scholarly journals Postpartum Hemorrhage: Kegawatdaruratan dalam Persalinan Ibu Hamil

2021 ◽  
Vol 1 (1) ◽  
pp. 48
Author(s):  
Ni Putu Narithya Julieta ◽  
Made Kurnia Widiastuti Giri
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Shock Index ◽  
Tissue Trauma

Postpartum hemorrhage merupakan penyebab kematian tertinggi pada ibu hamil utamanya pada negara berkembang. Hal ini disebabkan oleh berbagai kondisi yang di kelompokkan dalam 4T yaitu tone, tissue, trauma, dan trombosis namun atoni uteri yang termasuk dalam kelompok tone menempati posisi teratas. Tingginya angka kematian di negara berkembang memiliki korelasi dengan penatalaksanaan manajemen aktif kala tika. Ketersediaan oksitosin dan uterotonikyang terbatas di berbagai wilayah menyebabkan manajemen aktif kala tiga tidak bisa dilakukan, hal ini berpotensi tinggi berujung pada postpartum hemorrhage. Di lain sisi, aspek kultur budaya, sosial, ekonomi, dan tingkat pendidikan dari masyarakat juga mempengaruhi tingkat mortalitas dari postpartum hemorrhage. Postpartum hemorrhage terjadi dengan cepat dan tak terprediksi sehingga klinisi harus segera menyadari saat hal ini terjadi. Hingga saat ini belum ada algoritma tatalaksana yang pasti terkait pencegahan postpartum hemorrhage namun kunci dari keberhasilan penanganan adalah identifikasi penyebab perdarahan yang akurat dan cepat. Identifikasi dari postpartum hemorrhage dapat dilakukan dengan Obstetric Shock Index (OSI), sistem pengukuran menggunakan Quantitative Blood Loss (QBL), dan The Rule of 30. Penatalaksanaan terkait postpartum hemorrhage disesuaikan dengan kondisi dari ibu saat persalinan dan juga tahapan persalinan. Pasien dengan resiko postpartum hemorrhage akan mendapatkan tatalaksana yang berbeda baik pada kala satu, kala dua, dan kala tiga. Kunci dari pencegahan postpartum hemorrhage adalah dengan pemberian oksitosin dan uterotonik. Pencegahan dapat dilakukan dengan melakukan program pengenalan dan pemanfaatan fasilitas kesehatan serta melakukan manajemen aktif kala tiga Kata kunci: Postpartum hemorrhage, kematian, ibu hamil

scholarly journals Mismatch between estimated blood loss and shock index in transferred women with postpartum hemorrhage

2016 ◽  
Vol 4 (2) ◽  
pp. 88-96
Author(s):  
Noriko Hirose ◽  
Akihide Ohkuchi ◽  
Yosuke Baba ◽  
Rie Usui ◽  
Chikako Hirashima ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Shock Index ◽  
Estimated Blood Loss

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

2020 ◽  
Author(s):  
Aleksandra Polic ◽  
Tierra L. Curry ◽  
Judette M. Louis
Keyword(s):  
Interventional Radiology ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Tertiary Care ◽  
P Value ◽  
Obese Women ◽  
Severe Morbidity ◽  
The Impact ◽  
To Receive

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

scholarly journals A comprehensive digital phenotype for postpartum hemorrhage

2021 ◽  
Author(s):  
Amanda B Zheutlin ◽  
Luciana Vieira ◽  
Shilong Li ◽  
Zichen Wang ◽  
Emilio Schadt ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Chart Review ◽  
Diagnostic Codes ◽  
Treatment Data ◽  
Selected Subset ◽  
And Performance ◽  
Preventative Interventions ◽  
Surgical Treatments ◽  
Current Guidelines

ABSTRACTObjectiveWe aimed to establish a comprehensive digital phenotype for postpartum hemorrhage (PPH). Current guidelines rely primarily on estimates of blood loss, which can be inaccurate and biased, and ignore a suite of complementary information readily available in electronic medical records (EMR). Inaccurate and incomplete phenotyping contribute to ongoing challenges to track PPH outcomes, develop more accurate risk assessments, and identify novel interventions.MethodsWe constructed a cohort of 71,944 deliveries from the Mount Sinai Health System, 2011-2019. Estimates of postpartum blood loss, shifts in hematocrit intra- and postpartum, administration of uterotonics, surgical treatments, and associated diagnostic codes were combined to identify PPH retrospectively. All clinical features were extracted from structured EMR data and mapped to common data models for maximum interoperability across hospitals. Blinded chart review was done on a randomly selected subset of cases and controls for validation and performance was compared to alternate PPH phenotypes.ResultsWe identified 6,639 cases (9% prevalence) using our phenotype – more than three times as many as using blood loss alone (N=1,747), supporting the need to incorporate other diagnostic and treatment data. Blinded chart review revealed our phenotype had 96% sensitivity, 89% precision, 77% specificity, and 89% accuracy to detect PPH. Alternate phenotypes were less accurate, including a common blood loss-based definition (67%) and a previously published digital phenotype (74%).ConclusionWe have developed a scalable, accurate, and valid digital phenotype that may be of significant use for tracking outcomes and ongoing clinical research to deliver better preventative interventions for PPH.

scholarly journals Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

2014 ◽  
Vol 52 (193) ◽  
pp. 668-676 ◽  
Author(s):  
Meena Pradhan ◽  
Yong Shao
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Uterine Atony ◽  
Previous Caesarean Section ◽  
Peripartum Hysterectomy ◽  
Incidence Risk ◽  
Emergency Peripartum Hysterectomy

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

scholarly journals Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Masato Kinugasa ◽  
Hanako Tamai ◽  
Mayu Miyake ◽  
Takashi Shimizu
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Balloon Catheter ◽  
Stable Condition ◽  
Total Blood Loss ◽  
Total Blood ◽  
Balloon Tamponade ◽  
First Case ◽  
Uterine Balloon Tamponade

While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.

Transarterial embolization for postpartum hemorrhage: lessons learned

2018 ◽  
Vol 59 (12) ◽  
pp. 1451-1457
Author(s):  
Chen-Ju Fu ◽  
Wiwan Irama ◽  
Yon-Cheong Wong ◽  
Hsiao-Jung Tseng ◽  
Li-Jen Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postpartum Hemorrhage ◽  
Transarterial Embolization ◽  
Laboratory Data ◽  
Vital Signs ◽  
International Normalized Ratio ◽  
Lessons Learned ◽  
Clinical Failure ◽  
Shock Index ◽  
Independent Risk Factors

Background Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. Purpose To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. Material and Methods We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. Results In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. Conclusion The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.

Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Labib M. Ghulmiyyah ◽  
Alaa El-Husheimi ◽  
Ihab M. Usta ◽  
Cristina Colon-Aponte ◽  
Ghina Ghazeeri ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Primary Outcome ◽  
Dropout Rate ◽  
Significant Difference ◽  
Uterine Massage ◽  
Secondary Outcomes ◽  
Group 2 ◽  
Group 1

Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points

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