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Wang L, Pan JY. Predictive model for postpartum hemorrhage requiring hysterectomy in a minority ethnic region. World J Clin Cases 2024; 12:4865-4872. [DOI: 10.12998/wjcc.v12.i22.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, and hysterectomy is an important intervention for managing intractable PPH. Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates.
AIM To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan, China, to help guide clinical decision-making.
METHODS The study included 23490 patients, with 1050 having experienced PPH and 74 who underwent hysterectomies. The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model, and its predictive efficacy was subsequently evaluated.
RESULTS The proportion of hysterectomies among the included patients was 0.32% (74/23490), representing 7.05% (74/1050) of PPH cases. The number of deliveries, history of cesarean section, placenta previa, uterine atony, and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy. Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953 (95% confidence interval: 0.928-0.978) with a sensitivity of 90.50% and a specificity of 90.70%.
CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan, China.
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Affiliation(s)
- Ling Wang
- Intensive Care Unit, People's Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili 556000, Guizhou Province, China
| | - Jun-Yu Pan
- Intensive Care Unit, People's Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili 556000, Guizhou Province, China
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Makwe CC, Okunade KS. Conservative approaches to postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2024; 95:102516. [PMID: 38902107 DOI: 10.1016/j.bpobgyn.2024.102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/21/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024]
Abstract
Postpartum haemorrhage (PPH) and PPH-related deaths are disproportionately higher in low-income countries, with sub-Saharan Africa and Southern Asia accounting for approximately 85% of the global burden of PPH-related maternal deaths. Although PPH-related mortality is directly related to the amount and duration of bleeding, the high maternal death burden in resource-limited countries suggests that a great majority of these deaths would be avoidable with the appropriate resources and effective use of evidence-based interventions. Non-surgical management is often the first-line approach for PPH, but conservative surgical interventions may be required if bleeding persists or if the underlying cause is not responsive to the initial conservative measures. The appropriate interventions should be selected based on the individual's specific circumstances and clinical condition.
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Affiliation(s)
- Christian Chigozie Makwe
- Department of Obstetrics & Gynaecology, College of Medicine University of Lagos, Nigeria; Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Nigeria.
| | - Kehinde Sharafadeen Okunade
- Department of Obstetrics & Gynaecology, College of Medicine University of Lagos, Nigeria; Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Nigeria
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Neef V, Meybohm P, Zacharowski K, Kranke P. Current concepts in the use of cell salvage in obstetrics. Curr Opin Anaesthesiol 2024; 37:213-218. [PMID: 38391030 PMCID: PMC11062610 DOI: 10.1097/aco.0000000000001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. RECENT FINDINGS Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. SUMMARY Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy
| | - Peter Kranke
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
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Martins RIL, Novais JDSM, Reis ZSN. Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo14. [PMID: 38765539 PMCID: PMC11075434 DOI: 10.61622/rbgo/2024ao14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/01/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.
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Affiliation(s)
- Raíssa Isabelle Leão Martins
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Jussara de Souza Mayrink Novais
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Zilma Silveira Nogueira Reis
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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5
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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] [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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Cutland CL, Sawry S, Fairlie L, Barnabas S, Frajzyngier V, Roux JL, Izu A, Kekane-Mochwari KE, Vika C, De Jager J, Munson S, Jongihlati B, Stark JH, Absalon J. Obstetric and neonatal outcomes in South Africa. Vaccine 2024; 42:1352-1362. [PMID: 38310014 DOI: 10.1016/j.vaccine.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Background epidemiologic population data from low- and middle-income countries (LMIC), on maternal, foetal and neonatal adverse outcomes are limited. We aimed to estimate the incidence of maternal, foetal and neonatal adverse outcomes at South African maternal vaccine trial sites as reported directly in the clinical notes as well as using the 'Global Alignment of Immunization Safety Assessment in Pregnancy' case definitions (GAIA-CDs). GAIA-CDs were utilized as a tool to standardise data collection and outcome assessment, and the applicability and utility of the GAIA-CDs was evaluated in a LMIC observational study. METHODS We conducted a retrospective record review of maternity and neonatal case records for births that occurred in Soweto, Inner City- Johannesburg and Metro-East Cape Town, South Africa, between 1st July 2017 and 30th June 2018. Study staff abstracted data from randomly selected medical charts onto standardized study-specific forms. Incidence (per 100,000 population) was calculated for adverse maternal, foetal and neonatal outcomes, which were identified as priority outcomes in vaccine safety studies by the Brighton Collaboration and World Health Organization. Outcomes reported directly in the clinical notes and outcomes which fulfilled GAIA-CDs were compared. Incidence of outcomes was calculated by combining cases which were either reported in clinical notes by attending physicians and/ or fulfilled GAIA-CDs. FINDINGS Of 9371 pregnant women enrolled, 27·6% were HIV-infected, 19·9% attended antenatal clinic in the 1st trimester of pregnancy and 55·3% had ≥1 ultrasound examination. Fourteen percent of women had hypertensive disease of pregnancy, 1·3% had gestational diabetes mellitus and 16% experienced preterm labour. There were 150 stillbirths (1·6%), 26·8% of infants were preterm and five percent had microcephaly. Data available in clinical notes for some adverse outcomes, including maternal- & neonatal death, severe pre-eclampsia/ eclampsia, were able to fulfil GAIA-CDs criteria for all of the clinically-reported cases, however, missing data required to fulfil other GAIA-CD criteria (including stillbirth, gestational diabetes mellitus and gestational hypertension) led to poor correlation between clinically-reported adverse outcomes and outcomes fulfilling GAIA-CDs. Challenges were also encountered in accurately ascertaining gestational age. INTERPRETATION This study contributes to the expanding body of data on background rates of adverse maternal and foetal/ neonatal outcomes in LMICs. Utilization of GAIA-CDs assists with alignment of data, however, some GAIA-CDs require amendment to improve the applicability in LMICs. FUNDING This study was funded by Pfizer (Inc).
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Affiliation(s)
- Clare L Cutland
- Wits African Leadership in Vaccinology Expertise (Wits-Alive), School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science/ National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Shobna Sawry
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shaun Barnabas
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.
| | | | - Jean Le Roux
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science/ National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Kebonethebe Emmanuel Kekane-Mochwari
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Caroline Vika
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jeanne De Jager
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.
| | - Samantha Munson
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
| | - Babalwa Jongihlati
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
| | - James H Stark
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, 1 Portland St, Cambridge, MA, USA.
| | - Judith Absalon
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
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7
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Cunha ACMC, Katz L, Amorim AFC, Coutinho IC, Souza AS, Katz S, Souza G, Souza G, Farias L, Lemos R, Mello MZ, Neves L, Albuquerque M, Feitosa FE, Paiva J, Lima C, Lima M, Amorim MM. Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study. J Matern Fetal Neonatal Med 2023; 36:2260056. [PMID: 37748920 DOI: 10.1080/14767058.2023.2260056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.
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Affiliation(s)
- Anna Catharina M C Cunha
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | | | - Isabela Cristina Coutinho
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Alex Sandro Souza
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
| | - Sara Katz
- Universidade de Pernambuco, Recife, Brazil
| | | | | | | | - Raissa Lemos
- Universidade Catolica de Pernambuco, Recife, Brazil
| | | | - Lucas Neves
- Universidade Federal de Campina Grande, Campina Grande, Brazil
| | | | | | - Jordana Paiva
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Carolina Lima
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Marcelo Lima
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Petrolina Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
- Federal University of Campina Grande (UFCG), Campina Grande, Brazil
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Loechl CU, Datta-Mitra A, Fenlason L, Green R, Hackl L, Itzkowitz L, Koso-Thomas M, Moorthy D, Owino VO, Pachón H, Stoffel N, Zimmerman MB, Raiten DJ. Approaches to Address the Anemia Challenge. J Nutr 2023; 153 Suppl 1:S42-S59. [PMID: 37714779 PMCID: PMC10797550 DOI: 10.1016/j.tjnut.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/17/2023] Open
Abstract
Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention-inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.
