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1.
Medicine (Baltimore) ; 100(4): e23920, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530192

RESUMO

BACKGROUND: Lamaze breathing has been widely used as a breathing training method. Nursing intervention including postural nursing, delivery ball, doula nursing, massage and psychological nursing is usually provided by nurses during labor. A number of clinical studies have investigated the effect of Lamaze breathing training combined with nursing intervention on maternal pain relief and outcomes improvement. But there were some scholars who were against it. METHODS: Randomized controlled trials from January 2000 to November 2019 in PubMed, Cochrance Library, Medline, Web of Science, Embase, Chinese Academic Journals, Chinese Biomedical Literature Database, VIP Database, Wanfang Database were searched. Two researchers independently screened the literature according to the criteria. After extracting the data, the researchers used Cochrane system to evaluate the literature quality. Statistical analyses were performed by using Comprehensive Meta Analysis V2 software. RESULTS: Twenty-two randomized controlled trials conducted on 7035 primiparas were eligible. The results revealed that Lamaze breathing training combined with nursing intervention increased the rate of natural delivery (relative risk [RR] = 2.97, 95% confidence interval [CI] [2.48, 3.56]), shortened the length of labor (-2.604, 95% CI [-3.120, -2.087]), alleviated labor pain (RR = 0.194, 95% CI [0.115, 0.325]) and reduced postpartum bleeding (-2.966, 95% CI [-4.056, -1.877]). CONCLUSIONS: Lamaze breathing training combined with nursing intervention was effective for ameliorating the process and outcomes of childbirth in primiparae and deserves to be promoted and applied in clinical practice.


Assuntos
Trabalho de Parto/fisiologia , Parto Normal/métodos , Parto Normal/enfermagem , Parto/fisiologia , Feminino , Humanos , Dor do Parto/terapia , Paridade , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
2.
Medicine (Baltimore) ; 100(3): e23885, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545955

RESUMO

ABSTRACT: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and death worldwide. The history of cesarean section and the occurrence of placenta previa were significantly associated with the increase in blood transfusion. Therefore, to prevent PPH, it is important to understand the effect of blood transfusion during cesarean section on postpartum hemorrhage. The purpose of this study is to determine the cause of blood transfusion during cesarean section, especially large amounts of blood transfusion, and to take measures to reduce the blood demand caused by PPH with limited blood supply.This study was a retrospective study of patients who underwent blood transfusion during cesarean section in Qilu Hospital of Shandong University (China) from January 2013 to December 2016. Red blood cell infusion ≥10 U during cesarean section was defined as massive blood transfusion. The study collected the demographics of pregnant women, obstetric characteristics and reasons for blood transfusions, as well as blood components and blood transfusion results. Multivariate regression analysis was performed for evaluating the risk factors of PPN.From 2013 to 2016, a total of 587 patients received blood transfusions during cesarean section. The proportion of women receiving blood transfusion during cesarean section increased (from 3.21% to 7.40%, P < .001). The history of cesarean section (P = .005) and the occurrence of placenta previa were positively correlated with the increase in blood transfusion (P = .016). There were 72 cases of massive blood transfusion, accounting for 12.27% of blood transfusion patients. Among mass blood transfusions, 93.1% of cases had prior cesarean delivery, and placenta previa accounted for 95.8%. 19.4% of patients receiving massive blood transfusions underwent hysterectomy. There was no significant difference in maternal BMI and gestational age between the mass blood transfusion group and the non-mass blood transfusion group.From 2013 to 2016, the demand for blood transfusion, especially the demand for massive blood transfusion, increased. Repeated cesarean section and placental previa combined with uterine scar are positively correlated with increased blood transfusion. Reducing the initial cesarean section should help reduce the massive blood transfusion caused by placenta previa with a history of cesarean section.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Cesárea , Hemorragia Pós-Parto/prevenção & controle , Cuidado Pré-Natal , Adulto , Perda Sanguínea Cirúrgica , China/epidemiologia , Feminino , Humanos , Período Intraoperatório , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
4.
BJOG ; 128(1): 114-120, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32770781

