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Objective: To determine the better route of prostaglandin F2α either intramyometrial or intramuscular for the management of uterine atony and to prevent surgical intervention. Study Design: Randomized Controlled Trial. Settings: Bahawal Victoria Hospital. Period: Feb 2018 to July 2018. Material & Method: A total of 266 patients with primary PPH due to uterine atony of 20 to 39 years of age were enrolled in the study. Patients of primary PPH due to bleeding disorders, ruptured uterus, on anticoagulant therapy and hypersensitivity to prostaglandin were excluded. Patients were divided randomly into two groups i.e. Group A (for intramyometrial injection) & Group B (for intramuscular injection). Outcome variables like arrest of bleeding within 30 minutes after start of treatment (efficacy) were noted for successful or unsuccessful outcome. Results: The mean age of women in group A was 26.94 ± 4.43 and in group B was 26.21 ± 4.09 years (p=0.005). The mean parity in group A was 2.92 ± 0.87 and in group B was 2.93 ± 0.98 (p=0.8579). Efficacy was 82.71% in group A (Intramyometrial group) and 91.73% in group B (Intramuscular group) with p-value of 0.0276. Conclusion: This study concluded that intramuscular prostaglandin F2α has better efficacy i.e. 91.73% in a patient of uterine atony for management of primary PPH as compared to intramyometrial rout of administration for prostaglandin F2α.

Latar belakang : Kejadian perdarahan postpartum merupakan penyebab kematian ibu tertinggi ketiga di Kota Surabaya Provinsi Jawa Timur. Hal tersebut diiringi oleh kejadian anemia pada ibu hamil di Indonesia yang meningkat pada tahun 2018 sebesar 48.9% daripada tahun 2013 sebesar 37.1%. Penelitian ini bertujuan untuk menganalisis hubungan anemia dalam kehamilan dengan perdarahan postpartum primer di Rumah Sakit DKT Gubeng Pojok Kota Surabaya. Metode : penelitian ini menggunakan metode analitik observasional dengan rancangan penelitian case control design . Jumlah sampel sebanyak 60 ibu bersalin secara pervaginam yang sesuai dengan kriteria eksklusi dan inklusi. Variabel bebas anemia dalam kehamilan adalah sedangkan variabel terikat adalah perdarahan postpartum primer. Hasil : Sebagian besar ibu bersalin secara pervaginam 60% mengalami anemia dalam kehamilan dengan analisis uji chi square menunjukkan p value = 0.000 ( p < 0.05), Odds Ratio sebesar 21.35, dan berdasarkan hasil uji T test didapatkan rata-rata kadar Hb pada kelompok anemia sebesar 9.058 g% dengan standar deviasi 0.9782 dan rata-rata kadar Hb pada kelompok non-anemia sebesar 12.063 g% dengan standar deviasi 1.13792 yang menunjukkan bahwa terdapat perbedaan yang signifikan. Kesimpulan : Terdapat hubungan yang signifikan antara anemia dalam kehamilan dengan kejadian perdarahan postpartum primer sehingga bidan sebagai tenaga kesehatan di lini utama harus memperhatikan kadar Hb pada masa kehamilan. Abstract Background : Primary postpartum hemorrhage was the third-highest cause of maternal death in the city of Surabaya, East Java Province. This was accompanied by the incidence of anemia in a pregnant women in Indonesia which increased in 2018 by 48.9% compared to 2013 at 37.1%. This study aimed to analyze the relationship anemia in pregnancy with primary postpartum hemorrhage in DKT Gubeng Pojok hospitals in Surabaya city East Java. Method : This study used analytic observational methods with a case-control study research design. The number of samples was 60 vaginal delivery mothers who were under the criteria of exclusion and inclusion. A sampling of this study used purposive sampling with independent variable is anemia in pregnancy and dependent variable is primary postpartum hemorrhage. Result : Most of mothers that gave birth pervaginally 60% had anemia in pregnancy with analysis chi-square test showing p-value =0.000 (p

OBJECTIVES: We aimed to evaluate the effect of vaginal packing in the management of lower uterine segment atony that it is a distinct cause of primary postpartum hemorrhage. We also set out to determine the incidence of lower uterine segment atony. STUDY DESIGN: This is a retrospective study involving 967 births out of 25 000 deliveries in one institution in the year 2018. Of 967 births were managed by the corresponding author of this study. Of 14 lower uterine segment atony patients were occurred during the study period among 967 deliveries. All patients with lower uterine segment atony were treated by vaginal packing. RESULTS: The occurrence of postpartum hemorrhage among the study population was 57/967 (5.9%). We found the incidence of lower uterine segment atony to be 1.4% (14/967). Vaginal packing as a first attempt was found to be successful for controlling hemorrhage in 13/14 (92.8%) patients with lower uterine segment atony. It was found to occur in the repeated cesarean group more than other groups, but this difference was not statistically significant (p=0.157). Any complications were occurred related to packing. CONCLUSION: Vaginal packing was found to be simple, safe, and feasible in terms of achieving hemostasis in cases of postpartum hemorrhage due to lower uterine segment atony. Vaginal packing is a potential method for preserving the uterus before further surgical application.

