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At least 19 recordsLinked to original sources
PubMed1997

Management of postpartum hemorrhage.

Postpartum hemorrhage remains a source of maternal morbidity and mortality in modern obstetric medicine. While the risk factors for postpartum hemorrhage are well described, many patients who develop this complication have no known antenatal risk factors. Therefore, in every delivery the attending physician must be vigilant for signs of hemorrhage. Paramount to a successful outcome is the efficient enactment of a logical plan. Uterine atony causes more than 90 percent of cases of postpartum hemorrhage. Lower genital tract lacerations and retained placental products are the most common causes of hemorrhage when the uterus is firm. Successful treatment of postpartum hemorrhage requires the prompt recognition of ongoing bleeding, followed by uterine massage and oxytocin administration. The intramuscular administration of ergot or prostaglandin preparations can help with refractory bleeding. Most deaths from postpartum hemorrhage occur not because of brisk blood loss, but because of the ineffective management of continuous low-level bleeding.

Female↗
PubMed1986

The use of 15 methyl F2 alpha prostaglandin (Prostin 15M) for the control of postpartum hemorrhage.

Postpartum hemorrhage is a potentially life-threatening obstetric complication. A 22-month experience treating postpartum hemorrhage with Prostin 15M patients who had not responded to conventional therapy is presented. A total of 26 patients were treated. There were 22 successes and 4 failures (84.6% success rate). Two failures were documented placenta accreta. Side effects occurred in 13 of the 26 patients and were generally mild. This group of patients is at risk for significant blood loss as well as blood replacement. The treatment of postpartum hemorrhage with intramuscular Prostin 15M was found to be safe and effective.

Adult↗
PubMed2005

[Postpartum hemorrhage].

Postpartum hemorrhage, frequently due to uterine atony, is an important cause of maternal death and morbidity. The knowledge of causes, of antenatal and intrapartum risk factors and of physiopathological changes in hemodynamics and coagulation during pregnancy are essential for the management of the condition. At the present time, many efforts are made to organize a multidisciplinary approach to this complication of delivery involving clinical and laboratory staffs, since the rapid correction of hypovolemia, the diagnosis and treatment of defective coagulation, the surgical and pharmacological control of bleeding are mandatory. Several medical options have been developed and the surgical management includes traditional and newer conservative procedures with variable success rates. The developments in the treatment of postpartum hemorrhage may reduce hysterectomy that is to be considered the last resort to resolve the hemorrhage in some cases. In the modern management of postpartum hemorrhage protocols and guidelines should be available in every delivery room.

Embolization, Therapeutic↗
PubMed2004

[Influence of interventional radiotherapy for severe postpartum hemorrhage on postpartum menorrhea].

OBJECTIVE: To discuss the influence of interventional radiotherapy for treating severe postpartum hemorrhage on postpartum menorrhea. METHODS: From Mar. 1995 to Feb. 2002, 18 cases of severe postpartum hemorrhage treated with arterial embolization served as the interventional group. Twenty parturients without postpartum complication were recruited as control group. The continuance of lochia, recovery of menorrhea between the two groups were compared. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) of the non-lactating women in the two groups were assayed during the 3rd-5th days of the first menstrual cycle. RESULTS: Continuance times of lochia were (33.9 +/- 2.0) days, and (36.2 +/- 3.1) days in interventional group and control group, respectively. Recovery times of menorrhea were (75 +/- 17) days, and (95 +/- 16) days in interventional group and control group. The quantity of the postpartum menorrhea was 1.3 +/- 0.1 times of that before delivery in interventional group, 1.3 +/- 0.2 times of that in control group. The number of menstrual cycle before recovery to normal menorrhea was 2 cycles in interventional group, 1.9 cycles in control group. Postpartum menstrual cycle was (33.9 +/- 2.2) days in interventional group, (33.2 +/- 1.6) days in control group. Serum FSH, LH, E(2) of the non-lactating women during the 3rd approximately 5th days of the first menstrual cycle were (5.2 +/- 1.1) U/L, (7.5 +/- 1.6) U/L, (262 +/- 14) pmol/L in interventional group, (4.3 +/- 2.1) U/L, (6.3 +/- 1.3) U/L, (280 +/- 12) pmol/L in control group. There was no significant difference between the two groups (P > 0.05). CONCLUSIONS: No obvious influence of interventional radiotherapy for postpartum hemorrhage on postpartum menorrhea was observed.

Adult↗
PubMedDate not supplied

Perceptions matter: barriers to treatment of postpartum hemorrhage.

