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Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A. Impact and management of iron deficiency and iron deficiency anemia in women's health. Expert Rev Hematol 2018; 11:727-736. [PMID: 30019973 DOI: 10.1080/17474086.2018.1502081] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Iron deficiency and iron deficiency anemia are highly prevalent among women throughout their lives. Some females are particularly vulnerable to iron deficiency/iron deficiency anemia, including those with heavy menstrual bleeding (HMB) and pregnant/postpartum women. Despite the high prevalence of iron deficiency/iron deficiency anemia in women, the condition is still underdiagnosed and therefore undertreated, with serious clinical consequences. Areas covered: The following review examines the impact of iron deficiency and iron deficiency anemia on clinical outcomes and quality of life in women from adolescence to post-menopause, paying particular attention to guidelines and current recommendations for diagnostic tests and management. Expert commentary: There are numerous adverse health consequences of an iron-deficient state, affecting all aspects of the physical and emotional health and well-being of women. Guidelines must be developed to help clinicians better identify and treat women at risk of iron deficiency or iron deficiency anemia, particularly those with HMB, or who are pregnant or postpartum. Replacement therapy with oral or intravenous iron preparations is the mainstay of treatment for iron deficiency/iron deficiency anemia, with red blood cell transfusion reserved for emergency situations. Each iron therapy type is associated with benefits and limitations which impact their use.
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Affiliation(s)
- Fadi G Mirza
- a Department of Obstetrics and Gynecology, Faculty of Medicine , American University of Beirut , Beirut , Lebanon.,b Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Rezan Abdul-Kadir
- c Department of Obstetrics and Gynaecology , Royal Free Hospital , London , UK
| | - Christian Breymann
- d Perinatal and Gynecology Center , Seefeld Zurich/Clinic Hirslanden , Zurich , Switzerland.,e Obstetric Research-Feto Maternal Hematology Unit , University Hospital Zurich , Zurich , Switzerland
| | - Ian S Fraser
- f School of Women's and Children's Health , University of New South Wales, Royal Hospital for Women, Randwick , Sydney , Australia
| | - Ali Taher
- g Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
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Flood M, McDonald SJ, Pollock W, Cullinane F, Davey M. Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population‐based study using Victorian Perinatal Data Collection data for 764 244 births. Aust N Z J Obstet Gynaecol 2018; 59:228-234. [DOI: 10.1111/ajo.12826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/10/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Margaret Flood
- Judith Lumley CentreSchool of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
| | - Susan J. McDonald
- School of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
| | - Wendy Pollock
- School of Nursing and MidwiferyLa Trobe University Melbourne Victoria Australia
- Maternal Critical Care Melbourne Victoria Australia
- Department of NursingThe University of Melbourne Melbourne Victoria Australia
| | - Fiona Cullinane
- Maternity ServicesRoyal Women's Hospital Melbourne Victoria Australia
| | - Mary‐Ann Davey
- Department of Obstetrics and GynaecologyMonash University Melbourne Victoria Australia
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de Lange N, Schol P, Lancé M, Woiski M, Langenveld J, Rijnders R, Smits L, Wassen M, Henskens Y, Scheepers H. Restrictive Versus Massive Fluid Resuscitation Strategy (REFILL study), influence on blood loss and hemostatic parameters in obstetric hemorrhage: study protocol for a randomized controlled trial. Trials 2018; 19:166. [PMID: 29510717 PMCID: PMC5838856 DOI: 10.1186/s13063-018-2512-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 01/30/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is associated with maternal morbidity and mortality and has an increasing incidence in high-resource countries, despite dissemination of guidelines, introduction of skills training, and correction for risk factors. Current guidelines advise the administration, as fluid resuscitation, of almost twice the amount of blood lost. This advice is not evidence-based and could potentially harm patients. METHODS All women attending the outpatient clinic who are eligible will be informed of the study; oral and written informed consent will be obtained. Where there is more than 500 ml blood loss and ongoing bleeding, patients will be randomized to care as usual, fluid resuscitation with 1.5-2 times the amount of blood loss or fluid resuscitation with 0.75-1.0 times the blood loss. Blood loss will be assessed by weighing all draping. A blood sample, for determining hemoglobin concentration, hematocrit, thrombocyte concentration, and conventional coagulation parameters will be taken at the start of the study, after 60 min, and 12-18 h after delivery. In a subgroup of women, additional thromboelastometric parameters will be obtained. DISCUSSION Our hypothesis is that massive fluid administration might lead to a progression of bleeding due to secondary coagulation disorders. In non-pregnant individuals with massive blood loss, restrictive fluid management has been shown to prevent a progression to dilution coagulopathy. These data, however, cannot be extrapolated to women in labor. Our objective is to compare both resuscitation protocols in women with early, mild PPH (blood loss 500-750 ml) and ongoing bleeding, taking as primary outcome measure the progression to severe PPH (blood loss > 1000 ml). TRIAL REGISTRATION Netherlands Trial Register, NTR 3789 . Registered on 11 January 2013.
