Placental abruption an obstetric emergency: management and outcomes in 180 cases

Background: During a period of eight months, 180 cases of abruption that occurred from January 2007 to August 2007 at GMH, Nayapool, Hyderabad were analysed. Total number of deliveries during the study period of eight months were 14004. Incidence of abruption cases delivered was - 1.3%. In this series 88% were unbooked in our hospital, were referrals. Objective of this study was to study maternal fetal outcome of placental abruption.Methods: Initial clinical assessment, investigations for maternal fetal wellbeing, expedite delivery, manage complications as per accepted protocol. In this series of cases, ARM was done in 85 cases (47.22%), ARM was done and oxytocin drip was started in 36 (20%), ARM was done and PGE1 tablet 25 mcg. was inserted in the vagina in 39 (21.66%).Results: The bleeding was revealed in 146-81.1% and concealed in 34-18.88%. The number of cases with hypertension complicating pregnancy were 102-57%, hypotension in 16-8.88%, prolonged clotting time 13-7.22%, the number of patients who received blood transfusions were 105 (58.3%), number of patients who received fresh frozen plasma, FFP transfusions were 65-36.11%. Taken for LSCS at admission were - 46. Failure to progress after ARM or other methods of labour augmentation were 20 cases. The total number of caesarean deliveries were 66/180 - (36.66%), number of vaginal deliveries were 114 (63.33%). Perinatal outcome: the total number of intra uterine fetal deaths (IUFD) at admission were 103-57.2%. The number of still births were 7-3.8%. Live born babies were 70- 38.8%. Neonatal deaths were 11-6.1% and total perinatal deaths were 121-67.2%. (IUFD at admission-103, + still births - 7, + neonatal deaths - 11=121 perinatal deaths. There were five maternal deaths in 180 cases of placental abruption, 2.7% mortality.Conclusions: Need to consider measures to reduce the occurrence of this condition.

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Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

Journal of Perioperative Practice ◽

10.1177/1750458920950662 ◽

2021 ◽

pp. 175045892095066

Author(s):

Minna Kallioinen ◽

Mika Valtonen ◽

Marko Peltoniemi ◽

Ville-Veikko Hynninen ◽

Tuukka Saarikoski ◽

...

Keyword(s):

Cardiac Surgery ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Rotational Thromboelastometry ◽

Number Of Patients ◽

Fresh Frozen ◽

The Mean ◽

To Receive ◽

Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

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A Protocol for the Rapid Normalization of INR in Trauma Patients with Intracranial Hemorrhage on Prescribed Warfarin Therapy

The American Surgeon ◽

10.1177/000313480807400919 ◽

2008 ◽

Vol 74 (9) ◽

pp. 858-861 ◽

Cited By ~ 20

Author(s):

Michael Kalina ◽

Glen Tinkoff ◽

Adebayo Gbadebo ◽

Paula Veneri ◽

Gerard Fulda

Keyword(s):

Intracranial Hemorrhage ◽

Prothrombin Complex Concentrate ◽

Warfarin Therapy ◽

International Normalized Ratio ◽

Fresh Frozen Plasma ◽

Operative Intervention ◽

Trauma Patients ◽

Number Of Patients ◽

Fresh Frozen ◽

Factor Concentrate

Trauma patients on prescribed warfarin therapy sustaining intracranial hemorrhage can be difficult to manage. Rapid normalization of coagulopathy is imperative to operative intervention and may affect outcomes. To identify and expedite warfarin reversal, we designed a protocol to administer a prothrombin complex concentrate. A Proplex T protocol was instituted in May 2004. It dictated that trauma patients with an International Normalized Ratio (INR) greater than 1.5, history of prescribed warfarin therapy, and intracranial hemorrhage on CT scan receive a prothrombin complex concentrate for reversal of their coagulopathy. Neither the protocol nor the factor concentrate was validated for use in this subset of trauma patients; therefore, adherence to the protocol and use of the factor concentrate was not mandatory. Patients not administered the prothrombin complex concentrate received vitamin K and fresh-frozen plasma. The protocol resulted in an increased number of patients receiving Proplex T (54.3% vs 35.4%, P = 0.047). Protocol patients had improved times to normalization of INR (331.3 vs 737.8 minutes, P = 0.048), number of patients with reversal of coagulopathy (73.2% vs 50.9%, P = 0.026), and time to operative intervention (222.6 vs 351.3 minutes, P = 0.045) compared with control subjects. There were no differences in intensive care unit (ICU) days, hospital days, or mortality. The Proplex T protocol increased the number of patients who received prothrombin complex concentrate, provided rapid normalization of INR, and improved time to operative intervention.

