ABSTRACT
During the third stage of labor, oxytocin and tranexamic acid, oxytocin and misoprostol, oxytocin and methylergometrine, or carbetocin is recommended for the prevention of postpartum hemorrhage after vaginal delivery. Intravenous oxytocin (10 IU) immediately after delivery of the neonate (after either anterior shoulder or whole-body delivery) and before delivery of the placenta is recommended. If oxytocin and tranexamic acid combination is chosen, intravenous tranexamic acid (1 g) in addition to intravenous oxytocin (10 IU) immediately after delivery of the neonate and before placental delivery is recommended. If oxytocin and misoprostol combination is chosen, sublingual misoprostol (400 µg) in addition to intravenous oxytocin (10 IU) immediately after delivery of the neonate is recommended. If there is no intravenous access or if in low-resource settings, sublingual misoprostol (400 µg) and intramuscular oxytocin (10 IU) are recommended. If oxytocin and methylergometrine combination is chosen, intramuscular methylergometrine (0.2 mg) and intravenous oxytocin (10 IU) immediately after delivery of the neonate are recommended. Single-dose intravenous or intramuscular carbetocin (100 µg) immediately after delivery of the neonate is recommended. Controlled cord traction and delayed cord clamping for approximately 60 seconds is recommended. There is insufficient evidence to support or refute umbilical cord milking, uterine massage, or nipple stimulation for the prevention of postpartum hemorrhage. Repair of first- and second-degree lacerations with continuous synthetic suture technique is recommended. No repair of first-degree lacerations if hemostatic and normal cosmesis can be considered. Repair of third-degree lacerations with end-to-end or overlap continuous synthetic suture technique is recommended. Repair of fourth-degree lacerations with delayed absorbable 4-0 or 3-0 polyglactin or chromic suture in a running fashion is recommended. The use of single-dose second-generation cephalosporin at the time of third- or fourth-degree laceration repairs can be considered. Skin-to-skin contact after delivery is recommended. There is insufficient evidence to support or refute routine cord blood gas sampling after delivery. Public cord blood banking is recommended.
Subject(s)
Lacerations , Methylergonovine , Misoprostol , Oxytocics , Postpartum Hemorrhage , Tranexamic Acid , Female , Humans , Infant, Newborn , Lacerations/drug therapy , Methylergonovine/therapeutic use , Oxytocin/therapeutic use , Placenta , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/prevention & control , PregnancyABSTRACT
OBJECTIVE: To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. METHODS: A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. RESULTS: A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. CONCLUSION: Misoprostol showed to be effective and safe for treating postpartum hemorrhage.
Subject(s)
Misoprostol/therapeutic use , Oxytocics/therapeutic use , Postpartum Hemorrhage/drug therapy , Adult , Cross-Sectional Studies , Female , Gestational Age , Humans , Methylergonovine/therapeutic use , Oxytocin/therapeutic use , Pregnancy , Young AdultABSTRACT
ABSTRACT Objective To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. Methods A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. Results A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. Conclusion Misoprostol showed to be effective and safe for treating postpartum hemorrhage.
RESUMO Objetivo Caracterizar o uso do medicamento misoprostol para o tratamento da hemorragia pós-parto em gestantes. Métodos Estudo observacional descritivo realizado por meio de dados secundários de gestantes que fizeram uso do misoprostol para tratamento da hemorragia pós-parto em maternidade pública de referência, no período de julho de 2015 a junho de 2017. Caracterizaram-se os perfis clínico e sociodemográfico das gestantes, o padrão de utilização do misoprostol e sua taxa de sucesso no controle da hemorragia pós-parto. Resultados Foram identificadas 717 prescrições do misoprostol. Destas, 10% foram para tratamento da hemorragia pós-parto. Predominaram gestantes adultas jovens, casadas, com Ensino Médio completo, raça branca, da região urbana, multíparas (68,1%) e 25% apresentavam cesáreas prévias. A idade gestacional média foi 39 semanas e 51,4% das gestantes tiveram parto cesárea. Houve uso profilático de ocitocina em 47,2% das mulheres. O tratamento da hemorragia pós-parto eve sucesso em 84,7% das gestantes que usaram misoprostol. Destas, 79,2% também usaram ocitocina e 54,2% metilergometrina. Apenas 13,5% das gestantes tiveram menos de cinco consultas de pré-natal, e a principal causa da hemorragia pós-parto foi atonia uterina. Foram registrados 13 casos de complicações após a hemorragia, 15,3% necessitaram de hemotransfusão e houve um caso de óbito materno. Conclusão O misoprostol demonstrou ser efetivo e seguro para o tratamento da hemorragia pós-parto.
Subject(s)
Humans , Pregnancy , Adult , Young Adult , Oxytocics/therapeutic use , Misoprostol/therapeutic use , Postpartum Hemorrhage/drug therapy , Oxytocin/therapeutic use , Cross-Sectional Studies , Gestational Age , Methylergonovine/therapeutic useABSTRACT
OBJECTIVE: Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management. STUDY DESIGN: The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals. RESULTS: Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy. CONCLUSIONS: In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.
