A case report on caesarean myomectomy

Routine myomectomy at the time of caesarean section has been condemned in the past due to fear of uncontrolled haemorrhage and peripartum hysterectomy. It is still a topic of debate worldwide. However, in recent years, many case studies of caesarean myomectomy have been published validating its safety without any significant complications like excessive blood loss. We describe the case of a 23-year-old nulliparous women at 38 weeks of pregnancy with history of previous abortion. Her ultrasound was suggestive of singleton live intrauterine pregnancy with multiple intramurals and subserosal uterine fibroids seen in fundus, body region, posterior and anterior myometrium with largest fibroid of size 9×6.1 cm. The patient was taken up for elective caesarean section along with caesarean myomectomy. Live baby was delivered and successful myomectomy was done. Prophylactically oxytocin drip was given and intra myometrial carboprost was given to avoid blood loss. Patient was discharged on post-operative day 12 without any complications. Routine myomectomy at the time of caesarean section is not a standard procedure. However, it may be considered a safe option in carefully selected cases in the hands of an experienced obstetrician.

The compression of myometrium and occlusion of uterine artery by COMOC-MG technique for the management of postpartum haemorrhage: clinical perspective from ten cases

Compression of myometrium and occlusion of uterine artery by Dr. Mahesh Gupta (COMOC-MG) technique is an improved B-lynch stitch technique used to control postpartum hemorrhage (PPH). Objective was to study clinical perspective of the COMOC-MG technique on the effect of PPH in Indian women. Data of 10 patients with PPH who were managed by using the COMOC-MG technique in a tertiary care center in Gujarat from April 2022 to December 2022 were retrieved. Baseline characteristics, medical problems and history of women were recorded. Decision to perform COMOC-MG stitch was taken based on the indications such as PPH, per vaginal bleeding and degree of uterine contractility. Out of 10 women, four women had medical problems such as pregnancy-induced hypertension, dysfunctional uterine bleeding and using psychiatric medicines; two women had uterine surgery/ Laparotomy; four women were diagnosed with ailments such as pregnancy induced hypertension (PIH) and hypertension during the third trimester of pregnancy. Indications such as twins during a previous pregnancy, deflexed head, previous lower segment caesarean section (LSCS) with intrauterine growth restriction (IUGR), breech, prim parity, severe oligohydramnios, placental insufficiency and second baby were considered to carry out the CS delivery. Women were managed by COMOC-MG stitch followed by Misoprostol tablets; Carbetocin, Oxytocin, Methylergometrine and Carboprost injections to control PPH. Mean time between uterine closure to COMOC-MG was 10 min. COMOC-MG stitch resulted in good outcomes in seven patients except one patient had atonic PPH. Out of ten patients, one patient required a hysterectomy and three patients required blood transfusion. COMOC-MG stitch is an easy, simple method to control PPH.

Maternal and fetal outcome in second stage caesarean section: a retrospective study

Background: This study aims to observe the maternal and neonatal outcomes of caesarean delivery performed in the second stage of labor.Methods: This was retrospective observational study conducted at Cheluvamba hospital, Mysore medical college, Mysore, in the department of Obstetrics and Gynaecology. All second stage caesarean sections performed between January 2023 to June 2023 were analyzed in terms of incidence, indications of caesarean-section, intra-operative and postoperative complications, maternal and fetal outcome.Results: During the study period there were total 4194 deliveries. Out of this 1771 deliveries were done by caesarean section. Out of them 48 were 2nd stage caesarean sections contributing to 2.71% of total sections. Patwardhan method was used in 41.6% cases for delivery of deeply engaged head. Intra-operative complications were higher in terms of atonic pph (25%), hematuria (16.66 %). 14% cases had postoperative fever and 41.6% cases need prolonged catheterization. 20.83% babies required NICU admissions and neonatal death was 4.16%.Conclusions: Caesarean section in the 2nd stage of labour is associated with increased maternal and neonatal morbidity. A proper judgement is required by a skilled obstetrician to take a decision for caesarean section at full cervical dilatation.

