scholarly journals Evaluation of complications during third stage of labour among women delivering at tertiary care center

2018 ◽  
Vol 7 (7) ◽  
pp. 2706
Author(s):  
Tanya Agrawal ◽  
Ruchi Kalra ◽  
Aabha Suryavanshi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Active Management ◽  
Perineal Tear ◽  
Retained Placenta ◽  
Uterine Inversion ◽  
Perineal Tears ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

Background: The common complications occurring during third stage of labor are PPH Retained Placenta, Morbid adherent placenta- placenta accreta, placenta increta, percreta, perineal tears, uterine inversion increasing the maternal morbidity and mortality. The objective of the present study was to evaluate percentage and spectrum of obstetrics complication occurring during third stage of labor.Methods: An observational study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Center, Bhopal from January 2016 to December 2017. All women delivering vaginally including instrumental deliveries were included. The medio-lateral episiotomy was given to all primigravida and for multigravida decision was case based as big size babies, instrumental deliveries, rigid perineum. Active management of third stage of labor was practiced.Results: 899 women delivered vaginally during the study period of 2 years (Jan -Dec 2016 Jan -Dec 2017). Among these 6.45% (58 women) had various complications during third stage of labor . 55% were primigravida. Complications which were observed to occur during third stage of labor were perineal tear 4% (37/899 deliveries). Atonic PPH occurred in 0.5% (9/899 deliveries) Traumatic PPH was in 1.44% (13/899 deliveries and 0.3% cases had retained placenta. Associated condition in perineal tear cases were 92% had big size babies 5% cases were preterm labor and in 3% cases ventouse application was done.Conclusions: Common complications were 1st and 2nd degree perineal tears occurred in 4% deliveries and traumatic PPH were in 1.44% of cases.

scholarly journals Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fiona Urner ◽  
Roland Zimmermann ◽  
Alexander Krafft
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Retained Placenta ◽  
Manual Removal ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

scholarly journals Active management of third stage of labor

1970 ◽  
Vol 1 (2) ◽  
pp. 25-27
Author(s):  
Meena Thapa ◽  
Rachana Saha ◽  
Sumita Pradhan ◽  
Sushil Thakur ◽  
Archan Shamsher Rana
Keyword(s):  
Blood Loss ◽  
Post Partum ◽  
College Teaching ◽  
Uterine Atony ◽  
Active Management ◽  
Retained Placenta ◽  
Average Blood Loss ◽  
Cord Clamping ◽  
Third Stage Of Labor ◽  
Third Stage

Objective: Overall objective of the study was to see effects of active management of third stage of labour (AMSTL) with oxytocin. Specific objective of the study was to look for incidence of Post-Partum Haemorrhage (PPH), length of 3rd stage, incidence of retained placenta and average blood loss. Methodology: A hospital based prospective, descriptive, observational study was carried out from 1st July 2005 to 30th June 2006 at department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital (KMCTH). All patients undergoing vaginal delivery excluding twins, polyhydraminios and instrumental deliveries were included in the study. The active management of 3rd stage included administration of 10 units IU of oxytocin, early cord clamping, controlled cord traction and uterine massage. Blood loss was estimated by visual inspection and measured by jar pressed against perineum. Result: Total number of deliveries during the study period was 530. There were 13 cases of PPH. Incidence of PPH was 2.4%. There were six cases each of uterine atony and genital tract trauma. One case was of retained placenta requiring Manual Removal (MRP). Average third stage duration was less than 5 minutes. Average blood loss was 90 ml. In 2 cases the third stage lasted more than 30 mins. Conclusion: Active management of 3rd stage of labour reduces the incidence of PPH from uterine atony, reduces the duration as well as average blood loss during third stage.condition. Key words: Labor analgesia; epidural, combined spinal epidural; complications, dural puncture, postdural puncture headache (PDPH); prevention.   doi:10.3126/njog.v1i2.1490 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 25 - 27 Nov-Dec 2006

scholarly journals Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years

2020 ◽  
Vol 10 (1) ◽  
pp. 192
Author(s):  
Shikha Madan ◽  
Neetu Sangwan ◽  
Smiti Nanda ◽  
Daya Sirohiwal ◽  
Pushpa Dahiya ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Maternal Mortality ◽  
Postpartum Hemorrhage ◽  
Health Workers ◽  
Care Center ◽  
Tertiary Care ◽  
Normal Delivery ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Common Etiology

Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality.

scholarly journals Clinical study of post partum haemorrhage from a teaching hospital in Maharashtra, India

2017 ◽  
Vol 6 (6) ◽  
pp. 2366 ◽  
Author(s):  
Fasiha Tasneem ◽  
Shyam Sirsam ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Teaching Hospital ◽  
Postpartum Haemorrhage ◽  
Post Partum ◽  
Care Center ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Surgical Interventions ◽  
Maternal Morbidity And Mortality ◽  
Post Partum Haemorrhage

Background: To study the cases of postpartum haemorrhage, their causes and management in a tertiary care centre.Methods: A retrospective study of cases of postpartum haemorrhage for a period of 3yrs was conducted in Dept. of OBGY at a rural tertiary care center and teaching hospital in Maharashtra. The major causes, management modalities, morbidity and mortality associated with it were discussed.Results: Out of 37515 deliveries over the period of 3 years (2014-2016), there were 1333 cases of PPH out of which accounted for a prevalence of 3.55%. Study showed that 86% of cases were due to atonic PPH, 9.9% due to traumatic PPH, and 0.97% were due to both atonic and traumatic PPH. 2.7% of cases were due to retained placenta, 0.07% were due to bleeding diathesis.Conclusions: In an era with availability of excellent uterotonics and active management of 3rd stage of labour even today postpartum haemorrhage stands first as the cause of maternal morbidity and mortality. Even though with excellent medical and surgical interventions, maternal mortality due to PPH has been significantly reduced, the field still needs extensive research and new modalities to prevent and manage post-partum haemorrhage.

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 Evaluation of complication during third stage of labour at tertiary care center

2020 ◽  
Vol 9 (6) ◽  
pp. 2446
Author(s):  
Komal K. Rangholiya ◽  
Saumya P. Agrawal ◽  
Sapana R. Shah ◽  
Hetal Dodiya
Keyword(s):  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Conservative Surgery ◽  
Maternal Outcome ◽  
Tertiary Care Centre ◽  
Uterine Inversion ◽  
Third Stage ◽  
Life Threatening

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication.

scholarly journals A Comparative Study: Is Misoprostol as Effective as Oxytocin in Active Management of Third Stage of Labor?

2020 ◽  
Vol 3 (2) ◽  
pp. 272-276
Author(s):  
Prem Raj Pangeni ◽  
Padma Raj Dhungana ◽  
Rajesh Adhikari
Keyword(s):  
Active Management ◽  
P Value ◽  
The Third ◽  
Third Stage Of Labor ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Maternal Morbidity And Mortality ◽  
Misoprostol Group ◽  
Orally Active ◽  
To Receive

Background: The third stage of labor is that period from birth of the infant until the delivery of the placenta. Active management of the third stage of labor plays an important role in reducing maternal morbidity and mortality. Oxytocin is an effective drug in preventing postpartum hemorrhage (PPH) however; it requires a controlled environment and intramuscular administration. Misoprostol is an orally active uterotonic agent,stable at room temperature.The purpose of this study was to compare the efficacy of misoprostol with oxytocin in active management of third stage of labor. Materials and Methods: This was a hospital based study carried out in Paropakar Maternity and Women Hospital, Kathmandu, Nepal during six months period from February 2012 to July 2012. One hundred patients fulfilling inclusion criteria were recruited to receive either 10 unit of IM oxytocin or 600 mcg of oral misoprostol for the management of the third stage of labor. Results: The mean blood loss in misoprostol and oxytocin group was 209±76.7ml and 197±68.8 ml respectively with p value-0.41 which was insignificant. Similarly mean hemoglobin change was also not significant. The additional uterotonics needed in misoprostol was higher (9 cases) than that in oxytocin (5 cases) but it was also not significant. Shivering and fever were significantly high among misoprostol group than in oxytocin group. Conclusion: Efficacy of oxytocin and misoprostol is equal in active management of third stage of labor.

scholarly journals Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems – a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 575-581
Author(s):  
Martina Kreft ◽  
Roland Zimmermann ◽  
Nina Kimmich
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Low Grade ◽  
Singleton Pregnancy ◽  
Perineal Tear ◽  
Vertex Presentation

AbstractObjectivesBirth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals.MethodsIn a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird’s anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup.ResultsA total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes.ConclusionsThere were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.

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