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1.
PLoS One ; 16(10): e0258784, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34710153

RESUMEN

BACKGROUND: Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. METHODS: A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. RESULTS: Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. CONCLUSIONS: In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.


Asunto(s)
Trajes Gravitatorios/estadística & datos numéricos , Instituciones de Salud/normas , Personal de Salud/normas , Complicaciones del Trabajo de Parto/terapia , Hemorragia Posparto/terapia , Ropa de Protección/estadística & datos numéricos , Choque/prevención & control , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Primeros Auxilios , Humanos , Mortalidad Materna/tendencias , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/mortalidad , Hemorragia Posparto/epidemiología , Hemorragia Posparto/mortalidad , Embarazo
2.
PLoS One ; 16(10): e0258619, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34653202

RESUMEN

BACKGROUND: Postpartum hemorrhage (PPH) constitutes a major risk for maternal mortality and morbidity. Unfortunately, the severity of PPH can be underestimated because it is difficult to accurately measure blood loss by visual estimation. The delta neutrophil index (DNI), which reflects circulating immature granulocytes, is automatically calculated in hematological analyzers. We evaluated the significance of the DNI in predicting hemorrhage severity based on the requirement for massive transfusion (MT) in patients with PPH. METHODS: We retrospectively analyzed data from a prospective registry to evaluate the association between the DNI and MT. Moreover, we assessed the predictive ability of the combination of DNI and shock index (SI) for the requirement for MT. MT was defined as a transfusion of ≥10 units of red blood cells within 24 h of PPH. In total, 278 patients were enrolled in this study and 60 required MT. RESULTS: Multivariable logistic regression revealed that the DNI and SI were independent predictors of MT. The optimal cut-off values of ≥3.3% and ≥1.0 for the DNI and SI, respectively, were significantly associated with an increased risk of MT (DNI: positive likelihood ratio [PLR] 3.54, 95% confidence interval [CI] 2.5-5.1 and negative likelihood ratio [NLR] 0.48, 95% CI 0.4-0.7; SI: PLR 3.21, 95% CI 2.4-4.2 and NLR 0.31, 95% CI 0.19-0.49). The optimal cut-off point for predicted probability was calculated for combining the DNI value and SI value with the equation derived from logistic regression analysis. Compared with DNI or SI alone, the combination of DNI and SI significantly improved the specificity, accuracy, and positive likelihood ratio of the MT risk. CONCLUSION: The DNI and SI can be routinely and easily measured in the ED without additional costs or time and can therefore, be considered suitable parameters for the early risk stratification of patients with primary PPH.


Asunto(s)
Neutrófilos/metabolismo , Hemorragia Posparto/terapia , Choque/etiología , Adulto , Presión Sanguínea , Transfusión Sanguínea , Servicio de Urgencia en Hospital , Femenino , Frecuencia Cardíaca , Humanos , Recuento de Leucocitos , Modelos Logísticos , Hemorragia Posparto/sangre , Embarazo , Estudios Retrospectivos
3.
Medicina (Kaunas) ; 57(9)2021 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-34577906

RESUMEN

Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. Materials and Methods: We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. Results: MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage.


Asunto(s)
Hemorragia Posparto , Transfusión Sanguínea , Femenino , Hospitales Universitarios , Humanos , Japón , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos
4.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-34588204

RESUMEN

Postpartum haemorrhage (PPH) due to multiple vaginal lacerations is difficult to manage and tamponade is used as a life-saving measure. Condom catheter with stay sutures at the vaginal introitus for this purpose has not been reported. We describe successfully managing PPH due to multiple vaginal lacerations following a forceps delivery using a condom tied to an 18 FG Foley catheter. The device was introduced to the vagina, inflated with 700 mL of normal saline and was held in situ by sealing the vaginal introitus with interrupted nylon stitches running between the labia minora. Condom catheter is cheap and freely available in low-resource settings. The preparation and application can be done by a less experienced operator.