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Affiliation(s)
- Cornelia U Loechl
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ananya Datta-Mitra
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Lindy Fenlason
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, Davis, CA, United States
| | - Laura Hackl
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States
| | - Laura Itzkowitz
- Bureau for Global Health, USAID, Washington, DC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc., Arlington, VA, United States.
| | | | - Helena Pachón
- Food Fortification Initiative, Emory University, Atlanta, GA, United States
| | - Nicole Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zu¨rich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Michael B Zimmerman
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, Unites States
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9
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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] [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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10
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Riascos N, Loaiza-Osorio S, Monroy A, Barona JS, Carvajal J, Echavarria MP, Nasner D, Escobar MF. Effect of the postpartum hemorrhage intervention package implementation in a fourth-level hospital in Latin America. Int J Gynaecol Obstet 2023; 163:291-301. [PMID: 37269178 DOI: 10.1002/ijgo.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the implementation of intervention packages for postpartum hemorrhage (PPH) management in pregnant women hospitalized in a High Obstetric Complexity Unit in a Latin American country. METHODS Retrospective cohort study including pregnant women with PPH attended between January 2011 to December 2019. Three periods of time were defined according to management strategies We performed univariate and multivariate robust Poisson regression logistic models for each of the outcomes derived from each period. RESULTS We included 602 patients. There was a reduction in period 3 of the incidence of massive PPH (16% versus 12% P < 0.001, relative risk [RR] 0.61, 95% confidence interval [CI] 0.44-0.85; P = 0.003), major surgery (24%, 13%, 11%, P = 0.002, RR 0.54, 95% CI 0.33-0.883; P = 0.014), and admission to the intensive care unit (ICU) (14%, 7%, 6.1%, P = 0.0, RR 0.40, 95% CI 0.17-0.96 P = 0.00). CONCLUSION The implementation of PPH intervention packages in a hospital in a middle-income country from Latin America, led to a significant decrease in the incidence of massive bleeding, the rate of major surgery, and the ICU stay of pregnant women affected by this condition.
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Affiliation(s)
- Natalia Riascos
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza-Osorio
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Angelica Monroy
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan Sebastián Barona
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - María Fernanda Escobar
- Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
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11
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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] [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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12
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Erickson EN. A prolonged latent phase: An early career in oxytocin during birth. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 15:100190. [PMID: 37405229 PMCID: PMC10316000 DOI: 10.1016/j.cpnec.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
•The author, a nurse-midwife scientist, shares her path to the study of the causes and consequences of clinical oxytocin use.•This paper highlights mentors and key research that informed new thinking about the role of oxytocin during parturition.•Future directions for improving maternal care during childbirth are presented, including genetic and epigenetic perspectives.
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13
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Latt SM, Alderdice F, Elkington M, Awng Shar M, Kurinczuk JJ, Rowe R. Primary postpartum haemorrhage and longer-term physical, psychological, and psychosocial health outcomes for women and their partners in high income countries: A mixed-methods systematic review. PLoS One 2023; 18:e0274041. [PMID: 37315027 PMCID: PMC10266652 DOI: 10.1371/journal.pone.0274041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Most research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings. METHODS The review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH. RESULTS Data were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH. CONCLUSION This review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth. PROSPERO REGISTRATION PROSPERO registration number: CRD42020161144.
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Affiliation(s)
- Su Mon Latt
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Madeline Elkington
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mahkawnghta Awng Shar
- Health and Nutrition Specialist, United Nations International Children Fund, Myanmar
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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14
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Yılmaz Ergani S, Dicle İ, Aksan A, İbanoğlu MC, Tokgöz Çakır B, Kınay T, Erkaya S, İskender CT, Çelen Ş, Çağlar AT, Engin-Üstün Y. Postoperative care in the caesarean intensive care unit: experience from a tertiary maternity hospital. J Turk Ger Gynecol Assoc 2023; 24:42-47. [PMID: 35266372 PMCID: PMC10019003 DOI: 10.4274/jtgga.galenos.2022.2021-9-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective The aim was to determine whether follow-up in the intensive care unit (ICU) for the postoperative first eight hours was beneficial for early intervention in postpartum hemorrhage. Material and Methods In our hospital, all patients are admitted to the ICU for the first eight hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively. Results All cases (n=36,396) who underwent cesarean delivery were reviewed. Three hundred and fifty-nine patients with postpartum hemorrhage were identified and included. In the study group the time between cesarean section and diagnosis of postpartum hemorrhage was 10.1±19.1 hours, and the time between cesarean section and re-laparotomy was 9.26±23.1 hours. A total of three maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivering by cesarean section was 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births. Conclusion Follow-up of patients in the ICU in the first eight postoperative hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.
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Affiliation(s)
- Seval Yılmaz Ergani
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - İskender Dicle
- Clinic of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Alperen Aksan
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Müjde Can İbanoğlu
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Betül Tokgöz Çakır
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Tuğba Kınay
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Can Tekin İskender
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Ali Turhan Çağlar
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Üstün
- Clinic of Perinatology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
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15
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Sarıdoğan E, Onat T, Arda Düz S, Tuncay G, Abdurahmanova N, Orujova L, Karaer A. Bernard-Soulier Syndrome from the Perspective of the Obstetrician: A Case Report with a Review of the Literature. Z Geburtshilfe Neonatol 2023. [PMID: 36889343 DOI: 10.1055/a-2024-0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Bernard-Soulier syndrome (BSS) is one of the rare inherited platelet disorders that is characterized by macrothrombocytopenia and adhesion abnormality due to the absence or malfunctioning of the membrane GPIb-IX-V complex. There is no high-quality evidence on obstetric management of BSS owing to its rarity. Here we report an uncomplicated delivery of an adolescent with BSS and review the literature on the topic of BSS and pregnancy. METHODS PUBMED, EMBASE, COCHRANE, and Google Scholar databases were searched up to April 2022 without language and year restriction using the terms "Bernard Soulier" and "Pregnancy". The primary objectives were to evaluate maternal and fetal outcomes. The secondary objectives were to analyze pregnancy complications, gestational age at delivery, mode of delivery, administered prophylaxis, treatment approaches, duration of postpartum hospitalization, and the postpartum requirement of blood and blood product. RESULTS The patient was a 19-year-old and 39-week pregnant woman who was diagnosed with BSS at the age of 10 by flow cytometry and genetic analysis. Single donor platelet transfusions and oral tranexamic acid were administered as prophylaxis at the peripartum period. She was delivered by cesarean section due to failure of labor. The postpartum period was uneventful for both mother and neonate. In the literature review, postpartum hemorrhage (PPH) was found in 52.9% (27/51) of deliveries. Late PPH occurred more frequently than early PPH (35.3 and 31.4%, respectively). 49% (25/51) of pregnancies had severe thrombocytopenia, and antepartum hemorrhage was observed in 11.8% (6/51) of those. The platelet count was in close relation to antenatal complications. 64.7% (33/51) of the patients were delivered via cesarean section. PPH and late PPH were found to be more common in those who delivered vaginally compared to those who delivered by caesarean section. It was observed that PPH was less common in women who were given prophylaxis in the peripartum period. CONCLUSION BSS is an inherited macro-thrombocytopathy that may cause adverse maternal and neonatal outcomes. The optimal mode and timing of delivery remain unclear. A multidisciplinary approach with prophylaxis at the peripartum period should be applied.
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Affiliation(s)
- Erdinç Sarıdoğan
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Taylan Onat
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Senem Arda Düz
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Görkem Tuncay
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Nuray Abdurahmanova
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Lumayat Orujova
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
| | - Abdullah Karaer
- Obstetrics and Gynecology, Inonu University School of Medicine, Malatya, Turkey
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16
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Esan DT, Imene PO, Akingbade O, Ojo EF, Ramos C. Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:93-101. [PMID: 36228976 DOI: 10.1016/j.enfcle.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/18/2022] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH). METHODS The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis. RESULTS Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team. CONCLUSION The participants' experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.
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Affiliation(s)
- Deborah Tolulope Esan
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado- Ekiti, Ekiti State, Nigeria.
| | - Peace Oritseweyinmi Imene
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado- Ekiti, Ekiti State, Nigeria
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong; Institute of Nursing Research, Osogbo, Osun State, Nigeria
| | - Elizabeth Funmilayo Ojo
- Department of Nursing Science, College of Medicine and Health Sciences, Afe Babalola University, Ado- Ekiti, Ekiti State, Nigeria
| | - Carlos Ramos
- Department of Pediatrics, University of California San Diego, USA
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17
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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18
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Chauke L, Bhoora S, Ngene NC. Postpartum haemorrhage - an insurmountable problem? Case Rep Womens Health 2023; 37:e00482. [PMID: 37064210 PMCID: PMC10101845 DOI: 10.1016/j.crwh.2023.e00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Lawrence Chauke
- Department of Obstetrics and Gynaecology, School of Clinical Medicine & Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Corresponding author.
| | - Shastra Bhoora
- Department of Obstetrics and Gynaecology, School of Clinical Medicine & Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Baylor College of Medicine, TX, United States of America
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, Gauteng Province, South Africa
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19
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Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage. COMMUNICATIONS MEDICINE 2023; 3:11. [PMID: 36707542 PMCID: PMC9882749 DOI: 10.1038/s43856-023-00244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/12/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality. METHODS We measured and compared the level of OXTR DNA methylation between matched blood and uterine myometrium to evaluate blood as an indicator of uterine methylation status using targeted pyrosequencing and sites from the Illumina EPIC Array. Next, we tested for OXTR DNA methylation differences in blood between individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls following vaginal birth. Bivariate statistical tests, generalized linear modeling and Poisson regression were used in the analyses. RESULTS Here we show a significant positive correlation between blood and uterine DNA methylation levels at several OXTR loci. Females with higher OXTR DNA methylation in blood had required significantly more exogenous oxytocin during parturition. With higher DNA methylation, those who had oxytocin administered during labor had significantly greater relative risk for postpartum hemorrhage (IRR 2.95, 95% CI 1.53-5.71). CONCLUSIONS We provide evidence that epigenetic variability in OXTR is associated with the amount of oxytocin administered during parturition and moderates subsequent postpartum hemorrhage. Methylation can be measured using a peripheral tissue, suggesting potential use in identifying individuals susceptible to postpartum hemorrhage. Future studies are needed to quantify myometrial gene expression in connection with OXTR methylation.
