Increasing trends in atonic postpartum haemorrhage in Ireland: an 11‐year population‐based cohort study

Abstract

been associated with increased OASIS at the time of birth and at 3 months after birth in other studies. 5,6 Kalis et al. 1 also state that we extrapolate evidence from studies investigating angle shrinkage of mediolateral episiotomies, and use this to support our findings concerning healed lateral episiotomy. We are reluctant to classify the episiotomies in our study as lateral. The tradition in our two units is mediolateral episiotomy. Episiotomy incision lateral to the midline has only recently been advocated. Also, Tincello et al. 7 have shown that one-third of UK obstetricians and midwives start the episiotomy lateral to the midline. Therefore, we included the point of episiotomy incision, d, in the figure, believing that this would mirror episiotomy techniques more accurately. Consistent with earlier reports, we found that the episiotomies actually performed varied greatly from theoretical recommendations, with 'mediolateral episiotomies' being in practice anything from lateral to medial. 5,6 This discrepancy between technique and theory was one of the main reasons for our research.Kalis et al. 1 also suggest that data on the length from the end of the episiotomy to the midline, b, are of limited clinical value. We disagree. In clinical practice the posterior fourchette and the anal opening are the two points of reference, and d, length (e) and angle (a) are independent variables. As b is a function of theses variables, and can be approximately estimated visually from the two reference points and the independent variables, b might be of great clinical value if future studies indicate an association between b and OASIS. With an angle of 45°one will need an episiotomy with a longer distance e when performing a mediolateral episiotomy, compared with a lateral episiotomy, to achieve the same distance b. Thus, b might be an important guiding parameter to perform an episiotomy with optimal unloading effect.Lastly, Kalis et al. 1 imply that a major limitation in our discussion is the use of data from studies investigating mediolateral episiotomy. We do agree with Kalis et al. 1 that different episiotomy techniques have inherent differences in outcome, but disagree with the idea that previous research is not relevant to the discussion of our results. Because of the variation in how mediolateral episiotomy is performed, it is currently unrealistic to limit the data from episiotomy studies to specific types of episiotomy. [5][6][7] In response to Knobel et al., 2 we do not promote a liberal use of episiotomy. On the contrary, we strongly support the restricted but correct use of episiotomy. We argue that there are situations where episiotomy is clearly indicated, for example with instrumental delivery.

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

“…Some, but not all, of this rise may be accounted for by improved reporting in the developing world (International Classification of Diseases, 2014). Uterine atony (lack of effective myometrial contraction) is well accepted as the major cause of PPH accounting for 80-90% of all (Bateman et al, 2010;Driessen et al, 2011;Wickham, 2011;Lutomski et al, 2012;Radon and Divers, 2012;Mehrabadi et al, 2013;Wetta et al, 2013).…”

Effect of Pronurturance Plus on Labor Outcomes of Women at Risk to Postpartum Hemorrhage

“…the previous results contradicted with [Radon and Divers, 2012], who stated that no statistically significant difference was detected between the group who adopted the pronurturance plus and the group who adopted the routine hospital care regarding to the amount of blood loss and contraction of the uterine. This difference might be due to that the researchers didn"t exclude the coagulation disorder factor and poor neonatal sucking from her study, which may have affected on the result and that was more common in the study group.…”

Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery

“…Uterine massage should be continued if there is frequent uterine atony. [1][2][3] PPH is the occurrence of severe bleeding exceeding 500 ml, after childbirth. It usually takes place within the first 24 hour, but can happen up to 6 weeks after delivery, during the puerperium period.…”

“…Other causes are genital tract trauma, uterine rupture, retained placenta or part of placenta and coagulation disorders. 2,3 Common consequences of PPH are hypovolemic shock, disseminated intravascular coagulopathies (DIC), renal and hepatic failure and adult respiratory syndrome (ARDS) which may end up in maternal death. 1 PPH can be classified as primary postpartum hemorrhage: excessive bleeding during third stage of labor or within 24 hours of delivery and secondary postpartum hemorrhage: excessive bleeding between 24 hours to six weeks of delivery.…”

“…Depending upon parity and severity of PPH, we choose the best options. 2,3 In the modern technological age, different techniques have been introduced to manage PPH, if medical management failed. These include intrauterine balloon tamponade, uterine compression suturing, arterial embolization, and iliac artery ligation or uterine devascularization to treat PPH.…”