Complicaciones maternas y embarazo adolescente en América Latina: Revisión sistemática y metaanálisis / Maternal complications and adolescent pregnancy in Latin America: A systematic review and meta-analysis

RESUMEN Objetivo: Evaluar el riesgo de complicaciones maternas en el embarazo adolescente en Latinoamérica y El Caribe durante el periodo 2012 al 2021. Métodos: Se realizó una búsqueda sistemática en 6 bases de datos: PubMed, SCOPUS, Web Of Science, EMBase, LILACS y Scielo. Los artículos incluidos fueron procedentes de paises de Latinoamérica y contaron con cualquiera de las siguientes variables: preeclampsia, eclampsia, hemorragia puerperal y sepsis puerperal publicados desde el 2012 al 2021 y que compararan adolescentes y adultas embarazadas. Se excluyeron artículos que no presentaron hallazgos separados de Latinoamérica y/o El Caribe, que no se encontraban disponibles la versión completa y que estaban enfocados en pacientes con alguna enfermedad en específico. Para el riesgo de sesgo se empleó la Escala de Newcasttle-Ottawa para estudios de casos y controles. La medida de resumen empleada fue el Odds Ratio con un intervalo de confianza al 95% para cada estudio. Resultados: Se incluyeron 4 estudios. No se evidenció el riesgo de preeclampsia en adolescentes embarazadas (OR = 0.93, IC 95% 0.69 - 1.25) ni hemorragia puerperal (OR = 0.86, IC 95% 0.74 - 0.99). Por otro lado, se mostró el riesgo de eclampsia (OR = 2.43, IC 95% 1.29 - 4.58) en adolescentes embarazadas, pero con alta heterogeneidad entre los estudios (I2 = 76%). Conclusiones: Se evidenció un riesgo de eclampsia en adolescentes embarazadas, pero no en preeclampsia ni hemorragia puerperal; sin embargo, estos resultados deben de tomarse con cautela. Registro de protocolo: CRD42021286725 (PROSPERO)

ABSTRACT Objective: To assess whether maternal complications are a risk in adolescent pregnancy in Latin America and the Caribbean during the period 2012 to 2021. Methods: A systematic search was carried out in 6 databases: PubMed, SCOPUS, Web of Science, EMBase, LILACS and Scielo. The articles included were from Latin American countries and had any of the following variables: preeclampsia, eclampsia, puerperal hemorrhage and puerperal sepsis published from 2012 to 2021 and comparing pregnant adolescents and adults. Articles that did not present separate findings from Latin America and/or the Caribbean, that the full version was not available, and that were focused on patients with a specific disease were excluded. For risk of bias, the Newcastle-Ottawa Scale Case-Control Studies was used. The summary measure used was the Odds Ratio with a 95% confidence interval for each study. Results: 4 studies were included. The risk of preeclampsia in pregnant adolescents and postpartum hemorrhage (OR = 0.86, 95% CI 0.74 - 0.99) were not evidenced (OR = 0.93, 95% CI 0.69 - 1.25). On the other hand, the risk of eclampsia (OR = 2.43, 95% CI 1.29 - 4.58) in pregnant adolescents was shown, but with high heterogeneity between studies (I2 = 76%). Conclusions: A risk of eclampsia was evidenced in pregnant adolescents, but not in preeclampsia nor postpartum hemorrhage. However, these results should be taken with caution. Protocol record: CRD42021286725 (PROSPERO)

Correlation between vitamin D levels in third trimester and postpartum hemorrhage

Background: The aim of this study was to assess the correlation between antenatal vitamin D levels and postpartum hemorrhage.Methods: An analytical study was conducted among 385 term pregnant women admitted at Hassan institute of Medical Sciences and who went in spontaneous onset of labour or induced labour. Basic demographic details were noted. Vitamin D levels were assessed on admission in these patients prior to childbirth. Incidence of postpartum haemorrhage among these patients after delivery were noted and analysed.Results: Vitamin D levels were deficient in 225 (58.5%) antenatal women in the study. The overall rates of atonic postpartum haemorrhage were higher in vitamin D deficient women that is 19 (54.2%) when compared to woman having normal vitamin D levels.Conclusions: Our results suggest that vitamin D deficiency is highly prevalent among pregnant woman and is a risk factor for atonic postpartum hemorrhage. Hence antenatal supplementation of vitamin D could help prevent vitamin D deficiency and uterine atony.