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KEMATIAN PERINATAL DI BLU RSU PROF. DR. R. D. KANDOU MANADO

Jurnal e-Biomedik ◽

10.35790/ebm.1.1.2013.4585 ◽

2013 ◽

Vol 1 (1) ◽

Author(s):

Mercy Tumundo ◽

Hermie Tendean ◽

Eddy Suparman

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Perinatal Death ◽

Developed Countries ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Normal Birth ◽

Perinatal Mortality Rate ◽

Still Births ◽

Early Neonatal Deaths

Abstract: Perinatal death is a big problem especially in a developing country. Some of the hospitals in Indonesia have declared that the number of perinatal death in developing countries is higher than in developed countries. The purpose of this research is to determine the incidence of the factors that affecting perinatal mortality at Prof. DR. R. D. Kandou General Hospital Manado. This research used retrospective descriptive method through medical records of perinatal deaths patients. There were 164 cases of perinatal deaths found where 109 cases still births and 55 cases were early neonatal deaths in 2011, so the number of perinatal mortality rate was 40.17 per mil. The highest number of perinatal death was from multigravide mother, mother with age ≥ 35 years old, spontaneous parturition. There were unknown caused of still births cases (77,06%) and sepsis in early neonatal deaths. The normal birth weight is also with most include of perinatal deaths. Keywords: still birth, early neonatal death, perinatal deaths, perinatal mortality rate. Abstrak: Kematian perinatal merupakan masalah besar khususnya di negara sedang berkembang. Beberapa rumah sakit pendidikan di Indonesia melaporkan angka kematian perinatal yang tinggi dibandingkan dengan laporan angka kematian perinatal di negara – negara maju yang jumlahnya rendah. Tujuan penelitian untuk mengetahui angka kejadian kematian perinatal serta faktor – faktor yang mempengaruhinya. Penelitian ini menggunakan metode deskriptif retrospektif dengan menggunakan data catatan medik pasien. Hasil penelitian yaitu jumlah kematian perinatal pada tahun 2011 sebanyak 164 kasus dengan 109 kasus lahir mati dan 55 kasus kematian neonatal dini sehingga angka kematian perinatal pada tahun 2011 yaitu 40.17 per mil. Kematian perinatal paling banyak pada ibu multigravida, ibu dengan kelompok usia ≥ 35 tahun, menggunakan jenis persalinan spontan. Pada lahir mati 77.06 % penyebab kematiannya tidak diketahui sedangkan sepsis paling banyak menyebabkan kematian neonatal dini. Berat badan lahir normal juga menjadi salah satu faktor terjadinya kematian perinatal. Kata kunci: lahir mati, kematian neonatal dini, kematian perinatal, angka kematian perinatal.

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Fresh Frozen Plasma versus Crystalloid Priming of Cardiopulmonary Bypass Circuit in Pediatric Surgery

Anesthesiology ◽

10.1097/aln.0000000000003017 ◽

2020 ◽

Vol 132 (1) ◽

pp. 95-106 ◽

Cited By ~ 5

Author(s):

Audrey Dieu ◽

Maria Rosal Martins ◽

Stephane Eeckhoudt ◽

Amine Matta ◽

David Kahn ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Postoperative Bleeding ◽

