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Journal articles on the topic 'Obstetric Haemorrhage'

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Author: Grafiati

Published: 4 June 2021

Last updated: 19 February 2022

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1

Kilgert, K., and G. Pfanner. "Obstetric bleeding complications." Hämostaseologie 26, S 02 (2006): S56—S63. http://dx.doi.org/10.1055/s-0037-1617083.

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SummaryThe instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrom can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis.This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.

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2

MacLean, A. B. "Obstetric Haemorrhage." Journal of Obstetrics and Gynaecology 32, no. 1 (December 20, 2011): 1. http://dx.doi.org/10.3109/01443615.2012.638554.

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3

McLintock, Claire. "Obstetric haemorrhage." Thrombosis Research 123 (January 2009): S30—S34. http://dx.doi.org/10.1016/s0049-3848(09)70006-4.

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4

Wise, Arlene, and Vicki Clark. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 8, no. 8 (August 2007): 326–30. http://dx.doi.org/10.1016/j.mpaic.2007.06.002.

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5

Wise, Arlene, and Vicki Clark. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 11, no. 8 (August 2010): 319–23. http://dx.doi.org/10.1016/j.mpaic.2010.05.004.

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6

Maclennan, Kirsty, and Rachael Croft. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 14, no. 8 (August 2013): 337–41. http://dx.doi.org/10.1016/j.mpaic.2013.05.009.

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7

Mount, Thomas, and Kirsty MacLennan. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 17, no. 8 (August 2016): 379–83. http://dx.doi.org/10.1016/j.mpaic.2016.05.009.

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8

Ching, Rosanne, Thomas Mount, and Kirsty MacLennan. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 20, no. 9 (September 2019): 484–88. http://dx.doi.org/10.1016/j.mpaic.2019.07.006.

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9

Higgins, Shane. "Obstetric haemorrhage." Emergency Medicine Australasia 15, no. 3 (June 2003): 227–31. http://dx.doi.org/10.1046/j.1442-2026.2003.00464.x.

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10

Reyes Espinoza, Ixchel Suyapa. "Obstetric Hemorrhage, its role in maternal morbidity and mortality and the importance of its diagnosis, prevention and timely management." Mexican Journal of Medical Research ICSA 8, no. 15 (January 5, 2020): 37–44. http://dx.doi.org/10.29057/mjmr.v8i15.3906.

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Background: In recent years, different international and national campaigns have been implemented to combat obstetric haemorrhage. Maternal mortality (MM) is one of the main concerns of public health and represents a good indicator to measure the quality of care, an indicator that also allows to establish the socioeconomic differences between countries. There are still many activities to be carried out and achieve the objective set by the World Health Organization (WHO) and the Latin American Federation of Societies in Obstetrics and Gynaecology (FLASOG) "Zero deaths due to haemorrhage". Objective: Based on the scientific evidence available, deepen the knowledge of the role of obstetric haemorrhage as the main avoidable cause of maternal morbidity and mortality. Methodology: retrospective study through the search of original articles and systematic reviews in: Elsevier, Lancet, Intramed, PubMed, EMBASE, ScienceDirect and Cochrane Library. The following keywords were used for all sites: "Obstetric haemorrhage", "Maternal mortality and obstetric haemorrhage", "Maternal morbidity and obstetric haemorrhage", "Postpartum, late, secondary haemorrhage". The items with the highest level of evidence were selected. Conclusions: Obstetric haemorrhage is still a potential cause of maternal and fetal morbidity and mortality. Its appearance at any time of pregnancy is a cause for concern and alarm. Despite advances in obstetric and anesthetic care, its treatment remains a challenge for the surgical team, anesthesiologist, gynaecologist and Pediatrician.

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Jamal, Shehla, Archana Mehta, Neerja Goel, Mayuri Ahuja, Naima Afreen, and Sweety Malik. "Obstetrics ICU admissions: challenges faced at a tertiary referral centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 5 (April 28, 2018): 1840. http://dx.doi.org/10.18203/2320-1770.ijrcog20181914.

