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Nema J, Sundrani D, Randhir K, Deshpande J, Lalwani S, Wagh G, Gupte S, Joshi S. Maternal angiogenic factor disruptions prior to clinical diagnosis of preeclampsia: insights from the REVAMP study. Hypertens Res 2024:10.1038/s41440-024-01775-8. [PMID: 38965425 DOI: 10.1038/s41440-024-01775-8] [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: 12/12/2023] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024]
Abstract
Preeclampsia is characterized by impaired angiogenesis and assessment of angiogenic factors can play a crucial role in the early diagnosis of preeclampsia. The current study reports the levels of angiogenic factors longitudinally from early pregnancy in women with preeclampsia and in the subtypes of preeclampsia, to identify their role in early prediction of preeclampsia. A total of 1154 women with singleton pregnancies were recruited in early pregnancy from 2 hospitals. Blood samples were collected, plasma samples were separated and stored at four time points across gestation: V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks, and V4 = at delivery. The current study includes a total of 108 women developed preeclampsia (PE), and 216 matched controls. Angiogenic factors were estimated using commercially available ELISA kits. Receiver operating characteristic (ROC) curves were used to evaluate the potential diagnostic value in the prediction of PE. Lower levels of VEGF, PlGF, and higher levels of sEng and sEng/PlGF ratio (p < 0.05 for all) predate clinical diagnosis in women with preeclampsia. sEng levels and sEng/PlGF ratio showed significant correlation with odds of preeclampsia at all the timepoints. This study identifies a cut off of 33.5 for sFlt-1/PlGF and 25.9 for sEng/PlGF for prediction of early onset preeclampsia. This study reports various angiogenic factors serially across gestation in a general population to identify women at risk of developing preeclampsia and its subtypes. The study also reports a potential biomarker and a pragmatic window for estimation of angiogenic markers to identify women at risk.
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Affiliation(s)
- Juhi Nema
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Deepali Sundrani
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Karuna Randhir
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Juilee Deshpande
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, 411043, India
| | - Sanjay Gupte
- Gupte Hospital and Research Centre, Pune, 411004, India
| | - Sadhana Joshi
- Mother and Child Health, ICMR- Collaborating Centre of Excellence (ICMR-CCoE), Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune, 411043, India.
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Urech FL, Girard T, Brunner M, Schoetzau A, Lapaire O. Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study. J Perinat Med 2024; 52:494-500. [PMID: 38676940 DOI: 10.1515/jpm-2023-0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The University Hospital Basel implemented delayed umbilical cord clamping of 30-60 s in all laboring women on April 1, 2020. This practice has been widely researched showing substantial benefit for the neonate. Few studies focused on maternal blood loss. The objective of our retrospective comparative study was to assess the impact of immediate vs. delayed cord clamping on maternal blood loss in primary scheduled cesarean sections. METHODS We analyzed data of 98 women with singleton gestations undergoing primary scheduled cesarean section at term. Data from procedures with early cord clamping (ECC) were compared to those after implementation of delayed cord clamping (DCC). Primary outcomes were perioperative change in maternal hemoglobin levels, estimated and calculated blood loss. Secondary outcomes included duration of cesarean section and neonatal data. RESULTS There was a statistically significant difference in the mean perioperative decline of hemoglobin of 10.4 g/L (SD=7.92) and 18.7 g/L (SD=10.4) between the ECC and DCC group, respectively (p<0.001). The estimated (482 mL in ECC vs. 566 mL in DCC (p=0.011)) and the calculated blood loss (438 mL in ECC vs. 715 mL in DCC (p=0.002)) also differed significantly. Secondary outcomes showed no significant differences. CONCLUSIONS In our study DCC resulted in a statistically significant higher maternal blood loss. In our opinion the widely researched neonatal benefit of DCC outweighs the risk of higher maternal blood loss in low-risk patients. However, maternal risks must be minimized, improvements to preoperative blood management and operative techniques are required.
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Affiliation(s)
- Fabia L Urech
- Department of Anesthesiology, 30262 University Hospital Basel , Basel, Switzerland
| | - Thierry Girard
- Department of Anesthesiology, 30262 University Hospital Basel , Basel, Switzerland
| | - Maya Brunner
- Department of Anesthesiology, 30262 University Hospital Basel , Basel, Switzerland
| | - Andreas Schoetzau
- Department of Obstetrics and Antenatal Care, 30262 University Hospital Basel , Basel, Switzerland
| | - Olav Lapaire
- Department of Obstetrics and Antenatal Care, 30262 University Hospital Basel , Basel, Switzerland
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Leeson C, Jones M, Odendaal J, Choksey F, Quenby S. Routine use of cell salvage during cesarean section: A practice evaluation. Acta Obstet Gynecol Scand 2024; 103:498-504. [PMID: 38117692 PMCID: PMC10867391 DOI: 10.1111/aogs.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/04/2023] [Accepted: 12/01/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Intraoperative cell salvage is a well-documented alternative to donor blood transfusion given the scarcity of donor blood pools and the incumbent risk of allogenic blood transfusion. Its use in obstetrics has been limited by concern over fetal alloimmunization due to the risk of fetomaternal hemorrhage. However, there are a paucity of studies reporting on outcome. The aim of this study was to report on a four-year experience of routine use of intraoperative cell salvage and the impact on subsequent pregnancy outcomes. MATERIAL AND METHODS This was a tertiary center retrospective service evaluation cohort study and included all women undergoing cesarean section between December 2014 and November 2018 in a tertiary obstetric unit, identifying women who had reinfusion of intraoperative cell salvage. Data regarding index pregnancy as well as subsequent pregnancies at the hospital were extracted from hospital electronic records. Subsequent pregnancy outcome and maternal antibody status in that pregnancy were collected up until November 2022. RESULTS During the study period, 6656 cesarean sections were performed, with 436 (6.6%) receiving reinfusion of salvaged blood. The mean volume of reinfused blood was 396 mL. A total of 49 (0.7%) women received donor blood transfusion. Of those who received reinfusion of salvaged blood, 79 (18.1%) women had subsequent pregnancies over the eight-year follow-up period. There was one case (0.23%) of fetal cell alloimmunization demonstrated by the presence of anti-D antibodies on the subsequent pregnancy booking bloods. CONCLUSIONS Routine intraoperative cell salvage may be used to reduce the need for blood transfusion during cesarean section. The risk of fetal cell alloimmunization in a future pregnancy following reinfusion of intraoperative cell salvage is one in 436. Given an apparent small risk of fetal cell alloimmunization, further work is required to establish the safety profile of intraoperative cell salvage in pregnancy.
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Affiliation(s)
- Charlotte Leeson
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Molly Jones
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Joshua Odendaal
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical SchoolUniversity of WarwickCoventryUK
- University Hospitals Coventry & WarwickshireCoventryUK
| | | | - Siobhan Quenby
- Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical SchoolUniversity of WarwickCoventryUK
- University Hospitals Coventry & WarwickshireCoventryUK
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Kloka JA, Friedrichson B, Jasny T, Blum LV, Choorapoikayil S, Old O, Zacharowski K, Neef V. Anaemia and red blood cell transfusion in women with placenta accreta spectrum: an analysis of 38,060 cases. Sci Rep 2024; 14:4999. [PMID: 38424178 PMCID: PMC10904858 DOI: 10.1038/s41598-024-55531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/24/2024] [Indexed: 03/02/2024] Open
Abstract
Placenta accreta spectrum (PAS) has become a significant life-threatening issue due to its increased incidence and associated morbidity and mortality. Pregnancy is often associated with states of anaemia, and severe maternal haemorrhage represents a major risk factor for red blood cell (RBC) transfusion. The present study retrospectively analyzed the prevalence of anaemia, transfusion requirements and outcome in women with PAS. Using data from the German Statistical Office pregnant patients with deliveries hospitalized between January 2012 and December 2021 were included. Primary outcome was the prevalence of anemia and administration of RBCs. Secondary outcome were complications in women with PAS who received RBC transfusion. In total 6,493,606 pregnant women were analyzed, of which 38,060 (0.59%) were diagnosed with PAS. The rate of anaemia during pregnancy (60.36 vs. 23.25%; p < 0.0001), postpartum haemorrhage (47.08 vs. 4.41%; p < 0.0001) and RBC transfusion rate (14.68% vs. 0.72%; p < 0.0001) were higher in women with PAS compared to women without PAS. Women with PAS who had bleeding and transfusion experienced significantly more peripartum complications than those who did not. A multiple logistic regression revealed that the probability for RBC transfusion in all pregnant women was positively associated with anaemia (OR 21.96 (95% CI 21.36-22.58)). In women with PAS, RBC transfusion was positively associated with the presence of renal failure (OR 11.27 (95% CI 9.35-13.57)) and congestive heart failure (OR 6.02 (95% CI (5.2-7.07)). Early anaemia management prior to delivery as well as blood conservation strategies are crucial in women diagnosed with PAS.
