Study of Prevalence and Risk Factors Associated with Obstetrics Haemorrhage

Patil, Shailesh B.; Patil, Milind B.

doi:10.21088/ijog.2321.1636.6118.7

Cited by 2 publications

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“…According to the Millennium Development Goal, maternal mortality reduction can be achieved if only PPH management is prioritized [5]. WHO has emphasized that maternal morbidity and mortality due to PPH can be prevented with prompt recognition and timely management [6][7][8][9][10]. AMTSL has been made a part of safe delivery practices in order to prevent PPH [5,6].…”

Section: Discussionmentioning

confidence: 99%

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study

Sharma¹,

Kollabathula²,

Jindal³

et al. 2023

Cureus

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Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. PPH-preventing interventions need to be prioritized and can be integrated with conventional methods of PPH prevention. The introduction of negative intrauterine pressure using a suction cannula can be one of the cheapest modalities to decrease PPH secondary to uterine atonicity. This method has brought a renaissance to practical obstetrics in low-middle income countries (LMIC), where the cost and availability of uterotonics are major health issues. Methods: It was a prospective quality improvement (QI) study conducted in the labor and delivery wards of a tertiary care medical institute and teaching center over the duration of one year. We aimed to assess the decrease in the incidence of atonic PPH with a negative intrauterine pressure suction device (NIPSD) integrated with active management of the third stage of labor (AMTSL) in the prevention of atonic PPH following normal vaginal delivery in low-risk antenatal women. In the initial six months, routine AMTSL was instituted for all consenting women (group 1). In the next six months, NIPSD was integrated with AMTSL (group 2). Data pertaining to the amount of blood loss, the incidence of primary PPH, uterine tone, fall in hemoglobin and hematocrit levels post-delivery, need for blood transfusion, and doctor and patient satisfaction were tabulated for all patients. Results: A total of 1324 consenting women were eligible for enrollment during the study time frame. In the initial six months (baseline period, group 1), 715 participants were subjected to routine AMTSL in the third stage of labor. During the intervention phase (group 2), 609 parturient women were recruited. There was no significant difference in baseline parameters between the two groups. With the introduction of NIPSD to routine AMTSL, there was a significant decrease in the average volume of blood loss during vaginal delivery (group 1 = 389.45+65.42 ml, group 2 = 216.66+34.27 ml; p-value = 0.012). The incidence of atonic PPH was reduced by more than 75% (group 1 = 13 women, group 2 = 3 women; p-value = 0.001) after the introduction of NIPSD complementing routine AMTSL. The introduction of NIPSD has also been instrumental in reducing the cost burden on patient and hospital expenditures. The net benefit of its introduction resulted in a reduction of the overall cost burden of blood transfusions by around 70%. Conclusion: PPH is a public health problem, and measures to reduce PPH must be implemented to decrease this health burden. In countries with low resources, complementing routine AMTSL with NIPSD can be instrumental in decreasing the incidence of PPH. Considering its cost-effectiveness and reusability, LMIC can adopt NIPSD as a routine measure in all vaginal deliveries.

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Section: Discussionmentioning

confidence: 99%

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study

Sharma¹,

Kollabathula²,

Jindal³

et al. 2023

Cureus

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The Association of Serum Fibrinogen Levels With the Severity of Primary Postpartum Hemorrhage: A Prospective Study

Kaur,

Grover,

Kukar

et al. 2024

Cureus

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Introduction: Postpartum hemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. Coagulation disorders are a major risk factor for PPH that have not been studied adequately. Fibrinogen, a plasma glycoprotein, is integral to hemostasis and is involved in the final process of the coagulation cascade. Fibrinogen levels increase with advancing pregnancy probably because of an increase in estrogen levels and reach a peak (~5g/L) in the third trimester of pregnancy. However, in the postpartum period, the fibrinogen concentration shows a decreasing trend. Objective: The purpose of the study was to study the serum fibrinogen level in patients with PPH and to find its association with the severity of primary postpartum hemorrhage. Methodology: Patients were selected according to inclusion and exclusion criteria. Written and informed consents were taken. Routine investigations were done on admission and special investigations like red blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, and serum fibrinogen were done later when the patient developed PPH. Serial samples of all PPH patients for serum fibrinogen levels at 0, 1, 2, 4, and 24 hours were taken to study the serum fibrinogen levels and data were analyzed. Result: The mean fibrinogen level on admission was 3.92 ± 0.92 g/l in non-severe PPH and 2.03 ± 0.97 g/l in the severe PPH group. Fibrinogen levels in the non-severe group remained < 4.46 g/l at 0, 1, 2, 4, and 24 hours. In the severe group, fibrinogen levels were < 2.89 g/l at 0, 1, 2, and 4 hours and it was 2.44 ± 1.06 g/l in the 24-hour samples. Statistical significance was found in all the fibrinogen values among the two study groups (p = 0.001). Conclusion: Our results showed that zero-hour fibrinogen levels correlate significantly with the aggravation of PPH and levels <2 g/L can serve as a predictor for progression to severe PPH.

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Study of Prevalence and Risk Factors Associated with Obstetrics Haemorrhage

Cited by 2 publications

References 0 publications

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study

The Association of Serum Fibrinogen Levels With the Severity of Primary Postpartum Hemorrhage: A Prospective Study

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