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Background: Management of critically ill patients in obstetrics is a challenge owing to the changed physiology and unpredictability of the disease behaviour. Stratification strategy for early admission to obstetric ICU is imperative to reduce maternal morbidity and mortality. Due to lack of formal surveys regarding obstetrical ICU in our country, there is lack of precise national data on obstetrical ICU mortality. Aim of the present study was to estimate the obstetric ICU admission rate, to study the pattern of causative aetiology and to study the complications developed in ICU.Methods: The present study is a retrospective analytical study done in the Department of Obstetrics and Gynecology, from January 2015 to August 2017.Results: During the study period there were a total of 8466 obstetrical admissions, 2508 deliveries and 104 ICU admissions. Out of 104, analysis was done on 71 patients. Hypertensive disorders of the pregnancy were associated with maximum number of admissions (47.8%), followed by postpartum haemorrhage (12.6%). Maximum admissions were in postpartum period (63.4%). Anaemia was associated with 35.2% of the cases and it was closely followed by sepsis (28.2%). Mechanical ventilation was required for 30.9% of the patients.Conclusions: Hypertensive disorders of the pregnancy, haemorrhage and sepsis are the major risk factors for ICU admission in obstetric population.

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Padmasekar, Anju, and Shyamala Jothy. "Retrospective study of massive obstetric haemorrhage and its materno fetal outcomes in a tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 2 (January 31, 2017): 554. http://dx.doi.org/10.18203/2320-1770.ijrcog20170380.

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Background: Massive obstetric haemorrhage is defined as blood loss of >1500 ml, or a decrease in haemoglobin>4 gm/dl or acute transfusion requirement of >4 units of blood when need for further transfusion is foreseeable. The purpose of this study is to analyse the demographic, medical and obstetric risk factors for massive obstetric haemorrhage and it’s materno fetal outcomes.Methods: Criteria for patient selection was all patients who had an acute obstetric haemorrhage necessitating a transfusion of >4 units of blood at a stretch when there was a need for more. This is a retrospective study conducted for a period of one year January to December 2015. Data regarding all cases under study during this period was obtained from Medical Records Department with prior permission. This study was conducted in the Department of Obstetrics and Gynecology, Government Raja Mirasudhar Teaching Hospital, Thanjavur Medical College, Tamil Nadu. Maternal outcomes like mode of delivery, rate of hysterectomy, postpartum complications, maternal mortality and fetal outcomes like intra uterine death, still birth and preterm birth were analysed.Results: The rate of massive obstetric haemorrhage in our hospital during the study period was 5.7/1000 births. Massive obstetric haemorrhage contributed to 25% of all maternal deaths in 2015. Atonic PPH was the commonest cause. Multiparity and previous caesarean section were identified to be significant risk factors.Conclusions: We found an increased association of massive obstetric haemorrhage with multiparity, caesarean sections and pre-eclampsia. Atonic PPH was the commonest cause. Massive obstetric haemorrhage had contributed significantly to adverse maternal and perinatal outcomes.

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Plaat, F., and A. Shonfeld. "Major obstetric haemorrhage." BJA Education 15, no. 4 (August 2015): 190–93. http://dx.doi.org/10.1093/bjaceaccp/mku049.

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14

Bonnar, John. "Massive obstetric haemorrhage." Best Practice & Research Clinical Obstetrics & Gynaecology 14, no. 1 (February 2000): 1–18. http://dx.doi.org/10.1053/beog.1999.0060.

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15

Pinder, Amanda, and Martin Dresner. "Massive obstetric haemorrhage." Current Anaesthesia & Critical Care 16, no. 3 (June 2005): 181–88. http://dx.doi.org/10.1016/j.cacc.2005.08.004.

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Maheshwari, Shashi Lata Kabra, Nisha Kumari, and Syed N. Ahmad. "Role of bilateral internal iliac artery ligation in severe obstetric and gynaecological hemorrhage." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 3 (February 27, 2018): 1090. http://dx.doi.org/10.18203/2320-1770.ijrcog20180898.

