Incidence, Risk Factors, and Temporal Trends in Severe Postpartum Hemorrhage

Kramer, Michael S.; Berg, Caroline van den; Abenhaim, Haim A.; Dahhou, Mourad; Rouleau, Jocelyn; Mehrabadi, Azar; Joseph, K.S.

doi:10.1097/01.aoa.0000455571.79823.3f

Cited by 147 publications

(216 citation statements)

References 4 publications

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“…Postpartum hemorrhage accounts for the majority of these hemorrhage deaths (AbouZahr 2003;Prata et al 2013). Approximately 75% of the cases of postpartum hemorrhage are due to atonic uterus, which is loss of uterine muscular tone or strength to contract the uterus after delivery (Montufar-Rueda et al 2013;Kramer et al 2013). Prediction of atonic uterus is therefore important for the prevention of postpartum maternal death.…”

Section: Introductionmentioning

confidence: 99%

Exaggerated Placental Site, Consisting of Implantation Site Intermediate Trophoblasts, Causes Massive Postpartum Uterine Hemorrhage: Case Report and Literature Review

Takebayashi

Kimura

Yamanaka

et al. 2014

Tohoku J. Exp. Med.

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Every year, 14 million cases of obstetric hemorrhage occur worldwide, causing 127,000 maternal deaths. About 75% of postpartum hemorrhage cases are due to atonic uterus, which is loss of uterine muscular tone or strength for contraction of the uterus after delivery. The prediction of atonic uterus is therefore important for the prevention of postpartum maternal death. However, prediction of occurrence of atonic uterus is difficult before delivery, because the precise pathophysiological mechanism to trigger this condition remains unclear. Here, we present a case of severe postpartum hemorrhage due to atonic uterus. A 35-year-old woman gave a birth by vaginal delivery to a healthy boy. However, due to intractable massive hemorrhage after the removal of the retained placenta, we performed supravaginal hysterectomy as the best option for survival. Pathological examination showed that implantation site intermediate trophoblasts (ISITs) formed unusually large clumps in the decidua, diagnosed as exaggerated placental site (EPS). EPS is thought to be a condition consisting of an excessive number of ISITs. ISITs are differentiated from a trophoblast lineage in the process of placenta formation. ISITs anchor the placenta to the maternal tissue and are considered to maintain pregnancy, but the postpartum role of these cells remains unclear. Excessive infiltration of ISITs, namely EPS, may cause postpartum atonic uterus. In this article, we also reviewed the literatures on EPS. The present case and other reported cases indicate that EPS causes mass formation in the uterus, continuous uterine bleeding, and massive hemorrhage, resulting in hysterectomy.

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Section: Introductionmentioning

confidence: 99%

Exaggerated Placental Site, Consisting of Implantation Site Intermediate Trophoblasts, Causes Massive Postpartum Uterine Hemorrhage: Case Report and Literature Review

Takebayashi

Kimura

Yamanaka

et al. 2014

Tohoku J. Exp. Med.

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“…1,[5][6][7][8] In addition, hemorrhage remains a leading cause of maternal morbidity 24 and mortality 2 in the United States. As a consequence, there is a need to optimize preventive and therapeutic clinical practices in order to reduce rates of atonic PPH.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] In the developed world, the incidence of PPH overall, and that of severe cases resulting in transfusion and hysterectomy, have increased significantly over the past decade. 1,[5][6][7][8] These increases appear to be directly linked to a concomitant increase in the incidence of uterine atony. 1,6 For prophylaxis against uterine atony, oxytocin is routinely used during the third stage of labor.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Second-Line Uterotonic Use in a Large Sample of Hospitalizations for Childbirth in the United States

Bateman

Tsen

et al. 2015

Survey of Anesthesiology

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“…[1,2] Severe morbidity and mortality has been associated with overwhelming hemorrhage due to the various causes of obstetrical hemorrhage and its subsequent coagulopathy. [3] In addition, complicated intraabdominal pathology in some OB/GYN cases may require the expertise and skills of an Acute Care/Trauma Surgeon.…”

Section: Introductionmentioning

confidence: 99%

Acute Care/Trauma Surgeon's role in obstetrical/gynecologic emergencies (The OBCAT Alert)

Lee

Carrillo

Rosenthal

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic (OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon. The OB Critical Assessment Team (OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases. We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases. METHODS:We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015. An OBCAT is a hospital based alert system designed to immediately notify OB/GYN, anesthesiology, Acute Care/Trauma, the intensive care unit (ICU), and the blood bank of a potential emergency during an OB/GYN case.RESULTS: There were 7±3 OBCAT alerts/year. Seventeen patients required Acute Care/ Trauma surgery intervention for hemorrhage. Thirteen patients required damage control packing during their hospitalization. Blood loss averaged 6.8±5.5 L and patients received a total of 21±14 units during deliveries with hemorrhage. There were 17 other surgical interventions not related to hemorrhage; seven of these cases were related to adhesions or intestinal injury. Seven additional cases required evaluation post routine OB/GYN procedure; the most common reason was for severe wound complications. There were three deaths during this study period.CONCLUSION: Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming hemorrhage. Acute Care/ Trauma Surgeons have a key role in the treatment of these complex cases.

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Incidence, Risk Factors, and Temporal Trends in Severe Postpartum Hemorrhage

Cited by 147 publications

References 4 publications

Exaggerated Placental Site, Consisting of Implantation Site Intermediate Trophoblasts, Causes Massive Postpartum Uterine Hemorrhage: Case Report and Literature Review

Exaggerated Placental Site, Consisting of Implantation Site Intermediate Trophoblasts, Causes Massive Postpartum Uterine Hemorrhage: Case Report and Literature Review

Patterns of Second-Line Uterotonic Use in a Large Sample of Hospitalizations for Childbirth in the United States

Acute Care/Trauma Surgeon's role in obstetrical/gynecologic emergencies (The OBCAT Alert)

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