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20
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Mahmood I, Abdelrahman H, Hakim S, El-Menyar A, Rizoli S, Asim M, Al-hassani A, Abdulrahman Y, Strandvik G, Al-Thani H. A multidisciplinary approach to rescue a full-term pregnant and her fetus after blunt abdominal trauma: A case report and literature review. J Surg Case Rep 2022; 2022:rjac559. [PMCID: PMC9741517 DOI: 10.1093/jscr/rjac559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
Abstract
Blunt abdominal trauma due to motor vehicle crash is one of the leading causes of mortality during pregnancy. Though the trauma team plays a critical role in the initial management, a multidisciplinary contribution is essential to ensure the safety of the mother and her fetus. This case report followed the multidisciplinary approach for the management of a 32-year-old female during the last week of pregnancy. She sustained blunt trauma causing maternal and fetal distress due to abruption of the placenta with a large intrauterine and retroplacental hemorrhage, retro-hepatic and retroperitoneal hemorrhage, pseudoaneurysm of uterine arteries leading to postpartum hemorrhage. Immediate intervention and management at a Level 1 trauma center led to survival of both the mother and infant.
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Affiliation(s)
- Ismail Mahmood
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Husham Abdelrahman
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Suhail Hakim
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Ayman El-Menyar
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
- Weill Cornell Medical College Department of Clinical Medicine, , Doha, Qatar
| | - Sandro Rizoli
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Mohammad Asim
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Ammar Al-hassani
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Yassir Abdulrahman
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
| | - Gustav Strandvik
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
- Qatar University Department of Surgery, College of Medicine, , Doha, Qatar
| | - Hassan Al-Thani
- Hamad Medical Corporation Department of Surgery, Trauma Surgery, , Doha, Qatar
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Tolulope Esan D, Oritseweyinmi Imene P, Akingbade O, Funmilayo Ojo E, Ramos C. Manejo de la hemorragia posparto por parte de las matronas en centros sanitarios del estado de Ekiti: estudio cualitativo exploratorio. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Muacevic A, Adler JR, Prasad MK, Singh AV, Sharma S, Singh B, Singh TH, Kumar P, Singh HV, Singh S. Obstetric and Maternal Outcomes After B-Lynch Compression Sutures: A Meta-Analysis. Cureus 2022; 14:e31306. [PMID: 36514660 PMCID: PMC9734287 DOI: 10.7759/cureus.31306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
This review article aimed to determine the obstetric and maternal outcomes after B-Lynch compression sutures to control atonic postpartum hemorrhage (PPH). This meta-analysis was performed after registering the protocol in the PROSPERO database with the registration number CRD42022355358. Two independent reviewers systematically searched electronic databases and search engines (PubMed, Cochrane Library, and Google Scholar) to retrieve published articles from inception to July 2022. The obstetric and maternal outcomes after the B-Lynch compression suture were computed using the random-effects model in pooled proportion with a 95% confidence interval (CI). Meta-regression analysis and subgroup analysis were performed to explain any source of possible heterogeneity. Quality assessment of the included studies was done using Joanna Briggs Institute (JBI) tools which are critical appraisal tools for systematic reviews and meta-analyses. This meta-analysis included a total of 30 studies involving 1,270 subjects. The pooled proportion of B-Lynch suture alone was 91% (95% CI = 82-97%). The combined proportion of B-Lynch suture plus another compression suture was 1% (95% CI = 0-3%), and the pooled proportion of B-Lynch suture plus vessel ligation was 3% (95% CI = 1-6%). The pooled proportions of PPH controlled and hysterectomies were 94% (95% CI = 91-97%, I2 = 65.3%) and 7% (95% CI = 4-10%, I2 = 72.13%), respectively. Therefore, B-Lynch suture (either alone or in combination with other techniques) is a simple and effective measure to control atonic PPH.
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Faria I, Thivalapill N, Makin J, Puyana JC, Raykar N. Bleeding, Hemorrhagic Shock, and the Global Blood Supply. Crit Care Clin 2022; 38:775-793. [PMID: 36162910 DOI: 10.1016/j.ccc.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hemorrhage is responsible for at least 40% of deaths after trauma and 27% of maternal deaths worldwide. Patients with hemorrhagic shock require attentive critical care and transfusion of blood products. Access to a safe and affordable blood supply is critical to providing safe surgical care. Traumatic injury, obstetric hemorrhage, and upper gastrointestinal bleed are the main causes of severe bleeding requiring transfusion. This article discusses the presentation and management of these causes across the world and provides a brief overview of the current challenges in maintaining a global blood supply.
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Affiliation(s)
- Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Hungtington Avenue, Boston, MA 02115, USA; Faculdade de Medicina da Universidade Federal de Minas Gerais, 190 Avenida Professor Alfredo Balena, Belo Horizonte, MG 31130450, Brazil
| | - Neil Thivalapill
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago IL 60611, USA
| | - Jennifer Makin
- Department of Obstetrics, Gynecology and Reproductive Science, The University of Pittsburgh Medical Center Magee - Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Juan Carlos Puyana
- Critical Care Medicine, and Clinical Translational Science, Pittsburgh, PA 15213, USA; University of Pittsburgh, UPMC Presbyterian, F1263, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Nakul Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Hungtington Avenue, Boston, MA 02115, USA; Division of Trauma & Emergency Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, USA.
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Mulongo S, Kaura DM, Mash B. Determinants of Obstetric Near Miss in a Tertiary Hospital in Kenya: A Retrospective Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDKenya has a high burden of facility maternal deaths but there is scarce utilization of the near miss approach to understand facility related determinants of maternal mortality. The aim of this study was to investigate determinants of near miss in a major refferal hospital in Kenya using the World Health Organization near miss approach.METHODSA retrospective study design was used in a referral hospital in Kenya. Prevalence, direct and indirect causes of near miss were determined. Binomial logistic regression was used to determine associations between maternal characteristics and maternal near miss.RESULTSMaternal near miss ratio was 8.7 per 1000 live births. The most prevalent direct factors were: Severe post-partum hemorrhage (35%), eclampsia (18.9%) severe pre-eclampsia (17.4%), blood transfusion (79%), and hepatic dysfunction (3.7%). Anemia, previous ceaserean section and prolonged/obstructed labor were the most important contributory factors. The prevalence of organ dysfunction at admission was 39%. Only 74% of eclampsia cases had received magnesium sulphate on referral. Higher gestation at delivery (AOR = 0.640, 95% C.I =0.477–0.858) and those who received antenatal care from a level two or three facility (AOR = 0.190, 95% CI = 0.042–0.856) were less likely to experience a near miss.CONCLUSIONObstetric hemorrhage and pregnancy induced hypertension were the most important direct determinants of near miss, while anemia was the most important indirect determinant. Organ dysfunction on admission to the tertiary referral facility was high, suggesting delays in interventions at lower level facilities. Interventions addressing obstetric hemorrhage, pregnancy induced hypertension and pre-natal anemia may reduce the burden of near miss and mortality.
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Chen J, Ye Y, Huang D, Pan D, Qiu X, Lei L, Luo X, Li J, Wu K, Xiao S, Liu S, Zeng X. The mediating role of coagulation function on the association of prenatal exposure to aflatoxin B1 and postpartum hemorrhage in Guangxi, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:37543-37555. [PMID: 35066843 DOI: 10.1007/s11356-021-18186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Pregnant women are vulnerable to certain environmental agents, one of which is aflatoxin. As one of the most popular aflatoxins, Aflatoxin B1 (AFB1) has recently garnered increased attention concerning its potential association between exposure and adverse pregnancy outcomes. The aims of the study were to examine the associations between prenatal exposure to AFB1 and postpartum hemorrhage (PPH), and whether coagulation function has a mediating effect on their relationship. A total of 379 mother-infant pairs were included in the present study. Prenatal serum AFB1 albumin (AFB1-Alb) adduct levels in peripheral venous blood were detected by using an ELISA kit. Multiple linear and logistics regression models were applied to analyze the relationship between AFB1-Alb levels and PPH. We found mothers with high levels of AFB1-Alb adduct levels had significantly increased postpartum blood loss (partial regression coefficient (β) = 50.71, 95% confidence interval (CI) 3.48, 97.95). Mothers with high levels of AFB1-Alb adduct levels also had significantly increased risk of PPH (odds ratio (OR) = 4.81, 95% CI 1.01, 22.98). Moreover, concentrations of AFB1-Alb were positively associated with activated partial thromboplastin time (APTT) while negatively associated with fibrinogen (FIB). One-unit increase in APTT was correlated with a 6.62-ml (95% CI 3.04, 10.20) increase in postpartum blood loss. Mediation analysis suggested that the maternal blood APTT levels had a positive mediating effect in the association between AFB1-Alb adduct levels and postpartum blood loss (β = 0.32, 95% CI 0.04, 0.68). These results indicated that prenatal exposure to AFB1 was associated with increased postpartum blood loss, possibly by interfering with maternal APTT levels.
