<strong>Objective:</strong><span style="font-family:""><span style="font-family:Verdana;"> To assess the efficacy of intravenous tranexamic acid and ethamsylate in redu...<strong>Objective:</strong><span style="font-family:""><span style="font-family:Verdana;"> To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group’s total blood loss (149.22 ±</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">54.74</span><span style="font-family:""> </span><span style="font-family:Verdana;">ml) was significantly less than the control group (353.75 ±</span><span style="font-family:""> </span><span style="font-family:Verdana;">115.56 ml) (p < 0.001). In our study, postoperative hemoglobin and hematocrit were significantly higher in the study group than </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">control group (p < 0.001);Reduction in hemoglobin and hematocrit were significantly less in the study group than </span><span style="font-family:Verdana;">the </span><span style="font-family:""><span style="font-family:Verdana;">control group (p < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.</span></span>展开更多
Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum tim...Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.展开更多
Objective: The assessment indicators of postpartum hemorrhage(PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention....Objective: The assessment indicators of postpartum hemorrhage(PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention.Methods: A systematic literature search of 9 databases was conducted according to inclusion and exclusion criteria using a comprehensive strategy. Strengthening the Reporting of Observational Studies in Epidemiology(STROBE) strategy was chosen as the tool for quality assessment of included studies, and data concerning the basic study characteristics and assessment indicators were extracted.Results: Eleven studies were included in this review. The assessment indicators in different reports covered heart rate, blood pressure, placental and birth canal check, hemoglobin(Hb), hematocrit(HCT),coagulation function tests, hemodynamic parameters and arterial blood gas, but no data on the assessment of postpartum uterine contraction were found. The relationship between indicators and blood loss varies.The overall quality of 9 manuscripts was comparatively high or moderate, and 2 were rated as low.Conclusions: The association between blood loss and clinical symptoms is not conclusive based on the present studies, and specific cut-off points could not be formulated to determine the approximate amount of blood loss. However, some cut-off points can be considered warning signs for the need of advanced interventions, such as heart rate, prothrombin time, and placental implantation. Further research on comprehensive assessment and cut-off points should be performed such that birth attendants can distinguish PPH as early as possible.展开更多
文摘<strong>Objective:</strong><span style="font-family:""><span style="font-family:Verdana;"> To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group’s total blood loss (149.22 ±</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">54.74</span><span style="font-family:""> </span><span style="font-family:Verdana;">ml) was significantly less than the control group (353.75 ±</span><span style="font-family:""> </span><span style="font-family:Verdana;">115.56 ml) (p < 0.001). In our study, postoperative hemoglobin and hematocrit were significantly higher in the study group than </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">control group (p < 0.001);Reduction in hemoglobin and hematocrit were significantly less in the study group than </span><span style="font-family:Verdana;">the </span><span style="font-family:""><span style="font-family:Verdana;">control group (p < 0.001). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.</span></span>
文摘Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.
基金supported by Shanghai Nursing Association(No.2016SD-B03)
文摘Objective: The assessment indicators of postpartum hemorrhage(PPH) were systematically reviewed to explore their relationship with blood loss as an early warning sign to identify potential PPH for prompt intervention.Methods: A systematic literature search of 9 databases was conducted according to inclusion and exclusion criteria using a comprehensive strategy. Strengthening the Reporting of Observational Studies in Epidemiology(STROBE) strategy was chosen as the tool for quality assessment of included studies, and data concerning the basic study characteristics and assessment indicators were extracted.Results: Eleven studies were included in this review. The assessment indicators in different reports covered heart rate, blood pressure, placental and birth canal check, hemoglobin(Hb), hematocrit(HCT),coagulation function tests, hemodynamic parameters and arterial blood gas, but no data on the assessment of postpartum uterine contraction were found. The relationship between indicators and blood loss varies.The overall quality of 9 manuscripts was comparatively high or moderate, and 2 were rated as low.Conclusions: The association between blood loss and clinical symptoms is not conclusive based on the present studies, and specific cut-off points could not be formulated to determine the approximate amount of blood loss. However, some cut-off points can be considered warning signs for the need of advanced interventions, such as heart rate, prothrombin time, and placental implantation. Further research on comprehensive assessment and cut-off points should be performed such that birth attendants can distinguish PPH as early as possible.