Objective To explore diagnoses of postpartum haemorrhage following vaginal birth, in relation to socio-demographic and obstetrical data from women who gave birth at term, in Sweden, during the years 2005–2015. Study design A register-based cohort study was carried out, describing and comparing socio-demographic variables, obstetric variables and infant variables in 52 367 cases of diagnosed postpartum haemorrhage compared to 353 569 controls without a postpartum haemorrhage diagnosis. Postpartum hemorrhage was identified in The Swedish Medical Birth Register by ICD-10 code O72. Variables for maternal characteristics were dichotomized and used to calculate odds ratios to find possible explanatory variables for postpartum haemorrhage. Results Between 2005 and 2015 there was no statistically significant decrease in diagnoses of postpartum haemorrhage after vaginal birth at term. Primiparity was associated with the highest risk and women birthing their fifth or subsequent child were associated with the lowest risk of postpartum hemorrhage. Increased maternal age (> 35 years) and/or obesity (BMI > 30) were associated with higher odds of postpartum haemorrhage. The risk of postpartum hemorrhage was 55 % higher when vaginal birth followed induction as compared to vaginal birth after spontaneous onset. Some of the factors known to be associated with postpartum haemorrhage were poorly documented in The Swedish Medical Birth Register. Conclusions Birthing women in a Swedish contemporary setting are, despite efforts to improve care, still at risk of birth being complicated by postpartum haemorrhage. Primiparity, increasing maternal age and/or obesity are found to provoke an increased risk and the reasons for these findings need to be further investigated. However, grand multi-parity did not increase the risk for postpartum hemorrhage. Codes for diagnoses require correct documentation in the birth records: only when local statistics are sound and correctly reported can intrapartum care be improved, and the incidence of postpartum haemorrhage reduced.

Background: Postpartum hemorrhage (PPH) is the world‘s leading cause of maternal mortality, accounting for one-third of all maternal deaths worldwide. Aim of the Study was early identification of risk factors of primary postpartum hemorrhage. Research Design: A descriptive cross-sectional research design was utilized. Subject and setting: The study was carried out over a period of six months in obstetrics and gynecology department at Minia University Hospital for Obstetric and Pediatric. Tools for Data Collection: two tools were used; Tool I: Socio-demographic characteristics, and Tool II: Risk factors assessment tools. Results: The study revealed that, study group had low risk factors of current PPH had(previous uterine incision, History of PPH ), moderate risk factors of current PPH in women had (prior cesarean birth or prior uterine incision, History of one previous PP), high risk factors of current PPH in women ( had two or more moderate symptoms of risk factors, platelets level

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary PPH compared to uterine packing alone. Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional local pathway of management of PPH had failed to control bleeding. In 15 women(the case group), uterine pack impregnated with 20 ml of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without tranexamic acid was used, outcome studied include the need for further surgical intervention and need for blood product. Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference in effectiveness of both methods is statistically insignificant. The requirement for blood product transfusion was less in TXA group. Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive surgical intervention as hysterectomy.

Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births.A retrospective analysis was undertaken of all OOH births between the 1In total, 350 OOH births were included in this study with the majority involving multigravidas women (94.3%) and all but two involving singleton pregnancies. Oxytocin was administered following 222 births (63.4%), while 67 patients (19.1%) declined administration preferring a physiological third stage of labor, and in 61 cases (17.4%) oxytocin was withheld by the attending paramedic. There were no documented adverse events or side effects following administration. Oxytocin administration occurred on average 14 minutes (interquartile range 9-25) following the time of birth. The median time from oxytocin administration to placenta delivery was 10 minutes (interquartile range 5-22).Oxytocin is well accepted and safe treatment adjunct for the management of the third stage of labor in OOH births and should be considered for routine practice by other emergency medical services.

