scholarly journals Patient Blood Management in obstetrics

2020 ◽  
pp. 75-77
Author(s):  
Yu.V. Davydova
Keyword(s):  
Iron Deficiency ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Hemoglobin Concentration ◽  
First Trimester ◽  
Third Trimester ◽  
Intravenous Drugs ◽  
Increased Risk

Background. Patient blood management (PBM) in obstetrics is the timely application of evidence-based therapeutic and surgical concepts, aimed at maintaining hemoglobin concentration, optimizing hemostasis, and minimizing blood loss to improve clinical outcomes for the patient. Objective. To describe PBM in obstetrics. Materials and methods. Analysis of literature data on this issue. Results and discussion. Risk factors for increased blood loss include the history peculiarities (cesarean section, postpartum hemorrhage, rapid delivery), placenta previa, placenta accreta, multiple pregnancy, polyhydramnios, large fetus, comorbid conditions of the mother. The prevalence of postpartum anemia in 48 hours after delivery is about 50 % in Europe and up to 80 % in developing countries. The reasons for insufficient detection and correction of anemia and iron deficiency in the antenatal period include the lack of standardized examinations for iron deficiency and algorithms for its treatment, incomplete history, and misinterpretation of examination results. Most obstetric guidelines recommend screening for anemia in pregnant women only with a comprehensive blood test without ferritin. Early identification of anemia allows to eliminate it before entering the labor process. Ways to solve the problem of anemia in pregnant women and women in labor include the detection of iron deficiency before pregnancy or in its early stages, correction of iron deficiency with oral (first trimester) or intravenous (third trimester) drugs. In case of the increased blood loss during childbirth or abdominal delivery, rapid correction of iron deficiency with iron saccharate may be required. The consensus of the Network for the Advancement of PBM, Hemostasis and Thrombosis Prevention (NATA) recommends that maximum efforts must be made to treat iron deficiency anemia before delivery. Severe cases may require hospital settings. To eliminate individually calculated postpartum iron deficiency, it is recommended to use intravenous drugs (Sufer, “Yuria-Pharm”). After cesarean section, the aministration of uterotonics (oxytocin) is recommended. In women at increased risk of postpartum hemorrhage, the administration of tranexamic acid (Sangera, “Yuria-Pharm”) should also be considered. The WOMAN project (The World Maternal Antifibrynolytic) aimed to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and other adverse effects of bleeding. About 20,000 women who received tranexamic acid or placebo were examined. Significantly lower bleeding mortality was observed with tranexamic acid (1.5 % vs. 1.9 % in the placebo group; p<0.045). It is recommended to enter the first dose of this drug as soon as possible (within the first 3 hours) from the beginning of bleeding, the second – in case of the effect absence of effect in 30 minutes. Conclusions. 1. PBM in obstetrics is the timely application of evidence-based therapeutic and surgical concepts aimed at maintaining hemoglobin concentration, optimizing hemostasis and minimizing blood loss. 2. Early identification of anemia allows to eliminate it before entering the labor process. 3. Ways to solve the problem of anemia in pregnant women and women in labor are the detection of iron deficiency before pregnancy or in its early stages, correction of iron deficiency with oral (first trimester) or intravenous (third trimester) drugs. 4. To eliminate postpartum iron deficiency, it is recommended to use intravenous drugs (Sufer). 5. In women at increased risk of postpartum hemorrhage, the administration of tranexamic acid (Sangerа) should also be considered.

scholarly journals Thrombin Generation in Chinese Pregnant Women and the Effect of Insulin Use on Thrombin Generation in Patients with GDM

2019 ◽  
Vol 25 ◽  
pp. 107602961986349
Author(s):  
Feng Dong ◽  
Longhao Wang ◽  
Chengbin Wang
Keyword(s):  
Blood Glucose ◽  
Pregnant Women ◽  
Thrombin Generation ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Third Trimester ◽  
Control Blood Glucose ◽  
Normal Ranges ◽  
Increased Risk ◽  
Significant Difference