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Affiliation(s)
- Jan Andreas Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Benjamin Friedrichson
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Thomas Jasny
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Lea Valeska Blum
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Oliver Old
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Theodor-Stern Kai 7, 60590, Frankfurt, Germany.
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Kurakazu M, Kurakazu M, Kiyoshima C, Shigekawa K, Hirakawa T, Yoshikawa K, Ito T, Urushiyama D, Miyata K, Yotsumoto F. Clinical Prediction of Retained Products of Conception: Combining Obstetric History and Ultrasound for Improved Accuracy in Severe Postpartum Hemorrhage. Cureus 2024; 16:e53651. [PMID: 38449994 PMCID: PMC10917468 DOI: 10.7759/cureus.53651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Background The current challenge is how to improve the management of postpartum hemorrhage (PPH) to reduce the maternal mortality rate further. This study aimed to investigate whether a combined specific obstetric history and ultrasonographic findings can improve the predictive accuracy of retained products of conception (RPOC) with severe PPH. Methods This retrospective study included 56 patients who were diagnosed with RPOC. We extracted the following clinical data: obstetric history of second-trimester miscarriage, the time at which there was clinical suspicion of RPOC after the previous pregnancy (TIME), grayscale ultrasonographic finding (RPOC long-axis length [SIZE]), and color Doppler ultrasonographic finding based on the Gutenberg classification (RPOC hypervascularity). In this study, we defined cases requiring blood transfusion therapy or transcatheter arterial embolization as severe PPH. The patients were divided into two groups according to the presence or absence of severe PPH. The predictors of severe PPH were evaluated using logistic regression models. Model A comprised a combination of second-trimester miscarriage and TIME, Model B comprised a combination of Model A and long-axis SIZE, and Model C comprised a combination of Model B and RPOC hypervascularity. Results The multivariable analysis showed that long-axis SIZE was the only significant predictor of severe PPH (odds ratio [OR], 10.38; 95% confidence interval [CI], 2.06-63.86) independent of second-trimester miscarriage, TIME, and RPOC hypervascularity. The c-statistic was higher in Model C (OR, 0.863; 95% CI, 0.731-0.936) than in Model A (OR, 0.723; 95% CI, 0.551-0.847) and Model B (OR, 0.834; 95% CI, 0.677-0.923). Conclusion Combining a specific obstetric history (second-trimester miscarriage and TIME) and ultrasonographic findings (long-axis SIZE and RPOC hypervascularity) improves the predictive accuracy of RPOC with severe PPH. This prediction model may be a useful clinical screening tool for RPOC with severe PPH.
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Affiliation(s)
- Mariko Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Masamitsu Kurakazu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Chihiro Kiyoshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Koichiro Shigekawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Toyofumi Hirakawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kenichi Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Tomohiro Ito
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Daichi Urushiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Kohei Miyata
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
| | - Fusanori Yotsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fukuoka University, Fukuoka, JPN
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Caljé E, Oyston C, Wang Z, Bloomfield F, Marriott J, Dixon L, Groom K. The fatigue after infusion or transfusion pilot trial and feasibility study: A three-armed randomized pilot trial of intravenous iron and blood transfusion for the treatment of postpartum anemia. Transfusion 2024; 64:301-314. [PMID: 38149691 DOI: 10.1111/trf.17621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Evidence for the management of moderate-to-severe postpartum anemia is limited. A randomized trial is needed; recruitment may be challenging. STUDY DESIGN AND METHODS Randomized pilot trial with feasibility surveys. INCLUSION hemoglobin 65-79 g/L, ≤7 days of birth, hemodynamically stable. EXCLUSION ongoing heavy bleeding; already received, or contraindication to intravenous (IV)-iron or red blood cell transfusion (RBC-T). Intervention/control: IV-iron; RBC-T; or IV-iron and RBC-T. PRIMARY OUTCOME number of recruits; proportion of those approached; proportion considered potentially eligible. SECONDARY OUTCOMES fatigue, depression, baby-feeding, and hemoglobin at 1, 6 and 12 weeks; ferritin at 6 and 12 weeks. Surveys explored attitudes to trial participation. RESULTS Over 16 weeks and three sites, 26/34 (76%) women approached consented to trial participation, including eight (31%) Māori women. Of those potentially eligible, 26/167 (15.6%) consented to participate. Key participation enablers were altruism and study relevance. For clinicians and stakeholders the availability of research assistance was the key barrier/enabler. Between-group rates of fatigue and depression were similar. Although underpowered to address secondary outcomes, IV-iron and RBC-T compared with RBC-T were associated with higher hemoglobin concentrations at 6 (mean difference [MD] 11.7 g/L, 95% confidence interval [CI] 2.7-20.7) and 12 (MD 12.8 g/L, 95% CI 1.5-24.2) weeks, and higher ferritin concentrations at 6 weeks (MD 136.8 mcg/L, 95% CI 76.6-196.9). DISCUSSION Willingness to participate supports feasibility for a future trial assessing the effectiveness of IV-iron and RBC-T for postpartum anemia. Dedicated research assistance will be critical to the success of an appropriately powered trial including women-centered outcomes.
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Affiliation(s)
- Esther Caljé
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Zeke Wang
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Wu D, Lan X, Litscher G, Zhao YL, Wu YQ, Dai RJ, Cao K, Wang Y, Chen LQ. Laser acupuncture and photobiomodulation therapy in Bell's palsy with a duration of greater than 8 weeks: a randomized controlled trial. Lasers Med Sci 2024; 39:29. [PMID: 38216803 PMCID: PMC10787006 DOI: 10.1007/s10103-023-03970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
To investigate the efficacy of laser acupuncture and photobiomodulation therapy in alleviating symptoms among patients diagnosed with Bell's palsy with duration of greater than 8 weeks. The randomized controlled trial has been performed from May 2021 to April 2023. Patients were eligible who had Bell's palsy with duration of greater than 8 weeks on out-patient Department of Otorhinolaryngology in Beijing Tongren Hospital. The laser acupuncture group received class IV laser treatment for 3 times per weeks, a total of 72 times. The control group received the same treatment procedure except the laser parameter. The primary outcome measures comprised House-Brackmann facial nerve grading system and electroneurography. Secondary outcome measures comprised Sunnybrook facial grading system, electromyography, and the blink reflex. A total of 84 participants were included (42 control group, 42 laser acupuncture group). After treatment, House-Brackmann facial nerve grading system (OR, 0.11; 95% CI, 0.04-0.30; P < 0.001), and the pathologic numbers of electroneuronography were statistically different between the laser acupuncture group and control group, including orbicularis oculi (OR,0.08; 95% CI, 0.02-0.21; P < 0.001), Frontalis muscle (OR,0.14; 95% CI, 0.05-0.39; P < 0.001), Orbicularis oris (OR,0.13; 95% CI, 0.04-0.36; P < 0.001), Ala nasi muscle (OR,0.06; 95% CI, 0.02-0.18; P < 0.001). In secondary outcomes, Sunnybrook facial grading system, has significant difference between the two groups (20.26; 95% CI, 14.69 to 25.83; P < 0.01). Latency by ENoG, include orbicularis oculi (-0.61; 95% CI, -0.43 to -0.09; P < 0.001), frontalis muscle (-0.12; 95% CI, -0.21 to -0.03; P < 0.01), orbicularis oris (-0.28; 95% CI, -0.41 to -0.16; P < 0.001), and ala nasi muscle (-0.26; 95% CI, -0.38 to -0.16; P < 0.001). All amplitudes of MUAPs and durations by electromyography (EMG) showed statistically significant differences compared with the control group after treatment. For the frontalis muscle, the amplitude of MUAPs was -64.23 (95% CI, -80.89 to -47.56; P < 0.001) and duration was -1.18 (95% CI, -1.49 to -0.87; P < 0.001). For orbicularis oris, amplitude of MUAPs was -29.82 (95% CI, -55.03 to -4.62; P = 0.02) and duration was -0.57 (95% CI, -0.94 to -0.20; P < 0.001). For depressor angulli oris, amplitude of MUAPs was -47.06 (95% CI, -62.15 to -31.97; P < 0.001) and duration was -2.21 (95% CI, -2.69 to -1.72; P < 0.001). Blink reflex, including R1 (OR, 0.03; 95% CI, 0.01-0.16; P < .001), R2 (OR, 0.04; 95% CI, 0.004-0.29; P < .001), and R2 latency differences (OR, 0.15; 95% CI, 0.05-0.51; P < .001), have significant difference between the two groups, respectively. The findings suggest that laser acupuncture relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks.Trial registration: ClinicalTrials.gov Identifier: NCT05846217.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xin Lan
- Jococo Inc, Los Angeles, CA, USA
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA transcontinental; since 2012), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM (since 2014), Vice Chairperson, World Federation of Chinese Medicine Societies, Committee of Card. Rehab. (2023-2028), Honorary President of the European Federation of Acupuncture and Moxibustion Societies (2023), Honorary Professor of China Beijing International Acupuncture Training Center, China Academy of Chinese Medical Sciences (2023), Former Head of two Research Units at Medical University of Graz, 8036, Graz, Austria
| | - Yan-Ling Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun-Qing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru-Jun Dai
- TED Healthcare Technology Ltd (Beijing), Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture-Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lu-Quan Chen
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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8
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Caljé E, Groom KM, Dixon L, Marriott J, Foon R, Oyston C, Bloomfield FH, Jordan V. Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis. Syst Rev 2024; 13:9. [PMID: 38169415 PMCID: PMC10759729 DOI: 10.1186/s13643-023-02400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. METHODS A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). RESULTS Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. DISCUSSION For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.
