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Lounici N, Cheifa A, Bendjama O, Maireche A, Saadat MR, Seddiki K. Embolization of a postcesarean pseudo-aneurysm of a uterine artery: A case report. Radiol Case Rep 2024; 19:1876-1880. [PMID: 38434783 PMCID: PMC10905957 DOI: 10.1016/j.radcr.2024.01.076] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
Postpartum hemorrhage caused by a pseudoaneurysm of the uterine artery is suspected clinically in the case of abundant metrorrhagia. An ultrasound is performed, followed by further imaging modalities to confirm the diagnosis: CT scan, MRI, and angiography, the latter would also allow embolization. This is admittedly rare, however, since the pseudo aneurysm of the uterine artery is potentially fatal, it must be taken into account in the differential diagnosis of secondary postpartum hemorrhage, allowing adequate and rapid management. We report a case of pseudo aneurysm of the uterine artery, suspected clinically and confirmed by a CT scan, presenting as a secondary postpartum hemorrhage a few hours after delivery by cesarean section. It was eventually managed by embolization with excellent results several days after its onset when the cause was revealed. Angiographic embolization is an effective treatment for postpartum hemorrhage caused by pseudoaneurysm in stable patients. It should be considered before surgery in suitable cases.
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Affiliation(s)
- Nazim Lounici
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | | | | | - Ammar Maireche
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | | | - Karima Seddiki
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
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Papadopoulou A, Tournas G, Georgiopoulos G, Antsaklis P, Daskalakis G, Coomarasamy A, Devall AJ. Preventing postpartum hemorrhage: A network meta-analysis on routes of administration of uterotonics. Eur J Obstet Gynecol Reprod Biol 2024; 295:172-180. [PMID: 38367391 DOI: 10.1016/j.ejogrb.2024.02.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
1. OBJECTIVE To perform a network meta-analysis to specify the route of administration that maximises the effectiveness of each of the available prophylactic uterotonics without increasing the risk for side effects. 2. DATA SOURCES Literature searches on 12th September 2022 included: CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. The reference lists of the retrieved study records were also searched. 3. STUDY ELIGIBILITY CRITERIA Population: Randomized controlled trials involving women in the third stage of labour after a vaginal or caesarean delivery in hospital or community settings. INTERVENTIONS Systemically administered prophylactic uterotonics of any route and dose for primary postpartum hemorrhage prevention. Comparison: Any other prophylactic uterotonic, or a different route or dose of a given uterotonic, or placebo, or no treatment. Outcomes (primary): postpartum hemorrhage ≥ 500 mL and ≥ 1000 mL. 4. STUDY APPRAISAL AND SYNTHESIS METHODS Risk of bias and trustworthiness assessments were performed, according to Cochrane's guidance. Direct, indirect and network meta-analyses were conducted, and results were summarized either as risk ratio or mean difference with 95% confidence intervals for dichotomous and continuous outcomes, respectively. The certainty of generated evidence was assessed according to the GRADE approach. Cumulative probabilities were calculated and the surface under the cumulative ranking curve was used to create a ranking of the available drugs. 5. RESULTS One hundred eighty-one studies involving 122,867 randomised women were included. Most studies were conducted in hospital settings in lower-middle income countries and involved women delivering vaginally. When compared with intramuscular oxytocin, carbetocin (RR 0.58, 95 % CI 0.40-0.84) and oxytocin (RR 0.75, 95 % CI 0.59-0.97) by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination (RR 0.71, 95 % CI 0.56-0.91) are probably more effective in preventing primary postpartum hemorrhage. Intramuscularly administered oxytocin and carbetocin by an intravenous bolus have a favourable side effects profile. 6. CONCLUSIONS Generated evidence was generally moderate and global inconsistency was low. Carbetocin and oxytocin by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination are probably the top uterotonics for primary postpartum hemorrhage prevention. Large scale studies exploring different routes of administration for available prophylactic uterotonics, and women's views should be conducted.
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Affiliation(s)
- Argyro Papadopoulou
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom; Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece.
| | - Georgios Tournas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Panos Antsaklis
- Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Georgios Daskalakis
- Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom
| | - Adam J Devall
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom
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Deniau B, Ricbourg A, Weiss E, Paugam-Burtz C, Bonnet MP, Goffinet F, Mignon A, Morel O, Le Guen M, Binczak M, Carbonnel M, Michelet D, Dahmani S, Pili-Floury S, Ducloy Bouthors AS, Mebazaa A, Gayat E. Association of severe postpartum hemorrhage and development of psychological disorders: Results from the prospective and multicentre HELP MOM study. Anaesth Crit Care Pain Med 2024; 43:101340. [PMID: 38128731 DOI: 10.1016/j.accpm.2023.101340] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Post-partum hemorrhage (PPH) is the leading preventable cause of worldwide maternal morbidity and mortality. Risk factors for psychological disorders following PPH are currently unknown. HELP-MOM study aimed to determine the incidence and identify risk factors for psychological disorders following PPH. METHODS HELP-MOM study was a prospective, observational, national, and multicentre study including patients who experienced severe PPH requiring sulprostone. The primary endpoint was the occurrence of psychological disorders (anxiety and/or post-traumatic disorder and/or depression) following PPH, assessed at 1, 3, and 6 months after delivery using HADS, IES-R, and EPDS scales. RESULTS Between November 2014 and November 2016, 332 patients experienced a severe PPH and 236 (72%) answered self-questionnaires at 1, 3, and 6 months. A total of 161 (68%) patients declared a psychological disorder following severe PPH (146 (90.1%) were screened positive for anxiety, 96 (58.9%) were screened positive for post-traumatic stress disorder, and 94 (57.7%) were screened positive for post-partum depression). In multivariable analysis, the use of intra-uterine tamponnement balloon was associated with a lower risk to be screened positive for psychological disorder after severe PPH (OR = 0.33 [IC95% 0.15-0.69], p = 0.004, and after propensity score matching (OR=0.34 [IC95% 0.12-0.94], p = 0.04)). Low hemoglobin values during severe PPH management were associated with a higher risk of being screened positive for psychological disorders. Finally, we did not find differences in desire or pregnancy between patients without or with psychological disorders occurring in the year after severe PPH. DISCUSSION Severe PPH was associated with significant psychosocial morbidity including anxiety, post-traumatic disorder, and depression. This should engage a psychological follow-up. Large cohorts are urgently needed to confirm our results. REGISTRATION ClinicalTrials.gov under number NCT02118038.
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Affiliation(s)
- Benjamin Deniau
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Aude Ricbourg
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Emmanuel Weiss
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Catherine Paugam-Burtz
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Clichy, France
| | - Marie-Pierre Bonnet
- Université de Paris Cité, Paris, France; Département d'Anesthésie Réanimation, Hôpital Armand Trousseau, DMU DREAM, APHP, Paris, France
| | - François Goffinet
- Université de Paris Cité, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Alexandre Mignon
- Université de Paris Cité, Paris, France; Département d'Anesthésie-Réanimation, Hôpital Cochin-Port Royal, APHP, Paris, France; Maternité Cochin-Port Royal, APHP, Paris, France
| | - Olivier Morel
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire de Nancy, Nancy France
| | - Morgan Le Guen
- Université de Versailles Saint-Quentin, France; Département d'Anesthésie, Hôpital Foch, Suresnes, France
| | - Marie Binczak
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Marie Carbonnel
- Service de Gynécologie et Obstétrique, Hôpital Foch, Suresnes, France
| | - Daphné Michelet
- Département d'Anesthésie et Réanimation, CHU de Reims, France; Université de Reins Champagne Ardenne, Reims, France
| | - Souhayl Dahmani
- Université de Paris Cité, Paris, France; Service d'Anesthésie, Hôpital Robert Debré, APHP, Paris, France; Service d'Anesthésie et Réanimation, Hôpital Robert Ballanger, Aulnay-sous-Bois, France
| | | | | | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France; Réseau INI-CRCT, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation et Centre de Traitement des Brûlés, Hôpitaux Universitaires Saint-Louis - Lariboisière, AP-HP, Paris, France; UMR-S 942, INSERM, MASCOT, Paris University, Paris, France; Université de Paris Cité, Paris, France; FHU PROMICE, France.
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Nagai A, Shiko Y, Noguchi S, Ikeda Y, Kawasaki Y, Mazda Y. Protocolized oxytocin infusion for elective cesarean delivery: a retrospective before-and-after study. J Anesth 2024:10.1007/s00540-024-03329-1. [PMID: 38517531 DOI: 10.1007/s00540-024-03329-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/15/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To elucidate the clinical impact of the novel oxytocin protocol using a syringe pump with a stratified dose compared with the conventional practice of putting oxytocin into the bag. METHODS This is a retrospective cohort study. We collected the data of the patients who underwent elective cesarean delivery under neuraxial anesthesia between June 2019 and May 2020. The patients were allocated to two groups according to oxytocin administration methods; the control group (the attending anesthesiologist put oxytocin 5-10 units in the infusion bag and adjusted manually after childbirth) and the protocol group (the oxytocin protocol gave oxytocin bolus 1 or 3 units depending on the PPH risk, followed by 5 or 10 unit h-1 via a syringe pump). We compared the total amount of oxytocin within 24 h postpartum, estimated blood loss, and adverse clinical events within 24 h postpartum between the two groups. RESULTS During the study period, 262 parturients were included. Oxytocin doses of intraoperative and postoperative were significantly lower in the protocol group (9.7 vs. 11.7 units, intraoperative, 15.9 vs. 18 units, postoperative). The subgroup analyses showed that the impact was more remarkable in the low PPH risk than in the high PPH risk. The multivariate linear regression analyses also confirmed the difference. The groups had no significant difference in blood loss, requirement of additional uterotonics, and other adverse events. CONCLUSIONS Our oxytocin infusion protocol significantly reduced oxytocin requirements in elective cesarean delivery under neuraxial anesthesia without increasing blood loss. However, we could not find other clinical benefits of the novel protocol.
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Affiliation(s)
- Azusa Nagai
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yuki Shiko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Shohei Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yusuke Ikeda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yohei Kawasaki
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
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Abouda HS, Marzouk SB, Boussarsar Y, Aloui H, Frikha H, Hammami R, Chennoufi B, Maghrebi H. Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100285. [PMID: 38351966 PMCID: PMC10862398 DOI: 10.1016/j.eurox.2024.100285] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta. Study design It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without. Results 20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641). Conclusion In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.
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Affiliation(s)
- Hassine S. Abouda
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Sofiene B. Marzouk
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Yecer Boussarsar
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Haithem Aloui
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hatem Frikha
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Rami Hammami
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Badis Chennoufi
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hayen Maghrebi
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
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Siefen AC, Kurte MS, Kron F. Economic effects of treating postpartum hemorrhage with vacuum-induced hemorrhage control devices - A budget impact analysis of the Jada® System in the German obstetrics setting. Eur J Obstet Gynecol Reprod Biol 2024; 294:222-230. [PMID: 38301501 DOI: 10.1016/j.ejogrb.2024.01.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study aimed to assess the budget impact of vacuum-induced hemorrhage control (VHC) devices for treating postpartum hemorrhage (PPH) from the perspective of the German statutory health insurance (SHI). STUDY DESIGN Evidence shows that treating PPH with VHC instead of uterine balloon tamponade (UBT) can reduce resource consumption (e.g., reduced number of blood transfusions and length of stay). A budget impact model combining aggregated German real-world reimbursement data of PPH cases with the assumption of resource reduction due to VHC usage was developed. Diagnosis-related groups (DRG) of PPH cases and their frequencies were collected using a publicly available database. A "downgrading mechanism" was performed, leading to a less resource-intensive DRG, i.e., resulting in a lower flat fee to be paid by SHI. Four subgroups were differentiated based on coded diagnoses and procedures: 1) PPH (O72.-) as main diagnosis, 2) PPH as secondary diagnosis, 3) UBT procedure coded, and 4) UBT or standard tamponade coded. Weighted averages of cost savings per case were calculated. RESULTS Data from 7,129 (subgroup 1), 49,523 (subgroup 2), 1,668 (subgroup 3), and 3,406 (subgroup 4) cases were retrieved. After applying the downgrading mechanism, cost savings (weighted average) resulted in 184.09 €, 210.50 €, 921.33 €, and 633.74 € for subgroups 1-4, respectively, CONCLUSION: This is the first German budget impact analysis of VHC for the treatment of PPH. Results showed the highest cost-saving potential for cases currently treated with UBT. Demonstrating not only clinical but also financial consequences of innovative treatments is crucial for the adoption into clinical practice.