RESUMO

OBJECTIVE: To estimate the cost-effectiveness of tranexamic acid (TXA) use to prevent postpartum haemorrhage. DESIGN: A trial-based economic evaluation. SETTING: Fifteen French university maternity hospitals. POPULATION: Women enrolled in the TRAAP randomised controlled trial comparing TXA versus placebo in women with vaginal delivery. TRAAP failed to show a reduction in postpartum haemorrhage of at least 500 ml in the intervention arm but evidenced significant lower rates of secondary outcomes related to blood loss. METHODS & MAIN OUTCOME MEASURES: We estimated direct medical costs from within-trial hospital resources collected prospectively from the study report form. All resources were costed at their value to the hospital. We estimated incremental cost per incremental haemorrhage averted. RESULTS: Among the 4079 women in the TRAAP trial, data necessary to calculate costs were available for 3836 (94.0%). The average total costs in the TXA and control groups were €2278 ± 388 and €2288 ± 409 per woman, respectively (P = 0.79). In women with postpartum haemorrhage of at least 500 ml (trial primary endpoint), costs were €2359 ± 354 and €2409 ± 525 (P = 0.14); for provider-assessed clinically significant postpartum haemorrhage and postpartum haemorrhage of at least 1000 ml, costs were respectively €2316 ± 347 versus €2381 ± 521 (P = 0.22) and €2321 ± 318 versus €2411 ± 590 (P = 0.35) in the tranexamic and placebo groups, respectively. The probabilistic sensitivity analysis showed that the use of TXA had a 65-73% probability of saving costs and improving outcome. CONCLUSIONS: Our findings support the use of TXA, as both bleeding events and cost may be reduced three out of four times. TWEETABLE ABSTRACT: Tranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4.


Assuntos
Antifibrinolíticos/uso terapêutico , Parto Obstétrico , Hemorragia Pós-Parto/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Adulto , Antifibrinolíticos/economia , Análise Custo-Benefício , Feminino , França , Hospitais Universitários , Humanos , Gravidez , Cuidado Pré-Natal , Ácido Tranexâmico/economia
6.
Curr Opin Anaesthesiol ; 33(6): 793-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002958

RESUMO

PURPOSE OF REVIEW: Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. RECENT FINDINGS: Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficiencies. Development of regionalized centers for high-risk maternity care is a promising strategy to match women at risk for adverse events with appropriate resources. Opioids are a growing threat to maternal safety. There is growing evidence for racial inequities and health disparities in maternal morbidity and mortality. SUMMARY: Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.


Assuntos
Analgesia Obstétrica/tendências , Anestesia Obstétrica/tendências , Anestesiologistas/psicologia , Parto Obstétrico/tendências , Mortalidade Materna/tendências , Hemorragia Pós-Parto/prevenção & controle , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Serviços de Saúde Materna/normas , Erros Médicos/prevenção & controle , Gravidez , Complicações na Gravidez , Estados Unidos
7.
Medicine (Baltimore) ; 99(35): e21916, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871925

RESUMO

Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS.This retrospective study included all women who were diagnosed with PPP and PA and underwent PTUI CS from October 1, 2016, to October 31, 2018. Sixty-four patients were included: 34 underwent prophylactic IIA BO (IIA group), whereas 30 were treated without prophylactic IIA BO (control group). The primary outcome was a composite measure of perioperative blood management outcomes, including the estimated blood loss (EBL), donor blood transfusion, salvaged blood returned, fresh frozen plasma (FFP), pre- and postoperative serum hemoglobin and hematocrit. In addition, the baseline conditions of mother and neonates were compared.EBL was significantly higher in the IIA group compared to the control group (2883.5 mL in the IIA group vs 1868.7 mL in the control group, P = .001). Overall, the donor blood transfusion rate was 23.5% (8/34), averaging 4.2 U, in the IIA group versus 30% (9/30), averaging 3.4 U, in the control group, which were not significantly different. The FFP transfusion rate was 47%, averaging 765.6 mL, in the IIA group versus 20%, averaging 816.7 mL, in the control group. In the IIA group, 97.1% used cell savage and had salvaged blood returned, averaging 954.9 mL. In the control group, 90% had salvaged blood returned, averaging 617.9 mL. No cases of amniotic fluid embolism were observed with leukocyte depletion filters.Prophylactic IIA BO during PTUI CS in women with PPP and PA does not lead to a statistically significant reduction in EBL. Cell salvage was associated with a reduction in the rate of donor blood transfusion during PTUI CS.