A retrospective analysis of obstetric hysterectomy in a tertiary center over one year

Background: Obstetric hysterectomy is a lifesaving procedure in a setting of life-threatening obstetrical hemorrhage. There is and increasing need of obstetric hysterectomy due to rising cases of caesarean sections and morbidly adherent placenta. We aimed to study the incidence, indications and fetomaternal outcome of obstetric hysterectomy. Various risk factors are discussed which may be helpful in reducing maternal and neonatal morbidity.Methods: A one year hospital based retrospective study involving detailed medical records of patients who underwent obstetric hysterectomy between 1st April 2022 and 31st march 2023.Results: The overall incidence of obstetric hysterectomy was 0.2% in this study with majority of patients in the 20-25-year age group, and patients who were 2nd and 3rd para comprised of the maximum number. The indication identified in this study were morbidly adherent placenta followed by atonic PPH and caesarean scar ectopic. The major risk factors noted were previous LSCS in 60% and morbidly adherent placenta in 53.3% patients. Of the 15 patients, 60% underwent total while 40% underwent subtotal hysterectomy. ICU admission, fever and coagulopathy were the leading post op complications. There was one case of maternal death noted and one case each of intrauterine death and perinatal mortality.Conclusions: Obstetric hysterectomy is the last resort to intractable bleeding and hence an important lifesaving procedure. The feto-maternal outcome depends on timely decision, surgical techniques and stringent post op monitoring of these patients.

Gerenciamento clínico da hemorragia pós-parto pelo enfermeiro obstetra: um protocolo de revisão de escopo / Clinical management of postpartum hemorrhage by obstetric nurses: a scoping review protocol

OBJETIVO: Mapear as evidências científicas sobre as ações dos enfermeiros obstétricos no gerenciamento clínico da hemorragia pós-parto. MÉTODO: Trata-se de uma revisão de escopo elaborada segundo as recomendações do JBI Institute Manual do Revisor para Scoping Review. As buscas serão realizadas nas bases de dados eletrônicas CINAHL, Cochrane Library, EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science e na literatura cinzenta. Os estudos que serão incluídos precisarão responder ao objetivo desta pesquisa e estar nos idiomas Português, Espanhol ou Inglês. Além disso, é necessário ter disponibilidade dos estudos na íntegra através de acesso remoto pelo acesso da CAFe. Os estudos que não serão incluídos serão os em formato de editorial e carta ao editor. Haverá a seleção por meio da leitura do título e resumo dos materiais encontrados nas buscas, sendo assim avaliados de maneira independente por dois revisores e nos casos de divergências por um terceiro avaliador. Os dados coletados estarão organizados e relacionados segundo a análise descritiva. Os resultados poderão estar dispostos em tabelas ou quadros, e serão discutidos com suporte de literatura acerca da temática, retratando a quinta etapa do método escolhido.

OBJECTIVE: To map the scientific evidence regarding the actions of obstetric nurses in the clinical management of postpartum hemorrhage. METHOD: This scoping review was developed according to the JBI Institute Reviewer's Manual for Scoping Reviews. The electronic databases CINAHL, Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science, and gray literature were searched. Included studies must address the research objective in Portuguese, Spanish, or English. In addition, full remote access to the studies via CAFe is required. Studies in editorial or letter format will be excluded. Selection will be based on the title and abstract of the materials found in the searches, independently assessed by two reviewers, with disagreements resolved by a third reviewer. Collected data will be organized and related through descriptive analysis. Results may be presented in tables or figures and discussed with support from literature, reflecting the fifth step of the selected methodology.

The Relationship between Fluid Resuscitation and the Risk of Disseminated In-travascular Coagulation in Postpartum Hemorrhage Patients / 实用妇产科杂志