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Affiliation(s)
- Natascha de Lange
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, P.O. 11120, 9700 CC Groningen, the Netherlands
| | - Pim Schol
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. 616, 6200 MD Maastricht, the Netherlands
| | - Marcus Lancé
- Department of Anesthesiology and Pain Treatment, Department of Intensive Care, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Mallory Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, P.O. 9101, 6500 HB Nijmegen, the Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland, P.O. 5500, 6130 MB Sittard-Geleen, the Netherlands
| | - Robbert Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, P.O. 90153, 5200 ME ‘s-Hertogenbosch, the Netherlands
| | - Luc Smits
- Department of Epidemiology, Caphri School for Public Health and Primary Care, P.O. 616, 6200 MD Maastricht, the Netherlands
| | - Martine Wassen
- Department of Obstetrics and Gynecology, Zuyderland, P.O. 5500, 6130 MB Sittard-Geleen, the Netherlands
| | - Yvonne Henskens
- Central Diagnostics Laboratory, Maastricht University Medical Centre, P.O. 5500, 6202 AZ Maastricht, the Netherlands
| | - Hubertina Scheepers
- GROW: School for Oncology and Developmental Biology and Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. 616, 6200 MD Maastricht, the Netherlands
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Rubio-Álvarez A, Molina-Alarcón M, Arias-Arias Á, Hernández-Martínez A. Development and validation of a predictive model for excessive postpartum blood loss: A retrospective, cohort study. Int J Nurs Stud 2018; 79:114-121. [DOI: 10.1016/j.ijnurstu.2017.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
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Bischoff K, Nothacker M, Lehane C, Lang B, Meerpohl J, Schmucker C. Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review. BMC Pregnancy Childbirth 2017; 17:399. [PMID: 29187156 PMCID: PMC5708177 DOI: 10.1186/s12884-017-1584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women requiring cesarean delivery constitute a subset of patients that may exhibit an unpredictable response to oxytocin. We mapped the evidence for comparative studies investigating the hypothesis whether the risk for PPH is increased in women requiring cesarean section after induction or augmentation of labour. METHODS We performed a systematic literature search for clinical trials in Medline, Embase, Web of Science, and the Cochrane Library (May 2016). Additionally we searched for ongoing or unpublished trials in clinicaltrials.gov and the WHO registry platform. We identified a total of 36 controlled trials investigating the exogenous use of oxytocin in cesarean section. Data were extracted for study key characteristics and the current literature literature was described narratively. RESULTS Our evidence map shows that the majority of studies investigating the outcome PPH focused on prophylactic oxytocin use compared to other uterotonic agents in the third stage of labour. Only 2 dose-response studies investigated the required oxytocin dose to prevent uterine atony after cesarean delivery for labour arrest. These studies support the hypotheses that labouring women exposed to exogenous oxytocin require a higher oxytocin dose after delivery than non-labouring women to prevent uterine atony after cesarean section. However, the study findings are flawed by limitations of the study design as well as the outcome selection. No clinical trial was identified that directly compared exogenous oxytocin versus no oxytocin application before intrapartum cesarean delivery. CONCLUSION Despite some evidence from dose-response studies that the use of oxytocin may increase the risk for PPH in intrapartum cesarean delivery, current research has not investigated the prepartal application of oxytocin in well controlled clinical trials. It was striking that most studies on exogenous oxytocin are focused on PPH prophylaxis in the third stage of labour without differing between the indications of cesarean section and hence the prepartal oxytocin status.