Latar Belakang: Perdarahan postpartum primer yang terjadi dalam 24 jam pertama, merupakan penyebab tertinggi kematian ibu di Indonesia. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian perdarahan postpartum primer di RSUD Raden Mattaher Provinsi Jambi Tahun 2019. Metode: Penelitian ini merupakan survey analitik dengan metode observasional menggunakan pendekatan case control. Sampel kasus sebanyak 48 diambil secara total sampling yang merupakan jumlah kasus yang ditemukan tahun 2013-2018 dan sampel kontrol sebanyak 48 diambil menggunakan teknik purposive sampling dengan perbandingan jumlah 1:1. Pengumpulan data dilakukan dengan cara dokumentasi. Analisis data dilakukan secara univariat dan bivariat. Hasil: Sebagian responden berada pada umur dan paritas yang berisiko serta mengalami anemia dan hasil bivariat menunjukkan umur (p-value= 0,002 dan OR=4,109), paritas (p-value=0,000 dan OR=7,400), anemia (p-value=0,000 dan OR=14,224) memiliki hubungan bermakna dengan kejadian perdarahan postpartum primer. Kesimpulan: Umur, paritas dan anemia merupakan faktor yang berhubungan secara signifikan dengan kejadian perdarahan postpartum primer di RSUD Raden Mattaher Provinsi Jambi.

Background: Failure of the primary management at controlling the post-partum hemorrhage (PPH) is occasionally encountered. A catastrophic cause of PPH as vagina arterial aneurysms with AVF is rare and not reported in English literature.Case presentations: We present a 34-year-old woman of arterial aneurysms with arteriovenous fistulas (AVF) at bilateral lower vagina causing intractable PPH with aggressive bleeding. By trans-arterial embolization (TAE) the bleeding is successfully controlled, and patient then could recover smoothly.Conclusion: These vascular anomalies being fierce culprit of the PPH would result in primary management failure. Knowledge of the possible etiology of post-partum hemorrhage is crucial for treatment management. This case report aims to point out a pivotal role of TAE at detecting and treating this unusual cause of PPH.

Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor. Materials and Methods: A total of 104 women with term pregnancy were randomized to receive either 200 μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage. Results: A total of 104 women with term pregnancy in two groups of 52 were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; P = 0.11. There was no significant differences between the misoprostol and oxytocin groups with regard to the incidence of PPH (19.2% vs. 13.5% respectively; P = 0.43). More women in the misoprostol group experienced side effects compared with those in oxytocin group; however, the difference was not statistically significant ( P = 0.26). The mean duration of third stage of labor was similar and the difference was statistically not significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) ( P = 0.38), as well as need for additional oxytocics (13.5% vs. 5.8% P = 0.18) misoprostol and oxytocin, respectively. Conclusion: Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 μg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor. Keywords: Primary postpartum hemorrhage; misoprostol; uterotonics

Background: Globally, postpartum hemorrhage remained a leading cause of maternal mortality, accounting for nearly one quarter of all pregnancy related deaths. To decrease postpartum hemorrhage related maternal mortalities to desired level, identifying its risk factors is very crucial to guide interventions. In this regard, little is known about the link between inter-pregnancy interval and primary postpartum hemorrhage in Ethiopia where maternal mortality is one of the highest in the world (412 per 100,000 live births). Therefore, we mainly aimed to assess the effect of inter-pregnancy interval on primary postpartum hemorrhage in urban South Ethiopia.Methods: A community-based matched nested case control study was conducted among 365 women (73 cases and 292 controls). Cases were women with primary postpartum hemorrhage and controls were women without primary postpartum hemorrhage. Cases were individually matched with controls (1:4 ratio) for age group and location. A conditional logistic regression analysis was done using R version 4.0.3 software. Statistically significant association was declared at P < 0.05. Odds ratio and attributable fraction (AF) were used to report effect sizes from the adjusted model.Results: The incidence of primary postpartum hemorrhage was 2.9%, 95%CI: (2.2%, 3.6%). More than half (56%) of primary postpartum hemorrhage was attributed to short inter-pregnancy interval Conclusions: In this study, inter-pregnancy interval was causally related with primary postpartum hemorrhage. More than half of primary postpartum hemorrhage can be prevented by spacing pregnancy for at least 18 months. Other risk factors for primary postpartum hemorrhage were antepartum hemorrhage, prolonged labour and late initiation of breast feeding. Increasing existing maternal health service utilization (family planning emphasizing on spacing, antenatal care, health facility delivery with early referrals and postnatal care) will contribute for reducing primary postpartum hemorrhage, as the risk factors identified were maternal health service related and modifiable.