Objective:To explore the relationship between fluid dosage during fluid resuscitation and the risk of disseminated intravascular coagulation(DIC)in postpartum hemorrhage patients.Methods:A retrospective case-control study was conducted on patients who were admitted to Shenyang Women′s and Children′s Hospital between January 1,2016,and December 31,2022 with postpartum hemorrhage≥1000 ml.The patients were di-vided into two groups according to pregnancy-corrected ISTH scores:group with ISTH score＞26;group with ISTH score≤26.The two groups were matched for 1 ∶ 4 propensity scores and the differences between ratio of crystalloid solution to bleeding volume;ratio of colloidal solution to bleeding volume;ratio of red blood cell infusion to bleeding volume;ratio of plasma infusion to bleeding volume and peak decrease of fibrinogen in the two groups were compared.And analyze the relationship between various observation indicators and the occurrence of DIC.Results:The ROC area under the curve(AUC)values for predicting of the ratio of crystalloid solution to bleeding volume,ratio of colloidal solution to bleeding volume,the peak decrease in fibrinogen,ratio of red blood cell infu-sion to bleeding volume,ratio of plasma infusion to bleeding volume were 0.670(95%CI 0.589-0.751),0.532(95%CI 0.440-0.623),0.771(95%CI 0.706-0.837),0.530(95%CI 0.439-0.621),and 0.563(95%CI 0.473-0.653),the optimal cut off values were 1.23,0.29,0.77,0.48,0.24.The ratio of crystalloid solution to bleeding volume and the peak decrease in fibrinogen were positively correlated with the occurrence of DIC after postpartum hemorrhage,the OR values were 0.256(95%CI 0.111-0.590)and 0.074(95%CI 0.024-0.228).There was no correlation between the ratio of colloidal solution to bleeding volume,the ratio of red blood cell infusion to bleeding volume,the ratio of plasma infusion to bleeding volume and the occurrence of DIC after postpartum hemorrhage.Conclusions:The infusion volume of crystalloid solution is related to the occurrence of DIC,and restrictive fluid resuscitation can reduce the incidence of DIC.Additionally,to lower the risk of DIC,fibrin-ogen or cold precipitation should be rapidly supplied when the decrease of fibrinogen exceeded 0.77 g/L to re-duce the risk of postpartum hemorrhage DIC.

Survey on Regional Hierarchical and Transferal Management of Severe Post-partum Hemorrhage in Beijing / 实用妇产科杂志

Objective:To assess the current state of care for Severe Postpartum Hemorrhage(SPPH)in refer-ral centers and non-referral centers,and to propose enhanced strategies for the regional prevention and manage-ment of SPPH.Methods:The clinical data of patients with SPPH,defined as postpartum blood loss≥1500 ml or transfusion of blood products≥1000 ml,in two districts of Beijing from January 2021 to June 2023 were retrospec-tively analyzed.A total of 201 cases of SPPH were included and they were divided into 125 cases in the referral center group and 76 cases in the non-referral center group based on whether they were city level referral centers.The clinical characteristics between these two groups were compared.Furthermore,a stratified analysis was con-ducted using a Logistic regression model to identify the risk factors associated with massive postpartum hemor-rhage,defined as postpartum hemorrhage≥4000 ml,transfusion requirements exceeding suspended red blood cells(RBC)>10 U and(or)plasma>1000 ml.Results:Analysis of cases presenting with SPPH between the two study groups showed that patients in the referral center group exhibited advanced maternal age,smaller gestation-al weeks at delivery and a higher proportion of high-risk factors compared to those in the non-referral center group,and the difference was statistically significant(P<0.05).The primary cause of SPPH in the referral center group was placental factors,while uterine atony was identified as the main factor in the non-referral center group,and this difference was statistically significant(P<0.05).Additionally,within the non-referral center group,there was a higher amount of blood loss during cesarean section,lower proportion of B-Lynch suture/vascular suture ligation,and higher proportion of uterine packing(P<0.05).Furthermore,compared to the referral center group,there were significantly higher incidences of plasma transfution volume,return to operating room for further inter-vention or exploratory laparotomy procedures after initial delivery and complications related to postpartum hemor-rhage observed in the non-referral center group(P<0.05).Moreover,it was noted that there were more cases of massive postpartum hemorrhagic disease reported in the non-referral center group than in the referral center group(P<0.05).In massive postpartum hemorrhage cases analyzed,referring centers had a higher percentage of patients presenting with multiple high-risk factors for postpartum hemorrhage during pregnancy when compared to non-referring centers(71.4%vs.33.3%,P<0.05).Placental factors accounted for majority causes leading to hemorrhage within referring centers(57.1%),whereas both uterine atony and placental factors played major roles within non-referring centers′cases(42.9%,28.6%).The multivariate Logistic regression analysis revealed that non-referral center delivery(aOR 3.47,95%CI 1.40-9.18)and a history of multiple intrauterine operations(aOR 12.63,95%CI 1.24-131.30)were identified as significant risk factors for massive postpartum hemor-rhage.Conclusions:The outcomes of high-risk pregnant women referral management in the region exhibit an im-provement,necessitating the reinforcement of training in non-referral midwifery institutions regarding identification of high-risk factors,surgical suture techniques,and comprehensive SPPH management to avert excessive bleed-ing and blood transfusion.

