Use of Cholera Beds in the Delivery Room: A Simple and Appropriate Method for Direct Measurement of Postpartum Bleeding

2003 ◽  
Vol 33 (4) ◽  
pp. 215-216 ◽  
Author(s):  
Roland T Strand ◽  
Florinda da Silva ◽  
Staffan Bergström
Keyword(s):  
Blood Loss ◽  
Vaginal Bleeding ◽  
Postpartum Haemorrhage ◽  
Critical Time ◽  
Good Alternative ◽  
Active Management ◽  
Limited Resources ◽  
Visual Estimation ◽  
Postpartum Blood Loss ◽  
Third Stage

Abundant obstetric bleeding is a predominant cause of maternal death, with the immediate postpartum period being the most critical time. Visual estimation of postpartum haemorrhage (PPH) often leads to severe underestimation and delay in treatment. Various methods have been developed in order to measure blood loss accurately, but none has proved appropriate in poor settings. The aim of this study was to present a method which is appropriate for measuring postpartum blood loss in a setting with limited resources. Parturient women ( n=814) with active management of third stage of labour in Luanda, Angola were studied. Vaginal bleeding immediately after birth and during the first 2 hours postpartum was collected using a combination of a plastic sheet and a bucket below a cholera bed, in which the women rested during postpartum observation. Monitoring postpartum blood loss in the same way as cholera patients are monitored for loss of stool fluid was found to be a useful and practical way of measuring haemorrhage of parturient women after childbirth. The method described here is simple and appropriate, which makes it a good alternative to more costly methods in detecting and quantifying PPH.

scholarly journals Efficacy of tranexamic acid in preventing postpartum haemorrhage in vaginal delivery

2019 ◽  
Vol 8 (9) ◽  
pp. 3485
Author(s):  
G. Anantha Lakshmi Satyavathi ◽  
Chandrika K.
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postpartum Haemorrhage ◽  
Acid Group ◽  
Active Management ◽  
Singleton Pregnancy ◽  
Total Blood ◽  
Postpartum Blood Loss ◽  
Third Stage ◽  
History Of

Background: Postpartum blood loss is difficult to evaluate especially in developing countries like India where most of the women are anaemic with poor reserve and these conditions are further aggravated by increased demand during pregnancy and blood loss during third stage of labour. The present study was planned to compare the efficacy of prophylactic 10 IU intramuscular oxytocin and 10 IU intramuscular oxytocin +1g Tranexamic acid in reducing blood loss in the third stage of labour.Methods: The present study was carried out on full term pregnancies primigravida/ multiparas with singleton pregnancy being delivered vaginally at GSL Hospital, Rajahmundry between 2016-2017 were included. For this comparative study, 200 women in labor were included after obtaining informed consent. A detailed obstetric history, history of previous medical illnesses, history of the treatment received earlier, cardiovascular and respiratory system and other systems including thyroid and breast were noted.Results: The average total blood loss in IIIrd stage of labour with IM oxytocin was 210 ml and with IM oxytocin + Tranexamic acid was130 ml, which was statistically significant (p<0.001). Oxytocin + Tranexamic acid group had less blood loss when compared to oxytocin group alone. Side effects like, nausea vomiting, headache were slightly more with oxytocin + Tranexamic acid group when compared to oxytocin group alone.Conclusions: In the active management of IIIrd stage of labour 10 IU intramuscular Oxytocin + one gram of tranexamic acid IV is a better combination in reducing the blood loss at delivery when compared to 10 IU intramuscular oxytocin alone.

scholarly journals Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

2019 ◽  
Vol 8 (8) ◽  
pp. 3174
Author(s):  
Harshita Naidu ◽  
Sujatha B. S. ◽  
Muralidhar V. Pai
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Active Management ◽  
Control Group ◽  
Case Group ◽  
Postpartum Blood Loss ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Cervical Traction

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.

scholarly journals A comparative study of the effectiveness of placental blood drainage versus no placental blood drainage in active management of third stage of labor at a tertiary care hospital