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Affiliation(s)
- E Caljé
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - J Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - R Foon
- Waikato Hospital, Hamilton, New Zealand
| | - C Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - V Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Etemady M, Hajizadeh M, Gidaszewski B, Swain JA, Chua SC, Khajehei M. Use of iron in perinatal anaemia: Indications for women’s health care policies and procedure. World J Obstet Gynecol 2023; 12:33-44. [DOI: 10.5317/wjog.v12.i4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/04/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This paper reviews management of obstetric anaemia and the role of intravenous iron for the treatment of obstetric anaemia. Red blood cell transfusions are routinely used for haemoglobin restoration in anaemic women. The decision for red blood cell transfusion is made on a combination of haemoglobin level and clinical status, and it is suggested that transfusions are not necessary in those who are well compensated or when alternative therapy is available. To reduce the risk, intravenous iron infusion is proposed as a bloodless therapeutic approach. There are a variety of iron preparations. Intravenous iron infusion can reduce the requirement for blood transfusion in hemodynamically stable women with perinatal anaemia, especially in resource-scarce settings. It a cost-effective bloodless approach for the treatment of anaemia than can enhance patient outcomes. According to the literature, when haemoglobin is greater than 90 g/L, blood transfusion is not often required. In perinatal women with anaemia, the decision whether to administer blood or iron is based on patient preferences, haemoglobin levels, clinical symptoms, past and present medical conditions and the clinician’s judgement. Nevertheless, due to the lack of rigid criteria for blood transfusions in the majority of clinical settings, it is considered the default treatment for anaemia in perinatal women.
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Affiliation(s)
- Mike Etemady
- School of Health Sciences, University of Sydney, Sydney, Australia, Sydney 2000, NSW, Australia
| | - Melika Hajizadeh
- Stotts College, Acknowledge Education, Sydney 2000, NSW, Australia
| | - Beata Gidaszewski
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
| | - Julie Ann Swain
- Women's and Newborn Health, Westmead hospital, Westmead 2145, NSW, Australia
| | - Seng Chai Chua
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Clinical School, Western Sydney University, Sydney 2145, NSW, Australia
| | - Marjan Khajehei
- Department of Women’s and Newborn Health, Westmead Hospital, Westmead 2145, NSW, Australia
- Westmead Clinical School, University of Sydney, Sydney 2000, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney 2145, NSW, Australia
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10
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Ghaem Maghami N, Helfenstein F, Manegold-Brauer G, Amstad G. Risk factors for postpartum haemorrhage in women with histologically verified placenta accreta spectrum disorders: a retrospective single-centre cross-sectional study. BMC Pregnancy Childbirth 2023; 23:786. [PMID: 37951863 PMCID: PMC10638773 DOI: 10.1186/s12884-023-06103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) disorders have been reported with an increasing frequency of up to 3%. The increase in the incidence can be explained by the rising rate of Caesarean section (CS), assisted reproductive technology (ART) and previous uterine surgeries. PAS disorders are usually associated with postpartum haemorrhage (PPH). In our study, we investigated the risk factors for increased blood loss in women with histologically verified PAS disorders independent of delivery mode. METHODS In a retrospective single-centre cross-sectional study, 2,223 pregnant women with histologically verified PAS disorders were included. Risk factors for PPH in women with PAS disorders were examined and compared between women with PPH (study group; n = 879) and women with normal blood loss (control group; n = 1150), independent of delivery mode. PAS disorders were diagnosed histologically from the following specimens: placenta, placental-bed specimens, uterine curettage, uterine resection and/or total/partial hysterectomy. Medical data were extracted from clinical records of pregnant women with PAS disorders delivering at the University Hospital Basel between 1986 and 2019. The placenta data of women with PAS disorders were obtained and identified through a search from the database of the Department of Pathology, University Hospital Basel. RESULTS Between 1986 and 2019, there were 64,472 deliveries at the University Hospital Basel. PAS disorders were histologically verified in 2,223 women (2,223/64,472), and the prevalence of PAS disorders was 3.45%. A total of 879 women with PAS disorders showed PPH, independent of delivery mode (43.3%). Due to missing data for 194 women, the final analysis was conducted with the remaining 2,029 women. Placenta praevia (O.R. = 6.087; 95% CI, 3.813 to 9.778), previous endometritis (O.R. = 3.011; 95% CI, 1.060 to 9.018), previous manual placenta removal (O.R. = 2.530; 95% CI, 1.700 to 3.796), ART (O.R. = 2.169; 95% CI, 1.593 to 2.960) and vaginal operative birth (O.R. = 1.715; 95% CI, 1.225-2.428) can be considered important risk factors, and previous CS (O.R. = 1.408; 95% CI, 1.016 to 1.950) can be considered a moderate potential risk factor of PPH in women with PAS disorders. CONCLUSIONS Placenta praevia, previous endometritis, previous placenta removal, ART and vaginal operative birth can be considered important risk factors of PPH in women with PAS disorders. STUDY REGISTRATION The study was registered under http://www. CLINICALTRIALS gov (NCT05542043) on 15 September 2022.
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Affiliation(s)
- Naghmeh Ghaem Maghami
- Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, Basel, CH-4031, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Gwendolin Manegold-Brauer
- Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, Basel, CH-4031, Switzerland
| | - Gabriela Amstad
- Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, Basel, CH-4031, Switzerland.
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11
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Song KH, Choi ES, Kim HY, Ahn KH, Kim HJ. Patient blood management to minimize transfusions during the postpartum period. Obstet Gynecol Sci 2023; 66:484-497. [PMID: 37551109 PMCID: PMC10663398 DOI: 10.5468/ogs.22288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/11/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Patient blood management is an evidence-based concept that seeks to minimize blood loss by maintaining adequate hemoglobin levels and optimizing hemostasis during surgery. Since the coronavirus disease 2019 pandemic, patient blood management has gained significance due to fewer blood donations and reduced amounts of blood stored for transfusion. Recently, the prevalence of postpartum hemorrhage (PPH), as well as the frequency of PPH-associated transfusions, has steadily increased. Therefore, proper blood transfusion is required to minimize PPH-associated complications while saving the patient's life. Several guidelines have attempted to apply this concept to minimize anemia during pregnancy and bleeding during delivery, prevent bleeding after delivery, and optimize recovery methods from anemia. This study systematically reviewed various guidelines to determine blood loss management in pregnant women.
