Grand Multiparity and its association with Post-partum Blood Transfusion

Background There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH). Objectives Assess the effects of administrating prophylactic oxytocin at different times during CS. Methods We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty. Results We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15–2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69–2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18–0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13–1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12–72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting. Conclusions In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.

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Comparison of Oral Misoprostol with Intramuscular Oxytocin in the Active Management of Third Stage of Labour

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v10i1.13203 ◽

2015 ◽

Vol 10 (1) ◽

pp. 76-80

Author(s):

S Kaudel ◽

A Rana ◽

N Ojha

Keyword(s):

Blood Transfusion ◽

Post Partum ◽

University Teaching ◽

Active Management ◽

The Third ◽

Oral Misoprostol ◽

Third Stage ◽

Group A ◽

Prospective Comparative Study ◽

Group B

Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. Methods: This prospective comparative study was performed in Tribhuvan University Teaching Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage. One hundred and twenty women without risk of PPH were randomly allocated to receive either 600 mcg misoprostol orally (Group A) or 10 unit of oxytocin intramuscularly (Group B) within 1 minute of delivery. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in hemoglobin (Hb) and hematocrit (Hct) level from before delivery to 8 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Oral misoprostol was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage (PPH). There was no statistical difference in the duration of third stage of labour, need for additional uterotonics, need for uterine exploration/evacuation and need for blood transfusion in the two groups. Conclusions: Routine use of oral misoprostol 600 mcg appears to be as effective as 10 IU intramuscular oxytocin in minimizing blood loss during the third stage of labour.

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Distribution of indications for blood transfusion among the patients of Faridpur, Bangladesh

Bangladesh Medical Journal ◽

10.3329/bmj.v45i2.28981 ◽

2016 ◽

Vol 45 (2) ◽

pp. 85-89

Author(s):

Tonmoy Biswas ◽

Sunil Kumar Biswas ◽

Md Rassell ◽

Md Abdul Alim

Keyword(s):

At Risk ◽

Blood Transfusion ◽

Length Of Stay ◽

Middle Age ◽

Post Partum ◽

Descriptive Study ◽

Blood Transfusions ◽

Age Group ◽

Cross Sectional ◽

Hematological Cancer

For more than a century, blood transfusion is recognized as an important contributor to patients outcome. This study was focused on frequent indications of reported blood transfusions. This cross-sectional type of descriptive study was conducted in Faridpur, Bangladesh among the 719 patients from April, 2013 to July 2013. 30% had non-hemorrhagic anemia, 21% had intra or post-partum hemorrhage, 7% were undergoing haemodialysis, 6% had thalassemia, 4% had trauma, 2% had non-hematological cancer, 1% had leukemia and the rest had other causes. Middle age group and female patients required more transfusions. Moreover, conservative managements required more blood transfusion rather than surgical. However, Patients receiving a blood transfusion are at risk of increased morbidity, mortality, length of stay in hospital & ICU.Bangladesh Med J. 2016 May; 45 (2): 85-89

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Analysis of Obstetric Near Miss Cases of Different Health Facilities of Electoral Constituency Two of Arghakhanchi District

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v9i2.11760 ◽

2014 ◽

Vol 9 (2) ◽

pp. 38-41

Author(s):

S R Manandhar ◽

D S Manandhar ◽

D Adhikari ◽

J R Shrestha ◽

C Rai ◽

...

Keyword(s):

Blood Transfusion ◽

Health Facility ◽

Post Partum ◽

Placental Tissue ◽

Health Facilities ◽

Near Miss ◽

Common Complication ◽

Obstructed Labor ◽

Health Facility Staff ◽

Facility Staff

Aims: This study was done to identify and analyze obstetric near miss cases at health facilities of electoral constituency number 2 (EC 2) of Arghakhanchi district, Nepal. Methods: After receiving one day training on identifying obstetric near miss cases, health facility staff of EC 2 of Arghakhanchi district filled up WHO derived obstetric near miss forms for eight months duration. Causes of obstetric near miss cases were identified and analyzed in SPSS 16. Results: There were 31 obstetric near miss cases reported from different health facilities of EC 2 of Arghakhanchi. The commonest cause of obstetric near miss was Post-partum Hemorrhage (85%, n=26) followed by obstructed labor and ante partum hemorrhage (6%, n= 2) each. The leading cause of PPH was retained placenta/placental tissue in 55% cases (14) followed by atonic uterus (27%, n= 7). Two fifth of the mothers (39%, n=12) developed complication during labor. The most common complication developed after labor was hemorrhage. Conclusions: This study highlighted PPH as the most common serious obstetric problem in the health facilities and indicates the need for provision of blood transfusion at the health facility at least at Arghakhanchi. DOI: http://dx.doi.org/10.3126/njog.v9i2.11760