Fresh Frozen Plasma ◽

Postoperative Blood Loss ◽

Blood Product Transfusion ◽

Blood Products ◽

Packed Red Blood Cells ◽

Number Of Patients ◽

Fresh Frozen ◽

Frozen Plasma

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities. The hypothesis was that CPB priming with crystalloids would be different compared with FFP in terms of bleeding and/or need for blood product transfusion. Methods In this parallel-arm double-blinded study, patients weighing between 7 and 15 kg were randomly assigned to a CPB priming with 15 ml · kg−1 PlasmaLyte or 15 ml · kg−1 FFP in addition to a predefined amount of packed red blood cells used in all patients. The decision to transfuse was clinical and guided by point-of-care tests. The primary endpoints included postoperative bleeding tracked by chest tubes, number of patients transfused with any additional blood products, and the total number of additional blood products administered intra- and postoperatively. The postoperative period included the first 6 h after intensive care unit arrival. Results Respectively, 30 and 29 patients in the FFP and in the crystalloid group were analyzed in an intention-to-treat basis. Median postoperative blood loss was 7.1 ml · kg−1 (5.1, 9.4) in the FFP group and 5.7 ml · kg−1 (3.8, 8.5) in the crystalloid group (P = 0.219); difference (95% CI): 1.2 (−0.7 to 3.2). The proportion of patients additionally transfused was 26.7% (8 of 30) and 37.9% (11 of 29) in the FFP and the crystalloid groups, respectively (P = 0.355; odds ratio [95% CI], 1.7 [0.6 to 5.1]). The median number of any blood products transfused in addition to priming was 0 (0, 1) and 0 (0, 2) in the FFP and crystalloid groups, respectively (P = 0.254; difference [95% CI], 0 [0 to 0]). There were no study-related adverse events. Conclusions The results demonstrate that in infants and children, priming CPB with crystalloids does not result in a different risk of postoperative bleeding and need for transfusion of allogeneic blood products.

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Effect of low dose ASV with supportive care in poisonous snake bites in Marathwada region, Aurangabad, Maharashtra, India

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20151500 ◽

2015 ◽

Vol 1 (8) ◽

pp. 307

Author(s):

Mangala S. Borkar ◽

Chandrakant G. Lahane ◽

Akshay A. Kashid ◽

Swati U. Chavan ◽

Sandeep G. Uppod

Keyword(s):

Low Dose ◽

Fresh Frozen Plasma ◽

Average Dose ◽

Low Doses ◽

Number Of Patients ◽

Snake Bites ◽

Significant Difference ◽

Male Preponderance ◽

Fresh Frozen ◽

High Doses

Background: Due to a large number of patients and severe scarcity of ASV with patches of unavailability and unaffordable high cost, low doses of ASV had to be compulsorily used for treatment of poisonous snakebites. The main objective is to study the effectiveness of low dose ASV (total <50 ml) in the management of poisonous snake bites in the scenario of global ASV scarcity.Methods: Patients of snake bites with signs of envenomation were included in this observational, prospective study. Immediately, low dose (30 to 50 ml) of ASV was started after carefully testing intravenously. The patients were kept under intensive observation with supportive management (artificial ventilation, neostigmine-atropine, blood and fresh frozen plasma, as needed). Results: In the study of 309 patients, slight male preponderance was seen (161 males and 148 females).144 patients had vasculotoxic, 122 patients had neurotoxic and 43 patients had mixed type (both vasculotoxic and neurotoxic) of envenomation. Average dose of ASV given was 35.30 ml. 297 patients survived, 12 died. In 42 cases having both neurological and vasculotoxic (mixed) snake bite, 7 patients (16.66%) died. Among 122 neuroparalytic cases, 5 (4.0983%) died. We did not get any mortality in the 145 cases of vasculotoxic snake bites. There was no statistically significant difference in the outcome of the patients whether they received higher or low doses of ASV.Conclusions: There was no significant difference in the outcome of poisonous snake bites whether low dose (<50 ml) or high doses (>50 ml) of ASV were given and practically all the victims who came on time, survived with low doses of ASV. This is very important in developing countries like India where there is high incidence of poisonous snake bites and scarcity of ASV.