Asunto(s)
Laceraciones , Hemorragia Posparto , Taponamiento Uterino con Balón , Adulto , Catéteres , Condones , Femenino , Humanos , Hemorragia Posparto/terapia , Embarazo , Vagina
6.
BMJ Open ; 11(9): e047983, 2021 09 28.
Artículo en Inglés | MEDLINE | ID: mdl-34588243

RESUMEN

OBJECTIVES: This study aims to use the high-quality national monitoring data from the China's National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes. SETTINGS: Observational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS. PARTICIPANTS: 11 667 406 women were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: We screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies. RESULTS: Obstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012-2019 (14.03-29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%-9.92%) and MMR during hospitalisation (21.41‰-7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001). CONCLUSION: To minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.


Asunto(s)
Cesárea , Hemorragia Posparto , Transfusión Sanguínea , China/epidemiología , Femenino , Humanos , Histerectomía , Incidencia , Hemorragia Posparto/epidemiología , Hemorragia Posparto/terapia , Embarazo , Factores de Riesgo
7.
J Obstet Gynaecol Res ; 47(11): 3867-3874, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34482579

RESUMEN

AIM: In postpartum women, retained placenta is diagnosed in the absence of signs of placental separation and expulsion, and requires manual removal of the placenta (MROP). MROP may lead to massive hemorrhage, hemodynamic instability, and the need for emergency interventions including blood transfusion, interventional radiology, and hysterectomy. In this study, we aimed to identify the risk factors for retained placenta requiring MROP after vaginal delivery and postpartum hemorrhage (PPH) following MROP. METHODS: A multicenter retrospective study was performed using data from women who delivered at term between 2010 and 2018 at 13 facilities in Japan. Of 36 454 eligible women, 112 women who required MROP were identified. Multivariate logistic regression analyses were conducted to evaluate the risk factors for retained placenta and PPH following MROP. RESULTS: A history of abortion, assisted reproductive technology (ART), instrumental delivery, and delivery of small-for-gestational-age infant were independent risk factors for MROP (adjusted odds ratios [95% confidence intervals]: 1.93 [1.28-2.92], 8.41 [5.43-13.05], 1.80 [1.14-2.82], and 4.32 [1.97-9.48], respectively). ART was identified as an independent risk factor for PPH (adjusted odds ratio [95% confidence interval]: 6.67 [2.42-18.36]) in patients who underwent MROP. CONCLUSION: ART pregnancies significantly increased the risk of retained placenta requiring MROP and PPH. Our results suggest that clinicians need consider patient transfer to a higher-level facility and preparation of sufficient blood products before initiating MROP in cases of ART pregnancies. Our study may assist in identifying high-risk women for PPH before MROP and in guiding treatment decisions, especially in facilities without a blood bank.


Asunto(s)
Retención de la Placenta , Hemorragia Posparto , Parto Obstétrico , Femenino , Humanos , Placenta , Retención de la Placenta/epidemiología , Retención de la Placenta/terapia , Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos
8.
BMC Pregnancy Childbirth ; 21(1): 620, 2021 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-34517834

RESUMEN

BACKGROUND: Guidelines recommend that women at high risk of postpartum haemorrhage deliver at facilities able to handle heavy bleeding. However postpartum haemorrhage is often unexpected. This study aims to compare outcomes and health service use related to transfusion of ≥4 units of red blood cells between women delivering in tertiary and lower level hospitals. METHODS: The study population was women giving birth in public hospitals in New South Wales, Australia, between July 2006 and December 2010. Data were obtained from linked hospital, birth and blood bank databases. The exposure of interest was transfusion of four or more units of red cells during admission for delivery. Outcomes included maternal morbidity, length of stay, neonatal morbidity and need for other blood products or transfer to higher care. Multivariable regression models were developed to predict need of transfusion of ≥4 units of red cells using variables known early in pregnancy and those known by the birth admission. RESULTS: Data were available for 231,603 births, of which 4309 involved a blood transfusion, with 1011 (0.4%) receiving 4 or more units. Women giving birth in lower level and/or smaller hospitals were more likely to receive ≥4 units of red cells. Women receiving ≥4 units in tertiary settings were more likely to receive other blood products and have longer hospital stays, but morbidity, readmission and hysterectomy rates were similar. Although 46% of women had no identifiable risk factors early in pregnancy, 20% of transfusions of ≥4 units occurred within this group. By the birth admission 70% of women had at least one risk factor for requiring ≥4 units of red cells. CONCLUSIONS: Overall outcomes for women receiving ≥4 units of red cells were comparable between tertiary and non-tertiary facilities. This is important given the inability of known risk factors to predict many instances of postpartum haemorrhage.