Assuntos
Oclusão com Balão/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Cesárea/métodos , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/prevenção & controle , Útero/cirurgia , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Artéria Ilíaca , Recuperação de Sangue Operatório , Gravidez , Estudos Retrospectivos
8.
Obstet Gynecol ; 136(4): 692-697, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925628

RESUMO

OBJECTIVE: To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management. METHODS: We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliveries before 39 weeks of gestation and those not adherent to study protocol or with fetal anomalies were excluded. A composite of adverse outcomes (perinatal death or severe neonatal complications), third- or fourth-degree lacerations, and postpartum hemorrhage were evaluated. Log binomial regression models estimated relative risks and 95% CIs for associations of outcomes with patient characteristics including randomly assigned treatment group. Interactions between patient characteristics and treatment group were tested. RESULTS: Of 6,096 women with outcome data, 5,007 (82.1%) met criteria for inclusion in this analysis. Frequency of the perinatal composite was 252 (5.0%), 166 (3.3%) for third- or fourth-degree perineal laceration, and 237 (4.7%) for postpartum hemorrhage. In multivariable analysis, intended labor induction at 39 weeks of gestation was associated with a reduced perinatal composite outcome (4.1% vs 6.0%; adjusted relative risk [aRR] 0.71; 95% CI 0.55-0.90), whereas increasing body mass index (BMI) was associated with an increased perinatal composite outcome (aRR 1.04/unit increase; 95% CI 1.02-1.05). Decreased risk of third- or fourth-degree perineal laceration was observed with increasing BMI (aRR 0.96/unit increase; 95% CI 0.93-0.98) and in Black women compared with White women (1.2% vs 3.9%; aRR 0.34; 95% CI 0.19-0.60). Increased risk of postpartum hemorrhage was observed in Hispanic women compared with White women (6.3% vs 4.0%; aRR 1.64; 95% CI 1.18-2.29). Patient characteristics associated with adverse outcomes were similar between treatment groups (P for interaction >.05). CONCLUSION: Compared with expectant management, intended induction at 39 weeks of gestation was associated with reduced risk of adverse perinatal outcome. Patient characteristics associated with adverse outcomes were few and similar between groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01990612.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Trabalho de Parto Induzido , Lacerações , Complicações do Trabalho de Parto , Hemorragia Pós-Parto , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Lacerações/diagnóstico , Lacerações/etnologia , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Parto Normal/efeitos adversos , Parto Normal/métodos , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Paridade , Morte Perinatal , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etnologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez
9.
San Salvador; MINSAL; sept.16, 2020. 12 p. ilus, graf.
Não convencional em Espanhol | LILACS, BIGG - guias GRADE, BISSAL | ID: biblio-1121036

RESUMO

La presente guía se elaboró siguiendo los lineamientos del Manual para la elaboración de guías de la Organización Mundial de la Salud. De forma general, se creó un grupo desarrollador multidisciplinario, compuesto por expertos temáticos, epidemiólogos, metodólogos y pacientes. Con base en la evidencia proveniente de la guía para el uso de uterotónicos para la prevención de hemorragia posparto, se desarrolló una adaptación para el contexto del Sistema Nacional Integrado de Salud de El Salvador. Se incluyó de evidencia local y la contextualización de sus recomendaciones. Las recomendaciones fueron graduadas en un panel de expertos conformado por profesionales en estadística, enfermería, materno infantil y médicos generales y especialistas en las siguientes áreas: ginecología y obstetricia, perinatología, anestesiología, medicina familiar, economía de la salud, epidemiología, además se incluyó la participación de pacientes siguiendo el enfoque Grading of Recommendations, Assessment, Development and Evaluation (GRADE)


This guide was prepared following the guidelines of the Manual for the preparation of guidelines of the World Health Organization. In general, a multidisciplinary development group was created, composed of thematic experts, epidemiologists, methodologists, and patients. Based on the evidence from the guide for the use of uterotonics for the prevention of postpartum hemorrhage, an adaptation was developed for the context of the National Integrated Health System of El Salvador. Local evidence and the contextualization of their recommendations were included. The recommendations were graded by a panel of experts made up of professionals in statistics, nursing, maternal and child health, and general practitioners and specialists in the following areas: gynecology and obstetrics, perinatology, anesthesiology, family medicine, health economics, epidemiology, and it was also included patient participation following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)


Assuntos
Gravidez , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/terapia , Ocitocina/uso terapêutico , Misoprostol/uso terapêutico
10.
Am J Trop Med Hyg ; 103(5): 2129-2141, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32748770