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Affiliation(s)
| | - Melina S Kurte
- VITIS Healthcare Group, Cologne, Germany; Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany; Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany.
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Getahun GK, Wubishet D, Wubete BY, Akalu SY, Shitemaw T. Predictors of postpartum hemorrhage at public hospitals in Addis Ababa, Ethiopia: A case-control study. Heliyon 2024; 10:e26762. [PMID: 38434069 PMCID: PMC10906385 DOI: 10.1016/j.heliyon.2024.e26762] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Postpartum hemorrhage (PPH) is responsible for half of all maternal deaths during childbirth. Despite being preventable and curable, PPH remains the leading cause of maternal death in Ethiopia. Therefore, the aim of this study was to identify the determinants of PPH among women delivered at public hospitals in Addis Ababa, Ethiopia, in 2022. Methods A facility-based, unmatched case control study with 378 study participants was carried out in selected public hospitals in Addis Ababa, Ethiopia. Women who gave birth and developed PPH were considered cases, while women who gave birth in public hospitals in Addis Ababa and did not develop PPH were controls. Binary and multivariable logistic regression analyses were used to identify independent predictors of PPH. Variables was considered statistically significant in the final model if their p-value was less than 0.05. Results The result of this study identified that antenatal care follow-up (AOR: 2.58; 95% CI: 1.12, 5.96), history of cesarean delivery (AOR: 3.47; 95% CI: 1.40, 8.58), prolonged labor (AOR: 5.14; CI: 2.07, 12.75), and genital trauma apart from episiotomy (AOR: 4.39; CI: 1.51, 12.81) were determinants of PPH. Conclusion According to the finding of this study duration of labor, history of cesarean section, antenatal care follow-up, and genital trauma other than episiotomy were independent determinants of PPH. Therefore, it is crucial to screen and closely monitor high-risk mothers during antepartum care visit, including those who have a history of cesarean delivery.
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Affiliation(s)
- Genanew Kassie Getahun
- Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
- Yanet College, Addis Ababa, Ethiopia
| | | | | | | | - Tewodros Shitemaw
- Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
- Yanet College, Addis Ababa, Ethiopia
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Aizawa M, Ishihara S, Yokoyama T. Reply to a letter to the editor. J Anesth 2024; 38:147. [PMID: 37980695 DOI: 10.1007/s00540-023-03286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Mariko Aizawa
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan.
| | - Satoshi Ishihara
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan
| | - Takeshi Yokoyama
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan
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Alexander MV, Wang MJ, Srivastava A, Tummala S, Abbas D, Young S, Claus L, Yarrington C, Comfort A. Association between duration of intrapartum oxytocin exposure and obstetric hemorrhage. Arch Gynecol Obstet 2024; 309:491-501. [PMID: 36781431 DOI: 10.1007/s00404-022-06901-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/18/2022] [Indexed: 02/15/2023]
Abstract
PURPOSE Prolonged duration of intrapartum oxytocin exposure is included as a risk factor within widely adopted obstetric hemorrhage risk stratification tools. However, the duration of exposure that confers increased risk is poorly understood. This study aimed to assess the association between duration of intrapartum oxytocin exposure and obstetric blood loss, as measured by quantitative blood loss, and hemorrhage-related maternal morbidity. METHODS This was a retrospective cohort study of all deliveries from 2018 to 2019 at a single medical center. We included patients who had received any intrapartum oxytocin, and we categorized them into 1 of 5 groups: > 0-2, ≥ 2-4, ≥ 4-6, ≥ 6-12, and ≥ 12 h of intrapartum oxytocin exposure. The primary outcomes were mean quantitative blood loss, proportion with obstetric hemorrhage (defined as quantitative blood loss ≥ 1000 mL), and proportion with obstetric hemorrhage-related morbidity, a composite of hemorrhage-related morbidity outcomes. Secondary outcomes were hemorrhage-related pharmacologic and procedural interventions. A stratified analysis was also conducted to examine primary and secondary outcomes by delivery mode. RESULTS Of 5332 deliveries between January 1, 2018 and December 31, 2019 at our institution, 2232 (41.9%) utilized oxytocin for induction or augmentation. 326 (14.6%) had exposure of > 0-2 h, 295 (13.2%) ≥ 2-4 h, 298 (13.4%) ≥ 4-6 h, 562 (25.2%) ≥ 6-12 h, and 751 (33.6%) ≥ 12 h. Across all deliveries, there was higher mean quantitative blood loss (p < 0.01) as well as increased odds of obstetric hemorrhage (adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.21-1.91) for those with ≥ 12 h of oxytocin compared to all groups between > 0-12 h of exposure. In our stratified analysis, ≥ 12 h of oxytocin exposure was associated with higher mean quantitative blood loss (p = 0.04) and odds of obstetric hemorrhage in vaginal deliveries (aOR 1.47, 95% CI: 1.03-2.11), though not in cesarean deliveries (aOR 1.16, 95% CI 0.82-1.62). There were no differences in proportion with obstetric hemorrhage-related morbidity across all deliveries (p = 0.40) or in the stratified analysis. CONCLUSION Intrapartum oxytocin exposure of ≥ 12 h was associated with increased quantitative blood loss and odds of obstetric hemorrhage in vaginal, but not cesarean, deliveries.
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Affiliation(s)
- Megan V Alexander
- Boston University School of Medicine, Boston, MA, USA.
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA.
| | - Michelle J Wang
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
| | | | | | - Diana Abbas
- Boston University School of Medicine, Boston, MA, USA
| | - Sara Young
- Boston University School of Medicine, Boston, MA, USA
| | - Lindsey Claus
- Boston University School of Medicine, Boston, MA, USA
| | - Christina Yarrington
- Boston University School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
| | - Ashley Comfort
- Boston University School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 770 Albany Street, Dowling 4, Boston, MA, 02118, USA
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10
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Lummevaara L, Ordén MR, Mykkänen A, Keski-Nisula L. Delayed umbilical cord clamping in elective and nonelective term Cesarean delivery. J Gynecol Obstet Hum Reprod 2024; 53:102717. [PMID: 38142753 DOI: 10.1016/j.jogoh.2023.102717] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/05/2023] [Accepted: 12/22/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Delayed cord clamping (DCC) is recommended for preterm and term neonates, regardless of delivery mode. After impression of increased maternal blood loss following DCC implementation during Cesarean delivery (CD) concerns arose about maternal safety, particularly in term CDs. MATERIALS AND METHODS We conducted a retrospective cohort study by reviewing birth records from our tertiary hospital in Kuopio, Finland including 914 women with singleton term CD and recorded estimated blood loss. Early cord clamping (ECC) occurred from January 2016 to December 2019, while DCC (30-60 s) from January 2020 to December 2020. We evaluated maternal and neonatal outcomes for ECC vs. DCC and assessed severe postpartum hemorrhage (PPH) (≥1500 ml) and its potential clinical risk factors. RESULTS In total, 914 women were included (DCC N = 152; ECC N = 762). Estimated mean maternal blood loss showed no significant difference between DCC and ECC groups (697 ml vs. 750 ml, p < 0.96). Severe PPH was less frequent in the DCC group (4.6% vs. 10.5 %, p < 0.024). Neonatal outcomes were similar between groups. Multivariable analysis revealed that women with placenta previa (OR 5.63, p < 0.001), macrosomic neonate (OR 2.75, p < 0.001), and intrapartum infection (OR 2.00, p < 0.057) had an increased risk for severe PPH. Earlier CD was associated with less severe PPH (OR 0.36, p < 0.001). CONCLUSIONS DCC (30-60 s) during term CD did not increase maternal blood loss in singleton pregnancies and demonstrated no short-term adverse effects on neonates. Our findings support the general practice of DCC during both elective and nonelective term CD.
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Affiliation(s)
- Liina Lummevaara
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
| | - Maija-Riitta Ordén
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Anu Mykkänen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
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Bestman PL, Nget M, Kolleh EM, Moeng E, Brhane T, Fang JQ, Luo J. A comparative analysis of Postpartum Hemorrhage incidence and influencing factors between nulliparous and multiparous women in Hunan Province, China: A multicenter retrospective cohort study. Prev Med Rep 2024; 38:102580. [PMID: 38375184 PMCID: PMC10874836 DOI: 10.1016/j.pmedr.2023.102580] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 02/21/2024] Open
Abstract
Objectives Postpartum hemorrhage (PPH) is a common cause of maternal death worldwide, but data on PPH incidence and influencing factors for nulliparous and multiparous women is scarce. So, the study aimed to assess the differences in PPH incidence and influencing factors between nulliparous and multiparous women. Methods A multicenter retrospective cohort study was conducted among women who gave birth at ≥ 28 weeks of gestation in Hunan Province, China, from January 2017 to December 2018. Logistic regression assessed PPH-influencing factors, and the receiver operating characteristic curve (ROC curve) assessed the predictive performance of identified factors. Results A total of 144,845 postpartum women were included in the study. The incidence of PPH (blood loss ≥ 500 ml) was 2.1 % and 1.7 % for nulliparous and multiparous women, respectively. Among the nulliparous and multiparous women, similar influencing factors of PPH included erythrocyte suspension transfusion before childbirth, anemia, soft-birth canal avulsion, Cesarean-section, placenta abruption, and general anesthesia administration before birth. Thrombophlebitis was associated [aOR 18.46(1.67-20.31)] with PPH among only the nulliparous women, while instrument-assisted birth [aOR 1.95(1.16-3.28)] and gestational hypertension [aOR 1.57(1.13-2.19)] were associated with PPH among only the multiparous women. The areas under the ROC-curve for the overall-cohort, nulliparous, and multiparous groups were [0.829(0.821-0.838)], [0.828(0.815-0.840)] and [0.833(0.822-0.844)], respectively. Conclusion PPH incidence is higher among nulliparous women than among multiparous women, but influencing factors vary relatively by parity. The study findings provide new insights into the use of different approaches to PPH prevention for nulliparous and multiparous women in clinical practice.