2020 ◽  
Vol 9 (11) ◽  
pp. 4636
Author(s):  
Charul Mittal ◽  
Jaya Choudhary ◽  
Akshi Agarwal ◽  
Kalpana Tiwari
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Tertiary Care ◽  
Active Management ◽  
Control Group ◽  
Study Group ◽  
Care Hospital ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Placental Blood

Background: WHO defines postpartum haemorrhage (PPH) as when blood loss is greater than or equal to 500 ml within 24 hours after birth. When blood loss is greater than or equal to 1000 ml within 24 hourrs, it is called as severe primary postpartum haemorrhage. Placental blood drainage is done by clamping and cutting of umbilical cord after birth of baby followed by unclamping the maternal side of cord so the blood can drain freely into a container.Methods: 200 patients were studied in current research finding. Study group had 100 patients whose placental blood drainage was done and control group had 100 patients whose placental blood drainage was not done. This study was done to analyze the effectiveness of placental blood drainage in reducing blood loss.Results: The duration of third stage of labor was 295.70 seconds in study group and 475.20 seconds in control group. The amount of blood loss in study group was 273.76 ml and 294.92 ml in control group. p value was found to be significant. Incidence of PPH in study group was 1% and 8% in control group.Conclusions: Placenta blood drainage was safe and simple. It is a non invasive method very useful to prevent PPH. It reduces the duration of third stage of labor and reduces amount of blood loss.

scholarly journals POSTPARTUM HAEMORRHAGE

2015 ◽  
Vol 22 (06) ◽  
pp. 793-797
Author(s):  
Faiqa Saleem Baig ◽  
Nadeem Shahzad ◽  
Hafiza Naveeda Khurshid ◽  
Aisha Malik
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Controlled Trial ◽  
Significant Risk ◽  
Developed Countries ◽  
Active Management ◽  
Preventive Strategy ◽  
Third Stage ◽  
Group A ◽  
Group B

The most common complication 0f the third stage of labour is postpartumhaemorrhage, which remains a leading cause of maternal mortality (25.0%), especially indeveloping countries. In developed countries, 3-5% of deliveries are complicated by postpartumhaemorrhage: in developing countries, it is 50 times more common .Third stage of labourwhich exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage andpuerperal infection. The best preventive strategy for these complications is active managementof third stage of labour. Active management includes administration of oxytocin within oneminute of birth of baby. Objectives: To compare the mean blood loss after administration ofintra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active managementof third stage of labour. Study Design: Randomized controlled trial. Period: Six months from1-1-2013 to 30-06-2013. Setting: Department of Obstetrics and Gynaecology, Unit-III JinnahHospital Lahore. Methodology: 100 patients fulfilling selection criteria were included in thestudy from labour room. These patients were randomly divided into two groups by usinglottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml ofnormal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocinintravenous stat at anterior shoulder. Total blood loss was noted after complete delivery ofplacenta. Results: Mean age was 25.0±3.9 and 24.4±3.5 in group-A and B, respectively. Meangestational age was 38.20±0.96 weeks in group-A and 38.40±0.94 weeks in group-B. Meanblood loss in intraumbilical oxytocin group was 311.20±27.23 ml and in intravenous oxytocingroup mean blood loss was 373.60±66.47 ml. There was statistically significant differencebetween two groups (p<0.001). In group-A 15 patients (30.0%) and in group-B 20 patients(40.0%) were primigravida while remaining patients were multigravida. Conclusion: The usageof intraumbilical oxytocin in active management of third stage of labour is beneficial in reducingthe blood loss in third stage and thus helps in preventing postpartum haemorrhage.

scholarly journals Duration of Third Stage Labour and Postpartum Blood Loss: a Secondary Analysis of the WHO CHAMPION Trial Data

2021 ◽  
Author(s):  
Sumangala B Chikkamath ◽  
Geetanjali M Katageri ◽  
Ashalata A Mallapur ◽  
Sunil S Vernekar ◽  
Manjunath S Somannavar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Secondary Analysis ◽  
Positive Association ◽  
Trial Data ◽  
Active Management ◽  
P Value ◽  
Clinical Trial Registry ◽  
Main Trial ◽  
Postpartum Blood Loss ◽  
Third Stage