Predictive value of serum thrombospondin-1,D-dimer and tissue inhibitor of metalloproteinase-1 levels in late pregnancy for postpartum hemorrhage in re-pregnant women with scarred uterus / 新乡医学院学报

Objective To investigate the predictive value of serum thrombospondin-1(THBS-1),D-dimer(D-D)and tissue inhibitor of metalloproteinase-1(TIMP-1)levels in late pregnancy for postpartum hemorrhage(PPH)in re-pregnant women with scarred uterus.Methods Totally 108 re-pregnant women with scarred uterus admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2020 to August 2022 were selected and divided into the PPH group(n=21)and the non-PPH group(n=87)according to whether PPH occurred after delivery.On the day of admission,5 mL elbow venous blood was collected from re-pregnant women in the two groups,and the levels of serum THBS-1,D-D and TIMP-1 of pregnant women in the two groups were detected by enzyme-linked immunosorbent assay.The serum THBS-1,D-D TIMP-1 levels and clinical data of pregnant women between the two groups were compared.The influencing factors on the occurrence of PPH in re-pregnant women with scarred uterus were analyzed by multivariate logistic regression,and the predictive value of serum THBS-1,D-D and TIMP-1 levels on the occurrence of PPH in re-pregnant women with scarred uterus was evaluated by receiver operating characteristic curve.Results The percentage of patients with ≥ 2 induced abortions,placental abruption,uterine incision laceration,uterine inertia or scar thickness＜0.3 cm,as well as serum THBS-1 and D-D levels in late pregnancy in the PPH group were significantly higher than those in the non-PPH group,and serum TIMP-1 level in late pregnancy were significantly lower than that in the non-PPH group(P＜0.05).The uterine inertia,as well as high D-D and THBS-1 levels,were independent risk factors for PPH in re-pregnant women with scarred uterus(P＜0.05),and low TIMP-1 level was a protective factor(P＜0.05).The area under the curve of combined serum THBS-1,D-D and TIMP-1 levels to predict PPH in re-pregnant women with scarred uterus was greater than that predicted by the three factors alone(P＜0.05).Conclusion Serum THBS-1,D-D and TIMP-1 levels in late pregnancy can be used as reference indicators for predicting the occurrence of PPH in re-pregnant women with scarred uterus,and the combination of the three indexes is more effective in predicting the occurrence of PPH.

Fetomaternal hemorrhage with postpartum diagnosis of choriocarcinoma: a case report / 中华围产医学杂志

This paper reports a case of fetomaternal hemorrhage (FMH), which was diagnosed as choriocarcinoma due to late postpartum hemorrhage 20 days after full-term vaginal delivery. The patient fully recovered after chemotherapy combined with surgical treatment, and no disease progression was observed during a one-year follow-up. Choriocarcinoma is one of the risk factors for FMH. Therefore, it is suggested that the placenta should be examined in any suspected cases of FMH. Maternal human chorionic gonadotrophin (hCG) level should also be monitored after delivery for early diagnosis and better prognosis of choriocarcinoma.

Bundle para quantificação de perda sanguínea pós-parto vaginal / Bundle para la cuantificación de pérdida sanguínea posparto vaginal / Bundle for quantifying vaginal blood loss after childbirth

Resumo Objetivo Construir e validar o conteúdo de um bundle para quantificação da perda sanguínea pós-parto vaginal. Métodos Estudo metodológico desenvolvido de fevereiro a agosto de 2022, em três etapas: levantamento bibliográfico, construção do instrumento e validação de conteúdo por 14 experts. O instrumento para validação foi composto por 11 itens selecionados a partir de revisão sistemática. Para cada item do bundle aplicou-se escala Likert e para verificar a concordância entre experts, calculou-se o Índice de Concordância. Consideraram-se válidos os itens com concordância acima de 80%. A validação de conteúdo foi realizada em uma única rodada de avaliação. Resultados A versão final do bundle foi composta por nove itens. Os cuidados propostos estão relacionados à quantificação direta do sangramento pós-parto e seu registro, observação da puérpera, a utilização de protocolos institucionais em casos de hemorragia pós-parto, assim como a capacitação da equipe. Conclusão O estudo permitiu construir e validar bundle para quantificação da perda sanguínea pós-parto vaginal, com vistas à melhora do diagnóstico de hemorragia pós-parto.

