Management of primary postpartum haemorrhage

Drife, James Owen

doi:10.1111/j.1471-0528.1997.tb11453.x

Cited by 111 publications

(62 citation statements)

References 25 publications

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“…12,16 Kodla CS et al identified a hysterectomy rate of 10.31% which was similar to findings of Drief et al 19,22 Regarding maternal outcomes, 25.6% had DIVC, 8.5% developed septicaemia and 6% developed acute renal The most common cause was placenta previa with bleeding and irreversible haemorrhagic shock.…”

Section: Discussionsupporting

confidence: 74%

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

Padmasekar

Jothy

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Massive obstetric haemorrhage is defined as blood loss of >1500 ml, or a decrease in haemoglobin>4 gm/dl or acute transfusion requirement of >4 units of blood when need for further transfusion is foreseeable. The purpose of this study is to analyse the demographic, medical and obstetric risk factors for massive obstetric haemorrhage and it’s materno fetal outcomes.Methods: Criteria for patient selection was all patients who had an acute obstetric haemorrhage necessitating a transfusion of >4 units of blood at a stretch when there was a need for more. This is a retrospective study conducted for a period of one year January to December 2015. Data regarding all cases under study during this period was obtained from Medical Records Department with prior permission. This study was conducted in the Department of Obstetrics and Gynecology, Government Raja Mirasudhar Teaching Hospital, Thanjavur Medical College, Tamil Nadu. Maternal outcomes like mode of delivery, rate of hysterectomy, postpartum complications, maternal mortality and fetal outcomes like intra uterine death, still birth and preterm birth were analysed.Results: The rate of massive obstetric haemorrhage in our hospital during the study period was 5.7/1000 births. Massive obstetric haemorrhage contributed to 25% of all maternal deaths in 2015. Atonic PPH was the commonest cause. Multiparity and previous caesarean section were identified to be significant risk factors.Conclusions: We found an increased association of massive obstetric haemorrhage with multiparity, caesarean sections and pre-eclampsia. Atonic PPH was the commonest cause. Massive obstetric haemorrhage had contributed significantly to adverse maternal and perinatal outcomes.

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Section: Discussionsupporting

confidence: 74%

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

Padmasekar

Jothy

2017

Int J Reprod Contracept Obstet Gynecol

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“…Acil peripartum histerektomi (PH) gelişmekte olan ülkelerdeki anne ölümlerinin ve morbiditenin en sık sebebi olan doğum sırasında veya sonrasındaki aşırı kanamayı kontrol etmek için uygulanan hayat kurtarıcı bir cerrahi müdahaledir (1). Peripartum histerektomi sıklığı sezaryen oranları ile birlikte artmaktadır ve bu durum Türkiye gibi yüksek sezaryen hızı olan bir ülke için önem arz etmektedir (2,3).…”

