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Alam AU, Wu C, Kaul P, Jain V, Sun HL. Impact of inherited bleeding disorders on maternal bleeding and other pregnancy outcomes: A population-based cohort study. Haemophilia 2024; 30:478-489. [PMID: 38266510 DOI: 10.1111/hae.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Increasing rate of postpartum haemorrhage (PPH) has been observed between 2003 and 2010 in Canada. Inherited bleeding disorders contribute to the risk of PPH. AIM To identify the trend in PPH in the last decade, assess the impact of bleeding disorders on pregnancy outcomes and evaluate their coagulation workup during pregnancy. METHODS We conducted a population-based retrospective cohort study using the Alberta Pregnancy Birth Cohort from 2010 to 2018. We included women with von Willebrand disease (VWD) and haemophilia, identified by previously validated algorithm and matched with controls. Logistic regression was used to compute odds of PPH and other pregnancy outcomes. RESULTS We identified 311,330 women with a total of 454,400 pregnancies with live births. The rate of PPH did not change significantly from 10.13 per 100 deliveries (95% CI 10.10-10.16) in 2010-10.72 (95% CI 10.69-10.75) in 2018 (p for trend = .35). Women with bleeding disorders were significantly more likely to experience PPH (odds ratio [OR] 2.3; 95% CI 1.5-3.6), antepartum haemorrhage (OR 2.9; 95% CI 1.5-5.9) and red cell transfusion (OR 2.8; 95% CI 1.1-7.0). We observed a nonsignificant rise in the rate of PPH in women with VWD and haemophilia. Only 49.5% pregnancies with bleeding disorders had third trimester coagulation factor levels checked. Higher odds of PPH and antepartum haemorrhage were observed even with factor levels ≥0.50 IU/mL in third trimester. CONCLUSION Despite comprehensive care in women with bleeding disorders, they are still at higher risk of adverse pregnancy outcomes compared to population controls.
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Affiliation(s)
- Arafat Ul Alam
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Cynthia Wu
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Padma Kaul
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
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Barasinski C, Pranal M, Léger S, Debost-Legrand A, Vendittelli F. Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study). Healthcare (Basel) 2023; 11:healthcare11081111. [PMID: 37107946 PMCID: PMC10137816 DOI: 10.3390/healthcare11081111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Changes between pre- and postpartum hemoglobin might be useful for optimizing the postpartum diagnosis of postpartum hemorrhage (PPH), defined as a blood loss exceeding 500 mL. This study's principal objective was to estimate the mean change in hemoglobin (between pre/post-delivery hemoglobin) among women with vaginal deliveries and PPH. The secondary objectives were to analyze: hemoglobin changes according to blood volume loss, the appropriateness of standard thresholds for assessing hemoglobin loss, and the intrinsic and extrinsic performances of these threshold values for identifying PPH. French maternity units (n = 182) participated in the prospective HERA cohort study. Women with a vaginal delivery at or after a gestation of 22 weeks with a PPH (n = 2964) were eligible. The principal outcome was hemoglobin loss in g/L. The mean hemoglobin change was 30 ± 14 g/L among women with a PPH. Overall, hemoglobin decreased by at least 10% in 90.4% of women with PPH. Decreases ≥ 20 g/L and ≥40 g/L were found, respectively, in 73.9% and 23.7% of cases. Sensitivity and specificity values for identifying PPH were always <65%, the positive predictive values were between 35% and 94%, and the negative predictive values were between 14% and 84%. Hemoglobin decrease from before to after delivery should not be used as a PPH diagnostic screening test for PPH diagnosis for all vaginal deliveries.
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Affiliation(s)
- Chloé Barasinski
- Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Marine Pranal
- Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - Stéphanie Léger
- Laboratoire de Mathématiques UMR CNRS 6620, Université Blaise Pascal, F-64170 Aubière, France
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, Pôle Femme et Enfant, Centre Hospitalier Universitaire, Site Estaing, 1 Place Lucie et Raymond Aubrac, F-63003 Clermont-Ferrand CEDEX 1, France
| | - Françoise Vendittelli
- Université Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France
- Réseau de Santé en Périnatalité d'Auvergne, Pôle Femme et Enfant, Centre Hospitalier Universitaire, Site Estaing, 1 Place Lucie et Raymond Aubrac, F-63003 Clermont-Ferrand CEDEX 1, France
- AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, 7 Rue Guillaume Paradin, F-69372 Lyon CEDEX 08, France
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Hellmeyer L, Zinn-Kirchner Z, Königbauer JT. Maternal mortality in the city of Berlin: consequences for perinatal healthcare. J Perinat Med 2023; 51:182-187. [PMID: 34968015 DOI: 10.1515/jpm-2021-0604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The fifth of the United Nations' Millennium Development Goals proposed for 2000-2015 was to improve maternal health, which has only partially been achieved. Worldwide, the maternal mortality ratio is currently estimated at 216/100.000 livebirths, compared to 380/100,000 in 1990. As yet, there has been no published comprehensive analysis of maternal mortality data as it pertains to Berlin and by extension Germany. Aim of the study was to evaluate and analyze the maternal mortality rate of Berlin as a result of shortcomings in healthcare provision and identify possible solutions. METHODS The Institute for Quality and Transparency in the Healthcare Sector sourced external quality control from the Qualitätsbüro Berlin to provide maternal mortality data from Berlin hospitals from 2007 to 2020. RESULTS Nineteen maternal deaths were registered between 2007 and 2020 in total. Case analysis shows that two main events occur: thrombosis and hemorrhage at 31.6%, respectively, followed by hypertensive disorder (15.8%), and sepsis (15.8%). After detailed analysis of each case report, we determined 8/19 (42.1%) maternal deaths as being potentially preventable given slightly altered circumstances. CONCLUSIONS The system of registration of perinatal data in Germany does not allow for a comprehensive recording of maternal death and requires alteration to provide a more accurate picture of the phenomenon of maternal mortality; presumably, there exist twice as many unreported cases. Symptoms, risks, and primary prevention tactics of thromboembolism during pregnancy and birth should be imparted to every licensed professional in individual hospital settings, along with evidence-based simulation training for the event of obstetric or prepartum hemorrhage.