Postpartum hemorrhage is the leading cause of maternal deaths in developing countries. This report highlights the social and cultural factors that influence the decision to seek care in cases of postpartum bleeding. Survey data on awareness of danger signs in the postpartum period and findings from the anthropologic literature describing beliefs about bleeding in childbirth and the postpartum period are presented. Findings point to a mismatch between actual and perceived risks of danger in the postpartum period. This may reflect a viewpoint that there are few risks remaining after the baby is born. This may, in turn, shape the perception that the postpartum period is one in which less vigilance is required compared with labor and birth. Such beliefs are important to consider, as they may influence timely seeking of emergency obstetric care. Efforts to reduce the incidence of postpartum hemorrhage as a major cause of maternal death must progress on two fronts: on the supply side to ensure the provision of skilled care and on the demand side to ensure that women and their families accept the view that bleeding after birth is dangerous and that skilled care is preferable to traditional care.

Cultural Characteristics↗
PubMed1951

Primary postpartum hemorrhage.

Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal failure. The clinical situations in which hemorrhage is liable to occur must be better known, so that anticipatory and preventive measures can be taken. Recent knowledge about defibrinated blood in women with degenerative changes at the placental site must be incorporated in the thinking and practice of physicians dealing with obstetrical cases. The indications, limitations, and hazards of the various anesthetic methods available for parturient women should be carefully considered in the circumstances of each case.

Female↗
PubMed1988

Postpartum hemorrhage.

Postpartum hemorrhage is usually unexpected, and blood loss can be massive. Excessive bleeding after delivery may result from uterine atony, disruption of the genital tract, placental abnormalities, coagulation disorders and miscellaneous obstetric complications. Prompt treatment is imperative. Treatment options include oxytocics, prostaglandins, uterine exploration, uterine packing and, occasionally, surgery.

Ergonovine↗
PubMed1995

[Postpartum hemorrhage].

Postpartum hemorrhages are observed in 2 to 10% of all deliveries. They are severe in 1% of the pregnancies. However, they remain a major cause of maternal morbidity and mortality. Post-partum hemorrhages are generally separated in 2 categories. Acute hemorrhage occurs in the 24 hours following the delivery and is mainly caused by uterine atony, retained secondines, placenta accreta, birth canal trauma and uterine inversion. The delayed hemorrhage occurs after 1 day to 6 weeks after the delivery and is often related to uterine infection or abnormal involution of the placental bed. The management requires uterine massage and ocytocine or prostaglandins. Surgical or radiological selective ligation or embolization of the internal iliac arteries can be required. The hysterectomy is proposed in the most severe cases.

Acute Disease↗
PubMed2006

Postpartum hemorrhage.

Postpartum hemorrhage (PPH) is the most important single cause of maternal death in both developing and developed countries. It arises from abnormalities in one of four basic processes, with uterine atony being the most common. A multidisciplinary approach to management is important. The value of oxytocin and prostaglandins, including misoprostol, in treatment is discussed. Recently developed, less invasive treatment options, namely uterine tamponade and compression sutures, are fast becoming valuable alternatives to the traditional options of pelvic devascularization and hysterectomy. With a stark contrast in maternal mortality from PPH between the developing and developed countries, public health strategies and medical interventions intended to minimize this are further discussed.

Embolization, Therapeutic↗
PubMed2002

Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a big challenge for obstetricians. Fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.

Arteries↗
PubMed1999

[Postpartum hemorrhage].

Postpartum haemorrhage, the second cause of maternal mortality in France, is an obstetric and anaesthetic emergency. Yet, it often seems avoidable as most patients at risk can be identified before or during labour. In this respect, obstetrical conduct regarding delivery is essential; it makes it possible to foresee the necessary preventive and curative measures. Once haemorrhage has begun, any delay or hesitation in assuming multidisciplinary responsibility is potentially detrimental as it may lead to coagulopathy complications. Whenever possible, arterial embolisation presents an enormous progress in noninvasive conservative treatment, especially after vaginal delivery. Stepwise uterine devascularisation seems to be a promising surgical option as it can be used under all conditions, preserves maternal fertility, and is clearly effective.

Female↗
PubMed2004

High incidence of myocardial ischemia during postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage remains a major cause of global maternal morbidity and mortality, even in developed countries, despite the use of intensive care units. This study sought to (1) assess whether myocardial ischemia could be associated with and even aggravate hemorrhagic shock in young parturients admitted for postpartum hemorrhage, and (2) identify the independent risk factors for myocardial ischemia. METHODS: On their referral to the intensive care unit, a multidisciplinary team managed parturients with severe postpartum hemorrhage. Ventilation, transfusion, catecholamines, surgery, or angiography with uterine embolization were provided as clinically indicated. Plasma cardiac troponin I levels were used as a surrogate marker of acute myocardial injury and electrocardiograms of myocardial ischemia. RESULTS: A total of 55 parturients were referred with severe postpartum hemorrhage, all in hemorrhagic shock. Twenty-eight parturients (51%) had elevated serum levels of cardiac troponin I (9.4 microg/l [3.7-26.6 microg/l]), which were associated with electrocardiographic signs of ischemia and deteriorated myocardial contractility and correlated with the severity of hemorrhagic shock. Indeed, multivariate analysis identified low systolic and diastolic arterial blood pressure (< 88 and < 50 mmHg, respectively) and increased heart rate (> 115 beats/min) as independent predictors of myocardial injury. In addition, all patients who were given catecholamines also had elevated cardiac troponin I levels. CONCLUSIONS: These results suggest that treatment of postpartum hemorrhage-induced hemorrhagic shock should be coupled with concomitant prevention of myocardial ischemia, even in young parturients.