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Affiliation(s)
- Karin Bischoff
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management (IMWi), Karl-von-Frisch-Street 1, 35043 Marburg, Germany
| | - Cornelius Lehane
- Department of Anesthesiology and Critical Care, University Heart Center Freiburg-Bad Krozingen, Medical Center - University of Freiburg, Freiburg, Germany
| | - Britta Lang
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg Meerpohl
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Flood MM, Pollock WE, McDonald SJ, Davey MA. Monitoring postpartum haemorrhage in Australia: Opportunities to improve reporting. Women Birth 2017; 31:89-95. [PMID: 28838805 DOI: 10.1016/j.wombi.2017.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/14/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM The rate and severity of postpartum haemorrhage (PPH) are increasing, according to research reports and clinical anecdote, causing a significant health burden for Australian women giving birth. However, reporting a national Australian rate is not possible due to inconsistent reporting of PPH. BACKGROUND Clinician concerns about the incidence and severity of PPH are growing. Midwives contribute perinatal data on every birth, yet published population-based data on PPH seems to be limited. What PPH information is contributed? What data are publicly available? Do published data reflect the PPH concerns of clinicians? AIM To examine routine public reporting on PPH across Australia. METHODS We systematically analysed routine, publicly reported data on PPH published in the most recent perinatal data for each state, territory and national report (up to and including October 2016). We extracted PPH data on definitions, type and method of data recorded, markers of severity, whether any analyses were done and whether any trends or concerns were noted. FINDINGS PPH data are collected by all Australian states and territories however, definitions, identification method and documentation of data items vary. Not all states and territories published PPH rates; those that did ranged from 3.3% to 26.5% and were accompanied by minimal reporting of severity and possible risk factors. Whilst there are plans to include PPH as a mandatory reporting item, the timeline is uncertain. CONCLUSIONS Routinely published PPH data lack nationally consistent definitions and detail. All states and territories are urged to prioritise the adoption of nationally recommended PPH items.
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Affiliation(s)
- Margaret M Flood
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
| | - Wendy E Pollock
- School of Nursing and Midwifery, La Trobe University, Heidelberg, Victoria, Australia; Maternal Critical Care, Melbourne, Victoria, Australia; Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Susan J McDonald
- School of Nursing and Midwifery, La Trobe University, Heidelberg, Victoria, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
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Flood M, Pollock W, McDonald SJ, Davey MA. Accuracy of postpartum haemorrhage data in the 2011 Victorian Perinatal Data Collection: Results of a validation study. Aust N Z J Obstet Gynaecol 2017; 58:210-216. [PMID: 28857124 DOI: 10.1111/ajo.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The postpartum haemorrhage (PPH) rate in Victoria in 2009 for women having their first birth, based on information reported to the Victorian Perinatal Data Collection (VPDC), was 23.6% (primiparas). Prior to 2009 PPH was collected via a tick box item on the perinatal form. Estimated blood loss (EBL) volume is now collected and it is from this item the PPH rate is calculated. Periodic assessment of data accuracy is essential to inform clinicians and others who rely on these data of their quality and limitations. AIMS This paper describes the results of a state-wide validation study of the accuracy of EBL volume and EBL-related data items reported to VPDC. MATERIALS AND METHODS PPH data from a random sample of 1% of births in Victoria in 2011 were extracted from source medical records and compared with information submitted to the VPDC. Accuracy was determined, together with sensitivity, specificity, positive predictive value and negative predictive value for dichotomous items. RESULTS Accuracy of reporting for EBL ≥ 500 mL was 97.2% and for EBL ≥ 1500 mL was 99.7%. Sensitivity for EBL ≥ 500 mL was 89.0% (CI 83.1-93.0) and for EBL ≥ 1500 mL was 71.4% (CI 35.9-91.8). Blood product transfusion, peripartum hysterectomy and procedures to control bleeding were all accurately reported in >99% of cases. CONCLUSIONS Most PPH-related data items in the 2011 VPDC may be considered reliable. Our results suggest EBL ≥ 1500 mL is likely to be under-reported. Changes to policies and practices of recording blood loss could further increase accuracy of reporting.