Abstract Background: Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. To better describe the association between the duration of TSL and postpartum blood loss in women receiving active management of third stage of labour (AMTSL), this secondary analysis of the WHO CHAMPION trial data has been conducted.Methods: This was a secondary analysis of the WHO CHAMPION trial conducted in twenty-three sites in ten countries. We studied the association between the TSL duration and blood loss in the sub cohort of women from the CHAMPION trial defined above. We used a general linear model to fit blood loss as a function of TSL duration on the log scale, arm and center, using a normal distribution and the log link function. We showed this association separately for oxytocin and for Heat stable (HS) carbetocin.Results: For the 10,040 women analysed, blood loss rose steeply with third stage duration in the first 10 minutes, but more slowly after 10 minutes. This trend was observed for both Oxytocin and HS carbetocin and the difference in the trends for both drugs was not statistically significant (p-value=0.2070). Conclusions: There was a positive association between postpartum blood loss and TSL duration with either uterotonic. Blood loss rose steeply with TSL duration until 10 minutes, and more slowly after 10 minutes. Study registration: The main trial was registered with Australian New Zealand Clinical Trials Registry ACTRN12614000870651 and Clinical Trial Registry of India CTRI/2016/05/006969.

scholarly journals Active management of third stage of labour: a comparative study of intra-umbilical oxytocin versus intramuscular oxytocin

2017 ◽  
Vol 6 (8) ◽  
pp. 3434
Author(s):  
Neerja Gupta ◽  
Manjushree Athokpam
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Developed Countries ◽  
Active Management ◽  
Singleton Pregnancy ◽  
Third Stage ◽  
Maternal Morbidity And Mortality ◽  
Group 2 ◽  
Volume Difference ◽  
Group 1

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality, not only in the developing countries but also in developed countries. Every 4 minutes one woman dies from pregnancy or child birth related complications. The present study is to compare oxytocin used via intra-umbilical or intramuscular route in the active management of third stage of labour with respect to duration and amount of bleeding.Methods: Four hundred pregnant women at term of a singleton pregnancy with spontaneous onset of labour were included in the study and were randomly divided into 2 groups of 200 women each. Group 1, intra-umbilical oxytocin 10U diluted in 10ml of saline, and Group 2, intramuscular oxytocin 10U were given after the delivery of baby.Results: The outcome criteria with respect to third stage of labour were: duration of the 3rd stage of labour, blood loss by volume, difference in haemoglobin. A significant reduction in duration of third stage (p = 0.001) and blood loss in third stage (p =0.0001) in intra-umbilical oxytocin group was found when compared with intramuscular oxytocin use.Conclusions: Intra-umbilical oxytocin is better alternative to intramuscular oxytocin in active management of third stage of labour.

scholarly journals Active Management of the Third Stage of Labour: A Brief Review and Update

2020 ◽  
Vol 33 (2) ◽  
pp. 149-156
Author(s):  
Nahid Sultana ◽  
Ferdousi Begum ◽  
Shahana Shermin
Keyword(s):  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
Evidence Based ◽  
Mortality And Morbidity ◽  
The Third ◽  
Third Stage ◽  
Maternal Mortality And Morbidity ◽  
And Training ◽  
Uterine Fundus

Blood loss due to postpartum haemorrhage (PPH) and its complications constitute one ofthe major causes of maternal mortality and morbidity. Active management of third stage oflabour (AMTSL) plays an immense role in preventing maternal death due PPH. But till dateobstetricians all over the world and the concerned international bodies could not reach to asingle agreement about its universal use. This approach is practiced widely in many centresand there are some specific guidelines regarding its practical use. AMTSL as a prophylacticintervention and is composed of a package of three components or steps: 1) administrationof a uterotonic, preferably oxytocin, immediately after birth of the baby; 2) controlled cordtraction (CCT) to deliver the placenta; and 3) massage of the uterine fundus after the placentais delivered. In 2012, the results of a large WHO-directed, multi-centred clinical trial showedthat the most important AMTSL component was the administration of an uterotonic, theother two steps contributes relatively less in blood loss. But WHO recommends to continueall three steps of AMTSL for management and training of third stage of labour. This article isa brief review of the recent guidelines and evidence based practice of active management ofthe third stage of labour. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 149-156

scholarly journals Comparative study of various oxytocics in management of third stage of labour