RESUMO

Oxytocin is used for the prevention and treatment of postpartum hemorrhage, the leading cause of maternal mortality in low- and middle-income countries. Because of the high instability of oxytocin, most products are labeled for storage at 2-8°C. Some other products are on the market which are labeled for non-refrigerated storage, but independent evaluations of their stability hardly exist. In the present study, seven brands (nine batches) of oxytocin were purchased from wholesalers and medical stores in Malawi and Rwanda and investigated by accelerated stability testing according to the ICH/WHO guidelines. Two oxytocin brands approved by a stringent regulatory authority (SRA) or by the WHO Prequalification of Medicines program and purchased in Europe were used as comparison. All investigated brands which were either produced in countries with SRAs, or were WHO-prequalified products, were labeled for storage at 2-8°C, and all of them passed stability testing with very good results. Even exposure to 25°C or 30°C for several months hardly affected their oxytocin content. However, two other investigated brands were labeled for non-refrigerated storage, and both of them had been produced in countries without SRAs. These two preparations showed not higher but lower stability than the brands labeled for storage at 2-8°C, and, for both of them, noncompliance with pharmacopoeial specifications was found after accelerated stability testing. At 40°C, and in forced degradation studies at 80°C, chlorobutanol showed a remarkable stabilizing effect on oxytocin, which may deserve further investigation. The results of the present study support the policy "Buy Quality Oxytocin, Keep It Cool."


Assuntos
Clorobutanol/farmacologia , Ocitócicos/farmacologia , Ocitocina/farmacologia , Hemorragia Pós-Parto/prevenção & controle , Conservantes Farmacêuticos/farmacologia , Estabilidade de Medicamentos , Humanos , Malaui , Ocitócicos/química , Ocitocina/química , Ruanda , Temperatura
11.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 450-456, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842248

RESUMO

Objective: To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS). Methods: This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade (n=81) or gauze packing (n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results: All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group (P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%(78/81, 77/80) respectively (P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group (P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group (P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication (P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions: Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/estatística & dados numéricos , Placenta Acreta/terapia , Hemorragia Pós-Parto/prevenção & controle , Tamponamento com Balão Uterino/métodos , Aorta Abdominal , Oclusão com Balão/métodos , Transfusão de Sangue , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Incidência , Placenta Prévia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
12.
Curr Opin Anaesthesiol ; 33(4): 566-570, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628404

RESUMO

PURPOSE OF REVIEW: To discuss the recent results of the use of interventional radiology modalities treating postpartum hemorrhage (PPH). RECENT FINDINGS: PPH still is a leading cause of maternal morbidity and mortality. An important risk factor for the development of PPH is the placenta accreta spectrum. In patients with placenta accreta, we can use prophylactic balloon occlusion of the common or internal iliac artery or abdominal aorta to prevent PPH. Balloon occlusion of the abdominal aorta seems to ensure better results than balloon occlusion of the iliac artery in terms of blood loss, transfusion rate and hysterectomy rate reduction with a minimal risk of complications. To treat PPH uterine artery embolization can be effective and potentially fertility-sparing, while having a low complication rate. SUMMARY: The use of aortic balloon occlusion catheters for the prevention of PPH and uterine artery embolization for the treatment of PPH are well tolerated and feasible options for patients with placenta accreta spectrum.


Assuntos
Oclusão com Balão , Placenta Acreta/terapia , Hemorragia Pós-Parto/terapia , Radiologia Intervencionista , Aorta Abdominal , Feminino , Humanos , Obstetrícia , Hemorragia Pós-Parto/prevenção & controle , Gravidez
13.
PLoS One ; 15(5): e0232983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421737

RESUMO

BACKGROUND: Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. METHODS: Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. RESULTS: Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. CONCLUSION: Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço , Hemorragia Pós-Parto/terapia , Competência Clínica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Mão de Obra em Saúde , Humanos , Tocologia/educação , Mães , Avaliação de Resultados em Cuidados de Saúde , Parto , Assistência Perinatal , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Tanzânia/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32402601

RESUMO

The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented.