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Affiliation(s)
- Jiehua Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Ye Ye
- Guangxi Liuzhou Iron & Steel Group Co. Ltd Center for Disease Control and Prevention, Liuzhou, 545002, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Lei Lei
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Xingxi Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jinxiu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Kaili Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Suyang Xiao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Shun Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22 Shuangyong Road, Nanning, 530021, Guangxi, China.
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Uterine arteriovenous malformation (UAVM) as a rare cause of postpartum hemorrhage (PPH): a literature review. Arch Gynecol Obstet 2022; 306:1873-1884. [DOI: 10.1007/s00404-022-06498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/26/2022] [Indexed: 11/02/2022]
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Burke TF, Shivkumar PV, Priyadarshani P, Garg L, Conde-Agudelo A, Guha M. Impact of the introduction of a low-cost uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage in India: A comparative before-and-after study. Int J Gynaecol Obstet 2022; 159:466-473. [PMID: 35212417 DOI: 10.1002/ijgo.14156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of introducing a uterine balloon tamponade (ESM-UBT) device for managing severe postpartum hemorrhage (PPH), mainly due to uterine atony, in health facilities in India on the rates of PPH-related maternal death and invasive procedures for PPH control. METHODS We used a quasi-experimental, difference-in-difference (DID) design to compare changes in the rates of a composite outcome (PPH-related maternal death and/or artery ligation, uterine compression sutures, or hysterectomy) among women delivering in nine intervention facilities compared with those delivering in two control facilities, before and after the introduction of ESM-UBT. RESULTS The study sample included 214 123 deliveries (n = 78 509 before ESM-UBT introduction; n = 47 211 during ESM-UBT introduction; and n = 88 403 after ESM-UBT introduction). After introduction of ESM-UBT, there was a significant decline in the rate of the primary composite outcome in intervention facilities (21.0-11.4 per 10 000 deliveries; difference -9.6, 95% confidence interval -14.0 to -5.4). Change in the rate of the primary composite outcome was not significant in control facilities (11.7-17.2 per 10 000 deliveries; difference 5.4, 95% confidence interval -3.9 to 14.9). DID analyses showed there was a significant reduction in the rate of the primary composite outcome in intervention facilities relative to control facilities (adjusted DID estimate -15.0 per 10 000 points, 95% confidence interval -23.3 to -6.8; P = 0.005). CONCLUSION Introduction of the ESM-UBT in health facilities in India was associated with a significant reduction in PPH-related maternal death and/or invasive procedures for PPH control.
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Affiliation(s)
- Thomas F Burke
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Poonam V Shivkumar
- Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Preeti Priyadarshani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Lorraine Garg
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Moytrayee Guha
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Brown School of Public Health, Providence, Rhode Island, USA
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Charaya H, Soni M, Gupta J, Nayak A. Comparison of sublingual misoprostol with intramuscular oxytocin in active management of the third stage of labor. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wikkelsø AJ, Secher EL, Edwards H. General or regional anaesthesia for postpartum haemorrhage-A national population-based cohort study. Acta Anaesthesiol Scand 2022; 66:103-113. [PMID: 34582572 DOI: 10.1111/aas.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/03/2021] [Accepted: 09/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaesthesia is required to assist the treatment of postpartum haemorrhage (PPH) when manual removal of the placenta or emptying of the uterine cavity is required. The choice between general or regional anaesthesia may depend upon factors such as existing epidural, airway, hypovolaemia, and tradition. METHODS Data from a randomized controlled trial of PPH (FIB-PPH) was used to reveal differences between delivery centres. In addition, national data of 5,601 PPH procedures requiring anaesthesia during 2010-2015 was collected from the Danish Medical Birth Registry, the National Danish Patient Registry, and the Danish Anaesthesia Database. The aim is to describe the variation in choice of anaesthesia for treatment of PPH. RESULTS Data from the randomized trial showed large differences in practice between centres not explained by physiological factors. Using national Danish registry data, we show that large delivery centres as compared to small centres prefer regional anaesthesia for PPH procedures in opposed to general anaesthesia. Sevoflurane was used despite it causing uterine relaxation. The use of general anaesthesia was associated with younger parturients, larger blood loss, and larger Body-Mass Index. Aspiration was recorded in one case (0.02%). In the postoperative care-unit general anaesthesia was associated with a shorter stay, but also higher pain score at admission. CONCLUSION Practice varies immensely between delivery centres with large centres preferring regional anaesthesia. Difference in practice might be explained by level of experience, here large centres might be more confident using regional anaesthesia. Knowledge is being extrapolated from literature on caesarean sections. Future studies should address the optimal choice of anaesthesia for PPH procedures.
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Affiliation(s)
- Anne J. Wikkelsø
- Department of Anaesthesia and Intensive Care Medicine Herlev Hospital Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Medicine Bispebjerg Hospital Copenhagen Denmark
| | - Erik L. Secher
- Department of Anaesthesia and Intensive Care Medicine Rigshospitalet Copenhagen Denmark
| | - Hellen Edwards
- Department of Obstetrics and Gynaecology Herlev Hospital Copenhagen Denmark
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Alhousseini A, Romero R, Benshalom-Tirosh N, Gudicha D, Pacora P, Tirosh D, Kabiri D, Yeo L, Thachil J, Hsu CD, Hassan SS, Erez O. Nonovert disseminated intravascular coagulation (DIC) in pregnancy: a new scoring system for the identification of patients at risk for obstetrical hemorrhage requiring blood product transfusion. J Matern Fetal Neonatal Med 2022; 35:242-257. [PMID: 31931643 PMCID: PMC9019739 DOI: 10.1080/14767058.2020.1716330] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nonovert disseminated intravascular coagulation (DIC) is a subclinical hemostatic dysfunction that has not yet reached the decompensation stage. The detection of pregnant patients at this stage may assist in the identification of those who will develop severe obstetrical hemorrhage, as it is one of the leading causes for preventable maternal mortality. Currently, nonovert DIC is diagnosed by a scoring system based on nonpregnant patients, originally generated by the International Society on Thrombosis and Hemostasis (ISTH), which does not address the physiologic changes of the hemostatic system during pregnancy. OBJECTIVES (1) To develop a pregnancy-specific nonovert DIC score, (2) to determine the diagnostic performance of this score in detecting women at risk for obstetrical hemorrhage requiring blood product transfusion, and (3) to compare it to the existing ISTH nonovert DIC score. STUDY DESIGN This retrospective study has longitudinal and cross-sectional components and includes three steps: (1) characterization of the longitudinal changes in the components of modified ISTH nonovert DIC scores, including these parameters - fibrinogen, antithrombin III, protein C, prothrombin time (PT), platelets, thrombin-antithrombin (TAT) complex, and D-dimer - during gestation in a group of normal pregnancies (n = 50); (2) development of a pregnancy-specific nonovert DIC score in a cross-sectional design of high-risk (n = 152) and control (n = 50) pregnancies, based on the predictive performance of each analyte for the detection of women at risk for obstetrical hemorrhage requiring blood product transfusion and a logistic regression model; and (3) comparison between the diagnostic performance of the pregnancy-specific nonovert DIC score and the modified ISTH nonovert DIC score to detect, upon admission, women who are at increased risk for subsequent development of obstetrical hemorrhage requiring blood product transfusion. RESULTS (1) The study cohort included 202 patients, of which 21 (10%) had obstetrical hemorrhage that required blood product transfusion and were considered to have nonovert DIC; (2) using the nonpregnant ISTH nonovert DIC score, 92% of the patients had a D-dimer concentration above the 0.5 mg/L threshold, and only 2% were identified to have a low fibrinogen concentration (<100 mg/dL); thus, this scoring system was unable to identify any of the patients with nonovert DIC based on the suggested cutoff of a score of ≥5; (3) the parameters included in the pregnancy-specific nonovert DIC score were selected based on their contribution to the performance of the model for the prediction of women at risk for obstetrical hemorrhage requiring blood product transfusion; as a result, we excluded the PT difference parameter from the score and the TAT complex concentration was added; and (4) a pregnancy-specific nonovert DIC score of ≥3 had a sensitivity of 71.4% and a specificity of 77.9% to identify patients at risk for obstetrical hemorrhage requiring blood product transfusion. CONCLUSION We propose (1) a pregnancy-specific nonovert DIC score adjusted for the physiologic changes in the hemostatic system during gestation; and (2) that the pregnancy-specific nonovert DIC score can be a useful tool for the identification of patients at risk for obstetrical hemorrhage requiring blood product transfusion.
