Reaction to blood loss at delivery

Bloomfield, T. H.; Gordon, H.

doi:10.3109/01443619009151299

Cited by 17 publications

(4 citation statements)

References 9 publications

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“…In the context of these studies, in high-income countries with high levels of clinician expertise and adequate access to emergency care, healthy women do not appear to suffer unduly from the results of above average blood loss (about 500 mL) that does not reach the level of severe primary postpartum haemorrhage (PPH) (greater than 1000 mL) (Bloomfield 1990). For example, this review found only a small number of low-risk women (29 out of 3134, 0.9%) had a sufficiently large blood loss to require a blood transfusion.…”

Section: Authors’ Conclusionmentioning

confidence: 99%

“…This can be a primary haemorrhage (within the first 24 hours) (Mousa 2007) or a secondary haemorrhage (between 24 hours and six weeks) (McDonald 2003). Postpartum haemorrhage (PPH) is commonly defined as a blood loss in excess of 500 mL (WHO 2003), with severe haemorrhage being a loss of 1000 mL or more and very severe haemorrhage being a loss of 2500 mL or more (Bloomfield 1990; Greer 1998; Penney 2005). However, the impact of blood loss at birth on an individual woman can vary considerably and will depend not only on the volume of blood lost, but also on her general state of health, the speed of the loss, her haemoglobin (Hb) levels at the time and her coagulation system.…”

Section: Introductionmentioning

confidence: 99%

“…It is well documented that blood loss is consistently under- or over-estimated by clinicians (Razvi 2008), although many centres do try to measure and record blood loss accurately. In well-nourished women, some consider that, in general, there is little impact from a blood loss of 500 mL (Bloomfield 1990), this being equivalent to a routine blood donation (Burnley 2006), but in women in low-income countries who may be poorly nourished and anaemic, this loss can cause considerable morbidity or mortality. It has been estimated that at least 25% of maternal deaths in a number of countries are due to haemorrhage - most due to PPH (Abouzaher 1998; Khan 2006).…”

Section: Introductionmentioning

confidence: 99%

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Active versus expectant management for women in the third stage of labour

Begley

Gyte

Devane

et al. 2011

Cochrane Database of Systematic Reviews

192

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Although there is a lack of high quality evidence, active management of the third stage reduced the risk of haemorrhage greater than 1000 mL at the time of birth in a population of women at mixed risk of excessive bleeding, but adverse effects were identified. Women should be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management. Data are also required from low-income countries.

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Section: Authors’ Conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Active versus expectant management for women in the third stage of labour

Begley

Gyte

Devane

et al. 2011

Cochrane Database of Systematic Reviews

192

View full text Add to dashboard Cite

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“…The definition of ‘postpartum haemorrhage’ is dependent upon the method of assessment of blood loss. Visual estimation of blood loss has been shown to under‐estimate true blood loss by about one‐half 16 , the error increasing as the volume lost increase 17 . Thus blood loss of 500 ml is regarded as postpartum haemorrhage when the blood loss is esti‐ mated, but is the average blood loss when it is measured 6,16 .…”

Section: Discussionmentioning

confidence: 99%

A randomised placebo controlled trial of oral misoprostol in the third stage of labour

Hofmeyr

Nikodem

Jager

et al. 1998

BJOG

117

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Objective To compare oral misoprostol 400 pg with placebo in the routine management of the Design A double-blind placebo controlled trial. Setting The labour ward of an academic hospital in Johannesburg, South Africa with 7000Participants Low-risk women expected to deliver vaginally. Methods Women in labour were randomly allocated to receive either misoprosto1400 pg orally or placebo after the birth. Conventional oxytocics were given immediately if blood loss was thought to be more than usual. Postpartum blood loss in the first hour was measured by collection in a special flat plastic bedpan. Side effects were recorded.Main outcome measures Measured blood loss 2 1000 ml within the first hour after birth. Use of additional oxytocics.Results The groups were well matched. Measured blood loss 2 1000 ml occurred in 15/250 (6%) after misoprostol and 23/250 (9%) after placebo (relative risk 0.65; 95% confidence interval 0.35-1.22). The difference may have been reduced by the greater use of conventional oxytocics in the placebo group, which was statistically significant for intravenous oxytocin infusion (2.8% vs 8.4%, relative risk 0-33, 95% confidence interval 0.140.77). Shivering was more common in the misoprostol group (190/, vs 5%, relative risk 3.69; 95% confidence interval 2.05-6-64).Conclusions Shivering has been shown in this study to be a specific side effect of misoprostol administered orally in the puerperium. No serious side effects were noted. Misoprostol shows promise as a method of preventing postpartum haemorrhage. Because of the potential benefits for childbearing women, particularly those in developing countries, further research to determine its effects with greater certainty should be expedited.third stage of labour.deliveries per annum.

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