Assuntos
Terceira Fase do Trabalho de Parto/fisiologia , Tocologia , Placenta Retida/prevenção & controle , Hemorragia Pós-Parto/prevenção & controle , Cesárea , Ergonovina/administração & dosagem , Feminino , Humanos , Recém-Nascido , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Gravidez
15.
J. negat. no posit. results ; 5(4): 428-435, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194046

RESUMO

OBJETIVO: Demostrar la efectividad del alumbramiento dirigido con oxitocina vía intraumbilical en sala de partos del Hospital "Dr. José María Carabaño Tosta", en Maracay Estado Aragua, Venezuela. Tipo de estudio: Diseño transversal, realizado entre febrero-agosto del 2019. MATERIAL Y MÉTODOS: 50 pacientes manejadas con alumbramiento dirigido con 10 UI de oxitocina a través de la vena umbilical (grupo experimental) del extremo placentario y 50 pacientes manejadas con alumbramiento espontáneo (grupo control). Se comparó el tiempo de alumbramiento, perdidas hemáticas y evolución clínica. RESULTADOS: Grupo expuesto: tiempo medio de alumbramiento 3,52 minutos, volumen medio del sangrado 112,8 ml y valor medio de hemoglobina-hematocrito pre y post parto 11,01 gr/dl-34,3% y 10,7 gr/dl-32,4% respectivamente. Grupo control: tiempo medio de alumbramiento 13,02 minutos, volumen medio del sangrado 232,7 ml y valor medio de hemoglobina-hematocrito pre y post parto 11,3 gr/dl-34,9% y 10,1 gr/dl-31,2 respectivamente. El grupo expuesto no presento complicaciones, mientras que el 4% del grupo control presentó hipotonía uterina y hemorragia post parto. CONCLUSIÓN: En el grupo expuesto el alumbramiento fue significativamente más rápido y las perdidas hemáticas fueron significativamente menores (p: 0,000). Se concluye que el alumbramiento dirigido con oxitocina vía intraumbilical es más efectivo comparado con el alumbramiento espontáneo. No aplicar alumbramiento dirigido es un procedimiento que lleva a mayor riesgo de hemorragias puerperales y complicaciones obstétricas


OBJECTIVE: To demonstrate effectiveness of third stage of labor directed with intraumbilical oxytocin in the delivery room at Hospital "Dr. José María Carabaño Tosta", in Maracay, Aragua, Venezuela. Type of study: Cross-sectional, carried out between February-August 2019. MATERIALS AND METHODS: 50 patients managed with third stage of labor led with 10 IU oxytocin through the umbilical vein (exposed group) and 50 patients managed with spontaneous third stage of labor (control group). We compared time of birth, blood loss and clinical outcome. RESULTS: Exposed group: 3.52 minutes average delivery time, average volume of the bleeding 112.8 ml and mean hemoglobin hematocrit value pre and post-delivery 11,01 gr/dl-34,3% and 10.7 gr/dl-32,4% respectively. CONTROL GROUP: 13,02 minutes average delivery time, average volume of bleeding 232,7 ml and mean hemoglobin hematocrit value pre and post-partum 11.3 gr/dl-34,9% and 10.1 gr/dl-31,2% respectively. The exposed group did not present any complication, while 4% of the control group presented uterine hypotonia and post-partum hemorrhage. CONCLUSION: In the experimental group, the birth was significantly quicker and the lost blood were significantly lower (p: 0.000). We concluded that placenta with oxytocin via umbilical is more effective compared with spontaneous labor. There is no reason not to perform third stage of labor oxitocine in order to decrease obstetric hemorrhage risk and further complications


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Ocitocina/administração & dosagem , Parto Obstétrico/métodos , Trabalho de Parto Induzido/métodos , Hemorragia Pós-Parto/prevenção & controle , Estudos Transversais , Cordão Umbilical/efeitos dos fármacos , Complicações do Trabalho de Parto/tratamento farmacológico , Ocitócicos/farmacocinética
16.
Obstet Gynecol ; 135(4): 945-948, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32168220