BackgroundPostpartum hemorrhage (PPH) constitutes a major risk for maternal mortality and morbidity. Unfortunately, the severity of PPH can be underestimated because it is difficult to accurately measure blood loss by visual estimation. The delta neutrophil index (DNI), which reflects circulating immature granulocytes, is automatically calculated in hematological analyzers. We evaluated the significance of the DNI in predicting hemorrhage severity based on the requirement for massive transfusion (MT) in patients with PPH.MethodsWe retrospectively analyzed data from a prospective registry to evaluate the association between the DNI and MT. Moreover, we assessed the predictive ability of the combination of DNI and shock index (SI) for the requirement for MT. MT was defined as a transfusion of ≥10 units of red blood cells within 24 h of PPH. In total, 278 patients were enrolled in this study and 60 required MT.ResultsMultivariable logistic regression revealed that the DNI and SI were independent predictors of MT. The optimal cut-off values of ≥3.3% and ≥1.0 for the DNI and SI, respectively, were significantly associated with an increased risk of MT (DNI: positive likelihood ratio [PLR] 3.54, 95% confidence interval [CI] 2.5–5.1 and negative likelihood ratio [NLR] 0.48, 95% CI 0.4–0.7; SI: PLR 3.21, 95% CI 2.4–4.2 and NLR 0.31, 95% CI 0.19–0.49). The optimal cut-off point for predicted probability was calculated for combining the DNI value and SI value with the equation derived from logistic regression analysis. Compared with DNI or SI alone, the combination of DNI and SI significantly improved the specificity, accuracy, and positive likelihood ratio of the MT risk.ConclusionThe DNI and SI can be routinely and easily measured in the ED without additional costs or time and can therefore, be considered suitable parameters for the early risk stratification of patients with primary PPH.

Objective: The aim of this study was to determine the effects of three different methods in reducing primary postpartum hemorrhage.Methods: The study was carried out in Istanbul/Turkey with 150 people at a maternity hospital. The participants were assigned to the external circular fundus massage (ECFM) (n=50), external bimanual fundus compression (EBFC) (n=50) and control (C) (n=50) groups with the simple randomization method. The women in the experiment groups of external circular fundus massage or external bimanual uterus fundus compression received intervention for one hour in the postpartum period. At the 6th postpartum hour, the hemogram values and total lochia amount of all women were measured.Results: The mean ± standard deviation (SD) age of the women was 24.77±4.40 years, 63.3% were having their first birth, and 47.3% gained weight between 11 and 16 kg in their pregnancy. There was no significant difference between the groups in terms of the mean ± SD Hb at the 6th postpartum hour (ECFM group=11.5±1.1; EBFC Group =11.7±3.6; C group =11.4±1.0 g /dL, F= 0.371, p = 0.691). In comparison to the ECFM and C groups, the 2nd postpartum hour visual analog scale (VAS) score of the EBFC group was found to be significantly lower (p

Background: Postpartum hemorrhage (PPH) is responsible for about 25% of maternal deaths worldwide. Antifibrinolytic agents, mainly tranexamic acid (TXA), have been demonstrated to reduce blood loss in patients with established PPH. Objective: The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of TXA administration in women with established primary PPH after vaginal delivery. Data sources: The search was conducted using electronic databases from inception of each database through February 2018. Review of articles also included the abstracts of all references retrieved from the search. No restrictions for language or geographic location were applied. Study design: Selection criteria included RCTs comparing the use of TXA in women with established primary PPH after vaginal delivery with control (either placebo or no treatment). Trials in women undergoing cesarean delivery and trials in prevention of PPH were excluded. The primary outcome was the incidence of hysterectomy. The summary measures were reported as summary relative risk (RR) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird. Tabulation, integration, and results: Two trials including 14,363 women with established primary PPH after vaginal delivery were analyzed. Women who received TXA soon after the diagnosis of PPH had a significantly lower incidence of hysterectomy (0.5% vs 0.8%; RR 0.63, 95% CI 0.42–0.94), compared to those who did not. The risk of thrombotic events was not increased in the TXA group. Conclusion: In women with established PPH after vaginal delivery, the use of TXA reduces the risk of hysterectomy and does not increase the risk of thrombotic events. We recommend 1 g plus a second dose of 1 g if bleeding continues after 30 min.

Objective| To compare the effectiveness and safety profile of intrauterine balloon tamponade with uterovaginal roll gauze packing among patient of primary postpartum hemorrhage after normal vaginal delivery. Duration of Study| This study was conducted in the Department of Obstetrics & Gynaecology, of a Tertiary Care Hospital, Lahore from December 2015 to November 2016. Patients and Methods| In this Randomized controlled trial,212 patients of age range 20 to 40 years who presented with postpartum hemorrhage after a normal vaginal delivery (NVD) those who did not responded to medical treatment were included. Cases of PPH due to perineal, cervical or vaginal tear, episiotomy, retained placenta, coagulation disorder, secondary PPH and PPH with normal vaginal delivery after previous cesarean section were excluded from this study. Subjects were randomly assigned to either intrauterine balloon tamponade or uterovaginal roll gauze packing. Intrauterine packing (IP) was removed after 24 hours and balloon tamponade after 24 hours of insertion. Antibiotic coverage was also given to prevent intrauterine infection. All females were kept under observation in ward. Effectiveness was labeled if bleeding was stopped within 15 minutes after uterovaginal packing or balloon tamponade (BT) and patient remain hemodynamically stable and if no complications occur after applying or removing balloon tamponade or intrauterine packing safety was labeled. Data was analyzed by SPSS version 20.2.Frequencies and percentage of complications were calculated along with rate of successful cessation of bleeding were calculated. Result| Mean age group of woman in whom balloon tamponade and intrauterine packing was used was 29.22+6.52 and 29.05+ 6.802 years. Mean gestational age of woman in BT and IP group and was 39.95+1.304 and 38.98+ 1.428 years. Mean blood loss in woman in BT and IP group was 600.28+ 25.338 and 669.21+70.176 ml. Efficacy of group BT was 78(73.6%) and in IP was 63(59.4%).Safety of BT group was 97(91.51%) and IP group was 55(51.88%). Treatment of balloon tamponade was more effective and safe than intrauterine packing in female presented with PPH after normal vaginal delivery (p < .05). Conclusion| This study concluded that balloon tamponade is an effective and safe method than intrauterine packing for the management of PPH after normal vaginal delivery.

