Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Labib M. Ghulmiyyah ◽  
Alaa El-Husheimi ◽  
Ihab M. Usta ◽  
Cristina Colon-Aponte ◽  
Ghina Ghazeeri ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Primary Outcome ◽  
Dropout Rate ◽  
Significant Difference ◽  
Uterine Massage ◽  
Secondary Outcomes ◽  
Group 2 ◽  
Group 1

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

scholarly journals Application of Desmopressin and conjugated estrogens to reduce the volume of blood loss during arthroplsty of the hip joint in patients with end stage renal disease

2020 ◽  
Vol 26 (3) ◽  
pp. 57-63
Author(s):  
N. E. Mushtin ◽  
A. N. Tsed ◽  
A. K. Dulaev ◽  
A. A. Lednev ◽  
K. G. Iljushenko ◽  
...  
Keyword(s):  
Body Weight ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Blood Loss ◽  
Replacement Therapy ◽  
Hip Joint ◽  
Conjugated Estrogens ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

The objective was to determine the possibilities of using desmopressin and conjugated estrogens during primary hip joint arthroplasty in patients receiving renal replacement therapy.Methods and materials. The material for the study was data on 53 patients with pathology of the hip joint, who underwent primary arthroplasty from 2016 to 2018. All patients were divided into 2 groups. Group 1 (n=23) – patients not suffering from kidney diseases. Group 2 (n=30) – patients receiving renal replacement therapy. Each group was divided into 2 subgroups: 1 subgroup – comparisons, where the combination of desmopressin/conjugated estrogens was not used. 2 subgroup – control, where desmopressin was used at a dosage of 0.4 mg/kg 2 hours before the incision, conjugated estrogens was used at a dosage of 0.6 mg / kg of body weight within 5 days before the operation.Results. In group 1 (patients not suffering from kidney disease), there was no statistically significant difference between the subgroups. In group 2 (patients receiving hemodialysis), there was a statistically significant difference in the volume of blood loss. Thus, in the subgroup without using additional techniques, the volume of intraoperative blood loss was 769.5±389.3 ml; in the second subgroup (using desmopressin and estrogens) – 479.1±245.2 ml. The difference was statistically significant, p<0.05. The efficiency was 27.9 %.Conclusion. The additional use of conjugated estrogens at a dose of 0.6 mg/kg of body weight within 5 days before the operation, desmopressin at a dose of 0.4 mg/kg of body weight 2 hours before the incision reduced blood loss by 27.9 %. The use of combination of conjugated estrogens and desmopressin in patients not suffering from kidney disease did not affect the amount of blood loss.

scholarly journals Immersion in Water During Active Labor Decreases Postpartum Hematocrit Fall Following Vaginal Delivery

2018 ◽  
pp. 1
Author(s):  
Gul Nihal Buyuk ◽  
Serkan Kahyaoglu ◽  
Ezgi Turgut ◽  
Omer Hamid Yumuşak ◽  
Caner Kose ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Study Groups ◽  
Normal Vaginal Delivery ◽  
Control Group ◽  
The Mean ◽  
Group 2 ◽  
Water Birth ◽  
Control Group Group ◽  
Group 1

<p><strong>OBJECTIVE:</strong> The objective of the study was to investigate the effect of immersion in water strategy during labor on postpartum bleeding by calculating the postpartum reduction rates of the hematocrit values of the patients.</p><p><strong>STUDY DESIGN:</strong> The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (group 1) and the control group (group 2) of 84 women undergoing normal vaginal delivery. Patients who have received additional medical and surgical interventions for alleviation of postpartum hemorrhage, patients who have undergone an episiotomy and/or perineal trauma were not included in the study. All data were taken from patients who have delivered with spontaneous vaginal delivery. Postpartum hematocrit fall rates of the groups have been compared and the effect of immersion in water on postpartum hemorrhage has been evaluated.</p><p><strong>RESULTS:</strong> The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (Group 1) and the control group (Group 2) of 84 women undergoing vaginal delivery at the hospital. The women in the two groups were matched with respect to age, parity, birth weight and gestational age. The mean age of the women was 29.8±4.8 and 30.5±4.9 respectively. The mean hematocrit difference in the first group was 2.08 ± 1.88 and in the second group was 3.81 ± 1.55. The mean percentage of hematocrit reduction in the first group was 5.71% and in the second group 10.23%.</p><p><strong>CONCLUSION:</strong> Our data showed that mean hematocrit level decreases among women following vaginal delivery more than women who give birth vaginally within immersion in water during labor. The percentage of hematocrit reduction in the water birth group was lower than in the control group. Water birth seems to facilitate uterine contractions more efficiently following vaginal delivery.</p>

scholarly journals Efficacy of prophylactic tranexamic acid administration in prevention of postpartum hemorrhage in placenta previa cesarean section: an interventional study

