Effectiveness of Pre-operative Rectal Misoprostol in Reducing Blood Loss during Cesarean Section for Placenta Previa and Manual Removal of Retained Placenta: A Parallel Placebo-Controlled Study

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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Efficacy of prophylactic tranexamic acid administration in prevention of postpartum hemorrhage in placenta previa cesarean section: an interventional study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215094 ◽

2021 ◽

Vol 11 (1) ◽

pp. 153

Author(s):

Monika Rathore ◽

Anjali Gupta ◽

Nidhi Kumari

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Intravenous Infusion ◽

Very Low Birth Weight ◽

Placenta Previa ◽

Skin Incision ◽

Group 2 ◽

Group 1

Background: Postpartum hemorrhage accounts for the major part of the mortality as well as morbidity like severe anemia, need for blood transfusion, hospital stay and infection. Aim and objectives of the study were to determine the efficacy and safety of prophylactic tranexamic acid and intravenous tranexamic acid in preventing postpartum hemorrhage in women undergoing caesarean section for placenta previa.Methods: Seventy women with placenta previa over 1 year, randomized into 2 groups: group 1 (n=35): Women who received 10 IU oxytocin intravenous infusion after placental delivery and group 2 (n=35): Women who received 1 gm (10 ml) tranexamic acid IV before skin incision plus 10 IU oxytocin intravenous infusion after placental delivery.Results: The mean age was similar in 2 groups i.e., 26.34±4.78 years in group 1 and 27.31±5.62 years in group 2. Most women in the present study presented with type IV placenta previa i.e., 34.3% in group 1 and 48.6% in group 2. Mean pre-operative hemoglobin was 9.57±1.54 g/dl in group 1 and 9.59±1.35 g/dl in group 2. Intra-operative mean blood loss was 729.31±172.45 ml in intravenous oxytocin group and 464.86±28.00 ml in intravenous tranexamic acid group. A total of 74.3% women in group 1 and 20% women in group 2 developed postpartum hemorrhage. Mean post-operative hemoglobin was 8.04±1.34 g/dl in group 1 and 8.85±1.26 g/dl in group 2. In group 1, 5.7% neonates were born with very low birth weight and while none in group 2. 51.4% neonates in group 1 and 45.7% in group 2 had low birth weight.Conclusions: It is concluded that tranexamic acid used prophylactically intravenously before skin incision in patients undergoing cesarean section for placenta previa significantly reduces intra-operative blood loss.

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The Risk of Post-Partum Hemorrhage after Cesarean Section with General versus Spinal/Epidural Anesthesia

Journal of Gynecology Research Reviews & Reports ◽

10.47363/jgrrr/2019(2)107 ◽

2020 ◽

pp. 1-5

Author(s):

Raghda Ahmed El-Dakhakhni ◽

◽

Maram Ibrahim El Mazny ◽

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

General Anesthesia ◽

Epidural Anesthesia ◽

Postpartum Hemorrhage ◽

Post Partum ◽

Anesthetic Techniques ◽

Uterine Contractility ◽

Hospital Data ◽

Spinal Epidural

Blood loss of over 40 percent of total blood volume (approx. 2800 ml) is typically considered a’ life danger.’ It seems rational to introduce PPH protocols at an average blood loss far below this level, as the aim of management is to prevent hemorrhage from rising to the point that it is life-threatening Objectives Caesarean anesthetic treatment, which involves general anesthesia and spinal / epidural anesthesia, was seldom examined for the risks associated with postpartum hemorrhage and was focused on only a small number of cases from single hospital data sets. The function of different types of anesthesia in postpartum hemorrhage therefore needs to be further explained. Patients and methods This are a retrospective study on patients complicated by postpartum hemorrhage after cesarean section with history of type of anesthesia used; general or spinal or epidural to improve outcome of cesarean section. We included all women complicated by postpartum hemorrhage after cesarean section and collect data about the anesthesia used during cesarean section and also recorded other risk factors for postpartum hemorrhage if recorded in files in antenatal care sheet and the intraoperative circumstances as recorded in the operative sheet of the patient. Heart rates and blood pressures of patients of both groups were measured before delivery and at 1 min interval for 15 min after injection of oxytocin. Uterine contractility was assessed for both groups at 1,2,4,6,8,10 and 15 min after oxytocin injection. Results Our results showed that the age of the studied group ranged from 18 to 40 years with mean 23.97 years. Regarding parity 44.5% of them had one child and 36.7% of them had two, 42.3% of the studied group had general anesthesia and 57.7% of them had spinal. Also 82.2% of the cases were previous and 17.8% of them were emergent. Conclusion Anesthetic techniques might be affected by the possibility of bleeding or concern. We found that women who have undergone general anesthesia have a higher risk of postpartum hemorrhage compared with women who have received epidural, spinal anesthesia

