Post-Partum Hemorrhage is still killing mothers in Bangladesh: Inhaled oxytocin (IHO) can help

2021 ◽  
Author(s):  
Aminur Rahman ◽  
Anne Austin ◽  
Tahmina Begum ◽  
Iqbal Anwar
Keyword(s):  
Universal Access ◽  
Post Partum ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Similar Efficacy ◽  
Active Management ◽  
Cold Chain ◽  
Director General ◽  
Skilled Attendant ◽  
Third Stage

Abstract The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC); both include the administration of oxytocin. Traditional parenteral oxytocin administration requires a consistent cold chain and for a skilled attendant to administer the injection. Inhaled oxytocin (IHO), which does not require a cold chain, has been shown to have similar efficacy to parenteral oxytocin, in preventing PPH. In Bangladesh there are non-functioning institutionalized guidelines from the Director General of Health Services on the storage of parenteral oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to consider replacing parenteral oxytocin with IHO, as the cold chain capacity in Bangladesh is strained, and institutional guidelines for injectable oxytocin are not used. In parallel, Bangladesh should also continue efforts to ensure universal access to quality AMSTL and CEmOC services.

scholarly journals Post-Partum Hemorrhage is Still Killing Mothers in Bangladesh: An Observation from the 2016 Bangladesh Maternal Mortality Survey (BMMS)

2020 ◽  
Author(s):  
Aminur Rahman ◽  
Anne Austin ◽  
Tahmina Begum ◽  
Iqbal Anwar
Keyword(s):  
Maternal Mortality ◽  
Universal Access ◽  
Post Partum ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Active Management ◽  
Director General ◽  
Public And Private ◽  
Third Stage ◽  
Mortality Survey

Abstract The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC). Both of these interventions mandate the administration of oxytocin. In Bangladesh there are nonfunctioning institutionalized guidelines from the Director General of Health Services on the storage of oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to evaluate the potency of current stores of oxytocin used in both in public and private facilities, develop and enforce protocols to ensure the potency of oxytocin, and promote universal access to quality AMSTL and CEmOC services.

scholarly journals Study of incidence and outcome of acute inversion of uterus

2018 ◽  
Vol 7 (12) ◽  
pp. 5145
Author(s):  
Vidyadhar B. Bangal ◽  
Swati D. Gagare ◽  
Samita Bhardwaj ◽  
Sonal Raut
Keyword(s):  
Early Recognition ◽  
Hypovolemic Shock ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Severe Anaemia ◽  
Rural Hospital ◽  
Active Management ◽  
Cross Sectional ◽  
Vaginal Deliveries ◽  
Third Stage

Background: Acute inversion of uterus also called as puerperal inversion of uterus is a rare, but life-threatening complication of third stage of labour. Severe uterine atony, mismanagement of third stage of labour, adherent placenta are some of the common factors associated with the occurrence of acute inversion of uterus. Early recognition and prompt treatment are important to save life of the woman.Methods: A retrospective cross-sectional record-based study was carried out to find out the incidence, presentation and outcome of cases of acute inversion of uterus admitted to Pravara Rural Hospital Loni for a period of three years (October 2015 to September 2018).Results: During the study period, there were 27,134 deliveries including 8,834 caesarean sections. There were six cases of acute inversion of uterus in the hospital during study period. The incidence of acute inversion of uterus was 0.22 per one thousand deliveries (0.27 per thousand vaginal deliveries and 0.11per one thousand caesarean sections). Three cases were referred from outside hospital and three cases had delivered at Pravara Rural Hospital. Five cases had delivered vaginally, where as one case had undergone caesarean section. There were two maternal deaths and four survivals among six cases of inversion of uterus. Severe anaemia, irreversible hypovolemic shock and multi-organ failure were causes of maternal deaths.Conclusions: Prompt recognition of uterine inversion and its immediate reposition under anaesthesia was a key for successful management. Delay in recognition and transfer of cases resulted in haemorrhagic and neurogenic shock, leading to death of a women. Institutional deliveries with practice of principles of active management of third stage of labour (AMTSL) and improvement in emergency obstetric care services at peripheral hospitals, avoiding delays at all levels will help to reduce the incidence, morbidity and mortality associated with acute inversion of uterus.