2021 ◽  
Vol 11 (1) ◽  
pp. 153
Author(s):  
Monika Rathore ◽  
Anjali Gupta ◽  
Nidhi Kumari
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Intravenous Infusion ◽  
Very Low Birth Weight ◽  
Placenta Previa ◽  
Skin Incision ◽  
Group 2 ◽  
Group 1

Background: Postpartum hemorrhage accounts for the major part of the mortality as well as morbidity like severe anemia, need for blood transfusion, hospital stay and infection. Aim and objectives of the study were to determine the efficacy and safety of prophylactic tranexamic acid and intravenous tranexamic acid in preventing postpartum hemorrhage in women undergoing caesarean section for placenta previa.Methods: Seventy women with placenta previa over 1 year, randomized into 2 groups: group 1 (n=35): Women who received 10 IU oxytocin intravenous infusion after placental delivery and group 2 (n=35): Women who received 1 gm (10 ml) tranexamic acid IV before skin incision plus 10 IU oxytocin intravenous infusion after placental delivery.Results: The mean age was similar in 2 groups i.e., 26.34±4.78 years in group 1 and 27.31±5.62 years in group 2. Most women in the present study presented with type IV placenta previa i.e., 34.3% in group 1 and 48.6% in group 2. Mean pre-operative hemoglobin was 9.57±1.54 g/dl in group 1 and 9.59±1.35 g/dl in group 2. Intra-operative mean blood loss was 729.31±172.45 ml in intravenous oxytocin group and 464.86±28.00 ml in intravenous tranexamic acid group. A total of 74.3% women in group 1 and 20% women in group 2 developed postpartum hemorrhage. Mean post-operative hemoglobin was 8.04±1.34 g/dl in group 1 and 8.85±1.26 g/dl in group 2. In group 1, 5.7% neonates were born with very low birth weight and while none in group 2. 51.4% neonates in group 1 and 45.7% in group 2 had low birth weight.Conclusions: It is concluded that tranexamic acid used prophylactically intravenously before skin incision in patients undergoing cesarean section for placenta previa significantly reduces intra-operative blood loss. 

scholarly journals The Impact of Complications on Patients’ Assessment of the Outcome of Tension-Free Vaginal Tape Procedure

2017 ◽  
Vol 11 ◽  
pp. 117955811774237
Author(s):  
David Shaker ◽  
Alexander J Lindgren ◽  
Gwenda Chapman
Keyword(s):  
Primary Outcome ◽  
Telephone Interview ◽  
Response Rate ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
Patient Global Impression ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Introduction: Our study aimed to assess the impact of managed complications of tension-free vaginal tape (TVT) on the patients’ assessment of the results as measured by Patient Global Impression of Improvement (PGI-I). Materials and methods: This was a retrospective study, supplemented with a telephone interview, comparing patients who had complications of TVT procedures with those where no complications recorded. The primary outcome was the PGI-I score in the 2 groups. Results: A total of 118 invitations were sent. In all, 60 patients returned the signed consent and completed the telephone interview with one of the authors (response rate = 50.8%). Complications were recorded in 21 patients (group 1) and no complications in 39 patients (group 2). There was no statistically significant difference between PGI-I in both groups. Conclusions: Managed complications of TVT do not seem to affect patients’ assessment of outcome as measured by PGI-I score.

scholarly journals Functional outcome of long proximal femoral nail versus short proximal femoral nail in peritrochanteric fractures

2021 ◽  
Author(s):  
Sanjeev Gupta ◽  
Pallav Gupta ◽  
Gagandeep Singh Raina ◽  
Manoj Kumar ◽  
Gagandeep Singh
Keyword(s):  
Blood Loss ◽  
Functional Outcome ◽  
Proximal Femoral Nail ◽  
Surgical Time ◽  
Femoral Nail ◽  
Significant Difference ◽  
Intramedullary Implant ◽  
Group 2 ◽  
Surgical Duration ◽  
Group 1

Background: Proximal femoral nail (PFN) is an intramedullary implant which has been commonly used in the fixation of intertrochanteric fractures. However, controversy comes about the effect of nail length on fracture union and other complications. A comparative evaluation of surgical treatment and functional outcome of patients with peritrochanteric fractures treated with short versus long PFN.Methods:  Total of 100 patients have been included in study out of which 57 belonged to group 1 and were operated with short PFN and rest 43 were group 2 operated with long PFN. Patients were followed up for 6 months and were compared on various parameters.Results: There is no significant difference noted in the two group. However, the surgical duration and blood loss for short PFN was significantly less as compared to long PFN.Conclusions: Short PFN is better implant for peritrochantric fractures both stable and unstable with quicker surgical time and lesser blood loss.