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Affiliation(s)
- Kwan Heup Song
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Eun Saem Choi
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Hai Joong Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
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12
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Leung TW, Damodaran P, Torres R, Chuncharunee S, Chu MY, Gamilla Z, Lim NR, Luna J, Huang JP, Li WH, Tran TN, Sathar J, Jaisamrarn U. Expert consensus on improving iron deficiency anemia management in obstetrics and gynecology in Asia. Int J Gynaecol Obstet 2023; 163:495-509. [PMID: 37096333 DOI: 10.1002/ijgo.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023]
Abstract
Iron deficiency anemia (IDA) is a major health burden among women in Asia. Key issues in IDA management in Asia are under-diagnosis and under-treatment. The lack of Asia-specific guidelines, and suboptimal utilization of treatment compounds the management of IDA. To address these gaps, a panel of 12 experts in obstetrics, gynecology, and hematology from six regions in Asia convened to review current practices and clinical evidence and provide practical guidance on IDA diagnosis and management in Asian women. The Delphi approach was used to obtain objective opinions and attain consensus on statements pertaining to awareness, diagnosis, and management of IDA. In total, 79 statements attained consensus and are summarized to provide guidance on raising awareness of IDA and approaches for improved diagnosis and treatment of IDA among women in various settings: pregnancy, postpartum, heavy menstrual bleeding, gynecologic cancers, and perioperative care. This clinician-led consensus integrates appropriate recommendations based on clinical evidence and best practices and is intended to guide decision making in the management of iron deficiency/IDA in women. The expert panel raises a call for timely diagnosis and utilization of appropriate treatment, including use of high-dose intravenous iron, stringent blood management, and interdisciplinary collaboration, for optimization of IDA management among women in Asia.
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Affiliation(s)
- Tsin Wah Leung
- Department of Obstetrics & Gynecology, Kwong Wah Hospital, Hong Kong, China
| | - Premitha Damodaran
- Department of Obstetrics & Gynecology, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Rosalio Torres
- Section of Hematology, Makati Medical Center & Cardinal Santos Medical Center, San Juan, The Philippines
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Man Yee Chu
- Department of Obstetrics and Gynecology, Queen Mary Hospital, Hong Kong, China
| | - Zaida Gamilla
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, The Philippines
| | | | - Jericho Luna
- Division of Gynecologic Oncology, Philippine General Hospital, Manila, The Philippines
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wai Hou Li
- Division of Obstetrics and Gynecology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Thang Nhat Tran
- Department of Obstetrics and Gynecology, University Medical Centre, Ho Chi Minh City, Vietnam
| | - Jameela Sathar
- Department of Hematology, Ampang Hospital, Selangor, Malaysia
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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13
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Fabricant SP, Opara KN, Paul JV, Blissett G, Rau AR, White JD, Girma A, Sriprasert I, Korst LM, Mitchell EN. The Positive Predictive Value of Hospital Discharge Data for Identifying Severe Maternal Morbidity With and Without Blood Transfusion. Jt Comm J Qual Patient Saf 2023; 49:467-473. [PMID: 37365038 DOI: 10.1016/j.jcjq.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Blood transfusion is 1 of the 21 indicators for severe maternal morbidity (SMM) as defined by the Centers for Disease Control and Prevention (CDC) using administrative data. The CDC SMM definition is being prepared to measure hospital quality of care; however, transfusion coding reliability has been questioned. The authors assessed the positive predictive value (PPV) of administrative data for identifying gold standard SMM using the CDC SMM definition, with and without the transfusion indicator. METHODS A retrospective cohort study of one hospital's childbirth admissions (2016-2019) was performed. Data were screened for CDC SMM, and subgroups were created for those with transfusion as the sole indicator for SMM (transfusion-only SMM) versus those with at least one other SMM indicator (other SMM). Medical chart review classified CDC SMM cases based on gold standard SMM criteria. Gold standard SMM was defined by validated indicators identified by internal hospital quality reviews and confirmed by expert consensus. The PPV was calculated for all CDC SMM cases and the subgroups. RESULTS Of 4,212 eligible people, 278 (6.6%) had CDC SMM. Chart review identified 110 gold standard SMM cases among screen-positive cases, yielding an overall PPV of the CDC SMM definition for gold standard SMM of 39.6%. CDC SMM cases identified solely by administrative coding for transfusion were half as likely to meet gold standard criteria, compared to cases identified by other SMM administrative codes (25.9% vs. 49.4%). CONCLUSION Blood transfusion, coded as an independent risk factor, had a poor PPV for gold standard SMM. Given efforts to use CDC SMM for quality comparisons, more research is needed to reliably identify cases of SMM without relying on blood transfusion codes.
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14
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Anuragaa S, Chaturvedula L, Basavarajegowda A. Blood component therapy in patients having massive obstetric hemorrhage in a tertiary care center in Puducherry. Asian J Transfus Sci 2023; 17:210-216. [PMID: 38274969 PMCID: PMC10807513 DOI: 10.4103/ajts.ajts_101_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION A proper transfusion protocol must be followed for every patient with massive obstetric hemorrhage (MOH), as each patient may need a different pattern of transfusion support. In this background, it is prudent to understand the current prevalent practices and devise preparatory strategies for managing blood requirements during such scenarios. This study helps us know the pattern and type of blood components given to patients with MOHs. METHODOLOGY This prospective cross-sectional study was conducted on patients with a MOH admitted to a single center at a tertiary care teaching hospital in Puducherry between January 2020 and October 2021. During the hospital stay, patient parameters such as diagnosis, obstetric history, blood loss, transfusion of blood products, transfusion reaction, blood group, length of hospital stay, laboratory parameters, and patient vitals and comorbidities were recorded in a predesigned pro forma and tabulated into Excel sheet and analyzed using SPSS software version 19.0. RESULTS Fifty-four patients with MOH were included in our study. The median blood loss was 2.15 L, with a range of 2 L. The mean difference between the baseline and posthemorrhage hemoglobin is 1.7 g/dl. No correlation was observed between the number of packed red blood cell (PRBC) transfused and baseline hemoglobin or between random donor platelets (RDP) transfusion and baseline platelet count. The median number of hospital stays was 10 days, ranging from 7 to 14.5 days. Eleven (20.38%) patients had a hysterectomy done to control bleeding. The remaining 43 patients were managed successfully by other measures such as medical management, compressive surgical suturing, and arterial ligation. Forty-eight (88.9%) patients survived, and 6 (11.1%) patients expired. CONCLUSION The percentage of RDP and cryoprecipitate transfused to the patients was less than PRBC and fresh frozen plasma (FFP). The FFP-to-PRBC ratio was 2. Regular transfusion audits must be conducted to assess the flaws and improve current strategies.
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Affiliation(s)
- S. Anuragaa
- Departments of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Abhishekh Basavarajegowda
- Departments of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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15
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Neef V. Obstetric anesthesia from the beginning to the end: opportunities and challenges. Curr Opin Anaesthesiol 2023; 36:253-254. [PMID: 37114284 DOI: 10.1097/aco.0000000000001264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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16
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Wiesenack C, Meybohm P, Neef V, Kranke P. Current concepts in preoperative anemia management in obstetrics. Curr Opin Anaesthesiol 2023; 36:255-262. [PMID: 36794901 PMCID: PMC10155694 DOI: 10.1097/aco.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an overview of currently recommended treatment approaches for anemia during pregnancy, with a special focus on iron deficiency and iron deficiency anemia (IDA). RECENT FINDINGS As consistent patient blood management (PBM) guidelines in obstetrics are still lacking, recommendations regarding the timing of anemia screening and the treatment recommendations for iron deficiency and IDA during pregnancy are still controversial. Based on increasing evidence, early screening for anemia and iron deficiency should be recommended at the beginning of each pregnancy. To reduce maternal and fetal burden, any iron deficiency, even without anemia, should be treated as early as possible during pregnancy. While oral iron supplements administered every other day are the standard treatment in the first trimester, the use of intravenous iron supplements is increasingly suggested from the second trimester onwards. SUMMARY The treatment of anemia, and more specifically iron deficiency anemia during pregnancy, holds many possibilities for improvement. The fact that the period of risk is known well in advance and thus there is a long optimization phase is per se an ideal prerequisite for the best possible therapy of treatable causes of anemia. Standardization of recommendations and guidelines for screening and treatment of IDA in obstetrics is required for the future. In any case, a multidisciplinary consent is the precondition for a successfully implementation of anemia management in obstetrics to establish an approved algorithm easily enabling detection and treatment of IDA during pregnancy.
