Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Morris, Jessica; Khatun, Samia

doi:10.1002/ijgo.12704

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…A key component of this management is the use of a uterotonic medication, such as oxytocin, which is administered either intramuscularly or intravenously immediately following the birth of the baby. In settings where oxytocin is unavailable, misoprostol can be used, which has the advantage of being heat-stable and can be administered orally, rectally or sublingually (Morris and Khatun, 2019;WHO, 2018). Oxytocin and misoprostol are life-saving uterotonic medications for the treatment of PPH in cases of uterine atony.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing nurses' knowledge and skills in the prevention and management of postpartum haemorrhage

Angelina

Kibusi

Mwampagatwa

2019

African Journal of Midwifery and Women's Health

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Background: Postpartum haemorrhage (PPH) is one of the main causes of maternal death. In Tanzania, 25% of maternal deaths are the result of PPH. Gaps in practitioner knowledge in the prevention and management of this issue may lead to severe maternal complications and death. Little has been documented about nurses' knowledge and skills regarding PPH prevention and management. Objective: To determine the factors influencing nurses' knowledge and skill in the prevention and management of PPH in the Dodoma Region, Central Tanzania. Method: A cross-sectional study was conducted involving 172 nurses working in Dodoma, Tanzania. Data on the sociodemographic characteristics of the nurses was collected using a structured questionnaire. Knowledge on PPH was assessed using a validated questionnaire and skills were assessed using an observational checklist. The chi-squared test was used to find associations between sociodemographic characteristics and knowledge and skills. Binary logistic regression (both reduced and full models) was used to identify significant predictors of knowledge and skills. Results: The findings indicated that being ≥40 years old (OR=2.87, P=0.004), being a registered nurse (OR=2.73, P=0.002), having >3 years of professional training (OR=2.38, P=0.01), and having ≥5 years of experience in a maternity unit (OR=3.06, P<0.00) were significant predictors for knowledge in the prevention and management of PPH in a reduced model of binary logistic regression. Being ≥40 years old (OR=11.5, P=0.00), having >3 years of professional training (OR=4.58, P<0.00), and having ≥5 years of experience in a maternity unit (OR=9.14, P<0.00) were significant predictors for skills in the reduced model. After adjusting to control for possible confounders, being a registered nurse was the only significant predictor of nurses' knowledge (AOR=3.35, P=0.001), while having ≥5 years experience in a maternity unit was the only significant predictor of nurses' skills (AOR=3.89, P=0.01). Conclusion: Professional qualification and experience in a maternity unit are significant factors influencing nurses' knowledge and skills, respectively, in the prevention and management of PPH.

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Section: Introductionmentioning

confidence: 99%

Factors influencing nurses' knowledge and skills in the prevention and management of postpartum haemorrhage

Angelina

Kibusi

Mwampagatwa

2019

African Journal of Midwifery and Women's Health

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“…9,15 Although significant improvement was achieved in the prevention and management of PPH as a main obstetric near-miss, maternal mortality rates remain high in Kazakhstan. 10,23,24 To our knowledge, this is the first study to identify the prevalence, indications, and outcomes of peripartum hysterectomy in Kazakhstan using nationwide large-scale health-care data for the period of 5 years (2014-2018).…”

Section: Discussionmentioning

confidence: 99%

The Prevalence, Incidence, Indications and Outcomes of Peripartum Hysterectomy in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014–2018

Aimagambetova¹,

Sakko²,

Gusmanov³

et al. 2022

IJWH

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Peripartum hysterectomy is a surgical procedure performed as a life-saving surgery to manage severe postpartum hemorrhage. The prevalence of peripartum hysterectomy in high-resource settings is relatively low. However, maternal mortality due to postpartum hemorrhage and after peripartum hysterectomy remains high in developing countries. To date, there is a lack of information about the rates of peripartum hysterectomy and its common indications in Kazakhstan. Objectives were to study the prevalence, indications, and outcomes of peripartum hysterectomy using nationwide large-scale health-care data from the national registry. Patients and Methods: We performed a descriptive, population-based study among women who underwent a peripartum hysterectomy in any health-care setting of the Republic of Kazakhstan during the period of 2014-2018. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). Results: Data included 3838 medical records of women who had a peripartum hysterectomy performed due to specific indications for the period of 5 years (2014)(2015)(2016)(2017)(2018). The median age of the participants was 33 years old, with 60.7% of women aged between 18 and 34 years. The leading indications for peripartum hysterectomy were intrapartum hemorrhage (IPH) and postpartum hemorrhage (PPH) reported in 60% of the cases analyzed. The second most common indication was placental pathology -placental abruption and placenta previa in 9.6% and 7.9% of cases, respectively. In 1633 cases (42.4%), total abdominal hysterectomy was performed, while subtotal hysterectomy was done in 2195 cases (57.0%). Based on these data, the estimated prevalence of peripartum hysterectomies was calculated: overall weighted mean prevalence 1.93 per 1000 deliveries. Conclusion: IPH and PPH are the commonest indications for peripartum hysterectomy followed by placental pathology. Appropriate maternal care during labor and delivery should be reinforced to decrease the incidence of peripartum hysterectomy in Kazakhstan.

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“…The adverse effects of misoprostol, such as nausea, vomiting, diarrhoea, fever, and chills, are dosedependent. The recommended dose of misoprostol for prevention of PPH is 600 mg. 11 Previous studies in Benin, Nigeria, and Egypt showed that that the mean intraoperative blood loss volume was significantly lower in the sublingual than rectal group. [12][13][14][15] However, sublingual misoprostol use had more maternal side effects than rectal use.…”

Section: Introductionmentioning

confidence: 99%

Preoperative versus postoperative misoprostol use for prevention of blood loss during caesarean section in pregnant women at term: a multi-centre randomised controlled trial

Ajah,

Ezegwui

et al. 2023

J Int Med Res

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Objective Caesarean section is associated with higher blood loss than vaginal delivery. This study was performed to compare the safety and efficacy of preoperative versus postoperative rectal and sublingual misoprostol use for prevention of blood loss in women undergoing elective caesarean delivery. Methods Eligible patients in Southeast Nigeria were randomly classified into those that received 600 µg of preoperative rectal, postoperative rectal, preoperative sublingual, and postoperative sublingual misoprostol. All patients received 10 units of intravenous oxytocin immediately after delivery. Data were analysed with SPSS Version 23. Results Preoperative sublingual misoprostol use caused the highest postoperative packed cell volume, least change in the packed cell volume, and lowest intraoperative blood loss. Preoperative sublingual and rectal misoprostol use was associated with better haematological indices and maternal outcomes than postoperative use by these routes. However, preoperative sublingual and rectal use caused more maternal side effects than postoperative use by these routes. Conclusion Preoperative sublingual misoprostol was associated with the most favourable haematological indices. Although preoperative sublingual and rectal misoprostol use caused more maternal side effects, these routes were associated with better haematological indices and maternal outcomes than postoperative sublingual and rectal misoprostol use.

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Clinical guidelines—the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage

Cited by 6 publications

References 12 publications

Factors influencing nurses' knowledge and skills in the prevention and management of postpartum haemorrhage

Factors influencing nurses' knowledge and skills in the prevention and management of postpartum haemorrhage

The Prevalence, Incidence, Indications and Outcomes of Peripartum Hysterectomy in Kazakhstan: Data from Unified Nationwide Electronic Healthcare System 2014–2018

Preoperative versus postoperative misoprostol use for prevention of blood loss during caesarean section in pregnant women at term: a multi-centre randomised controlled trial

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