Section: Introductionunclassified

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

Velipaşaoğlu¹,

Şentürk²,

Tanir³

2017

Akd Med J

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ÖZAmaç: Peripartum histerektomi sıklığı tüm dünyada giderek artmakta olan, obstetrik kanamaların tedavisinde son basamak olarak uygulanan hayat kurtarıcı bir cerrahi müdahaledir. Özellikle artan sezaryen hızları ile birlikte gelişen plasental anomaliler (plasenta previa ve invazyon anomalileri) peripartum histerektominin önemini artırmaktadır.Çalışmanın amacı, peripartum histerektominin bir üniversite kliniğindeki risk faktörlerini, insidansını endikasyonlarını, yönetim stratejilerini ve komplikasyonlarını incelemektir. Gereç ve Yöntemler:Bu retrospektif çalışmaya Mart 1997 ile Mart 2017 tarihleri arasında kliniğimizde doğum sonrası ilk 24 saat içinde peripartum histerektomi yapılan olguları dahil edilmiştir. Olguların demografik verileri, plasental anomali varlığı, histerektomi endikasyonları, yapıldı ise histerektomiye ek cerrahi müdahaleler, intraoperatif komplikasyonlar, transfüzyon ihtiyacı, verilen kan ürünü tipleri ve miktarları ile maternal ve perinatal mortaliteleri incelenmiştir. Bulgular:Kliniğimizde 20 yıl içinde 23 peripartum histerektomi yapılmış olup bu müdahale ‰ 1,7 sıklıkla uygulanmıştır. Peripartum histerektomi endikasyonları arasında en sık olarak plasenta invazyon anomalileri (n=8; %34,8), ikinci en sık olarak ise uterin atoni (n=7; %30,4) olarak yer almaktaydı. Plasental anomalilerin (plasenta previa ve invazyon anomalileri) toplam oranı %52,17 olarak tespit edilmişti. Hastaların tamamına eritrosit süspansiyonu verilmiş olup verilen ortalama eritrosit süspan-siyonu miktarı 11,52 (± 9,27) ünitedir. Perinatal mortalite hızı ‰ 120 iken maternal mortalite hızı ‰ 4,3 (n=1) olarak tespit edilmiştir.Sonuç: Çalışma plasental anomalilere (plasenta previa ve invazyon anomalileri) bağlı peripartum histerektomi sıklığının giderek artığını göstermektedir. Bu nedenle bu problemlerin antenatal dönemde tanısının konması ve bu hastaların doğum yönetiminin tecrübeli bir ekip tarafından multidisipliner yaklaşımla yapılması gerekmektedir.Anahtar Sözcükler: Peripartum histerektomi, Obstetrik kanama, Plasenta akreata, Uterin atoni, Plasenta previa ABSTRACT Objective: Peripartum hysterectomy is a lifesaving procedure that is performed as the last step in the management of massive obstetric hemorrhage. Its incidence is increasing worldwide. Placental abnormalities that are associated with high cesarean rates are of utmost importance in the concept of peripartum hysterectomy.The purpose of this study was to elucidate the risk factors, incidence indications, management strategies and complications of peripartum hysterectomy in a university setting. Material and Methods:This retrospective study included the patients who gave birth and underwent hysterectomy in the 24h after delivery at our clinic between March 1997 and March 2017. Demographic characteristics, the presence of placental abnormalities, indications of hysterectomy, surgical interventions other than hysterectomy, intraoperative complications, need of transfusion, types and amount of transfused blood products, and perinatal and maternal mortality were exam...

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“…1 Life-threatening obstetric haemorrhage occurs in approximately 1 per 1000 deliveries. 2 The importance of accurate estimation of blood loss, prompt recognition and treatment of clotting disorders, early involvement of a consultant haematologist, involvement of a consultant anaesthetist in resuscitation, use of adequately sized intravenous cannulae and precise monitoring of central venous pressure have all been repeatedly advocated. Introduction of specialised obstetric anaesthetists, labour ward protocols, participation in regular 'fire drills' and improved obstetric training have gone part way to addressing these important issues; yet, visual estimation of blood loss at vaginal and abdominal delivery remains inaccurate.…”

Section: Introductionmentioning

confidence: 99%

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Bose¹,

Regan

Paterson‐Brown³

2006

BJOG

348

218

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Objectives Following the results of the Confidential Enquiries into Maternal Deaths report, which claims two maternal deaths annually in the UK from postpartum haemorrhage, our aim was to assess the accuracy of ‘visual estimation of blood loss’ and produce suitable pictorial and written algorithms to aid in the recognition and management of massive obstetric haemorrhage. Design Observational study to determine discrepancy between actual blood loss (ABL) and estimated blood loss (EBL). Setting Teaching hospital. Population Hundred and three obstetricians, anaesthetists, midwives, nurses and healthcare assistants. Methods Clinical scenarios were reproduced in the form of 12 Objective Structured Clinical Examination (OSCE) style stations augmented with known volumes of whole blood. Individual staff estimated the blood loss visually and recorded their results. Digital photographs were used to produce a pictorial ‘algorithm’ suitable for use as a teaching tool in labour ward. Main outcome measures Areas of greatest discrepancy between EBL and ABL. Results Significant underestimation of the ABL occurred in 5 of the 12 OSCE stations: 500‐ml (50‐cm diameter) floor spill, 1000‐ml (75‐cm diameter) floor spill, 1500‐ml (100‐cm diameter) floor spill, 350‐ml capacity of soaked 45‐ × 45‐cm large swab and the 2‐l vaginal postpartum haemorrhage on bed/floor. Conclusions Accurate visual estimation of blood loss is known to facilitate timely resuscitation, minimising the risk of disseminated intravascular coagulation and reducing the severity of haemorrhagic shock. Participation in clinical reconstructions may encourage early diagnosis and prompt treatment of postpartum haemorrhage. Written and pictorial guidelines may help all staff working in labour wards.

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Management of primary postpartum haemorrhage

Cited by 111 publications

References 25 publications

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

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