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 Third stage of labour: expectant versus active management-a comparative study in local low risk population

2019 ◽  
Vol 8 (2) ◽  
pp. 641
Author(s):  
Kavita A. Chandnani ◽  
Deepti D. Sharma
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Maternal Mortality ◽  
Post Partum ◽  
Expectant Management ◽  
Active Management ◽  
Research Centre ◽  
Third Stage ◽  
Group A ◽  
Group B

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

scholarly journals OBSTETRIC CHOLESTASIS

2003 ◽  
Vol 41 (142) ◽  
pp. 335-340
Author(s):  
Pramila Pradhan
Keyword(s):  
Perinatal Mortality ◽  
Maternal Morbidity ◽  
Post Partum ◽  
Active Management ◽  
Close Monitoring ◽  
The Third ◽  
Oestrogen Level ◽  
Increased Risk ◽  
Third Stage ◽  
In Pregnancy

Obstetric Cholestasis is the commonest liver disease that causes pruritis and is uniqueto pregnancy. Pruritis can be so intense as to lead insomnia.The Significance of thisdisease has been highlighted more recently due to the associated perinatal mortalityand maternal morbidity. Aetiology and pathophysiology still uncertain. There, appearsto be genetic predisposition in certain individuals resulting in an increasedsusceptibility to the high oestrogen levels found in pregnancy specially in 3rdtrimesterand resolving promptly after delivery when oestrogen level falls rapidly. Pruritis iscentral in origin and thus fails to respond to commonly used antihistamines and lotiocalamine locally. Recently ursodeoxycholic acid an exogenous bile acid is increasinglybeing used and showed improved both pruritis and liver function and favourablechanges were observed in the foetus as well. Delivery planned at 37-38 weeks ofgestation reduced perinatal mortality. Because of increased rate of adverse intrapartumevents, close monitoring is appropriate. Active management of the third stage isnecessary because of the increased risk of post partum haemorrhage.Key Words: Pruritis, pregnancy, planned delivery, perinatal mortality and maternal morbidity.

scholarly journals Defragmenting the Health Care System in Mexico: Universal Access For Obstetric Emergencies

2020 ◽  
Vol 4 (1) ◽  
pp. 80-92
Author(s):  
María G. Ramírez-Rojas ◽  
María G. Freyermuth-Enciso ◽  
María B. Duarte-Gómez
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Emergency Services ◽  
Universal Access ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Medical Emergency ◽  
Cross Sectional ◽  
Obstetric Emergencies ◽  
Care System

Background and Objectives: This article aims to analyze how the needs of Mexican women requiring emergency obstetric care (EmOC) can be fully met through initiatives such as the General Agreement on Inter-Institutional Collaboration for Emergency Obstetric Care (the Agreement). We compared EmOCaccredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services. Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement interinstitutional strategy within four different scenarios in order to verify whether Mexico was in compliance with United Nations (UN) recommendations on EmOC availability: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants. Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734 438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients. Conclusion and Implications For Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure. Key words: • Medical emergency services • Mexico, Medical assistance • Hospitalization • Health regulation • Agreements.   Copyright © 2020 Ramírez-Rojas et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work which is published in this journal is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

scholarly journals Healthcare workers’ knowledge and attitude towards prompt referral of women with postpartum haemorrhage in Nigeria: a community-based study

2019 ◽  
Vol 9 (1) ◽  
pp. 335
Author(s):  
Adekemi Eunice Olowokere ◽  
Aanuoluwapo Omobolanle Olajubu ◽  
Ifeoluwa Eunice Ayeni ◽  
Olayinka Olaitan Aremu
Keyword(s):  
Rural Areas ◽  
Healthcare Workers ◽  
Postpartum Haemorrhage ◽  
Early Recognition ◽  
Post Partum ◽  
Emergency Obstetric Care ◽  
Estimate Blood Loss ◽  
Obstetric Care ◽  
Community Based ◽  
Knowledge And Attitude