Objectives: To see the changing trends in causative factors and various treatmentoptions in pirmary PPH. Study Design: Retrospective study of all the cases who experiencedprimary postpartum hemorrhage. Period: 4 years i.e: June 2013 to June 2017. Setting:NESCOM Hospital Islamabad. Material and Methods: The sociodemographic characteristics,mode of delivery, antenatal risk factors, causative factors and the treatment received by thepatients were extracted from patient’s case notes, entered into computer programme SPSSand analysed. Results: Total number of cases who went into PPH were 77. Majority of patientswere belonging to age group 26-34 years. 50% of patients were multiparous whereas 41% wereprimiparous and 7.7% were grand multiparous. 66% of patients had caesarean section while34% were delivered vaginally. Commonly identified risk factor was anaemia as in 19% of cases.Others were high parity 12%, prolong labour 7%, augmented labour 5%, and fetal macrosomiain 7% of cases. No risk factors were identified in 43% of cases. Uterine atony was found to bea major causative factor in 70% of cases and genital tract trauma in 23% of cases. 51.9% ofpatients were successfully managed with medical treatment. Special feature of the medicaltreatment was the use of tranexamic acid which added to success rate.48% of patients requiredsurgical intervention. Conclusion: It is worthy to note that postpartum hemorrhage can occurin the absence of any identifiable risk factors. Therefore, the anticipation of its occurrence andprompt, adequate, and timely intervention will go a long way in reducing the adverse outcome.

Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Methylergonovine and carboprost are both highly effective second-line agents with severe potential side effects. Recent studies have called into question the effectiveness of misoprostol as an adjunct to other uterotonic agents, but it remains a useful therapeutic in resource-limited practice environments. We review the current role these medications play in the prevention and treatment of uterine atony.

Grand-multiparity is a serious risk factor in pregnancy and common in developing countries. The objective was to compare the obstetric outcome of grand-multiparous women with that of low parity in our center. The study comprised of 150 grand-multiparous women (cases) and 150 multiparous women (para 2 - 4) in this index pregnancy as controls matched for age and admitted for delivery. The mean age of the grand-multiparous women at delivery was 37.0 ± 2.8 years. Grand-multiparity was significantly higher among women with only primary education (48.0% versus 44.7%), polygamous marriages (9.3% versus 3.3%) and Muslims (17.3% versus 6.7%). Pregnancy induced hypertension and primary postpartum hemorrhage were significantly more often seen among grand-multiparous women than among the controls. The mean packed cell volume before delivery in the grand-multiparous women was significantly lower (33.6% ± 2.7%) than in the multiparous group (35.2% ± 2.7%) (P-value = 0.000). Grand-multiparity with its associated complications still occurs frequently in our environment. However, with adequate antenatal surveillance, optimal care during labour and contraceptive use, these problems will be reduced.

Objective: The aim of this retrospective observational study was to determine the efficacy of carbetocin in reducing blood loss and primary postpartum hemorrhage (PPH) in vaginal and cesarean deliveries in a tertiary hospital in Taiwan. Materials and methods: Eligible gravid women (27–41 weeks) with available data were categorized into those treated prophylactically with and without carbetocin. The primary outcome was blood loss and incidence of primary PPH as measured by intrapartum/intraoperative and postpartum (recovery room) blood loss. Results: A total of 1069 deliveries were evaluated. Maternal age (∼31 years of age), body mass index (∼27 kg/m2) and parity (∼1.4) were similar among those treated with and without carbetocin for both vaginal and cesarean deliveries. The majority [749/1069 (70.1%)] of deliveries were vaginal; a similar proportion of women undergoing vaginal [221/749 (29.5%)] and cesarean [110/320 (34.4%)] deliveries received prophylactic carbetocin for prevention of PPH. Among vaginal deliveries, there was no significant difference in intrapartum (p = 0.083) or postpartum (p = 0.925) blood loss, or incidence of PPH (p = 0.092) between women with versus without carbetocin prophylaxis. However, there was a significant reduction in the intraoperative and total blood loss among cesarean deliveries with versus without carbetocin prophylaxis (p