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Affiliation(s)
- Ali Alhousseini
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA,Detroit Medical Center, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Miami International University, Miami, Florida, USA
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dereje Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Doron Kabiri
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA,Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Maternity Department “D,” Division of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Rouzi AA, Sulaimani M. Damage-Control Surgery for Maternal Near-Miss Cases of Placenta Previa and Placenta Accreta Spectrum. Int J Womens Health 2021; 13:1161-1165. [PMID: 34858065 PMCID: PMC8631974 DOI: 10.2147/ijwh.s334743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose There is paucity of reports on damage control surgery use in near-miss cases associated with placenta previa, and placenta accreta spectrum. The objective is to report the outcome of damage control surgery for the obstetrical hemorrhage in near-miss cases of placenta previa and placenta accreta spectrum. Materials and Methods The records of all women who had damage control surgery defined as abdominopelvic packing, followed by a period of medical stabilization in the intensive care unit for near-miss placenta previa and placenta accreta spectrum at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between November 1, 2007, and March 1, 2020, were identified and reviewed. Results During the study period, seven women met the inclusion criteria. There were three women with placenta previa, three women with placenta previa accreta, and one woman with placenta accreta. Five women had cesarean section followed by laparotomy, hysterectomy, and damage control surgery, one woman had a cesarean hysterectomy and damage control surgery, and one woman had hysterectomy and damage control surgery. Estimated “near-miss” intraoperative bleeding ranged from 2 to 7 liters for the seven women (median 5 L; IQR 3.5, 6), which was managed by massive blood transfusion. Complications included disseminated intravascular coagulation (3 women), intestinal obstruction (1 woman), acute renal failure (1 woman), and vesicovaginal fistula (1 woman). Hospital stay ranged from 8 to 44 days (median 37; IQR 21, 39). Conclusion Damage control surgery can be life-saving. It should be in the armamentarium of the health care providers managing women with placenta previa, and placenta accreta spectrum.
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Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Sulaimani
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
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Yang Y, He J, Deng N. Factors Associated with Primary Postpartum Hemorrhage in Elderly Women Undergoing Repeated Cesarean Deliveries. Int J Womens Health 2021; 13:1261-1267. [PMID: 35002333 PMCID: PMC8721015 DOI: 10.2147/ijwh.s332020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to analyze the risk factors for primary postpartum hemorrhage in elderly parturients undergoing repeated cesarean delivery (PHEPWRCD). Participants and Methods The clinical data of 1675 elderly parturients who underwent repeated cesarean delivery in our hospital from May 2011 to March 2020 were retrospectively collected for analysis. The women were divided into a postpartum hemorrhage group (116 individuals) and a nonpostpartum hemorrhage group (1559 individuals). We analyzed the association of maternal age, maternal history, pregnancy complications, placenta and other factors with postpartum hemorrhage in elderly women who underwent repeated cesarean delivery and screened out independent risk factors by multivariate logistic regression analysis. Results The incidence rate of PHEPWRCD was 6.92% (116/1675). Using single-factor analysis of variance, we found that maternal age (p=0.012), the number of pregnancies (p=0.007), the number of cesarean deliveries (p<0.001), fetal position (p<0.001), fetal macrosomiaren (p<0.001), placental attachment position (p<0.001), placenta previa (p<0.001), and placental implantation (p<0.001) were significantly associated with PHEPWRCD. Multivariate logistic regression analysis showed that the number of cesarean deliveries (OR=2.457, 95% CI=1.453–4.540, P=0.013), placenta previa (OR=11.741, 95% CI=5.874–26.078, P<0.001), placenta implantation (OR=6.844, 95% CI=3.514–14.873, P<0.001), placental attachment position (OR=2.421, 95% CI=1.275–3.917, P=0.009) and fetal position (OR=5.722, 95% CI=3.817–16.577, P<0.001) were independent risk factors for PHEPWRCD. Conclusion This study found that the number of cesarean deliveries, placental attachment, placental previa, and placental implantation are independent risk factors for PHEPWRCD.
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Affiliation(s)
- Yan Yang
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
- Correspondence: Yan Yang Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of ChinaTel/Fax +86 23-85653335 Email
| | - Jiajia He
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
| | - Na Deng
- Department of Obstetrics, Dianjiang Country People’s Hospital of Chongqing, Chongqing, 408300, People’s Republic of China
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Knoll W, Phelan R, Hopman WM, Ho AMH, Cenkowski M, Mizubuti GB, Ghasemlou N, Klar G. Retrospective review of time to uterotonic administration and maternal outcomes following post-partum hemorrhage. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:490-495. [PMID: 34844004 DOI: 10.1016/j.jogc.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Despite advances in health care and ample resources, post-partum hemorrhage (PPH) rates are increasing in high income countries. Although guidelines recommend therapeutic uterotonics, timing of administration is open to judgement and most often based on (inherently inaccurate) visual estimates of blood loss. With severe hemorrhage, every minute of delay can have significant consequences. Our objective was to examine the timing of uterotonic administration and its impact upon maternal outcomes. We hypothesized that increased time to uterotonic administration following the identification of PPH, would be associated with a greater decline in hemoglobin (Hb) and higher odds of hypotension and transfusion. METHODS We reviewed all cases of PPH that occurred at an academic centre between June 2015 and September 2017. All cases of primary PPH (i.e., those declared within 24 h of delivery with estimated blood loss [EBL] >500 mL for vaginal and >1000 mL for cesarean deliveries) were analyzed. Patient records were excluded if they were missing information regarding time of PPH declaration, uterotonic administration, and/or Hb measures, or if a pre-existing medical condition could have contributed to PPH. RESULTS Of 4397 births, there were 259 (5.9%) cases of primary PPH, of which 128 were included in this analysis. For these patients, each 5-minute delay in uterotonic treatment was associated with 26% higher odds of hypotension following delivery of any type. For vaginal deliveries (n = 86), each 5-minute delay was associated with 31% and 34% higher odds of hypotension and transfusion, respectively. CONCLUSION In this study, delay in administration of therapeutic uterotonics was associated with a higher incidence of hypotension and transfusion in primary PPH patients.
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Affiliation(s)
- William Knoll
- Queen's University School of Medicine, Department of Anesthesiology and Perioperative Medicine, Department of Molecular and Biological Sciences, Queen's University, Botterell Hall, 18 Stuart Street, Kingston ON K7L 3N6 Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston ON K7L 2V7 Canada
| | - Wilma M Hopman
- Kingston Health Sciences Research Institute, KGHRI, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Marta Cenkowski
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada
| | - Nader Ghasemlou
- Department of Molecular and Biological Sciences, Department of Anesthesiology and Perioperative Medicine, ueen's University, Botterell Hall, 18 Stuart Street, Kingston ON K7L 3N6 Canada
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Victory 2, Kingston General Hospital site, Kingston Health Sciences Centre, 76 Stuart Street Kingston, ON K7L 2V7 Canada.
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Chen Y, Shi J, Zhu Y, Kong X, Lu Y, Chu Y, Mishu MM. Women with maternal near-miss in the intensive care unit in Yangzhou, China: a 5-year retrospective study. BMC Pregnancy Childbirth 2021; 21:784. [PMID: 34798869 PMCID: PMC8602992 DOI: 10.1186/s12884-021-04237-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analysis of "maternal near-misses" is expected to facilitate assessment of the quality of maternity care in health facilities. Therefore, this study aimed to investigate incidence, risk factors and causes of maternal near-misses (MNM) admitted to the intensive care unit (ICU) within five years by using the World Health Organization's MNM approach. METHODS A five-year retrospective study was conducted in Subei People's Hospital of Yangzhou, Jiangsu Province from January 1, 2015 to December 31, 2019. Risk factors in 65 women with MNM in the intensive care unit (ICU) were explored by using chi-square tests and multivariable logistic regression analysis. Causes and interventions in MNM were investigated by descriptive analysis. RESULTS Average maternal near-miss incidence ratio (MNMIR) for ICU admission was 3.5 per 1000 live births. Average maternal mortality ratio (MMR) was 5 per 100,000 live births. MI for all MNM was 0.7%. Steady growth of MNMIR in ICU was witnessed in the five-year study period. Women who were referred from other hospitals (aOR 3.32; 95%CI 1.40-7.32) and had cesarean birth (aOR 4.96; 95%CI 1.66-14.86) were more likely to be admitted in ICU. Neonates born to women with MNM admitted in ICU had lower birthweight (aOR 5.41; 95%CI 2.53-11.58) and Apgar score at 5 min (aOR 6.39; 95%CI 2.20-18.55) compared with women with MNM outside ICU. ICU admission because of MNM occurred mostly postpartum (n = 63; 96.9%). Leading direct obstetric causes of MNM admitted in ICU were hypertensive diseases of pregnancy (n = 24; 36.9%), followed by postpartum hemorrhage (n = 14; 21.5%), while the leading indirect obstetric cause was heart diseases (n = 3; 4.6%). CONCLUSIONS Risk factors that were associated with MNM in ICU were referral and cesarean birth. Hypertensive disease of pregnancy and postpartum hemorrhage were the main obstetric causes of MNM in ICU. These findings would provide guidance to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for cesarean birth.
