For a systematic policy of i.v. oxytocin inducted placenta deliveries in a unit where a fairly active management of third stage of labour is yet applied: results of a controlled trial

Pierre, Fabrice H.F.; Mesnard, Louis; Body, G

doi:10.1016/0028-2243(92)90069-b

Cited by 34 publications

(10 citation statements)

References 7 publications

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“…In the light of the previous analysis, the present incidence was 0·23% (previously 1·29%), 0·008% of institutional vaginal deliveries compared to the previous 0·19%, and this is very very low. The reason for this low gure is third-stage management strategies, especially in high-risk cases with a preventive and individualised approach, prophylactic engometrine or oxytocin, controlled cord traction, fundal massage and early cord clamping Elbourne et al, 1988;Pierre et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Retained placenta continues to be fatal but frequency can be reduced

Chhabra

Dhorey

2002

Journal of Obstetrics and Gynaecology

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Retained placenta is potentially lift-threatening not only because of retention per se, but because of associated haemorrhage and infection as well as complications related to its removal. These risks are increased in women in poor social circumstances due to pre-existing malnutrition, anaemia and unsupervised home deliveries. The present study was undertaken to assess the situation in this rural area. A previous study at the same place suggested preventive strategies an and individualised approach. Incidence of retained placenta has been 0.23% of all births over 15 years. Of the deliveries at Kasturba Hospital, the incidence of retained placenta was 0.008% (two of 23,838 vaginal deliveries). Sixty-five women were admitted with retained placenta after home deliveries and three after delivery at other hospitals The age of most of the patients was between 20 and 29 years and most were para 2 or 3. In twenty-three (32.4%) cases, women had delivered preterm. Twelve (16.9%) women had previous uterine surgery and 10 (14.1%) had had a retained placenta in the past. Twenty-six (36.61%) women had come in a state of severe shock. Thirty-six (50.7%) women required general anaesthesia for manual removal. One woman with an adherent placenta had to undergo hysterectomy (1.40%). The maternal mortality was 5.6%. Perinatal loss was 7.04%. It is unfortunate that of the four deaths, two women had actually delivered at a near by district hospital and were referred moribund and died. A properly conducted delivery can reduce the incidence of retained placenta and if retention occurs, timely appropriate treatment can save life.

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Section: Discussionmentioning

confidence: 99%

Retained placenta continues to be fatal but frequency can be reduced

Chhabra

Dhorey

2002

Journal of Obstetrics and Gynaecology

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“…Various studies have shown that oxytocic drugs, when routinely used in the third stage of labour, can lessen the risk of PPH by approximately 40-70% [46][47][48]. AMTSL includes the administration of a uterotonic agent, clamping of the umbilical cord and controlled cord traction.…”

Section: Routine Active Management Of the Third Stage Of Labourmentioning

confidence: 99%

The impact of post-partum haemorrhage in “near-miss” morbidity and mortality in developing countries

Bagga

Jain

2006

Eur Clinics Obstet Gynaecol

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The global maternal mortality ratio (MMR) of 400 per 100,000 live births results in an estimated 529,000 maternal deaths annually. Most of these deaths occur in developing countries and only about 1% in developed countries. Besides mortality data, the identification and accurate documentation of "near-miss" morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Haemorrhage remains a major cause of maternal mortality in both developing and developed countries followed by anaemia and infection, which are more common in developing countries. Post-partum haemorrhage (PPH) is a frequent complication of delivery. PPH occurred in 10.5% of all live births worldwide resulting in 13,795,000 cases in the year 2000. The case fatality rate for PPH was 1% and there were 132,000 deaths attributable to PPH. Anaemia as a consequence of PPH was estimated to occur in 1.6 million women every year. Thus, the prevention and adequate management of obstetric haemorrhage are likely to result in a significant reduction in the MMR and in the less frequently monitored "near-miss" morbidity. Strategies to be adopted with regard to PPH in developing countries may differ from those routinely available and practised in developed countries because of limited access to health care facilities and low institutional delivery rate in the former countries. Some low cost, simple techniques to prevent and manage PPH are described. These need to be tested in a wider population to determine which is most suitable for a particular area or country. The mortality and "near-miss" morbidity data should be continually assessed and only then will the impact of these strategies be known.First level midwifery care plus backup by well-equipped hospitals must be developed concomitantly. Anyone can conduct a normal delivery when all is going well but only those with good clinical judgement and the necessary skills will be able to anticipate and manage a problem. This is especially important in the context of PPH where the under-estimation of blood loss coupled with the rapidity of development of serious consequences is the key issue.

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“…En effet, « l'administration préventive d'utérotoniques » est recommandée par une large majorité des maternités étudiées (84 %). Le bénéfice apporté par cette administration en termes de réduction de l'incidence des HPP ou de réduction de la perte sanguine moyenne du post-partum a été montré dans plusieurs essais [11][12][13], regroupés dans une méta-analyse [6]. Ces résultats semblent donc avoir été intégrés plus aisément dans la politique de prévention des HPP d'une majorité de maternités de l'échantillon de l'étude.…”

Section: Prévention De L'hppunclassified

“…Ce constat d'une inadéqua-tion des soins dans des séries d'HPP, mortelles ou non, amène une question : s'agit-il d'une sélection de cas où la pratique individuelle s'est écartée de la politique locale de soins relative aux HPP, ou d'une inadéquation de la politique de soins relative aux HPP au niveau de la maternité ? L'analyse des données de la littérature montre que certaines interventions ont une influence sur l'incidence et/ou la gravité de l'HPP, en particulier en termes de prévention [5][6][7][8][9][10][11][12][13][14][15][16][17]. Il paraît donc important de savoir quelle est la traduction de ces résultats acquis dans les politiques de soins des maternités.…”

Section: Introductionunclassified