scholarly journals Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Jiajie Yu ◽  
Yujia Cai ◽  
Guanyue Su ◽  
Youping Li
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Randomized Controlled Trials ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Background. Motherwort injection, a common traditional Chinese medicine, is widely used for the prevention of postpartum hemorrhage (PPH), which has been found to be potential benefit in clinical practice.Objectives. This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery.Methods. We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Paired reviewers independently screened citations, assessed risk of bias, and extracted data. Random-effects model by Mantel-Haenszal method was applied to pool the data. Predefined subgroup analyses and sensitivity analyses were conducted to explore the heterogeneity and robustness of results. The GRADE approach was used to rate the quality of evidence.Main Results. 37 randomized controlled trials involving 7887 participants were included, all of which were at moderate to high risk of bias. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). However, pooling of 29 trials suggested a reduced risk of blood loss (within 2 hours: MD -55.06mL, 95% CI -84.06 to -26.06; within 24 hours: MD -85.57 mL, 95% CI -94.26 to -76.88, very low quality), PPH events (RR 0.29, 95% CI 0.21 to 0.39, low quality), and adverse events (Peto OR 0.53, 95% CI 0.40 to 0.70, very low quality) in participants treated with motherwort injection and oxytocin versus oxytocin alone.Conclusions. The current evidence supports the suggestion that the additional use of motherwort injection on oxytocin had a preferable outcome. However, given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects.

scholarly journals Comparative study to identify the safety, effectiveness and ease of obstetric forceps for delivery of floating head in cesarean section

2018 ◽  
Vol 7 (5) ◽  
pp. 1760 ◽  
Author(s):  
Sonali Jitendra Ingole ◽  
Saloni Manwani
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Apgar Score ◽  
Uterine Artery ◽  
Fetal Head ◽  
Uterine Incision ◽  
Assisted Delivery ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background: Difficulty is frequently encountered in extraction of floating fetal head. This study will focus on comparison of Forceps assisted fetal head extraction during Lower segment caesarean section (LSCS) with manual method of extraction in LSCS.Methods: The ANC patients attending antenatal OPD and admitted for elective caesarean section fulfilling the inclusion criteria were randomly divided into two groups each of 400 patients: Group 1 of patients undergoing manual extraction of fetal head during LSCS; and Group 2 consisting of patients with forceps assisted delivery of fetal head in LSCS. Following factors will be evaluated in patients: maternal blood loss, any extension of uterine incision, difference in pre and post op hemoglobin levels of the patient and Apgar score of baby at 1 and 5 minutes.Results: Patients in both the groups were matched demographically. The demographic variables such as maternal age, weight, parity and MGA (Mean Gestational age) were comparable in both the groups. Blood loss was significant in Group 1 (manual delivery) as compared with Forceps assisted delivery. This is also reflected in difference in pre and post op Hemoglobin levels. Although baby outcome in terms of Apgar score was similar in both groups, however morbidity in terms of uterine artery trauma, extension of uterine incision was much less in group 2 (Forceps assisted LSCS delivery)Conclusions: Although there was no statistically significant difference in outcome of babies (APGAR score), complication(s) were less (blood loss, uterine artery trauma) in Forceps assisted LSCS delivery group. Proper selection of patient(s), early anticipation for application for Forceps can help for better outcome of caesarean delivery.

The effect of the use of oxytocin on blood loss during different postpartum periods

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Ulaş Fidan ◽  
Uğur Keskin ◽  
Mustafa Ulubay ◽  
Rıza Efendi Karaca ◽  
Fahri Burçin Fıratlıgil ◽  
...  
Keyword(s):  
Blood Loss ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Biochemical Parameters ◽  
Developed Countries ◽  
Maternal Deaths ◽  
Before And After ◽  
Group 2 ◽  
Group 1

AbstractPostpartum hemorrhage is the most important reason for maternal mortality. In developed countries, the reason of 13% of maternal deaths is postpartum hemorrhage while this percentage reaches more than 30% in other countries. In this study, the effect of oxytocin use in different times at the 3In the study, 89 pregnant women to whom oxytocin was administered after placenta separation were studied in Group 1, 89 pregnant women were included in Group 2, and oxytocin was administered after delivery of the shoulder. The levels of hemoglobin and hematocrit before and after delivery were quantified.The biochemical parameters were examined, there was no significant statistical differences in the levels of hemoglobin and hemotocrit before delivery between the two groups. When compared to Group 1, Δ-hemoglobin (P=>0.001), Δ-hematocrit (P=>0.001), the change between the prepartum and postpartum hemoglobin percentage (P<=0.001), and change between the prepartum and postpartum hemotocrit percentage (P<=0.001) were statistically lower in Group 2.It was determined that the use of oxytocin after shoulder delivery has more effects on decreasing the amount of postpartum hemorrhage.

Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

2020 ◽  
pp. 155335062092947
Author(s):  
Hua-Xian Chen ◽  
Zu-Qing Chen ◽  
Liang Huang ◽  
Chang-Peng Han ◽  
Ruo-Xu Dou ◽  
...  
Keyword(s):  
Blood Loss ◽  
Rectal Prolapse ◽  
Operative Time ◽  
Rectal Resection ◽  
Stapled Transanal Rectal Resection ◽  
Significant Difference ◽  
Delorme’S Procedure ◽  
Group 2 ◽  
Delorme's Procedure ◽  
Group 1

Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme’s procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme’s procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 ( P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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