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Niu B, Duffett L, El-Chaâr D, Tinmouth A, Wang TF, Khalife R. Bleeding disorders and postpartum hemorrhage by mode of delivery: a retrospective cohort study. Res Pract Thromb Haemost 2023; 7:100166. [PMID: 37255855 PMCID: PMC10225912 DOI: 10.1016/j.rpth.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
Background Pregnant persons with bleeding disorders and their potentially affected newborns are at a higher risk of peripartum bleeding complications. The safest mode of delivery for persons with bleeding disorders remains debated, leading to uncertainties in decision-making between the patient and her multidisciplinary team. Objectives This study aimed to describe maternal outcomes for pregnant persons with bleeding disorders by mode of delivery and to examine whether postpartum hemorrhage (PPH) and neonatal hemorrhagic manifestations are associated with the mode of delivery. Methods We collected retrospective data on pregnant persons with bleeding disorders who delivered at a single center from 2010 to 2021. Descriptive statistics, Fisher exact test, and odds ratios were used for analysis. Results A total of 82 pregnancies in 56 subjects were included. Hemophilia A and von Willebrand disease represented the largest cohort, at 30% (17/56) each. Overall rates of primary and secondary PPH were 7.3% (6/82) and 17.4% (12/69), respectively. We did not find a statistically significant difference between mode of delivery and PPH. Upon comparing vaginal and cesarian deliveries, we found an odds ratio of 0.7 (95% CI, 0.1-3.4) for primary PPH and 2.6 (95% CI, 0.4-16.4) for secondary PPH. One male newborn with severe hemophilia A was treated for a suspected intracranial hemorrhage. Conclusion In our cohort, high rates of PPH remained an important complication for pregnant persons with bleeding disorders. There was no significant difference in PPH based on modes of delivery. The small sample size likely limited the power of our study, and consequently, future larger studies are needed.
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Affiliation(s)
- Bonnie Niu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Duffett
- Department of Medicine, Division of Hematology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Darine El-Chaâr
- Department of Obstetrics and Gynecology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Department of Medicine, Division of Hematology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Tzu-Fei Wang
- Department of Medicine, Division of Hematology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Roy Khalife
- Department of Medicine, Division of Hematology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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2
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Chainarong N, Deevongkij K, Petpichetchian C. Secondary postpartum hemorrhage: Incidence, etiologies, and clinical courses in the setting of a high cesarean delivery rate. PLoS One 2022; 17:e0264583. [PMID: 35231065 PMCID: PMC8887715 DOI: 10.1371/journal.pone.0264583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/13/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To evaluate the incidence, etiologies, and clinical outcomes of secondary postpartum hemorrhage in a hospital with a high cesarean section rate and to compare the etiologies of secondary postpartum hemorrhage following cesarean delivery versus vaginal delivery. Materials and methods This retrospective study included 123 women with secondary postpartum hemorrhage who were treated at a tertiary-level hospital between January 2004 and June 2018. Descriptive statistics and the chi-square test were used for data analysis. Results The incidence of secondary postpartum hemorrhage was 0.21%. The median onset of bleeding was 12 days after delivery. Fifty-two percent of the deliveries were by cesarean section. The most common etiology of secondary postpartum hemorrhage was endometritis (67.5%), followed by retained placental tissue (21.1%). Women who delivered by cesarean section had a higher rate of endometritis (80.0% vs 53.4%) and a lower rate of retained placental tissue (10.8% vs. 32.8%) than those who delivered vaginally. Surgical intervention included uterine evacuation in 29.3% and hysterectomy in 8.1% of the patients. Five percent of women were treated by embolization. Conclusions Endometritis was the most common cause of secondary postpartum hemorrhage. Women who delivered by cesarean section were less likely to have retained placental tissue but were at higher risk for endometritis and uterine pseudoaneurysm than those who delivered vaginally.
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Affiliation(s)
- Natthicha Chainarong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Kittiya Deevongkij
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Chusana Petpichetchian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
- * E-mail:
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Ghaffari P, Vanda R, Aramesh S, Jamali L, Bazarganipour F, Ghatee MA. Hospital discharge on the first compared with the second day after a planned cesarean delivery had equivalent maternal postpartum outcomes: a randomized single-blind controlled clinical trial. BMC Pregnancy Childbirth 2021; 21:466. [PMID: 34193059 PMCID: PMC8243545 DOI: 10.1186/s12884-021-03873-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Determining the effect of discharge time after elective cesarean section on maternal outcomes. METHODS This study is a randomized clinical trial that performed on 294 women who undergo elective cesarean section. The patients were randomized in two groups by simple randomization method: Group A (discharge 24 h after cesarean) and group B (discharge for 48 h after cesarean). In both groups, during the first 24 h, they received intravenous antibiotic (cefazolin as routine order) and pethidine at the time of pain. The patients were discharged with the hematinic and mefenamic acid. The main outcome variables were satisfaction of the patient, surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage and pain of the patient on discharge day, one and six weeks after cesarean. RESULTS Satisfaction scores and pain score at discharge day, one and six weeks after discharge were not significant different in the study groups (P > 0.05). Another key finding of this paper was no significant difference in the incidence of surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage at one and six weeks after discharge in the study groups(P > 0.05). CONCLUSION The time of discharge can be reduced to 24 h after surgery if the mother to be at good general condition, the vital signs are stable, the patient has no underlying problem and disease, and it is financed for the patient and the health system.
