Risk Factors for Postpartum Hemorrhage in a Thai-Myanmar Border Community Hospital: A Nested Case-Control Study

Impact of risk mitigation strategies on non-fatal injuries in the construction sector in qatar: a retrospective analysis

PURPOSE

The construction sector has the highest risk of fatal and non-fatal injuries worldwide. This study examined the impact of risk mitigation strategies implemented in Qatar's construction sector between 2013 and 2021 on non-fatal injuries.

METHODS

This study employed quantitative and qualitative methods. Data on implemented strategies were gathered through a systematic website search and structured interviews with Safety and Occupational Health officers. Retrospective injury data were obtained from Hamad Trauma Center medical records. Systematic website search identified key legislation and guidelines. Interview transcripts were analyzed using qualitative content analysis. Injury data were categorized into pre- and post-implementation data. Differences were assessed using means, standard deviations, percentages, effect sizes, and confidence intervals.

RESULTS

Eight safety legislation/policies and guidelines were issued. Interview analysis identified technical, behavioral, and organizational measures as key themes in risk mitigation strategies. Comparing pre- and post-implementation data, non-fatal injury incidence (effect size (ES): 0.21, 95% CI 0.19-0.28) and severity (ES: 0.32, 95% CI 0.25-0.40) were reduced. Hospital and ICU stays were shorter post-implementation (ES: 0.2, 95% CI 0.12-0.27 and 0.014, 95% CI 0.010-0.021). Injury reductions were observed across major affected areas, except for the chest and skin. Non-fatal injuries remained more common among general laborers (ES: - 0.26, 95% CI - 0.34, 0.18) and those wearing protective devices (ES; - 0.1, CI - 0.12, - 0.07).

CONCLUSION

Implemented risk mitigation strategies collectively reduced non-fatal injury incidence and severity and improved outcomes in the construction sector. Future research should explore observed trends through prospective studies and job hazard analysis.

Delayed umbilical cord clamping in elective and nonelective term Cesarean delivery

BACKGROUND

Delayed cord clamping (DCC) is recommended for preterm and term neonates, regardless of delivery mode. After impression of increased maternal blood loss following DCC implementation during Cesarean delivery (CD) concerns arose about maternal safety, particularly in term CDs.

MATERIALS AND METHODS

We conducted a retrospective cohort study by reviewing birth records from our tertiary hospital in Kuopio, Finland including 914 women with singleton term CD and recorded estimated blood loss. Early cord clamping (ECC) occurred from January 2016 to December 2019, while DCC (30-60 s) from January 2020 to December 2020. We evaluated maternal and neonatal outcomes for ECC vs. DCC and assessed severe postpartum hemorrhage (PPH) (≥1500 ml) and its potential clinical risk factors.

RESULTS

In total, 914 women were included (DCC N = 152; ECC N = 762). Estimated mean maternal blood loss showed no significant difference between DCC and ECC groups (697 ml vs. 750 ml, p < 0.96). Severe PPH was less frequent in the DCC group (4.6% vs. 10.5 %, p < 0.024). Neonatal outcomes were similar between groups. Multivariable analysis revealed that women with placenta previa (OR 5.63, p < 0.001), macrosomic neonate (OR 2.75, p < 0.001), and intrapartum infection (OR 2.00, p < 0.057) had an increased risk for severe PPH. Earlier CD was associated with less severe PPH (OR 0.36, p < 0.001).

CONCLUSIONS

DCC (30-60 s) during term CD did not increase maternal blood loss in singleton pregnancies and demonstrated no short-term adverse effects on neonates. Our findings support the general practice of DCC during both elective and nonelective term CD.

Prepartum Anemia and Risk of Postpartum Hemorrhage: A Meta-Analysis and Brief Review

Postpartum hemorrhage (PPH) is responsible for 30% to 50% of maternal deaths. There is conflicting evidence if prepartum anemia facilitates PPH. A comprehensive analysis of studies describing their relation is missing. An extensive database search was conducted applying the terms "anemia" OR "hemoglobin" AND "postpartum hemorrhage." We used a random-effects meta-analysis model to estimate an overall odds ratio (OR) for PPH and prepartum anemia, separating studies that were conformant and non-conformant with the World Health Organization (WHO) definitions for anemia. The search yielded 2519 studies, and 46 were appropriate for analysis. The meta-analyses of WHO-conformant (n = 22) and non-conformant (n = 24) studies showed that the risk of PPH was increased when anemia was present. The ORs were 1.45 (CL: 1.23-1.71) for WHO-conformant studies, 2.88 (CL: 1.38-6.02) for studies applying lower thresholds for anemia, and 3.28 (CL: 2.08-5.19) for undefined anemia thresholds. PPH risk appeared to increase with lower anemia thresholds. Prepartum anemia is associated with an increased risk of PPH, an observation that is important regarding improved anemia correction strategies such as iron supplementation.

Race/Ethnicity as a Risk Factor in the Development of Postpartum Hemorrhage: A Thorough Systematic Review of Disparity in the Relationship Between Pregnancy and the Rate of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide. Throughout the years, there have not been many studies looking into the association of race and ethnicity with the occurrence of PPH. The goal of this study was to assess race and ethnicity as risk factors in the development of PPH in pregnant women. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) standards, we conducted the analysis and conducted a literature search using Google Scholar and PubMed. After applying our inclusion and exclusion criteria, the search technique yielded a total of eight articles. The analysis included seven observational studies and one randomized controlled trial. The incidence of PPH was chosen as the major outcome measure. An evaluation of eight studies revealed that although Hispanics, Asians, Native Hawaiians, and other Pacific Islanders (NHOPI) have a higher chance of developing PPH caused by uterine atony, Caucasians had a greater rate of transfusion than the other groups. In addition, compared to Caucasians, African Americans or African descendants had a lower risk of atonic PPH but increased odds of atonic PPH requiring interventions. On the other hand, compared to non-native groups, Native Americans had increased odds of uterine atony. The results showed that, in contrast to other races/ethnicities, Caucasians had the lowest risk of PPH. Additionally, it was shown that African Americans or those descended from Africans had a higher chance of PPH but a lower risk of atonic PPH.