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Wu N, Ye E, Ba Y, Caikai S, Ba B, Li L, Zhu Q. The global burden of maternal disorders attributable to iron deficiency related sub-disorders in 204 countries and territories: an analysis for the Global Burden of Disease study. Front Public Health 2024; 12:1406549. [PMID: 39310906 PMCID: PMC11413869 DOI: 10.3389/fpubh.2024.1406549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
Background Pregnancy-related anemia presents a significant health concern for approximately 500 million women of reproductive age worldwide. To better prevent maternal disorders, it is essential to understand the impact of iron deficiency across different maternal disorders, regions, age groups, and subcategories. Methods Based on the comprehensive maternal disorders data sourced from the 2019 Global Burden of Disease study, an investigation was carried out focusing on Disability-Adjusted Life Years (DALYs) associated with iron deficiency spanning the period from 1990 to 2019. In addition, Estimated Annual Percentage Changes (EAPCs) were computed for the duration of the study. Results Our study indicates decreasing mortality rates and years of life lost due to maternal conditions related to iron deficiency, such as maternal hemorrhage, miscarriage, abortion, hypertensive disorders, and infections. However, mortality rates and years of life lost due to indirect and late maternal deaths, as well as deaths aggravated by HIV/AIDS, have increased in high socio-demographic index (SDI) regions, especially in North America. Moreover, the proportion of maternal deaths aggravated by HIV/AIDS due to iron deficiency is rising globally, especially in Southern Sub-Saharan Africa, Oceania, and Georgia. In addition, in the Maldives, the age-standardized DALYs for maternal disorders attributable to iron deficiency exhibited a notable decreasing trend, encompassing a range of conditions. Furthermore, there was a significant decrease in Disability-Adjusted Life Years rate for miscarriages and preterm births among women aged 15-49, with hypertensive disorders posing the highest burden among women aged 15-39. Conclusion The burden of maternal disorders caused by iron deficiency is decreasing in most regions and subtypes, except for deaths aggravated by HIV/AIDS. By thoroughly understanding the details of how iron deficiency impacts the health of pregnant women, health policymakers, healthcare professionals, and researchers can more effectively pinpoint and address the root causes of inequalities in maternal health.
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Affiliation(s)
- Nuer Wu
- Department of Obstetrics, Center of Maternal-Fetal Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Erdengqieqieke Ye
- Department of Prenatal Diagnosis, Reproductive Medicine Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yulan Ba
- Department of Rehabilitation Medicine, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shareli Caikai
- Department of Respiratory Intensive Care Unit, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bayinsilema Ba
- Department of Cardiology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Li
- Department of Obstetrics, Center of Maternal-Fetal Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiying Zhu
- Department of Obstetrics, Center of Maternal-Fetal Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Lee SW, Park B, Seo J, Lee S, Sim JH. Development of a machine learning approach for prediction of red blood cell transfusion in patients undergoing Cesarean section at a single institution. Sci Rep 2024; 14:16628. [PMID: 39025903 PMCID: PMC11258332 DOI: 10.1038/s41598-024-67784-2] [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: 01/05/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024] Open
Abstract
Despite recent advances in surgical techniques and perinatal management in obstetrics for reducing intraoperative bleeding, blood transfusion may occur during a cesarean section (CS). This study aims to identify machine learning models with an optimal diagnostic performance for intraoperative transfusion prediction in parturients undergoing a CS. Additionally, to address model performance degradation due to data imbalance, this study further investigated the variation in predictive model performance depending on the ratio of event to non-event data (1:1, 1:2, 1:3, and 1:4 model datasets and raw data).The area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) were evaluated to compare the predictive accuracy of different machine learning algorithms, including XGBoost, K-nearest neighbor, decision tree, support vector machine, multilayer perceptron, logistic regression, random forest, and deep neural network. We compared the predictive performance of eight prediction algorithms that were applied to five types of datasets. The intraoperative transfusion in maternal CS was 7.2% (1020/14,254). XGBoost showed the highest AUROC (0.8257) and AUPRC (0.4825) among the models. The most significant predictors for transfusion in maternal CS as per machine learning models were placenta previa totalis, haemoglobin, placenta previa partialis, and platelets. In all eight prediction algorithms, the change in predictive performance based on the AUROC and AUPRC according to the resampling ratio was insignificant. The XGBoost algorithm exhibited optimal performance for predicting intraoperative transfusion. Data balancing techniques employed to alter the event data composition ratio of the training data failed to improve the performance of the prediction model.
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Affiliation(s)
- Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Pungnap 2(i)-dong, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Bumwoo Park
- Big Data Research Center, Asan Medical Center, Seoul, 05505, Republic of Korea
| | - Jimung Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ji-Hoon Sim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Pungnap 2(i)-dong, Songpa-gu, Seoul, 05505, Republic of Korea.
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Martins RIL, Novais JDSM, Reis ZSN. Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo14. [PMID: 38765539 PMCID: PMC11075434 DOI: 10.61622/rbgo/2024ao14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 08/01/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.
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Affiliation(s)
- Raíssa Isabelle Leão Martins
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Jussara de Souza Mayrink Novais
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Zilma Silveira Nogueira Reis
- Universidade Federal de Minas GeraisFaculty of MedicineDepartment of Gynecology and ObstetricsBelo HorizonteMGBrazilDepartment of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Ghulmiyyah LM, El-Husheimi A, Usta IM, Colon-Aponte C, Ghazeeri G, Hobeika E, Mirza FG, Tamim H, Hamadeh C, Nassar AH. Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial. Am J Perinatol 2023; 40:1644-1650. [PMID: 34775581 DOI: 10.1055/s-0041-1739409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. STUDY DESIGN This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. RESULTS A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). CONCLUSION There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. KEY POINTS · Transabdominal uterine compression and uterine massage are appropriate to prevent postpartum hemorrhage.. · No significant difference in blood loss or maternal discomfort observed between the two techniques.. · Both methods are equally effective and either one can be used based on provider preference..
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Affiliation(s)
- Labib M Ghulmiyyah
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
| | - Alaa El-Husheimi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ihab M Usta
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cristina Colon-Aponte
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami, Miami, Florida
| | - Ghina Ghazeeri
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Hobeika
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi G Mirza
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Caroline Hamadeh
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Alhousseini A, Farr C, Ogunyemi D, Wharton K, Fawaz A, Bazzi N, Andrews-Johnson T, Bahado-Singh R. Delivery of a Fetus with a Non-Reassuring Status Is Associated with Significant Maternal Morbidity. Gynecol Obstet Invest 2023; 88:359-365. [PMID: 37751727 DOI: 10.1159/000534189] [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: 11/16/2022] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES When a labor process is complicated by non-reassuring fetal status (NRFS), obstetricians focus on delivery to optimize neonatal status. We explored maternal morbidity in the setting of NRFS. Our hypothesis is that delivery of a live newborn with NRFS is associated with significant maternal morbidity. Design, Participants, Setting, and Methods: A large retrospective cohort study of 27,886 women who delivered between January 2013 and December 2016 in a single health system was studied. Inclusion criteria included (1) women over the age of 18 at the time of admission; (2) singleton pregnancy; (3) live birth; and (4) gestational age greater than or equal to 37 weeks at the time of admission. NRFS was defined as umbilical cord pH less than or equal to 7.00, fetal bradycardia, late decelerations, and/or umbilical artery base excess ≤-12. Univariate and multivariate logistic regression and propensity score analyses were performed, and propensity score adjusted odds ratios (AORPS) were derived. p values <0.05 were considered statistically significant. Primary outcomes are maternal blood transfusion, maternal readmission, maternal intensive care unit (ICU) admission, and cesarean delivery in relation to umbilical artery pH, fetal bradycardia, and late decelerations. RESULTS Umbilical artery pH less than or equal to 7 was associated with maternal blood transfusion (AORPS 6.83 [95% CI 2.22-21.0, p < 0.001]), maternal readmission (AORPS 12.6 [95% CI 2.26-69.8, p = 0.0039]), and cesarean delivery (AORPS 5.76 [95% CI 3.63-9.15, p < 0.0001]). Fetal bradycardia was associated with transfusion (AORPS 2.13 [95% CI 1.26-3.59, p < 0.005]) and maternal ICU admission (AORPS 3.22 [95% CI 1.23-8.46, p < 0.017]). Late decelerations were associated with cesarean delivery (AORPS 1.65 [95% CI 1.55-1.76, p < 0.0001]), clinical chorioamnionitis (AORPS 2.88 [95% CI 2.46-3.37, p < 0.0001]), and maternal need for antibiotics (AORPS 1.89 [95% CI 1.66-2.15, p < 0.0001]). Umbilical artery base excess less than or equal to -12 was associated with readmission (AORPS 6.71 [95% CI 2.22-20.3, p = 0.0007]), clinical chorioamnionitis (AORPS 1.89 [95% CI 1.24-2.89, p = 0.0031]), and maternal need for antibiotics (AORPS 1.53 [95% CI 1.03-2.26, p = 0.0344]). LIMITATIONS The retrospective design contributes to potential bias compared to the prospective design. However, by utilizing multivariate logistic regression analysis with a propensity score method, specifically inverse probability of treatment weighting, we attempted to minimize the impact of confounding variables. Additionally, only a portion of the data set had quantitative blood losses recorded, while the remainder had estimated blood losses. CONCLUSION NRFS is associated with significant maternal complications, in the form of increased need for blood transfusions, ICU admissions, and increased infection and readmission rates. Strategies for minimizing maternal complications need to be proactively considered in the management of NRFS.
