scholarly journals Experience with surgical options for managing atonic post-partum haemorrhage

1970 ◽  
Vol 3 (1) ◽  
pp. 10-13
Author(s):  
Rachana Saha ◽  
Chanda Karki ◽  
Saraswati M Padhye
Keyword(s):  
Genital Tract ◽  
Post Partum ◽  
Artery Ligation ◽  
Maternal Deaths ◽  
Single Procedure ◽  
Uterine Artery Ligation ◽  
Surgical Methods ◽  
Surgical Options ◽  
Post Partum Haemorrhage ◽  
Placenta Accrete

Aim: To analyse the measures taken for controlling primary Post-partum haemorrhage (PPH). Methods: A hospital based descriptive and retrospective study was carried out from 1st January 2005 to 31st December 2006 in the department of Obstetrics & Gynaecology at KMCTH. All patients of having primary Post-partum haemorrhage were analysed for the treatment they received. Results: There were 15 cases of primary Post-Partum Haemorrhage (PPH) from a total delivery of 700 in the year 2005. 9 cases were solely of atonic post-partum haemorrhage. 2 cases were genital tract injuries, 1 case of retained placenta, 1 case of vulval haematoma and 2 cases were of combined cervical tear and atonic primary post-partum haemorrhage. Atonic post-partum haemorrhage remained most important cause. The most common treatment was use of oxytocic. Surgical procedure bilateral uterine artery ligation was frequently performed in 6 cases but it was not effective as a single procedure. B-Lynch brace suture was applied in 5 cases and was successful without further intervention. There were 2 maternal deaths from post-partum haemorrhage. In the year 2006 total number of deliveries was 835 and there were total 11 cases of post partum haemorrhage. The trend changed to from atonic PPH to traumatic PPH. There were 8 cases of traumatic PPH and there were 2 cases of placenta accrete. There was one case of atonic PPH. The overall incidence in two years was 1.6%. Conclusion: Among the various surgical methods adopted B-Lynch brace suture was found to be simple, effective and minimally invasive. Keywords: Atonic post-partum haemorrhage (PPH), surgical management of PPH.  doi:10.3126/njog.v3i1.1432 NJOG 2008 May-June; 3(1): 10 - 13

scholarly journals Obstetrical Haemorrhagic Mortality in a Tertiary Hospital of the Limpopo Province, South Africa

2017 ◽  
Vol 1 (1) ◽  
pp. 42
Author(s):  
Sam T Ntuli
Keyword(s):  
South Africa ◽  
Maternal Death ◽  
Post Partum ◽  
Tertiary Hospital ◽  
Limpopo Province ◽  
Hospital Death ◽  
Maternal Deaths ◽  
Obstetric Haemorrhage ◽  
District Hospitals ◽  
Post Partum Haemorrhage

<p><strong><em>Background</em></strong><em>:</em><em> </em><em>Obstetric haemorrhage is potentially fatal. Its frequency</em><em> </em><em>contributes to assessment of population health. So this study purpose was to</em><em> assess the maternal death</em><em>s</em><em>due to obstetric haemorrhage in a tertiary hospital of the Limpopo Province, South Africa. </em></p><p><strong><em>Methods</em></strong><em>:</em><em> </em><em>All</em><em>maternal deaths, which occurred at Pietersburg Hospital</em><em>from January 2011 to December 2015 were reviewed.</em><em> The hospital death register was used to collate the list of maternal deaths</em><em>.Maternal</em><em>age, parity, referring facility, date of admission and death, ward where death occurred, and causes of death</em><em>were collected from delivery registers and patient medical records.</em><em></em></p><p><strong><em>Results</em></strong><em>: There were 232 maternal deaths of which 48 (20.7%) were due to obstetrical haemorrhage.</em><em> </em><em>The mean age of the </em><em>48</em><em> </em><em>women</em><em> </em><em>was </em><em>31.7±6.7 year range 15-48 years</em><em>.</em><em> Thirty one of 48 haemorrhagic deaths (65%)</em><em> occurred within 24 hours of admission,</em><em> </em><em>16 of 48</em><em> </em><em>(33%) had a parity of 3 or more,</em><em> 19</em><em> </em><em>(40%) died in ICU and</em><em> 12</em><em> </em><em>(</em><em>25%) in casualty. </em><em>Forty three of 48 women</em><em> </em><em>(</em><em>90%)</em><em> </em><em>were referred</em><em>,</em><em> of which</em><em> </em><em>36</em><em> </em><em>(84%) were from district hospitals. Post-partum haemorrhage accounted for</em><em> </em><em>39 of 48</em><em> </em><em>(81%) deaths followed by unspecifiedante-partum haemorrhage</em><em> accounting for 4 (</em><em>8%)</em><em> </em><em>and placenta abruption 2 of 48 (4%).</em><em></em></p><strong><em>Conclusion</em></strong><em>: This study demonstrated that a maternal death due to obstetric haemorrhage remains a major concern in Limpopo Province. Post-partum haemorrhage was the main cause of deaths.</em>

scholarly journals Management of obstetric hemorrhage; an observational study highlighting the efficacy of uterine artery ligation