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Affiliation(s)
- Ying Chen
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jiaoyang Shi
- Department of Obstetrics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Yuting Zhu
- School of Nursing, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xiang Kong
- Department of Obstetrics and Gynecology, Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China.
| | - Yang Lu
- Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yanru Chu
- Ningbo Center for Disease Control and Prevention, Ningbo, China
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Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health 2021; 11:04048. [PMID: 34737857 PMCID: PMC8542378 DOI: 10.7189/jogh.11.04048] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Maternal deaths remain high in Sub-Saharan Africa (SSA) and their causes of maternal death must be analysed frequently in this region to guide interventions. Methods We conducted a systematic review of studies published from 2015 to 2020 that reported the causes of maternal deaths in 57 SSA countries. The objective was to identify the leading causes of maternal deaths using the international classification of disease - 10th revision, for maternal mortality (ICD-MM). We searched PubMed, WorldCat Discovery Libraries Worldwide (including Medline, Web of Science, LISTA and CNHAL databases), and Google Scholar databases and citations, using the search words "maternal mortality", "maternal death", "pregnancy-related death", "reproductive age mortality" and "causes" as MeSH terms or keywords. The last date of search from all databases was 21 May 2021. We included original research articles published in English and excluded articles that mentioned SSA country names without study results for those countries, studies that reported death from a single cause or assigned causes of death using computer models or incompletely broke down the causes of death. We exported, de-duplicated and screened the searches electronically in EndNote version 20. We selected the final articles by reading the titles, abstracts and full texts. Two authors searched the articles and assessed the risk of bias using a tool adapted from Montoya and others. Data from the articles were extracted onto an Excel worksheet and the deaths classified into ICD-MM groups. Proportions were calculated with 95% confidence intervals and compared for deaths attributed to each cause and ICD-MM group. We compared the results with WHO and Global Burden of Disease (GDB) estimates. Results We identified 38 studies that reported 11 427 maternal and four incidental deaths. Twenty-one of the third-eight studies were retrospective record reviews. The leading causes of death (proportions and 95% confidence intervals (CI)) were obstetric hemorrhage: 28.8% (95% CI = 26.5%-31.2%), hypertensive disorders in pregnancy: 22.1% (95% CI = 19.9%-24.2%), non-obstetric complications: 18.8% (95% CI = 16.4%-21.2%) and pregnancy-related infections: 11.5% (95% CI = 9.8%-13.2%). The studies reported few deaths of unknown/undetermined and incidental causes. Conclusions Limitations of this review were the failure to access more data from government reports, but the study results compared well with WHO and GDB estimates. Obstetric hemorrhage, hypertensive disorders in pregnancy, non-obstetric complications, and pregnancy-related infections are the leading causes of maternal deaths in SSA. However, deaths from incidental causes are likely under-reported in this region. SSA countries must continue to invest in health information systems that collect and publishes comprehensive, quality, maternal death causes data. A publicly accessible repository of data sets and government reports for causes of maternal death will be helpful in future reviews. This review received no specific funding and was not registered.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, South Africa.,Department of Obstetrics and Gynaecology, Victoria Falls Hospital, Zimbabwe
| | - Michael Nyakura
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoderick Machekano
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, South Africa
| | - Robert Pattinson
- Unit of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Yargawa J, Fottrell E, Hill Z. Women's perceptions and self-reports of excessive bleeding during and after delivery: findings from a mixed-methods study in Northern Nigeria. BMJ Open 2021; 11:e047711. [PMID: 34635515 PMCID: PMC8506868 DOI: 10.1136/bmjopen-2020-047711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore lay perceptions of bleeding during and after delivery, and measure the frequency of self-reported indicators of bleeding. SETTING Yola, North-East Nigeria. PARTICIPANTS Women aged 15-49 years who delivered in the preceding 2 years of data collection period (2015-2016), and their family members who played key roles. METHODS Data on perceptions of bleeding were collected through 7 focus group discussions, 21 in-depth interviews and 10 family interviews. Sampling was purposive and data were analysed thematically. A household survey was then conducted with 640 women using cluster sampling on postpartum bleeding indicators developed from the qualitative data; data were analysed descriptively. RESULTS Perceptions of excessive bleeding fell under four themes: quantity of blood lost; rate/duration of blood flow; symptoms related to blood loss and receiving birth interventions/hearing comments from birth attendants. Young and less educated rural women had difficulty quantifying blood loss objectively, including when shown quantities using bottles. Respondents felt that acceptable blood loss levels depended on the individual woman and whether the blood is 'good' or 'diseased/bad.' Respondents believed that 'diseased' blood was a normal result of delivery and universally took steps to help it 'come out.' In the quantitative survey, indicators representing less blood loss were reported more frequently than those representing greater loss, for example, more women reported staining their clothes (33.6%) than the bed (18.1%) and the floor (6.2%). Overall, indicators related to quantity and rate of blood flow had higher frequencies compared with symptom and intervention-related/comment-related indicators. CONCLUSION Women quantify bleeding during and after delivery in varied ways and some women do not see bleeding as problematic. This suggests the need for standard messaging to address subjectivity. The range of indicators and varied frequencies highlight the challenges of measuring excessive bleeding from self-reports. More work is needed in improving and testing validity of questions.
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Affiliation(s)
- Judith Yargawa
- Institute for Global Health, University College London, London, UK
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
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Mesfin S, Dheresa M, Fage SG, Tura AK. Assessment of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: A Cross-Sectional Study. Int J Womens Health 2021; 13:663-669. [PMID: 34262356 PMCID: PMC8273907 DOI: 10.2147/ijwh.s300143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
Objective Despite implementation of different strategies, postpartum hemorrhage (PPH) continued to account for a substantial proportion of maternal deaths in Ethiopia. The objective of this study was to assess the magnitude of PPH and its associated factors among women who gave birth in a university hospital in eastern Ethiopia from 1 to 31 March 2020. Methods An institution-based cross-sectional study was conducted. A review of 653 randomly selected medical records of all deliveries from 1 March 2018 to 29 February 2020 in Hiwot Fana Specialized University Hospital (HFSUH), a university hospital in eastern Ethiopia, was conducted. Data were collected on sociodemographic characteristics, obstetric and reproductive health conditions, and presence of PPH. Data were coded, checked for completeness and entered using EpiData 3.1 and exported to SPSS 20 for analysis. Results were expressed using frequencies, tables and figures. Binary and multiple logistic regression were fitted to identify factors associated with PPH and associations were described using adjusted odds ratio (aOR) along with 95% confidence intervals (CI). Associations with p<0.05 in the multivariable logistic regression were declared as statistically significant. Results From a total of 642 (98.3%) women included in this study, 83 (12.9%; 95% CI 10.4–15.6) had PPH. Maternal age >35 years (aOR = 3.08; 95% CI 1.56, 6.07), no antenatal care (aOR = 3.65; 95% CI 1.97, 6.76), history of PPH (aOR = 4.18; 95% CI 1.99, 8.82), and being grand multigravida (aOR = 3.33; 95% CI 1.14, 9.74) were significantly associated with having PPH. Conclusion A high proportion of women who gave birth in HFSUH experienced PPH. Prevention and management of PPH should focus on improving antenatal care and prioritize grand multigravida, older women, and women with a previous history of PPH.
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Affiliation(s)
- Sinetibeb Mesfin
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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TorkmannejadSabzevari M, Eftekhari Yazdi M, Rad M. Lived experiences of women with maternal near miss: a qualitative research. J Matern Fetal Neonatal Med 2021; 35:7158-7165. [PMID: 34219597 DOI: 10.1080/14767058.2021.1945576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A near-miss experience has long-term and major impacts on mothers and their families. Therefore, evaluating the nature of maternal near-miss (MNM) could shed light on various aspects of the associated complications in women. The present study aimed to determine the lived experiences of women with MNM. METHODS AND MATERIALS This qualitative research was conducted using conventional content analysis on 10 mothers with an MNM experience, who were selected based on the inclusion criteria. Data were collected via semi-structured interviews about the experiences of the mothers during and after the near-miss incident. Data analysis was performed using the conventional content analysis technique. RESULTS Five main categories were extracted, including fears and concerns, failure to accept and adapt, tolerating physical and psychological pain and hardships, death experience, and medical team mismanagement. Regret and fear of raising the child with siblings, fear of the re-marriage of the spouse, and fear of complications and costs were among the subcategories of fears and concerns. Lack of adaptation to the complications and prolonged mourning were the subcategories of failure to accept and adapt, and the subcategories of tolerating physical and psychological pain and hardships were a sense of guilt, tolerating physical pain, hopelessness, irritability, hatred toward the medical team, and postpartum depression. In addition, returning to normal life, and seeing/actually feeling death were the subcategories of the death experience. The subcategories of the medical team mismanagement included medical errors, lack of support/negligence, communication problems, and distrust of the medical center. DISCUSSION According to the results, the mothers were faced with multiple problems, including fears and concerns, failure to adapt to the problem, and numerous physical and psychological issues after an MNM experience. However, they believed that medical errors, the improper communications of the medical team, and their negligence toward patients were among the factors intensifying the complications.