Background: Postpartum Haemorrhage (PPH) is a major contributor to maternal mortality in developing countries most especially in the rural areas where Emergency Obstetric Care (EmOC) are not available. Delay in referring women from rural health facilities to settings where EmOC services are available have been reported. This study assessed community-based healthcare workers’ (CHWs) knowledge and attitude towards the prevention, early recognition and prompt referral of women with Post-Partum Haemorrhage (PPH) for Emergency Obstetric Care (EmOC).Methods: Descriptive cross-sectional design was used. Structured questionnaire was used to collect data from 200 CHWs recruited from community-based healthcare. Data analysis was done in SPSS version 20 at significance level of 0.05.Results: Findings show that 86.5% (n=173) of the respondents had good knowledge while 12% (n=24) and 1.5% (n=3) had moderate and poor knowledge respectively. Negative attitude towards prompt referral of women affected with PPH was found among 51% (n=102) of the respondents. Unavailability of blood drapes to estimate blood loss [χ2 (1, n=200) = 4.51, p=0.03], lack of ambulance [χ2 (1, n=200) = 4.46, p=0.03], and poor state of the roads [χ2 (1, n=200) = 4.44, p=0.03] were factors linked to poor attitude of CHWs towards prompt referral of affected women.Conclusions: The study concluded that there is a need for intervention that can help improve community healthcare workers’ attitude towards prompt referral of women affected with postpartum haemorrhage. There is also a need for general overhaul of community-based facilities to effectively support prompt referral.

scholarly journals Comparison of Oral Misoprostol with Intramuscular Oxytocin in the Active Management of Third Stage of Labour

2015 ◽  
Vol 10 (1) ◽  
pp. 76-80
Author(s):  
S Kaudel ◽  
A Rana ◽  
N Ojha
Keyword(s):  
Blood Transfusion ◽  
Post Partum ◽  
University Teaching ◽  
Active Management ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B

Aims: This study aimed at comparing the efficacy of oral misoprostol 600 mcg with intramuscular oxytocin 10 IU in the active management of third stage of labour. Methods: This prospective comparative study was performed in Tribhuvan University Teaching Hospital to compare the efficacy of oral misoprostol with intramuscular oxytocin in the third stage of labour for the prevention of postpartum hemorrhage. One hundred and twenty women without risk of PPH were randomly allocated to receive either 600 mcg misoprostol orally (Group A) or 10 unit of oxytocin intramuscularly (Group B) within 1 minute of delivery. The efficacy and the safety of these two drugs were analyzed on the basis of percentages fall in hemoglobin (Hb) and hematocrit (Hct) level from before delivery to 8 completed hours after delivery, need for additional uterotonic agents, need for exploration and uterine evacuation, need for blood transfusion, duration of third stage of labour and the numbers of retained placenta and need for MRP. Results: Oral misoprostol was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage (PPH). There was no statistical difference in the duration of third stage of labour, need for additional uterotonics, need for uterine exploration/evacuation and need for blood transfusion in the two groups. Conclusions: Routine use of oral misoprostol 600 mcg appears to be as effective as 10 IU intramuscular oxytocin in minimizing blood loss during the third stage of labour.

scholarly journals Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

2017 ◽  
Vol 6 (2) ◽  
pp. 516 ◽  
Author(s):  
Moussa Diallo ◽  
Toura Sylla ◽  
Abdoul Aziz Diouf ◽  
Phillipe Marc Moreira ◽  
Omar Gassama ◽  
...  
Keyword(s):  
Average Rate ◽  
Post Partum ◽  
Low Risk ◽  
University Hospital ◽  
Active Management ◽  
Controlled Clinical Trial ◽  
The Third ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Misoprostol Group

Background: Assess the effectiveness of oral misoprostol as an alternative to oxytocin in the active management of the third stage of labour in Dakar/Senegal.Methods: Randomized controlled clinical trial conducted in the maternity ward of a university hospital on 304 women who had vaginal delivery. These women were randomly assigned into 2 groups based on active delivery conditions: the first group received an oral administration of misoprostol (400 mcg) and the second group 5 IU oxytocin through intravenous route.Results: The average volume of blood loss was 196.55 ml in the misoprostol group and 208.39 ml in the oxytocin group (p=0.63). The incidence of postpartum haemorrhage (>500 cc) was 6.49% in the misoprostol group and 9.33% in the oxytocin group (p=0.358). The average rate of haemo globin decline was 0.38 g/dl in the misoprostol group and 0.29 g/dl in the oxytocin group (p=0.99). The proportion of hyperthermia, shivering, and nausea in the misoprostol and oxytocin groups were respectively: 2.59% against 0.6% (p=0.123), 7.14% against 2% (p=0.001) and 2.59% against 0.6% (p=0.498).Conclusions: In Senegal, Misoprostol despite its side effects, is an effective alternative to oxytocin in the active management of the third stage of labour for low-risk parturient women to reduce the risk of maternal deaths due to post-partum hemorrhage.

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