Asunto(s)
Transfusión Sanguínea , Hospitalización/estadística & datos numéricos , Hospitales Públicos , Parto/sangre , Hemorragia Posparto/epidemiología , Hemorragia Posparto/terapia , Adulto , Femenino , Humanos , Morbilidad , Nueva Gales del Sur/epidemiología , Embarazo , Factores de Riesgo , Datos de Salud Recolectados Rutinariamente
9.
BMC Emerg Med ; 21(1): 98, 2021 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-34454430

RESUMEN

BACKGROUND: Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel's competence in PPH and AC, utilizing different tools. METHODS: The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses. RESULTS: A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels' responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8. CONCLUSIONS: This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.


Asunto(s)
Servicios Médicos de Urgencia , Hemorragia Posparto , Adulto , Técnicos Medios en Salud , Aorta , Atención a la Salud , Femenino , Humanos , Masculino , Noruega , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/terapia , Embarazo
10.
Obstet Gynecol ; 138(3): 361-365, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34352848

RESUMEN

BACKGROUND: Postpartum hemorrhage is a main cause of maternal mortality worldwide, with rising incidence, thus demanding new treatment approaches. Intrauterine balloon systems with application of intrauterine vacuum are a promising new method. METHOD: All women treated with vacuum-induced tamponade using a modified balloon system were included in this single-center study. Aiming to reduce uterine size for control of postpartum hemorrhage, the intrauterine balloon was filled to 50-100 mL and connected to a vacuum device. Success rate of vacuum-induced tamponade, defined as no need for additional interventional treatment, was analyzed by etiology of postpartum hemorrhage and time period of use. EXPERIENCE: Vacuum-induced tamponade was applied in 66 women. Success rate was 86% in women with uterine atony (n=44) and 73% in women with postpartum hemorrhage due to placental pathology (n=22). Success rate improved over the study period, culminating in a success rate of 100% in women with postpartum hemorrhage due to uterine atony in the second half of the observation period (n=22). CONCLUSION: This observational study supports our pathophysiologic understanding of uterine atony: to treat an atonic uterus, uterine volume must be reduced, leading to coiling of the uterine spiral arteries and, hence, reduced blood loss.


Asunto(s)
Hemorragia Posparto/terapia , Taponamiento Uterino con Balón , Adulto , Estudios de Cohortes , Femenino , Humanos , Embarazo , Suiza , Resultado del Tratamiento , Inercia Uterina , Vacio
11.
Transfus Apher Sci ; 60(4): 103207, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34353706

RESUMEN

Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.


Asunto(s)
Bancos de Sangre/organización & administración , Transfusión Sanguínea , Procedimientos Médicos y Quirúrgicos sin Sangre , Anemia/terapia , Bancos de Sangre/economía , Pérdida de Sangre Quirúrgica , Seguridad de la Sangre , Transfusión Sanguínea/economía , Infecciones de Transmisión Sanguínea/prevención & control , Procedimientos Médicos y Quirúrgicos sin Sangre/economía , COVID-19 , Toma de Decisiones Clínicas , Países en Desarrollo , Selección de Donante/economía , Medicina Basada en la Evidencia , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Pandemias , Hemorragia Posparto/terapia , Guías de Práctica Clínica como Asunto , Embarazo , Prevalencia , Utilización de Procedimientos y Técnicas , SARS-CoV-2 , Sudáfrica/epidemiología , Medicina Transfusional/educación
12.
Transfusion ; 61(10): 2898-2905, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34455611