Pregnancy is a hypercoagulable state associated with an increased risk of venous thrombosis. Calibrated automated thrombogram (CAT) is a test to monitor the thrombin generation (TG), a laboratory marker of thrombosis risk, and increases during normal pregnancy, but it is still unclear whether TG is related to the use of insulin in pregnant women with gestational diabetes mellitus (GDM). We performed thrombin generation by CAT on 135 normal pregnant women, including 43 in first trimester, 32 in second trimester, 60 in third trimester, respectively; 68 pregnant women with GDM were also enrolled, 19 patients with GDM using insulin to control blood glucose and 49 patients control their blood glucose through diet and exercise with noninsulin treatment. The overall CAT parameters were calculated using descriptive statistics method with mean ± standard deviation. Mean endogenous thrombin potential, peak thrombin generation, and StartTail time increased significantly with the pregnancy. There was no significant difference in TG test parameters except StartTail time( P = .003) in insulin-treated GDM group when compared to those without insulin in the GDM group. The normal ranges for CAT parameters in pregnant women were determined. Thrombin generation increased significantly in first trimester and remains stable in second and third trimester. The use of insulin in patient with GDM did not affect thrombin generation test. Our study helps to establish the reference range of thrombin generation in Chinese normal pregnant population and provide more basis to predict the risk of thrombus complicating during pregnancy.

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.

scholarly journals Radioimmunoassay of plasma ouabain in healthy and pregnant individuals

2000 ◽  
Vol 165 (3) ◽  
pp. 669-677 ◽  
Author(s):  
O Vakkuri ◽  
SS Arnason ◽  
A Pouta ◽  
O Vuolteenaho ◽  
J Leppaluoto
Keyword(s):  
Pregnant Women ◽  
Human Plasma ◽  
High Performance ◽  
Chemical Nature ◽  
Solid Phase ◽  
Plasma Concentrations ◽  
First Trimester ◽  
Plasma Samples ◽  
Third Trimester ◽  
Endogenous Substances

Ouabain was recently isolated from human plasma, bovine hypothalamus and bovine adrenal in attempts to identify endogenous substances inhibiting the cell membrane sodium pump. A number of radioimmunoassays have been developed in order to study the clinical significance of ouabain. The results have been controversial with regard to the presence and chemical nature of plasma ouabain-like immunoreactivity. We have now measured ouabain in healthy and pregnant individuals using solid-phase extraction of plasma samples followed by a new radioimmunoassay with the extraordinary sensitivity of at least 2 fmol/tube (5 pmol/l). Plasma extracts, a previously isolated human plasma ouabain-like compound and bovine hypothalamic inhibitory factor displaced the tracer in parallel and eluted identically with ouabain in high-performance liquid chromatography. Plasma ouabain immunoreactivity was found to be much lower than reported previously: 12.6+/-1.3 pmol/l in healthy men (mean+/-s.e., n=20) and 9.4+/-0.7 pmol/l in women (n=14). In pregnant women (n=28) plasma ouabain concentration was 16.3+/-4.0 pmol/l during the first trimester, 18.8+/-4.3 pmol/l during the second trimester and 24.3+/-4.0 pmol/l during the third trimester (all P<0.01 compared with non-pregnant women). Plasma ouabain 3-5 days after the delivery was 13.6+/-1.1 pmol/l (n=10, P<0.05-0.01 compared with second and third trimesters). The pregnancy-related changes in the plasma concentrations of ouabain resembled those of cortisol. Therefore cortisol was measured from the same plasma samples and a significant positive correlation was found (r=0.512, P=0.006). The similar profiles of plasma ouabain and cortisol during pregnancy and their rapid decreases postpartum are consistent with the adrenal cortical origin of ouabain and also show that the secretions of these hormones are possibly under the control of same factors.

TSH/miR‐17‐5p/ZNF367 axis is related to spontaneous abortion in patients with TSH above 2.5 mIU/L

2021 ◽  
Author(s):  
Yang Yang ◽  
Jiashu Li ◽  
Yingying Zhou ◽  
Wen Dai ◽  
Weiping Teng ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Spontaneous Abortion ◽  
Biological Function ◽  
Zinc Finger Protein ◽  
First Trimester ◽  
Cell Counting ◽  
Luciferase Reporter ◽  
Migration And Invasion ◽  
Chorionic Villi ◽  
Increased Risk

Elevated thyroid stimulating hormone (TSH) is associated with an increased risk of spontaneous abortion (SA); however, the associated mechanism remains unclear. This study aimed to investigate the expression of microRNAs (miRNAs) and pathogenesis in the chorionic villi of TSH > 2.5 mIU/L-related SA patients. The chorionic villi were collected from pregnant women in the first trimester with TSH > 2.5 mIU/L with or without SA, as well as TSH < 2.5 mIU/L with or without SA to determine the level of miRNA expression. Differentially expressed miRNAs were confirmed by qRT-PCR in a total of 92 subjects. Cell counting kit-8 (CCK8), wound healing, transwell assays, and Western blotting were used to measure cellular biological functions and related protein in HTR-8/SVneo cells. The potential mechanisms were determined using a Luciferase reporter assay and rescue experiment. Compared with normal pregnant women, miR-17-5p was decreased and zinc finger protein 367 (ZNF367) was upregulated in the chorionic villi of TSH > 2.5 mIU/L-related SA patients. Using HTR-8/SVneo cells, we demonstrated that elevated TSH inhibited miR-17-5p expression, as well as trophoblast migration and invasion. The overexpression of miR-17-5p targeted and inhibited ZNF367 expression promoting the biological function of trophoblasts. Further studies confirmed that ZNF367 interference partially reversed the biological function of the miR-17-5p inhibitor on HTR-8/SVneo cells. Taken together, our results showed that miR-17-5p promoted biological function of trophoblasts by suppressing ZNF367.

