a centrally generated allocation sequence, stratified by country, to placental delivery with gravity and maternal effort (simplified package) or controlled cord traction applied immediately after uterine contraction and cord clamping (full package). After randomisation, allocation could not be concealed from investigators, participants, or assessors. Oxytocin 10 IU was administered immediately after birth with cord clamping after 1-3 min. Uterine massage was done after placental delivery according to local policy. The primary (non-inferiority) outcome was blood loss of 1000 mL or more (severe haemorrhage). The non-inferiority margin for the risk ratio was 1·3. Analysis was by modified intention-to-treat, excluding women who had emergency caesarean sections. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN 12608000434392. FINDINGS Between June 1, 2009, and Oct 30, 2010, 12,227 women were randomly assigned to the simplified package group and 12,163 to the full package group. After exclusion of women who had emergency caesarean sections, 11,861 were in the simplified package group and 11,820 were in the full package group. The primary outcome of blood loss of 1000 mL or more had a risk ratio of 1·09 (95% CI 0·91-1·31) and the upper 95% CI limit crossed the pre-stated non-inferiority margin. One case of uterine inversion occurred in the full package group. Other adverse events were haemorrhage-related. INTERPRETATION Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Scaling up of haemorrhage prevention programmes for non-hospital settings can safely focus on use of oxytocin. FUNDING United States Agency for International Development and UN Development Programme/UN Population Fund/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research.
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Affiliation(s)
- A Metin Gülmezoglu
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
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Chong YS, Arulkumaran S. Keep things simple for safer childbirth and better medicine. Lancet 2012; 379:1684-5. [PMID: 22398173 DOI: 10.1016/s0140-6736(12)60354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119228, Singapore.
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Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 2012; 286:549-61. [DOI: 10.1007/s00404-012-2329-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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De Bonis M, Torricelli M, Leoni L, Berti P, Ciani V, Puzzutiello R, Severi FM, Petraglia F. Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage. J Matern Fetal Neonatal Med 2011; 25:732-5. [PMID: 21761999 DOI: 10.3109/14767058.2011.587920] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. METHODS Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. RESULTS The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. CONCLUSIONS A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.
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Affiliation(s)
- Maria De Bonis
- Section of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Siena, Italy
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