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Affiliation(s)
- Christoph Wiesenack
- Department of Anaesthesiology, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg
| | - Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg
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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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18
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Elshamy E, Rezk M, Shaheen AE. Is it worth to insert uterine pack instead of Bakri balloon to control postpartum hemorrhage after vaginal delivery in hypertensive patients? Arch Gynecol Obstet 2023; 307:1195-1201. [PMID: 35396973 DOI: 10.1007/s00404-022-06543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/18/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the safety and effectiveness of uterine packing with gauze compared to Bakri balloon to control postpartum hemorrhage (PPH) after vaginal delivery in patients with hypertensive disorders with pregnancy (HDP). METHODS This was a prospective observational study conducted on 142 patients with HDP who suffered atonic PPH following vaginal delivery and were allocated either to insert uterine packing with gauze (n = 68) or insertion of Bakri balloon (n = 74). Success of the tamponade to arrest bleeding was the primary outcome measure. Data was collected and analyzed. RESULTS Most of the included patients experienced spontaneous onset of labour (69%), had not receive I.V. antihypertensive drugs (83.1%) or magnesium sulphate (94.4%), or calcium channel blocker (95.7%), underwent spontaneous vaginal delivery (85.9%), received Pethidine by IMI for pain relief during labour (67.6%), did not need an episiotomy (59.2%), with spontaneous delivery of the placenta (95.77%). Bakri balloon was associated with a shorter duration to insert (p < 0.001), a higher failure rate with the need for laparotomy (p < 0.05) and more post-delivery hospital stay compared to uterine packing (p < 0.001). CONCLUSION Although uterine packing with gauze to control PPH after vaginal delivery in patients with HDP requires a longer time to insert compared to Bakri balloon yet associated with a lesser need for laparotomy and shorter hospital stay. Larger trials are warranted to confirm or refute these findings.
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Affiliation(s)
- Elsayed Elshamy
- Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
- Department of Obstetrics and Gynecology, King Abdul-Aziz Airbase Hospital, 041/9 Prince Sattam street, Al-Khobar, Dhahran, Saudi Arabia.
| | - Mohamed Rezk
- Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt
- Department of Obstetrics and Gynecology, Rabia Hospital, Riyadh, Saudi Arabia
| | - Abd-Elhamid Shaheen
- Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt
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19
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Calje E, Marriott J, Oyston C, Dixon L, Bloomfield F, Groom K. Postpartum anaemia in three New Zealand district health board regions: An observational study of incidence and management. Aust N Z J Obstet Gynaecol 2023; 63:178-186. [PMID: 35851951 DOI: 10.1111/ajo.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The incidence of postpartum anaemia (PPA) in New Zealand, and the extent of intravenous iron (IV-iron) use in its treatment, are unknown. AIMS To report the incidence of PPA in three district health board (DHB) regions and describe current management of moderate to severe PPA, including by ethnicity. MATERIALS AND METHODS Retrospective observational study of PPA (haemoglobin (Hb) <100 g/L) in three DHBs from July-December 2019. Cases with moderate to severe PPA (Hb <90 g/L) were reviewed and management compared to local and national guidance. Logistic regression examined demographic associations of PPA. RESULTS There were 8849 women who gave birth during the study period: 4076 (46%) had postpartum Hb testing and 1544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% CI 0.37-0.57, P < 0.01). Of 681 women with Hb <90 g/L, 278 (41%) received IV-iron only, 66 (10%) red blood cell transfusion (RBC-T) only and 155 (23%) both. Of those receiving RBC-T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90 g/L had the highest incidence of IV-iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding. CONCLUSION The incidence and management of PPA differs by ethnicity but fewer than half of the women had Hb testing, making precise determination of incidence impossible. The majority of women with Hb <90 g/L received IV-iron, with or without RBC-T.
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Affiliation(s)
- Esther Calje
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Joy Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Katie Groom
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
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20
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Wangi Ngoy Y, Nganga Nkanga MS, Ndelembo Baina G, Katende Katende A, Bikaula Ngwidiwo J, Mpudi Massamba L, Walo Diessa F, Kuyangisa Boloko B, Mawalala Malengele H, Longo-Mbenza B. Critical Assessment of Transfusional Practices in the Obstetrics and Gynecology Department At the University Hospital of Kinshasa. J Blood Med 2023; 14:221-231. [PMID: 37009130 PMCID: PMC10065013 DOI: 10.2147/jbm.s381016] [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: 07/11/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Gynecology and obstetrics are among the specialties where blood transfusion is most practiced. This situation requires the use of good transfusion practices. The objective of this study was to assess the quality of transfusion practice in the Gynecology and Obstetrics Department of the University Hospital of Kinshasa (UHK). Methods This is a prospective, evaluative and descriptive study performed at the Department of Gyneco-Obstetrics of the University Hospital of Kinshasa from February 25 to June 25, 2020; which dealt with patients who received at least one blood transfusion. Results About 498 patients, 54 patients were transfused and their average age was 36.4 years, with the extremes of 14 and 60 years, the transfusion rate was 10.8%. Most of patients (n=36: 2/3) were transfused during weekend days, sachets were used as delivery materials of blood product in 57.4% of cases (n = 31). Among the prescribers of blood products, 70.4% were nurses. All transfusions were carried out in type-specific and cross-matched Rh. All the transfused patients were not aware of the disadvantages of transfusion. Compatibility tests at the patient's bedside were not performed in 61.1% of cases and the concordance control between the patient and the blood component to be transfused was not performed in 70.4% of cases. Close monitoring of blood transfusion in the first ten minutes was not performed in 59.3% of cases. Conclusion Transfusion encounters real practical problems in the gyneco-obstetrical environment of countries with limited resources. However, an assessment and multidisciplinary collaboration would be necessary to improve transfusion practice in medical field.
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Affiliation(s)
- Yvon Wangi Ngoy
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Lomo University of Research, Kinshasa, Democratic Republic of Congo
- Department of Medical Biology, Institute for Health Science Research, Kinshasa, Democratic Republic of Congo
| | - Mireille Solange Nganga Nkanga
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Lomo University of Research, Kinshasa, Democratic Republic of Congo
| | - Guy Ndelembo Baina
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Audrey Katende Katende
- Department of Medical Biology, Institute for Health Science Research, Kinshasa, Democratic Republic of Congo
| | - Jacques Bikaula Ngwidiwo
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lethy Mpudi Massamba
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Fanny Walo Diessa
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Bienvenu Kuyangisa Boloko
- Department of Medical Biology, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Héritier Mawalala Malengele
- Lomo University of Research, Kinshasa, Democratic Republic of Congo
- Department of Internal Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Benjamin Longo-Mbenza
- Lomo University of Research, Kinshasa, Democratic Republic of Congo
- Department of Internal Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Health, Walter Sisulu University, Mthatha, South Africa
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21
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Blood Transfusion and Associated Factors in Pregnant Women Admitted to a Tertiary Care Hospital in Southeast Iran. HEALTH SCOPE 2023. [DOI: 10.5812/jhealthscope-128705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Effective blood transfusion is a life-saving practice in obstetrics and gynecology emergencies that can prevent blood product wastage in hospitals. Objectives: This study was performed to evaluate the appropriateness of the use of blood products in pregnant women in a tertiary care hospital in Zahedan, southeast Iran. Methods: This cross-sectional study was carried out from September 2019 to March 2020 to assess the patterns of blood utilization in a tertiary care hospital in Zahedan, Iran. Blood bank registries and the data of 1,500 pregnant women were used for data analysis, using blood transfusion indices, including cross-matched to transfusion (C/T) ratio, transfusion probability (T), and transfusion index (TI). Results: Out of 1,064 units of requested blood products, 581 (54.6%) were cross-matched, and 774 (72.7%) were transfused to patients. The blood transfusion indices of C/T, T%, and TI were 2.11, 48.48%, and 0.76, respectively. The transfusion rate was 6.2%, and the commonest associated obstetrics complication requiring transfusion was uterine atony (32.2%), followed by anemia (17.2%). There was a statistically significant relationship between the type of delivery, uterine and placental problems, coagulation disorders during pregnancy, number of deliveries, and residence place, and the probability of blood transfusion (P > 0.05). Conclusions: The overall blood utilization indices were encouraging; however, the proportion of blood wastage was relatively high. Regular auditing is needed to optimize the use of blood and blood products in obstetrics and gynecology departments.
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22
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Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best Pract Res Clin Anaesthesiol 2022; 36:325-339. [PMID: 36513428 DOI: 10.1016/j.bpa.2022.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/17/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency complicating 1-10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. Despite all the significant progress in healthcare, the incidence of PPH is rising due to an incomplete implementation of guidelines, resulting in treatment delays and suboptimal care. A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.