RESUMEN

BACKGROUND: Postpartum hemorrhage (PPH) can be associated with coagulopathy, which may be difficult to rapidly assess and may exacerbate blood loss. Rotational thromboelastometry (ROTEM) at the point of care can guide clinician choice of blood products and has been shown in some settings to reduce transfusions and improve outcomes. This hospital-based observational study aims to measure effects of a ROTEM-guided transfusion protocol on transfusion practice and clinical outcomes in patients with PPH managed in the operating theater. STUDY DESIGN AND METHODS: We compared a retrospective cohort of 450 consecutive patients with PPH treated in the operating theater before the introduction of a ROTEM-guided transfusion algorithm in June 2016, with 450 patients treated after its introduction. Multivariate regression was used to evaluate the effect of ROTEM introduction on the primary outcome, patients requiring a packed red blood cell (PRBC) transfusion and adjusting for demographic and obstetric confounders. Secondary outcomes included other blood product transfusions, hysterectomy, and intensive care unit admission. RESULTS: A total of 90 (20%) of patients treated prior to ROTEM introduction received a PRBC transfusion, compared with 102 (22.7%) of those treated after ROTEM introduction (95% confidence interval [CI] 1.0-2.0, p = .04). There was no difference in PRBC transfusion in patients undergoing caesarean section (95% CI 0.5-1.8, p = .99). There was a trend toward increased use of cryoprecipitate and reduced use of platelets and fresh frozen plasma after ROTEM introduction. CONCLUSION: In our institution, the introduction of ROTEM-guided transfusion did not reduce PRBC transfusion in patients with PPH treated in the operating theater.


Asunto(s)
Transfusión Sanguínea/métodos , Hemorragia Posparto/cirugía , Tromboelastografía/métodos , Adulto , Coagulación Sanguínea , Transfusión de Eritrocitos/métodos , Femenino , Humanos , Hemorragia Posparto/sangre , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos
13.
Afr Health Sci ; 21(1): 311-319, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34394312

RESUMEN

Background: Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives' experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH. Methods: Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation. Results: After data analysis, one theme emerged "challenges experienced by midwives managing women with PPH" and five subthemes, including: "difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation". Conclusion: The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease.


Asunto(s)
Adhesión a Directriz/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud Materna/organización & administración , Partería/métodos , Enfermeras Obstetrices/psicología , Hemorragia Posparto/terapia , Población Rural , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Mortalidad Materna , Persona de Mediana Edad , Hemorragia Posparto/mortalidad , Hemorragia Posparto/prevención & control , Embarazo , Investigación Cualitativa , Sudáfrica
14.
Expert Rev Med Devices ; 18(9): 849-853, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34355991

RESUMEN

INTRODUCTION: Abnormal postpartum uterine bleeding occurs commonly after birth and can quickly become an obstetric emergency. With postpartum hemorrhage representing the leading cause of maternal mortality, accounting for 25% of maternal deaths due to obstetric complications, there is a critical need for effective and easy to use treatment options. AREAS COVERED: This profile describes the Jada System, a novel intrauterine vacuum-induced hemorrhage control device that provides a rapid and effective treatment option for abnormal postpartum uterine bleeding and postpartum hemorrhage. In addition to explaining the mechanism of action of vacuum-induced hemorrhage control and reviewing the device's safety and effectiveness, this profile elucidates how the Jada System compares to currently available medications and devices for treatment of this obstetric emergency. EXPERT OPINION: New therapies to address this life-threatening condition are needed to reduce the risk of maternal mortality and severe maternal morbidity. Data demonstrate that the Jada System provides rapid, effective control of abnormal postpartum uterine bleeding and postpartum hemorrhage, while offering reported ease of use and short treatment duration. These results suggest that use of the Jada System in treatment algorithms may improve outcomes.