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Affiliation(s)
- Ali Alhousseini
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
- Department of Obstetrics and Gynecology, Michigan State University, Lansing, Michigan, USA
| | - Carly Farr
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Kurt Wharton
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Aya Fawaz
- Department of Obstetrics and Gynecology, Michigan State University, Lansing, Michigan, USA
| | - Nagham Bazzi
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
- Department of Surgery, Lebanese University, Beirut, Lebanon
| | - Tonyie Andrews-Johnson
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ray Bahado-Singh
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
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Temporal Trends of Maternal Mortality Due to Obstetric Hemorrhage in Chinese Mainland: Evidence from the Population-Based Surveillance Data Between 2000 and 2019. MATERNAL-FETAL MEDICINE 2022. [DOI: 10.1097/fm9.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cao X, Luo Y, Zhou S, Zhao Q, Qin X, Liu Z, Xu Z. Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:876411. [PMID: 35692549 PMCID: PMC9174790 DOI: 10.3389/fmed.2022.876411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background In recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. Methods This retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted. Results The overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05-2.51, P = 0.031; AOR = 1.71; 95% CI, 1.08-2.70, P = 0.022; AOR = 1.98, 95% CI, 1.21-3.25, P = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04-2.82, P = 0.036; OR = 1.90, 95% CI, 1.13-3.21, P = 0.016; OR = 2.48, 95% CI, 1.41-4.38, P = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies. Conclusion Growth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.
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Affiliation(s)
- Xiuhong Cao
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ye Luo
- Department of Research and Education, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangqiong Zhou
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qingsong Zhao
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuewei Qin
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Powell S, Garrahy D, Stephenson KAJ, Burke T. Postpartum haemorrhage associated choroidopathy. BMJ Case Rep 2022; 15:e249226. [PMID: 35296498 PMCID: PMC8928242 DOI: 10.1136/bcr-2022-249226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sarah Powell
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Darragh Garrahy
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Tomas Burke
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
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Alhousseini A, Romero R, Benshalom-Tirosh N, Gudicha D, Pacora P, Tirosh D, Kabiri D, Yeo L, Thachil J, Hsu CD, Hassan SS, Erez O. Nonovert disseminated intravascular coagulation (DIC) in pregnancy: a new scoring system for the identification of patients at risk for obstetrical hemorrhage requiring blood product transfusion. J Matern Fetal Neonatal Med 2022; 35:242-257. [PMID: 31931643 PMCID: PMC9019739 DOI: 10.1080/14767058.2020.1716330] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nonovert disseminated intravascular coagulation (DIC) is a subclinical hemostatic dysfunction that has not yet reached the decompensation stage. The detection of pregnant patients at this stage may assist in the identification of those who will develop severe obstetrical hemorrhage, as it is one of the leading causes for preventable maternal mortality. Currently, nonovert DIC is diagnosed by a scoring system based on nonpregnant patients, originally generated by the International Society on Thrombosis and Hemostasis (ISTH), which does not address the physiologic changes of the hemostatic system during pregnancy. OBJECTIVES (1) To develop a pregnancy-specific nonovert DIC score, (2) to determine the diagnostic performance of this score in detecting women at risk for obstetrical hemorrhage requiring blood product transfusion, and (3) to compare it to the existing ISTH nonovert DIC score. STUDY DESIGN This retrospective study has longitudinal and cross-sectional components and includes three steps: (1) characterization of the longitudinal changes in the components of modified ISTH nonovert DIC scores, including these parameters - fibrinogen, antithrombin III, protein C, prothrombin time (PT), platelets, thrombin-antithrombin (TAT) complex, and D-dimer - during gestation in a group of normal pregnancies (n = 50); (2) development of a pregnancy-specific nonovert DIC score in a cross-sectional design of high-risk (n = 152) and control (n = 50) pregnancies, based on the predictive performance of each analyte for the detection of women at risk for obstetrical hemorrhage requiring blood product transfusion and a logistic regression model; and (3) comparison between the diagnostic performance of the pregnancy-specific nonovert DIC score and the modified ISTH nonovert DIC score to detect, upon admission, women who are at increased risk for subsequent development of obstetrical hemorrhage requiring blood product transfusion. RESULTS (1) The study cohort included 202 patients, of which 21 (10%) had obstetrical hemorrhage that required blood product transfusion and were considered to have nonovert DIC; (2) using the nonpregnant ISTH nonovert DIC score, 92% of the patients had a D-dimer concentration above the 0.5 mg/L threshold, and only 2% were identified to have a low fibrinogen concentration (<100 mg/dL); thus, this scoring system was unable to identify any of the patients with nonovert DIC based on the suggested cutoff of a score of ≥5; (3) the parameters included in the pregnancy-specific nonovert DIC score were selected based on their contribution to the performance of the model for the prediction of women at risk for obstetrical hemorrhage requiring blood product transfusion; as a result, we excluded the PT difference parameter from the score and the TAT complex concentration was added; and (4) a pregnancy-specific nonovert DIC score of ≥3 had a sensitivity of 71.4% and a specificity of 77.9% to identify patients at risk for obstetrical hemorrhage requiring blood product transfusion. CONCLUSION We propose (1) a pregnancy-specific nonovert DIC score adjusted for the physiologic changes in the hemostatic system during gestation; and (2) that the pregnancy-specific nonovert DIC score can be a useful tool for the identification of patients at risk for obstetrical hemorrhage requiring blood product transfusion.
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Affiliation(s)
- Ali Alhousseini
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA,Detroit Medical Center, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Miami International University, Miami, Florida, USA
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dereje Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Doron Kabiri
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA,Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA,Maternity Department “D,” Division of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
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11
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Nagahama G, Korkes HA, Sass N. Clinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:655-661. [PMID: 34670299 PMCID: PMC10183868 DOI: 10.1055/s-0041-1735228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. METHODS Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. RESULTS Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and preeclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. CONCLUSION The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.