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Affiliation(s)
- Lars Hellmeyer
- Vivantes Klinikum im Friedrichshain, Academic Hospital of Charité - Universitätsklinikum Berlin, Berlin, Germany
| | | | - Josefine T Königbauer
- Vivantes Klinikum im Friedrichshain, Academic Hospital of Charité - Universitätsklinikum Berlin, Berlin, Germany
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Hossain N, Shaikh ZF. Maternal deaths due to indirect causes: Report from a tertiary care center of a developing country. Obstet Med 2022; 15:176-179. [PMID: 36262822 PMCID: PMC9574443 DOI: 10.1177/1753495x211037916] [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: 02/27/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 09/03/2023] Open
Abstract
Objective To assess the causes of indirect maternal deaths. Setting The Department of Obstetrics & Gynecology, of a tertiary referral center in Karachi, Pakistan, from January 2018 to December 2020. Maternal deaths were categorized according to World Health Organization guidelines into direct and indirect deaths. Result The total maternal deaths during the study period were 96, with 26 (27%) due to indirect causes. The mean age in the indirect group was 27 (range: 20-35) years, with only eight (31%) registered (attending for three of more antenatal visits). The mean gestational age was 33 (range: 22-39) weeks. Cesarean section was the main mode of delivery, in 13 (50%). Perinatal mortality was 68%. Cardiac and hepatic diseases (each six deaths, 23%) were the main causes of indirect maternal deaths. The majority of women (20; 76%) died during the postpartum period. Delays in seeking medical help, referral, and appropriate treatment were observed in 10, 9, and 7 cases, respectively. Conclusion Indirect maternal deaths are an important cause of maternal mortality.
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Affiliation(s)
- Nazli Hossain
- Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital & Dow
Medical College, Pakistan
| | - Zeenat F Shaikh
- Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital & Dow
Medical College, Pakistan
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Arias MP, Wang E, Leitner K, Sannah T, Keegan M, Delferro J, Iluore C, Arimoro F, Streaty T, Hamm RF. The impact on postpartum care by telehealth: a retrospective cohort study. Am J Obstet Gynecol MFM 2022; 4:100611. [PMID: 35331971 PMCID: PMC10134102 DOI: 10.1016/j.ajogmf.2022.100611] [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: 01/08/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, our institution turned to telehealth as the primary method of postpartum care delivery. OBJECTIVE We aimed to determine the impact of telehealth on completion of postpartum care goals. STUDY DESIGN In a single-center retrospective cohort study, we compared a 14-week period, March to June 2019, before implementation of telehealth, with the same calendar months after implementation during 2020. Patients with a postpartum visit scheduled at our institution during the study period were included. To demonstrate a 10% difference in attendance to the postpartum visit in the postimplementation compared with the preimplementation group, a power analysis calculation resulted in a requirement of at least 356 subjects per group. Our primary outcome was attendance to the postpartum visit. Secondary outcomes included completion of postpartum depression screening, contraception selection, breastfeeding status at postpartum visit, completion of 2-hour glucose tolerance test postpartum for those with gestational diabetes mellitus, and cardiology follow-up when recommended. Multivariable logistic regression with backward elimination was used to control for confounders. RESULTS Of the 1579 patients meeting inclusion criteria, 780 were in the preimplementation group and 799 in the postimplementation group. Subjects in the postimplementation group were at 90% increased odds of attending a postpartum visit compared with those in the preimplementation group, even when controlling for race, prenatal care provider, parity, gestational age at delivery, and insurance status (82.9% vs 72.4%; P<.001; adjusted odds ratio, 1.90; 95% confidence interval, 1.47-2.46). Patients in the postimplementation group were also more likely to be screened for postpartum depression (86.3% vs 65.1%; P<.001). Although subjects in both groups were equally likely to choose contraception, those in the postimplementation group were less likely to select long-acting reversible contraception or permanent sterilization (26.2% vs 33.2%; P=.03). There was no significant difference in breastfeeding status, postpartum 2-hour glucose tolerance test completion, or cardiology follow-up between groups. CONCLUSION Availability of telehealth during the COVID-19 pandemic is associated with increased postpartum visit attendance and postpartum depression screening. However, telehealth was also associated with a decrease in use of long-acting reversible contraception or permanent sterilization.
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Affiliation(s)
- Maria Paula Arias
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA..
| | - Eileen Wang
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Kristin Leitner
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Tasneem Sannah
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Morgan Keegan
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Joseph Delferro
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Charissa Iluore
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Faith Arimoro
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Taylor Streaty
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
| | - Rebecca F Hamm
- Perelman School of Medicine and the Department of Obstetrics and Gynecology at Penn Medicine, Philadelphia, PA
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Wong MJ, Bharadwaj S, Galey JL, Lankford AS, Galvagno S, Kodali BS. Extracorporeal Membrane Oxygenation for Pregnant and Postpartum Patients. Anesth Analg 2022; 135:277-289. [PMID: 35122684 DOI: 10.1213/ane.0000000000005861] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) has seen increasing use for critically ill pregnant and postpartum patients over the past decade. Growing experience continues to demonstrate the feasibility of ECMO in obstetric patients and attest to its favorable outcomes. However, the interaction of pregnancy physiology with ECMO life support requires careful planning and adaptation for success. Additionally, the maintenance of fetal oxygenation and perfusion is essential for safely continuing pregnancy during ECMO support. This review summarizes the considerations for use of ECMO in obstetric patients and how to address these concerns.
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Affiliation(s)
- Michael J Wong
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shobana Bharadwaj
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jessica L Galey
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Allison S Lankford
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine and Program in Trauma and Anesthesia Critical Care, Shock Trauma Center, Baltimore, Maryland
| | - Samuel Galvagno
- Department of Anesthesiology, Multi Trauma Critical Care Unit, Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bhavani Shankar Kodali
- From the Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
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Graugaard HL, Maimburg RD. Is the increase in postpartum hemorrhage after vaginal birth because of altered clinical practice?: A register-based cohort study. Birth 2021; 48:338-346. [PMID: 33694193 DOI: 10.1111/birt.12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND To identify risk factors for severe postpartum hemorrhage (PPH) ≥1000 ml in women giving birth vaginally. METHOD A register-based cohort study including women with singleton pregnancies giving birth vaginally at term to a live-born child at Aarhus University Hospital, Denmark, from January 1, 2004, to December 31, 2012. Logistic multivariable regression was used to analyze data. RESULTS In 31 837 births, 1832 women (5.7%) experienced severe PPH. Maternal age, smoking during pregnancy, and prepregnancy body mass index did not increase the risk of severe PPH. However, nulliparous and multiparous women with a previous cesarean birth had an increased risk of severe PPH. Antepartum and intrapartum risk factors for severe PPH included gestational age >40 weeks, induction of labor, augmentation of labor, irregular fetal position, instrumental birth, and birthweight >4000 g. In particular, the combination of induction and augmentation of labor doubled the risk of severe PPH. Among genital tract tears, vaginal tears >3 cm were associated with the highest risk of severe PPH. CONCLUSIONS Maternal characteristics did not increase the risk of severe PPH, except for nulliparous and multiparous women with a previous cesarean birth. Obstetric interventions such as induction of labor, augmentation of labor, and a birthweight higher than 4000 g increased the risk of severe PPH. Larger vaginal tears presented the highest risk of severe PPH. Clinical practice with rigorous indications for obstetric interventions and timely identification and management of genital tract tears may reduce risk of severe PPH.