Asunto(s)
Hemorragia Posparto , Taponamiento Uterino con Balón , Femenino , Humanos , Hemorragia Posparto/etiología , Hemorragia Posparto/terapia , Periodo Posparto , Embarazo , Vacio
15.
Sci Rep ; 11(1): 14709, 2021 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-34282160

RESUMEN

Obstetric hemorrhage is one of the leading preventable causes of maternal mortality in the United States. Although hemorrhage risk-prediction models exist, there remains a gap in literature describing if these risk-prediction tools can identify composite maternal morbidity. We investigate how well an established obstetric hemorrhage risk-assessment tool predicts composite hemorrhage-associated morbidity. We conducted a retrospective cohort analysis of a multicenter database including women admitted to Labor and Delivery from 2016 to 2018, at centers implementing the Association of Women's Health, Obstetric, and Neonatal Nurses risk assessment tool on admission. A composite morbidity score incorporated factors including obstetric hemorrhage (estimated blood loss ≥ 1000 mL), blood transfusion, or ICU admission. Out of 56,903 women, 14,803 (26%) were categorized as low-risk, 26,163 (46%) as medium-risk and 15,937 (28%) as high-risk for obstetric hemorrhage. Composite morbidity occurred at a rate of 2.2%, 8.0% and 11.9% within these groups, respectively. Medium- and high-risk groups had an increased combined risk of composite morbidity (diagnostic OR 4.58; 4.09-5.13) compared to the low-risk group. This established hemorrhage risk-assessment tool predicts clinically-relevant composite morbidity. Future randomized trials in obstetric hemorrhage can incorporate these tools for screening patients at highest risk for composite morbidity.


Asunto(s)
Modelos Estadísticos , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/epidemiología , Transfusión Sanguínea/estadística & datos numéricos , Estudios de Cohortes , Bases de Datos Factuales/estadística & datos numéricos , Parto Obstétrico/efectos adversos , Femenino , Humanos , Morbilidad , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/epidemiología , Hemorragia Posparto/terapia , Embarazo , Pronóstico , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiología , Proyectos de Investigación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología
16.
Sci Rep ; 11(1): 13990, 2021 07 07.
Artículo en Inglés | MEDLINE | ID: mdl-34234162

RESUMEN

This study intend to compare the long-term psychological impact (depression, post-traumatic stress disorder) on both partners between patients that underwent uterine artery embolization (UAE) for post-partum hemorrhage (PPH) and uneventful deliveries. Women who experienced severe PPH treated by UAE in our institution between 2003 and 2013 were identified in our obstetrical database. These cases were matched to controls with uneventful deliveries. Matching criteria were maternal age, parity, ethnicity, year of delivery, birthweight, gestational age and mode of delivery. Patients and their partners completed validated questionnaires measuring post-traumatic stress (TSQ), as well as depression symptoms (MINI). A total of 63 cases of PPH and 189 matched controls (1:3) participated in a study exploring gynecological and obstetrical outcomes. With a mean of 8 years post-index delivery, patients after PPH showed increased risk of depression (p = 0.015) and post-traumatic stress disorder (22.2% versus 4.8%, p < 0.005) compared to controls. PPH remains strongly associated with post-traumatic stress disorder, even after adjustment for depression (adjusted odds ratio 5.1; 95% confidence intervals 1.5-17.5). Similarly, partners of patients with PPH showed a propensity to depression (p = 0.029) and post-traumatic stress disorder (11.5% versus 1.5%, p = 0.019). In conclusion, both women and their partners are at increased risk of long-term psychological adverse outcomes after PPH. Couples may benefit from psychological support.


Asunto(s)
Hemorragia Posparto/psicología , Adulto , Femenino , Humanos , Masculino , Hemorragia Posparto/terapia , Embarazo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Evaluación de Síntomas , Factores de Tiempo , Embolización de la Arteria Uterina/efectos adversos , Embolización de la Arteria Uterina/métodos
17.
Emerg Radiol ; 28(6): 1127-1133, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34302560

RESUMEN

PURPOSE: To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. METHODS: We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. RESULTS: The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). CONCLUSION: S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.