Resumen Objetivo Elaborar y validar el contenido de un bundle para la cuantificación de pérdida sanguínea posparto vaginal. Métodos Estudio metodológico, llevado a cabo de febrero a agosto de 2022, en tres etapas: análisis bibliográfico, construcción del instrumento y validación de contenido por 14 expertos. El instrumento para validación consistió en 11 ítems seleccionados a partir de revisión sistemática. Se aplicó la escala Likert para cada ítem del bundle; y para verificar la concordancia entre expertos, se calculó el Índice de Concordancia. Se consideraron válidos los ítems con concordancia superior a 80 %. La validación de contenido se realizó en una única ronda de evaluación. Resultados La versión final del bundle consistió en nueve ítems. Los cuidados propuestos están relacionados con la cuantificación directa del sangrado posparto y su registro, la observación de la puérpera, la utilización de protocolos institucionales en casos de hemorragia posparto, así como también la capacitación del equipo. Conclusión El estudio permitió elaborar y validar un bundle para la cuantificación de pérdida sanguínea posparto vaginal, con el fin de mejorar el diagnóstico de hemorragia posparto.

Abstract Objective To construct and validate the content of a bundle to quantify vaginal blood loss after childbirth. Methods This is a methodological study developed from February to August 2022, divided into bibliographic survey, instrument construction and content validity, by 14 experts. The instrument for validity consisted of 11 items selected from a systematic review. For each item in the bundle, a Likert scale was applied, and to check agreement among experts, the Concordance Index was calculated. Items with agreement above 80% were considered valid. Content validity was carried out in a single round of assessment. Results The final version of the bundle consisted of nine items. The proposed care is related to direct quantification of postpartum bleeding and its recording, observation of postpartum women, use of institutional protocols in cases of postpartum hemorrhage as well as team training. Conclusion The study allowed constructing and validating a bundle for quantifying vaginal blood loss after childbirth, with a view to improving postpartum hemorrhage diagnosis.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products

Abstract Objective Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Methods Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Results Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. Conclusion The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

Effects of oxytocin induction on early postpartum hemorrhage, perineal integrity, and breastfeeding: a case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the postpartum hemorrhage, perineal integrity, and breastfeeding results of mothers who underwent oxytocin induction in the first stage of labor in the early postpartum period. METHODS: This single-center observational case-control study was conducted in the obstetric unit of a public hospital in Istanbul. The study sampling included 44 pregnant women who received oxytocin induction (case group) and 44 pregnant women who did not receive oxytocin (control group). The Personal Information Form, LATCH Breastfeeding Assessment Tool, Breastfeeding Self-Efficacy Scale, Redness, Edema, Ecchymosis, Discharge, and Approximation Scale, and Postpartum Hemorrhage Collection Bag were used in data collection, and pad follow-up was carried out. RESULTS: The amount of hemorrhage in the first 24 h of the postpartum period and the mean Redness, Edema, Ecchymosis, Discharge, and Approximation Scale score were significantly higher in the case group. While 47.7% of the oxytocin-induced women had 1st or 2nd, and 11.4% had 3rd or 4th degrees of lacerations, 20.5% of the control group had 1st or 2nd, and 2.3% had 3rd or 4th degrees of lacerations. There was no significant difference between the mean scores of the Breastfeeding Self-Efficacy Scale and LATCH Breastfeeding Assessment Tool in both groups. CONCLUSION: According to the study findings, it was determined that oxytocin induction administered in the first stage of labor increased hemorrhage and perineal trauma in the early postpartum period but did not affect the results of breastfeeding. Clinical Trial Registration Number: NCT04441125.