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Affiliation(s)
- Hanne Lønstrup Graugaard
- Department of Midwifery, University College South Denmark, Esbjerg, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Damkjaer Maimburg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,School of Nursing and Midwifery, Western Sydney University, Greater Western Sydney, NSW, Australia
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Factors associated with giving birth at advanced maternal age in the United States. Midwifery 2021; 98:102975. [PMID: 33813304 DOI: 10.1016/j.midw.2021.102975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In 2018, 17 percent of all births in the United States occurred to women of advanced maternal age (AMA.) While the outcomes of AMA pregnancies have been examined extensively, the drivers behind increasing rates of AMA pregnancies in the United States are less understood. Some scholars have asserted that women are increasingly delaying their first birth in favor of educational and career aspirations. Yet birth trends in the United States do not support this as the primary explanatory factor of AMA births. Other factors may also contribute to high rates of AMA in the United States. This study sought to identify main predictors of AMA birth using a cross-sectional retrospective sample. DESIGN We employed a multivariate logistic regression analysis on a cross-sectional retrospective sample to identify significant independent predictors of giving birth at advance maternal age (AMA) in the United States. SETTING Data was obtained from the Unites States Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 Core Questionnaire and linked birth certificates. Questions are designed to assess maternal attitudes and experiences before, during and just after pregnancy. Surveys for Phase 7 were completed in 2017 and 2018. The study population represents mothers from 34 states that met the CDC's 55% response rate threshold and Puerto Rico. PARTICIPANTS The PRAMS dataset comprises self-reported data and linked birth certificate data from women who recently gave birth. A total of 38,549 mothers are included in the Phase 7 dataset. State sample sizes ranged from 503 mothers in Wyoming to 1,897 mothers in Michigan. All mothers gave birth in the year 2017. MEASUREMENTS AND FINDINGS The outcome of interest was AMA birth, defined as conceiving and subsequently giving birth to a baby at age 35 or older. Predictors for AMA birth were selected a priori and included: pregnancy intention, history of previous live birth, insurance status, income, education, race/ethnicity, marital status, and urban location. Previous live birth to at least one child was a significant independent predictor for AMA birth. Mothers with high parity, defined as 6 or more previous live births, were 17 times more likely to give birth at advanced maternal age. Mothers with an unwanted pregnancy were 1.9 times more likely to have an AMA birth. College attainment, high income, marital status, urbanicity, and race/ethnicity were also independent predictors of AMA birth. Health insurance was not a significant predictor of AMA birth after accounting for other factors. KEY CONCLUSIONS Delayed and late childbirth may not be intentional for a significant group of older mothers. Converse to popular assumptions that women delay childbearing in favor of career aspirations, the majority of AMA mothers have previous children. Half of AMA mothers have two or more previous children. The findings in this paper suggests that multiple factors predict AMA births. There may be several subtypes of women who enter pregnancy at advanced maternal age. IMPLICATIONS FOR PRACTICE As women weigh personal desire to bear children against competing social expectations, they may find themselves navigating their own unique path shaped in part by the region in which they live. Better characterization of the circumstances that lead to advanced maternal age in the United States, including exploration of unintended and unwanted AMA pregnancy, is necessary to develop policies and interventions that meet women's needs. This work should utilize a reproductive justice framework to ensure that women's preferences, particularly women of color, are upheld while promoting health and wellbeing for women.
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Vendittelli F, Barasinski C, Legrand A, Costa-Correia CD, Crenn-Hébert C, Rivière O, Dreyfus M, Lémery D. A French audit of maternity unit protocols for immediate postpartum hemorrhage: A cross-sectional study (HERA). J Gynecol Obstet Hum Reprod 2020; 50:101934. [PMID: 33035719 DOI: 10.1016/j.jogoh.2020.101934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The principal objective of this work was to assess how well the written protocols of maternity units used for the prevention and management of postpartum hemorrhage (PPH) corresponded to the 2004 French guidelines on this topic. The second objective was to assess whether or not this correspondence with the national guidelines varied according to hospital level (basic, specialized, and subspecialized) and status (teaching, public, and private). METHODS This observational multicenter cross-sectional study took place in September 2010 and included French perinatal networks that volunteered to participate. We asked 300 French maternity units belonging to these networks to participate by emailing a copy of their department's protocol for PPH to the study team. This team designed and performed a clinical audit of these protocols, defining 16 criteria that incorporated the 2004 French guidelines for prevention and management of PPH. The main outcome measure was the percentage of units reporting protocols meeting these criteria. RESULTS Of the 244 maternity units responding, 97.1 % had a written protocol but only 67.0 % had a local protocol. Protocol correspondence with the 2004 French guidelines was good for the criteria involving quantitative assessment of the quantity of blood loss (83.5 %) and secondary management of PPH (>80 %). Correspondence with the guidelines was poor in terms of defining PPH in the protocol (25.3 %) and of requiring the recording of the time of PPH diagnosis (53.2 %) and of the volume of blood loss (55.7 %). These results differed only slightly according to maternity unit status or level. CONCLUSION In all, 67.0 % (159/237) of maternity units had a local protocol for PPH. The contents of these protocols should be improved to be closer to the national guidelines.