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Background: Massive pelvic haemorrhage is a potentially lethal complication while undergoing obstetric and gynaecological surgery. The objective of this study was to study of role of bilateral internal iliac artery ligation in severe obstetric and gynaecological haemorrhage. It was a prospective interventional study carried out in a multi-speciality tertiary care hospital in New Delhi.Methods: Thirty-five patients (31 obstetric and 4 gynaecological) fulfilling the inclusion criteria over a period of 2 years were included in the study cohort after informed consent. After laparotomy, internal iliac arteries were exposed by incising the peritoneal fold between the infundibulo-pelvic and round ligaments. A number 1 silk suture and right-angled artery forceps were used to tie the internal iliac arteries approximately 1 inch below their origin. The success and complications of the procedure were analysed.Results: In the present study 31 out of 35 cases underwent BIIAL for obstetrical cause of haemorrhage and rest 4 for gynaecological cause. In 19 out of 31 patients, hysterectomy preceded or followed BILAL depending upon the clinical situation making a uterine salvation rate of 38.7%. The success rate of BIIAL was 67.7% in 31 obstetric cases. In the 4 gynaecological cases BILAL was done to arrest post-hysterectomy haemorrhage and success rate was 100%. Among 35 patients one patient died of haemorrhagic shock and 4 other died of full blown sepsis and MODS in surgical ICU. No significant procedure related complications were encountered.Conclusions: BILAL is a very effective procedure to control PPH and pelvic haemorrhage due to other causes and helps save the much precious lives and uteri. This procedure can always be tried where procedures like embolization are unavailable.

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Remneva, O. V., E. G. Ershova, A. E. Chernova, A. I. Galchenko, and V. A. Borovko. "Major obstetric haemorrhage: portrait of "near miss" and risk management-based optimisation of obstetric techniques and telemedicine technologies." Fundamental and Clinical Medicine 4, no. 3 (October 2, 2019): 41–47. http://dx.doi.org/10.23946/2500-0764-2019-4-3-41-47.

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Aim. To identify measures for the improvement of obstetric techniques and telemedicine technologies in women with major obstetric haemorrhage.Materials and Methods. We analyzed medical documentation of 54 women in Altai Krai who experienced major obstetric haemorrhage within 28- 36 weeks of gestation before (2008-2012) and after (2013-2017) implementation of risk management using the telemedicine “Registry of pregnancies” technology.Results. Implementation of risk management principles led to the admission of women with major obstetric haemorrhage exclusively to specialised hospitals in contrast to the preceding period. Further, it was associated with a higher prevalence of caesarean sections (from 55.6% to 96.3%) in women with major obstetric haemorrhage due to an increase in cases of complete placenta previa or placenta increta. In 73.0% of cases, such patients delivered in specialised hospitals where autologous blood transfusion or intrauterine balloon tamponade could be applied. In spite of increase in frequency of major obstetric haemorrhages, risk management reduced their severity by decreasing blood loss and, hence, the risk of posthaemorrhagic complications and blood transfusion side effects.Conclusions. Risk management-based strategy for optimising obstetric care by telemedicine technologies leads to the admission of high-risk, even “near miss” patients in specialised hospitals that is particularly efficient in regions with low population density and a large network of primary healthcare facilities.

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18

Saleem, Saadia, Tasnim Tahira, Naureen Javed, and Sumera Tahir. "Emergency bilateral internal iliac artery ligation in massive obstetric haemorrhage: 5 years experience At Tertiary Care Hospital." Professional Medical Journal 27, no. 12 (December 10, 2020): 2691–95. http://dx.doi.org/10.29309/tpmj/2020.27.12.4360.