Prevención de hemorragia posparto durante la cesárea mediante ligadura de las arterias uterinas en pacientes con factores de riesgo / Uterine artery ligation for prevention of postpartum hemorrhage in patients with risk factors for cesarean section

Resumen OBJETIVO: Evaluar la utilidad preventiva de la hemorragia posparto mediante la ligadura bilateral de las arterias uterinas en pacientes con factores de riesgo. MATERIALES Y MÉTODOS: Estudio prospectivo, experimental, aleatorizado no probabilístico, por conveniencia, de casos y controles, longitudinal, comparativo al que se incluyeron pacientes con factores de riesgo de hemorragia posparto que finalizaron el embarazo mediante cesárea de urgencia. Se integraron dos grupos: experimental, en quienes se aplicó la técnica de ligadura bilateral de arterias uterinas y el grupo control: solo con cesárea. Antes y después del procedimiento quirúrgico se estimaron la pérdida de sangre, los parámetros de hemoglobina y hematocrito y se compararon con el grupo de control. RESULTADOS: Se estudiaron 91 pacientes: 45 en el grupo experimental y 46 de solo cesárea. Se observaron diferencias significativas en la pérdida de sangre del grupo experimental (345.56 ± 64.69 mL) en comparación con el grupo control (426.06 ± 125.49 mL; p = 0.000247), en los parámetros de hemoglobina (grupo experimental: 11:13 ± 1.62 g/dL; grupo control: 10.49 ± 1.32 g/dL, p = 0.037) y hematocrito (grupo experimental: 33.86%; grupo control: 31.87%; p = 0.017). CONCLUSIÓN: La ligadura bilateral de las arterias uterinas a pacientes con factores de riesgo de hemorragia poscesárea es una medida preventiva eficaz que ayuda a disminuir la pérdida sanguínea. Al complementarla con los uterotónicos reduce el volumen de sangrado.

Abstract OBJECTIVE: Evaluation of the benefits and harms of bilateral uterine artery ligation for prevention of postpartum hemorrhage in patients with risk factors. MATERIALS AND METHODS: Prospective, experimental, randomized, case-control, longitudinal, comparative study conducted during 2022, which included patients with risk factors for postpartum hemorrhage who terminated pregnancy by emergency cesarean section. Two groups were included: the experimental group, in which the technique of bilateral uterine artery ligation was applied, and the control group, in which only cesarean section was performed. Before and after the surgical procedure, blood loss, hemoglobin and hematocrit parameters were estimated and compared with the control group. RESULTS: Ninety-one patients were studied: 45 in the experimental group and 46 in the cesarean only group. Significant differences were observed in blood loss in the experimental group (345.56 ± 64.69 mL) compared to the control group (426.06 ± 125.49 mL; p = 0.000247), in hemoglobin (experimental group: 11:13 ± 1.62 g/dL; control group: 10.49 ± 1.32 g/dL, p = 0.037) and hematocrit (experimental group: 33.86%; control group: 31.87%; p = 0.017). CONCLUSION: Bilateral uterine artery ligation in patients with risk factors for post-cesarean hemorrhage is an effective preventive measure that helps to reduce blood loss. When combined with uterotonics, it reduces the volume of bleeding.

Postpartum hemorrhage in electronic health records: risk factors at admission and in-hospital occurrence

Abstract Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods: A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results: The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion: Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.

Risk factors for postpartum hemorrhage according to the Robson classification in a low-risk maternity hospital

Abstract Objective To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.

The profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study

Abstract Objective In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO). Methods A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU. Results The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO. Conclusion The principal factors associated with poor maternal outcome were being multiparous and placental abruption.

Factores de riesgo relacionados con las complicaciones de la hemorragia obstétrica / Risk factors related to complications of obstetric hemorrhage