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Affiliation(s)
- Françoise Vendittelli
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000, Clermont-Ferrand, France.
| | - Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Anne Legrand
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000, Clermont-Ferrand, France
| | - Caroline Da Costa-Correia
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000, Clermont-Ferrand, France
| | | | - Olivier Rivière
- Audipog, Université Claude Bernard Lyon 1 - Laennec, Lyon, France
| | - Michel Dreyfus
- Centre Hospitalier Universitaire de Caen, Hôpital Femme-Enfant-Hématologie, UFR Médecine Caen, Caen cedex 9, France
| | - Didier Lémery
- Fédération Nationale des Réseaux de Santé en Périnatalité, Nantes, France
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10
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Balciuniene G, Balciunas L, Jakubauskiene L, Ramasauskaite D, Serpytis M, Gumbiene L, Dementaviciene J. Massive postpartum pulmonary embolism successfully treated with v-a-v ECMO: a case report. J OBSTET GYNAECOL 2020; 41:662-664. [PMID: 32799721 DOI: 10.1080/01443615.2020.1785408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Greta Balciuniene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lukas Balciunas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Jakubauskiene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Ramasauskaite
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Mindaugas Serpytis
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Lina Gumbiene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jurate Dementaviciene
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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11
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Jeong W, Jang SI, Park EC, Nam JY. The Effect of Socioeconomic Status on All-Cause Maternal Mortality: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124606. [PMID: 32604879 PMCID: PMC7345089 DOI: 10.3390/ijerph17124606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Abstract
Improving maternal health is one of the 13 targets of Sustainable Development Goal 3; consequently, preventing maternal death, which usually occurs in women’s prime productive years, is an important issue that needs to be addressed immediately. This study examines the association between socioeconomic status and all-cause maternal mortality in South Korea and provides evidence of preventable risk factors for maternal death. For this population-based retrospective cohort study, data on 3,334,663 nulliparous women were extracted from the Korean National Health Insurance Service database between 2003 and 2018. The outcome variables were all-cause maternal mortality within six weeks and a year after childbirth. A log-binomial regression model determined the association between maternal mortality and income-level adjusted covariates. Women with lower income levels had higher risk of maternal death within six weeks (risk ratio (RR) = 2.42, 95% confidence interval (CI) = 1.65–3.53) and within one year (RR = 1.83, 95% CI = 1.47–2.28), especially those who were aged 35–39 years, lived in rural areas, delivered via cesarean section, and had maternal comorbidities. The study identifies a significant relationship between South Korean primiparas’ socioeconomic status and maternal death within six weeks or one year after childbirth, suggesting interventions to alleviate the risk of maternal death.
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Affiliation(s)
- Wonjeong Jeong
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (S.-I.J.); (E.-C.P.)
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (S.-I.J.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (S.-I.J.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Jin Young Nam
- Department of Public Health Science, BK21PLUS Program in Embodiment, Health-Society Interaction, Graduate School, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-718-7977
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The Effect of Pregnancy in the Hemoglobin Concentration of Pregnant Women: A Longitudinal Study. J Pregnancy 2020; 2020:2789536. [PMID: 32566297 PMCID: PMC7290874 DOI: 10.1155/2020/2789536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study was to estimate and identify the determinants of hemoglobin concentration before pregnancy, during pregnancy, and after labor and delivery. Methods A prospective cohort study design was implemented. Data were collected from May 2015 to September 2018. A simple random sampling technique was used to select the participants. An interview technique was used to collect the data. Blood samples were collected before pregnancy, during each trimester, during labor and delivery, after third stage of labor, and at the 6-week postpartum period. Descriptive statistics were used to describe the profile of study participants. Generalized estimating equations were used to identify the determinants of hemoglobin concentration during each phase of pregnancy. Results The mean hemoglobin concentrations of primigravida and multigravida before pregnancy were 12.41 g/dl and 10.78 g/dl, respectively. The hemoglobin concentration decreases with consecutive trimester reaching the lowest level at 42 days after delivery. The hemoglobin concentrations of pregnant women were decreased by hookworm 0.24 g/dl [95% CI:0.18-0.29], multiple pregnancy 0.16 g/dl [95% CI: 0.07-0.24], episiotomy 0.05 g/dl [95% CI: 0.01-0.09], gravidity 0.15 g/dl [95% CI: 0.09-0.21], age 0.03 g/dl [95% CI: 0.03-0.04], and gestational age 0.1 g/dl [95% CI: 0.09-0.11]. The hemoglobin concentration increased by iron supplementation 1.02 g/dl [95% CI: 0.97-1.07] and birth weight 0.14 g/dl [95% CI: 0.02-0.11]. Conclusion Pregnancy significantly decreases the hemoglobin concentration of pregnant women reaching the lowest point during labor and delivery. Recommendation. Regular anemia screening intervention should be implemented after delivery.
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Liabsuetrakul T, Sukmanee J, Thungthong J, Lumbiganon P. Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data. AJP Rep 2019; 9:e328-e336. [PMID: 31673478 PMCID: PMC6821536 DOI: 10.1055/s-0039-1697656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/16/2019] [Indexed: 10/30/2022] Open
Abstract
Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs ( r = 0.20, p = 0.03) and birth asphyxia ( r = 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jarawee Sukmanee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jutatip Thungthong
- National Health Security Office (NHSO) Thailand, Chaengwattana Road, Lak Si, Bangkok, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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14
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Kang H, Shin YM, Kim SM, Kim Y, Dalla Vecchia LA, Ho KM. Multidisciplinary team approach on massive postpartum pulmonary thromboembolism: experience from three cases. J Thorac Dis 2019; 11:1690-1696. [PMID: 31179115 DOI: 10.21037/jtd.2019.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hyeran Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju-si, Republic of Korea
| | | | - Kwok Ming Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia
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Engin-Üstün Y, Sanisoğlu S, Keskin HL, Karaahmetoğlu S, Özcan A, Çelen Ş, Üstün Y, Alkan A, Ongun V, Şencan İ. Changing trends in the Turkish maternal deaths, with a focus on direct and indirect causes. Eur J Obstet Gynecol Reprod Biol 2019; 234:21-25. [PMID: 30640122 DOI: 10.1016/j.ejogrb.2018.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our aim is to evaluate trends in the direct and indirect causes' distribution using data from National Maternal Mortality Surveillance (2012-2015). STUDY DESIGN A population-based retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher's exact test for categorical variables. RESULTS Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases. CONCLUSION Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.