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Affiliation(s)
| | - Mitra Eftekhari Yazdi
- Department of Obstetrics and Gynecology, School of Medicine, Mobini Maternity Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mostafa Rad
- Medical Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Cuesta-Galindo MG, Bravo-Aguirre DE, Serna-Vela FJ, Camarillo-Contreras OO, Yañez-Torres JDJO, Robles-Martínez MDC, Rosas-Cabral A. Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes. Cureus 2021; 13:e16145. [PMID: 34354884 PMCID: PMC8328394 DOI: 10.7759/cureus.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background Extreme maternal morbidity is defined as "events that potentially threaten the life of a pregnant woman during pregnancy, childbirth or the puerperium, but that due to a medical intervention the patient does not die", and this is an indicator of health quality at the hospital and demographic level. Objective The aim of this study was to determine the prevalence of extreme maternal morbidity in the Women´s Hospital of Aguascalientes, Mexico. Material and methods A retrospective cross-sectional study was conducted under the criteria of the World Health Organization and the Latin American Federation of Obstetrics and Gynecology Societies for the definition of extreme maternal morbidity to determine the prevalence of near miss morbidity, between January 1 and December 31, 2016. Results We found 165 cases of extreme maternal morbidity; no maternal death was registered during the study year. The extreme maternal morbidity rate was 0.016 and 16.69 per 1000 live births; the ratio of extreme maternal morbidity cases / obstetric admissions was 11.07. The prevalence of extreme maternal morbidity was 1.6%. The main causes of extreme maternal morbidity were hypertensive disorders (57%), obstetric hemorrhage (29%), sepsis (1%) and other (13%). Conclusion Extreme maternal morbidity in our institution had a similar prevalence to that reported in other countries and was mainly caused by hypertensive disorders.
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Affiliation(s)
- Mayela G Cuesta-Galindo
- Gynecology and Obstetrics Department, Women's Hospital of Aguascalientes, Aguascalientes, MEX
| | - Daniel E Bravo-Aguirre
- Gynecology and Obstetrics Department, Women's Hospital of Aguascalientes, Aguascalientes, MEX
| | - Francisco J Serna-Vela
- Investigation Department, Health Services Institute of the State of Aguascalientes, Aguascalientes, MEX
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Gaitán-Duarte H, Estrada-Orozco K. La seguridad en los servicios de salud, un problema prioritario en la atención de la mujer a nivel mundial. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2021; 72:141-148. [PMID: 34506701 PMCID: PMC8425359 DOI: 10.18597/rcog.3750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/05/2022]
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Escobar MF, Valencia P, Jaimes LM, Hincapié LC, Pulgarín EE, Nasner D, Carvajal J, Echavarría MP, Burke T, Prada S. Resource use decrease after implementation of care bundles for treatment of postpartum hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7874-7881. [PMID: 34112062 DOI: 10.1080/14767058.2021.1937989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). METHODS Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011-2014 and 2015-2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. RESULTS The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). CONCLUSIONS The use of PPH care bundles may be associated with lower resource use and fewer interventions.
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Affiliation(s)
- María Fernanda Escobar
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paola Valencia
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia
| | | | | | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Paula Echavarría
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Thomas Burke
- Department of Emergency Medicine Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sergio Prada
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.,Centro PROESA, Universidad Icesi, Cali, Colombia
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Almutairi WM. Literature Review: Physiological Management for Preventing Postpartum Hemorrhage. Healthcare (Basel) 2021; 9:658. [PMID: 34073073 PMCID: PMC8227540 DOI: 10.3390/healthcare9060658] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper was to summarize the existing literature regarding postpartum hemorrhage (PPH) and its physiological management (i.e., skin-to-skin contact and breastfeeding). The background surrounding PPH and the role of skin-to-skin contact (SSC) and breastfeeding (BF) in PPH are identified, and these interventions are supported as a crucial means of preventing or minimizing the incidence of PPH. Despite its importance, to the best of my knowledge, an evaluation of this relationship has not yet been undertaken. The narrative literature review approach was used to summarize topic related researches. The search included three databases: CINAHL, PubMed, and Google Scholar. All articles related to the role of SSC and BF in PPH were chosen from the different databases. The findings demonstrate that SSC and BF are cost-effective methods that could be considered practices for the prevention of PPH. Immediate Skin-to-skin contact (SSC) and breastfeeding (BF) are central mediators of the psychophysiological process during the first hour after delivery (the third and fourth stages of labor).
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Affiliation(s)
- Wedad M Almutairi
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Karlsson O, Jeppsson A, Hellgren M. Factor XIII activity at onset of labour and association with postpartum haemorrhage: an exploratory post-hoc study. Int J Obstet Anesth 2021; 47:103174. [PMID: 34023143 DOI: 10.1016/j.ijoa.2021.103174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/08/2021] [Accepted: 04/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Platelets, fibrinogen and factor XIII (FXIII) are required to form a stable clot in case of haemorrhage. The aims of this study were to evaluate a possible association between FXIII activity at the onset of labour and postpartum haemorrhage (PPH), and to ascertain whether FXIII activity at labour onset differs from after delivery. METHODS FXIII activity in 239 women with PPH (blood loss >1 L) and in 76 women without PPH was compared, as was activity before and after delivery in a third group of 80 women. RESULTS FXIII activity at onset of labour was significantly lower in the PPH group compared with the control group (mean ± SD 0.98 ± 0.20 vs 1.05 ± 0.17 kIU/L; P=0.0006). The difference was significantly greater in subgroups having vaginal delivery with no oxytocin stimulation or uterine exploration (absolute difference 0.131; 95% CI 0.055 to 0.206), compared with a subgroup experiencing any complication (0.04; 95% CI -0.023 to 0.104; interaction P-value 0.098). There was a weak but statistically significant inverse correlation between FXIII and estimated blood loss (r=-0.25; P=0.030) in the control group but not the PPH group. There was no significant difference between FXIII activity at onset of labour and after delivery (mean ± SD 1.03 ± 0.17 vs 1.04 ± 0.19 kIU/L; P=0.093). CONCLUSIONS At the onset of labour women with a subsequent PPH had significantly lower mean FXIII activity than that of women without PPH. This difference was small and within normal limits. FXIII activity did not change during normal delivery. The importance of FXIII during PPH requires study.
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Affiliation(s)
- O Karlsson
- Department of Anesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Orthopedics, NU-Hospital Group, Trollhättan, Sweden.
| | - A Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Hellgren
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sweden
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Rahman AS, Chao TE, Trelles M, Dominguez L, Mupenda J, Kasonga C, Akemani C, Kondo KM, Chu KM. The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States. World J Surg 2021; 45:1400-1408. [PMID: 33560502 DOI: 10.1007/s00268-021-05972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified. METHODS This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008-December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period. RESULTS There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention. CONCLUSION Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.
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Affiliation(s)
- Arifeen S Rahman
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tiffany E Chao
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Miguel Trelles
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Lynette Dominguez
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Jerome Mupenda
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Cheride Kasonga
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Clemence Akemani
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kalla Moussa Kondo
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Dr, Tygerberg Hospital, Cape Town, 7505, South Africa.
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Dejene M, Tefera A, Dires A, Gedamu S, Getachew Y, Ademe S. Low Blood Donation Practice of Health Sciences College Students in Northeast Ethiopia: A Cross-Sectional Study. J Blood Med 2021; 12:43-51. [PMID: 33536805 PMCID: PMC7850436 DOI: 10.2147/jbm.s287398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Blood transfusion is a basic and an emergency intervention in health care facilities which has a great role in reducing significant morbidity and mortality. However, there is a major shortage of blood and blood products in developing countries including Ethiopia. This study aimed to assess practice of blood donation and associated factors among health science college students in Dessie town, northeast Ethiopia. METHODS An institution-based cross-sectional study was conducted among health science college students from May to June 2019. A pre-tested and self-administered structured questionnaire was used for data collection. Multivariable logistic regression analysis model was applied to identify independent predictors of blood donation practice at the level of significance below 0.05. RESULTS Overall, 12.4% (95% CI: 9.5-15.5) of participants had been donated blood at least once in their lifetime. However, 59.2% of participants have willingness to donate blood in the future. In this study, older age (≥25years) (AOR=2.30, 95% CI: 1.18-4.46), had family history of blood transfusion (AOR=3.55, 95% CI: 1.71-7.36), had knowledge (AOR=2.09, 95% CI: 1.04-4.17) and favorable attitude (AOR=2.41, 95% CI: 1.01-5.75) about blood donation were significantly associated with practice of donating blood. CONCLUSION In this study, blood donation practice of health sciences college students was found to be low. Age, family history of blood transfusion, knowledge and attitude towards blood donation were independent predictors of blood donation practice. Therefore, Red Cross societies, Dessie town health office, health science colleges and other stakeholders should enhance the awareness of college students regarding the importance of donating blood.