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Affiliation(s)
- Parvin Ghaffari
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Raziyeh Vanda
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Shahintaj Aramesh
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Leila Jamali
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
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Shinohara S, Okuda Y, Hirata S, Suzuki K. Predictive factors for secondary postpartum hemorrhage: a case-control study in Japan. J Matern Fetal Neonatal Med 2020; 35:3943-3947. [PMID: 33167729 DOI: 10.1080/14767058.2020.1844654] [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: 10/23/2022]
Abstract
BACKGROUND Secondary postpartum hemorrhage (PPH) is defined as excessive vaginal blood loss occurring between 24 h and 6-12 weeks after birth. The incidence of secondary PPH varies from 0.2% to 3.0%, and the peak incidence ranges from 1 to 2 weeks postpartum. There is no clinical evidence regarding the cause of secondary PPH. Therefore, this study aimed to determine the predictive factors for secondary PPH in an Asian population. METHODS A case-control study was performed. The clinical data of 25 secondary PPH patients who had been admitted to our hospital between June 2012 and January 2019 were obtained for this study. Control patients (n = 100) were selected from pregnant women who delivered at the hospital during the same period; they were matched to secondary PPH patients using propensity score matching to adjust for maternal age at delivery, parity, and the use of assisted reproductive technology (ART). A multiple logistic regression analysis was used to determine the predictive factors for secondary PPH. RESULTS The median maternal age was 34 years (range, 24-42 years); 85 (68.0%) women were nulliparous, 31 (24.8%) used ART, and 116 (92.8%) had term deliveries. Immediate PPH (adjusted odds ratio [OR], 2.84; 95% confidence interval [CI], 1.04-7.75) and manual removal of the placenta (adjusted OR, 6.14; 95% CI, 1.21-31.1) were associated with secondary PPH. CONCLUSION Increasing the awareness of the predictive factors for secondary PPH could play an important role in the recognition and treatment of postpartum morbidity.
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Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
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Prapawichar P, Ratinthorn A, Utriyaprasit K, Viwatwongkasem C. Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand. BMC Pregnancy Childbirth 2020; 20:172. [PMID: 32183723 PMCID: PMC7079495 DOI: 10.1186/s12884-020-2846-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/27/2020] [Indexed: 12/28/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6–10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.
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Affiliation(s)
- Phat Prapawichar
- Faculty of Nursing Science, Mahidol University, Bangkok, Thailand
| | | | | | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand
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Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Obstetric Hemorrhage. J Obstet Gynecol Neonatal Nurs 2019; 48:288-299. [DOI: 10.1016/j.jogn.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 12/27/2022] Open
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Patel N, Radeos M. Severe Delayed Postpartum Hemorrhage after Cesarean Section. J Emerg Med 2018; 55:408-410. [PMID: 29753568 DOI: 10.1016/j.jemermed.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/23/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Severe secondary or delayed postpartum hemorrhage (PPH) is rare and affects 0.23-3% of all pregnancies. It happens between 24 hours to 12 weeks postdelivery. These PPHs occur more often during normal vaginal delivery; only a small subset of these PPHs occur after cesarean section. The top differential diagnoses of both primary and secondary PPH are different, and as a result, the management may be different. Although uterine atony causes 80% of primary PPHs, extensive literature review exposed the rarity of it in the setting of secondary PPH. CASE REPORT A 27-year-old woman presented to the emergency department 1 week after a cesarean section for severe vaginal bleeding that started an hour earlier. The patient required rigorous uterine massage for approximately 30 min along with oxytocin, carboprost, methergine, and misopristol before bleeding subsided. She required 1 unit of O- blood transfusion during resuscitation and still had a hemoglobin drop of 2.7 g/dL from arrival to after bleeding subsided. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PPH is a life-threatening condition that emergency physicians rarely encounter and may be uncomfortable managing. It is important to be familiar with the differential diagnosis of both primary and secondary PPH and the management of each of the causes.
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Affiliation(s)
- Nirav Patel
- Emergency Medicine Department, Coney Island Hospital, Brooklyn, New York
| | - Michael Radeos
- Emergency Medicine Department, Coney Island Hospital, Brooklyn, New York
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Matsubara S, Takahashi H. Pseudoaneurysm Hidden Behind Secondary Postpartum Hemorrhage. Birth 2016; 43:184-5. [PMID: 27160376 DOI: 10.1111/birt.12223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Tochigi, Shimotsuke, 329-0498, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Tochigi, Shimotsuke, 329-0498, Japan
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Vendittelli F, Dossou M, Debost-Legrand A, Déchelotte P, Lémery D. Reply. Birth 2016; 43:185-6. [PMID: 27160377 DOI: 10.1111/birt.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Françoise Vendittelli
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.,Service de Santé Publique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de Médecine RTH Laennec, Lyon, France.,Pôle Femmes et Enfants, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathieu Dossou
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Anne Debost-Legrand
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.,Service de Santé Publique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Déchelotte
- Service d'Anatomie Pathologique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Didier Lémery
- EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.,Service de Santé Publique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.,AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de Médecine RTH Laennec, Lyon, France.,Pôle Femmes et Enfants, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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