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Affiliation(s)
- Yaprak Engin-Üstün
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Sema Sanisoğlu
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Hüseyin Levent Keskin
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey.
| | - Selma Karaahmetoğlu
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Ayşe Özcan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Şevki Çelen
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Yusuf Üstün
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Afra Alkan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - Veli Ongun
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
| | - İrfan Şencan
- Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health, Ankara, Turkey
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16
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Injury-related maternal mortality. Am J Obstet Gynecol 2018; 219:307-308. [PMID: 29852158 DOI: 10.1016/j.ajog.2018.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
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17
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Tiruneh GT, Karim AM, Avan BI, Zemichael NF, Wereta TG, Wickremasinghe D, Keweti ZN, Kebede Z, Betemariam WA. The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia. BMC Pregnancy Childbirth 2018; 18:123. [PMID: 29720108 PMCID: PMC5932776 DOI: 10.1186/s12884-018-1751-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. METHODS Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose-response relationships between outcome and explanatory variables of interest using regression methods. RESULTS The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose-response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1-6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need. CONCLUSION The BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
| | - Ali Mehryar Karim
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Washington DC, USA.
| | - Bilal Iqbal Avan
- IDEAS project, London School of Hygiene & Tropical Medicine, London, UK
| | - Nebreed Fesseha Zemichael
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | | | | | - Zinar Nebi Keweti
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
| | - Zewditu Kebede
- United States Agency for International Development (USAID), Addis Ababa, Ethiopia
| | - Wuleta Aklilu Betemariam
- The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia
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18
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Association between maternal death and cesarean section in Latin America: A systematic literature review. Midwifery 2018; 59:88-93. [DOI: 10.1016/j.midw.2018.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/22/2017] [Accepted: 01/12/2018] [Indexed: 11/20/2022]
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19
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Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage. J Clin Anesth 2018; 44:50-56. [DOI: 10.1016/j.jclinane.2017.10.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/21/2017] [Accepted: 10/14/2017] [Indexed: 11/21/2022]
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20
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Woiski MD, van Vugt HC, Dijkman A, Grol RP, Marcus A, Middeldorp JM, Mol BW, Mols F, Oudijk MA, Porath M, Scheepers HJ, Hermens RP. From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality. Matern Child Health J 2017; 20:2160-8. [PMID: 27395381 PMCID: PMC5025494 DOI: 10.1007/s10995-016-2050-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1–7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of ‘when to perform’ a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.
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Affiliation(s)
- Mallory D Woiski
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Helena C van Vugt
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Anneke Dijkman
- Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands
| | - Richard P Grol
- Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Abraham Marcus
- Department of Anesthesiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Femke Mols
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Martina Porath
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, P.O. Box 90052, 5600 PD, Veldhoven, The Netherlands
| | - Hubertina J Scheepers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Rosella P Hermens
- Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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21
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Kouskouti C, Evangelatos N, Brand A, Kainer F. Maternal sepsis in the era of genomic medicine. Arch Gynecol Obstet 2017; 297:49-60. [PMID: 29103195 DOI: 10.1007/s00404-017-4584-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/26/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE Maternal sepsis remains one of the leading causes of direct and indirect maternal mortality both in high- and low-income environments. In the last two decades, systems biology approaches, based on '-omics' technologies, have started revolutionizing the diagnosis and management of the septic syndrome. The scope of this narrative review is to present an overview of the basic '-omics' technologies, exemplified by cases relevant to maternal sepsis. METHODS Narrative review of the new '-omics' technologies based on a detailed review of the literature. RESULTS After presenting the main 'omics' technologies, we discuss their limitations and the need for integrated approaches that encompass research efforts across multiple '-omics' layers in the '-omics' cascade between the genome and the phenome. CONCLUSIONS Systems biology approaches are revolutionizing the research landscape in maternal sepsis. There is a need for increased awareness, from the side of health practitioners, as a requirement for the effective implementation of the new technologies in the research and clinical practice in maternal sepsis.
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Affiliation(s)
- C Kouskouti
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419, Nuremberg, Germany.
| | - N Evangelatos
- Intensive Care Medicine Unit, Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany.,UNU-MERIT (Maastricht Economic and Social Research Institute on Innovation and Technology), Maastricht University, Boschstraat 24, 6211 AX, Maastricht, The Netherlands
| | - A Brand
- Public Health Genomics, Department International Health, Maastricht University, Duboisdomain 30, 6229 GT, Maastricht, The Netherlands.,Professorial Fellow, UNU-MERIT (Maastricht Economic and Social Research Institute on Innovation and Technology), Maastricht University, Boschstraat 24, 6211 AX, Maastricht, The Netherlands.,Dr. TMA Pai Endowed Chair Public Health Genomics, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India
| | - F Kainer
- Department of Obstetrics and Perinatal Medicine, Klinik Hallerwiese, St. Johannis-Mühlgasse 19, 90419, Nuremberg, Germany
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Idoko P, Anyanwu MO, Bass S. A retrospective analysis of trends in maternal mortality in a Gambian tertiary health centre. BMC Res Notes 2017; 10:493. [PMID: 28985755 PMCID: PMC6389080 DOI: 10.1186/s13104-017-2817-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 09/30/2017] [Indexed: 11/27/2022] Open
Abstract
Background Maternal mortality ratio (MMR) has been on the decline in the Gambia since 1990. However, there has been no steady decline in maternal mortality ratio in the Edward Francis Small Teaching Hospital, the only tertiary health facility in the Gambia. The aim of the study is to determine the trend in maternal mortality over the last 8 years.A retrospective review of all maternal deaths occurring at the Edward Francis Small Teaching Hospital from 1st January 2007 to 31st December 2014 was done. Case abstraction was done with a pre-structured questionnaire using the WHO definition of maternal mortality. Results There were 663 maternal deaths recorded during the study period. During the same period the total number of live births were 38,896. The annual MMR in each year varied with a range between 1461 and 2105 per 100,000 live births. The MMR in the hospital in on the rise compared to earlier studies. The causes of maternal mortality have not changed much in the hospital. However, the seasonal variation in maternal mortality in earlier studies attributed to the influence of malaria and anaemia was not seen in this study. We attribute this change to the widespread use of intermittent prophylactic treatment for malaria in the antenatal period. Conclusion While MMR was decreasing in the country, it was increasing in the only tertiary health facility in the country. This was attributed to increasing referrals from other health facilities. The influence of malaria and anemia as a cause of maternal mortality seems to be declining.