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Affiliation(s)
- Prince L. Bestman
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Musa Nget
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Edwina M. Kolleh
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Eva Moeng
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
| | - Tesfit Brhane
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jun qun Fang
- Department of Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410078, Hunan, China
| | - Jiayou Luo
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China
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12
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Taniguchi M, Akinaga C, Suzuki K, Tarui K, Tamura N, Shiko Y, Kawasaki Y, Nakajima Y. The effect of assisted reproductive technology on postpartum bleeding: hormonal cycle frozen embryo transfer might increase blood loss. J Anesth 2024; 38:19-28. [PMID: 37945905 DOI: 10.1007/s00540-023-03268-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Among assisted reproductive technologies, frozen thawed embryo transfer (FET) is associated with increased blood loss at delivery. Anesthesiologists need to be aware of new factors that affect postpartum blood loss. This study investigated whether FET cycles with or without hormonal support affect the amount of postpartum bleeding. METHODS We conducted a retrospective cohort study of patients admitted for delivery at a single university hospital between January 2015 and December 2018. Patients were divided into no-assisted reproductive technology (No-ART), hormonal cycle FET (HC-FET) and natural cycle FET (NC-FET) group. The primary outcome was the amount of blood loss after delivery (median [interquartile range]), which was compared among the three groups. Multiple regression analysis was performed to investigate the factors affecting blood loss. RESULTS Between 2015 and 2018, 3187 women delivered neonates. In vaginal delivery, postpartum blood loss in the HC-FET group (1060 [830] g) was significantly greater than in the NC-FET group (650 [485] g, P = 0.001) and in the No-ART group (590 [420] g P < 0.001). Multiple linear regression analysis showed that HC-FET (P < 0.001) was one of the independent factors for the amount of bleeding. In cesarean delivery, the HC-FET group had more blood loss than the No-ART group (910 [676] g vs. 784 [524] g, P = 0.039). However, HC-FET was not an independent factor for postpartum blood loss. CONCLUSIONS The HC-FET group had more blood loss than the No-ART group for both vaginal and cesarean deliveries. Furthermore, HC-FET was an independent factor that increased postpartum blood loss in vaginal deliveries.
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Affiliation(s)
- Mizuki Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Chieko Akinaga
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Kota Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Kaori Tarui
- Department of Anesthesiology, Adachi Hospital, Kyoto, Japan
| | - Naoaki Tamura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
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13
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Vuong ADB, Pham TH, Bui VH, Nguyen XT, Trinh NB, Nguyen YON, Le DKT, Nguyen PN. Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review. Int J Emerg Med 2024; 17:14. [PMID: 38287235 PMCID: PMC10823749 DOI: 10.1186/s12245-024-00587-4] [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: 06/11/2023] [Accepted: 01/12/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital. CASE PRESENTATION A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications. CONCLUSIONS The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Hoang Bui
- Integrated Planning Room, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Yen Oanh Ngoc Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Dang Khoa Tran Le
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao Ward, District 1, Ho Chi Minh City, 71012, Vietnam.
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam.
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14
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Han L, Zhang B, Xu H, Yin H, Pang Y, Zhang X, Zhai Q, Liu X, Wang Y, Zhang C, Xu Y, Liu Y, Chen X. A new step-wise surgical technique of knapsack-like uterine compression sutures for intractable postpartum hemorrhage in cesarean section. BMC Pregnancy Childbirth 2024; 24:9. [PMID: 38166803 PMCID: PMC10759382 DOI: 10.1186/s12884-023-06208-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. METHODS The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. RESULTS This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. CONCLUSIONS This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).
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Affiliation(s)
- Lei Han
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
| | - Baolin Zhang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Central Hospital, Binzhou City, 251700, Shandong Province, P. R. China
| | - Huishu Xu
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Hongmei Yin
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yiwei Pang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Xianghui Zhang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Qingliang Zhai
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Xiaofeng Liu
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yanlin Wang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Caiying Zhang
- Department of Postgraduate Student Office, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yingjiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China
| | - Yanni Liu
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
| | - Xuemei Chen
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou City, 256603, Shandong Province, P. R. China.
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Suzuki T, Sugiura T, Okazaki J, Kimura H. Postpartum hemorrhage with associated placenta previa in a kidney transplant recipient: A case report. Int J Surg Case Rep 2024; 114:109109. [PMID: 38086133 PMCID: PMC10726234 DOI: 10.1016/j.ijscr.2023.109109] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The efficacy and safety of uterine artery embolization (UAE) and prophylactic resuscitative endovascular balloon occlusion of the aorta (REBOA) against postpartum hemorrhage (PPH) in pregnant women after kidney transplantation have not been reported. Here, we describe a case of PPH associated with placenta previa in pregnancy following kidney transplantation, which was managed with UAE and prophylactic REBOA. CASE PRESENTATION A 35-year-old, gravida 2, para 1 woman with total placenta previa presented with vaginal bleeding (460 mL) at 33 weeks and 3 days of gestation. Previously, she underwent a living-donor kidney transplantation for IgA nephropathy, and the renal artery of the transplanted kidney was anastomosed with the right internal iliac artery. An emergency cesarean section with prophylactic REBOA was performed under general anesthesia. A balloon catheter was introduced via the left femoral artery and positioned above the aortic bifurcation (Aortic zone 3). Upon confirming fetal delivery, the balloon was immediately inflated, and the total aortic occlusion time was 20 min. However, following aortic balloon deflation, atonic bleeding continued despite Bakri balloon usage and uterotonic drug administration. Subsequently, UAE was performed for the refractory PPH, the left uterine artery was embolized using a gelatin sponge, and hemostasis was successfully achieved. The patient recovered uneventfully and was discharged on postoperative day 7. DISCUSSION AND CONCLUSION In pregnancies following kidney transplantation, prophylactic REBOA controls bleeding; however, it decreases blood flow to the transplanted kidney. Furthermore, uterine nutrient vasculature alterations are observed, necessitating a thorough understanding of the uterine artery supply pathways during UAE.
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Affiliation(s)
- Toshinao Suzuki
- Department of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, Japan.
| | - Takahiro Sugiura
- Department of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, Japan.
| | - Junko Okazaki
- Department of Anesthesiology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, Japan
| | - Hiroaki Kimura
- Department of Obstetrics and Gynecology, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-8535, Japan
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Qazi Q, Liaqat N, Afridi F, Khattak S. Association of high pre-pregnancy body mass index with adverse maternal and perinatal outcomes. Pak J Med Sci 2024; 40:313-317. [PMID: 38356804 PMCID: PMC10862445 DOI: 10.12669/pjms.40.3.7317] [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: 11/02/2022] [Revised: 02/17/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background & Objectives Obesity is an epidemic of the 21st century with its rates doubling in both developed and developing countries. It raises concerns for both maternal and fetal well-being and needs altered care throughout pregnancy and in postnatal period. Raised BMI prior to conception is associated with adverse feto-maternal outcomes. Limited data is available about its association with adverse maternofetal outcome in this region of the world. Our objective was to find out association of high pre-pregnancy BMI with adverse maternal and perinatal outcomes. Methods This cohort study of 390 patients was conducted in Gynae department of Lady Reading Hospital Peshawar. Study duration was from June 2021 to March 2022. Patients enrolled in third trimester of gestation (≥ 37 weeks) were divided into two groups based on BMI i.e., Group-A with BMI <25 and Group-B with BMI ≥ 25. Both groups were followed until their delivery and discharge. Results The mean age of 390 women was 28.2 ± 4.8 years. There was statistically significant association between raised pre pregnancy BMI and maternal risks like postpartum hemorrhage (p-0.0001), genital tract (p-0.0002) and perineal trauma (p-0.04). Neonatal risks significantly associated with high pre-pregnancy BMI were macrosomia (p-0.0001), and one minute APGAR score of < 8/10(p- 0.01). Both groups had no statistically significant difference for different modes of delivery i.e normal vaginal/ instrumental delivery and cesarean section (P-value 0.9). Conclusion Maternal pre-conception BMI of ≥ 25 leads to poor maternal and perinatal outcomes.
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Affiliation(s)
- Qudsia Qazi
- Dr. Qudsia Qazi, FCPS. Associate Professor, Department of Gynae, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Nazia Liaqat
- Dr. Nazia Liaqat, FCPS. Assistant Professor, Department of Gynae, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
| | - Fauzia Afridi
- Dr. Fouzia Afridi, FCPS. Assistant Professor, Department of Gynae, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Saima Khattak
- Dr Saima Khattak, FCPS. Assistant Professor, Department of Gynae, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Arya P, Yadav G, Singh P, Ghuman NK, Sharma C, Gothwal M, Kathuria P. Tranexamic Acid, a Trivial in Preventing Postpartum Blood Loss in Vaginal Delivery- a Double Blinded, Randomized Controlled Trial. Am J Obstet Gynecol 2023:S0002-9378(23)02192-0. [PMID: 38151222 DOI: 10.1016/j.ajog.2023.12.033] [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: 09/06/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To assess the effect of intravenous tranexamic acid (1 g) in reducing blood loss during the 3rd and 4th stages of labor following vaginal delivery, in addition to active management of the third stage of labor. METHODS This double-blinded randomized controlled trial included 650 women with singleton pregnancies of ≥ 34 weeks gestation undergoing vaginal delivery. Eligible women were randomly assigned to receive 1 g of tranexamic acid or placebo intravenously in addition to active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the 3rd and 4th stages of labor. RESULTS Out of 886 expectant women who were approached, 650 instances that met the study's inclusion criteria were enrolled and a total of 320 women in group A and 321 in group B were analyzed. Maternal characteristics did not differ between the two groups. Mean blood loss did not differ significantly among the intervention and placebo groups (378.5±261.2 ml vs. 383±258.9 ml; p = 0.93). The incidence of primary postpartum hemorrhage was comparable in both groups (Group A: 15.9%, Group B: 15.3%, p = 0.814). The median fall in haemoglobin within 12-24 hours following delivery in both groups was comparable (group A: 0.60 g% with interquartile range (IQR) 0.4-0.9 g %; group B: 0.6 g% with IQR 0.4-0.8 g %; p = 0.95). The most common adverse effect reported was dizziness. No thromboembolic events were reported at the follow-up of three months in both groups. CONCLUSION Prophylactic use of tranexamic acid in addition to active management of the third stage of labor does not help further reduce postpartum blood loss following vaginal delivery.
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Affiliation(s)
- Pratibha Arya
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
| | - Garima Yadav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005.
| | - Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
| | - Navdeep Kaur Ghuman
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
| | - Charu Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
| | - Meenakshi Gothwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
| | - Priyanka Kathuria
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni, Jodhpur, India, 342005
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Thijssen KMJ, van den Broek MJM, Koenraads FA, Cantineau-Goedegebuure JI, Papatsonis DNM, van Willigen BG, Dieleman JP, van der Hout-van der Jagt MB, Westerhuis MEMH, Oei SG. Detection of postpartum uterine activity with electrohysterography. Eur J Obstet Gynecol Reprod Biol 2023; 291:23-28. [PMID: 37806028 DOI: 10.1016/j.ejogrb.2023.10.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Uterine contractions are essential for childbirth, but also for expulsion of the placenta and for limiting postpartum blood loss. Postpartum hemorrhage is associated with almost 25% of the maternal deaths worldwide and the leading cause of maternal death in most low-income countries. Little is known about the physiology of the uterus postpartum, particularly due to the lack of an accurate measurement tool. The primary objective of this pilot study is to explore the potential of using electrohysterography to detect postpartum uterine contractions. If postpartum uterine activity can be objectified, this could contribute to understanding the physiology of the uterus and improve diagnosis and treatment of postpartum hemorrhage. STUDY DESIGN In this observational study we included women aiming for a vaginal birth in two large maternity clinics in the Netherlands, Amphia Hospital Breda (group A, N2018-0161) and Máxima Medical Center Veldhoven (group B, N17.149). An electrode patch was placed on the maternal abdomen to record real-time electrical uterine activity until one hour postpartum continuously. In group A, the placement of the patch was lower than in group B. For analysis, tracings were divided into five different phases (1: dilatation until start pushing, 2: from start pushing until childbirth, 3: from childbirth until placental expulsion, 4: first hour after placental expulsion and 5: after one hour postpartum). Readability, signal quality and contraction frequency per hour were assessed. Additionally, patient satisfaction was evaluated through a survey. RESULTS In total 91 pregnant women were included of whom 45 in group A and 46 women in group B. Complete registrations were obtained throughout the five labor phases with very little artefacts or signal loss. The readability of the tracings decreased after childbirth. A significantly better readability was found in tracings where the patch placement was lower on the abdomen for phases 4 and 5. Contraction frequency was highest during phase 2 and decreased towards phase 5. Women rated the satisfaction with electrohysterography as high and mostly did not notice the patch. CONCLUSION It is possible to detect uterine activity postpartum with electrohysterography. Further investigation is recommended to improve diagnosis and treatment of postpartum hemorrhage.