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Retained placenta and postpartum hemorrhage: time is not everything

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06027-5 ◽

2021 ◽

Author(s):

Denise Franke ◽

Julia Zepf ◽

Tilo Burkhardt ◽

Philipp Stein ◽

Roland Zimmermann ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Time Window ◽

Uterine Atony ◽

Blood Collection ◽

Stage Duration ◽

Retained Placenta ◽

Manual Removal ◽

Third Stage

Abstract Purpose Postpartum hemorrhage is the major cause of maternal mortality worldwide. Retained placenta accounts for nearly 20% of severe cases. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics. Methods Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology. Results Correlation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. A shorter third stage (< 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). Uterine atony was significantly associated with greater decrease in hemoglobin (p < 0.001), higher measured blood loss (p < 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p < 0.001). Conclusion Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage.

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The Risk of Post-Partum Hemorrhage after Cesarean Section with General versus Spinal/Epidural Anesthesia

Journal of Gynecology Research Reviews & Reports ◽

10.47363/jgrrr/2020(2)107 ◽

2020 ◽

pp. 1-5

Author(s):

Raghda Ahmed El-Dakhakhni ◽

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

General Anesthesia ◽

Epidural Anesthesia ◽

Postpartum Hemorrhage ◽

Post Partum ◽

Anesthetic Techniques ◽

Uterine Contractility ◽

Hospital Data ◽

Spinal Epidural

Blood loss of over 40 percent of total blood volume (approx. 2800 ml) is typically considered a’ life danger.’ It seems rational to introduce PPH protocols at an average blood loss far below this level, as the aim of management is to prevent hemorrhage from rising to the point that it is life-threatening Objectives Caesarean anesthetic treatment, which involves general anesthesia and spinal / epidural anesthesia, was seldom examined for the risks associated with postpartum hemorrhage and was focused on only a small number of cases from single hospital data sets. The function of different types of anesthesia in postpartum hemorrhage therefore needs to be further explained. Patients and methods This are a retrospective study on patients complicated by postpartum hemorrhage after cesarean section with history of type of anesthesia used; general or spinal or epidural to improve outcome of cesarean section. We included all women complicated by postpartum hemorrhage after cesarean section and collect data about the anesthesia used during cesarean section and also recorded other risk factors for postpartum hemorrhage if recorded in files in antenatal care sheet and the intraoperative circumstances as recorded in the operative sheet of the patient. Heart rates and blood pressures of patients of both groups were measured before delivery and at 1 min interval for 15 min after injection of oxytocin. Uterine contractility was assessed for both groups at 1,2,4,6,8,10 and 15 min after oxytocin injection. Results Our results showed that the age of the studied group ranged from 18 to 40 years with mean 23.97 years. Regarding parity 44.5% of them had one child and 36.7% of them had two, 42.3% of the studied group had general anesthesia and 57.7% of them had spinal. Also 82.2% of the cases were previous and 17.8% of them were emergent. Conclusion Anesthetic techniques might be affected by the possibility of bleeding or concern. We found that women who have undergone general anesthesia have a higher risk of postpartum hemorrhage compared with women who have received epidural, spinal anesthesia.

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Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00154-6 ◽

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.

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

Journal of Nepal Medical Association ◽

10.31729/jnma.2375 ◽

2014 ◽

Vol 52 (193) ◽

pp. 668-676 ◽

Cited By ~ 3

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.

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