Introducción: La hemorragia obstétrica es considerada una causa mayor de mortalidad materna. El reconocimiento de las mujeres con riesgo de desarrollar complicaciones durante la hemorragia obstétrica, es la primera acción para promover un tratamiento optimizado y evitar la muerte. Objetivo: Identificar los factores de riesgo de complicaciones en pacientes con hemorragia obstétrica. Métodos: Estudio observacional, analítico de casos y controles, con 12 casos (con complicaciones) y 24 controles (sin complicaciones). Se aplicó las medidas resúmenes para cada tipo de variables y la determinación de los factores de riesgos mediante la aplicación del odds ratio (OR), se utilizó el paquete estadístico SPSS versión 26.0, con un intervalo de confianza (IC) del 95 por ciento. Resultados: La combinación del choque hipovolémico, más la insuficiencia renal aguda, fue la complicación más frecuente para un 13,8 por ciento. Predominó la atonía uterina para un 50,0 por ciento como causa de hemorragia.Las variables predictivas de complicaciones fueron: el valor de creatinina ≥ 113 µmol/L (OR= 19,08; IC: 2,75-138,36), índice internacional normalizado ≥ 2 (OR= 4,66; IC: 1,46-14,90), hematocrito < 0,23 (OR= 4,00; IC: 1,76-9,08) y hemoglobina < 70 g/L (OR= 2,22; IC: 1,25-3,95). Conclusiones: La creatinina ≥ 113 µmol/L, índice internacional normalizado ≥ 2, hematocrito < 0,23 y hemoglobina < 70 g/L son los principales factores de riesgo identificados para el desarrollo de complicaciones durante la hemorragia obstétrica(AU)

Introduction: Obstetric hemorrhage is considered a major cause of maternal mortality. Recognition of women at risk of developing complications during obstetric hemorrhage is the first action to promote optimized treatment and avoid death. Objective: Identify risk factors for complications in patients with obstetric hemorrhage. Methods: Observational, analytical case-control study, with 12 cases (with complications) and 24 controls (without complications). The summary measures were applied for each type of variables and the determination of the risk factors by applying the odds ratio (OR), the SPSS statistical package version 26.0 was used, with a confidence interval (CI) of 95 percent. Results: The combination of hypovolemic shock, plus acute renal failure, was the most frequent complication for 13.8 percent. Uterine atony predominated for 50.0 percent as the cause of hemorrhage. The predictive variables of complications were: creatinine value ≥ 113 µmol/L (OR= 19.08; CI: 2.75-138.36), international normalized ratio ≥ 2 (OR= 4.66; CI: 1. 46-14.90), hematocrit < 0.23 (OR= 4.00; CI: 1.76-9.08) and hemoglobin < 70 g/L (OR= 2.22; CI: 1.25-3.95). Conclusions: Creatinine ≥ 113 µmol/L, international normalized ratio ≥ 2, hematocrit < 0.23 and hemoglobin < 70 g/L are the main risk factors identified for the development of complications during obstetric hemorrhage(AU)

An analysis of the efficacy of uterine artery embolization in obstetrical hemorrhage

Background: Obstetrical hemorrhage is the single most important cause of maternal morbidity and mortality. The study is conducted at a tertiary-care hospital to assess the efficacy of uterine artery embolization as a treatment for obstetrical uterine hemorrhage. It examines various aspects such as the outcome of the procedure, need of blood and blood products, need of secondary procedures post intervention and the possibility of future pregnancies.Methods: It was a retrospective observational study conducted with sample size of 20 patients with obstetrical hemorrhage at the Department of Obstetrics and Gynecology of Bhagwan Mahaveer Jain Hospital, Bengaluru in India between January 2011 to July 2019.Results: Records of 20 patients with obstetrical hemorrhage were assessed. The study indicates that 11 patients experienced postpartum hemorrhage (PPH), 5 postabortal bleeding & 4 bleeding due to scar ectopic. Out of 20 patients, hemodynamic stability was achieved in 17 cases (85%), hysterectomy was needed in 2 cases (10%) and 1 (5%) patient died after the procedure. Of total 20 cases, 18 (90%) required secondary procedures post-intervention like dilatation and evacuation 6 cases (33.3% of total cases), vaginal suturing and packing 10 cases (55.5% of total cases) and supportive measures like PPH and Disseminated intravascular coagulation (DIC) management in 2 cases (11.1% of total cases). Blood transfusion was given in 15 cases (75%) after the procedure. Future pregnancy was attained in 8 cases (47%) after considering the history of the patients, loss of follow-up, possibility of complications, family planning and hysterectomy performed.Conclusions: Uterine artery embolization is a very effective method to control obstetric hemorrhage with high success and low complication rate and hysterectomy can be avoided to preserve fertility.