2018 ◽  
Vol 7 (10) ◽  
pp. 4035
Author(s):  
Shrinivas N. Gadappa ◽  
Deepika Sharma ◽  
Yogita Gavit
Keyword(s):  
Side Effects ◽  
Blood Loss ◽  
Comparative Study ◽  
Maternal Mortality ◽  
Postpartum Haemorrhage ◽  
Active Management ◽  
Onset Of Action ◽  
Drug Of Choice ◽  
Significant Difference ◽  
Third Stage

Background: Causes of maternal mortality are haemorrhages, infections, unsafe abortions, and obstructed labour. 25% of these are caused by haemorrhages and are preventable, one of the measures is active management of third stage of labour (AMTSL). For prevention, treatment of postpartum haemorrhage oxytocics are available oxytocin, methylergometrine, misoprostol, prostaglandin F2α.Methods: Study was conducted, 160 patients were randomly given one of following oxytocics a) tablet misoprostol 600 µg per rectal b) Inj. Oxytocin 10 IU IM c) Inj. Methylergometrine 0.2 mg IM d) Inj. PGF2α. Duration for the delivery of placenta and amount of blood loss was measured, side effects were noted, and comparison of haemoglobin and blood loss done.Results: No significant difference in mean blood loss in all group with respect to parity and type of labour. In present study it seems that no oxytocic is superior to other in reducing the blood loss. Misoprostol has variable onset of action. Mean duration of 3rd stage in various groups is same. In respect to side effects HTN is common with methylergometrine, shivering and fever with misoprostol and diarrhoea with PGF2α.Conclusions: Study concluded that all uterotonics have some advantages, oxytocin is ultimate drug of choice in skilled hand due to its definite onset of action while Tab misoprostol in unskilled hands, other oxytocin are reserved for complementary usage and treatment of PPH but Misoprostol has variable onset of action.

scholarly journals Duration of third stage labour and postpartum blood loss: a secondary analysis of the WHO CHAMPION trial data

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sumangala B. Chikkamath ◽  
Geetanjali M. Katageri ◽  
Ashalata A. Mallapur ◽  
Sunil S. Vernekar ◽  
Manjunath S. Somannavar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Secondary Analysis ◽  
Positive Association ◽  
Trial Data ◽  
Active Management ◽  
P Value ◽  
Clinical Trial Registry ◽  
Main Trial ◽  
Postpartum Blood Loss ◽  
Third Stage

Abstract Background Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. To better describe the association between the duration of TSL and postpartum blood loss in women receiving active management of third stage of labour (AMTSL), this secondary analysis of the WHO CHAMPION trial data has been conducted. Methods This was a secondary analysis of the WHO CHAMPION trial conducted in twenty-three sites in ten countries. We studied the association between the TSL duration and blood loss in the sub cohort of women from the CHAMPION trial (all of whom received AMTSL), with TSL upto 60 min and no interventions for postpartum haemorrhage. We used a general linear model to fit blood loss as a function of TSL duration on the log scale, arm and center, using a normal distribution and the log link function. We showed this association separately for oxytocin and for Heat stable (HS) carbetocin. Results For the 10,040 women analysed, blood loss rose steeply with third stage duration in the first 10 min, but more slowly after 10 min. This trend was observed for both Oxytocin and HS carbetocin and the difference in the trends for both drugs was not statistically significant (p-value = 0.2070). Conclusions There was a positive association between postpartum blood loss and TSL duration with either uterotonic. Blood loss rose steeply with TSL duration until 10 min, and more slowly after 10 min. Study registration The main trial was registered with Australian New Zealand Clinical Trials Registry ACTRN12614000870651 and Clinical Trial Registry of India CTRI/2016/05/006969

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