Emerging technology for early detection and management of postpartum hemorrhage to prevent morbidity

Lord, Megan G.; Calderon, Joaquin A.; Pacheco, Luis D.; Ahmadzia, Homa K.

doi:10.1016/j.ajogmf.2022.100742

Cited by 10 publications

(7 citation statements)

References 104 publications

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“…Massive hemorrhage, as one of the most serious medical emergencies, is associated with an increased risk of mortality and morbidity. [58][59][60] TAE has emerged as an efficient and safe method for hemorrhage control, [1,61,62] avoiding the difficult and potentially morbid open surgical procedure. The embolic particulates, such as trisacryl gelatin hydrogel microspheres and PVA hydrogel microspheres, are capable of inducing thrombosis of the bleeding site through increased platelet aggregation and procoagulant activity.…”

Section: Hemorrhagementioning

confidence: 99%

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

Ullah

et al. 2023

Adv Healthcare Materials

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Transcatheter arterial embolization, a minimally invasive treatment to deliberately occlude the blood vessels, has become a safe and effective procedure for the management of vascular diseases and benign/malignant tumors. Particularly, hydrogel‐based embolic agents have garnered much attention because of their potential to address some of the limitations of clinically used embolic agents and can be rationally designed to impart more favorable characteristics or functions. In this review, the recent progress toward the development of polymer‐based hydrogels for effective endovascular embolization, including the in situ gelling hydrogels mediated by physically or chemically crosslinking, imageable hydrogels for intraprocedural and postprocedural feedback, use of hydrogels as the drug depot for local delivery of therapeutic drugs, hemostatic hydrogels inducing extrinsic or intrinsic coagulation of blood, stimuli‐responsive shape memory hydrogels as the smart embolization devices, and hydrogels incorporating external‐stimuli functional materials for multidisciplinary therapy, is systemically summarized. Moreover, the potential considerations of hydrogel‐based embolic agents confronted in therapeutic embolization are pointed out. Finally, the perspectives for the development of more effective embolic hydrogels are also highlighted.

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Section: Hemorrhagementioning

confidence: 99%

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

Ullah

et al. 2023

Adv Healthcare Materials

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“…Obstetric haemorrhage accounts for 6% of maternal deaths in the UK [1 ▪▪ ]. Visual assessment of blood loss can underestimate the volume by up to 40% [9 ▪▪ ] and does not account for any concealed bleeding. At full term, the uterus receives 10% of maternal cardiac output resulting in large volumes of blood lost rapidly [6].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

“…At full term, the uterus receives 10% of maternal cardiac output resulting in large volumes of blood lost rapidly [6]. Obstetric patients often compensate well with tachycardia and hypotension being late signs [9 ▪▪ ].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

“…Whilst there is no set threshold for initiating a transfusion, many hospitals will have a localised protocol to guide management. In a massive obstetric haemorrhage, a fixed ratio protocol of 1:1 packed red cells to fresh frozen plasma is recommended as empirical treatment to replace volume [9 ▪▪ ,10 ▪ ]. Further blood products are titrated to laboratory results, aiming to keep platelets >75 × 10 9 /l and fibrinogen >2 g/l with cryoprecipitate [10 ▪ ].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

“…Viscoelastic haemostatic assays such as rotational thromboelastometry (ROTEM) or thromboelastography (TEG) can provide real-time graphical depiction of coagulation, to guide transfusion efforts. Drawbacks to their use include limited validation of pregnancy-specific values [9 ▪▪ ] and their limited availability in all centres, especially district general hospitals or standalone obstetric units. Other important considerations in major haemorrhage management include complications such as hyperkalaemia, hypocalcaemia and hypothermia [9 ▪▪ ].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

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Postpartum maternal tachycardia – diagnostic pitfalls!

Mathur,

Tohani,

Patil

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Maternal tachycardia is a common sign with a multitude of causes. We attempt to look at the most common sinister ones in the postpartum period. Recent findings Current guidelines differ in the definition of maternal tachycardia. It has been associated with adverse outcomes such as increased length of stay as well as higher mortality if there is underlying peripartum cardiomyopathy. Some recent studies look at common investigations and how these apply to peripartum women, such as ECG markers of arrhythmogenesis, reference ranges for PCT and echocardiogram findings during pregnancy prior to diagnosis of peripartum cardiomyopathy. Summary Physiological changes make it difficult to interpret maternal tachycardia and thus how best to manage it. We propose the idea of a three-step approach for the assessment of patients, aiming to identify causes including tachyarrhythmias, obstetric haemorrhage, sepsis, venous thromboembolism and peripartum cardiomyopathy. The first step ‘BEDSIDE’ applies to all patients looking at observations, history and examination. The second step ‘BASIC’, applies to most patients and covers ECG and basic blood tests. The final step ‘EXTRA’ assesses the need for further investigations including additional blood tests and imaging. By using this model, clinicians and healthcare professionals should be able to rationalise the need for more invasive investigations whilst maintain good high-quality care.

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Comparison of quantitative and calculated postpartum blood loss after vaginal delivery

Madar

Sentilhes

Goffinet

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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Emerging technology for early detection and management of postpartum hemorrhage to prevent morbidity

Cited by 10 publications

References 104 publications

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

Postpartum maternal tachycardia – diagnostic pitfalls!

Comparison of quantitative and calculated postpartum blood loss after vaginal delivery

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