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Affiliation(s)
- Gilberto Nagahama
- Department of Obstetrics, Hospital Maternidade Escola de Vila Nova Cachoeirinha, São Paulo, SP, Brazil
| | - Henri Augusto Korkes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brazil
| | - Nelson Sass
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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12
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Leleu A, Ghesquiere L, Machuron F, Caudrelier C, Devouge P, Subtil D, Houflin-Debarge V, Garabedian C. Intrauterine balloon tamponade in the management of severe postpartum haemorrhage after vaginal delivery: Is the failure early predictable? Eur J Obstet Gynecol Reprod Biol 2021; 258:317-323. [PMID: 33498006 DOI: 10.1016/j.ejogrb.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality world-wide. The arrival of intrauterine balloon devices has revolutionised PPH management. However, it seems interesting to know the situations of failure to improve the management. The objective is to define the factors related to failure of intrauterine balloon tamponade (IUBT) in women with a postpartum haemorrhage (PPH) after vaginal delivery, and especially blood loss after placement to avoid delaying management. Retrospective cohort study was conducted in 2 centers. All PPH after vaginal deliveries treated by IUBT were included. Two groups were defined (successes and failures) and compared. Failure was defined as the need of invasive procedure. Calculated area under receiver operating characteristic (ROC) curves and thresholds of bleeding at 10 min were also calculated for prediction of failure. 127 women were included. The overall success rate was 78.0 % (95 % CI 70.7-85.1 %). Blood loss at 10 min was factor prognostic of early IUBT failure. The ROC curve of blood loss at 10 min for prediction of failure of IUBT had an area under the curve of 0.876 (95 % CI 0.782-0.970). The predictive positive value of blood loss at 10 min were respectively 0.53, 0.8 and 0.94 for blood loss of 100, 200 and 250 mL. Physicians should be alerted if blood loss are more than 200 mL at 10 min after placement of IUBT and considered invasive procedure if more than 250 mL to avoid delaying management of PPH.
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Affiliation(s)
- A Leleu
- CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - L Ghesquiere
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France
| | - F Machuron
- University of Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, F-59000, Lille, France
| | - C Caudrelier
- CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - P Devouge
- CH Valenciennes, Department of Obstetrics, F-59000, Valenciennes, France
| | - D Subtil
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, CHU Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, F-59000, Lille, France
| | - V Houflin-Debarge
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000, Lille, France; University of Lille, EA 4489 - Perinatal Environment and Health, F-59000, Lille, France.
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13
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Cortegiani A, Absalom AR, Hunt BJ. Intramuscular tranexamic acid: a real-world application of pharmacokinetics. Br J Anaesth 2020; 126:17-20. [PMID: 33131654 DOI: 10.1016/j.bja.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Andrea Cortegiani
- Department of Surgical Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy; Department of Anaesthesiology Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
| | - Anthony R Absalom
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Beverley J Hunt
- Kings Healthcare Partners, Thrombosis & Haemophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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14
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Optimal Profile Limits for Maternal Mortality Rates (MMR) Influenced by Haemorrhage and Unsafe Abortion in South Sudan. J Pregnancy 2020; 2020:2793960. [PMID: 32566298 PMCID: PMC7296467 DOI: 10.1155/2020/2793960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
Maternal mortality rate (MMR) is one of the main worldwide public health challenges. Presently, the high levels of MMR are a common problem in the world public health and especially, in developing countries. Half of these maternal deaths occur in Sub-Saharan Africa where little or nothing progress has been made. South Sudan is one of the developing countries which has the highest MMR. Thus, this paper deploys statistical analysis to identify the significant physiological causes of MMR in South Sudan. Prediction models based on Poisson Regression are then developed to predict MMR in terms of the significant physiological causes. Coefficients of determination and variance inflation factor are deployed to assess the influence of the individual causes on MMR. Efficacy of the models is assessed by analyzing their prediction errors. The paper for the first time has used optimization procedures to develop yearly lower and upper profile limits for MMR. Hemorrhaging and unsafe abortion are used to achieve UN 2030 lower and upper MMR targets. The statistical analysis indicates that reducing haemorrhaging by 1.91% per year would reduce MMR by 1.91% (95% CI (42.85–52.53)), reducing unsafe abortion by 0.49% per year would reduce MMR by 0.49% (95% CI (11.06–13.56)). The results indicate that the most influential predictors of MMR are; hemorrhaging (38%), sepsis (11.5%), obstructed labour (11.5%), unsafe abortion (10%), and indirect causes such as anaemia, malaria, and HIV/AIDs virus (29%). The results also show that to obtain the UN recommended MMR levels of minimum 21 and maximum 42 by 2030, the Government and other stakeholders should simultaneously, reduce haemorrhaging from the current value of 62 to 33.38 and 16.69, reduce unsafe abortion from the current value of 16 to 8.62 and 4.31. Thirty years of data is used to develop the optimal reduced Poisson Model based on hemorrhaging and unsafe abortion. The model with R2 of 92.68% can predict MMR with mean error of −0.42329 and SE-mean of 0.02268. The yearly optimal level of hemorrhage, unsafe abortion, and MMR can aid the government and other stakeholders on resources allocation to reduce the risk of maternal death.
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15
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Hu K, Lapinski MM, Mischler G, Allen RH, Manbachi A, Seay RC. Improved Treatment of Postpartum Hemorrhage: Design, Development, and Bench-Top Validation of a Reusable Intrauterine Tamponade Device for Low-Resource Settings. J Med Device 2020. [DOI: 10.1115/1.4045965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractPostpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, and effective interventions for addressing PPH are urgently needed. Uterine balloon tamponade (UBT) is a technique to control PPH. Commercially available UBT devices are expensive and frequently require imaging technology to ensure placement. Condom-catheter uterine tamponade (C-UBT) is a technique appropriate for low-resource settings. Testing of the C-UBT is needed to better understand and optimize this technique for use in a variety of clinical settings including low-resource contexts. We describe here the design, development, and bench-top validation of a reusable C-UBT device optimized for low-resource settings. The device was tested in three differently sized uterine models using a variety of condom balloon configurations. Intrauterine wall pressure application was measured to evaluate the device capacity to apply pressure of at least 90 mmHg, estimating the mean arterial pressure within the uterine vasculature. Bench-top experimental validation of pressure exerted in uterine models demonstrated the device's capability of reaching hemostatic pressure in uterine volumes ranging from 170 to 1740 mL. Device adaptability and versatility were shown through its ability to reach the target pressure of 90 mmHg in different uterine sizes by varying balloon parameters, including condom thickness and condom configuration. The results of this study show the potential of a low-cost, reusable C-UBT device optimized to treat PPH in a variety of clinical settings, including low-resource contexts.
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Affiliation(s)
- Katherine Hu
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218
| | - Maya M. Lapinski
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218
| | - Gavin Mischler
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218
| | - Robert H. Allen
- Albert Einstein College of Medicine, Yeshiva University, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue, Belfer Building, Room 512, Bronx, NY 10461
| | - Amir Manbachi
- Department of Neurosurgery, The Johns Hopkins University, Meyer Building, Room 8-181C, 600 N Wolfe Street, Baltimore, MD 21287; Department of Biomedical Engineering, The Johns Hopkins University, Clark Hall, Room 208F, 3400 N Charles Street, Baltimore, MD 21218
| | - Rachel Chan Seay
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, A Building, Room 121, 4940 Eastern Avenue, Baltimore, MD 21224
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16
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Rottenstreich A, Regev N, Levin G, Ezra Y, Yagel S, Sompolinsky Y, Mankuta D, Kalish Y, Elchalal U. Factors associated with postcesarean blood transfusion: a case control study. J Matern Fetal Neonatal Med 2020; 35:495-502. [PMID: 32041460 DOI: 10.1080/14767058.2020.1724945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Cesarean delivery (CD) is a known risk factor for postpartum hemorrhage. However, the characteristics associated with post-CD transfusion are not well-established. We aimed to assess blood transfusion rates and associated factors following CD.Methods: A retrospective case-control study of women who underwent CD at a university hospital. The study group comprised all women who received blood transfusion following surgery. A control group of women who did not receive postoperative blood transfusion was assigned in a two-to-one ratio.Results: During study period, the overall post-CD blood transfusion rate was 4.7%. The study group comprised 170 women, and the control group 340. Maternal age (aOR [95% CI]: 1.07 (1.03, 1.11), p = .001), parity (aOR [95% CI]: 1.26 (1.09, 1.47), p = .002), gestational hypertensive disorders (aOR [95% CI]: 4.07 (1.52, 10.91), p = .005), maternal comorbidities (aOR [95% CI]: 4.16 (1.88, 9.1), p < .001), lower predelivery hemoglobin level (aOR [95% CI]: 0.43 (0.34, 0.54), p < .001), and major placental abnormalities (aOR [95% CI]: 2.74 (1.04, 7.18), p = .04) were independently associated with blood transfusion requirement. Intrapartum characteristics associated with blood transfusion requirement included nonelective procedure (aOR [95% CI]: 3.21 (1.72, 5.99), p < .001), prolonged second stage of labor (aOR [95% CI]: 5.50 (2.57, 11.78), p < .001), longer duration of surgery (aOR [95% CI]: 1.03 (1.02, 1.04), p < .001), general anesthesia (aOR [95% CI]: 2.11 (1.14, 3.91), p = .02), and greater estimated operative blood loss (aOR [95% CI]: 5.72 (3.15, 10.36), p < .001).Conclusions: Among women who underwent CD, we identified 11 factors associated with blood transfusion following surgery. Prospective studies are warranted to assess the implementations of prophylactic interventions to reduce transfusion rates among those deemed at high risk for CD-related bleeding.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noam Regev
- Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Mankuta
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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17
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Tiruneh GT, Yakob B, Ayele WM, Yigzaw M, Roro MA, Medhanyi AA, Hailu EG, Bayou YT. Effect of community-based distribution of misoprostol on facility delivery: a scoping review. BMC Pregnancy Childbirth 2019; 19:404. [PMID: 31694580 PMCID: PMC6836344 DOI: 10.1186/s12884-019-2539-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/26/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse. METHODS We included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated. RESULTS Three qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups [OR 1.011; 95% CI: 0.906-1.129]. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases. In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed. CONCLUSIONS The claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages, especially in resource-limited settings.
