Post partum haemorrhage, estimated blood loss at delivery and relationship with duration, concentration and total dose of exogenous oxytocin administered in labour

Aim – The aim of the study was to study the effect of sublingual misoprostol for prevention of PPH. Materials and Methods – This was a prospective, randomized, double blind, placebo controlled study. Inclusion criteria were women aged 20-40 years with 38-40 weeks of gestation who underwent elective caesarean section. Exclusion criteria were women have risk factors for post-partum haemorrhage, active thromboembolic disease and intrinsic risk for thrombosis. Participants were randomly assigned to misoprostol group or group A (n=50) and placebo group or group B(n=50). Group A received 400µg of sublingual misoprostol after delivery of the baby, group B received placebo tablet at the same time. Primary outcome measures were blood loss from delivery of the placenta to the end of the caesarean section to 2 hours postpartum, haemoglobin estimation was done in all patients pre operatively and 24 hours post operatively and the change in concentration was noted. Secondary outcome measures were need for additional uterotonics, use of additional surgical interventions to control post-partum haemorrhage. Result – Blood loss from both placental delivery to the end of caesarean section and from end of caesarean section to 2 hours postpartum were signicantly lower in the study group. (p<0.0001). Change ifn haemoglobin concentration in study group was also signicantly less than in the control group. (p<0.0001). Total amount of Oxytocin required was signicantly less in the study group (p=0.01). The number of women requiring other oxytocics (inj. Methyl ergometrine, inj. Carboprost) was signicantly less in study group (p=0.0078). Conclusion – Sublingual misoprostol has been found to be effective in preventing PPH.

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Comparative Study of Rectal Misoprostol to Oxytocin Infusion in Preventing Postpartum Haemorrhage After Caesarean Section

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v8i2.9767 ◽

2014 ◽

Vol 8 (2) ◽

pp. 34-37 ◽

Cited By ~ 2

Author(s):

AI Adanikin ◽

E Orji ◽

PO Adanikin ◽

O Olaniyan

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Comparative Study ◽

Postpartum Haemorrhage ◽

Post Partum ◽

Operative Blood Loss ◽

Oxytocin Infusion ◽

The Mean ◽

Post Partum Haemorrhage ◽

To Receive

Aims: This comparative study aimed to compare the efficacy of rectal misoprostol to oxytocin infusion in preventing primary postpartum haemorrhage after caesarean section. Methods: Fifty pregnant women with identifiable risk factors for post-partum haemorrhage who delivered baby by caesarean section were randomized to receive 600 μg rectal misoprostol and a placebo infusion intravenously or placebo rectally and a 20 iu oxytocin infusion. Post-operative blood loss four hours after surgery was estimated by application of pads of known weight. Results: The mean immediate four hours post-operative blood loss was not significantly different between the rectal misoprostol and oxytocin infusion group (100.08 ± 24.85 ml versus 108.20 ± 29.93 ml; p =0.144) and the change between the pre-operative and post-operative hematocrit was similar. Conclusions: Post-caesarean section rectal misoprostol has comparative efficacy to oxytocin infusion in preventing post-partum haemorrhage. It is recommended for use as alternative uterotonic in settings where there is low refrigeration capacity.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 34-37 DOI: http://dx.doi.org/10.3126/njog.v8i2.9767

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Post partum haemorrhage: Prevalence, morbidity and management pattern in Dhulikhel Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3561 ◽

1970 ◽

Vol 8 (2) ◽

pp. 212-215 ◽

Cited By ~ 3

Author(s):

AS Dongol ◽

A Shrestha ◽

CD Chawla

Keyword(s):

Blood Loss ◽

Genital Tract ◽

Post Partum ◽

Medical Science ◽

Active Management ◽

Management Pattern ◽

Standard Format ◽

Retained Placenta ◽

Manual Removal ◽

Post Partum Haemorrhage

Background: Post partum haemorrhage (PPH) is the leading cause of maternal death worldwide. PPH occurs in up to 18% of total births. Among different factors, PPH due to uterine atony is the primary and direct cause of maternal mortality comprising about 90%. Objective: The objective of the present study was to assess the prevalence, morbidity and management pattern of PPH in Dhulikhel Hospital. Materials and methods: Hospital based retrospective study was carried out at Kathmandu University School of Medical Science, Dhulikhel Hospital from the period of January 2007 till October 2009. The study group included total of 60 patients. All women who had PPH both primary and secondary were studied. Information regarding total number of deliveries obtained from Obstetrics ward. The cases with PPH were identified and detail records were reviewed using standard format. The main outcome measures used for the analysis were amount of blood loss, cause of PPH and treatment methods. Results: In Dhulikhel hospital, from January 2007 till October 2009 a total of 3805 deliveries took place. Out of which 60 women had PPH. The prevalence was 16/1000 deliveries. There are 41 (68.3%) cases of primary PPH and 19 (31.7%) cases of secondary PPH. PPH was found more in home deliveries, unbooked case and in multiparas. The mean blood loss was 1055ml. As an aetiology, retained placenta and retained placental bits of tissue was found in 37(61.7%) cases, atonic uterus in 10 (16.7%) cases, genital tract trauma in 8(13.3%), sepsis of genital tract in 3(5%), case of ruptured uterus in one case and a case of angle bleeding from previous uterine scar following caesarean section. Among all 15 (25%) cases underwent manual removal of placenta, 5(8.3%) underwent controlled cord traction, 3 (5%) underwent manual removal of placenta followed by check curettage in cases of retained placenta, 16 (26.7%) cases were managed by check curettage for retained bits of placental tissue and membrane. Trauma in genital tract was managed by repair of trauma in 6 (10%) cases. Hysterectomy was required in 3 (5%) cases. Conservative management with uterotonics only required in 12 (20%) cases. Conclusion: Active management of third stage of labour can prevent PPH so delivery by skilled hand in hospital should be promoted. Secondary PPH besides primary can result in significant maternal morbidity. It also deserves similar attention. Key words: Atonic uterus; Postpartum haemorrhage DOI: 10.3126/kumj.v8i2.3561 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215