RESUMO

OBJECTIVE: To evaluate the pharmacokinetics of tranexamic acid after oral administration to postpartum women. METHODS: We conducted a single-center pharmacokinetic study at Teaching Hospital-Jaffna, Sri Lanka, on 12 healthy postpartum women who delivered vaginally. After oral administration of 2 g of immediate-release tranexamic acid 1 hour after delivery, pharmacokinetic parameters were measured on plasma samples at 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, and 12 hours. Plasma tranexamic acid concentrations were determined by high-performance liquid chromatography. The outcome measures were maximum observed plasma concentration, time to maximum plasma concentration, time to reach effective plasma concentration, time period effective serum concentration lasted, area under the curve for drug concentration, and half-life of tranexamic acid. RESULTS: The mean maximum observed plasma concentration was 10.06 micrograms/mL (range 8.56-12.22 micrograms/mL). The mean time to maximum plasma concentration was 2.92 hours (range 2.5-3.5 hours). Mean time taken to reach the effective plasma concentration of 5 micrograms/mL and the mean time this concentration lasted were 0.87 hours and 6.73 hours, respectively. Duration for which plasma tranexamic acid concentration remained greater than 5 micrograms/mL was 5.86 hours. Half-life was 1.65 hours. Area under the curve for drug concentration was 49.16 micrograms.h/mL (range 43.75-52.69 micrograms.h/mL). CONCLUSION: Clinically effective plasma concentrations of tranexamic acid in postpartum women may be achieved within 1 hour of oral administration. Given the promising pharmacokinetic properties, we recommend additional studies with larger sample sizes to investigate the potential of oral tranexamic acid for the treatment or prophylaxis of postpartum hemorrhage.


Assuntos
Antifibrinolíticos/farmacocinética , Hemorragia Pós-Parto/prevenção & controle , Período Pós-Parto/sangue , Ácido Tranexâmico/farmacocinética , Administração Oral , Adulto , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Hemorragia Pós-Parto/sangue , Gravidez , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Adulto Jovem
17.
Medicine (Baltimore) ; 99(3): e18792, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011478

RESUMO

BACKGROUND: Tranexamic acid (TA) has been demonstrated to reduce blood loss and the incidences of postpartum hemorrhage (PPH) during caesarean sections. We compared the clinical efficacy of TA administration on vaginal deliveries with recently published papers. METHODS: Electronic databases of PubMed, Cochrane Library, Embase and Chinese CNKI (Chinese database) and Wanfang were searched through November 2019.The randomized controlled trials were selected between TA and control groups. The relevant studies included four trials with a total of 4579 patients. RESULTS: Patients treated with TA had a reduction in total blood loss (P = .009), lower postoperative blood loss (P < .00001), a reduced number of PPH (P = .02). However, the occurrence of nausea or/and vomiting is higher in the TA group (the incidence of nausea or vomiting [P < .00001], nausea [P < .00001] and vomiting [P < .00001]). CONCLUSION: TA resulted in fewer occurrence rates of PPH, and no significant increase in occurrences of dizziness or photopsia, but higher incidence of vomiting and nausea.


Assuntos
Antifibrinolíticos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Antifibrinolíticos/efeitos adversos , Parto Obstétrico , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ácido Tranexâmico/efeitos adversos
18.
Medicine (Baltimore) ; 99(7): e19221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049861

RESUMO

BACKGROUND: To evaluate the effectiveness and safety of a newly designed intrauterine double-balloon catheter to arrest postpartum hemorrhage (PPH) following cesarean delivery (CD) for placenta previa. METHODS: We conducted an open-label, multicenter randomized controlled trial in two referral centers and one general hospital. Women with continuous bleeding after placental delivery following CD for placenta previa, who failed to respond to uterotonics, suturing and uterine devascularization, and in the absence of suspected deeply invasive accreta were eligible subjects. Eligible subjects were randomized to receive intrauterine double-balloon catheter (n = 102) or gauze packing (n = 102). The main outcome was the rate of successful hemostasis without the need for additional surgical interventions. The secondary outcomes included the volume of blood loss during and after CD, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, surgical complications, intensive care unit admission, need for re-laparotomy, length of hospital stay, and readmission. RESULTS: The 224 participants were recruited before delivery, with 20 excluded (14 cases bleeding stopped after uterotonics and/or local myometrium sutures and 6 patients with placental increta). Finally, 102 women were assigned in catheter group and 102 others in gauze group. There was no difference in the rate of successful hemostasis in the catheter and gauze groups (93.1% vs 91.2%, P = .80). Compared with those in the gauze group, women in the catheter group showed significantly less blood loss within 24 hours postpartum (895 [612.3-1297.8] vs 1156 [882.5-1453.3] ml, P < .01), lower rate of PPH ≥1000 ml (42.2% vs 63.7%, P < .01). Accordingly, women in the catheter group had significantly less maternal adverse events such as postpartum anemia, puerperal morbidity, and postpartum pain. CONCLUSION: Uterine tamponade using a double-balloon catheter was as effective as gauze packing in hemostasis, and appeared to be superior in reducing postpartum blood loss and pain following CD for placenta previa. Using double-balloon catheter in managing PPH in this situation may be a preferable alternative to minimize maternal morbidity.