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Affiliation(s)
- Kirsten M J Thijssen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; University MC Utrecht, P.O Box 85500, 3508 GA, Utrecht, the Netherlands.
| | - Michelle J M van den Broek
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands
| | - Feikje A Koenraads
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | | | - Dimitri N M Papatsonis
- Amphia Hospital, Department of Obstetrics and Gynecology, P.O. Box 90158, 4800 RK Breda, the Netherlands
| | - Bettine G van Willigen
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
| | - Jeanne P Dieleman
- MMC Academy, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, the Netherlands
| | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands; Faculty of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands
| | - Michelle E M H Westerhuis
- Department of Obstetrics and Gynecology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, the Netherlands
| | - S Guid Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, P.O. Box 7777, 5500 MB Veldhoven, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, the Netherlands; Eindhoven MedTech Innovation Center (e/MTIC), P.O. Box 513, 5612 AX Eindhoven, the Netherlands
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Abu-Zaid A, Baradwan S, Albouq B, Ghazi A, Khadawardi K, Bukhari IA, Alyousef A, Abdulmalik NA, Alblewi H, Alsehaimi SO, Albadawi MI, Abuzaid M, Alomar O, Salem H. Tranexamic acid versus misoprostol for management of postpartum hemorrhage: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2023; 291:61-69. [PMID: 37832480 DOI: 10.1016/j.ejogrb.2023.10.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
AIM To conduct the first-ever systematic review and meta-analysis of randomized controlled trials (RCTs) on the antihemorrhagic utility and safety of tranexamic acid (TXA) versus misoprostol for management (prevention and/or treatment) of postpartum hemorrhage (PPH). METHODS Six databases were screened from inception until May 2023 and updated in September 2023. The RCTs were assessed for quality according to the Cochrane's risk of bias tool. The endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. RESULTS Ten RCTs with 2121 patients (TXA = 1061 and misoprostol = 1060) were analyzed. There was no significant difference between TXA and misoprostol groups regarding the mean intraoperative blood loss (n = 9 RCTs, MD = 17.32 ml, 95% CI [-40.43, 75.07], p = 0.56), mean change in hemoglobin (n = 6 RCTs, MD = 0.11 mg/dl, 95% CI [-0.1, 0.31], p = 0.30), mean hospital stay (n = 2 RCTs, MD = -0.3 day, 95% CI [-0.61, 0.01], p = 0.06), blood transfusion rate (n = 4 RCTs, RR = 0.49, 95% CI [0.16, 1.47], p = 0.2), and rate of additional uterotonic agents (n = 4 RCTs, RR = 1.05, 95% CI [0.72, 1.53], p = 0.81). Leave-one-out sensitivity analysis showed robustness of the results, and there was no evidence of publication bias. Regarding safety endpoints, there was no significant difference between both groups regarding the rates of minor side effects, such as diarrhea, fever, nausea, and vomiting. No patient developed thromboembolic events in the TXA group. CONCLUSION There was no significant antihemorrhagic efficacy between adjunct TXA and misoprostol for the management of PPH. The safety profile was comparable between both agents.
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Affiliation(s)
- Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Bayan Albouq
- Department of Obstetrics and Gynecology, Prince Mohammed Bin Abdulaziz National Guard Hospital, Madinah, Saudi Arabia
| | - Ahmed Ghazi
- Department of Obstetrics and Gynecology, College of Medicine, Jeddah University, Jeddah, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Department of Obstetrics and Gynecology, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdullah Alyousef
- Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Nadia Ahmed Abdulmalik
- Department of Obstetrics and Gynecology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Hedaya Alblewi
- Department of Obstetrics and Gynecology, National Guard Hospital, Riyadh, Saudi Arabia
| | - Saud Owaimer Alsehaimi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, Muhayil General Hospital, Muhayil, Saudi Arabia
| | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hany Salem
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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HadaviBavili P, Tizro G. Glove Balloon in Postpartum Hemorrhage: A Case Report. J Obstet Gynaecol India 2023; 73:531-533. [PMID: 38205115 PMCID: PMC10774465 DOI: 10.1007/s13224-023-01755-x] [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: 11/19/2022] [Accepted: 03/23/2023] [Indexed: 01/12/2024] Open
Abstract
Postpartum hemorrhage is a long-running and frequent cause of maternal death in most developing countries and is associated with uterine atony. Nowadays, balloon tamponade has gained popularity due to its advantages. It is a technically simple, safely applied, time saver, and easily removed in a low-risk method and also needs less expertise and no special equipment. Despite all advantages, the Bakri balloon is very expensive in less developed countries and not available everywhere, especially in limited resource settings. Such disadvantages prompted us to perform an innovative, cost-effective, and practical method relying on low-resource equipment and named it "Glove Balloon." A 26-year-old woman presented in her third pregnancy underwent an elective cesarean section. Following the surgeon's mention of low segment atony, the patient returned to the operating room quickly. The bleeding continued despite the administration of uterotonic drugs, and because of active bleeding, the decision was made to apply a glove balloon. After gently inserting the glove balloon into the uterus, 500 ccs of saline was inflated into the balloon, and the bleeding stopped shortly afterward. The patient was discharged on the third postoperative day and remained well after. We believe that junior obstetricians and midwives should consider all options, even new strategies, to stop hemorrhages before considering invasive surgical procedures. The "Glove Balloon" is an innovative, practical uterine tamponade balloon that can make the difference between life and death in treating postpartum hemorrhage cases and should be considered a life-saver tool in all settings.
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Affiliation(s)
- Parisa HadaviBavili
- Faculty of Health Sciences, Department of Midwifery, Esentepe Campus, Sakarya University, 54100 Serdivan, Sakarya, Türkiye
- Department of Midwifery, Institute of Health Science, Sakarya University, Sakarya, Türkiye
| | - Gholamreza Tizro
- Department of Obstetrics and Gynecology, Obstetrician and Gynecologist, Faculty of Medical Science, Urmia University, Orjhans Street, Resalat Blvd, Urmia, 571478334 Iran
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22
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Akay A, Akdaş Reis Y, Çelik S, Fıratlıgil FB, Engin Üstün Y. Peripartum Hysterectomy Outcomes: Our Eleven-Year Experience at a Tertiary Care Hospital. J Obstet Gynaecol India 2023; 73:185-190. [PMID: 38143966 PMCID: PMC10746615 DOI: 10.1007/s13224-023-01818-z] [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: 04/15/2023] [Accepted: 07/24/2023] [Indexed: 12/26/2023] Open
Abstract
Aim To investigate the outcomes of peripartum hysterectomies (PHs) conducted to prevent maternal morbidity and mortality at a tertiary care hospital with 15,000 deliveries per year. Method Patients who underwent PHs during delivery and/or within 24 h of delivery between the years 2011-2022 were retrospectively evaluated. Hysterectomies not performed in the peripartum period, cases that were managed by methods such as balloon tamponade, compression suture, or arterial ligation rather than hysterectomy, and hysterectomies performed before 20 weeks were excluded. Obstetric and demographic characteristics of the cases, as well as indications and outcomes of PH, were investigated. Results Among the 130 patients who underwent PH, 4 (3.04%) patients delivered vaginally, 1 (0.7%) patient delivered vaginally after cesarean section, 12 (9.2%) patients delivered by primary cesarean section, and 113 (86.9%) patients delivered by secondary cesarean section. Placenta accreta spectrum disorder was the reason for PH in 54.6% (n = 71) of the cases while 16.1% (n = 21) underwent PH due to uterine atony. The PH rate was 0.75 per 1000 births, and the maternal mortality rate was 7.6 per 1000 hysterectomies in this study. Conclusion Obstetricians in developed/ing countries support the active management of the third stage of labor mainly to mitigate the preventable risk factors of post-/peri-partum hemorrhage. The current study suggests that obstetricians need to focus on the placenta in order to reduce PH.
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Affiliation(s)
- Arife Akay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
- Department of Obstetrics and Gynecology, Bingöl Maternety and Children Hospital, Bingöl, Türkiye
| | - Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Susam Çelik
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
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Köroğlu N, Tayyar A, Soydar A, Albayrak N, Aydın T, Çetin BA. Pre-delivery fibrinogen level is a predictor for severity of placental abruption. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100264. [PMID: 38058588 PMCID: PMC10696460 DOI: 10.1016/j.eurox.2023.100264] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/05/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Abstract
Objective To determine pre-delivery fibrinogen levels in predicting adverse maternal or neonatal outcomes in patients with placental abruption. Materials and method We conducted a retrospective study of all women admitted for placental abruption between January 2012 and May 2018. Postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC), massive blood transfusion and hospitalization in intensive care unit parameters were evaluated for maternal outcomes. For the neonatal outcomes, the 5th minute APGAR score, umbilical artery pH and stillbirth were evaluated. Results The mean predelivery fibrinogen levels were 221.3 ± 111.6 mg/dL. In multivariate logistic regression analysis, fibrinogen level was determined as an independent indicator for PPH, red cell concentrate (RCC) and fresh frozen plasma (FFP) transfusion. When fibrinogen levels decreased below 130 mg/dL, the risk of PPH increased and when fibrinogen levels decreased below 100 mg/dL, the risk of overt DİC and also the risk of red cell concentrate and fresh frozen plasma transfusion increased. In terms of the fetal results, there may be adverse neonatal outcomes when fibrinogen levels are below 250 mg/dL. Conclusion Predelivery fibrinogen levels are good indicators for predicting adverse maternal outcomes in placental abruption cases. In addition, fibrinogen levels might be a guide for management of placental abruption cases.
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Affiliation(s)
- Nadiye Köroğlu
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ahmet Tayyar
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ali Soydar
- Akhisar Mustafa Kirazoğlu State Hospital, Department of Obstetrics and Gynecology, Manisa, Turkey
| | - Nazli Albayrak
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Turgut Aydın
- Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Berna Aslan Çetin
- Başakşehir Çam ve Sakura City Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Sheth V, Vaishnav S, Sapre S, Bhattacharjee R, Raithatha N, Asrani M. Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India. J Obstet Gynaecol India 2023; 73:206-212. [PMID: 38143980 PMCID: PMC10746675 DOI: 10.1007/s13224-023-01842-z] [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: 10/11/2022] [Accepted: 08/19/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Design Retrospective observational and comparative study from single rural tertiary care referral center of western India. Method A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Results Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Conclusion Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.