Background: Postpartum hemorrhage is still the leading cause of death of birthing mothers in the world today. Pronurturance plus evidence-based practice which includes early skin-to-skin contact and breastfeeding has a significant positive effect to improve the labor outcomes and decrease the occurrence of postpartum hemorrhage. Aim: was to study the effect of pronurturance plus on labor outcomes of women at risk to postpartum hemorrhage. A Quasi-experimental research study carried out at the Delivery Room and Postpartum Department in one of the Hospital that affiliated to the Ministry of Health, Fayoum, Egypt. Sample: A purposive sample of 90 laboring women at risk for postpartum hemorrhage was divided into the study and control groups (45 for each). The control group received routine hospital care and the study group received the pronurturance plus practice. Seven women were excluded from the study group due to that some babies failed to initiate breastfeeding after delivery and some mothers didn‟t complete the duration of skin to skin contact. Finally, the sample size reached 45 & 38 women in the control and study groups respectively. Four tools were used: 1) Laboring women‟s‟ demographic data assessment tool,2)Risk factors‟ to postpartum hemorrhage assessment tool 3) Labor outcomes assessment tool, and 4) Women‟s‟ satisfaction assessment tool. The results: There were statistically significant differences between the study and the control groups with regard to the labor outcomes in third and fourth stage of labor. The study group exhibited less duration of 3 rd stage of labor, efficient uterine contraction, less amount of blood loss, less occurrence of primary postpartum hemorrhage, and high satisfaction level regarding to the apply of pronurturance plus. Conclusion: The pronurturance plus practice had a positive effect in improving labor outcomes and reducing the occurrence of primary postpartum hemorrhage among women at risk to postpartum hemorrhage. Recommendations: The practice of pronurturance plus should be a part of routine 3 rd and 4 th stage care for all birthing women regardless of their level of risk.

The objective of this study is to evaluate the actions taken by obstetricians when faced with postpartum hemorrhage (PPH).A standardized open-ended survey was applied to 235 physicians at five hospitals and at an obstetrics and gynecology conference, inquiring about which actions are recommended in the initial stages of PPH. We calculated the frequency and confidence intervals of the actions mentioned and correlated the number of actions with the number of clinicians mentioning them using Spearman's rho test.Asking for help was mentioned by 45% of the respondents and 38% asked for vital signs. Only one-fifth of those surveyed asked for blood count, coagulation testing, arterial blood gas, or urinary catheter. Very few mentioned hypothermia prevention, oxygen administration, or blood transfusion. A total of 80% of those interviewed only mentioned 3 of the 16 recommended actions.Postpartum hemorrhage training should include instructions on initial steps in order to improve treatment comprehension and outcomes.

BACKGROUND: Postpartum hemorrhage (PPH) is responsible for about 25% of maternal deaths worldwide. Antifibrinolytic agents, mainly tranexamic acid, have been demonstrated to reduce maternal blood loss and need for transfusion requirements at delivery in some settings. OBJECTIVE: The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effectiveness of tranexamic acid for the prevention of PPH after vaginal delivery. DATA SOURCES: The search was conducted using electronic databases from the inception of each database through February 2018. Review of articles also included the abstracts of all references retrieved from the search. No restrictions for language or geographic location were applied. STUDY DESIGN: Selection criteria included RCTs comparing the prophylactic use of tranexamic acid after vaginal delivery with control (either placebo or no treatment). Trials in women undergoing cesarean delivery and trials in women with established PPH were excluded. The primary outcome was the incidence of primary PPH. The summary measures were reported as summary relative risk (RR) with 95% confidence interval (CI) using the random-effects model of DerSimonian and Laird. TABULATION, INTEGRATION, AND RESULTS: Four RCTs, including 4671 participants, evaluating tranexamic acid usually 1 g intravenous (IV) within 10 min after vaginal delivery in addition to oxytocin, cord traction, and uterine massage, at or near term for prevention of primary PPH, defined mostly as blood loss ≥500 mL in the first 24 h following delivery, were analyzed. Women who received prophylactic tranexamic acid after vaginal delivery had a significantly lower incidence of primary PPH (8.7 versus 11.4%; RR 0.61, 95% CI 0.41-0.91) and lower mean blood loss mean difference (MD) -84.74 mL, 95% CI -109.76 to -59.72). The risk of thrombotic events was not increased in the tranexamic acid group. CONCLUSIONS: Prophylactic tranexamic acid 1 g IV within 10 min after vaginal delivery reduces the risk of primary PPH.