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Affiliation(s)
- Gizachew Tadele Tiruneh
- JSI Research & Training Institute, Inc./ The Last Ten Kilometers (L10K) Project, Addis Ababa, Ethiopia. .,Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.
| | - Bereket Yakob
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,Department of Global Health and Population /Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Wubegzier Mekonnen Ayele
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Muluneh Yigzaw
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,Jhpiego/HRH Project, Addis Ababa, Ethiopia
| | - Meselech Assegid Roro
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Araya Abrha Medhanyi
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Etenesh Gebreyohannes Hailu
- Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yibeltal Tebekaw Bayou
- JSI Research & Training Institute, Inc./ The Last Ten Kilometers (L10K) Project, Addis Ababa, Ethiopia.,Members of the National Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH-N) Research Advisory Council (RAC), Addis Ababa, Ethiopia
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18
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Dueckelmann AM, Hinkson L, Nonnenmacher A, Siedentopf JP, Schoenborn I, Weizsaecker K, Kaufner L, Henrich W, Braun T. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol 2019; 240:151-155. [DOI: 10.1016/j.ejogrb.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
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19
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Amoo TB, Ajayi OS. Maternal mortality and factors affecting it, among pregnant women in Abeokuta South, Nigeria. ACTA ACUST UNITED AC 2019. [DOI: 10.29328/journal.cjog.1001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Miller ES, Sakowicz A, Roy A, Liu LY, Yee LM. The association between 17-hydroxyprogesterone caproate use and postpartum hemorrhage. Am J Obstet Gynecol MFM 2019; 1:144-147. [PMID: 32914089 DOI: 10.1016/j.ajogmf.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate whether receipt of 17α-hydroxyprogesterone caproate within seven days of delivery is associated with increased risk of postpartum hemorrhage. STUDY DESIGN This was a retrospective cohort study of women who were receiving 17α-hydroxyprogesterone caproate for preterm birth prevention and delivered between 2010 and 2014. Women were dichotomized by whether a dose of 17α-hydroxyprogesterone caproate was administered within seven days of delivery. Demographic and clinical characteristics were examined, including obstetric history and details of 17α-hydroxyprogesterone caproate receipt. Bivariable analyses were used to compare the frequency of postpartum hemorrhage in women stratified by 17α-hydroxyprogesterone caproate receipt within seven days of delivery. Multivariable analysis was used to adjust for potential confounders. RESULTS Of 221 women who met inclusion criteria, 93 (42%) received 17α-hydroxyprogesterone caproate within seven days of delivery and 18 (7.8%) experienced a postpartum hemorrhage. No differences were observed in the frequency of postpartum hemorrhage between women who did and did not deliver within seven days of 17α-hydroxyprogesterone caproate injection (9.7% vs 7.0%, p=0.478). These findings persisted after adjusting for potential confounders (aOR for PPH 2.9, 95% CI, 0.5-15.8). CONCLUSION Recent receipt of 17α-hydroxyprogesterone caproate for prevention of recurrent preterm birth is not associated with risk of postpartum hemorrhage.
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Affiliation(s)
- Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Allie Sakowicz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Archana Roy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lilly Y Liu
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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21
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Abstract
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. The majority of maternal deaths associated with hemorrhage could be preventable. The accurate assessment of blood loss, identification of risk factors and timely recognition of postpartum hemorrhage remain major challenges in obstetrics. It is important to review available modalities for estimation and quantification of peripartum blood loss, the value of risk assessment tools as well as the challenges in early recognition of clinical signs and symptoms of postpartum hemorrhage.
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Affiliation(s)
- Maria Andrikopoulou
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
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22
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Newsam R. Operating department practitioners and midwives: The undervalued obstetric care collaboration. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.11.714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Newsam
- Operating department practitioner, Liverpool Heart and Chest Hospital NHS Foundation Trust
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23
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Abd El Aziz MA, Iraqi A, Abedi P, Jahanfar S. The effect of carbetocin compared to misoprostol in management of the third stage of labor and prevention of postpartum hemorrhage: a systematic review. Syst Rev 2018; 7:170. [PMID: 30342555 PMCID: PMC6195687 DOI: 10.1186/s13643-018-0832-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) and the amount of blood loss are directly related to management of the third stage of labor. No previous report has compared the effects of carbetocin to those of misoprostol. The aim of this systematic review was to compare the effects of carbetocin to those of misoprostol for management of the third stage of labor and for the prevention of PPH. METHODS We searched the Cochrane Library (Central), Web of Science, Scopus, Science Direct, Ovid, clinicaltrial.gov , and PubMed databases on December 28, 2017. Data extraction and risk of bias assessment were performed by 2 of the authors independently. Individual and pooled incidences were calculated for the included studies, with 95% confidence intervals (CIs). We used a fixed model for forest plots without heterogeneity and a random effect model for those with heterogeneity. RESULTS Our search identified 117 studies; however, 29 studies were duplicate. Of the 88 non-duplicate studies, 5 met the inclusion criteria. Of these five studies, two are currently underway. Hence, three studies were finally included in our meta-analysis. The pooled estimate of the impact of carbetocin on PPH (500-1000 ml) was (OR 0.27, 95% CI 0.14-0.50). Carbetocin significantly reduced the need for additional uterotonics (RR 0.28, 95% CI 0.15 to 0.49). Reduction in the hemoglobin level and blood loss during the third stage of labor was significantly lower in women who received carbetocin than in those who received misoprostol. The length of the third stage of labor was significantly lower in women who received carbetocin than in those who received misoprostol. The incidence of side effects, such as heat sensation, metallic taste, fever, and shivering, were significantly lower in women who received carbetocin than in those who received misoprostol. CONCLUSION Although this review showed that carbetocin is effective for decreasing PPH, blood loss, the length of the third stage of labor, and the need for additional uterotonics, this conclusion should be considered with caution. Because assessment of PPH is a subjective issue and it is uncertain whether outcomes were assessed blindly in respect to treatment. We recommend future research to verify our findings. Also clinicians may like to consider use of carbetocin for women with low risk for PPH.
