Active versus expectant management for women in the third stage of labour

Begley, Cecily; Devane, Declan; Murphy, Deirdre J.; Gyte, Gillian ML; McDonald, Susan; McGuire, William

doi:10.1002/14651858.cd007412

Cited by 52 publications

(68 citation statements)

References 39 publications

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“…Uterine atony is the commonest cause for PPH. Active management of third stage of labour has been shown to be associated with a significant reduction in blood loss and the need for blood transfusion [116]. This entails the administration of a prophylactic uterotonic agent (e.g.…”

Section: Postpartum Periodmentioning

confidence: 99%

Pregnancy and rare bleeding disorders

2009

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Rare bleeding disorders include deficiency of fibrinogen, prothrombin, factor V, factor VII, factor X, factor XI and factor XIII together with combined deficiency disorders, factor V+VIII deficiency, and deficiency of the vitamin K-dependent factors (factor II, VII, IX and X). They account for 3-5% of all inherited coagulation disorders. Due to their rarity, information about pregnancy complications and management is limited and mostly derived from case reports. Deficiency of fibrinogen and FXIII are both found to be strongly associated with increased risk of recurrent miscarriage and placental abruption. Factor replacement is used to reduce these risks. However, the risk of miscarriage and ante-partum complications is less clear in women with other bleeding disorders. Haemostatic abnormalities in women with rare bleeding disorders seem to persist throughout pregnancy especially if the defect is severe. Therefore women affected with these disorders are at risk of post-partum haemorrhage. The fetus can also be affected and potentially at risk of bleeding complications. Specialised multidisciplinary management is essential to minimise the potential maternal and neonatal complications and ensure an optimal outcome. This paper presents literature review for pregnancy complications in each of the rare bleeding disorders. In addition general principles for management of pregnancy, labour and delivery are discussed.

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Section: Postpartum Periodmentioning

confidence: 99%

Pregnancy and rare bleeding disorders

2009

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“…A randomised control trial published in 1988 (Prendiville et al, 1988) and subsequent updates (Begley, 1990;Prendiville et al, 2000;Begley et al, 2010;Begley et al, 2011) were influential on health policy. The Department of Health in NSW -the state in which this study was set -based its policy on this RCT.…”

Section: Introductionmentioning

confidence: 99%

Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study

et al. 2015

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“…AMTSL can alone prevent PPH by over 60%. [23] Our study found out that 39% of the maternal deaths are attributed International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 10…”

Section: Discussionmentioning

confidence: 68%

Improved access to safe blood must be prioritized as a core component of comprehensive efforts to prevent maternal deaths in Uttar Pradesh, India.

Sahoo¹,

Raj²,

Manthri³

2014

Int J Med Sci Public Health

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Background: Postpartum hemorrhage is responsible for 39% of maternal deaths in India. Provision of blood transfusion is one of the key components of functional First Referral Units (FRU) meant for providing Comprehensive Emergency Obstetric Care (CEmONC). However, in the absence of functional FRUs, there is hardly any facility available which can provide safe blood transfusion to a haemorrhagic woman in Uttar Pradesh (UP). Aims & Objectives: The objective of this study was to argue for improving access and availability of safe blood transfusion for women, who are haemorrhagic and/ or severely anaemic, on priority basis, to prevent maternal deaths. Materials and Methods: Community based maternal death review and facility review was conducted in district Unnao, UP, and information gathered on maternal deaths. Out of the 57 maternal deaths analyzed, 37 were due to hemorrhage and severe anaemia. Pearson correlation test was performed between maternal mortality ratio (MMR) and number of estimated pregnancies per blood bank, for five key states including UP. Results: Out of 57 maternal deaths, 37 maternal deaths were due to hemorrhage (39%) and severe anaemia (26%). Out of 15 facilities assessed; only the district hospital (6.7%) had a blood bank and transfusion facility and the rest 14 (93.3%) of the facilities had no provision for blood transfusion, blood storage unit (BSU) or dedicated staffs to handle any emergency. A significant correlation was observed between the MMR and number of pregnancies per blood bank (r = 0.970, p=0.006). Conclusion: Given the role of blood transfusion in multiple obstetric emergencies, provision of blood bank /BSU at the FRUs, district hospitals, sub-divisional hospital (SDH) or community health center (CHC) needs to be given high level of priority to avert preventable maternal deaths in UP.

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Active versus expectant management for women in the third stage of labour

Cited by 52 publications

References 39 publications

Pregnancy and rare bleeding disorders

Pregnancy and rare bleeding disorders

Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study

Improved access to safe blood must be prioritized as a core component of comprehensive efforts to prevent maternal deaths in Uttar Pradesh, India.

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