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Affiliation(s)
- Jan Bláha
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
| | - Tereza Bartošová
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
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23
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Enste R, Cricchio P, Dewandre PY, Braun T, Leonards CO, Niggemann P, Spies C, Henrich W, Kaufner L. Placenta Accreta Spectrum Part II: hemostatic considerations based on an extended review of the literature. J Perinat Med 2022; 51:455-467. [PMID: 36181735 DOI: 10.1515/jpm-2022-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
"Placenta accreta spectrum" (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality-as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized "centers of excellence," and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.
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Affiliation(s)
- Rick Enste
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Patrick Cricchio
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pierre-Yves Dewandre
- Department of Anesthesia and Intensive Care Medicine, Université de Liège, Liege, Belgium
| | - Thorsten Braun
- Department of Obstetrics and 'Exp. Obstetrics', Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christopher O Leonards
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Phil Niggemann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics and 'Exp. Obstetrics', Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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24
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Iron metabolism and iron deficiency anemia in women. Fertil Steril 2022; 118:607-614. [PMID: 36075747 DOI: 10.1016/j.fertnstert.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 01/13/2023]
Abstract
Iron deficiency (ID) and iron deficiency anemia (IDA) are highly prevalent among women across their reproductive age. An iron-deficient state has been associated with and causes a number of adverse health consequences, affecting all aspects of the physical and emotional well-being of women. Heavy menstrual bleeding, pregnancy, and the postpartum period are the major causes of ID and IDA. However, despite the high prevalence and the impact on quality of life, ID and IDA among women in their reproductive age is still underdiagnosed and undertreated. In this chapter we summarized the iron metabolism and the diagnosis and treatment of ID and IDA in women.
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25
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Tomić Mahečić T, Brooks R, Noitz M, Sarmiento I, Baronica R, Meier J. The Limits of Acute Anemia. J Clin Med 2022; 11:jcm11185279. [PMID: 36142930 PMCID: PMC9505011 DOI: 10.3390/jcm11185279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 01/28/2023] Open
Abstract
For many years, physicians’ approach to the transfusion of allogeneic red blood cells (RBC) was not individualized. It was accepted that a hemoglobin concentration (Hb) of less than 10 g/dL was a general transfusion threshold and the majority of patients were transfused immediately. In recent years, there has been increasing evidence that even significantly lower hemoglobin concentrations can be survived in the short term without sequelae. This somehow contradicts the observation that moderate or mild anemia is associated with relevant long-term morbidity and mortality. To resolve this apparent contradiction, it must be recognized that we have to avoid acute anemia or treat it by alternative methods. The aim of this article is to describe the physiological limits of acute anemia, match these considerations with clinical realities, and then present “patient blood management” (PBM) as the therapeutic concept that can prevent both anemia and unnecessary transfusion of RBC concentrates in a clinical context, especially in Intensive Care Units (ICU). This treatment concept may prove to be the key to high-quality patient care in the ICU setting in the future.
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Affiliation(s)
- Tina Tomić Mahečić
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Center Zagreb—“Rebro”, 10000 Zagreb, Croatia
| | - Roxane Brooks
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
| | - Matthias Noitz
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
| | - Ignacio Sarmiento
- Department of Anesthesiology, Clinica Santa Maria, Santiago 7520378, Chile
| | - Robert Baronica
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Center Zagreb—“Rebro”, 10000 Zagreb, Croatia
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH, Johannes Kepler University, 4040 Linz, Austria
- Correspondence:
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26
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Froessler B, Schubert KO, Palm P, Church R, Aboustate N, Kelly TL, Dekker GA, Hodyl NA. Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial. BJOG 2022; 130:15-23. [PMID: 36047598 PMCID: PMC10087028 DOI: 10.1111/1471-0528.17288] [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: 06/26/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test equivalence of two doses of intravenous iron (ferric carboxymaltose) in pregnancy. DESIGN Parallel, two-arm equivalence randomised controlled trial with an equivalence margin of 5%. SETTING Single centre in Australia. POPULATION 278 pregnant women with iron deficiency. METHODS Participants received either 500 mg (n=152) or 1000mg (n=126) of intravenous ferric carboxymaltose in the second or third trimester. MAIN OUTCOME MEASURES The proportion of participants requiring additional intravenous iron (500mg) to achieve and maintain ferritin >30ug/L (diagnostic threshold for iron deficiency) at 4 weeks post-infusion, and at 6 weeks, and 3-, 6- and 12-months postpartum. Secondary endpoints included repeat infusion rate, iron status, birth, and safety outcomes. RESULTS The two doses were not equivalent within a 5% margin at any timepoint. At 4 weeks post infusion, 26/73 (36%) participants required a repeat infusion in the 500 mg group compared with 5/67 (8%) in the 1000 mg group (difference in proportions, 0.283 95% confidence interval (0.177, 0.389)). Overall, participants in the 500 mg arm received twice the repeat infusion rate (0.81 (SD= 0.824 vs 0.40 (SD= 0.69), rate ratio 2.05, 95% CI (1.45, 2.91)). CONCLUSIONS Administration of 1000 mg ferric carboxymaltose in pregnancy maintains iron stores and reduces the need for repeat infusions. A 500 mg dose requires ongoing monitoring to ensure adequate iron stores are reached and sustained.
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Affiliation(s)
- B Froessler
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - K O Schubert
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Northern Adelaide Mental Health Services, Lyell McEwin Hospital, Vale, Elizabeth, SA.,Robinson Research Institute
| | - P Palm
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - R Church
- Department of Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Vale, Elizabeth, SA, Australia.,Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, SA, Australia
| | - N Aboustate
- University of South Australia, Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, SA, Australia
| | - T-L Kelly
- Department of Obstetrics and Gynaecology, Lyell McEwin Hospital, SA, Australia
| | - G A Dekker
- Adelaide Medical School, The University of Adelaide, SA, Australia
| | - N A Hodyl
- Adelaide Medical School, The University of Adelaide, SA, Australia.,Hunter Medical Research Institute, Newcastle, NSW
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27
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Helmer P, Schlesinger T, Hottenrott S, Papsdorf M, Wöckel A, Sitter M, Skazel T, Wurmb T, Türkmeneli I, Härtel C, Hofer S, Alkatout I, Messroghli L, Girard T, Meybohm P, Kranke P. [Postpartum hemorrhage : Interdisciplinary consideration in the context of patient blood management]. Anaesthesist 2022; 71:181-189. [PMID: 35244736 DOI: 10.1007/s00101-022-01098-8] [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] [Accepted: 08/11/2021] [Indexed: 12/20/2022]
Abstract
Postpartum hemorrhage (PPH) nowadays still represents a severe complication of both a vaginal delivery and a cesarean section. In German-speaking areas a new definition of the term has recently become established and the nomenclature with respect to the severe form of PPH was dropped. The handling of misoprostol as a uterotonic during treatment of PPH is also new, which is available in Germany only as a medical direct import. For adequate diagnostics and targeted treatment interdisciplinary and standardized algorithms should be established and the specialist disciplines involved should be sensitized to this problem. In addition to an adequate hemostasis, a developing coagulopathy must be recognized at an early stage and treated with targeted coagulation management. Through implementation concepts, particularly the second pillar (minimization of blood loss) and the third pillar (rational use of blood transfusions) of patient blood management, various aspects for improvement of treatment of a PPH can be identified.
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Affiliation(s)
- Philipp Helmer
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Sebastian Hottenrott
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Michael Papsdorf
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Achim Wöckel
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Skazel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Ismail Türkmeneli
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Christoph Härtel
- Kinderklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Stefan Hofer
- Klinik für Anästhesie, Intensiv‑, Notfallmedizin und Schmerztherapie, Westpfalz-Klinikum, Kaiserslautern, Deutschland
| | - Ibrahim Alkatout
- Klinik für Gynäkologie und Geburtshilfe (Frauenheilkunde), Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Leila Messroghli
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Thierry Girard
- Anästhesiologie, Universitätsspital Basel, Basel, Schweiz
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Helmer P, Schlesinger T, Hottenrott S, Papsdorf M, Wöckel A, Diessner J, Stumpner J, Sitter M, Skazel T, Wurmb T, Härtel C, Hofer S, Alkatout I, Girard T, Meybohm P, Kranke P. [Patient blood management in the preparation for birth, obstetrics and postpartum period]. Anaesthesist 2022; 71:171-180. [PMID: 35234987 DOI: 10.1007/s00101-022-01109-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/17/2023]
Abstract
The implementation of patient blood management (PBM) is increasingly becoming standard in operative medicine. Recently, interest has also been shown for the vulnerable collective of pregnant women and neonates. As the information regarding anesthesiological procedures for pregnant women and the peripartum period including an informed consent process should be carried out long before childbirth, this provides a good possibility in this connection to incorporate PBM. An anesthesiological risk estimation as well as the diagnostic workup and treatment of potential anemia should be carried out during the pregnancy. Furthermore, loss of blood in anticipation of bleeding complications should be reduced by interdisciplinary preventive measures and an individually coordinated postpartum care should be organized. This results in an early diagnosis of anemia or iron deficiency with subsequent treatment also postpartum, analogous to the prepartum period.