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Affiliation(s)
| | | | - Parvin Abedi
- Midwifery Department, Nursing and Midwifery School, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Golestan Ave, Ahvaz, Iran
- School of Health Sciences, Health Professions 2239, Central Michigan University, Mount Pleasant, MI USA
| | - Shayesteh Jahanfar
- School of Health Sciences, Health Professions 2239, Central Michigan University, Mount Pleasant, MI USA
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Ahmed SM, Nordeng H, Sundby J, Aragaw YA, de Boer HJ. The use of medicinal plants by pregnant women in Africa: A systematic review. JOURNAL OF ETHNOPHARMACOLOGY 2018; 224:297-313. [PMID: 29842963 DOI: 10.1016/j.jep.2018.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Medicinal plant (MP) use during pregnancy is common in Africa and may have profound effects on both the mother and the developing foetus. A lack of overview complicates monitoring and regulating the use of MPs during pregnancy. AIM OF THE STUDY This systematic review analyses prevalence of use of MPs during pregnancy, regional distribution, types and prevalence, MP properties, potential health risks, and consensus of MPs use, and suggests relevant measures to mitigate negative effects on pregnancy. MATERIALS AND METHODS A search was undertaken using a range of scientific databases (Medline, Embase, African Journals OnLine, Google Scholar and Biological Abstracts), non-governmental organisations, various African universities and regulatory websites for original published and unpublished studies that assess and indicate the prevalence of use of MPs during pregnancy in Africa. Additional articles were located by exploring pertinent bibliographies, and contacting experts. RESULTS A total of 3659 MP-use studies were found, but only 303 articles received full-text assessment for eligibility and finally only 50 scientific papers were eligible for the systematic review. The prevalence of MP use by pregnant women varied widely from 2% to 100%. Twenty-eight studies (56%) specified one or more plant species used as MP during pregnancy. The major reasons for MP use were relief of nausea and vomiting during pregnancy (NVP), stimulation of labour, and facilitation of childbirth. The most commonly cited MP species were Zingiber officinale Roscoe, Allium sativum L. and Cucurbita pepo L. and these were used for relief of NVP, motion sickness and as a nutritional supplement. Route of administration was most commonly oral, and few adverse effects were reported. CONCLUSIONS The use of MPs among pregnant women in Africa is prevalent, and the most commonly used plant species are not known to have harmful foetal effects during pregnancy. However, many of the MP species are poorly studied and teratogenic effects cannot be ruled out. Collaboration between healthcare providers and traditional practitioners to inform about the safe use of MPs may promote safer pregnancies and better health for mothers and infants.
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Affiliation(s)
- Seid Mussa Ahmed
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway.
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Yesuf Ahmed Aragaw
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Jimma Institute of Health, Jimma University, Ethiopia.
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25
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Manzano-Nunez R, Escobar-Vidarte MF, Orlas CP, Herrera-Escobar JP, Galvagno SM, Melendez JJ, Padilla N, McCarty JC, Nieto AJ, Ordoñez CA. Resuscitative endovascular balloon occlusion of the aorta deployed by acute care surgeons in patients with morbidly adherent placenta: a feasible solution for two lives in peril. World J Emerg Surg 2018; 13:44. [PMID: 30258488 PMCID: PMC6154816 DOI: 10.1186/s13017-018-0205-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/11/2018] [Indexed: 02/04/2023] Open
Abstract
Morbidly adherent placenta (MAP), which includes accreta, increta, and percreta, is a condition characterized by the invasion of the uterine wall by placental tissue. The condition is associated with higher odds of massive post-partum hemorrhage. Several interventions have been developed to improve hemorrhage-related outcomes in these patients; however, there is no evidence to prefer any intervention over another. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular intervention that may be useful and effective to reduce hemorrhage and transfusions in MAP patients. The objective of this narrative review is to summarize the evidence for REBOA in patients with MAP. We posit that acute care surgeons can perform REBOA for patients with MAP.
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Affiliation(s)
- Ramiro Manzano-Nunez
- 1Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.,2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Maria F Escobar-Vidarte
- 6Critical Care Obstetrics, Department of Gynecology and Obstetrics, Fundacion Valle del Lili, Cali, Colombia
| | - Claudia P Orlas
- 1Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.,3Trauma and Acute Care Surgery Division, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Juan P Herrera-Escobar
- 2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Juan J Melendez
- 5Trauma Division and Trauma and Emergency Surgery Fellowship, Universidad del Valle, Cali, Colombia
| | | | - Justin C McCarty
- 2Center for Surgery and Public Health - Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Albaro J Nieto
- 6Critical Care Obstetrics, Department of Gynecology and Obstetrics, Fundacion Valle del Lili, Cali, Colombia
| | - Carlos A Ordoñez
- 3Trauma and Acute Care Surgery Division, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.,5Trauma Division and Trauma and Emergency Surgery Fellowship, Universidad del Valle, Cali, Colombia
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26
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Seidel V, Braun T, Weizsäcker K, Henrich W. Application of chitosan-covered gauze in combination with intrauterine balloon tamponade for postpartum hemorrhage treatment - Case report of a novel "uterine sandwich" approach. Int J Surg Case Rep 2018; 48:101-103. [PMID: 29883918 PMCID: PMC6041203 DOI: 10.1016/j.ijscr.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/29/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death worldwide. Fertility preserving second stage interventions following uterotonic medications may include compression sutures, uterine balloon tamponade and ligation or embolization of arteries. PRESENTATION OF CASE We present a case of PPH where a novel "uterine sandwich" approach (combination of chitosan-covered gauze with intrauterine balloon tamponade) was effectively used to stop further blood loss and prevented more invasive second stage interventions. Furthermore, we present the ultrasonographic image of chitosan-covered gauze in the uterine cavity. DISCUSSION Chitosan-covered gauze and intrauterine balloon tamponade are complementary in their mechanism of work, the balloon reducing blood flow into the uterus and the chitosan-covered gauze enhancing the coagulation. CONCLUSION This novel "uterine sandwich" approach can be a useful method for fertility preserving management of PPH.
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Affiliation(s)
- Vera Seidel
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178 Berlin, Germany.
| | - Thorsten Braun
- Department of 'Experimental Obstetrics', Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Germany
| | - Katharina Weizsäcker
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Schlembach D, Helmer H, Henrich W, von Heymann C, Kainer F, Korte W, Kühnert M, Lier H, Maul H, Rath W, Steppat S, Surbek D, Wacker J. Peripartum Haemorrhage, Diagnosis and Therapy. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/063, March 2016). Geburtshilfe Frauenheilkd 2018; 78:382-399. [PMID: 29720744 PMCID: PMC5925693 DOI: 10.1055/a-0582-0122] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose
This is an official interdisciplinary guideline, published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking countries and is backed by the German Society of Anaesthesiology and Intensive Medicine (DGAI), the Society of Thrombosis and Haemostasis Research (GTH) and the German Association of Midwives. The aim is to provide a consensus-based overview of the diagnosis and management of peripartum bleeding obtained from an evaluation of the relevant literature.
Methods
This S2k guideline was developed from the structured consensus of representative members of the various professional associations and professions commissioned by the Guideline Commission of the DGGG.
Recommendations
The guideline encompasses recommendations on definitions, risk stratification, prevention and management.
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Affiliation(s)
| | - Hanns Helmer
- Universitätsklinik für Frauenheilkunde, Klinische Abteilung für Geburtshilfe und feto-maternale Medizin, Medizinische Universität Wien, Wien, Austria
| | - Wolfgang Henrich
- Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian von Heymann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Franz Kainer
- Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
| | | | - Maritta Kühnert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen-Marburg, Marburg, Germany
| | - Heiko Lier
- Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinik Köln, Köln, Germany
| | - Holger Maul
- Geburtshilfe & Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Werner Rath
- Gynäkologie und Geburtshilfe, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | | | - Daniel Surbek
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und feto-maternale Medizin, Bern, Switzerland
| | - Jürgen Wacker
- Klinik für Gynäkologie und Geburtshilfe, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Germany
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Tadesse M, Boltena AT, Asamoah BO. Husbands' participation in birth preparedness and complication readiness and associated factors in Wolaita Sodo town, Southern Ethiopia. Afr J Prim Health Care Fam Med 2018; 10:e1-e8. [PMID: 29781684 PMCID: PMC5913778 DOI: 10.4102/phcfm.v10i1.1471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 11/21/2022] Open
Abstract
Background The poor emphasis on the role of husbands in birth preparedness and complication readiness (BPCR) is a major factor that should be addressed in tackling maternal mortality. Aim To assess the level of husbands’ participation in BPCR and associated factors. Setting Wolaita Sodo town, Southern Ethiopia. Methods A community based cross-sectional study was conducted among 608 husbands of pregnant women and nursing mothers. Multivariate logistic regression model was used for the analysis. Results Forty-five per cent of husbands studied had poor participation in BPCR. Out of the total husbands studied, 40% (235) did not identify transportation, 49% (291) did not accompany their wives to antenatal care (ANC) clinic, 59% (350) did not identify skilled birth attendant, 26% (155) did not identify health facility for delivery and 30% (179) did not save money for emergency. Only 42% (250) of husbands had awareness of emergency conditions, while 75% (444) did not make postpartum plan. Husbands who knew the place of birth of the baby [adjusted odds ratio (AOR) = 7.23; 95% confidence interval (CI): 2.98–17.54] and those who discussed with their wives about birth preparedness (AOR = 2.03; 95% CI: 1.37–3.02) were significantly more likely to participate in BPCR compared to those who did not. Conclusion Participation of husbands in BPCR was poor in the study area. The level of participation in relation to selection of service provider and health facility, financial and transportation planning for delivery and identifying blood donor needs attention to achieve better husband participation in BPCR.