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Prevalence and pregnancy outcomes in patients with antepartum haemorrhage in a tertiary hospital in Ibadan, Nigeria

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193017 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2631

Author(s):

Chinedum A. C. Onebunne ◽

Christopher O. Aimakhu

Keyword(s):

Placental Abruption ◽

Hypovolemic Shock ◽

Tertiary Hospital ◽

P Value ◽

College Hospital ◽

Neonatal Deaths ◽

Antepartum Haemorrhage ◽

Still Births ◽

Obstetric Emergencies ◽

The University

Background: Antepartum haemorrhage (APH) as one of the major obstetric emergencies contributing greatly to maternal and fetal morbidity and mortality is of serious concern in the developing world. A retrospective analysis of the APH cases and evaluation of its impact on fetal and maternal outcomes was conducted.Methods: A retrospective study of cases managed between January 2013 and December 2014 at the University College Hospital Ibadan; all cases at a minimum of 28 weeks of gestation with antepartum bleeding were selected. Data was retrieved from the hospital records.Results: Around 5.8% prevalence rate of APH was documented during the study period with placental abruption and placenta praevia accounting for 46.8% and 39.2% of these cases respectively. Only 28.5% of cases were booked. Three-fifths of the women had anemia, 17.7% suffered hypovolemic shock, 33.9% also had primary PPH while 4 out of every 10 (39.8%) were transfused with blood. Seven out of every ten premature deliveries (prior to 34weeks gestation) were due to placental abruption with p value of <0.001. There were 2 maternal deaths (1%), 61 (31%) still births and 11 (5.6%) early neonatal deaths giving a perinatal mortality rate of 35.6%.Conclusions: Antepartum hemorrhage was associated with poor maternal and neonatal outcome in this study. There is need to improve on infrastructures, such as functional blood banks, appropriate antenatal care and referral system in our health facilities to be able to cope with increasing challenges of this obstetric hemorrhage.

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Feto maternal outcome in eclampsia after 28 weeks of pregnancy: vaginal delivery versus caesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174025 ◽

2017 ◽

Vol 6 (9) ◽

pp. 3875

Author(s):

Bhawna Madan

Keyword(s):

Caesarean Section ◽

Perinatal Mortality ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Signs And Symptoms ◽

Fetal Outcome ◽

Maternal Complications ◽

Maternal Deaths ◽

Neonatal Deaths ◽

Still Births

Background: Eclampsia is the occurrence of convulsions or coma unrelated to other cerebral condition with signs and symptoms of preeclampsia. Objective of present study was the comparison of maternal and fetal outcome of women with more than 28 weeks gestation complicated by antepartum eclampsia when terminated either by caesarean section or by vaginal delivery.Methods: 200 Women with more than 28 weeks of gestation with antepartum eclampsia were studied from admission to discharge or death. Depending upon the mode of delivery, they were divided into two groups: C.D. group. Where caesarean section was performed and V.D. group, where vaginal delivery was carried out. Maternal and Perinatal outcome were studied in the two groups and compared.Results: Of the 200 cases, caesarean section was done in 40% of the cases, while vaginal delivery was carried out in 60%. Maternal complications were seen in 15% of the cases in the C.D group and 60% of the cases in the V.D. group. Maternal deaths occurred in none of the case in the C.D group and in 33% of the cases in the V.D group. The incidence of live births, still births and neonatal deaths was 87.8%, 2.43% and 9.75% respectively in the C.D group, while it was 49.16%, 45.16% and 9.67% in the V.D group The Corrected perinatal mortality was 9.75% in the C.D group and 43.55% in the V.D group. Apgar score less than 5 at l minute was seen in 35% cases in the C.D group and 82.35% cases in the V.D group.30% of the cases in the C.D group and 76.47% of the cases in the V.D group required NICU admission.Conclusions: Timely caesarean section reduces maternal and Perinatal mortality and improves their outcome in antepartum eclampsia, especially in women with more than 28 weeks of pregnancy.

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Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i2.6898 ◽

2012 ◽

Vol 32 (2) ◽

pp. 150-153 ◽

Cited By ~ 1

Author(s):

M Shrestha ◽

L Shrestha ◽

S Basnet ◽

PS Shrestha

Keyword(s):

Perinatal Mortality ◽

Teaching Hospital ◽

Perinatal Asphyxia ◽

University Teaching ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Still Births ◽

Perinatal Audit ◽

Mortality Review ◽

Annual Mortality

Introduction: The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia. J. Nepal Paediatr. Soc. 32(2) 2012 150-153 doi: http://dx.doi.org/10.3126/jnps.v32i2.6898

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Anesthesia for Pediatric Heart Transplantation: Are Patients With a Failing Hemi-Fontan- or Fontan-Physiology Different?