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Affiliation(s)
- Margaret Flood
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Wendy Pollock
- Maternal Critical Care, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, La Trobe University, Heidelberg, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan J McDonald
- School of Nursing and Midwifery, La Trobe University, Heidelberg, Victoria, Australia
| | - Mary-Ann Davey
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Orbach-Zinger S, Einav S, Yona? A, Eidelman LA, Fein S, Davis A, Ioscovich A. A survey of physicians’ attitudes toward uterotonic administration in parturients undergoing cesarean section. J Matern Fetal Neonatal Med 2017; 31:3183-3190. [DOI: 10.1080/14767058.2017.1366981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sharon Orbach-Zinger
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Einav
- Department of Anesthesia, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Yona?
- Department of Pediatrics, Soroka Medical Center, Ben-Gurion University, Be’er Sheva, Israel
| | - Leonid A. Eidelman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shia Fein
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atara Davis
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Ioscovich
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Heller HM, Ravelli ACJ, Bruning AHL, de Groot CJM, Scheele F, van Pampus MG, Honig A. Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:166. [PMID: 28577352 PMCID: PMC5457563 DOI: 10.1186/s12884-017-1334-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/18/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage is a major obstetric risk worldwide. Therefore risk factors need to be investigated to control for this serious complication. A recent systematic review and meta-analysis revealed that the use of both serotonergic and non-serotonergic antidepressants in pregnancy are associated with a higher risk of postpartum haemorrhage. However, use of antidepressants in pregnancy is often necessary because untreated depression in pregnancy is associated with adverse maternal and neonatal outcome, such as postpartum depression, preterm birth and dysmaturity. Therefore it is of utmost importance to unravel the possible association between postpartum haemorrhage and the use of serotonergic and other psychopharmacological medication during pregnancy. METHODS We performed a matched cohort observational study consecutively including all pregnant women using serotonergic medication (n = 578) or other psychopharmacological medication (n = 50) visiting two teaching hospitals in Amsterdam between 2010 and 2014. The incidence of postpartum haemorrhage in women using serotonergic medication or other psychopharmacological medication was compared with the incidence of postpartum haemorrhage in 641,364 pregnant women not using psychiatric medication selected from the database of the Netherlands Perinatal Registry foundation (Perined). Matching took place 1:5 for nine factors, i.e., parity, maternal age, ethnicity, socioeconomic status, macrosomia, gestational duration, history of postpartum haemorrhage, labour induction and hypertensive disorder. RESULTS Postpartum haemorrhage occurred in 9.7% of the women using serotonergic medication. In the matched controls this was 6.6% (p = 0.01). The adjusted odds ratio (aOR) before matching was 1.6 (95% CI 1.2-2.1) and after matching 1.5 (95% CI 1.1-2.1). Among the women using other psychopharmacological medication, the incidence of postpartum haemorrhage before matching was 12.0% versus 6.1% (p = 0.08) with OR 2.1 (95% CI 0.9-4.9), and after matching 12.1% versus 4.4% (p = 0.03) with aOR of 3.3 (95% CI 1.1-9.8). CONCLUSIONS Pregnant women using serotonergic medication have an increased risk of postpartum haemorrhage, but this high risk is also seen in pregnant women using other psychopharmacological medication. We suggest that this higher risk of postpartum haemorrhage could not only be explained by serotonin, but also by other mechanisms. An additional explanation could be the underlying psychiatric disorder.
