Evaluation of process management of postpartum hemorrhage due to uterine atony

Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.

Oxytocin and Uterine Atony during Cesarean Section

In our medical practice, in particular obstetrics, it is difficult to change certain consolidated dogmas, but the necessity and the current situation of our obstetrical exercise pushed us to find new technical supports, to make the exercise of our specialty as stripped of pitfalls as possible. Our work is summarized in a prospective comparative study, aimed at evaluating the existence or not of a difference between the administration of oxytocin just before the hysterotomy in a cesarean section and its administration after fetal extraction. We used a set of criteria to include patients in our study. This study took place over a period of one year (2020) in the Mother and Child regional center, in Meknes Imperial city, Morocco, involving a total number of 364 patients. With a group A comprising 176 patients 48% (176/364) who received oxytocin just before the hysterotomy and a group B of 188 patients 52% (188/364) who received it classically after fetal extraction. The difference was very significant as detailed in the article. Conclusion: the very convincing results of our study and the difference between the two groups, allowed us to demonstrate the effectiveness of our process and to endorse its use in our routine practice, with the perspective of conducting a prospective randomized study on a larger series.

The Active Management of Postpartum Uterine Atony—A Checklist Based Approach

Uterine atony remains the major cause of postpartum hemorrhage, and of death from postpartum hemorrhage in the United States. While existing guidelines outlining a general approach to postpartum hemorrhage are useful, recent data suggest that greater specificity may be necessary to significantly impact mortality. We present a highly specific and methodical approach to the management of uterine atony, which addresses what we believe to be the most common cause of preventable maternal hemorrhagic death in the US—lack of an intensive, focused approach to atony and perseverance with therapies that are not working. This protocol should result in cessation of hemorrhage by medical or surgical means within 1 hour of diagnosis. We then apply this protocol to a number of illustrative cases of maternal death due to atony. An approach involving the active management of uterine atony may assist clinicians in avoiding severe morbidity and mortality from uterine atony.

A Ten-Year Review of Primary Postpartum Haemrrhage at a University Teaching Hospital, Sagamu, Nigeria: A Case-Control Study

Objective: To determine the incidence of primary postpartum haemorrhage, identify risk/aetiological factors contributing to primary postpartum haemorrhage and review the different therapeutic approaches in the management of primary postpartum haemorrhage. Method: A retrospective case-control study of all patients with primary postpartum haemorrhage from January 1, 2001 to December 31, 2010 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Result: In the period under review, 272 cases of primary postpartum haemorrhage were documented while there were a total of 5929 deliveries, giving an incidence of 1 in 26 (25.6%). The average blood loss in the cases reviewed was 1550 mls whilst in the controls, the average blood loss was 200 mls. There was statistical significant difference between the grandmultiparous cases and grandmultiparous controls (58.4% versus 16.5%, OR = 6.74, p < 0.05), suggesting that grandmultiparity may be an implicated factor in primary postpartum haemorrhage. In the unbooked cases, retained placenta was the major cause of primary postpartum haemorrhage constituting 109 (51.7%), whereas in booked cases, uterine atony contributed 70.5% to primary postpartum haemorrhage. Four maternal deaths were recorded giving a case fatality rate of 1.5%;all were unbooked. Conclusion: Postpartum haemorrhage ranks high in the list of causes of maternal death and the case fatality rate can be very high. Prevention is the key to reducing the incidence of PPH and its sequale, with preventive measures based upon the identification of risk factors, surveillance of women at risk and seemingly not at risk and avoidance of procedure during delivery which could potentially result in complications.

丛状雪旺氏瘤8例临床病理分析

丛状雪旺氏瘤(plexiform schwannoma,PS)是一-种少见的良性周围神经鞘膜肿瘤,占雪旺氏瘤4%,主要发生于真皮和皮下组织。丛状雪旺氏瘤组织学特征为由以细胞致密区(Antoni A区)为主,形成多个具有丛状结构的圆形至卵圆形结节。

Balloon Tamponade in the Management of Postpartum Hemorrhage: Three Years of Experience in a Single Center

Introduction: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death in the world and it is reported to occur in 5% - 8% of pregnancies. Objective: This study aimed to present a single centre’s experience in treating PPH by balloon tamponade. Methods: During the time period between January 2013 and March 2016, 50 patients who had undergone balloon tamponade for postpartum hemorrhage in our clinic were evaluated retrospectively. The patients’ age, parity, type of delivery, birth weight, hemoglobin and platelet values, total blood loss from catheter, balloon’s staying time, blood and platelet transfusion status, the presence of placenta anomalies and the Bakri balloon hemostasis success rate were evaluated. Results: During the study period, there were 27,249 deliveries. The frequency of massive postpartum hemorrhage was 0.61% (n = 168). Among the 168 patients with massive postpartum hemorrhage, there were 50 patients in whom the Bakri balloon catheter was used. Bakri balloons were placed via cesarean section incision in 19 patients and via vagina in 31 patients. The mean staying time of Bakri balloon was 18 hours. In 8 patients, balloon tamponade failed. Two patients underwent hysterectomy;other two patients had surgical ligation of the hypogastric artery. Four cases were referred to a tertiary center. Placental invasion abnormalities were observed in five patients. The overall Bakri balloon hemostasis successful rate was found to be as 84% in all cases. Conclusion: Bakri balloon tamponade is an effective, safe and practical approach in the treatment of postpartum hemorrhage.