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Affiliation(s)
- Minyahil Tadesse
- School of Public Health, College of Health Sciences, Wolaita Sodo University.
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29
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Maestre JM, Pedraja J, Herrero L, Cano M, Rojo E, Suárez C, Odriozola JM, Gomez R, Cuerno L, Romon I, Terán V, Fernández M, Fariñas-Alvarez C. [Clinical simulation for quality improvement in the care of postpartum haemorrhage]. J Healthc Qual Res 2018; 33:88-95. [PMID: 31610983 DOI: 10.1016/j.jhqr.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 01/02/2018] [Accepted: 01/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse and redesign the care process for patients with severe post-partum haemorrhage using simulation and a human factors approach. METHODS The project was developed between June 2016 and May 2017. The working group was created following the participatory leadership method and included professionals with knowledge and position to influence the organisation. The existing process and clinical protocols were reviewed. An in situ simulation was used to observe team performance in the hospital recovery room. Information was expanded through an open and structured interview with professionals selected for their experience in the subject matter. Task analysis was used to document the process, and a failure mode and effects analysis was made to assess system vulnerabilities. Results were mapped using a flow chart. RESULTS The analysis identified six groups of people working on different tasks, their activities and sequence of action, the importance of naming an explicit coordinator, the way in which information is disseminated and transformed, and the stages where it is necessary to share information and make key clinical decisions. The existing clinical protocols and the aids established in order to use the available resources were integrated, including blood draws and haemostatic agents, as well as an administration guide. CONCLUSIONS The analysis of the patient care process in post-partum haemorrhage using in situ simulation with a human factors perspective, including an analysis of the interaction between professionals and the system where they work, established a detailed and personalised map of the components that determine how work flows through the organisation.
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Affiliation(s)
- José María Maestre
- Hospital virtual Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Juan Pedraja
- Hospital virtual Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Laura Herrero
- Instituto de Investigación Sanitaria Marqués de Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Marina Cano
- Instituto de Investigación Sanitaria Marqués de Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Elena Rojo
- Hospital virtual Valdecilla, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Ceferina Suárez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Juan Manuel Odriozola
- Servicio de Obstetricia y Ginecología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Raquel Gomez
- Enfermería Quirúrgica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Loli Cuerno
- Enfermería Quirúrgica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Iñigo Romon
- Banco de Sangre, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Virginia Terán
- Unidad de Matronas, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - María Fernández
- Unidad de Matronas, Hospital Universitario Marqués de Valdecilla, Santander, España
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Martinelli KG, Garcia ÉM, Santos Neto ETD, Gama SGND. Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis. CAD SAUDE PUBLICA 2018; 34:e00206116. [PMID: 29489954 DOI: 10.1590/0102-311x00206116] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/09/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.
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Affiliation(s)
- Katrini Guidolini Martinelli
- Universidade Federal do Espírito Santo, Vitória, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Seidel V, Braun T, Chekerov R, Nonnenmacher A, Siedentopf JP, Henrich W. Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU).
Data sources
A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described.
Results
Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied.
Discussion and conclusion
Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.
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Marshall AL, Durani U, Bartley A, Hagen CE, Ashrani A, Rose C, Go RS, Pruthi RK. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol 2017; 217:344.e1-344.e6. [PMID: 28502758 DOI: 10.1016/j.ajog.2017.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postpartum hemorrhage is a major cause of maternal morbidity and mortality, but the association between postpartum hemorrhage and hospital length of stay has not been rigorously investigated. OBJECTIVE We explored the impact of postpartum hemorrhage on hospital length of stay and inpatient mortality, as these outcomes have both clinical and economic significance. STUDY DESIGN We performed a retrospective analysis using data from the National Inpatient Sample database during the 2012 through 2013 time period. Deliveries were classified as postpartum hemorrhage due to uterine atony, nonatonic postpartum hemorrhage, or not complicated by postpartum hemorrhage (nonpostpartum hemorrhage). Average length of stay and inpatient mortality rates were compared between groups. RESULTS Over the study interval, postpartum hemorrhage occurred in 3% of deliveries. Among deliveries complicated by postpartum hemorrhage, 76.6% were attributed to uterine atony and 23.4% were nonatonic. Women with nonatonic postpartum hemorrhage had the highest average length of stay (3.67 days) followed by atonic postpartum hemorrhage (2.98 days) and nonpostpartum hemorrhage (2.63 days); P < .001, all comparisons. Inpatient mortality rate of nonatonic postpartum hemorrhage over the entire study period was 104 per 100,000 compared to 019 per 100,000 for atonic postpartum hemorrhage and 3 per 100,000 for nonpostpartum hemorrhage deliveries (P < .001). CONCLUSION From 2012 through 2013, women with postpartum hemorrhage experienced significantly longer length of stay and higher inpatient mortality rates than women without postpartum hemorrhage, largely attributable to nonatonic causes of postpartum hemorrhage. As hospital length of stay and inpatient mortality are important outcomes from both clinical and societal perspectives, interventions to reduce morbidity and mortality related to postpartum hemorrhage may simultaneously facilitate delivery of more cost-effective care and improve both maternal and population health.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
| | - Urshila Durani
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Adam Bartley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Clinton E Hagen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Aneel Ashrani
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Carl Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rajiv K Pruthi
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Transcatheter arterial embolization as first-line rescue in intractable primary postpartum hemorrhage: Assessment, outcome, and subsequent fertility. J Formos Med Assoc 2017; 116:380-387. [DOI: 10.1016/j.jfma.2016.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022] Open
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Abstract
Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period. Obstetric-specific hemorrhage protocols, facilitating the integration and timely escalation of pharmacologic, radiological, surgical, and transfusion interventions, are critical to the successful management of peripartum bleeding.
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Affiliation(s)
- Emily J Baird
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailcode UH2, Portland, OR 97239, USA.
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Dillard AC. Obstetric Hemorrhage in the Rural Emergency Department: Rapid Response. J Emerg Nurs 2017; 43:15-20. [PMID: 28131345 DOI: 10.1016/j.jen.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
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Nkwonta CA, Oyetunde MO. Midwives Utilization of Life Saving Skills for Prevention and Management of Hemorrhage in Primary Health Centers in Anambra State, Nigeria. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Nigeria, 58,000 women die annually of complications of pregnancy and childbirth. Of these deaths, 23.73% are caused by obstetric hemorrhage, which can be prevented with life saving skills (LSS), an early, aggressive, and coordinated intervention for prevention and management of hemorrhage. This study assessed the midwives’ knowledge and practice of LSS among 177 Nigerian midwives at 126 primary health centers. Data were collected using a self-administered questionnaire and observation checklist. Finding indicated 52.5% of the midwives were highly knowledgeable about LSS. However, although 70.6% self-reported a high level of implementing LSS procedures, only 21.7% of the midwives observed actually demonstrated a high level of implementation. The majority practiced some LSS components, including early clamping and cutting the cord (95%) and uterine massage (73.3%); all administered oxytocin, most frequently when delivering the anterior shoulders. The midwives reported numerous challenges to implementing LSS, including lack of an assistant when on duty (23.7%) and shortage of oxytocin (20.3%). These limitations were confirmed by on-site observation in which 66.7% were the sole midwife on duty and 23.3% had no assistant available. A positive relationship was found between midwives’ knowledge and practice, with knowledge varying by academic qualifications. However, practice patterns did not differ by years of experience. These findings indicate a gap exists between the midwives’ actual practice and evidence-based practice standard. Therefore, continuous training, frequent monitoring, and supervision are necessary to improve regular implementation of LSS in practice.