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Affiliation(s)
- Hanna M Heller
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Andrea H L Bruning
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG Hospital (East), Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Hospital Psychiatry, OLVG Hospital (West), Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
- Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Harvey SA, Lim E, Gandhi KR, Miyamura J, Nakagawa K. Racial-ethnic Disparities in Postpartum Hemorrhage in Native Hawaiians, Pacific Islanders, and Asians. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2017; 76:128-132. [PMID: 28484667 PMCID: PMC5418537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The objective of this study was to assess racial-ethnic differences in the prevalence of postpartum hemorrhage (PPH) among Native Hawaiians and other Pacific Islanders (NHOPI), Asians, and Whites. We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawai'i between January 1995 and December 2013. A total of 243,693 in-hospital delivery discharges (35.0% NHOPI, 44.0% Asian, and 21.0% White) were studied. Among patients with PPH, there were more NHOPI (37.1%) and Asians (47.6%), compared to Whites (15.3%). Multivariable logistic regression was used to assess the impact of maternal race-ethnicity on the prevalence of PPH after adjusting for delivery type, labor induction, prolonged labor, multiple gestation, gestational hypertension, gestational diabetes, preeclampsia, chorioamnionitis, placental abruption, placenta previa, obesity, and period with different diagnostic criteria for preeclampsia. In the multivariable analyses, NHOPI (adjusted odds ratio [aOR], 1.40; 95% confidence interval [CI], 1.32-1.48) and Asians (aOR, 1.45; 95% CI, 1.37-1.53) were more likely to have PPH compared to Whites. In the secondary analyses of 12,142 discharges with PPH, NHOPI and Asians had higher prevalence of uterine atony than Whites (NHOPI: 77.2%, Asians: 73.9% vs Whites: 65.1%, P < .001 for both comparisons).
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Affiliation(s)
| | - Eunjung Lim
- The Queen's Medical Center, Honolulu, HI (SAH, KN)
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Rubio-Álvarez A, Molina-Alarcón M, Hernández-Martínez A. Relationship between the degree of perineal trauma at vaginal birth and change in haemoglobin concentration. Women Birth 2017; 30:382-388. [PMID: 28412037 DOI: 10.1016/j.wombi.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Postpartum anaemia is a problem with high prevalence that significantly affects maternal recovery. Among the causal factors is perineal trauma. However, it is still not known what degree of perineal trauma produces a greater reduction of haemoglobin. AIM To assess the relationship between the degree of perineal trauma and change in haemoglobin concentration at vaginal birth. METHODS An observational, analytical retrospective cohort study was performed at the Mancha-Centro Hospital (Spain) during the period 2010-2014. Data were collected regarding 3479 women who gave birth vaginally. The main outcome variable was the change in haemoglobin concentration. Multivariate analysis by means of multiple linear regression was performed to control possible confounding factors and to determine the net effect of each degree of perineal trauma on haemoglobin reduction. FINDINGS Of the total sample, 20.1% of women (699) had an intact perineum, 41.6% (1446) experienced some form of perineal trauma, but not episiotomy, and the remaining 38.3% of women (1334) underwent an episiotomy. The average reduction of haemoglobin was 1.46g/dL (Standard Deviation (SD)=1.09g/dL) for women without episiotomy with a second degree tear and 2.07g/dL (SD=1.24g/dL) for women who had an episiotomy and no perineal tear. The greatest reduction occurred among women with episiotomy and a third or fourth degree tear with a decrease of 3.10g/dL (SD=1.32g/dL). CONCLUSION Episiotomy is related to greater reduction of haemoglobin concentration in comparison with all degrees of spontaneous perineal trauma. The use of episiotomy should be strictly limited.
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Nathan HL, Cottam K, Hezelgrave NL, Seed PT, Briley A, Bewley S, Chappell LC, Shennan AH. Determination of Normal Ranges of Shock Index and Other Haemodynamic Variables in the Immediate Postpartum Period: A Cohort Study. PLoS One 2016; 11:e0168535. [PMID: 27997586 PMCID: PMC5173287 DOI: 10.1371/journal.pone.0168535] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the normal ranges of vital signs, including blood pressure (BP), mean arterial pressure (MAP), heart rate (HR) and shock index (SI) (HR/systolic BP), in the immediate postpartum period to inform the development of robust obstetric early warning scores. STUDY DESIGN We conducted a secondary analysis of a prospective observational cohort study evaluating vital signs collected within one hour following delivery in women with estimated blood loss (EBL) <500ml (316 women) delivering at a UK tertiary centre over a one-year period. Simple and multiple linear regression were used to explore associations of demographic and obstetric factors with SI. RESULTS Median (90% reference range) was 120 (100-145) for systolic BP, 75 (58-90) for diastolic BP, 90 (73-108) for MAP, 81 (61-102) for HR, and 0.66 (0.52-0.89) for SI. Third stage Syntometrine® administration was associated with a 0.03 decrease in SI (p = 0.035) and epidural use with a 0.05 increase (p = 0.003). No other demographic or obstetric factors were associated with a change in shock index in this cohort. CONCLUSION This is the first study to determine normal ranges of maternal BP, MAP, HR and SI within one hour of birth, a time of considerable haemodynamic adjustment, with minimal effect of demographic and obstetric factors demonstrated. The lower 90% reference point for systolic BP and upper 90% reference point for HR correspond to triggers used to recognise shock in obstetric practice, as do the upper 90% reference points for systolic and diastolic BP for obstetric hypertensive triggers. The SI upper limit of 0.89 in well postpartum women supports current literature suggesting a threshold of 0.9 as indicating increased risk of adverse outcomes.
