POSTPARTUM HEMORRHAGE - PREVENTION AND MANAGEMENT

2017 ◽  
pp. 32-39
Author(s):  
Gia Dinh Nguyen
Keyword(s):  
Low Income ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Low Income Countries ◽  
Obstetric Hemorrhage ◽  
Maternal Deaths ◽  
Birth Attendants ◽  
Prediction And Prevention ◽  
Life Threatening ◽  
Life Threatening Event

Most maternal deaths due to postpartum hemorrhage (PPH) occur in low-income countries in settings (both hospital and community) where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent and manage PPH and shock. In hospital, obstetricians should try to perform the prediction and prevention of PPH, finding the risk factors for developing PPH and how can they be minimised. The treatment of patients with PPH has two major components: (1) Resuscitation and management of obstetric hemorrhage and, possibly, hypovolemic shock and (2) Indentification and management of the underlying cause(s) of the hemorrhage. Successful management of PPH requires that both components be simultaneously and systematically addressed. PPH is a potential life-threatening event. Right from the start, obstetricians have early opportunities to assess risk, anticipate, prevent, plan in advance of a PPH, and can help to improve patients outcomes Key words: postpartum hemorrhage (PPH)

scholarly journals Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature

2020 ◽  
Vol 17 (2) ◽  
pp. 615 ◽  
Author(s):  
Narcisa Muresu ◽  
Giovanni Sotgiu ◽  
Bianca Maria Are ◽  
Andrea Cossu ◽  
Clementina Cocuzza ◽  
...  
Keyword(s):  
Low Income ◽  
Delayed Diagnosis ◽  
Low Income Countries ◽  
Travel Health ◽  
High Incidence ◽  
Health Advice ◽  
Life Threatening ◽  
Risk Of Disease ◽  
Resistant Strains ◽  
Drug Resistant Strains

Enteric fever is a foodborne infectious disease caused by Salmonella enterica serotypes Typhi and Paratyphi A, B and C. The high incidence in low income countries can increase the risk of disease in travelers coming from high income countries. Pre-travel health advice on hygiene and sanitation practices and vaccines can significantly reduce the risk of acquiring infections. Although the majority of the cases are self-limiting, life-threatening complications can occur. Delayed diagnosis and cases of infections caused by multi-drug resistant strains can complicate the clinical management and affect the prognosis. More international efforts are needed to reduce the burden of disease in low income countries, indirectly reducing the risk of travelers in endemic settings. Surveillance activities can help monitor the epidemiology of cases caused by drug-susceptible and resistant strains.

scholarly journals 441: The burden of preeclampsia and potentially life threatening complications (PLTC) in high versus low- income countries

2019 ◽  
Vol 220 (1) ◽  
pp. S297-S298
Author(s):  
Irina A. Buhimschi ◽  
Jennifer Makin ◽  
Kara M. Rood ◽  
Hillary Bracken ◽  
Catalin S. Buhimschi ◽  
...  
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Life Threatening

scholarly journals Severe Postpartum Hemorrhage from Uterine Atony: A Multicentric Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Carlos Montufar-Rueda ◽  
Laritza Rodriguez ◽  
José Douglas Jarquin ◽  
Alejandra Barboza ◽  
Maura Carolina Bustillo ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Target Organ Damage ◽  
Hypovolemic Shock ◽  
Uterine Atony ◽  
Teaching Hospitals ◽  
Transfusion Therapy ◽  
Maternal Deaths ◽  
Multicentric Study ◽  
Live Births ◽  
Prospective Longitudinal

Objective. Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management.Study Design. The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals.Results. Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy.Conclusions. In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.