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Affiliation(s)
- Philipp Helmer
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Schlesinger
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Sebastian Hottenrott
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Michael Papsdorf
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Achim Wöckel
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Joachim Diessner
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Jan Stumpner
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Tobias Skazel
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Thomas Wurmb
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Christoph Härtel
- Kinderklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Stefan Hofer
- Klinik für Anästhesie, Intensiv‑, Notfallmedizin und Schmerztherapie, Westpfalz-Klinikum, Kaiserslautern, Deutschland
| | - Ibrahim Alkatout
- Klinik für Gynäkologie und Geburtshilfe (Frauenheilkunde), Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Thierry Girard
- Anästhesiologie, Universitätsspital Basel, Basel, Schweiz
| | - Patrick Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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Casellas Caro M, Hidalgo MJC, García-Erce JA, Baquero Úbeda JL, Torras Boatella MG, Gredilla Díaz E, Ruano Encinar M, Martín Bayón I, Nicolás Picó J, Arjona Berral JE, Muñoz Solano A, Jiménez Merino S, Cerezales M, Cuervo J. Applying reflective multicriteria decision analysis to understand the value of therapeutic alternatives in the management of gestational and peripartum anaemia in Spain. BMC Pregnancy Childbirth 2022; 22:157. [PMID: 35216553 PMCID: PMC8881868 DOI: 10.1186/s12884-022-04481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the FeminFER project was to assess the value of ferric carboxymaltose following a multicriteria decision analysis in obstetrics and gynaecology in Spain. METHODS Ferric carboxymaltose (FCM) and ferrous sulphate were evaluated using the EVIDEM framework. Ten stakeholders participated to collect different perspectives. The framework was adapted considering evidence retrieved with a PICO-S search strategy and grey literature. Criteria/subcriteria were weighted by level of relevance and an evidence-based decision-making exercise was developed in each criterion; weights and scores were combined to obtain the value of intervention relative to each criterion/subcriterion, that were further combined into the Modulated Relative Benefit-Risk Balance (MRBRB). RESULTS The most important criterion favouring FCM was Compared Efficacy/Effectiveness (0.183 ± 0.07), followed by Patient Preferences (0.059 ± 0.10). Only Direct medical costs criterion favoured FS (-0.003 ± 0.03). MRBRB favoured FCM; 0.45 ± 0.19; in a scale from -1 to + 1. CONCLUSIONS In conclusion, considering the several criteria involved in the decision-making process, participants agreed with the use of FCM according to its MRBRB.
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Affiliation(s)
- Manel Casellas Caro
- Department of Obstetrics, Hospital Universitari Vall d´Hebron, Passeig de la Vall d'Hebron, 119, 08035, Barcelona, Spain
| | - María Jesús Cancelo Hidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Guadalajara, Calle Donante de Sangre, 19002, Guadalajara, S/N, Spain
| | - José Antonio García-Erce
- Banco de Sangre Y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Calle Irunlarrea, 3, 31008, Pamplona, Spain
- Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de La Salud, Avenida San Juan Bosco, 13, 50009, Zaragoza, Spain
- PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Maria Glòria Torras Boatella
- Àrea d'Innovació, Hospital Universitari Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat, 08907, Barcelona, S/N, Spain
- Institut Català de La Salut, Barcelona, Spain
| | - Elena Gredilla Díaz
- Anaesthesia Department, Hospital La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | | | - Israel Martín Bayón
- CS Polop-La Nucía, Avenida de Sagi Barba, 24, Polop, La Nucía, 03520, Alicante, Spain
| | - Jordi Nicolás Picó
- Hospital Universitari Mutua Terrasa, Plaça del Doctor Robert, 5, 08221, Terrassa, Spain
| | | | - Alberto Muñoz Solano
- Department of Obstetrics and Gynecology, Hospital Universitario Marqués de Valdecilla, Avenida de Valdecilla, 25, 39008, Santander, Spain
| | | | - Mónica Cerezales
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain
| | - Jesús Cuervo
- Axentiva Solutions S.L., Calle Monte Cerrau, 28, 33006, Asturias, Oviedo, Spain.
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Clinical outcomes of uterine artery embolization and experience of postoperative transvaginal fibroid expulsion: a retrospective analysis. Arch Gynecol Obstet 2022; 306:829-840. [PMID: 35122498 DOI: 10.1007/s00404-022-06407-5] [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: 10/29/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore the efficacy of uterine artery embolization (UAE) in the treatment of uterine fibroid and share the experience of transvaginal fibroid expulsion (FE) after UAE. METHODS We retrospectively analyzed the changes in uterine and fibroid volume in 152 patients with symptomatic uterine fibroid after UAE at Fujian Provincial Hospital and Fujian Longyan People Hospital from March 2014 to March 2020. After a 12-month follow-up, the improvement in postoperative clinical symptoms and the incidence of complications were evaluated. We also shared the clinical features and imaging findings of four patients with FE after UAE. RESULTS All 152 patients successfully underwent UAE. After a 12-month follow-up, the postoperative volumes of the uterus and fibroid at 3, 6, and 12 months were significantly reduced or disappeared compared to those before surgery (P < 0.05). Clinical symptoms, such as menorrhagia, dysmenorrhea, prolonged menstrual period, anemia, increased leucorrhea, pelvic discomfort, and urinary tract compression, were significantly improved after UAE. Among the 152 patients, the incidences of postoperative fever, nausea, vomiting, lower abdominal pain, and increased vaginal secretion were 7.89%, 7.24%, 3.95%, 19.08%, and 4.61%, respectively. Additionally, there were six cases of FE, with an incidence of 3.95%. Three cases of fibroid specimens and pathological images of fibroid biopsy, which were expelled through the vagina, were also provided. CONCLUSION UAE is a satisfactory alternative surgical method for symptomatic uterine fibroid with definitive efficacy and high safety. However, it is necessary to guard against the occurrence of postoperative complications such as FE.
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Postpartum hemorrhage risk is driven by changes in blood composition through pregnancy. Sci Rep 2021; 11:19238. [PMID: 34584125 PMCID: PMC8478943 DOI: 10.1038/s41598-021-98411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
The extent to which women differ in the course of blood cell counts throughout pregnancy, and the importance of these changes to pregnancy outcomes has not been well defined. Here, we develop a series of statistical analyses of repeated measures data to reveal the degree to which women differ in the course of pregnancy, predict the changes that occur, and determine the importance of these changes for post-partum hemorrhage (PPH) which is one of the leading causes of maternal mortality. We present a prospective cohort of 4082 births recorded at the University Hospital, Lausanne, Switzerland between 2009 and 2014 where full labour records could be obtained, along with complete blood count data taken at hospital admission. We find significant differences, at a \documentclass[12pt]{minimal}
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\begin{document}$$p<0.001$$\end{document}p<0.001 level, among women in how blood count values change through pregnancy for mean corpuscular hemoglobin, mean corpuscular volume, mean platelet volume, platelet count and red cell distribution width. We find evidence that almost all complete blood count values show trimester-specific associations with PPH. For example, high platelet count (OR 1.20, 95% CI 1.01–1.53), high mean platelet volume (OR 1.58, 95% CI 1.04–2.08), and high erythrocyte levels (OR 1.36, 95% CI 1.01–1.57) in trimester 1 increased PPH, but high values in trimester 3 decreased PPH risk (OR 0.85, 0.79, 0.67 respectively). We show that differences among women in the course of blood cell counts throughout pregnancy have an important role in shaping pregnancy outcome and tracking blood count value changes through pregnancy improves identification of women at increased risk of postpartum hemorrhage. This study provides greater understanding of the complex changes in blood count values that occur through pregnancy and provides indicators to guide the stratification of patients into risk groups.