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Objectives: To study the efficacy and safety of emergency bilateral internal iliac artery ligation (BIAL) in arresting massive obstetric haemorrahge. Study Design: Retrospective study. Setting: Department of Obstetrics and Gynaecology Unit-I, Allied Hospital, Faisalabad. Period: January 2014 to December 2018. Material & Methods: Fifty eight (58) patients with obstetric haemorrhage were included in this retrospective study. Bilateral internal iliac artery ligation was performed to control massive postpartum haemorrhage, post-operative internal haemorrhage. Results: The fifty eight (58) women underwent BIAl. Booked cases were onlhy (27%) and (73%) were unbooked. Out of 58 women 16(27%) women were with morbid adherent placenta, 14(24%) with uterine atony, 11(19%) uterine rupture, 9(17%) post-operative internal haemorrhage and 8(13%) coagulopathy were underwent BIAL. Out of 58 women 15(36%) ended in hysterectomy because of failure to control bleeding and uterus preserved in (64%). Overall efficacy in term of saving maternal life was 90%. One women had ureteric injury that was managed by Urologist. One another patient required re-laparotomy for persistant internal haemorrahge. Conclusion: Bilateral internal iliac artery ligation is safe and effective technique to control massive obstetric haemorrhage. Timely decision is also important to prevent hysterectomy. BIAL should include in algorithm to control intractable obstetric haemorrhage and consultant obstetricians and gynaecologist should learn that technique.

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Bangal, Vidyadhar Bangal, Satyajit P. Gavhane, Kunal H. Aher, Dhruval K. Bhavsar, Priyanka R. Verma, and Swati D. Gagare. "Pattern of utilization of blood and blood components in obstetrics at tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 10 (September 23, 2017): 4671. http://dx.doi.org/10.18203/2320-1770.ijrcog20174462.

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Background: Obstetric emergencies occur suddenly and unexpectedly. Blood transfusion becomes one of the live saving measures in such situations. Severe anaemia due to nutritional deficiency, obstetric haemorrhage either during pregnancy, labour or in postpartum period are the commonest indications for blood transfusion worldwide. Blood bank services play important role in saving lives in obstetric emergencies. Health institutions must carry out internal blood transfusion audits to reassure optimal and judicious use of blood and blood components.Methods: Analysis of 755 Obstetric patients requiring blood transfusion in eighteen months period was done to find out the incidence and indications for blood transfusion at tertiary care hospital.Results: Overall, 5.33% of obstetric admissions required transfusion of blood or its components. Severe anaemia (36.55%), accidental haemorrhage (20.92%), postpartum haemorrhage (8.34%), placenta praevia (5.03%) and caesarean section (10.33%) were the common indications for blood transfusion. In more than 65% cases, two or three unit of blood were transfused. In majority of cases (96%) components were used.Conclusions: Blood transfusion helped to save many lives in the present study. Severe anaemia and obstetric haemorrhage of varied aetiology were the common indications for blood transfusion. Component therapy helped to correct specific deficiency. Voluntary blood donation should be encouraged in the younger generation to keep adequate stock of blood in blood bank for emergency use. Preventive measures like improving dietary iron intake and prophylactic iron therapy will go a long way in reducing the need for blood transfusion in Obstetrics.

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SAID, SOHA, and MICHAEL GEARY. "PREVENTION OF OBSTETRIC HAEMORRHAGE." Fetal and Maternal Medicine Review 18, no. 3 (August 2007): 257–88. http://dx.doi.org/10.1017/s0965539507002008.

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Obstetric haemorrhage has been recognised as a major cause of maternal death as long as physicians have studied and written about childbirth. Until the 20th century, however, little was possible in the way of effective treatment. Postpartum haemorrhage (PPH) is still a frequent cause of death in many parts of the world. Even in developing countries, it remains the 3rd biggest killer of women in childbirth, despite considerable advances in medical care in the last half-century. The modern management of PPH may include a team of anaesthetists, haematologists, vascular surgeons, gynaecologists and radiologists.1Clearly, this change represents an advance which has saved and will continue to save countless lives, not only in the developed world where such teamwork is routine, but also in developing nations that are desperately looking for ways to reduce maternal mortality as part of their efforts to comply with the United Nations Millennium Development Goals by the year 2015.2

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Verma, Pallavi, Pavitra Manu Dogra, Shivendra Kumar Sinha, Ramesh Kaushik, and Davinder Bhardwaj. "Neglected obstetric haemorrhage leading to acute kidney injury." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 11 (October 28, 2017): 5177. http://dx.doi.org/10.18203/2320-1770.ijrcog20175051.