Asunto(s)
Embolización Terapéutica , Hemorragia Posparto , Parto Obstétrico , Femenino , Genitales , Humanos , Hemorragia Posparto/diagnóstico por imagen , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos , Resultado del Tratamiento
18.
J Obstet Gynaecol Res ; 47(9): 3159-3170, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34254400

RESUMEN

AIM: To investigate the management of obstetrical disseminated intravascular coagulation (DIC) in Japan. METHODS: We sent a surveillance questionnaire to 2299 institutions to collect details about the deliveries they performed in 2018. We investigated differences in the management of obstetrical DIC among three types of institutions: perinatal medical centers (PMCs), general hospitals with obstetrical facilities (GHs), and maternal clinics with beds (MCs). RESULTS: We received responses from 703 institutions (30.6% of the total mailed) with results of 306 799 women who gave birth in 2018. In Japan, the potential to treat postpartum hemorrhage and obstetrical DIC was high in the PMC group, moderate in the GH group, and low in the MC group. The incidence of obstetrical DIC in the PMC group (0.44%) was significantly higher than that in the GH (0.21%) and MC (0.06%) groups. The mortality of women with obstetrical DIC in PMCs (1.3%) was similar to that in GHs (0.6%) and MCs (0.0%). The percentages of PMCs that always or sometimes transfused fresh frozen plasma or fibrinogen concentrates (100% and 42.2%, respectively) were significantly higher than those in the GH (88.2% and 29.5%, respectively) and MC groups (29.4% and 5.3%, respectively). Furthermore, institutions whose internal protocols mandated that replacement therapy be always administered in women with obstetrical DIC scores of ≥8 had similar protocols to those for women with fibrinogen levels of ≤1.5 g/L. CONCLUSIONS: The capacity to provide therapy for postpartum hemorrhage and obstetrical DIC varied widely among the three groups of institutions.


Asunto(s)
Coagulación Intravascular Diseminada , Hemorragia Posparto , Coagulación Intravascular Diseminada/epidemiología , Coagulación Intravascular Diseminada/terapia , Femenino , Humanos , Japón/epidemiología , Hemorragia Posparto/epidemiología , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos , Encuestas y Cuestionarios
20.
Clin Lab ; 67(7)2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34258970

RESUMEN

BACKGROUND: To analyze the correlation of component blood transfusion and prognosis of patients with pregnancy-induced hypertension (PIH) and postpartum hemorrhage (PPH) in assisted reproductive technology (ART). METHODS: A retrospective analysis of clinical data on 85 pregnant women with ART-induced PIH and PPH was completed. They were divided into observation group and control group based on whether there was component transfusion after massive hemorrhage. The plasma coagulation and blood platelet-related indexes of the two groups of patients were assayed before blood transfusion, 24 hours after blood transfusion, and 12 weeks post-partum. The incidence of adverse reactions of blood transfusion within one week of blood transfusion, the proportion of patients transferred to the general ward, the blood pressure, and biochemical indexes at 12 weeks postpartum were recorded. RESULTS: There was no significant difference in coagulation function before blood transfusion between the two groups of patients (p > 0.05). After 24 hours of massive blood transfusion, APTT, PT, and TT in the observation group were obviously shorter than those in the control group (p < 0.001), whereas FIB and PLT were higher than the control group (p < 0.01). In contrast to the control group at 12 weeks postpartum, the APTT, TT, and PT of the observation group were shortened (p < 0.05), while the FIB level was higher (p < 0.01). The probability of adverse reactions of transfusion in the observation group was lower than the control group (p < 0.05). The correlation between component transfusion and disease improvement after one week of transfusion and 12 weeks postpartum was 0.350 (0.159 - 0.530) (p < 0.01) and 0.441 (0.258 - 0.608) (p < 0.001). CONCLUSIONS: Component blood transfusion in ART-induced PIH patients can improve their coagulation function, reduce the probability of adverse reactions caused by massive blood transfusion, and improve their prognosis.


Asunto(s)
Hipertensión , Hemorragia Posparto , Coagulación Sanguínea , Transfusión Sanguínea , Femenino , Humanos , Hipertensión/terapia , Hemorragia Posparto/diagnóstico , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos
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