Response to ‘Letter to “Ring compression suture for controlling post-partum hemorrhage during cesarean section”: Some additions’

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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A randomized controlled trial of sublingual Misoprostol - 600µg versus intravenous Oxytocin - 10IU in prevention of post partum hemorrhage during cesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194206 ◽

2019 ◽

Vol 8 (10) ◽

pp. 3865 ◽

Cited By ~ 1

Author(s):

Rajasri G. Yaliwal ◽

Shailaja R. Bidri ◽

Ashwini S. Navani

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Late Onset ◽

Post Partum ◽

Common Side Effect ◽

Suitable Alternative ◽

Post Partum Hemorrhage ◽

Emergency Cesarean ◽

Estimated Blood Loss ◽

Sublingual Misoprostol

Background: Mortality related to pregnancy and childbirth causes half a million women around the world to die annually. About 35% of these deaths are from postpartum hemorrhage (PPH). Prevention of PPH has been advised by the WHO by the use of Oxytocin 10 IU IM or IV and Misoprostol 600 µg in low resource settings in vaginal delivery. However there have been only a few reports on the use of Misoprostol during cesarean section. The best route and dose of Misoprostol is still being debated.Methods: One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive either Misoprostol 600µg sublingually or intravenous oxytocin 10 IU soon after delivery of the baby. Estimated blood loss and comparative change in preoperative hemoglobin to post operative hemoglobin levels and side effects were evaluated.Results: Blood loss was found to be more in Misoprostol than Oxytocin. Eight patients of the Misoprostol group required additional oxytocics. Oxytocin group did not receive any additional drugs. No surgical intervention was made in either of the groups. The most common side effect with Misoprostol was shivering (46%) and in Oxytocin group fever (4%).Conclusions: Sublingual Misoprostol of 600µg works to prevent postpartum bleeding. In our study Oxytocin was more effective than Misoprostol in preventing PPH during cesarean section. Late onset of action of Misoprostol in comparison to Oxytocin may render suturing of the uterus difficult due to pooling of blood. In settings in which use of Oxytocin is not feasible, Misoprostol might be a suitable alternative for post-partum hemorrhage.

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Management of refractory atonic post partum hemorrhage by upper segment compression suture

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1041 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Rakhshanda Toheed ◽

Naela Tarique ◽

Saqib Siddique

Keyword(s):

Medical Treatment ◽

Post Partum ◽

Medical Institute ◽

Effective Technique ◽

Post Partum Hemorrhage ◽

Uterine Massage ◽

Compression Suture ◽

Complex Surgical Procedures ◽

Normal Menstruation

Aims: The study was undertaken to test the efficacy of Upper Segment Compression Suture(USC Suture) for the control of atonic post partum hemorrhage unresponsive to medical treatment. Study Design: Observational study. Duration:: From March 1998 to March 2003. Setting: Department of Obstetrics & Gynaecology, Lahore General Hospital , Post Graduate Medical Institute, Lahore, Pakistan. Subjects: Fourteen women with atonic PPH refractory to medical treatment. Results:: Fourteen women with severe atonic PPH were managed using uterine massage and utero tonic drugs. Failing these measures, Upper Segment compression suture was used as first line conservative surgical technique. There was no relaparotomy for recurrent PPH. All cases were managed successfully avoiding hysterectomy or other complex surgical procedures. Recovery in all cases was uneventful.Long term follow up was available in four cases. All were having normal menstruation. Two o f them achieved spontaneous pregnancies. Conclusion:: Upper Segment Compression Suture is an effective technique for managing refractory PPH caused by uterine atony.

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Comparative Study between Modified Transverse and Hayman Suture Regarding the Efficacy and Purperium Complications in Thi-Qar

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31737 ◽

2021 ◽

pp. 22-33

Author(s):

Aseel Mosa Jabber

Keyword(s):

Statistical Difference ◽

Post Partum ◽

High Rate ◽

P Value ◽

Post Partum Hemorrhage ◽

Significant Statistical Difference ◽

Surgeon Experience ◽

Compression Suture ◽

Uncontrolled Hemorrhage

Background: Main causes of death post-partum is the uncontrolled hemorrhage, that managed by different modalities, whereuterine compression suture had different efficacies as a main interventional tools of sever postpartum hemorrhage. Aim: comparing different sutures types (modified transverse and Hayman suture) regarding their efficacy through its impact and in determining the final outcome and complications of post-partum hemorrhage. Materials and methods: A prospective comparative analytical study including 122 females , who underwent delivery between march 2017and December 2019, all of them followed for , 1 week, 6,weeks 6 months. Were the samples collected from Bent-Al-Huda teaching hospital and Al-Rehman private hospital-Thi-Qar, 2 groups of study; 1st one (52) underwent modified B-lynch suturing (Hyman suturing) while the 2nd group(70) underwent transverse sutures of modified Ouahba suture, written consent had taken from all patients, SPSS version 24 used for analysis. Results: Among 122 delivered women suffer from primary post-partum hemorrhage, 52 (42.63%) were sutured by Hayman suture, and 70 (57.37%)were sutured by transverse suturing,There was significant statistical difference between the types of intervention and blood loss P value <0.05. There was significant statistical difference between the types of intervention and complication development (p value=0.0001). There was no significant independent predictors or determinant for the complication development except the type of intervention. Only follow-up period and complication were truly to be correlated with type of intervention, the other variable were confounders Conclusion: Even though the hemostasis had been achieved in both maneuver with excellent success rate, the transvers suture carrying high rate of persistent pain but the Hayman suture carry higher rate of serious complication such hysterectomy and intestinal obstruction. several factors determine the choosing of the suture type such as site, severity and cause of bleeding and the surgeon experience.

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