scholarly journals Serum Glucose Level and Hemoglobin Concentration in Third Trimester of Pregnancy

2016 ◽  
Vol 10 (2) ◽  
pp. 67-70
Author(s):  
Sumaira Sufrin ◽  
Akhtarun Nessa ◽  
Md Tazul Islam
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Glucose Level ◽  
Hemoglobin Concentration ◽  
Serum Glucose ◽  
Serum Glucose Level ◽  
Control Group ◽  
Third Trimester ◽  
Cross Sectional ◽  
Altered Glucose

Background : Pregnancy is a state of physiological adaptations to accommodate the needs of the developing fetus. Elevated blood glucose during pregnancy could lead to gestational diabetes and anemia could cause intercurrent infection.Objective: To assess the serum glucose level & hemoglobin concentration in third trimester of pregnancy in order to find out the risk of gestational diabetes and physiological anemia.Method: This cross-sectional study was carried out in the Department of Physiology Mymensingh Medical College, Mymensingh, between the period of July, 2013 to June,2014. One hundred pregnant women in their third trimester of pregnancy aged 18-35years were enrolled in study group and age matched 100 healthy non-pregnant women were control group. Random serum glucose was estimated by GOD-PAP method and hemoglobin concentration was measured by cyanmethemoglobin (CMG) method. Data were analyzed by student’s un paired t test and chi square test.Result: Mean serum glucose level (6.76±1.72 mmol/L) was significantly higher and hemoglobin concentration (8.21±1.23 g/dl) was significantly lower in pregnant women than non-pregnant women. Increased frequency of high glucose (38%) and low H b(88%) was found in pregnant women in third trimester.Conclusion: This study concludes altered glucose metabolism may lead to gestational diabetes as well as physiological anemia may be exaggerated in third trimester of pregnancyBangladesh Soc Physiol. 2015, December; 10(2): 67-70

scholarly journals Systematic review to investigate the safety of induction and augmentation of labour among pregnant women with iron-deficiency anaemia

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021793 ◽  
Author(s):  
Kathryn Bunch ◽  
Nia Roberts ◽  
Marian Knight ◽  
Manisha Nair
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anaemia ◽  
Case Reports ◽  
Case Series ◽  
Severe Anaemia ◽  
Risk Of Bias ◽  
Deficiency Anaemia ◽  
Increased Risk

ObjectiveTo conduct a systematic review to investigate the safety of induction and/or augmentation of labour compared with spontaneous-onset normal labour among pregnant women with iron-deficiency anaemia.DesignSystematic review.SettingStudies from all countries, worldwide.PopulationPregnant women with iron-deficiency anaemia at labour and delivery.InterventionAny intervention related to induction and/or augmentation of labour.Outcome measuresPrimary: Postpartum haemorrhage (PPH), heart failure and maternal death. Secondary: Emergency caesarean section, hysterectomy, admission to intensive care unit.MethodWe searched 10 databases, including Medline and Embase, from database inception to 1 October 2018. We included all study designs except cross-sectional studies without a comparator group, case reports, case series, ecological studies, and expert opinion. The searches were conducted by a healthcare librarian and two authors independently screened and reviewed the studies. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approachto ascertain risk of bias and conducted a narrative synthesis.ResultsWe identified 3217 journal articles, 223 conference papers, 45 dissertations and 218 registered trials. Ten articles were included for full-text review and only one was found to fulfil the eligibility criteria. This was a retrospective cohort study from India, which showed that pregnant women with moderate and severe anaemia could have an increased risk of PPH if they underwent induction and/or augmentation of labour, but the evidence was weak (graded as ‘high risk of bias’).ConclusionThe best approach is to prevent anaemia, but a large number of women in low-to-middle-income countries present with severe anaemia during labour. In such women, appropriate peripartum management could prevent complications and death. Our review showed that at present we do not know if induction and augmentation of labour is safe in pregnant women with iron-deficiency anaemia and further research is required.PROSPERO registration numberCRD42015032421.