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Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery. Arch Gynecol Obstet 2016; 295:75-80. [DOI: 10.1007/s00404-016-4208-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
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Bao Y, Xu C, Qu X, Quan S, Dong Y, Ying H. Risk factors for transfusion in cesarean section deliveries at a tertiary hospital. Transfusion 2016; 56:2062-8. [PMID: 27239976 DOI: 10.1111/trf.13671] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Yirong Bao
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
| | - Chuanlu Xu
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
| | - Xiaoxian Qu
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
| | - Sijie Quan
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
| | - Yinuo Dong
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
| | - Hao Ying
- Department of Obstetrics; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine; Shanghai China
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Omakwu O, Uppal T, Infante Torres F. The role of ultrasonography in the management of post-partum haemorrhage associated with retained products of conception: A case report. Australas J Ultrasound Med 2016; 19:78-83. [DOI: 10.1002/ajum.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Oine Omakwu
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Talat Uppal
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Fernando Infante Torres
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
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Kuriya A, Piedimonte S, Spence AR, Czuzoj-Shulman N, Kezouh A, Abenhaim HA. Incidence and causes of maternal mortality in the USA. J Obstet Gynaecol Res 2016; 42:661-8. [DOI: 10.1111/jog.12954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anita Kuriya
- Department of Obstetrics and Gynecology; Jewish General Hospital, McGill University; Montreal Quebec Canada
| | - Sabrina Piedimonte
- Department of Obstetrics and Gynecology; Jewish General Hospital, McGill University; Montreal Quebec Canada
| | - Andrea R. Spence
- Center for Clinical Epidemiology and Community Studies; Jewish General Hospital; Montreal Quebec Canada
| | - Nicholas Czuzoj-Shulman
- Center for Clinical Epidemiology and Community Studies; Jewish General Hospital; Montreal Quebec Canada
| | - Abbas Kezouh
- Center for Clinical Epidemiology and Community Studies; Jewish General Hospital; Montreal Quebec Canada
| | - Haim A. Abenhaim
- Department of Obstetrics and Gynecology; Jewish General Hospital, McGill University; Montreal Quebec Canada
- Center for Clinical Epidemiology and Community Studies; Jewish General Hospital; Montreal Quebec Canada
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Which uterine sparing technique should be used for uterine atony during cesarean section? The Bakri balloon or the B-Lynch suture? Arch Gynecol Obstet 2016; 294:511-7. [DOI: 10.1007/s00404-016-4015-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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Bartlett L, Cantor D, Lynam P, Kaur G, Rawlins B, Ricca J, Tripathi V, Rosen HE. Facility-based active management of the third stage of labour: assessment of quality in six countries in sub-Saharan Africa. Bull World Health Organ 2015; 93:759-67. [PMID: 26549903 PMCID: PMC4622150 DOI: 10.2471/blt.14.142604] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 05/29/2015] [Accepted: 06/10/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the quality of facility-based active management of the third stage of labour in Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and the United Republic of Tanzania. METHODS Between 2009 and 2012, using a cross-sectional design, 2317 women in 390 health facilities were directly observed during the third stage of labour. Observers recorded the use of uterotonic medicines, controlled cord traction and uterine massage. Facility infrastructure and supplies needed for active management were audited and relevant guidelines reviewed. FINDINGS Most (94%; 2173) of the women observed were given oxytocin (2043) or another uterotonic (130). The frequencies of controlled cord traction and uterine massage and the timing of uterotonic administration showed considerable between-country variation. Of the women given a uterotonic, 1640 (76%) received it within three minutes of the birth. Uterotonics and related supplies were generally available onsite. Although all of the study countries had national policies and/or guidelines that supported the active management of the third stage of labour, the presence of guidelines in facilities varied across countries and only 377 (36%) of 1037 investigated providers had received relevant training in the previous three years. CONCLUSION In the study countries, quality and coverage of the active management of the third stage of labour were high. However, to improve active management, there needs to be more research on optimizing the timing of uterotonic administration. Training on the use of new clinical guidelines and implementation research on the best methods to update such training are also needed.
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Affiliation(s)
- Linda Bartlett
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States of America (USA)
| | | | | | | | | | | | - Vandana Tripathi
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States of America (USA)
| | - Heather E Rosen
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States of America (USA)
| | - on behalf of the Quality of Maternal and Newborn Care Study Group of the Maternal and Child Health Integrated Program
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States of America (USA)
- ICF International, Rockville, USA
- Jhpiego, Nairobi, Kenya
- Christ Hospital, Cincinnati, USA
- Jhpiego, Washington, USA
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Conner SN, Tuuli MG, Colvin R, Shanks AL, Macones GA, Cahill AG. Accuracy of Estimated Blood Loss in Predicting Need for Transfusion after Delivery. Am J Perinatol 2015; 32:1225-30. [PMID: 26007310 PMCID: PMC4655180 DOI: 10.1055/s-0035-1552940] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The definition of postpartum hemorrhage (PPH) was developed more than 50 years ago. Since then, the obstetric population has changed dramatically. We sought to determine how well we estimated blood loss (EBL) and find thresholds predicting need for transfusion. STUDY DESIGN We performed a prospective cohort study from 2010 to 2012, comparing those who needed transfusion postpartum and those who did not. EBL, calculated EBL (cEBL), and change in hematocrit were calculated for patients who did not receive transfusion, and EBL was calculated for those who did receive transfusion, stratified by delivery type. Receiver operator curves were created and optimal thresholds of EBL to predict transfusion were estimated. RESULTS Among 4,804 patients, transfusion was required for 0.65% of vaginal and 8.7% of cesarean deliveries. Median EBL was higher in women requiring transfusion. A weak correlation was noted between EBL and cEBL for all deliveries. Thresholds of 500 mL blood loss for vaginal delivery and 1,000 mL for cesarean had the best predictive ability for transfusion. CONCLUSION In this modern obstetric, cohort EBL is weakly correlated with cEBL, suggesting that accuracy of clinical estimates of blood loss is modest. However, EBL predicts need for transfusion, with optimal thresholds of 500 mL for a vaginal delivery and 1,000 mL in a cesarean. This validates the traditional definitions of PPH in our modern population.
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Affiliation(s)
- Shayna N. Conner
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Methodius G. Tuuli
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan Colvin
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony L. Shanks
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - George A. Macones
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Tort J, Rozenberg P, Traoré M, Fournier P, Dumont A. Factors associated with postpartum hemorrhage maternal death in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey. BMC Pregnancy Childbirth 2015; 15:235. [PMID: 26423997 PMCID: PMC4590311 DOI: 10.1186/s12884-015-0669-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Sub-Saharan-Africa (SSA). Although clinical guidelines treating PPH are available, their implementation remains a great challenge in resource poor settings. A better understanding of the factors associated with PPH maternal mortality is critical for preventing risk of hospital-based maternal death. The purpose of this study was thus to assess which factors contribute to maternal death occurring during PPH. The factors were as follows: women’s characteristics, aspects of pregnancy and delivery; components of PPH management; and organizational characteristics of the referral hospitals in Senegal and Mali. Methods A cross-sectional survey nested in a cluster randomized trial (QUARITE trial) was carried out in 46 referral hospitals during the pre-intervention period from October 2007 to September 2008 in Senegal and Mali. Individual and hospital characteristics data were collected through standardized questionnaires. A multivariable logistic mixed model was used to identify the factors that were significantly associated with PPH maternal death. Results Among the 3,278 women who experienced PPH, 178 (5.4 %) of them died before hospital discharge. The factors that were significantly associated with PPH maternal mortality were: age over 35 years (adjusted OR = 2.16 [1.26–3.72]), living in Mali (adjusted OR = 1.84 [1.13–3.00]), residing outside the region location of the hospital (adjusted OR = 2.43 [1.29–4.56]), pre-existing chronic disease before pregnancy (adjusted OR = 7.54 [2.54–22.44]), prepartum severe anemia (adjusted OR = 6.65 [3.77–11.74]), forceps or vacuum delivery (adjusted OR = 2.63 [1.19–5.81]), birth weight greater than 4000 grs (adjusted OR = 2.54 [1.26–5.10]), transfusion (adjusted OR = 2.17 [1.53–3.09]), transfer to another hospital (adjusted OR = 13.35 [6.20–28.76]). There was a smaller risk of PPH maternal death in hospitals with gynecologist-obstetrician (adjusted OR = 0.55 [0.35–0.89]) than those with only a general practitioner trained in emergency obstetric care (EmOC). Conclusions Our findings may have direct implications for preventing PPH maternal death in resource poor settings. In particular, we suggest anemia should be diagnosed and treated before delivery and inter-hospital transfer of women should be improved, as well as the management of blood banks for a quicker access to transfusion. Finally, an extent training of general practitioners in EmOC would contribute to the decrease of PPH maternal mortality.