Assuntos
Cesárea/efeitos adversos , Placenta Prévia , Hemorragia Pós-Parto/prevenção & controle , Tamponamento com Balão Uterino/instrumentação , Adulto , Feminino , Humanos , Hemorragia Pós-Parto/etiologia , Gravidez
19.
BMC Pregnancy Childbirth ; 20(1): 63, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005192

RESUMO

BACKGROUND: An antifibrinolytic agent that blocks lysine-binding sites on plasminogen molecules, tranexamic acid reduces bleeding-related mortality in women with postpartum hemorrhage (PPH), especially administered fairly soon after delivery. According to the randomized controlled trials thus far reported for PPH prevention after cesarean deliveries (n = 16), women who received tranexamic acid had significantly less postpartum blood loss and no increase in severe adverse effects. These were, however, primarily small single-center studies that had fundamental methodological flaws. Multicenter randomized controlled trials with adequate power are necessary to demonstrate its value persuasively before tranexamic acid goes into widespread use for the prevention of PPH after cesarean deliveries. METHODS/DESIGN: This study will be a multicenter, double-blind, randomized controlled trial with two parallel groups including 4524 women with cesarean deliveries before or during labor, at a term ≥34 weeks, modeled on our previous study of tranexamic acid administered after vaginal deliveries. Treatment (either tranexamic acid 1 g or placebo) will be administered intravenously just after birth. All women will also receive a prophylactic uterotonic agent. The primary outcome will be the incidence of PPH, defined by a calculated estimated blood loss > 1000 mL or a red blood cell transfusion before day 2 postpartum. This study will have 80% power to show a 20% reduction in the incidence of PPH, from 15.0 to 12.0%. DISCUSSION: As an, inexpensive, easy to administer drug that can be add to the routine management of cesarean births in delivery rooms, tranexamic acid is a promising candidate for preventing PPH after these births. This large, adequately powered, multicenter randomized placebo-controlled trial seeks to determine if the benefits of the routine prophylactic use of tranexamic acid after cesarean delivery significantly outweigh its risks. TRIAL REGISTRATION: ClinicalTrials.gov NCT03431805 (February 12, 2018).


Assuntos
Antifibrinolíticos/uso terapêutico , Cesárea , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/prevenção & controle , Ácido Tranexâmico/uso terapêutico , Administração Intravenosa , Método Duplo-Cego , Feminino , Monitorização Hemodinâmica , Humanos , Estudos Multicêntricos como Assunto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Medicine (Baltimore) ; 99(5): e18943, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000415

RESUMO

RATIONALE: The incidence of obstetric hemorrhage due to pernicious placenta previa (PPP) and placenta accreta is currently increasing in China. Parallel transverse uterine incision (PTUI) cesarean section (CS) is a novel technique designed to avoid transecting the placenta and control postpartum hemorrhage during CS in these patients in our hospital. A key point of anesthesia management related to PTUI CS involves keeping the uterus relaxed. General anesthesia (GA) has often been performed, and inhaled volatile anesthetics have traditionally been recommended for this purpose; however, GA may be contraindicated in patients with difficult airways. PATIENT CONCERNS: The patient was predicted to have a difficult airway, and GA may have resulted in potentially life-threatening complications. An alternative and safer method of achieving uterine relaxation during PTUI CS was thus required. DIAGNOSES: The patient was diagnosed with PPP, and a predicted difficult airway was suspected preoperatively. INTERVENTIONS: PTUI CS was planned to control postpartum hemorrhage and preserve fertility during CS. Uterine relaxation during PTUI CS was achieved with intravenous nitroglycerin under combined spinal-epidural anesthesia. OUTCOME: Intravenous nitroglycerin and combined spinal-epidural anesthesia achieved uterine relaxation during the time from delivery of the neonate to making the second transverse incision in the lower segment of the uterus during PTUI CS. Both the parturient and neonate were well and were discharged 4 days later. LESSIONS: Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage.


Assuntos
Cesárea/métodos , Nitroglicerina/uso terapêutico , Placenta Acreta/terapia , Placenta Prévia/terapia , Hemorragia Pós-Parto/prevenção & controle , Vasodilatadores/uso terapêutico , Administração Intravenosa , Adulto , Feminino , Humanos , Gravidez
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