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Affiliation(s)
- Hannah L. Nathan
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Kate Cottam
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | | | - Paul T. Seed
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Annette Briley
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Susan Bewley
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Andrew H. Shennan
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
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Kerr R, Eckert LO, Winikoff B, Durocher J, Meher S, Fawcus S, Mundle S, Mol B, Arulkumaran S, Khan K, Wandwabwa J, Kochhar S, Weeks A. Postpartum haemorrhage: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6102-6109. [PMID: 27431424 PMCID: PMC5139805 DOI: 10.1016/j.vaccine.2016.03.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/02/2022]
Affiliation(s)
| | | | | | | | | | - Sue Fawcus
- Mowbray Maternity Hospital, South Africa
| | | | - Ben Mol
- University of Adelaide, Australia
| | | | - Khalid Khan
- Barts and The London School of Medicine and Dentistry, UK
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64
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Initial management of postpartum hemorrhage: A cohort study in Benin and Mali. Int J Gynaecol Obstet 2016; 135 Suppl 1:S84-S88. [PMID: 27836091 DOI: 10.1016/j.ijgo.2016.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the components of initial management associated with a decreased risk of severe postpartum hemorrhage (PPH) in Benin and Mali. METHODS A cohort study was conducted between May 2013 and September 2014 that included all women who delivered vaginally in seven participating centers and who presented excessive bleeding after birth. Severe PPH was defined as PPH that required surgical treatment (vascular ligature and/or hysterectomy), and/or blood transfusion, and/or transfer to an intensive care unit, and/or an outcome of maternal death. Logistic regression was used to identify the components of initial PPH management that were associated with severe PPH, adjusting for case mix. RESULTS A total of 223 women presented a primary PPH presumably caused by uterine atony. Among those, 88 (39.5%) had severe PPH. Nearly one-third of women (30.4%) had a late injection of oxytocin (>10 minutes) after PPH diagnosis or no injection. Oxytocin injection within 10 minutes after the PPH diagnosis was significantly associated with a decreased risk of severe PPH (adjusted OR=0.3; 95% CI, 0.14-0.77). CONCLUSION Decrease in the delays in oxytocin administration is a key determinant to improve maternal outcomes related to PPH in this context.
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65
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Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery. Arch Gynecol Obstet 2016; 295:75-80. [DOI: 10.1007/s00404-016-4208-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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66
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Cauldwell M, Von Klemperer K, Uebing A, Swan L, Steer PJ, Gatzoulis M, Johnson MR. Why is post-partum haemorrhage more common in women with congenital heart disease? Int J Cardiol 2016; 218:285-290. [DOI: 10.1016/j.ijcard.2016.05.068] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/12/2016] [Indexed: 11/26/2022]
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67
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Vendittelli F, Barasinski C, Pereira B, Lémery D. Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study). BMC Pregnancy Childbirth 2016; 16:242. [PMID: 27552986 PMCID: PMC4995746 DOI: 10.1186/s12884-016-1008-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies. Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management. METHODS This prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence. RESULTS PPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25-3.47 %] and after cesareans 2.83 % [95 % CI: 2.63-3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05-1.18 %] and after cesareans 1.00 % [95 % CI: 0.88-1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %). CONCLUSIONS The incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.