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Affiliation(s)
- Vishal Sheth
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Smruti Vaishnav
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Shilpa Sapre
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Rumi Bhattacharjee
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Nitin Raithatha
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
| | - Manisha Asrani
- Department of Obstetrics and Gynecology, Shree Krishna Hospital and Pramukh Swami Medical College, Anand-Sojitra Road, Karamsad, Anand, Gujarat PIN: 388325 India
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Al-Dardery NM, Abdelwahab OA, Abouzid M, Albakri K, Elkhadragy A, Katamesh BE, Hamamreh R, Mohd AB, Abdelaziz A, Khaity A. Efficacy and safety of tranexamic acid in prevention of postpartum hemorrhage: a systematic review and meta-analysis of 18,649 patients. BMC Pregnancy Childbirth 2023; 23:817. [PMID: 38001439 PMCID: PMC10668444 DOI: 10.1186/s12884-023-06100-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/17/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In this meta-analysis, we aimed to update the clinical evidence regarding the efficacy and safety of TXA in the prevention of PPH. METHODS A literature search of PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library from inception until December 2022 was conducted. We included randomized controlled trials (RCTs) comparing TXA with a placebo among pregnant women. All relevant outcomes, such as total blood loss, the occurrence of nausea and/or vomiting, and changes in hemoglobin, were combined as odds ratios (OR) or mean differences (MD) in the meta-analysis models using STATA 17 MP. RESULTS We included 59 RCTs (18,649 patients) in this meta-analysis. For cesarean birth, TXA was favored over the placebo in reducing total blood loss (MD= -2.11 mL, 95%CI [-3.09 to -1.14], P < 0.001), and occurrence of nausea or/and vomiting (OR = 1.36, 95%CI [1.07 to 1.74], P = 0.01). For vaginal birth, the prophylactic use of TXA was associated with lower total blood loss, and higher occurrence of nausea and/or vomiting (MD= -0.89 mL, 95%CI [-1.47 to -0.31], OR = 2.36, 95%CI [1.32 to 4.21], P = 0.02), respectively. However, there were no differences between the groups in changes in hemoglobin during vaginal birth (MD = 0.20 g/dl, 95%CI [-0.07 to 0.48], P = 0.15). The overall risk of bias among the included studies varies from low to high risk of bias using ROB-II tool for RCTs. CONCLUSIONS This meta-analysis suggested that TXA administration is effective among women undergoing cesarean birth or vaginal birth in lowering total blood loss and limiting the occurrence of PPH. Further clinical trials are recommended to test its efficacy on high-risk populations.
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Affiliation(s)
- Nada Mostafa Al-Dardery
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
| | - Omar Ahmed Abdelwahab
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
| | - Khaled Albakri
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ali Elkhadragy
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Rawan Hamamreh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ahmed B Mohd
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdulrhman Khaity
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Elrazi University, Khartoum, 11115, Sudan.
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Ma G, Yang Y, Fu Q. The incidence, indications, risk factors and pregnancy outcomes of peripartum hysterectomy at a tertiary hospital between 2013 and 2022. Arch Gynecol Obstet 2023:10.1007/s00404-023-07276-2. [PMID: 37966518 DOI: 10.1007/s00404-023-07276-2] [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: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH). METHODS We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH. RESULTS The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05). CONCLUSION The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.
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Affiliation(s)
- Guojun Ma
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
| | - Yi Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China
| | - Qin Fu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 20030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 20030, China.
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Umeda S, Abe T, Obata S, Aoki S, Takeuchi I. Effectiveness of call system implementation for postpartum hemorrhage in a tertiary emergency medical center: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:787. [PMID: 37951860 PMCID: PMC10638699 DOI: 10.1186/s12884-023-06095-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage is the leading cause of maternal death and severe maternal morbidity worldwide. Previous studies have reported the importance of multidisciplinary treatment approaches for postpartum hemorrhage; however, only a few studies have shown a clear improvement in maternal outcomes. Therefore, this study aimed to investigate the efficacy of a call system for postpartum hemorrhage in a tertiary emergency facility for rapid multidisciplinary treatment and its effect on maternal outcomes. METHODS This single-center retrospective cohort study included patients transferred to our hospital due to postpartum hemorrhage between April 1, 2013, and March 31, 2019. The primary outcome was mortality, and the secondary outcomes were morbidity (duration of hospital stay, duration of intensive care unit stay, admission to the intensive care unit, respirator use, duration of ventilator support, acute kidney injury, transfusion-associated circulatory overload/transfusion-related acute lung injury, hysterectomy, composite adverse events, blood transfusion initiation time, blood transfusion volume, and treatment for postpartum hemorrhage). An in-hospital call system implementation commenced on April 1, 2016. The study outcomes were compared 3 years before and after implementing the call system. RESULTS The blood transfusion initiation time and duration of hospital stay were significantly shortened after implementing the call system for postpartum hemorrhage. No maternal deaths were observed after implementing the system. CONCLUSIONS Implementing call systems specialized for postpartum hemorrhage in tertiary emergency facilities may improve maternal outcomes.
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Affiliation(s)
- Sayo Umeda
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan.
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Mraihi F, Basly J, Mezni A, Ghali Z, Hafsi M, Chelli D. Secondary postpartum hemorrhage due to uterine scar dehiscence, a case report. Int J Surg Case Rep 2023; 112:108883. [PMID: 37883876 PMCID: PMC10667773 DOI: 10.1016/j.ijscr.2023.108883] [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: 09/05/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Secondary postpartum hemorrhage is rare. The most common cause is retained placenta. Having a uterine scar dehiscence as an etiology is unusual. Complete dehiscence of the uterine scar is even rarer. This rare but serious cause of post-partum haemorrhage can be potentially life threatening due to severe hemorrhage if not managed in adequate time. PRESENTATION OF CASE We present the case of a 35-year-old patient, gravida 2 para 2. She had undergone two caesarean sections in our department and, after the last one in March 2021, she presented twice to our emergency department with relatively abundant metrorrhagia, but neither the clinical nor the radiological examinations revealed any abnormalities. At 43 days postpartum, she presented to the emergency with severe bleeding per vaginum. The bleeding was profuse, causing hemodynamic instability and severe acute anaemia. An explorative laparotomy was necessary to diagnose the etiology and manage the treatment. Surgical exploration revealed a lateral uterine rupture in the broad ligament and complete dislocation of the caesarean scar. An urgent hysterectomy was performed. DISCUSSION Partial or complete dehiscence of the hysterorrhoea is a rare cause of secondary postpartum hemorrhage after caesarean section. When hysterorrhaphy dehiscence does occur, the origin of the bleeding is likely to be related to erosion of the vessels at the incision angles. CONCLUSION The diagnosis of partial or complete dehiscence of the uterine scar may be misleading in the absence of specific clinical or radiological signs. This condition must therefore be considered and suspected in cases of secondary postpartum hemorrhage.
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Affiliation(s)
- Fathi Mraihi
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia.
| | - Jihene Basly
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Amani Mezni
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Zeineb Ghali
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Montasar Hafsi
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Dalenda Chelli
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
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Sebri H, Halouani A, Masmoudi Y, Aloui H, Triki A, Amor AB. Sepsis-associated encephalopathy and uterine necrosis revealing HIV infection after artery ligation and uterine compression sutures: Case report. Int J Surg Case Rep 2023; 112:108909. [PMID: 37862771 PMCID: PMC10667784 DOI: 10.1016/j.ijscr.2023.108909] [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: 08/02/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Infection with the human immunodeficiency virus (HIV) targets immune cells and exposes infected patients to several diseases. For these reasons, HIV infection should be suspected in each situation where post-operative sepsis occurs, to afford therapy and improve the patient's prognosis. CASE PRESENTATION We present a case of a pregnant woman at 39 weeks of gestation who missed her prenatal follow-up. She underwent an emergency caesarian section for severe abnormality in the fetal heart rate. The caesarian section was complicated by a post-partum hemorrhage (PPH). PPH was managed with uterine artery ligation and B-Lynch modified sutures. CLINICAL DISCUSSION Postoperatively, there was the succession of the following events: purulent uterine necrosis, peritonitis, and encephalitis leading to a life-saving hysterectomy. Due to the worsening of the septic condition, HIV screening was performed, after obtaining the patient's consent, and came back positive. CONCLUSION The aim of this case report is to push practicians to think about HIV infection when necessary because missing the diagnosis can seriously threaten patients' health.
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Affiliation(s)
- Hajer Sebri
- Department of obstetrics and gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia.
| | - Ahmed Halouani
- Department of obstetrics and gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia
| | - Yassine Masmoudi
- Department of obstetrics and gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia
| | - Haithem Aloui
- Department of Obstetrics and Gynecology 'C', Maternity and Neonatology Center of Tunisia, Tunis, Tunisia
| | - Amel Triki
- Department of obstetrics and gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia
| | - Anissa Ben Amor
- Department of obstetrics and gynecology, University Hospital Mongi Slim La Marsa, Tunis, Tunisia
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Song KH, Choi ES, Kim HY, Ahn KH, Kim HJ. Patient blood management to minimize transfusions during the postpartum period. Obstet Gynecol Sci 2023; 66:484-497. [PMID: 37551109 PMCID: PMC10663398 DOI: 10.5468/ogs.22288] [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: 10/30/2022] [Revised: 01/11/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Patient blood management is an evidence-based concept that seeks to minimize blood loss by maintaining adequate hemoglobin levels and optimizing hemostasis during surgery. Since the coronavirus disease 2019 pandemic, patient blood management has gained significance due to fewer blood donations and reduced amounts of blood stored for transfusion. Recently, the prevalence of postpartum hemorrhage (PPH), as well as the frequency of PPH-associated transfusions, has steadily increased. Therefore, proper blood transfusion is required to minimize PPH-associated complications while saving the patient's life. Several guidelines have attempted to apply this concept to minimize anemia during pregnancy and bleeding during delivery, prevent bleeding after delivery, and optimize recovery methods from anemia. This study systematically reviewed various guidelines to determine blood loss management in pregnant women.
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Affiliation(s)
- Kwan Heup Song
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Eun Saem Choi
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Hai Joong Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
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31
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Seo GH, Kim JY, Lee DY, Lee C, Lee J. Risk factors for severe postpartum hemorrhage requiring blood transfusion after cesarean delivery for twin pregnancy: a nationwide cohort study. Anesth Pain Med (Seoul) 2023; 18:367-375. [PMID: 37559229 PMCID: PMC10635857 DOI: 10.17085/apm.23019] [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: 02/20/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Twin pregnancy and cesarean delivery are well-known risk factors for PPH. However, few studies have investigated PPH risk factors in mothers who have undergone cesarean delivery for twin pregnancies. Therefore, this study investigated the risk factors associated with severe PPH after cesarean delivery for twin pregnancies. METHODS We searched and reviewed the Korean Health Insurance Review and Assessment Service's claims data from July 2008 to June 2021 using the code corresponding to cesarean delivery for twin pregnancy. Severe PPH was defined as hemorrhage requiring red blood cell (RBC) transfusion during the peripartum period. The risk factors associated with severe PPH were identified among the procedure and diagnosis code variables and analyzed using univariate and multivariate logistic regressions. RESULTS We analyzed 31,074 cesarean deliveries for twin pregnancies, and 4,892 patients who underwent cesarean deliveries for twin pregnancies and received RBC transfusions for severe PPH were included. According to the multivariate analysis, placental disorders (odds ratio, 4.50; 95% confidence interval, 4.09- 4.95; P < 0.001), general anesthesia (2.33, 2.18-2.49; P < 0.001), preeclampsia (2.20, 1.99-2.43; P < 0.001), hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome (2.12, 1.22-3.68; P = 0.008), induction failure (1.37, 1.07-1.76; P = 0.014), and hypertension (1.31, 1.18-1.44; P < 0.001) predicted severe PPH. CONCLUSIONS Placental disorders, hypertensive disorders such as preeclampsia and HELLP syndrome, and induction failure increased the risk of severe PPH after cesarean delivery for twin pregnancy.