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Pregnancy related acute kidney injury takes substantial share of acute kidney injury (AKI) in India, with obstetrical haemorrhage having high morbidity and mortality. A young female had neglected obstetric haemorrhage (unrecognized intrauterine and massive intraperitoneal bleeding post caesarean, due to uterine trauma and atony) and dangerous intra-abdominal hypertension with exsanguination eventually leading to shock, multifactorial AKI, metabolic acidosis, and hyperkalemia. Intensive and aggressive management with subtotal hysterectomy, inotropes, fluid management, mechanical ventilation, tracheostomy, and hemodialysis changed the outcome. Despite odds against, neglected obstetric haemorrhage with complicated AKI, was managed successfully by emergency hysterectomy, aggressive intervention for AKI with intensive fluid, ventilatory management and daily hemodialysis. Timely identification and aggressive management of this condition and complications is pivotal in preventing complications, morbidity, and maternal mortality.

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Vasava, Dipti C., Rajal V. Thaker, Aditi A. Tyagi, and Foram P. Patel. "Analysis of transfusion of blood and blood products and their utilization pattern at department of obstetrics of tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 1 (December 26, 2019): 261. http://dx.doi.org/10.18203/2320-1770.ijrcog20196030.

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Background: In developing countries, nutritional anaemia and obstetric complications are leading causes of transfusion of blood and blood products. The study was aimed to analyse utilization pattern and to identify the indications of transfusion of blood and blood products in obstetrics and to study outcome and management of pregnancy in patients who required blood and/or blood products.Methods: This retrospective study was carried out at department of obstetrics of tertiary care teaching hospital from September 2018 to November 2018 and data was collected from all patients who had received transfusion of blood and/or blood products for any obstetric cause.Results: A total of 164(6.8%) patients received blood and blood products transfusion. Department of obstetrics utilized maximum units of blood and FFP whereas PRC utilization was second highest. There were 62(37.8%) of patients who had not taken any antenatal care, whereas 64(39.0%) patients had less than 4 antenatal visits. Three most common indications for transfusion of blood and blood products were 63.4% in nutritional anaemia, 17.1% in obstetric haemorrhage and 11.6% in first trimester complications.Conclusions: Three most common indications for transfusion were nutritional anaemia, obstetric haemorrhage and first trimester complications. Majority of patients had inadequate or no antenatal care. Early and regular antenatal care, early diagnosis and management of high-risk pregnancies and obstetric complications, institutional delivery can reduce the rate of transfusion of blood and blood products.

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Ahirwar, Neetu, and Rekha Wadhwani. "Analysis of obstetrics hysterectomy in tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 6 (May 26, 2018): 2192. http://dx.doi.org/10.18203/2320-1770.ijrcog20182318.