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Affiliation(s)
- Françoise Vendittelli
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France. .,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France. .,AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France.
| | - Chloé Barasinski
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France
| | - Didier Lémery
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France.,AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France
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68
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Chi Z, Zhang S, Wang Y, Yang L, Yang Y, Li X. Research of the assessable method of postpartum hemorrhage. Technol Health Care 2016; 24 Suppl 2:S465-9. [DOI: 10.3233/thc-161169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zhenyu Chi
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Song Zhang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Yang Wang
- Shenzhen Huada Gene Research Institute, Shenzhen, Guangdong, China
| | - Lin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Yimin Yang
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
| | - Xuwen Li
- College of Life Science and Bio-engineering, Beijing University of Technology, Beijing, China
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69
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Predelivery maternal fibrinogen as a predictor of blood loss after vaginal delivery. Arch Gynecol Obstet 2016; 294:745-51. [DOI: 10.1007/s00404-016-4031-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/27/2016] [Indexed: 11/25/2022]
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70
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Woiski MD, Scheepers HC, Liefers J, Lance M, Middeldorp JM, Lotgering FK, Grol RP, Hermens RP. Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2015. [PMID: 26222391 DOI: 10.1111/aogs.12718] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION To systematically develop a set of guideline-based quality indicators for postpartum hemorrhage (PPH) as a tool to measure guideline adherence in actual PPH care. MATERIAL AND METHODS A Rand-modified Delphi procedure was used to systematically achieve consensus among a panel of 22 experts on PPH care on recommendations extracted from evidence-based guidelines, Managing-Obstetrics-Emergencies-Trauma (MOET) instructions and international literature. The selected recommendations were individually rated on health gain (prevention of maternal mortality and morbidity) and overall efficiency by the expert panel. Subsequently, consensus about the most important recommendations to measure quality of PPH care among the panel members was reached, followed by a final approval. Last, definition of the final set by critical appraisal of the recommendations regarding measurability took place. The main outcome measure was a set of valid quality indicators for prevention and management of PPH. RESULTS From the 69 extracted recommendations, 50 were selected and translated into 22 quality indicators on professional performance (n = 17) and organization of PPH care (n = 5). The professional performance indicators covered all fields of PPH care, such as prevention (n = 2) and management of PPH, including communication and documentation (n = 4), monitoring and prevention of shock (n = 3), use of blood products (n = 3) and treatment of PPH (n = 5). Organizational indicators (n = 5) were clustered into protocols and agreements, audit, accessibility and documentation. CONCLUSIONS This study describes a stepwise systematic development of 22 performance and organizational indicators to use for measuring the whole care process of prevention and management of PPH.
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Affiliation(s)
- Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Janine Liefers
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcus Lance
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fred K Lotgering
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard P Grol
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Bruning AH, Heller HM, Kieviet N, Bakker PC, de Groot CJ, Dolman KM, Honig A. Antidepressants during pregnancy and postpartum hemorrhage: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 189:38-47. [DOI: 10.1016/j.ejogrb.2015.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/05/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
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72
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Nathan HL, El Ayadi A, Hezelgrave NL, Seed P, Butrick E, Miller S, Briley A, Bewley S, Shennan AH. Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG 2014; 122:268-75. [DOI: 10.1111/1471-0528.13206] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- HL Nathan
- Women's Health Academic Centre; King's College London; London UK
| | - A El Ayadi
- Safe Motherhood Programs; University of California; San Francisco CA USA
| | - NL Hezelgrave
- Women's Health Academic Centre; King's College London; London UK
| | - P Seed
- Women's Health Academic Centre; King's College London; London UK
| | - E Butrick
- Safe Motherhood Programs; University of California; San Francisco CA USA
| | - S Miller
- Safe Motherhood Programs; University of California; San Francisco CA USA
| | - A Briley
- Women's Health Academic Centre; King's College London; London UK
| | - S Bewley
- Women's Health Academic Centre; King's College London; London UK
| | - AH Shennan
- Women's Health Academic Centre; King's College London; London UK
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Rocha Filho EA, Costa ML, Cecatti JG, Parpinelli MA, Haddad SM, Pacagnella RC, Sousa MH, Melo EF, Surita FG, Souza JP. Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study. Int J Gynaecol Obstet 2014; 128:131-6. [DOI: 10.1016/j.ijgo.2014.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/21/2014] [Accepted: 10/23/2014] [Indexed: 11/26/2022]
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