Subject(s)
Postpartum Hemorrhage/therapy , Shock/therapy , Uterine Inertia/therapy , Adolescent , Adult , Blood Component Transfusion/methods , Central America , Cesarean Section , Cohort Studies , Delivery, Obstetric , Erythrocyte Transfusion/methods , Female , Humans , Ligation/methods , Longitudinal Studies , Methylergonovine/therapeutic use , Oxytocics/therapeutic use , Oxytocin/therapeutic use , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/mortality , Pregnancy , Prospective Studies , Prostaglandins/therapeutic use , Severity of Illness Index , Shock/etiology , Shock/mortality , Suture Techniques , Uterine Artery/surgery , Uterine Artery Embolization/methods , Uterine Balloon Tamponade , Uterine Inertia/mortality , Young AdultABSTRACT
BACKGROUND: Methylergonovine is an ergot alkaloid widely used in postpartum women. It is also an active metabolite of methysergide and previous studies suggest that it could be effective against refractory headache and cluster headache. The purpose of the present study was to assess the potential therapeutic effectiveness of methylergonovine in the emergency treatment of severe migraine. METHODS: One hundred and twenty five female patients with migraine attending the emergency department received 0.15 mg of methylergonovine intravenously. Pain intensity, heart rate, blood pressure, and methylergonovine side effects were checked 5, 10, 15, 30 and 60 minutes after drug administration. An additional 0.075 mg dose of methylergonovine was administered to those patients who did not experienced relevant pain relief 15 minutes after dosing. RESULTS: Pain intensity decreased markedly from the first minutes after dosing, the 74.4% of patients being pain free at 60 minutes. Only seven patients required an additional dose of methylergonovine. Nausea and vomiting were the most relevant side effects related with methylergonovine administration (84% of patients). A substantial decrease (10 to 25 mmHg) in systolic blood pressure values was observed in 56% of the patients. A significant correlation (p < 0.0001) was found between the decrease in pain intensity and the reduction of systolic blood pressure. CONCLUSION: Although limited by the non-controlled design of the study, our data suggest that intravenous methylergonovine can be an effective and safe drug in the management of severe migraine attacks in the emergency room.
Subject(s)
Emergency Treatment , Methylergonovine/therapeutic use , Migraine Disorders/drug therapy , Oxytocics/therapeutic use , Adult , Analysis of Variance , Blood Pressure/drug effects , Emergency Service, Hospital , Female , Humans , Methylergonovine/administration & dosage , Middle Aged , Oxytocics/administration & dosage , Pain Measurement , Treatment OutcomeABSTRACT
Objetivos: El objetivo del presente estudio es establecer la seguridad, eficacia y costos del Misoprostol sublingual, en el manejo activo del tercer periódo del parto. Material y métodos: Se hace un estudio prospectivo, randomizado, controlado, donde se distribuyen 75 pacientes en tres grupos de 25 pacientes: A. Misoprostol sublingual, B. Oxitocina endovenosa, C. Metil-ergonovina postalumbramiento. Se cuantificó el sangrado durante la primera hora posparto y tiempo de alumbramiento. Se valoró el costo de los insumos utilizados en cada grupo, el comportamiento de los signos vitales antes y después del alumbramiento y los efectos colaterales de la droga en cada uno de los grupos. Resultados: El sangrado en la primera hora posparto fue de 389cc ñ 271.7 en el grupo de Misoprostol Vs 467cc ñ 427.5 en el grupo de oxitocina; Vs 546.8 ñ 338.5 para el grupo de Metil-ergonovina postalumbramiento, Siendo estos resultados estadísticamente significativos p<0.01. El tiempo de alumbramiento fue menor en el grupo de Misoprostol 308 seg ñ 57 Vs 362 seg ñ 162.3 con oxitocina, Vs 557 seg ñ 256.2 (p<0.05). Los costos con Misoprostol fueron de $500 Vs $8.000 con oxitocina y $2.000 con Metil-ergonovina. No se presentaron efectos colaterales en ninguno de los grupos. Conclusión: El uso de 50 mcgr de Misoprostol sublingual demostró ser seguro, eficaz y económico en el manejo del tercer periodo del parto.
Subject(s)
Humans , Male , Female , Labor, Obstetric , Methylergonovine , Misoprostol , OxytocinABSTRACT
Se realizó un estudio prospectivo evaluando el uso de oxitocina o metilergobasina al ocurrir la salida del hombro anterior del feto, para determinar si disminuye el sangrado el tercer período del parto. Se evaluaron 150 pacientes que ingresaron a la sala de parto de la Maternidad Concepción Palacios entre agosto de 1997, con embarazos a término. Se distribuyeron en tres grupos: oxitocina, metilergobasina y sin medicamentos. Ambas drogas redujeron el sangrado durante el tercer período del parto, con respecto al grupo control, con un mínimo de complicacions durante el procedimiento. Recomendamos el uso de oxitocina o metilergobasina durante el alumbramiento por ende la morbimortalidad materna