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253219870635 ◽

2019 ◽

Vol 23 (4) ◽

pp. 393-398 ◽

Cited By ~ 1

Author(s):

Matthias F. Mueller ◽

Ann-Catrin Paul ◽

Valesco Mann ◽

Christian M. Koerner ◽

Klaus Valeske ◽

...

Keyword(s):

Coagulation Factor ◽

Absolute Number ◽

Fresh Frozen Plasma ◽

Fontan Circulation ◽

Bleeding Complications ◽

Number Of Patients ◽

Fresh Frozen ◽

Inotropic Score ◽

Group A ◽

Group B

Background. The absolute number of patients presenting with failure of the hemi-Fontan or Fontan circulation for cardiac transplantation (cTx) will continuously rise. We aimed to analyze the intraoperative differences in patients undergoing cTx for a failing hemi-Fontan or Fontan circulation (group A) with those undergoing cTx for cardiomyopathy and congenital heart disease (group B). Methods. Data of patients undergoing cTx during a 10-year period were compared between group A and group B patients. Results. cTx was performed in 83 patients (group A, n = 21; group B, n = 62). Surgical times including median incision-suture time (549 minutes vs 386 minutes, P < .05) and median organ ischemia time (305 minutes vs 233 minutes, P < .05) were longer in group A patients. After weaning off cardiopulmonary bypass a higher median modified Vasoactive Inotropic Score (16 vs 10, P < .05) was necessary in group A patients. During surgery more fresh frozen plasma (44 mL/kg vs 20 mL/kg, P < .05), platelet concentrates (20 mL/kg vs 14 mL/kg, P < .05), and coagulation factor concentrates were given in group A patients. Mortality during the first 90 days after cTx was higher in group A (23.8% vs 6.5%, P < .05). Conclusion. Patients undergoing cTx for a failing hemi-Fontan or Fontan circulation are challenging. They require an intensive vasoactive and inotropic support; furthermore, special attention should be paid to the management of bleeding complications. cTx for this group of patients is associated with higher 90 days mortality.

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Treatment of rare factor deficiencies other than hemophilia

Blood ◽

10.1182/blood-2018-06-820738 ◽

2019 ◽

Vol 133 (5) ◽

pp. 415-424 ◽

Cited By ~ 20

Author(s):

Marzia Menegatti ◽

Flora Peyvandi

Keyword(s):

Fresh Frozen Plasma ◽

Von Willebrand Disease ◽

Factor V ◽

Number Of Patients ◽

Fresh Frozen ◽

Life Threatening ◽

Tissue Factor Pathway ◽

Von Willebrand ◽

Frozen Plasma

Abstract The deficiency of fibrinogen, prothrombin, factor V (FV), FVII, FVIII, FIX, FX, FXI, and FXIII, called rare coagulation disorders (RCDs), may result in coagulopathies leading to spontaneous or posttrauma and postsurgery hemorrhages. RCDs are characterized by a wide variety of symptoms, from mild to severe, which can vary significantly from 1 disease to another and from 1 patient to another. The most typical symptoms of all RCDs are mucosal bleedings and bleeding at the time of invasive procedures, whereas other life-threatening symptoms such as central nervous system bleeding and hemarthroses are mostly present only in some deficiencies (afibrinogenemia, FX, and FXIII). At variance with hemophilia A and B and von Willebrand disease, RCDs are much less prevalent, ranging from 1 case in 500 000 to 1 in 2 million in the general population. Their clinical heterogeneity associated with the low number of patients has led to a delay in the development of appropriate therapies. Indeed, a similar heterogeneity can also be found in the treatment products available, ranging from the specific recombinant proteins to treat FVII- and FXIII-deficient patients to the complete absence of specific products to treat patients with FII or FV deficiencies, for whom prothrombin complex concentrates or fresh frozen plasma are, to date, the only option. The recent development of novel hemostatic approaches for hemophilia, such as the use of nonsubstitutive therapy as RNA interference, anti–tissue factor pathway inhibitor, and the gene therapy aimed at improving the patient’s quality of life may also have an important role in the treatment of patients with RCDs in the future.

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