Procedures and Uterine-Sparing Surgeries for Managing Postpartum Hemorrhage

Sathe, Nila A; Likis, Frances E; Young, Jessica L; Morgans, Amee; Carlson-Bremer, Daphne; Andrews, J.M.

doi:10.1097/ogx.0000000000000273

Cited by 38 publications

(42 citation statements)

References 54 publications

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“…A larger 2016 systematic review including 1648 women assessed the evidence for intrauterine tamponade as being insufficient owing to the small numbers of study participants and important study limitations. 24 While there were few reported adverse events, the review notes that harms were not well characterized. However, our results raise the possibility that tamponade could increase the risk of life-threatening sepsis.…”

Section: Type Of Deliverymentioning

confidence: 99%

Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage

Cornelissen

Woodd

Shakur-Still

et al. 2019

Intl J Gynecology & Obste

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Objective To examine the association between the use of invasive treatments for postpartum hemorrhage and the risk of sepsis and severe sepsis. Methods Secondary data analysis of the WOMAN randomized controlled trial, including 20 060 women with postpartum hemorrhage in 21 countries. Logistic regression with random effects was used. Results The cumulative incidence was 1.8% for sepsis and 0.5% for severe sepsis. All‐cause mortality was 40.4% in women with severe sepsis versus 2.2% for women without. After adjusting for bleeding severity and other confounders, intrauterine tamponade, hysterectomy, and laparotomy increased the risk of sepsis (aOR 1.77 [95% CI 1.21–2.59], P=0.004; aOR 1.97 [95% CI 1.49–2.65], P<0.001; and aOR 6.63 [95% CI 4.29–10.24], P<0.001, respectively) and severe sepsis (aOR 2.60 [95% CI 1.47–4.59], P=0.002; aOR 1.97 [95% CI 0.83–2.46], P=0.033; and aOR 5.35 [95% CI 2.61–10.98], P<0.001, respectively). Conclusion In this secondary data analysis, certain invasive treatments for postpartum hemorrhage appear to increase the risk of sepsis. Further research is needed to confirm this finding and investigate the role of prophylactic antibiotics during these procedures. The harms and benefits of such interventions must be carefully weighed, both in treatment guidelines and during individual patient management. Trial Registration: ISRCTN76912190

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Section: Type Of Deliverymentioning

confidence: 99%

Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage

Cornelissen

Woodd

Shakur-Still

et al. 2019

Intl J Gynecology & Obste

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“…The majority of all deaths related to PPH will occur within 24 h following delivery in settings, where operative measures are not readily available. Nearly all of these deaths could be prevented by swift intervention with a series of non-operative and operative measures [3]. …”

Section: Introductionmentioning

confidence: 99%

“…Strategies for implementing uterine tamponade include uterine packing with sterile gauze, inflated foley catheters, condom catheters, and silicone obstetrical balloons [3, 10, 11]. Although case series data demonstrate the efficacy of these methods, none is ideal for use in the low resource setting.…”

Section: Introductionmentioning

confidence: 99%

A novel tamponade agent for management of post partum hemorrhage: adaptation of the Xstat mini-sponge applicator for obstetric use

Rodríguez

Jensen

Gregory

et al. 2017

BMC Pregnancy Childbirth

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BackgroundAlthough uterine tamponade is an effective treatment for postpartum hemorrhage (PPH), current methods have key limitations in their use, particularly in low resource settings. The XStat™ Mini Sponge Dressing (MSD) is approved for the management of non-compressible wounds in the battlefield/trauma setting. The MSD applies highly compressed medical sponges capable of stopping high-flow arterial bleeding within seconds. The objective of our study was to adopt the MSD for use in managing PPH.MethodsWe performed desktop testing using a uterine model with pressure sensors to compare key design elements of the obstetrical prototype MSD (fundal pressure achieved, reduction in fluid loss, time to deploy, and time to remove) with alternativetechniques (uterine packing, balloon tamponade). To evaluate safety, we delivered the fetus of pregnant ewes by cesarean section and used the prototype to deliver the MSD into one uterine horn, and closed the hysterotomy. We followed the clinical recovery of animals (n = 3) over 24 h, and then removed the reproductive tract for histologic evaluation. To evaluate late effects, we surgically removed the MSDs after 24 h, and followed the clinical recovery of animals (n = 6) for an additional seven days before tissue removal.ResultsThe obstetrical prototype has a long tapered delivery system designed to be deployed during vaginal examination, and administers three times the volume of the approved MSD trauma bandage. The MSD are deployed within a mesh bag to facilitate removal by vaginaltraction. On desktop testing, the MSD resulted in the highest average fundal pressure (113 mmHg), followed by the MSD bag device (85.8 mmHg), gauze packing (15.5 mmHg), and the uterine balloon (8.2 mmHg). The MSD bag test group achieved the largest fluid flow reduction of −74%, followed by gauze packing (−55%), MSD (−35%), and uterine balloon (−19%). Animal testing demonstrated good uterine fill with no evidence of adverse clinical recovery, uterine trauma or infection at 24 h, or up to 7 days following device removal.ConclusionWe adapted a highly effective trauma dressing and applicator for use in the treatment of severe PPH. Preliminary desktop and animal testing provide a basis for initial clinical trials in women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1373-x) contains supplementary material, which is available to authorized users.

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“…Another recent systematic review, including 28 small studies about procedures, as embolization or uterine tamponade, or surgeries, arterial ligation or uterine compression sutures, concluded that given the insufficient evidence, clinicians must continue to make individual care decisions based on each woman's clinical situation and available management options [57]. Some studies with longer term follow-up reported infertility in women undergoing embolization.…”

Section: Pelvic Artery Embolization (Pae)mentioning

confidence: 99%

Massive Postpartum Hemorrhage: Protocol and Red Code

Masip¹,

Almeida-Toledano²,

Ferrero-Martínez³

et al. 2017

Obstetrics

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Postpartum hemorrhage (PPH) is the leading cause of maternal death. In developing countries, approximately 8% of maternal death is caused by PPH. Protocols should provide a standardized approach to evaluate and monitor the patients. A standard protocol must be recognized by the institution and must be accepted and known by all team members. Additionally, it is important to have a massive obstetric hemorrhage protocol (red code) for those patients with an important bleeding who require blood products available as soon as possible. In the red code activation protocol there are several key points to consider: the management algorithm must be known and accepted by all team members, a clear and effective communication between the team must be established and all the participants must know the role they play. Massive obstetric hemorrhage has a multidisciplinary implication: obstetricians, anesthesiologists, pediatricians, midwife, nurses, auxiliary staff, and laboratory blood bank staff. The active participation of the multidisciplinary team in simulations before the protocols implementation facilitates the evaluation of critical points and subsequent changes before their final application, the assessment of the adequacy of circuits and infrastructure, as well as a better protocols compliance.

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Procedures and Uterine-Sparing Surgeries for Managing Postpartum Hemorrhage

Cited by 38 publications

References 54 publications

Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage

Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage

A novel tamponade agent for management of post partum hemorrhage: adaptation of the Xstat mini-sponge applicator for obstetric use

Massive Postpartum Hemorrhage: Protocol and Red Code

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