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O271 A study of the relationship between visually estimated blood loss during delivery and post partum hematocrit change

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(09)60643-3 ◽

2009 ◽

Vol 107 ◽

pp. S170-S170

Author(s):

E. Enabudoso ◽

E. Gharoro

Keyword(s):

Blood Loss ◽

Post Partum ◽

Estimated Blood Loss ◽

The Relationship

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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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The management and prevention of post partum Haemorrhage in a clinic

Curationis ◽

10.4102/curationis.v2i3.499 ◽

1979 ◽

Vol 2 (3) ◽

Author(s):

J.V. Larsen

Keyword(s):

Blood Loss ◽

Genital Tract ◽

Post Partum ◽

Post Partum Haemorrhage ◽

Definition Of ◽

Excessive Blood Loss

Post-partum haemorrhage is best defined as excessive blood loss from the genital tract following the birth of the fetus. For statistical purposes, the definition of excessive blood loss is 600 ml or more. Traditionally, post-partum haemorrhage is divided into primary PPH which is bleeding occurring within 24 hours of delivery, and secondary PPH which is bleeding occurring after that time.

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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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A randomised controlled study for the prevention of post-partum haemorrhage with oxytocin plus methyl ergometrine versus oxytocin alone in the third stage of labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211509 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1906

Author(s):

Rajani Somanathan ◽

Mohanapriya Balu ◽

Elizabeth Jacob ◽

Sr Marykutty Illickal

Keyword(s):

Blood Loss ◽

Post Partum ◽

Controlled Study ◽

The Third ◽

Combined Use ◽

Randomised Controlled Study ◽

Third Stage ◽

Post Partum Haemorrhage ◽

The Difference ◽

Randomised Controlled

Background: Postpartum haemorrhage is the leading cause of maternal death. Uterine atony which is preventable, causes 80% of Post partum haemorrhage (PPH). Active management of third stage of labour (AMTSL) lowers maternal blood loss and reduces the risk of PPH. In this open labelled randomised controlled study we compared the combined use of oxytocin and methyl ergometrine vs oxytocin alone in prevention of PPH in the third stage of labour.Methods: 200 Women admitted for safe confinement and following the inclusion criteria were randomised immediately post delivery to receive either oxytocin +methyl ergometrine or oxytocin alone. The amount of blood loss was assessed objectively by weighing the mops and under sheets used during delivery. If bleeding could not be controlled, additional uterotonics were given. The incidence of PPH, amount of blood loss, use of additional uterotonics and side effects were recorded. The difference in pre natal and post natal haemoglobin (Hb) and the need for blood transfusion were assessed.Results: There was no statistically significant difference in the incidence of PPH between the groups. Post partum blood loss was significantly lesser in the combined group. Additional oxytocics were required more often in the oxytocin only group. The incidence of headache was significantly more in the combined group. The difference in haemoglobin levels post natally and the need for blood transfusion was comparable among both groups.Conclusions: The combined use of methyl ergometrine +oxytocin is not recommended over oxytocin alone in the third stage of labour for prevention of PPH.

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Prophylactic Tranexamic acid usage in Prevention of Post-Partum Hemorrhage a Prospective Cohort Study

10.21203/rs.2.14870/v1 ◽

2019 ◽

Author(s):

Seifeldin Sadek ◽

Arnold M Mahesan ◽

Hadi Ramadan ◽

Nimra Dad ◽

Vani Movva ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Blood Loss ◽

Tranexamic Acid ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Post Partum ◽

Secondary Outcome ◽

Post Partum Hemorrhage ◽

Estimated Blood Loss

Abstract Background Post-partum hemorrhage (PPH) is the leading cause of obstetric morbidity and mortality around the world. Prophylactic administration of tranexamic acid (TXA) in patients at risk for PPH is aimed at reducing estimated blood loss (EBL). Method This was a prospective cohort study. Patients at high risk of PPH were given 1000mg of TXA intravenously at cord clamping after delivery of the baby, and compared with high PPH risk controls who did not receive TXA. Both cesarean section deliveries (CD) and vaginal deliveries (VD) were included. The primary outcome was postpartum hemorrhage, and the secondary outcome was calculated estimated blood loss (cEBL). Results Between January 2017 and May 2017, 101 patients at high risk for PPH were enrolled. Fifty one received TXA and 50 did not. There were 20 cases of PPH in the TXA group compared with 30 cases in the control group (OR 0.43, 95% CI, NNT=5). The average cEBL for VD and CD were significantly lower in the patients who received TXA compared with controls: 561ml ±336ml compared with 841ml ±462ml (p=0.0006) for VD and 658ml ±294mL compared with 1024ml ±276 for CD (p=0.0007). Conclusions Intravenous TXA may be used as prophylaxis for PPH in obstetric patients at high risk.

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