Adult↗
PubMed2005

Pharmacological and surgical therapy for primary postpartum hemorrhage.

Early postpartum hemorrhage remains a significant cause of maternal morbidity and mortality. Postpartum hemorrhage is most commonly due to uterine atony and often responds to medical treatments such as administration of uterotonic drugs, alone or in combination with uterine massage or bimanual compression. As the incidence of cesarean section continues to rise, the problem of placenta previa and accreta is likely to become more common. For first-line management of postpartum hemorrhage adequate blood and fluid replacement is mandatory. In recent years new therapeutic measures to control the bleeding have gained attention. Although, these newer therapies focus on avoiding the need for emergency hysterectomy and preservation of reproductive function, reports of subsequent pregnancies are still scarce. Established management options are shortly reviewed and novel medical and surgical treatments are more extensively discussed.

Adult↗
PubMed2000

B-Lynch suture for postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage is a major contributor to maternal morbidity and mortality. Numerous medical and surgical therapies have been used, but none has been uniformly successful. CASE: Two women with postpartum hemorrhage due to uterine atony after cesarean for twins are presented. Neither responded to medical management. In the first subject, O'Leary uterine artery ligation and utero-ovarian branch ligations were done without benefit. The B-Lynch suture immediately sustained correction of hemorrhage in both subjects. Magnetic resonance imaging and hysterosalpingogram after the first case showed no uterine defects. CONCLUSION: The B-Lynch suture might be a valuable addition to the surgical treatment of postpartum hemorrhage due to uterine atony.

Adolescent↗
PubMed1997

Vaginal ligature of uterine arteries during postpartum hemorrhage.

Immediate postpartum hemorrhage due to uterine inertia is usually treated by injection of oxytocics. In some situations, bleeding continues and distends the uterine cavity, in turn disturbing the hemostasis that accompanies uterine retraction. Uterine bleeding must be rapidly reduced while the coagulation defect is corrected. The authors propose the vaginal ligature of uterine arteries, which can be performed in the delivery room, as an alternative to hysterectomy.

Adult↗
PubMed2003

Medical and conservative surgical management of postpartum hemorrhage.

Massive postpartum hemorrhage (PPH) is a major cause of maternal mortality in the United Kingdom and worldwide. Life-threatening PPH occurs with a frequency of 1 in 1000 deliveries in the developed world. In the latest triennial Why Mothers Die: Confidential Enquiries into Maternal Deaths in the United Kingdom (1997-1999), PPH was the fifth most common cause of maternal mortality. In this review, we discuss the role of medical management in primary PPH and the use of the "tamponade test" when such management fails. The less radical surgical options discussed include uterine compression sutures, uterine or internal iliac artery ligation, and arterial embolization, all of which have the advantage of potentially preserving reproductive function. Radical surgical options, including subtotal or total hysterectomy, are not discussed in this review. A systematic or algorithmic method of tackling the problem is described. The suggested management approach is likely to reduce maternal morbidity from bleeding, hysterectomies, and maternal deaths.

Arteries↗
PubMed2006

The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage (PPH) is a major source of maternal morbidity. OBJECTIVES: This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity. PATIENTS AND METHODS: We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter. RESULTS: At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration <or=2 gL(-1) was 100%. CONCLUSION: These findings indicate that a simple fibrinogen measurement can anticipate the risk of severe bleeding in PPH.

Adult↗
PubMed2005

Acute promyelocytic leukemia: an unusual cause of fatal secondary postpartum hemorrhage.

INTRODUCTION: Postpartum haemorrhage can rarely be associated with an underlying coagulation or haematological disorder. We wish to discuss a case of acute promyelocytic leukemia (APL) presenting as secondary postpartum hemorrhage (PPH), its clinical and pathological features and maternal outcome. CASE REPORT: We describe a 28-year-old woman who presented with secondary PPH accompanied by bleeding from gums, marked pallor, hematemesis, ecchymotic and purpuric spots all over the body, 8 days post-partum. Investigations revealed her to be having APL, a diagnosis not suspected by the referring clinic. She was given supportive therapy but died before chemotherapy could be started. CONCLUSION: The case emphasizes the importance of suspecting, investigating and energetically treating uncommon causes such as acute leukemia when an unusually severe clinical picture in a postpartum setting suggests such a possibility. This may prove to be life saving, particularly if the leukemia happens to be APL, a cancer with a very high cure rate.

Adult↗