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Heat stable carbetocin vs. oxytocin for the prevention of post-partum hemorrhage in emergency caesarean delivery: a randomized controlled trial

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0206 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Shaymaa Al Zubaidi ◽

Taghreed Alhaidari

Keyword(s):

Blood Pressure ◽

Blood Transfusion ◽

Pulse Rate ◽

Post Partum ◽

Controlled Trial ◽

Relative Risks ◽

Heat Stable ◽

Emergency Cesarean ◽

Clinically Significant ◽

Double Blinded

Abstract Objectives To evaluate the uterotonic effect of carbetocin compared with oxytocin in emergency cesarean delivery in Iraq. Methods A double-blinded randomized noninferiority single center trial. Three-hundred patients were systematically randomized to intravenous bolus injection of 10 IU oxytocin or 100 mcg carbetocin after delivery in a ratio of 2:1. The primary outcome was additional uterotonic use when inadequate uterine tone occur in the first 24 h after delivery. Secondary outcomes include the need for blood transfusion, blood pressure and pulse rate changes within an hour of drugs administration. Noninferiority margins for the relative risks outcomes was 4%. Results Addition uterotonics use was significantly lower in carbetocin group with a risk ratio of 0.36. Carbetocin was superior to oxytocin in reducing the need for additional uterotonic drugs by 12% and non-inferior to oxytocin for blood transfusion 3.5%. Noninferiority was not shown for the outcome of sever blood loss. Miner changes in blood pressure and pulse rate were observed in carbetocin group compared to oxytocin but clinically were not significant. Conclusions Heat stable carbetocin is effective in reducing additional uterotonics use compared to oxytocin without clinically significant change in blood pressure or pulse rate, therefore, can be a potential alternative in Iraq.

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Letter: Post-partum rubella vaccination, anti-D immunoglobulin, and blood transfusion.

BMJ ◽

10.1136/bmj.4.5935.47-a ◽

1974 ◽

Vol 4 (5935) ◽

pp. 47-47 ◽

Cited By ~ 4

Author(s):

L Grillner ◽

L Forssman

Keyword(s):

Blood Transfusion ◽

Post Partum ◽

Rubella Vaccination

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Intramuscular oxytocin 10 units versus intravenous methylergometrine 0.2 mg in active management of third stage of labour for prevention of postpartum haemorrhage: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196072 ◽

2020 ◽

Vol 9 (2) ◽

pp. 494

Author(s):

Divya Narayana ◽

B. Pathak ◽

Abha Khurana ◽

Uttara Aiyer Kohli

Keyword(s):

Side Effects ◽

Blood Transfusion ◽

Blood Loss ◽

Post Partum ◽

Tertiary Care ◽

Active Management ◽

Normal Delivery ◽

Post Partum Hemorrhage ◽

The Third ◽

Third Stage

Background: To compare the effectiveness of 10 IU of oxytocin IM with 0.2 mg methyl ergometrine IV in the prevention of post-partum hemorrhage when used as a part of active management of third stage of labour. This study aims to compare their influence on duration of the third stage of labour, the amount of blood loss during the third stage of labour and the immediate post-partum period and side effects of the drugs if any.Methods: The study was conducted in a tertiary care teaching hospital. 200 women, who underwent normal delivery with or without episiotomy, were enrolled and were randomly distributed into two groups. 100 women received 10 IU of intramuscular Oxytocin and 100 women received intravenous 0.2 mg of methyl ergometrine. Women of both the groups were given the medication after delivery of anterior shoulder of the baby. Comparison done between percentages fall in Hb from before delivery to 24 hours after delivery, need for additional uterotonic agents, need for blood transfusion, duration of third stage of labour and any side effects including retained placenta and need for manual removal of placenta.Results: Intravenous methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage. There was no difference in the duration of third stage of labour, amount of blood loss, need for additional uterotonic agents, and need for blood transfusion in both the groups. There was no significant side effect in both the groups.Conclusions: Intramuscular oxytocin is as efficacious as Intravenous methylergometrine in the prevention of postpartum hemorrhage with no side effects.

