POSTPARTUM HEMORRHAGE

Research Article


Abstract views: 1666 / PDF downloads: 571

Authors

  • Felis S

DOI:

https://doi.org/10.58372/2835-6276.1101

Keywords:

postpartum hemorrhage, oxitocine, quantitative blood loss, target therapy, delivery room

Abstract

Postpartum haemorrhage (PPH) is the primary cause of maternal mortality and morbidity worldwide: in fact, about a quarter of deaths that occur during pregnancy, childbirth or the puerperium are caused by postpartum hemorrhage. There are many causes of postpartum haemorrhage, the most important are: uterine atony, lacerations of the cervix and/or perineum, retention of placental material, coagulation problems, uterine inversion, uterine rupture. This causes of PPH are represented by the '4Ts' formula: tone, tissue, trauma, thrombin.

An important role is played by prevention: identification of risk factors, prophylaxis with oxytocin at the time of delivery, early treatment. The first important thing is the quantification of blood loss because the clinical signs are often blurred and due to frank anaemia resulting in tachycardia, small and frequent pulse, hypotension, sweating, paleness. As previously mentioned, it is important to act early in the case of PPH through maintenance of volaemia and targeted therapies that differ according to the cause of PPH (the 4T algorithm is useful). Early intervention reduces the need for blood transfusions and reduces the incidence of serious complications such as DIC. However, the management of postpartum haemorrhage is not limited to the postpartum phase, but the patient must be monitored in the puerperium, a phase in which the thromboembolic risk is increased. The couple must also be informed of the risk of PPH in future pregnancies.

PPH represents a serious risk for the patient and requires multidisciplinary input and proper preparation of the team working in the delivery room.

References

WHO. World Health Organization. Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization, 2012.

Maternal Mortality From Hemorrhage, Haeri, Sina et al. Seminars in Perinatology, Volume 36 , Issue 1 , 48 – 55, 2012.

ISTAT “La mortalità per causa in Italia” anni 1970-1998, Istituto Nazionale di Statistica, Roma.

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, Riris S, Thomson AJ on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2016; DOI: .10.1111/1471-0528.14178.

Livio Zanoio, Barcellona Eliana, Zacchè Gabrio, Ginecologia e ostetricia, Milano, Elsevier Masson, 2013.

Italian Obstetric Surveillance System (Itoss), Emorragia post-partum: come prevenirla, come curarla”. 2016.

McCandlish R, Bowler U, Van Asten H et al. A randomised controlled trial of care of the perineum during second stage of normal labour. Br J Obstet Gynaecol 1998; 105:1262-72.

Fitzpatrick KE, Sellers S, Spark P et al. Incidence and risk factors for placentaaccreta/increta/percreta in the UK: a national case-control study. PLoS One 2012; 7: e52893.

Cunningham, F. Gary, et al. Williams Obstetrics. 24th edition. New York: McGraw-Hill Education, 2014.

Leduc D, Senikas V, Lalonde A. SOCG Clinical Practice Guide- line: no 235, Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynecol Canada 2009; 31:980-93.

Le Bas A, Chandraharan E, Addei A et al. “Use of the “obstetrics shock index” as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage. Int J Gynecol Obstet 2014; 24:253-55.

Su LL, Chong YS, Samuel M. Carbetocin for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2012; 4:CD005457.

Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005457. Review.

Jin B, Du Y, Zhang F, Zhang K, Wang L, Cui L. Carbetocin for the prevention of postpartum hemorrhage: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2016; 29:400- 7.

Wang HY, Hong SK, Duan Y, Yin HM. Tranexamic acid and blood loss during and after cesarean section: a meta- analysis. J Perinatol 2015; 35:818-25.

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2015; 6:CD007872.

Y. N. Bakri, A. Amri, F. Abdul Jabbar: “Tamponade balloon for obstetrical bleeding,” International Journal of Gynecology and Obstetrics, 74 (2001) 139-142.

G. S. Condous, S. Arulkumaran, I. Symonds, R. Chapman, A. Sinha, K. Razvi the "tamponade test" in the management of massive postpartum hemorrhage. Obstet Gynecol. 2003 Apr; 101(4): 767–772.

Kettle C, Hills RK & Ismail KMK. Continuous versus interrupted sutures for repair of episiotomy or second-degree tears. Co- chrane Database Syst Rev 2007; (4):CD000947.

C B-Lynch e et al., The B-Lynch surgical technique for the control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported., in British Journal of Obstetrics and Gynaecology, vol. 104, nº 3, marzo 1997, pp. 372–375.

Hayman R, Arulkumaran S, Steer P. Uterine compression sutures: surgical management of postpartum hemorrhage. Obstet Gynecol 2002; 99:502–6.

Makino S, Tanaka T, Yorifuji T, Koshiishi T, Sugimura M, Takeda S. Double vertical compression sutures: A novel conservative approach to managing post-partum haemorrhage due to placenta praevia and atonic bleeding. Aust N Z J Obstet Gynaecol 2012; 52:290–2.

Cho JH, Jun HS, Lee CN: Haemostatic suturing technique or uterine bleeding during cesarean delivery. Obstet Gynaecol 96:129, 2000

Linee guida AOGOI: “Emorragia post-partum: linee guida per la prevenzione, la diagnosi ed il trattamento”.

Rouse DJ: Epidemiological investigation of a temporal increase in atonic post- partum haemorrhage: a population-based retrospective cohort study. Obstet Gynecol 122(3):693, 2013.

Prendiville WJ, Elbourne D, Mc Donald S. Active versus expectant management in the third stage of labour. The Cochrane Library. Issue 3. Oxford, England: Update Software;2003.

Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007; 297:1241–52.

Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; 8:CD003248

NICE, National Collaborating Centre for Women’s and Children’s Health. Intrapartum care: care of healthy women and their babies during childbirth. NICE Clinical Guideline 190, London: National Institute for Health and Clinical Excellence 2014.

Du Y, Ye M, Zheng F. Active management of the third stage of labor with and without controlled cord traction: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2014; 93:626-33.

Anorlu RI, Maholwana B, Hofmeyr GJ. Methods of delivering the placenta at caesarean section. Cochrane Database Syst Rev 2008; 3:CD004737.

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Published

2023-11-25

How to Cite

Felis S. (2023). POSTPARTUM HEMORRHAGE: Research Article. American Journal of Medical and Clinical Research & Reviews, 2(11), 1–28. https://doi.org/10.58372/2835-6276.1101

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