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Affiliation(s)
- Patrick Idoko
- School of Medical and Allied Health Sciences, University of The Gambia, Banjul, The Gambia. .,Edward Francis Small Teaching Hospital, Banjul, The Gambia.
| | - Matthew O Anyanwu
- School of Medical and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.,Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Sabel Bass
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
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Liabsuetrakul T, Palanukunwong K, Chinduereh A, Oumudee N. Evaluation of a multifaceted postpartum hemorrhage-management intervention in community hospitals in Southern Thailand. Int J Gynaecol Obstet 2017; 139:39-44. [PMID: 28675429 DOI: 10.1002/ijgo.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/14/2017] [Accepted: 06/30/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess a multifaceted postpartum hemorrhage (PPH)-management intervention in community hospitals in Southern Thailand. METHODS The present prospective study was conducted from November 1, 2012 to April 30, 2015. The medical records of women with PPH were collected before (January 1, 2011, and October 31, 2012) and after (March 1, 2013, and December 31, 2014) the implementation of a multifaceted PPH-management intervention at three community hospitals in Southern Thailand; these patients were compared with patients diagnosed with PPH at three control hospitals in the same provinces during the same time periods. The intervention, delivered to general practitioners and nurses, utilized previously developed PPH-management guidelines. PPH management was compared between the intervention and control hospitals and factors associated with PPH management were evaluated using univariate and multiple logistic regressions. RESULTS The post-intervention median blood loss within 2 hours of delivery was lower in intervention hospitals (P<0.001) and post-intervention indwelling bladder catheterization was higher (P=0.004). Increased odds of indwelling bladder catheterization were recorded among patients treated at intervention hospitals (adjusted odds ratio [aOR] 2.79, 95% confidence interval [CI] 1.40-5.55) and patients who experienced more than 500 mL of blood loss (501-1000 mL [aOR 2.41, 95% CI 1.22-4.76] or >1000 mL [aOR 16.45, 95% CI 2.04-132.80]). CONCLUSION Implementation of the multifaceted intervention improved PPH management at community hospitals.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | | | | - Nurlisa Oumudee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Akazawa M, Nishida M. Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature. Acta Obstet Gynecol Scand 2017; 96:529-535. [PMID: 28222238 DOI: 10.1111/aogs.13116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 12/14/2022]
Abstract
Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery. Blood transfusion was necessary in all cases except for one (12/13; 92%). In seven cases (7/13; 54%), a large amount of blood was required for transfusion. Subsequent laparotomy to control bleeding was required in five cases (5/13; 38%), including three cases of hysterectomy and two cases of hematoma removal, all of which involved cesarean delivery. In cases of transvaginal delivery, there was no report of laparotomy. The occurrence of severe bleeding was high in relation to cesarean section, compared with vaginal deliveries. Using rt-PA in relation to cesarean section might be worth avoiding. However, the paucity of data in the literature makes it difficult to assess the ultimate outcomes and safety of this treatment.
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Affiliation(s)
- Munetoshi Akazawa
- Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Makoto Nishida
- Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan
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25
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Point-of-Care Thromboelastometry in the Management of Acute Obstetric Hemorrhage. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Vendittelli F, Barasinski C, Pereira B, Lémery D. Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study). BMC Pregnancy Childbirth 2016; 16:242. [PMID: 27552986 PMCID: PMC4995746 DOI: 10.1186/s12884-016-1008-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies. Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management. METHODS This prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence. RESULTS PPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25-3.47 %] and after cesareans 2.83 % [95 % CI: 2.63-3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05-1.18 %] and after cesareans 1.00 % [95 % CI: 0.88-1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %). CONCLUSIONS The incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.
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Affiliation(s)
- Françoise Vendittelli
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France. .,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France. .,AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France.
| | - Chloé Barasinski
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France
| | - Didier Lémery
- Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont Université, Clermont-Ferrand, France.,AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France
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Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 206:12-21. [PMID: 27612214 DOI: 10.1016/j.ejogrb.2016.07.510] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/04/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007. OBJECTIVES To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH. SEARCH STRATEGY A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library. SELECTION CRITERIA All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases. DATA COLLECTION AND ANALYSIS Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review. MAIN RESULTS The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3-100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9-90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%). CONCLUSIONS PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.
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Bashour H, Saad-Haddad G, DeJong J, Ramadan MC, Hassan S, Breebaart M, Wick L, Hassanein N, Kharouf M. A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria. BMC Pregnancy Childbirth 2015; 15:296. [PMID: 26566955 PMCID: PMC4644334 DOI: 10.1186/s12884-015-0733-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. Methods We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. Results A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6 %) and Dar Al Tawleed hospital in Syria (14.3 %), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO’s Multicountry Survey using the same data collection tool, our study’s mortality indices are higher than the index of 5.6 % among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1 %) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals. Conclusions Findings from this formative stage confirmed the need for quality improvement interventions. The high reported coverage of the main clinical interventions in the study hospitals would appear to be in contradiction with the above findings as the level of coverage of key evidence-based interventions was high. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0733-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyam Bashour
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Ghada Saad-Haddad
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Jocelyn DeJong
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | | | - Sahar Hassan
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine.
| | - Miral Breebaart
- Social Research Center, American University in Cairo, Cairo, Egypt.
| | - Laura Wick
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine.
| | | | - Mayada Kharouf
- Faculty of Medicine, Damascus University, Damascus, Syria.
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Influencing factors for high quality care on postpartum haemorrhage in the Netherlands: patient and professional perspectives. BMC Pregnancy Childbirth 2015; 15:272. [PMID: 26497307 PMCID: PMC4619207 DOI: 10.1186/s12884-015-0707-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/15/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) remains a major contributor to maternal morbidity even in high resource settings, despite the development and dissemination of evidence-based guidelines and Advance-Trauma-Life-Support (ATLS) based courses for optimal management of PPH. We aimed to assess current influencing factors (obstacles and facilitators) for the delivery of high quality PPH-care from both patient and professional perspective. METHODS We qualitatively explored influencing factors for delivering high quality PPH-care, by having individual interviews with PPH-patients and focus group interviews with the different types of professionals working in the delivery room. For both perspectives, the theoretical frameworks of Grol and Cabana were used to classify the influencing factors for optimal PPH-care (factors of the guidelines, of professionals, of patients, of the social setting and of the organisation). In order to assess the importance of the influencing factors found among the professionals, we quantified these factors in a web-based questionnaire. RESULTS A total of 12 patients and 41 professionals participated in the interviews, and 315 complete surveys were analyzed. The main obstacle for high quality PPH-care identified by patients was the lack of information given by the professionals to the patient and partner before, during and after the PPH event. An informative patient website, a patient leaflet and a follow-up consultation were mentioned as facilitators. The main obstacles according to the professionals were: lack of clarity of the guidelines, lack of knowledge and failing team-communication. Team training and checklists/ flowcharts were considered facilitators. CONCLUSIONS Different obstacles to the delivery of high quality PPH-care were identified by both patients and professionals. These data can be used to develop a focused strategy to improve PPH-care. TRIAL REGISTRATION NCT 00928863.