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Affiliation(s)
- Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Da Yeong Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Changjin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jiyoung Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Aizawa M, Ishihara S, Yokoyama T. Singleton pregnancy using in vitro fertilization or intracytoplasmic sperm injection does not increase risk of bleeding in cesarean delivery: a retrospective cohort study. J Anesth 2023; 37:769-774. [PMID: 37612435 DOI: 10.1007/s00540-023-03234-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/22/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Several studies indicate that assisted reproductive technology (ART) including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies carries increased risk of complications including postpartum hemorrhage (PPH). However, the association between IVF/ICSI and the bleeding risk particularly in cesarean delivery has not been systematically assessed. The aim of this study was to evaluate bleeding risk during and after cesarean delivery in parturients who conceived using IVF or ICSI. METHODS This is a retrospective observational study analyzing data from 310 parturients who underwent cesarean delivery: 155 who had conceived using IVF or ICSI (IVF/ICSI group) and 155 age and year of delivery matched controls who had conceived spontaneously (control group). The primary outcome measure was the amount of blood lost during and within 24 h after cesarean delivery. Secondary outcome measure was the incidence of severe PPH. With 132 parturients in each group, we had 90% power to detect a 200 mL difference in the bleeding amount, at a 0.05 two-sided significance level. RESULTS The amount of bleeding in the IVF/ICSI group was 1234 ± 669 mL, which was 124 mL (11.2%) greater than that in the control group (95% CI - 34 to 282; p = 0.12). The incidence of severe PPH in the IVF/ICSI group and in the control group was 23.9% and 16.8%, respectively (p = 0.16), and the unadjusted odds ratio was 1.6 (95% CI, 0.9-2.7; p = 0.12). No significant independent effect of IVF/ICSI on the bleeding amount and the incidence of severe PPH was observed in multivariable regression analyses (p = 0.22, p = 0.16). CONCLUSION In this study, IVF and ICSI were not associated with increasing risk of bleeding in cesarean delivery.
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Affiliation(s)
- Mariko Aizawa
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan.
| | - Satoshi Ishihara
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan
| | - Takeshi Yokoyama
- Department of Anesthesia, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine, Sapporo, 006-8555, Japan
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Ishida Y, Homma Y, Murakoshi T, Toba Y. Clinical experience of the use of fibrinogen concentrate for massive postpartum hemorrhage: a retrospective case series study. J Anesth 2023; 37:820-822. [PMID: 37620626 PMCID: PMC10543518 DOI: 10.1007/s00540-023-03247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Yoshiaki Ishida
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, Naka Ku, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan.
- Department of Critical Care Medicine, Tokyo Metropolitan Bokutoh Hospital, Sumida-Ku, Tokyo, Japan.
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takeshi Murakoshi
- Department of Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshie Toba
- Department of Anesthesiology, Seirei Hamamatsu General Hospital, Naka Ku, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
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Haury J, Seco A, Goffinet F, Lepercq J. Risk of disseminated intravascular coagulation in postpartum hemorrhage associated with intrauterine infection. J Gynecol Obstet Hum Reprod 2023; 52:102626. [PMID: 37354968 DOI: 10.1016/j.jogoh.2023.102626] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To evaluate the risk of disseminated intravascular coagulation (DIC) in postpartum hemorrhage (PPH) associated with intrauterine infection. MATERIAL AND METHODS A retrospective cohort study of pregnancies complicated by PPH performed at a tertiary academic center in France from 2017 through 2021. Patients giving birth after 22 weeks of gestation with PPH were eligible. Patients with a PPH associated with an intrauterine infection were compared to patients with a PPH without intrauterine infection. Intrauterine infection was defined by a composite criterion available at delivery. DIC was defined by a specific pregnancy DIC score. The association between DIC and intrauterine infection was assessed by logistic regression. The causal effect of intrauterine infection on DIC was estimated by mediation analysis. RESULTS Of 2,093 patients with PPH, 49 exposed to a clinical intrauterine infection were compared to 49 unexposed patients. The rate of DIC was higher in patients with than without infection (22 (45.8%) vs. 7 (14.6%), P = .001), and coagulation anomalies occurred sooner in patients with than without infection (7, 2-11 h vs. 14, 9-19 h, P < .001). In the multivariate analysis, intrauterine infection was the only factor independently associated with DIC (adjusted odds ratio 5.01, 95% CI 1.83-13.73). Mediation analysis showed that 14% (95% CI, 0-50%) of this association between intrauterine infection and DIC was mediated by severe PPH, and 86% resulted from the direct effect of intrauterine infection on DIC. CONCLUSION In PPH, intrauterine infection had a major direct effect on the occurrence, timing, and severity of DIC.
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Affiliation(s)
- Julie Haury
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France. Paris Cité University, Paris, France
| | - Aurelien Seco
- Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Center for Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - François Goffinet
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France. Paris Cité University, Paris, France; Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Center for Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Jacques Lepercq
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France. Paris Cité University, Paris, France.
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Cetin C, Tanoglu FB, Hanligil E, Gokce A, Pasin O, Ozcan P. Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial. Gynecol Obstet Invest 2023; 88:366-374. [PMID: 37778349 DOI: 10.1159/000534375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid. DESIGN A multicentric randomized controlled trial. PARTICIPANTS/MATERIALS, SETTING, AND METHODS This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75). RESULTS The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6). LIMITATIONS The most important limitation of the study is a relatively small number of participants. CONCLUSION In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.
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Affiliation(s)
- Caglar Cetin
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Fatma Basak Tanoglu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Erhan Hanligil
- Department of Obstetrics and Gynecology, Van Research and Training Hospital, Van, Turkey
| | - Ali Gokce
- Department of Obstetrics and Gynecology, Ankara University Medical School, Ankara, Turkey
| | - Ozge Pasin
- Faculty of Medicine, Department of Basic Medical Sciences, Department of Biostatistics and Medical Informatics, Bezmialem Vakif University, Istanbul, Turkey
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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Kadirogullari P, Aslan Cetin B, Goksu M, Cetin Arslan H, Seckin KD. The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage. Arch Gynecol Obstet 2023:10.1007/s00404-023-07211-5. [PMID: 37698604 DOI: 10.1007/s00404-023-07211-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of uterine massage performed before placental delivery on the third stage of labor and postpartum hemorrhage after vaginal delivery. MATERIALS AND METHODS The study was designed as a prospective randomized controlled study. Between June 2018 and June 2019, 242 women who gave birth in Istanbul Kanuni Sultan Suleyman Training and Research Hospital were included in the study. The women were divided into two groups; group 1 received uterine massage after vaginal delivery before placental delivery (n: 128) and group 2 did not receive massage (n: 114). Demographic characteristics, delivery times of the baby and placenta, duration of uterine massage, amount of postpartum hemorrhage and postpartum hemoglobin values of both groups were recorded. RESULTS Baseline characteristics were similar in both groups. Placental output time after delivery was 8.3 ± 4.2 min in group 1 and 13.5 ± 6.3 min in group 2. The third stage of labor was significantly shorter in group 1 (p = 0.012). The amount of blood loss of 500 mL or more after delivery was higher in group 2 but not statistically different (p > 0.05). Hemoglobin value measured within 12-24 h after delivery was significantly lower in group 2 (hemoglobin < 8 g/dL after 12-24 h p = 0.003; hemoglobin < 10 g/dL after 12-24 h p = 0.001). Delta hb value was also significantly lower in group 2 (p = 0.03). With this result, it was determined that bleeding intense enough to require transfusion was more common in group 2. CONCLUSION In patients delivering vaginally, uterine massage before placental delivery shortens the placental delivery time and reduces postpartum hemorrhage. In addition to oxytocin and controlled cord traction to reduce postpartum blood loss, uterine massage should be routinely used in the active management of the third stage of labor. CLINICAL TRIALS NUMBER NCT03858569.
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Affiliation(s)
- Pinar Kadirogullari
- Department of Obstetrics and Gynecology, Acıbadem University Atakent Hospital, Istanbul, Turkey.
| | - Berna Aslan Cetin
- Department of Obstetrics and Gynecology, Health Sciences University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Goksu
- Department of Obstetrics and Gynecology, Health Sciences University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Hale Cetin Arslan
- Department of Obstetrics and Gynecology, Health Sciences University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Kerem Doga Seckin
- Department of Obstetrics and Gynecology, Istinye University Liv Hospital Vadi Istanbul, Istanbul, Turkey
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Qi S, Fu X. Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study. BMC Pregnancy Childbirth 2023; 23:644. [PMID: 37679691 PMCID: PMC10486133 DOI: 10.1186/s12884-023-05933-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies. METHODS All patients who gave birth at Ningbo Women and Children's Hospital from January 2018 to August 2022 were recruited. Patients were randomly allocated to a training cohort (n[Formula: see text]1395) validation cohort (n[Formula: see text]650) at a 7:3 ratio. In the training cohort, LASSO regression for screening variables and multifactorial logistic regression analysis were performed to identify independent risk factors for postpartum hemorrhage in twin pregnancies. A nomogram was established based on the results of multiple logistic regression analysis. Nomogram performance was quantified using the receiver operating characteristic curve, Hosmer- Lemeshow test and decision curve analysis. RESULTS A total of 2045 patients were included in this study. Multifactorial Logistic regression analysis showed maternal age, assisted reproduction, platelet count, fibrinogen level, albumin level, hypertensive disorders of pregnancy, placenta praevia, number of previous cesarean deliveries, number of previous intrauterine manipulation, and neonatal weight were independent risk factors for postpartum hemorrhage in twin births. The area under curve (AUC) for the training cohort was 0.810 [95[Formula: see text] CI (0.781, 0.839)], with a sensitivity of 76.5[Formula: see text], specificity of 71.0[Formula: see text], and positive and negative predictive values of 0.358 and 0.935, respectively, while the AUC for the validation cohort was 0.821 [95[Formula: see text] CI (0.781, 0.860)], with a sensitivity of 80.9[Formula: see text], specificity of 69.49[Formula: see text], and positive predictive value and negative predictive value of 0.426 and 0.929, respectively. CONCLUSION The predictive model can effectively and quantitatively assess the risk of postpartum hemorrhage in twin pregnancies and help clinicians to take personalized preventive measures.
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Affiliation(s)
- Sangsang Qi
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, No. 339 Liuting Street, Haishu District, 315012, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
| | - Xianhu Fu
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, No. 339 Liuting Street, Haishu District, 315012, Ningbo, China.
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Shahrrava N, Lerner J, Patel N, Sandman Z, Cuevas J, Moretti M, Bahl S. Prophylactic uterine artery embolization in first-trimester cervical pregnancy termination with placenta accreta: A case report. Case Rep Womens Health 2023; 39:e00554. [PMID: 37868259 PMCID: PMC10585350 DOI: 10.1016/j.crwh.2023.e00554] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
The current standard treatment for placenta accreta is a hysterectomy, which carries a significant risk of hemorrhage. Although prophylactic uterine artery embolization (UAE) is established as an effective means of minimizing perioperative bleeding, there are few reports of its use early in pregnancy with invasive placenta. A 45-year-old woman, gravida 6, para 1, at 11 weeks of gestation presented with heavy, painless uterine bleeding and was diagnosed with a spontaneous abortion complicated by cervical pregnancy and placenta accreta. The patient underwent bilateral UAE followed by gravid hysterectomy. This case report encourages prophylactic UAE prior to abdominal hysterectomy in patients with early gestational cervical pregnancy and placenta accreta to minimize blood loss during surgery.