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Affiliation(s)
- Julie Tort
- Research Institute for Development, Paris Descartes University, Sorbonne Paris Cité, MERIT - UMR 216, Paris, France. .,UPMC University, Paris, France. .,Paris Diderot University, Paris, France. .,UMR 216, Faculté de Pharmacie, Laboratoire de Parasitologie, 4 Avenue de l'Observatoire, 75270, Paris Cedex 6, France.
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France. .,EA7285, Clinical risk and safety in women's health and perinatal health, University of Versailles Saint-Quentin (UVSQ), St Quentin en Yvelines, France.
| | - Mamadou Traoré
- URFOSAME, Referral health center of the Commune V, Bamako, Mali.
| | - Pierre Fournier
- Research Centre of CHUM (CRCHUM), University of Montreal, Montreal, Canada.
| | - Alexandre Dumont
- Research Institute for Development, Paris Descartes University, Sorbonne Paris Cité, MERIT - UMR 216, Paris, France. .,UPMC University, Paris, France.
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Vintejoux E, Ulrich D, Mousty E, Masia F, Marès P, de Tayrac R, Letouzey V. Success factors for Bakri™balloon usage secondary to uterine atony: a retrospective, multicentre study. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanuelle Vintejoux
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
| | - Daniela Ulrich
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
- Department of Obstetrics and Gynecology; Graz University Hospital; Graz Austria
| | - Eve Mousty
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
| | - Florent Masia
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
| | - Pierre Marès
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology; Nimes University Hospital; Nîmes France
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Stevens TA, Swaim LS, Clark SL. The Role of Obstetrics/Gynecology Hospitalists in Reducing Maternal Mortality. Obstet Gynecol Clin North Am 2015; 42:463-75. [PMID: 26333636 DOI: 10.1016/j.ogc.2015.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The United States experienced a 6.1% annual increase in the maternal death rate from 2000 to 2013. Maternal deaths from hemorrhage and complications of preeclampsia are significant contributors to the maternal death rate. Many of these deaths are preventable. By virtue of their continuous care of laboring patients, active involvement in hospital safety initiatives, and immediate availability, obstetric hospitalists are uniquely positioned to evaluate patients, initiate care, and coordinate a multidisciplinary effort. In cases of significant maternal hemorrhage, hypertensive crisis, and acute pulmonary edema, the availability of an obstetrics hospitalist may facilitate improved patient safety and fewer maternal deaths.
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Affiliation(s)
- Tobey A Stevens
- Department of Obstetrics & Gynecology, Baylor College of Medicine, 6651 Main Street, Suite1020, Houston, TX 77030, USA.
| | - Laurie S Swaim
- Division of Gynecologic and Obstetric Specialists, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Suite 1020, Houston, TX 77030, USA
| | - Steven L Clark
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Suite 1020, Houston, TX 77030, USA
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Prick BW, Auf Altenstadt JFVS, Hukkelhoven CWPM, Bonsel GJ, Steegers EAP, Mol BW, Schutte JM, Bloemenkamp KWM, Duvekot JJ. Regional differences in severe postpartum hemorrhage: a nationwide comparative study of 1.6 million deliveries. BMC Pregnancy Childbirth 2015; 15:43. [PMID: 25885884 PMCID: PMC4341225 DOI: 10.1186/s12884-015-0473-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/06/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands. METHODS We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation. RESULTS We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting. CONCLUSIONS In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable.
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Affiliation(s)
- Babette W Prick
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, 's-Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands. .,Department of Obstetrics and Gynecology, Maasstad Hospital, Maasstadweg 21, 3079, DZ Rotterdam, the Netherlands.
| | | | | | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, 's-Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, 's-Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands.
| | - Ben W Mol
- Robinsion Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, 5000, SA, Australia.
| | - Joke M Schutte
- Department of Obstetrics and Gynecology, Isala Klinieken, Groot Wezenland 20, 8011, JW Zwolle, The Netherlands.
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA Leiden, The Netherlands.
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, 's-Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands.
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New approaches to obstetric hemorrhage: the postpartum hemorrhage consensus algorithm. Curr Opin Anaesthesiol 2014; 27:267-74. [PMID: 24739248 DOI: 10.1097/aco.0000000000000081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Postpartum hemorrhage is increasingly frequent and a major contributor to maternal morbidity and mortality. Although individual steps, such as coagulation or surgical management, have been reviewed, there is little information on treatment algorithms. RECENT FINDINGS A treatment algorithm for postpartum hemorrhage was developed by the experts from three different specialties and from three countries. The algorithm describes symptoms, diagnosis, general measurements, medication, and organizational aspects. SUMMARY The algorithm is thought to serve as a template for local adaptation. It will hopefully improve the management of postpartum hemorrhage.
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Yego F, D'Este C, Byles J, Nyongesa P, Williams JS. A case-control study of risk factors for fetal and early neonatal deaths in a tertiary hospital in Kenya. BMC Pregnancy Childbirth 2014; 14:389. [PMID: 25432735 PMCID: PMC4298961 DOI: 10.1186/s12884-014-0389-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is important to understand the risk factors for fetal and neonatal mortality which is a major contributor to high under five deaths globally. Fetal and neonatal mortality is a sensitive indicator of maternal health in society. This study aimed to examine the risk factors for fetal and early neonatal mortality at the Moi Teaching and Referral Hospital in Kenya. METHODS This was a case-control study. Cases were fetal and early neonatal deaths (n = 200). The controls were infants born alive immediately preceding and following the cases (n = 400). Bivariate comparisons and multiple logistic regression analyses were undertaken. RESULTS The odds of having 0-1 antenatal visits relative to 2-3 visits were higher for cases than controls (Adjusted Odds Ratio (AOR) = 4.5; 95% CI: 1.2-16.7; p = 0.03)). There were lower odds among cases of having a doctor rather than a midwife as a birth attendant (AOR = 0.2; 95% CI: 0.1-0.6; p < 0.01). The odds of mothers having Premature Rupture of Membranes (AOR = 4.1; 95% CI: 1.4-12.1; p = 0.01), haemorrhage (AOR = 4.8; 95% CI: 1.1-21.9; p = 0.04) and dystocia (AOR = 3.6; 95% CI: 1.2-10.9; p = 0.02) were higher for the cases compared with the controls. The odds of gestational age less than 37 weeks (AOR = 7.0; 95% CI 2.4-20.4) and above 42 weeks (AOR = 16.2; 95% CI 2.8-92.3) compared to 37-42 weeks, were higher for cases relative to controls (p < 0.01). Cases had higher odds of being born with congenital malformations (AOR = 6.3; 95% CI: 1.2-31.6; p = 0.04) and with Apgar scores of below six at five minutes (AOR = 26.4; 95% CI: 6.1-113.8; p < 0.001). CONCLUSION Interventions that focus on educating mothers on antenatal attendance, screening, monitoring and management of maternal conditions during the antenatal period should be strengthened. Doctor attendance at each birth and for emergency admissions is important to ensure early neonatal survival and avert potential risk factors for mortality.
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