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Woiski MD, Scheepers HC, Liefers J, Lance M, Middeldorp JM, Lotgering FK, Grol RP, Hermens RP. Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage. Acta Obstet Gynecol Scand 2015. [PMID: 26222391 DOI: 10.1111/aogs.12718] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION To systematically develop a set of guideline-based quality indicators for postpartum hemorrhage (PPH) as a tool to measure guideline adherence in actual PPH care. MATERIAL AND METHODS A Rand-modified Delphi procedure was used to systematically achieve consensus among a panel of 22 experts on PPH care on recommendations extracted from evidence-based guidelines, Managing-Obstetrics-Emergencies-Trauma (MOET) instructions and international literature. The selected recommendations were individually rated on health gain (prevention of maternal mortality and morbidity) and overall efficiency by the expert panel. Subsequently, consensus about the most important recommendations to measure quality of PPH care among the panel members was reached, followed by a final approval. Last, definition of the final set by critical appraisal of the recommendations regarding measurability took place. The main outcome measure was a set of valid quality indicators for prevention and management of PPH. RESULTS From the 69 extracted recommendations, 50 were selected and translated into 22 quality indicators on professional performance (n = 17) and organization of PPH care (n = 5). The professional performance indicators covered all fields of PPH care, such as prevention (n = 2) and management of PPH, including communication and documentation (n = 4), monitoring and prevention of shock (n = 3), use of blood products (n = 3) and treatment of PPH (n = 5). Organizational indicators (n = 5) were clustered into protocols and agreements, audit, accessibility and documentation. CONCLUSIONS This study describes a stepwise systematic development of 22 performance and organizational indicators to use for measuring the whole care process of prevention and management of PPH.
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Affiliation(s)
- Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Janine Liefers
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcus Lance
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fred K Lotgering
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard P Grol
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Seeho SK, Nippita TA, Roberts CL, Morris JM, Nassar N. Venous thromboembolism prophylaxis during and following caesarean section: a survey of clinical practice. Aust N Z J Obstet Gynaecol 2015; 56:54-9. [DOI: 10.1111/ajo.12393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 07/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Sean K.M. Seeho
- Clinical and Population Perinatal Health Research; Kolling Institute; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Tanya A. Nippita
- Clinical and Population Perinatal Health Research; Kolling Institute; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Christine L. Roberts
- Clinical and Population Perinatal Health Research; Kolling Institute; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
| | - Jonathan M. Morris
- Clinical and Population Perinatal Health Research; Kolling Institute; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
- Department of Obstetrics and Gynaecology; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Health Research; Kolling Institute; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; St Leonards New South Wales Australia
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Tebeu PM, Pierre-Marie T, Halle-Ekane G, Gregory HE, Da Itambi M, Maxwell DI, Enow Mbu R, Robinson EM, Mawamba Y, Yvette M, Fomulu JN, Nelson FJ. Maternal mortality in Cameroon: a university teaching hospital report. Pan Afr Med J 2015; 21:16. [PMID: 26401210 PMCID: PMC4561158 DOI: 10.11604/pamj.2015.21.16.3912] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.
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Affiliation(s)
| | - Tebeu Pierre-Marie
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon ; Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Cameroon
| | | | | | | | - Da Itambi Maxwell
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
| | | | - Enow Mbu Robinson
- Department of Obstetrics-Gynecology, Central Hospital, Yaoundé, Cameroon
| | | | - Mawamba Yvette
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
| | | | - Fomulu Joseph Nelson
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
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The contributions of maternity care to reducing adverse pregnancy outcomes: a cohort study in Dabat district, northwest Ethiopia. Matern Child Health J 2015; 18:1336-44. [PMID: 24045911 DOI: 10.1007/s10995-013-1367-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21%) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6%) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits, <4 ANC visits and delivery by skilled attendant showed 25% (OR 0.75; 95% CI 0.25, 2.75), 9% (OR 0.91; 95% CI 0.43, 1.69) and 31% (OR 0.69; 95% CI 0.36, 1.33) reduction in the occurrence of adverse pregnancy outcomes, respectively. Skilled maternal care showed reduction in adverse pregnancy outcomes (complications and deaths). However, the associations were not significant. Improving the quality of maternity care services and ensuring continuum of care in the health care system are imperative for effective maternal health care in the study area.
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Lumbiganon P, Laopaiboon M, Intarut N, Vogel JP, Souza JP, Gülmezoglu AM, Mori R. Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1:32-9. [DOI: 10.1111/1471-0528.12647] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 02/06/2023]
Affiliation(s)
- P Lumbiganon
- Department of Obstetrics & Gynaecology; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - M Laopaiboon
- Department of Biostatistics & Demography; Faculty of Public Health; Khon Kaen University; Khon Kaen Thailand
| | - N Intarut
- Department of Biostatistics & Demography; Faculty of Public Health; Khon Kaen University; Khon Kaen Thailand
| | - JP Vogel
- Faculty of Medicine, Dentistry and Health Sciences; School of Population Health; University of Western Australia; Crawley WA Australia
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - JP Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - AM Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction; Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
| | - R Mori
- Department of Health Policy; National Center for Child Health and Development; Tokyo Japan
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Morillas-Ramírez F, Ortiz-Gómez JR, Palacio-Abizanda FJ, Fornet-Ruiz I, Pérez-Lucas R, Bermejo-Albares L. [An update of the obstetrics hemorrhage treatment protocol]. ACTA ACUST UNITED AC 2014; 61:196-204. [PMID: 24560060 DOI: 10.1016/j.redar.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/17/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features.
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Affiliation(s)
| | - J R Ortiz-Gómez
- Servicio de Anestesiología, Hospital Virgen del Camino, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - I Fornet-Ruiz
- Servicio de Anestesiología, Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - R Pérez-Lucas
- Servicio de Ginecología, Hospital Gregorio Marañón, Madrid, España
| | - L Bermejo-Albares
- Servicio de Anestesiología, Hospital Gregorio Marañón, Madrid, España
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Rath WH, Hofer S, Sinicina I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:126-32. [PMID: 24622759 PMCID: PMC3959223 DOI: 10.3238/arztebl.2014.0126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 of every 100 000 deliveries. With a mortality of 11% to 44%, it is among the leading direct causes of maternal death. This entity is an interdisciplinary challenge because of its presentation with sudden cardiac arrest without any immediately obvious cause, the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, including cardio - pulmonary resuscitation. METHOD We selectively reviewed pertinent literature published from 2000 to May 2013 that was retrieved by a PubMed search. RESULTS The identified risk factors for AFE are maternal age 35 and above (odds ratio [OR] 1.86), Cesarean section (OR 12.4), placenta previa (OR 10.5), and multiple pregnancy (OR 8.5). AFE is diagnosed on clinical grounds after the exclusion of other causes of acute cardiovascular decompensation during delivery, such as pulmonary thromboembolism or myocardial infarction. Its main clinical features are severe hypotension, arrhythmia, cardiac arrest, pulmonary and neurological manifestations, and profuse bleeding because of disseminated intravascular coagulation and/or hyperfibrinolysis. Its treatment requires immediate, optimal interdisciplinary cooperation. Low-level evidence favors treating women suffering from AFE by securing the airway, adequate oxygenation, circulatory support, and correction of hemostatic disturbances. The sudden, unexplained death of a pregnant woman necessitates a forensic autopsy. The histological or immunohistochemical demonstration of formed amniotic fluid components in the pulmonary bloodflow establishes the diagnosis of AFE. CONCLUSION AFE has become more common in recent years, for unclear reasons. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. Establishing evidence-based recommendations for intervention is an important goal for the near future.