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Affiliation(s)
- Mekedes Dejene
- Emergency Department, Dessie Referral Hospital, Dessie, Ethiopia
| | - Azeb Tefera
- Emergency Department, Dessie Referral Hospital, Dessie, Ethiopia
| | - Abebe Dires
- Department of Nursing, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Gedamu
- Department of Nursing, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yemiamrew Getachew
- Department of Community and Mental Health, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sewunet Ademe
- Department of Nursing, School of Nursing and Midwifery, College of Medicine & Health Sciences, Wollo University, Dessie, Ethiopia
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Mekonnen A, Fikadu G, Seyoum K, Ganfure G, Degno S, Lencha B. Factors associated with maternal near-miss at public hospitals of South-East Ethiopia: An institutional-based cross-sectional study. WOMEN'S HEALTH 2021; 17:17455065211060617. [PMID: 34798796 PMCID: PMC8606979 DOI: 10.1177/17455065211060617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction: Maternal near-miss precedes maternal mortality, and women are still alive indicating that the numbers of near-misses occur more often than maternal mortality. This study aims to assess the prevalence of maternal near-miss and associated factors at public hospitals of Bale zone, Southeast Ethiopia. Methods: Facility-based cross-sectional study design was carried out from 1 October 2018 to 28 February 2019, among 300 women admitted to maternity wards. A structured questionnaire and checklist were used to collect data. Epi-info for data entry and statistical package for social science for analysis were used. The descriptive findings were summarized using tables and text. Adjusted odds ratio with 95% confidence interval and p-value < 0.05 were used to examine the association between the independent and dependent variables. Result: The prevalence of maternal near-miss in our study area was 28.7%. Age < 20 years, age at first marriage < 20 years, husbands with primary education, and being from rural areas are factors significantly associated with the prevalence of maternal near-miss. The zonal health department in collaboration with the education department and justice office has to mitigate early marriage by educating the community about the impacts of early marriage on health.
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Affiliation(s)
- Ashenafi Mekonnen
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Genet Fikadu
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Gemechu Ganfure
- Department of Midwifery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Sisay Degno
- Department of Public Health, School of Health Science, Madda Walabu University, Shashemene, Ethiopia
| | - Bikila Lencha
- Department of Public Health, School of Health Science, Madda Walabu University, Shashemene, Ethiopia
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The Role of Skin-to-Skin Contact and Breastfeeding on Atonic Postpartum Hemorrhage. NURSING REPORTS 2020; 11:1-11. [PMID: 34968307 PMCID: PMC8608112 DOI: 10.3390/nursrep11010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: were to (a) determine incidence of postpartum hemorrhage (PPH) in all women delivering between 2009 and 2015, and (b) determine the amount of Estimated Blood Loss (EBL) and duration of the third stage of labor in each subgroup for women with or without PPH, and (c) compare EBL and duration of 3rd stage of labor between subgroups in groups of women with or without PPH. Design: A retrospective chart review conducted using codes for atonic PPH. Setting: Records from a University based tertiary setting, 264 charts were reviewed and data from 154 charts were analyzed. One-way ANOVAs followed with post-hocs and a 2-way ANOVA were conducted. Results: PPH rate increased by 47.50% from 2009–2015. For women with PPH, EBL was lower in skin to skin contact (SSC) + Breastfeeding (BF) subgroup. For women without PPH, EBL was lower in SSC only subgroup. Third stage of labor duration was longer in women with PPH. Conclusions: Study confirmed the increasing trends of PPH due to uterine atony and proposed role of SSC and BF in decreasing EBL and shorten the duration of the 3rd stage of labor for PPH women, usefulness of SSC and BF as physiologic practices merit further study.
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Incidences of Atonic Postpartum Hemorrhage and Related Risk Factors at a Tertiary Hospital in Saudi Arabia. NURSING REPORTS 2020; 10:164-171. [PMID: 34968361 PMCID: PMC8608049 DOI: 10.3390/nursrep10020020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background: In 2017, there were 295,000 maternal deaths worldwide from preventable causes related to birth. The leading cause of maternal mortality is obstetric hemorrhage. In Saudi Arabia, a paucity of evidence about incidences of atonic Postpartum Hemorrhage (PPH) and related risk factors exists. Therefore, aims were to (a) identify incidences of atonic PPH from 2015 to 2018 (b) determine risk factors of atonic PPH in vaginal birth. Methods: Retrospective chart review with purposive sampling conducted revealed 386 charts, 220 (57%) vaginal birth and 166 (43%) caesarian section (CS). Logistic regression analysis was used. Results: Incidences of atonic PPH were 2.5% from 2015 to 2017, with the rate increasing by 12% from 2017 to 2018. In vaginal birth, significant associations between the severity of blood loss with epidural (F = 6.314, df = 1, p = 0.013), episiotomy (F = 4.38, df = 1, p = 0.038), induction of labor (IOL) (F = 1.224, df = 1, p = 0.004), and Interaction between IOL, AUG, and epidural (F = 7.24, df = 1, p = 0.041) found. Discussion: Increasing rate of atonic PPH confirmed. Epidural, episiotomy, induction of labor, and induction with augmentation are factors associated with severe atonic PPH in vaginal birth.
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50
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Verschueren KJ, Kodan LR, Paidin RR, Samijadi SM, Paidin RR, Rijken MJ, Browne JL, Bloemenkamp KW. Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname. J Glob Health 2020; 10:020429. [PMID: 33214899 PMCID: PMC7649043 DOI: 10.7189/jogh.10.020429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal near-miss (MNM) is an important maternal health quality-of-care indicator. To facilitate comparison between countries, the World Health Organization (WHO) developed the "MNM-tool". However, several low- and middle-income countries have proposed adaptations to prevent underreporting, ie, Namibian and Sub-Sahara African (SSA)-criteria. This study aims to assess MNM and associated factors in middle-income country Suriname by applying the three different MNM tools. METHODS A nationwide prospective population-based cohort study was conducted using the Suriname Obstetric Surveillance System (SurOSS). We included women with MNM-criteria defined by WHO-, Namibian- and SSA-tools during one year (March 2017-February 2018) and used hospital births (86% of total) as a reference group. RESULTS There were 9114 hospital live births in Suriname in the one-year study period. SurOSS identified 71 women with WHO-MNM (8/1000 live births, mortality-index 12%), 118 with Namibian-MNM (13/1000 live births, mortality-index 8%), and 242 with SSA-MNM (27/1000 live births, mortality-index 4%). Namibian- and SSA-tools identified all women with WHO-criteria. Blood transfusion thresholds and eclampsia explained the majority of differences in MNM prevalence. Eclampsia was not considered a WHO-MNM in 80% (n = 35/44) of cases. Nevertheless, mortality-index for MNM with hypertensive disorders was 17% and the most frequent underlying cause of maternal deaths (n = 4/10, 40%) and MNM (n = 24/71, 34%). Women of advanced age and maroon ethnicity had twice the odds of WHO-MNM (respectively adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4-4.8 and aOR = 2.0, 95% CI = 1.2-3.6). The stillbirths rate among women with WHO-MNM was 193/1000births, with six times higher odds than women without MNM (aOR = 6.8, 95%CI = 3.0-15.8). While the prevalence and mortality-index differ between the three MNM tools, the underlying causes of and factors associated with MNM were comparable. CONCLUSIONS The MNM ratio in Suriname is comparable to other countries in the region. The WHO-tool underestimates the prevalence of MNM (high mortality-index), while the adapted tools may overestimate MNM and compromise global comparability. Contextualized MNM-criteria per obstetric transition stage may improve comparability and reduce underreporting. While MNM studies facilitate international comparison, audit will remain necessary to identify shortfalls in quality-of-care and improve maternal outcomes.
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Affiliation(s)
- Kim Jc Verschueren
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lachmi R Kodan
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Raëz R Paidin
- Department of Obstetrics, Diakonessen Hospital Paramaribo, Paramaribo, Suriname
| | - Sarah M Samijadi
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Rubinah R Paidin
- Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Marcus J Rijken
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kitty Wm Bloemenkamp
- Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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