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P.13 Allowable blood loss calculator for caesarean section: proof of concept. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Katz D, Farber MK. Can measuring blood loss at delivery reduce hemorrhage-related morbidity? Int J Obstet Anesth 2021; 46:102968. [PMID: 33774489 DOI: 10.1016/j.ijoa.2021.102968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/03/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
Quantitation of blood loss after vaginal and cesarean delivery has been advocated for the timely detection of postpartum hemorrhage and activation of protocols for resuscitation. Morbidity and mortality from postpartum hemorrhage is considered to be largely preventable and is attributed to delayed recognition with under-resuscitation or inappropriate resuscitation. Optimizing detection of postpartum hemorrhage through refining how blood loss is measured is therefore clinically relevant. In this review on quantitative blood loss for postpartum hemorrhage, recent advances in the methods used to quantitate blood loss will be reviewed, with a comparison of utility and precision for blood loss measurement after vaginal and cesarean delivery. Considerations for the implementation of a quantitative blood loss system on the labor and delivery unit, including its benefits and challenges, will be discussed. The existing evidence for impact of blood loss quantitation in obstetrics on hemorrhage-related morbidity will be delineated, along with knowledge gaps and future research priorities.
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Affiliation(s)
- D Katz
- Icaha School of Medicine at Mount Sinai, New York, NY, USA
| | - M K Farber
- Brigham and Women's Hospital, Boston, MA, USA.
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Kumar VDA, Sharmila S, Kumar A, Bashir AK, Rashid M, Gupta SK, Alnumay WS. A novel solution for finding postpartum haemorrhage using fuzzy neural techniques. Neural Comput Appl 2021. [DOI: 10.1007/s00521-020-05683-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frigo MG, Agostini V, Brizzi A, Ragusa A, Svelato A. Practical approach to transfusion management of post-partum haemorrhage. Transfus Med 2021; 31:11-15. [PMID: 33400316 DOI: 10.1111/tme.12755] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe transfusion management during post-partum haemorrhage (PPH) and the usefulness of standard or point-of-care (POC) laboratory tests for guiding haemostatic management. BACKGROUND PPH is the leading cause of maternal mortality and severe maternal morbidity worldwide. Despite the efforts made in recent years, PPH is often burdened by preventable death. Recent data from the active Italian Obstetric Surveillance System (ItOSS) highlighted the following main critical issues: inadequate communication between healthcare professionals, inability to correctly and promptly assess the severity of haemorrhage, delays in diagnosis and treatment, failure to request blood promptly and inappropriate monitoring post-partum. MATERIALS AND METHODS Data in the literature have been compared with the rotational thromboelastometry (ROTEM)- and the thromboelastography (TEG)-guided algorithms applied in the authors' departments. RESULTS PPH transfusion therapy may have an empirical approach based on the standard use of blood products or a targeted approach based on coagulation monitoring by laboratory or POC tests. Here, the authors describe how they manage PPH in their departments, according to the Italian guidelines, along with the addition of a ROTEM- and a TEG-guided algorithms developed by themselves. CONCLUSION Although the proposed algorithms have not been validated by trials or observational studies conducted in our departments, we believe that these indications could be useful for supporting clinical practice. Furthermore, we deem it appropriate to emphasise the importance of a multidisciplinary approach and the need for standardised and shared protocols to support the decisions of healthcare professionals.
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Affiliation(s)
- Maria Grazia Frigo
- Department of Anesthesia and Resuscitation in Obstetrics, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Vanessa Agostini
- Transfusion Medicine Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Agostino Brizzi
- General and Locoregional Anesthesia Department, Santa Maria Clinic, Bari, Italy
| | - Antonio Ragusa
- Obstetric and Gynaecology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Alessandro Svelato
- Obstetric and Gynaecology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Wali A, Ishtiaq A, Rahim A, Iftikhar S. The Impact of Evidence-Based Transformation on Healthcare Practices at a Teaching Hospital. Cureus 2020; 12:e11744. [PMID: 33403174 PMCID: PMC7773286 DOI: 10.7759/cureus.11744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective In this study, we aimed to compare the frequency of anemia, blood transfusions, and the use of antimicrobial therapy (AMT) before the implementation of standard protocols in obstetrics and gynecology with the data after one year of implementation at a teaching hospital. Methods In this retrospective observational study, the pre-intervention data (group A) were compared to the data after the implementation of standard protocols (group B). Data were retrieved from hospital electronic medical records and were entered and analyzed on SPSS Statistics version 24 (IBM, Armonk, NY). Results In obstetrics (n=829), anemia was observed in 43.1% vs. 26.8% (p<0.001) and transfusion rate in 5.4% vs. 0.6% (p<0.001) in the groups A and B respectively. In vaginal deliveries (VD), the use of AMT for >24 hours was 98% in group A vs. 9% in group B, and in cesarean deliveries (CD), it was 100% in group A vs. 54.5% in group B (p<0.001). The cost of AMT decreased by 78.4% in VD and by 51.1% in CD. In gynecology (n=221), the prevalence of anemia was 22.6% in group A vs. 17.9% in group B (p=NS). In minor procedures, the use of AMT for >24 hours was 76.7% vs. 8.4% (p<0.001), and in major procedures, it was 86.5% vs. 38% (p<0.001) between the two groups. The cost of AMT decreased by 79.5% in minor procedures and 26.4% in major procedures. Conclusion The implementation of quality standards can bring about significant improvements in clinical outcomes in a short period of time.
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Affiliation(s)
- Aisha Wali
- Obstetrics and Gynecology, The Indus Hospital, Karachi, PAK
| | | | - Anum Rahim
- Epidemiology and Public Health, The Indus Hospital, Karachi, PAK
| | - Sundus Iftikhar
- Statistics, Indus Hospital Research Center, The Indus Hospital, Karachi, PAK
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Zhou J, Wang Y, Zhao J, Gu L, Yang C, Wang J, Zhang H, Tian Y, Tuo H, Li D, Wei M, He B. The metabolic and immunological characteristics of pregnant women with COVID-19 and their neonates. Eur J Clin Microbiol Infect Dis 2020; 40:565-574. [PMID: 33006691 PMCID: PMC7530551 DOI: 10.1007/s10096-020-04033-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
Our aim was to investigate whether SARS-CoV-2 infection raised high risks of late pregnancy complications, and posed health problems in fetuses and neonates. We analyzed the data of COVID-19 pregnant women with COVID-19 during late pregnancy and their neonates. Eleven out of 16 (69%) pregnant women with COVID-19 had ++ or +++ of ketone body in urine. The blood uric acid of pregnant patients was 334 μmol/L (IQR, 269–452). D-dimer and FDP in pregnant patients were 3.32 mg/L (IQR, 2.18–4.21) and 9.6 mg/L (IQR, 5.9–12.4). Results of blood samples collected at birth showed that 16 neonates had leukocytes (15.7 × 109/L (IQR, 13.7–17.2)), neutrophils (11.1 × 109/L (IQR, 9.2–13.2)), CK (401 U/L (IQR, 382–647)), and LDH (445 U/L (IQR, 417–559)). Twenty-four hours after birth, a neonate from COVID-19 woman had fever and positive of SARS-CoV-2 gene. Another woman had strongly positive for SARS-CoV-2 gene (+++) for 4 weeks, and delivered one neonate who had SARS-CoV-2 IgM (46 AU/mL) and IgG (140 AU/mL) on day 1 after birth. In the third trimester, COVID-19 infection in pregnant patients raised high risks of ketonuria, hypercoagulable state, and hyperfibrinolysis, which may lead to severe complications. COVID-19 increased the inflammatory responses of placenta, and fetuses and neonates had potential organ dysregulation and coagulation disorders. There was a potential intrauterine transmission while pregnant women had high titer of SARS-CoV-2, but it is necessary to detect SARS-CoV-2 in the blood cord, placenta, and amniotic fluid to further confirm intrauterine infection of fetuses.
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Affiliation(s)
- Jingjiao Zhou
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Yudie Wang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Juan Zhao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Lixing Gu
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Cheng Yang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Wang
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Heng Zhang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Yu Tian
- Department of Biology and Genetics, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, China
- Institute of Biology and Medicine, College of Life Sciences and Health, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Hu Tuo
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Dan Li
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Min Wei
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China
| | - Bing He
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430065, Hubei, China.
- Department of Pediatrics, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, China.
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