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Active management of third stage of labour: comparison between prophylactic intramuscular methylergometrine and intramuscular oxytocin

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i2.1451 ◽

1970 ◽

Vol 2 (2) ◽

pp. 24-28 ◽

Cited By ~ 5

Author(s):

Shilu Adhikari ◽

Ashma Rana ◽

Kesang D Bista

Keyword(s):

Side Effects ◽

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Post Partum ◽

Statistical Significance ◽

Active Management ◽

Normal Vaginal Delivery ◽

The Third ◽

Third Stage

Aim: Aimed at comparing the efficacy of prophylactic intramuscular methylergometrine with intramuscular oxytocin in reducing blood loss in the third stage of labour (TSL). Methods: This is a randomized, comparative, clinical trial to compare the efficacy of intramuscular methylergometrine with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage Two hundred women undergoing normal vaginal delivery were recruited, 100 in each group- Group A receiving .2mg methylergometrine intramuscularly and Group B receiving 10U oxytocin intramuscularly immediately after the delivery of the anterior shoulder of the baby. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in haemoglobin (Hb) and haematocrit (Hct) level from before delivery to 24 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Intramuscular methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post partum haemorrhage (PPH) [defined as fall in Hb and /or Hct level³ 10% from before delivery to 24 hours after delivery]. There was no difference in the risk of prolonged third stage, need for additional uterotonic agents, need for exploration and uterine evacuation and need for blood transfusion in the two groups. The side effects were all mild in nature and the overall incidence was too low for statistical significance to be elicited. Conclusion: Intramuscular methylergometrine is as efficacious as intramuscular oxytocin in the prevention of third stage blood loss with comparable side effects. Keywords: Third stage of labour, postpartum hemorrhage, methylergometrine, oxytocin. doi:10.3126/njog.v2i2.1451 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 24 - 28

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Massive Blood Transfusion for Traumatic Post-partum Haemorrhage

BMJ ◽

10.1136/bmj.1.4966.547 ◽

1956 ◽

Vol 1 (4966) ◽

pp. 547-549

Author(s):

G. G. Lennon ◽

G. H. Tovey

Keyword(s):

Blood Transfusion ◽

Post Partum ◽

Massive Blood Transfusion ◽

Post Partum Haemorrhage

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POST PARTUM HAEMORRHAGE PROPHYLAXIS

The Professional Medical Journal ◽

10.29309/tpmj/2008.15.03.2836 ◽

2008 ◽

Vol 15 (03) ◽

pp. 323-327

Author(s):

ALIYA ISLAM ◽

ASIFA SIRAJ ◽

NADIA ARIF

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Post Partum ◽

Military Hospital ◽

Standard Size ◽

Group I ◽

Significant Difference ◽

Post Partum Haemorrhage ◽

Group Ii ◽

Group 2

Post partum hemorrhage (PPH) is defined as the loss of greater than 500ml of blood from the genitaltract in the first 24 hours following delivery. PPH occurs in 2-11% of all deliveries. Objective: To compare the efficacyof misoprostol and ergometrine for the prophylaxis of Post Partum Haemorrhage. Design: Prospective study. Setting:Gynaecology and Obstetrics Department Military Hospital Rawalpindi. Period: From 01 July 2006 to 31 Dec 2006.Patients & Methods: A total of 200 patients were recruited in the study, they were divided in two groups, group – I (n100) included those patients who were administered ergometrine intravenously at the time of delivery of head for theprophylaxis of post partum haemorrhage, Group – 2 (n-100) included those patients who were administered Misoprostol800 microgram per rectally just before the start of cesarean section for the same purpose. Blood loss was calculatedobjectively by squeezing the soaked pads and quantifying the amount of clots in a kidney tray of standard size to beequal to 500ml.Results: In group I (n-100) 15 patients had mild PPH blood loss >500ml, out of them 03 had severePPH requiring bimanual message and 02 patients required blood transfusion, in group II( n-100). 08 patients had PPH,blood loss >500 ml, out of them 01 patient required uterine message and none required blood transfusion. Chi-squaretest was applied to compare the efficacy of the two groups, P>0.05 showed no significant difference in the efficacy ofthe two groups but the side effects were obviously less in the Misoprostol group. No patient in group II had GI symptomswhile 36 patient in group I had retching and, vomiting and 03 patients had raised B.P after the administration ofergometrine. Conclusion: Misoprostol administered per rectally has equal efficacy to ergometrine given intravenouslyfor the prophylaxis of post partum haemorrhage but the side effect profile and patient tolerability is better withMisoprostol.

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