Background Primary postpartum hemorrhage is the leading cause of maternal mortality worldwide. Ethiopia has made significant progress in maternal health care services. Despite this, primary postpartum hemorrhage continues to remain the leading cause of maternal mortality in Ethiopia. This study aimed to assess the prevalence and predictors of primary postpartum hemorrhage among mothers who gave birth at selected hospitals in the Southern Ethiopia. Methods An institution-based cross-sectional study was employed from March 2–28, 2018. Four hundred and twenty-two study participants were obtained using the consecutive sampling method. A structured interviewer-administered questionnaire and chart review were used to collect data. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 22. Multivariable logistic regression were used to determine the predictors of primary postpartum hemorrhage with 95% CI and p-value < 0.05. Results The overall prevalence of primary postpartum hemorrhage was 16.6%. Mothers aged 35 and above [AOR = 6.8, 95% CI (3.6, 16.0)], pre-partum anemia [AOR = 5.3, 95% CI (2.2, 12.8)], complications during labor [AOR = 1.8, 95% CI (2.8, 4.2)], history of previous postpartum hemorrhage [AOR = 2.7, 95% CI (1.1, 6.8)] and instrumental delivery [AOR = 5.3, 95% CI (2.2, 12.8)] were significant predictors of primary postpartum hemorrhage. Conclusion Primary postpartum hemorrhage is quite common in the study area. Mothers aged 35 and above, complications during labor, history of previous postpartum hemorrhage, and instrumental delivery were predictors of primary postpartum hemorrhage. Since postpartum hemorrhage being relatively common, all obstetrics unit members should be prepared to manage mothers who experience it.

Solwayo Ngwenya1–3 1Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Bulawayo, Zimbabwe; 2Royal Women’s Clinic, Bulawayo, Zimbabwe; 3Medical School, National University of Science and Technology, Matabeleland, Zimbabwe Background: Primary postpartum hemorrhage (PPH) is defined as blood loss from the genital tract of 500 mL or more following a normal vaginal delivery (NVD) or 1,000 mL or more following a cesarean section within 24 hours of birth. PPH contributes significantly to maternal morbidity and mortality worldwide. Women can rapidly hemorrhage and die soon after giving birth. It can be a devastating outcome to many young families. Women giving birth in low-resource settings are at a higher risk of death than their counterparts in resource-rich environments. PPH is a leading cause of maternal deaths globally, contributing to a quarter of the deaths annually. Aims: This study aims 1) to document the incidence, risk factors, and causes of PPH in a low-resource setting and 2) to document the maternal outcomes of PPH in low-resource setting. Methods: This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the labor ward birth registers for patients who had a diagnosis of PPH during the period from January 1, 2016 to June 30, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered. Blood loss was estimated postdelivery by the attending clinician – either a midwife or a doctor. At this maternity unit, blood loss is not measured but estimated owing to prevailing resource constraints. The SPSS Version 21 statistical tool was used to calculate the mean and standard deviation (SD) values. Simple statistical tests were used on absolute numbers to calculate percentages. Results: There were 4,567 deliveries at the institution during the period from January 1, 2016 to June 30, 2016. There were 74 cases of PPH during the study period. The incidence of primary PPH was 1.6%. The mean age was 27.7 years (SD ±6.9), mean gestational age was 38.6 weeks gestation (SD ±2.2), and mean birth weight was 3.16 kg (SD ±0.65) for the studied group of patients. Three-quarters (75.7%) of the cases had NVD. The majority of the cases (77.0%) had an identifiable risk factor for developing primary PPH. The most identifiable risk factor for primary PPH was pregnancy-induced hypertension followed by prolonged labor. Uterine atony was the most common cause of postpartum hemorrhage (82.4%). The women who delivered by NVD, who were diagnosed with a PPH, and who lost an estimated 500–1,000 mL of blood were 73.2%; 25% lost 1,000–1,500 mL of blood, and 1.8% lost more than 1,500 mL of blood. The women who delivered by lower-segment cesarean section, who were diagnosed with a PPH, and who lost an estimated 1,000–1,500 mL of blood were 77.8%, and 22.2% bled an estimated 1,500 mL of blood or more. The majority of the cases of primary PPH (94.6%) survived the condition and 5.4% died. Conclusion: The incidence of PPH at Mpilo Central Hospital was 1.6% during the study period, lower than that reported elsewhere in similar setting in the literature. This study, therefore, is important as it documents for the first time for this maternity unit and for a Zimbabwean setting, the incidence of one of the most important causes of global maternal deaths. Future studies should involve the effect on maternal outcomes of PPH following widespread introduction of misoprostol therapy into practice. This data can help in mobilizing global efforts to improve women’s health. Keywords: causes, uterotonics, avoidable deaths, maternal outcomes, low-resource settings