2020 ◽  
Vol 8 (6) ◽  
pp. 2238
Author(s):  
Ambreen Ghouri ◽  
Bushra Mushtaq ◽  
Azra Ahmed ◽  
Najma Dalwani ◽  
Padma Bai ◽  
...  
Keyword(s):  
Uterine Artery ◽  
Post Partum ◽  
Age Groups ◽  
Sampling Technique ◽  
P Value ◽  
Obstetric Hemorrhage ◽  
Chi Square ◽  
Artery Ligation ◽  
Cross Sectional ◽  
Uterine Artery Ligation

Background: Obstetrical hemorrhage is leading cause of maternal mortality. UAE is termed safe and effective method for resolving hemorrhage. objective of this study was to determine efficacy of uterine artery ligation in management of obstetrical hemorrhage.Methods: This cross sectional observational using non-probability convenient sampling technique was carried out for six months. After ethical approval, females between 18 to 35 years diagnosed with obstetrical hemorrhage, uterine atony refractory to medical treatment, having active bleeding from placental side or having normal coagulation profile were while females with post-partum hemorrhage because of retained products of conception, due to genital tract trauma or with disseminated intravascular coagulation were excluded. Analysis of data was done using SPSS version 23.0. Quantitative variables were reported as mean and standard deviation and for qualitative variables, frequency and percentages. Chi-square test was applied keeping p-value of <0.05 as statistically significant.Results: From 109 females with mean age 47±5.25 years. In comparison of parity distribution, 62 (56.88%) were multiparous and 47 (43.12%) were primiparous. Type of bleeding observed was antepartum 36(33.03%), peripartum 39 (35.78%) and postpartum in 34 (31.19%). Efficacy of uterine artery ligation in management of obstetric hemorrhage was observed to be 35 (32.11%). The efficacy of uterine artery ligation in management of obstetric hemorrhage in three categories of age groups reported significant association (p=0.0005) and type of bleeding (p=0.025).Conclusions: Efficacy of UAE in different types of obstetrical hemorrhage reported in our study was lower than expected in about one-third of females.

Use of Recombinant Activated Factor VII in Severe Post-Partum Haemorrhage: Data From the Italian Registry. A Multicentric Observational Retrospective Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4434-4434
Author(s):  
Giovanni Barillari ◽  
Maria Grazia Frigo ◽  
Maddalena Casarotto ◽  
Antonio Farnia ◽  
Barbara Massè ◽  
...  
Keyword(s):  
Post Partum ◽  
Factor Vii ◽  
Recombinant Activated Factor Vii ◽  
Maternal Deaths ◽  
Activated Factor Vii ◽  
Rfviia Administration ◽  
Perioperative Bleeding ◽  
Before And After ◽  
Life Threatening ◽  
Post Partum Haemorrhage

Abstract Abstract 4434 Introduction Major Post-Partum Haemorrhage (PPH) is a life-threatening labour complication, which mainly occurs without warning, predictive signs or symptoms and often in absence of predisposing conditions. Severe PPH is defined by an estimated blood loss during the first 24 hours post-partum, of more than 500mL in case of natural delivery and of more than 1000mL in case of caesarean section. In developed countries PPH incidence is reported between 0.5% and 2%. In these countries it is the third cause of maternal mortality, after venous thromboembolism (VTE) and hypertension. In developing countries, major PPH is cause of 120-000-150.000 maternal deaths every year. Therapeutic strategies for severe PPH management are largely standardized. Recombinant activated factor VII (rFVIIa) is an activated factor VII form, produced from factor VII cDNA transfected into hamster kidneys. The first case of rFVIIa administration during perioperative bleeding has been reported in 1999, since this time rFVIIa has been used as adjunctive therapy in the management of patients with life-threatening and critical haemorrhages caused by trauma, abdominal or cardiac surgery or urological surgery, liver transplantation, post partum and any other bleeding condition leading to impairment of haemostasis Purpose To report the Italian real experience in clinical practice, in order to provide wide and detailed clinical information about use of rFVIIa in the management of massive primary PPH in our country and in order to evaluate the role of haemostatic therapy in the management of this severe life- threatening obstetric complication, so contributing to treatment protocols development. Methods An Italian retrospective survey of severe primary PPH cases treated with rFVIIa was performed. Anamnestic, clinical and haemostatic data about fourty-three patients with PPH, from 2005 to 2007, were collected. Coagulative parameters and transfusion requirements before and after rFVIIa treatment were compared. Results After rFVIIa administration INR was significantly decreased, while fibrinogen levels were markedly increased. Median of packed red blood cells units, platelets units, fresh frozen plasma, crystalloids and colloids needed, before and after rFVIIa administration, were significantly decreased (tab.1). Thirty-four of 43 patients needed surgical intervention before rFVIIa administration, 11/43 after treatment. Hysterectomies have been performed respectively in 12/43 cases before and in 7/43 cases after rFVIIa infusion. The response to rFVIIa is shown in table 2 No maternal deaths have been reported. No adverse events or thromboembolic complications were observed. Conclusion rFVIIa administration represents a safe haemostatic approach in the management of severe PPH cases, when other conventional medical, surgical and radiology interventional approaches have not been successful. Data from Italian Registry, as well as from other case series, demonstrate the rFVIIa efficacy to reduce or stop obstetric critical bleeding. The use of rFVIIa as lifesaving therapy in cases, in which medical and surgical standard approach have failed, should be always considered as life well as uterus lifesaving treatment. Disclosures: Off Label Use: Safety and efficacy of rFVIIa in postpartum hemorrhage.