scholarly journals Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Gayani Shashikala Amarasinghe ◽  
Thilini Chanchala Agampodi ◽  
Vasana Mendis ◽  
Krishanthi Malawanage ◽  
Chamila Kappagoda ◽  
...  
Keyword(s):  
Public Health ◽  
Iron Deficiency ◽  
Pregnant Women ◽  
Blood Count ◽  
First Trimester ◽  
Full Blood Count ◽  
Red Cell ◽  
Middle Income ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Abstract Background The Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure. Methods All first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing. Results Among 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed. Conclusion Even though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

scholarly journals Iron deficiency among pregnant women attending an antenatal clinic in Northern Uganda: a cross-sectional study

2019 ◽  
Author(s):  
Samson Udho ◽  
Joyce Nankumbi ◽  
Mariam Namutebi ◽  
Grace Ndeezi ◽  
Joshua Epuitai ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Serum Ferritin ◽  
Antenatal Clinic ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Third Trimester ◽  
Cross Sectional ◽  
Iron Supplements ◽  
The Third

Abstract Background Iron deficiency is a leading cause of anemia among pregnant women in Uganda. However, due to the high cost of biochemical tests required to determine iron deficiency, the prevalence and factors associated with iron deficiency remain largely unstudied in our setting. Therefore, this study aimed at determining the prevalence of iron deficiency and its associated factors among pregnant women attending an antenatal clinic, Lira District-Uganda.Methods A cross-sectional study was conducted among 320 pregnant women attending an antenatal clinic at Lira Regional Referral Hospital. Maternal serum ferritin was used as a measure of iron deficiency and was determined using a Cobas 6000 Automated Analyzer. Iron deficiency was based on serum ferritin of <30 μg/L. A semi-structured questionnaire was used to obtain the characteristics of the study participants. Binary and multivariate logistic regression were performed to identify the associated factors.Results The prevalence of iron deficiency was 45%. Non-adherence to iron supplements (AOR: 2.05 95% CI: 1.02-4.12) & third trimester pregnancy (AOR: 1.88 95% CI: 1.20-2.94) were significantly associated with iron deficiency during pregnancy.Conclusion Nearly 5 in 10 of the participants had iron deficiency. Iron deficiency during pregnancy was associated with non-adherence to iron supplements and being in the third trimester of pregnancy. Midwives should encourage pregnant women to adhere to iron supplements during pregnancy especially pregnant women who are in the third trimester.

scholarly journals Changes in fatty acid levels (saturated, monounsaturated and polyunsaturated) during pregnancy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Estefania Aparicio ◽  
Carla Martín-Grau ◽  
Carmen Hernández-Martinez ◽  
Nuria Voltas ◽  
Josefa Canals ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Arachidonic Acid ◽  
Fatty Acid ◽  
Docosahexaenoic Acid ◽  
Serum Concentration ◽  
Eicosapentaenoic Acid ◽  
Pregnant Women ◽  
First Trimester ◽  
Third Trimester ◽  
Total N

Abstract Background During pregnancy a high amount of fatty acids (FA) is necessary to meet foetus demands, which vary during gestation. The present study describes the changes in maternal fatty acid concentrations during pregnancy in a sample of pregnant women. Methods This is a longitudinal study of 479 pregnant women who were monitored from the first trimester to third trimester of pregnancy. Data on maternal characteristics were recorded and a serum sample was collected in each trimester. The fatty acid profile (saturated (SFA: total, lauric acid, myristic acid, palmitic acid, stearic acid), monounsaturated (MUFA: total, palmitoleic acid, oleic acid) and polyunsaturated fatty acids (PUFA: total omega-6 (n-6), linoleic acid, dihomo-γ-linolenic acid, arachidonic acid (AA), total omega-3 (n-3), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) was analysed with a gas chromatography-mass spectrometry combination. Results From the first trimester to third trimester of pregnancy, a significant increase in total SFA, total MUFA and total n-6 PUFA was found. (p < 0.001). Nevertheless, the serum concentration of arachidonic acid (AA), eicosapentaenoic acid (EPA) and total n-3 PUFA decreased during gestation (p < 0.001). A statistically non-significant result was observed for the docosahexaenoic acid (DHA) serum concentration between the first and third trimesters of pregnancy. Significant correlations were observed between each total fatty acid concentrations of the first and third trimesters. Conclusion The circulating serum concentration of SFA, MUFA and n-6 PUFA increases during pregnancy, whereas essential fatty acids such as AA and EPA decrease, and DHA remains unchanged. Further research is necessary to understand the role played by FA throughout gestation.

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