Objectives: The aim of our study is to determine the effectiveness of uterinemassage with active management and compare it with active management alone, in primarypostpartum hemorrhage prevention. Study Design: Randomized control trial. Period: 8months from September 2014 to April 2015. Setting: Tertiary Care Hospital in Karachi, Pakistan.Method: The study population consists of n=118 patients, both emergency and elected cases,who came to the gynecology and obstetrics ward at our hospital. The patient population wasdivided into two groups, group I received active management of labor ( third stage ) while groupII received active management of labor (third stage) in addition to the uterine massage (for a 2hrduration), the outcome was measured by measuring the amount of blood loss and the need foruterotonic agents. A p value of less than 0.05 was considered significant. Results: The studypopulation consisted of n=118 patients, undergoing spontaneous labor, and divided into twogroups, the mean blood loss in group I (control group) was 211.4mls and in group II (massagegroup) was 167.8mls (p value= 0.015). In group I n=15 patients required additional uterotonicsupport, while in group II only n=3 patients required it (p value= 0.00058). Conclusion:According to the results of our study, uterine massage in addition to the active managementof labor reduces post-partum hemorrhage, and it also reduces the requirement for additionaluterotonic agents for the control of hemorrhage.

Background: Approximately 800 women die from pregnancy-related conditions daily with 99% of these maternal deaths occurring in low resource countries. Primary postpartum haemorrhage accounts for 25.7% of maternal deaths in Africa. In Cameroon, primary postpartum hemorrhage remains the leading cause of maternal death. Objective: The aim of this study was to determine the prevalence, risk factors, and the maternal and fetal outcomes of primary postpartum hemorrhage in the Bonassama District Hospital, Douala, Cameroon. Methods: This study was a cross-sectional study. Of the 556 women interviewed regarding their willingness to participate in the study, 550 consented. Quantification of blood loss was done over the 24 hours using a 700cc measuring cylinder, an electronic weighing balance and the Pathfinder International wall chart for visual estimation of blood loss. The well-being of the neonates was evaluated by a pediatrician. Data was collected using a structured questionnaire and analyzed using EPI-INFOTM version 7.1.4.0. A P-value

Aims: To study the effectiveness of uterovaginal packing in the management of primary postpartum hemorrhage (PPH).Methods: This is a retrospective study conducted in Patan hospital, Lalitpur from January 2009-2011. Patients included in the study were those with intractable hemorrhage not responding to oxytocics. Exclusion criteria included cases of PPH due to trauma. Packing was done using approximately six inches sterile gauze soaked with povidine iodine packed into the uterus from the uterine fundus up to the vaginal canal. The packing is removed after 48 hours of insertion or earlier in cases of failure to control hemorrhage.Results: There were 46 cases of uterovaginal packing for primary PPH. Uterine atony was the commonest cause of packing. Uterovaginal packing was successful in 39(84.7%) cases.Conclusion: Uterovaginal packing is safe, easy and quick procedure to manage primary PPH. It is beneficial in cases of PPH due to atony thereby conserve the uterus.

Objectives: Major obstetric hemorrhage (MOH) is the leading cause of severe maternal morbidity and mortality, and can have a significant impact on a woman's life. This study aims to gain insight into the patients reported experiences (PREs) and outcomes (PROs) after a major obstetric hemorrhage, and to investigate which patients are most at risk for negative experiences. Material and methods: A Consumer Assessment of Healthcare Providers and Systems (CAHPS) based questionnaire was developed covering items on the PREs and PROs, and send to all patients with blood loss exceeding 2500 ml in six hospitals over the period of 2008-2012. A regression analysis was performed to find determinants for negative experiences. Results: In total 372 of the 570 questionnaires were returned. Women scored the overall care before, during and after the MOH with a mean of 7.67, 7.62 and 7.28, respectively. However, most PRE items individually were scored suboptimal, with items regarding information supply scoring the lowest. Our results on the PROs showed 81% of the women (362) sustaining extreme fatigue, whereas problems with concentration (53% of 373 women), memory (49% of 353), or reliving (49% of 356) and irritability (51 % of 355) were also frequently endured. Negative long term effects were observed in 28% of the women (106 of 372). We found 'year of the MOH longer ago', 'a lower total blood loss' and 'a large location of birth' to be determinants for negative experiences. Conclusions: Women frequently reported negative experiences and outcomes following a MOH. Information supply after an MOH concerning both physical and psychological complaints is essential for the improvement of care. (C) 2018 Elsevier B.V. All rights reserved.