scholarly journals Post partum haemorrhage: Prevalence, morbidity and management pattern in Dhulikhel Hospital

1970 ◽  
Vol 8 (2) ◽  
pp. 212-215 ◽  
Author(s):  
AS Dongol ◽  
A Shrestha ◽  
CD Chawla
Keyword(s):  
Blood Loss ◽  
Genital Tract ◽  
Post Partum ◽  
Medical Science ◽  
Active Management ◽  
Management Pattern ◽  
Standard Format ◽  
Retained Placenta ◽  
Manual Removal ◽  
Post Partum Haemorrhage

Background: Post partum haemorrhage (PPH) is the leading cause of maternal death worldwide. PPH occurs in up to 18% of total births. Among different factors, PPH due to uterine atony is the primary and direct cause of maternal mortality comprising about 90%. Objective: The objective of the present study was to assess the prevalence, morbidity and management pattern of PPH in Dhulikhel Hospital. Materials and methods: Hospital based retrospective study was carried out at Kathmandu University School of Medical Science, Dhulikhel Hospital from the period of January 2007 till October 2009. The study group included total of 60 patients. All women who had PPH both primary and secondary were studied. Information regarding total number of deliveries obtained from Obstetrics ward. The cases with PPH were identified and detail records were reviewed using standard format. The main outcome measures used for the analysis were amount of blood loss, cause of PPH and treatment methods. Results: In Dhulikhel hospital, from January 2007 till October 2009 a total of 3805 deliveries took place. Out of which 60 women had PPH. The prevalence was 16/1000 deliveries. There are 41 (68.3%) cases of primary PPH and 19 (31.7%) cases of secondary PPH. PPH was found more in home deliveries, unbooked case and in multiparas. The mean blood loss was 1055ml. As an aetiology, retained placenta and retained placental bits of tissue was found in 37(61.7%) cases, atonic uterus in 10 (16.7%) cases, genital tract trauma in 8(13.3%), sepsis of genital tract in 3(5%), case of ruptured uterus in one case and a case of angle bleeding from previous uterine scar following caesarean section. Among all 15 (25%) cases underwent manual removal of placenta, 5(8.3%) underwent controlled cord traction, 3 (5%) underwent manual removal of placenta followed by check curettage in cases of retained placenta, 16 (26.7%) cases were managed by check curettage for retained bits of placental tissue and membrane. Trauma in genital tract was managed by repair of trauma in 6 (10%) cases. Hysterectomy was required in 3 (5%) cases. Conservative management with uterotonics only required in 12 (20%) cases. Conclusion: Active management of third stage of labour can prevent PPH so delivery by skilled hand in hospital should be promoted. Secondary PPH besides primary can result in significant maternal morbidity. It also deserves similar attention. Key words: Atonic uterus; Postpartum haemorrhage DOI: 10.3126/kumj.v8i2.3561 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215

scholarly journals Active management of third stage of labour, post–partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

2010 ◽  
Vol 2 (1) ◽  
Author(s):  
Jean-Pierre Fina Lubaki ◽  
Jean-Robert Musiti Ngolo ◽  
Lucie Zikudieka Maniati
Keyword(s):  
Maternal Death ◽  
Democratic Republic ◽  
Post Partum ◽  
Active Management ◽  
Maternal Deaths ◽  
Third Stage ◽  
Post Test ◽  
Republic Of The Congo ◽  
Health Zone ◽  
Post Partum Haemorrhage

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone.Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest.Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths – two of which were related to PPH – were reported during the study period, which means there was a decline of 70% compared with the previous two years.Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives.

scholarly journals The management and prevention of post partum Haemorrhage in a clinic

Curationis ◽  
1979 ◽  
Vol 2 (3) ◽  
Author(s):  
J.V. Larsen
Keyword(s):  
Blood Loss ◽  
Genital Tract ◽  
Post Partum ◽  
Post Partum Haemorrhage ◽  
Definition Of ◽  
Excessive Blood Loss

Post-partum haemorrhage is best defined as excessive blood loss from the genital tract following the birth of the fetus. For statistical purposes, the definition of excessive blood loss is 600 ml or more. Traditionally, post-partum haemorrhage is divided into primary PPH which is bleeding occurring within 24 hours of delivery, and secondary PPH which is bleeding occurring after that time.

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