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Affiliation(s)
- Werner H Rath
- Faculty of Medicine, Gynecology and Obstetrics, University Hospital RWTH Aachen
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg
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Turrentine MA. Antenatal antibiotics: too much, too little, or just right? BJOG 2013; 120:1453-5. [PMID: 24118810 DOI: 10.1111/1471-0528.12372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M A Turrentine
- Obstetrics & Gynecology, Kelsey-Seybold Clinic, Houston, TX, USA; Department of Obstetrics & Gynecology, Baylor College of Medicine and UTHealth Medical School, Houston, TX, USA
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Trends in maternal mortality in Hungary between 1978 and 2010. Eur J Obstet Gynecol Reprod Biol 2013; 173:29-33. [PMID: 24275231 DOI: 10.1016/j.ejogrb.2013.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/23/2013] [Accepted: 11/01/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We evaluated the trends of the last decades in maternal mortality in Hungary and compared Hungarian results with those of other European countries. STUDY DESIGN Cases of maternal death in Hungary during the study period from calendar year 1978 to 2010 were analyzed in a retrospective manner to characterize mortality distribution and to identify potential clinical or demographic predictors. Data in all cases were extracted both from the national Obstetric Registry operated by the National Institute of Gynecology and Obstetrics, from the Hungarian Central Bureau of Statistics and from the National Public Health and Medical Officer Service. Detailed clinical data were obtained based on obligatory reporting by individual clinical institutions. RESULTS The annual maternal mortality rate (MMR) was 26.7 per 100,000 live births in the period 1978-1987 and declined significantly to 10.9 per 100,000 live births in the period 1997-2010. In the period 1988-1996 (with missing associated clinical and demographic data) the MMR was 16.4 per 100,000 live births. The proportion of delivery-associated causes of death increased significantly between the two study periods from 49.4% to 62.9% (p<0.05). Among obstetric causes of death, the rate of thromboembolism showed a significant increase, while there was a trend toward a decline in rate of maternal deaths attributable to hemorrhagic shock. Among medical causes of death not directly attributable to obstetric complications, the rate of renal and gastrointestinal etiologies declined significantly throughout the study periods. CONCLUSIONS We observed a marked decline in maternal mortality during the last few decades in Hungary. Recent changes in mortality distribution highlight current characteristics of pregnancy care in Hungary and may help identify strategies for future improvement.
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Tessmer-Tuck JA, Arendt KW, Craigo PA. Update on Maternal Mortality in the Developed World. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bonnet MP, Basso O, Bouvier-Colle MH, Dupont C, Rudigoz RC, Fuhrer R, Deneux-Tharaux C. Postpartum haemorrhage in Canada and France: a population-based comparison. PLoS One 2013; 8:e66882. [PMID: 23826165 PMCID: PMC3691240 DOI: 10.1371/journal.pone.0066882] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/12/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries. METHODS Using data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH). We assessed factors associated with PPH through multivariate logistic models. RESULTS PPH incidence, overall (4.8% (95% CI 4.7-4.9) in Canada and 4.5% (95% CI 4.4-4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2-5.4) in Canada and 4.8 (95%CI 4.7-4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23-1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery. CONCLUSION PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.
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Affiliation(s)
- Marie-Pierre Bonnet
- INSERM, U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France.
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Worku AG, Yalew AW, Afework MF. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia. PLoS One 2013; 8:e60171. [PMID: 23555915 PMCID: PMC3610646 DOI: 10.1371/journal.pone.0060171] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/24/2013] [Indexed: 11/19/2022] Open
Abstract
Background Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. Methods This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles) using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. Results Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7%) reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6%) sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. Conclusion Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved in not using skilled maternal care.
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Affiliation(s)
- Abebaw Gebeyehu Worku
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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Hendriks J, Zwart JJ, Briët E, Brand A, van Roosmalen J. The clinical benefit of blood transfusion: a hypothetical experiment based on a nationwide survey of severe maternal morbidity. Vox Sang 2012; 104:234-9. [PMID: 23061811 DOI: 10.1111/j.1423-0410.2012.01654.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is beyond doubt that blood transfusion services have added to the decline in maternal mortality in high-resource countries. To quantify the clinical benefit of red blood cell (RBC) transfusion in obstetric care, we performed a hypothetical experimental study using data from a prospective nationwide cohort of women giving birth in the Netherlands. STUDY DESIGN AND METHODS Data were abstracted from a nationwide cohort study on severe maternal morbidity, including obstetric haemorrhage requiring 4 or more units of RBC, to obtain an observed and a hypothetical control group consisting of the same women. In the hypothetical control group, we simulated a situation where RBC transfusion was unavailable and estimated how many of these women would have died in that situation. A questionnaire survey asked experts in major (obstetric) haemorrhage to choose a critical minimal number of RBC transfusions at which a woman with obstetric haemorrhage would have died if RBC transfusion was not available. Maternal mortality rate per 100,000 maternities [maternal mortality ratios (MMR)] and relative risk were calculated for the observed and hypothetical group. RESULTS The observed MMR was 13 per 100,000 maternities. According to 47 responding experts, the median number of RBC units without which a woman would have most probably died was nine, resulting in a hypothetical MMR of 87 per 100,000 maternities (relative risk 6·5; 95% confidence interval 4·2-10·0). CONCLUSIONS It can be expected that unavailability of RBC transfusion in obstetric care increases the risk of maternal death 6.5-fold. Blood transfusion thus largely contributes to the decline of MMR and would also be an important pillar of improving quality of care in resource-poor settings.
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Affiliation(s)
- J Hendriks
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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