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Affiliation(s)
- Niki Shahrrava
- St. George's University School of Medicine, St. George's, Grenada, West Indies
| | - Jade Lerner
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, United States
| | - Neil Patel
- The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States
| | - Zachary Sandman
- The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States
| | - Juana Cuevas
- The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States
| | - Michael Moretti
- The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States
| | - Sumeet Bahl
- The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY 11201, United States
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Niknami M, Farash M, Rahnavardi M, Maroufizadeh S, Darkhaneh RF. The effect of date fruit consumption on early postpartum hemorrhage: a randomized clinical trial. BMC Womens Health 2023; 23:441. [PMID: 37612639 PMCID: PMC10463832 DOI: 10.1186/s12905-023-02604-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage, anemia, and iron deficiency are important health problems. Using safe, cheap, and available methods to reduce the amount of hemorrhage after childbirth can be effective for the mother's health during this period. Therefore, this study was conducted to determine the effect of date fruit consumption on the amount of hemorrhage after natural childbirth. METHODS This randomized clinical trial was conducted on 98 women referred to the maternity ward of Al-Zahra Hospital in Rasht using the available sampling method. The primary outcome was postpartum hemorrhage, measured using the Pictorial Blood Loss Assessment Chart (PBLAC). Two hours after delivery, 100 g of date fruits were given to the intervention group, and the amount of hemorrhage was recorded during the first 24 h. Comparison between the two groups was done with the Mann-Whitney test with the Hodges-Lehmann estimator and corresponding exact conditional nonparametric confidence interval (CI) as effect estimate. A P < 0.05 was considered significant. RESULTS The median of postpartum hemorrhage after normal delivery in the date and control groups was 35.0 [interquartile range (IQR): 22.0 to 39.8] and 39.0 [IQR: 27.5 to 64.5], respectively. Using the Hodges-Lehmann estimator, on average, the median postpartum hemorrhage in the date group was 9.0 (95% CI: 2.00-18.0) units lower than the control group (P = 0.009). CONCLUSION Consumption of dates effectively reduces the amount of hemorrhage after natural childbirth; thus, consuming this fruit during postpartum period is recommended. Also to confirm the findings, it is recommended to conduct similar studies in this field. TRIAL REGISTRATION This trial was registered with the Iranian Registry of Clinical Trials; https://www.irct.ir/trial/59197 (IRCT20210607051505N2) on 31/10/2021.
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Affiliation(s)
- Maryam Niknami
- Department of Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Farash
- MSc Student of Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mona Rahnavardi
- Department of Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Faraji Darkhaneh
- Professor of Obstetrics & Gynecology, Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Kim DJ, Cho SY, Jung KT. Tranexamic acid - a promising hemostatic agent with limitations: a narrative review. Korean J Anesthesiol 2023:kja.23530. [PMID: 37599607 DOI: 10.4097/kja.23530] [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: 07/07/2023] [Accepted: 08/21/2023] [Indexed: 08/22/2023] Open
Abstract
Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has been used for several decades to reduce blood loss during surgery and after trauma. TXA was traditionally used to reduce bleeding in various clinical settings such as menorrhagia, hemophilia, or other bleeding disorder . Numerous studies have demonstrated the efficacy of TXA in reducing blood loss and the need for transfusions. Interest in the potential applications of TXA beyond its traditional use has been growing recently, with studies investigating the use of TXA in postpartum hemorrhage, cardiac surgery, trauma, neurosurgery, and orthopedic surgery. Despite its widespread use and expanding indications, data regarding the safe and appropriate use of TXA is lacking. Recent clinical trials have found various potential risks and limitations in the long-term benefits of TXA. This narrative review summarizes the clinical applications and limitations of TXA.
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Affiliation(s)
- Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, College of Medicine and Medical School, Chosun University, Gwangju, Korea
| | - Su Yeon Cho
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, College of Medicine and Medical School, Chosun University, Gwangju, Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, College of Medicine and Medical School, Chosun University, Gwangju, Korea
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Lanza AV, Amorim MM, Ferreira M, Cavalcante CM, Katz L. Factors associated with severe maternal outcome in patients admitted to an intensive care unit in northeastern Brazil with postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:573. [PMID: 37563728 PMCID: PMC10413525 DOI: 10.1186/s12884-023-05874-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, particularly in low- and middle-income countries; however, the majority of these deaths could be avoided with adequate obstetric care. Analyzing severe maternal outcomes (SMO) has been a major approach for evaluating the quality of the obstetric care provided, since the morbid events that lead to maternal death generally occur in sequence. The objective of this study was to analyze the clinical profile, management, maternal outcomes and factors associated with SMO in women who developed PPH and were admitted to an obstetric intensive care unit (ICU) in northeastern Brazil. METHODS This retrospective cohort study included a non-probabilistic, consecutive sample of postpartum women with a diagnosis of PPH who were admitted to the obstetric ICU of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between January 2012 and March 2020. Sociodemographic, biological and obstetric characteristics and data regarding childbirth, the management of PPH and outcomes were collected and analyzed. The frequency of maternal near miss (MNM) and death was calculated. Multiple logistic regression analysis was performed to determine the adjusted odd ratios (AOR) and their 95% confidence intervals (95% CI) for a SMO. RESULTS Overall, 136 cases of SMO were identified (37.9%), with 125 cases of MNM (34.9%) and 11 cases of maternal death (3.0%). The factors that remained associated with an SMO following multivariate analysis were gestational age ≤ 34 weeks (AOR = 2.01; 95% CI: 1.12-3.64; p < 0.02), multiparity (AOR = 2.20; 95% CI: 1.10-4.68; p = 0.02) and not having delivered in the institute (AOR = 2.22; 955 CI: 1.02-4.81; p = 0.04). CONCLUSION Women admitted to the obstetric ICU with a diagnosis of PPH who had had two or more previous deliveries, gestational age ≤ 34 weeks and who had delivered elsewhere were more likely to have a SMO.
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Affiliation(s)
- André Vieira Lanza
- Teaching Hospital of the Federal University of Uberlândia (UFU), Minas Gerais, Uberlândia, Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil
- Federal University of Campina Grande (UFCG), Campina Grande, Paraíba, Brazil
| | | | | | - Leila Katz
- Federal University of Campina Grande (UFCG), Campina Grande, Paraíba, Brazil.
- , Recife, Brazil.
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Musa B, Alswang JM, Di Ioia R, Grubic L, Naif A, Mbuguje EM, Vuong V, Newsome J, Shaygi B, Ramalingam V, Gaupp FML. Uterine artery embolization in Tanzania: a procedure with major public health implications. CVIR Endovasc 2023; 6:40. [PMID: 37548779 PMCID: PMC10406993 DOI: 10.1186/s42155-023-00384-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment. METHODS From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania's first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests. RESULTS During the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109). CONCLUSIONS UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region's leading cause of maternal mortality, postpartum hemorrhage.
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Affiliation(s)
- Balowa Musa
- Radiology and Imaging Department, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Jared Mark Alswang
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Rose Di Ioia
- Faculty of Medicine and Health Sciences, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1A3, Canada
| | - Lydia Grubic
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA
| | - Azza Naif
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Erick Michael Mbuguje
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Victoria Vuong
- Department of Radiology, University of California San Diego Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Janice Newsome
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Behnam Shaygi
- Department of Radiology, London North West University Healthcare NHS Trust, A404 Watford Rd, Harrow, HA1 3UJ, UK
| | - Vijay Ramalingam
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Fabian Max Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Chaudhary P, Priyadarshi M, Singh P, Chaurasia S, Chaturvedi J, Basu S. Effects of delayed cord clamping at different time intervals in late preterm and term neonates: a randomized controlled trial. Eur J Pediatr 2023; 182:3701-3711. [PMID: 37278737 PMCID: PMC10243262 DOI: 10.1007/s00431-023-05053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
Delayed cord clamping (DCC) at delivery has well-recognized benefits; however, current scientific guidelines lack uniformity in its definition. This parallel-group, three-arm assessor-blinded randomized controlled trial compared the effects of three different timings of DCC at 30, 60, and 120 s on venous hematocrit and serum ferritin levels in late preterm and term neonates not requiring resuscitation. Eligible newborns (n = 204) were randomized to DCC 30 (n = 65), DCC 60 (n = 70), and DCC 120 (n = 69) groups immediately after delivery. The primary outcome variable was venous hematocrit at 24 ± 2 h. Secondary outcome variables were respiratory support, axillary temperature, vital parameters, incidences of polycythemia, neonatal hyperbilirubinemia (NNH), need and duration of phototherapy, and postpartum hemorrhage (PPH). Additionally, serum ferritin levels, the incidence of iron deficiency, exclusive breastfeeding (EBF) rate, and anthropometric parameters were assessed during post-discharge follow-up at 12 ± 2 weeks. Over one-third of the included mothers were anemic. DCC 120 was associated with a significant increase in the mean hematocrit by 2%, incidence of polycythemia, and duration of phototherapy, compared to DCC30 and DCC60; though the incidence of NNH and need for phototherapy was similar. No other serious neonatal or maternal adverse events including PPH were observed. No significant difference was documented in serum ferritin, incidences of iron deficiency, and growth parameters at 3 months even in the presence of a high EBF rate. Conclusion: The standard recommendation of DCC at 30-60 s may be considered a safe and effective intervention in the busy settings of low-middle-income countries with a high prevalence of maternal anemia. Trial registration: Clinical trial registry of India (CTRI/2021/10/037070). What is Known: • The benefits of delayed cord clamping (DCC) makes it an increasingly well-accepted practice in the delivery room. • However, uncertainty continues regarding the optimal timing of clamping; this may be of concern both in the neonate and the mother. What is New: • DCC at 120 s led to higher hematocrit, polycythemia and longer duration of phototherapy, without any difference in serum ferritin, and incidence of iron deficiency. • DCC at 30-60 s may be considered a safe and effective intervention in LMICs.
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Affiliation(s)
- Pankaj Chaudhary
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
| | - Jaya Chaturvedi
- Departments of Obstetrics & Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India
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Naruse S, Mazda Y, Akinaga C, Itoh H, Nakajima Y. Uterotonic administration during cesarean section in Japan. J Anesth 2023; 37:657-658. [PMID: 37086271 DOI: 10.1007/s00540-023-03194-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Satoshi Naruse
- Perinatal Center, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Chieko Akinaga
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Itoh
- Perinatal Center, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Kishimoto N, Miyamoto M, Imauji A, Takada M, Nishitani S, Tanabe R, Ito T, Hada T, Otsuka Y, Takano M. Clinical significance of retained products of conception in placenta previa: a retrospective analysis. BMC Pregnancy Childbirth 2023; 23:481. [PMID: 37391723 DOI: 10.1186/s12884-023-05805-0] [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: 12/30/2022] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Retained products of conception (RPOC) often cause severe postpartum hemorrhage (PPH) but the clinical significance of RPOC in placenta previa is unclear. This study aimed to investigate the clinical significance of RPOC in women with placenta previa. The primary outcome was to evaluate risk factors of RPOC and the secondary outcome was to consider risk factors of severe PPH. METHODS Singleton pregnant women with placenta previa who underwent cesarean section (CS) and placenta removal during the operation at the National Defense Medical College Hospital between January 2004 and December 2021 were identified. A retrospective analysis was performed to examine the frequency and risk factors of RPOC and the association of RPOC with severe PPH in pregnant women with placenta previa. RESULTS This study included 335 pregnant women. Among these, 24 (7.2%) pregnant women developed RPOC. Pregnant women with prior CS (Odds Ratio (OR) 5.98; 95% Confidence Interval (CI) 2.35-15.20, p < 0.01), major previa (OR 3.15; 95% CI 1.19-8.32, p < 0.01), and placenta accreta spectrum (PAS) (OR 92.7; 95% CI 18.39-467.22, p < 0.01) were more frequent in the RPOC group. Multivariate analysis revealed that prior CS (OR 10.70; 95% CI 3.47-33.00, p < 0.01,) and PAS (OR 140.32; 95% CI 23.84-825.79, p < 0.01) were risk factors for RPOC. In pregnant women who have placenta previa with RPOC or without RPOC, the ratio of severe PPH were 58.3% and 4.5%, respectively (p < 0.01). Furthermore, the occurrence of prior CS (OR 9.23; 95% CI 4.02-21.20, p < 0.01), major previa (OR 11.35; 95% CI 3.35-38.38, p < 0.01), placenta at the anterior wall (OR 3.44; 95% CI 1.40-8.44, p = 0.01), PAS (OR 16.47; 95% CI 4.66-58.26, p < 0.01), and RPOC (OR 29.70; 95% CI 11.23-78.55, p < 0.01) was more in pregnant women with severe PPH. In the multivariate analysis for severe PPH, prior CS (OR 4.71; 95% CI 1.29-17.13, p = 0.02), major previa (OR 7.50; 95% CI 1.98-28.43, p < 0.01), and RPOC (OR 13.26; 95% CI 3.61-48.63, p < 0.01) were identified as risk factors. CONCLUSIONS Prior CS and PAS were identified as risk factors for RPOC in placenta previa and RPOC is closely associated with severe PPH. Therefore, a new strategy for RPOC in placenta previa is needed.