Next Generation Medical Management of Postpartum Hemorrhage

2019 ◽  
Vol 25 (5) ◽  
pp. 549-555 ◽  
Author(s):  
Jaclyn M. Phillips ◽  
John N. van den Anker ◽  
Homa K. Ahmadzia
Keyword(s):  
Low Income ◽  
Postpartum Hemorrhage ◽  
Medical Management ◽  
Low Income Countries ◽  
Fibrinogen Concentrate ◽  
Childbearing Age ◽  
New Approach ◽  
Patients At Risk ◽  
Target Prevention ◽  
New Generation

Background: Postpartum hemorrhage remains a significant contributor to morbidity and mortality of women of childbearing age worldwide. Trends in both incidence and severity of postpartum hemorrhage are increasing which makes it imperative to identify drugs that could target prevention and/or treatment of these postpartum hemorrhages for women living in high, middle and low-income countries. Methods: We have reviewed current advances in the medical management of postpartum hemorrhage focusing on non-uterotonic therapy. We specifically describe the use and mechanism of action of tranexamic acid (TXA) and fibrinogen concentrate. Furthermore, we address the existing data for using these medications in postpartum hemorrhage, highlighting both strengths and limitations. Results: This review describes a new generation of medications that are promising for the prevention and/or treatment of postpartum hemorrhage. For patients at risk for significant hemorrhage, TXA has been shown to reduce intraoperative blood loss and can be given as a prophylactic agent. For the treatment of postpartum hemorrhage, early use of TXA has the potential to reduce mortality. In addition, some data exists supporting the use of fibrinogen concentrate, though more studies are required to help formulate guidelines for its use. Conclusion: A promising new approach for the management of severe postpartum hemorrhage is using medications that alter coagulation. More data are needed to describe ideal patient populations, dosing, the time of administration, and infusion rate.

Using Mobile Technology to Address the ‘Three Delays' to Reduce Maternal Mortality in Zanzibar

2016 ◽  
pp. 1140-1154 ◽  
Author(s):  
Rachel Hoy Deussom ◽  
Marc Mitchell ◽  
Julia Dae Ruben
Keyword(s):  
Maternal Mortality ◽  
Mobile Technology ◽  
Low Income ◽  
Low Income Countries ◽  
Danger Signs ◽  
Birth Attendants ◽  
Adequate Care ◽  
Three Delays ◽  
Clinical Algorithms ◽  
Health Facility Staff

The hallmark article by Thaddeus and Maine (1994) presented a framework to reducing maternal mortality by addressing the delays: (1) deciding to seek care; (2) reaching care; and (3) receiving adequate care. This project developed a phone-based system used by traditional birth attendants to address the three delays in two districts in rural Zanzibar. Mobile phones provided: clinical algorithms to screen pregnant mothers for danger signs; phone numbers and mobile banking to arrange and pay for transportation; and contacts for health facility staff to alert them of referrals. 938 mothers participated in the “mHealth for Safer Deliveries” project. The intervention achieved a 71.0% facility delivery rate in the project zone, compared to the regional average of 32.0% (NBS and ICF Macro, 2011). This project demonstrated the effectiveness of mobile technology in addressing childbirth's three delays and its potential to impact maternal mortality in low-income countries.

scholarly journals Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Jennifer Makin ◽  
Daniela I. Suarez-Rebling ◽  
Poonam Varma Shivkumar ◽  
Vincent Tarimo ◽  
Thomas F. Burke
Keyword(s):  
Postpartum Hemorrhage ◽  
Low Cost ◽  
Molar Pregnancy ◽  
Obstetric Hemorrhage ◽  
Maternal Deaths ◽  
Cervical Pregnancy ◽  
The Third ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade ◽  
Women In India

Background. Postpartum hemorrhage is the most common cause of maternal deaths worldwide, the majority of which occur in low-resource settings. Uterine balloon tamponade (UBT) is an effective method of addressing uncontrolled postpartum hemorrhage (PPH) from uterine atony; however, UBT devices are often not affordable. We report on three novel uses of an ultra-low-cost condom uterine balloon tamponade (ESM-UBT) device. Cases. ESM-UBT devices were used in innovative ways to arrest severe uncontrolled pregnancy-related hemorrhage among three women in India and Tanzania. The first had sustained deep vaginal lacerations, the second a cervical pregnancy, and the third a complete molar pregnancy. Conclusion. The ESM-UBT device may be useful for control of obstetric hemorrhage caused by complex vaginal tears as well as cervical and molar pregnancies.

scholarly journals Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara V. Flanagan ◽  
Tina Razafinamanana ◽  
Charlotte Warren ◽  
Jana Smith
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Clinical Decision Making ◽  
Behavioral Science ◽  
Low Risk ◽  
Low Income Countries ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. Methods In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. Results We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Conclusions Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

Sign in / Sign up

Export Citation Format

Share Document