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Affiliation(s)
- Naohisa Kishimoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Akari Imauji
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Minori Takada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Soko Nishitani
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Risa Tanabe
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Tsubasa Ito
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Taira Hada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yuka Otsuka
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Yang F, Wang H, Shen M. Effect of preoperative prophylactic intravenous tranexamic acid on perioperative blood loss control in patients undergoing cesarean delivery: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:420. [PMID: 37280562 DOI: 10.1186/s12884-023-05753-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is one of the important risk factors leading to maternal mortality and intervention is essential. Oxytocin therapy is widely used clinically, but the effect is unsatisfactory. The efficacy of tranexamic acid (TXA) in hemostasis is notable, whereas its use in preventing PPH warrants exploration. AIMS To evaluate the effect of prophylactic administration of TXA on perioperative blood loss in women undergoing cesarean section by systematic review and meta-analysis of published studies. METHODS Bibliographic databases were screened from their inception to December 2022 to retrieve relevant studies. Study outcomes including blood loss during cesarean section, 2-h postpartum blood loss, total blood loss (during cesarean section and 2-h postpartum), and 6-h postpartum, as well as hemoglobin changes were extracted and compared. RESULTS A total of 21 studies, nine randomized clinical trials and 12 cohort studies, involving 1896 patients given TXA prophylactically and 1909 patients given placebo or no treatment, were analyzed. Compared with the control group, the preoperative prophylactic intravenous administration of TXA significantly reduced the intraoperative (RCT: P < 0.00001, cohort studies: P < 0.00001), 2-h postpartum (RCT: P = 0.02, cohort studies: P < 0.00001) and total blood loss (RCT: P < 0.00001, cohort studies: P = 0.0002), and reduced the decline in hemoglobin (RCT: P < 0.00001, cohort studies: P = 0.0001), but did not significantly affect blood loss at 6-h postpartum (P = 0.05). CONCLUSION Prophylactic intravenous TXA before cesarean section is helpful in preventing perioperative bleeding in women. TRIAL REGISTRATION http://www.crd.york.ac.uk/PROSPERO , identifier: CRD 42022363450.
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Affiliation(s)
- Fan Yang
- Department of Intensive Care Unit, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China
| | - Han Wang
- Department of Gynecology and Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China
| | - Mengdie Shen
- Department of Internal Medicine, Women's Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, 310003, People's Republic of China.
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Kaserer A, Castellucci C, Henckert D, Breymann C, Spahn DR. Patient Blood Management in Pregnancy. Transfus Med Hemother 2023; 50:245-255. [PMID: 37435001 PMCID: PMC10331157 DOI: 10.1159/000528390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/18/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Patient blood management (PBM) is a multidisciplinary and patient-centered treatment approach, comprising the detection and treatment of anemia, the minimization of blood loss, and the rational use of allogeneic transfusions. Pregnancy, delivery, and the puerperium are associated with increased rates of iron deficiency and anemia, which correlates with worse maternal and fetal outcomes and places pregnant women at increased risk of obstetric hemorrhage. SUMMARY Early screening for iron deficiency before the onset of anemia, as well as the use of oral and intravenous iron to treat iron deficiency anemia, has been shown to be beneficial. Anemia in pregnancy and the puerperium should be treated according to a staged regimen, administering either iron alone or in combination with an off-label use of human recombinant erythropoietin in selected patients. This regimen should be tailored to the needs of each individual patient. Postpartum hemorrhage (PPH) accounts for up to one-third of maternal deaths in both developing and developed countries. Bleeding complications should be anticipated and blood loss reduced by interdisciplinary preventive measures and individually tailored care. It is recommended that facilities have a PPH algorithm, primarily focusing on prevention through use of uterotonics, but also incorporating early diagnosis of the cause of bleeding, optimization of hemostatic conditions, timely administration of tranexamic acid, and integration of point-of-care tests to support the guided substitution of coagulation factors, alongside standard laboratory tests. Additionally, cell salvage has proven beneficial and should be considered for various indications in obstetrics including hematologic disturbances, as well as various forms of placental disorders. KEY MESSAGE This article reviews PBM in pregnancy, delivery, and the puerperium. The concept comprises early screening and treatment of anemia and iron deficiency, a transfusion and coagulation algorithm during delivery, as well as cell salvage.
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Affiliation(s)
- Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Clara Castellucci
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - David Henckert
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christian Breymann
- Zentrum Gyn & Perinatal, Ärztezentrum Seefeld Hirslanden Klinik Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
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Kapfhammer E, Pfammatter T, Brun R, Zimmermann R, Haslinger C. Success Rate and Long-Term Effects of Embolization of Pelvic Arteries for the Treatment of Postpartum Hemorrhage. Transfus Med Hemother 2023; 50:226-233. [PMID: 37434998 PMCID: PMC10331153 DOI: 10.1159/000527614] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Postpartum hemorrhage (PPH) is the leading cause of peripartal maternal mortality and accounts for 25% of all maternal deaths worldwide. The most common reasons of PPH are uterine atony, retained placenta, or placenta accreta spectrum. Treatment of PPH depends on the etiology and corresponds to a stepwise approach, which follows the German, Austrian and Swiss guideline for the diagnosis and therapy of PPH in Switzerland. In severe ongoing PPH, hysterectomy has been the ultima ratio for many decades. Nowadays, interventional embolization of the pelvic arteries (PAE) has become a popular alternative. Besides being a highly effective minimally invasive method, PAE avoids hysterectomy with consecutively reduced morbidity and mortality. However, data on the long-term effects of PAE on fertility and menstrual cycle are scarce. Methods We performed a monocentric study consisting of a retro- and a prospective part including all women who had undergone a PAE between 2012 and 2016 at University Hospital Zurich. Descriptive characteristics of patients and efficacy of PAE defined as cessation of bleeding were analyzed retrospectively. In the prospective part, all patients were contacted for a follow-up questionnaire regarding menstruation and fertility after embolization. Results Twenty patients with PAE were evaluated. Our data showed a success rate of PAE in 95% of patients with PPH; only 1 patient needed a second, then successful, PAE. No patient needed a hysterectomy or any other surgical intervention. In our study, an association between mode of delivery and identified etiology of PPH is observed. After spontaneous delivery (n = 6), the main reason of severe PPH was retained placenta (n = 4), while after cesarean section (n = 14), uterine atony was identified in most cases (n = 8). Regarding menstruation after embolization, all women reported regular menstruation after the breastfeeding period (100%). The majority reported a regular pattern with a shorter or similar duration (73%) and lower or similar intensity (64%). Dysmenorrhea decreased in 67% of patients. Four patients planned another pregnancy, of whom only one had become pregnant with assisted reproductive technology and ended up in a miscarriage. Discussion Our study confirms the efficacy of PAE in PPH, thus obviating complex surgical interventions and associated morbidity. The success of PAE does not depend on the primary cause of PPH. Our results may encourage the prompt decision to perform PAE in the management of severe PPH in case of failure of conservative management and help physicians in the post-interventional counseling regarding menstruation patterns and fertility.
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Affiliation(s)
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Romana Brun
- Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland
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Kim BM, Jeon GS, Choi MJ, Hong NS. Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings. World J Clin Cases 2023; 11:3471-3480. [PMID: 37383902 PMCID: PMC10294178 DOI: 10.12998/wjcc.v11.i15.3471] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Transcatheter arterial embolization (TAE) has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management, but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage (PPH).
AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings.
METHODS We conducted a research from January 2008 to July 2022 on all 83 patients (mean: 32 years, range: 24-43 years) presented with secondary PPH and they were treated with TAE in two university hospitals. The medical records and angiography were retrospective reviewed in order to evaluate the patients’ characteristics, delivery details, clinical status and peri-embolization management, angiography and embolization details, technical/clinical success and complications. The group with active bleeding sign and the group without it were also compared and analyzed.
RESULTS On angiography, 46 (55.4%) patients showed active bleeding signs such as contrast extravasation (n = 37) or pseudoaneurysm (n = 8) or both (n = 1), and 37 (44.6%) patients showed non-active bleeding signs such as only spastic uterine artery (n = 2) or hyperemia (n = 35). In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. The technical success rates were 97.8% (45/46) in active bleeding sign group and 91.9% (34/37) in non-active bleeding sign group, and the overall clinical success rates were 95.7% (44/46) and 97.3% (36/37). An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization, therefore hysterostomy and retained placenta removal were performed which was a major complication.
CONCLUSION TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.
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Affiliation(s)
- Bong Man Kim
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungcheongnam-do, South Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam-si 13496, Gyeonggi-do, South Korea
| | - Min Jeong Choi
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si 31116, Chungcheongnam-do, South Korea
| | - Nam-Soo Hong
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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Abu Shqara R, Chole S, Sgayer I, Rozano Gorelick A, Lowensetin L, Frank Wolf M. The utility of inpatient anemia workup in hemoglobin < 10 g/dL diagnosed randomly in the third trimester: a retrospective study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07069-7. [PMID: 37162561 DOI: 10.1007/s00404-023-07069-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE About 40% of pregnant women are anemic and at an increased risk for complications. We examined the efficacy of inpatient anemia workup and treatment in pregnant women diagnosed with moderate-severe anemia (hemoglobin < 10 mg/dL), during hospitalization in the late second-trimester and third-trimester. METHODS This retrospective study, conducted between March 2020 and November 2022, included women at ≥ 24 gestational weeks who were hospitalized due to various indications and diagnosed with anemia (hemoglobin < 10 mg/dL). The study group comprised women who underwent an inpatient anemia workup and initiation of anemia treatment. The comparison group comprised women who did not undergo an inpatient anemia investigation. The primary outcome was the rate of pre-delivery hemoglobin > 11 g/dL. RESULTS The most frequent etiology of anemia in the study group (n = 188) was iron-deficiency anemia (30.2%), followed by mixed anemia of iron, folate and vitamin-B12 deficiencies (20.7%). In the study vs. the comparison group (n = 179), the rate of pre-delivery hemoglobin > 11 g/dL was higher, and the increase in hemoglobin from intervention to delivery was greater. The ideal timing for anemia intervention for maximizing the increase in pre-delivery hemoglobin was 6-weeks or more prior to delivery. The rates of postpartum hemorrhage and blood transfusions were similar. The rate of postpartum hemoglobin < 10 g/dL was lower in the study than the comparison group. CONCLUSION Inpatient anemia investigation and treatment resulted in higher peri-delivery hemoglobin. In women randomly diagnosed with anemia at hospitalization, the rate of pre-delivery hemoglobin > 11 g/dL was increased among those who underwent a simple anemia investigation and treatment initiation.
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Affiliation(s)
- Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Samuel Chole
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Lior Lowensetin
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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