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Background: Emergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. Obstetrics hysterectomy is performed on gravid uterus during pregnancy labor puerperium. It is a catastrophic inevitable lifesaving emergency procedure in cases of rupture uterus, uncontrollable post-partum haemorrhage, morbidly adherent placenta, and some cases of trauma, sever infection of pregnant uterus. Newer drug like prostaglandins, antibiotics and blood transfusion has brought down the incidence of obstetric hysterectomy.Methods: This retrospective study is performed in department of obstetrics and gynaecology SZH Gandhi medical college Bhopal. Retrospective analysis of record done.Results: In this study there were 51867 deliveries and 99 0bstetric hysterectomy giving the incidence as 1 in 524 deliveries. There were 17113 cesarean section performed hence the incidence as 1 in 173 cesaren section. Majority of patient belong to group para 4 and above i.e. 32.32%. Least incidence is among nullipara patient i.e. 2.02%. The most common indication of obstetric hysterectomy in this study was morbidly adherent placenta, 52 cases i.e. 52.52%% Rupture uterus was second common indication accounting for 36.36% of cases. Most common additional surgical procedure done during obstetric hysterectomy was repair of bladder tear and salpingoophrectomy done in 7 cases i.e. 7.07% of each. Repair of bowel injury done in 1 case i.e. 1.01%.Conclusions: Incidence of maternal mortality in cases of obstetric hysterectomy was 9.09%. most common cause of maternal mortality was haemorrhagic shock accounting for 55.55.

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Duffy, Shane. "Obstetric haemorrhage in Gimbie, Ethiopia." Obstetrician & Gynaecologist 9, no. 2 (April 2007): 121–26. http://dx.doi.org/10.1576/toag.9.2.121.27314.

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Lefkou, Eleftheria, and Beverley Hunt. "Haematological management of obstetric haemorrhage." Obstetrics, Gynaecology & Reproductive Medicine 18, no. 10 (October 2008): 265–71. http://dx.doi.org/10.1016/j.ogrm.2008.08.006.

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Limbachiya, D., S. Shah, P. Gandhi, M. Kenkre, and R. Tiwari. "Laparoscopic Management of Obstetric Haemorrhage." Journal of Minimally Invasive Gynecology 25, no. 7 (November 2018): S173. http://dx.doi.org/10.1016/j.jmig.2018.09.504.

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27

Stefanovic, Vedran. "Modern Approaches to Obstetric Haemorrhage." International Journal of Gynecological and Obstetrical Research 2, no. 1 (June 2014): 58–66. http://dx.doi.org/10.14205/2309-4400.2014.02.01.8.

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Irvine, LM. "Massive non-obstetric postpartum haemorrhage." Journal of Obstetrics and Gynaecology 24, no. 2 (February 2004): 179–80. http://dx.doi.org/10.1080/01443610410001648340.

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Montoro García, J., M. Cabellos Olivares, A. Cabana Navia, J. López Saña, and J. R. Rodríguez Fraile. "Unexpected obstetric haemorrhage. Krukenberg tumour." Revista Española de Anestesiología y Reanimación (English Edition) 64, no. 8 (October 2017): 479–82. http://dx.doi.org/10.1016/j.redare.2017.06.009.

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30

Trikha, Anjan, and PreetMohinder Singh. "Management of major obstetric haemorrhage." Indian Journal of Anaesthesia 62, no. 9 (2018): 698. http://dx.doi.org/10.4103/ija.ija_448_18.

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Collis, R. E., and P. W. Collins. "Haemostatic management of obstetric haemorrhage." Anaesthesia 70 (December 1, 2014): 78—e28. http://dx.doi.org/10.1111/anae.12913.

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Krishna, Archana, and Edwin Chandraharan. "Management of Massive Obstetric Haemorrhage." Current Women's Health Reviews 7, no. 2 (May 1, 2011): 136–42. http://dx.doi.org/10.2174/157340411795445811.

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33

Wise, Arlene, and Vicki Clark. "Challenges of major obstetric haemorrhage." Best Practice & Research Clinical Obstetrics & Gynaecology 24, no. 3 (June 2010): 353–65. http://dx.doi.org/10.1016/j.bpobgyn.2009.11.011.

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Boulton, Frank E., and Elizabeth Letsky. "Obstetric Haemorrhage: Causes and Management." Clinics in Haematology 14, no. 3 (October 1985): 683–728. http://dx.doi.org/10.1016/s0308-2261(21)00501-4.

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35

Panchbudhe, Shruti Ashok, and Ashwini Sudhir Desai. "Assessment of obstetric and gynaecological problems in females with bleeding disorders." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 4 (March 24, 2021): 1573. http://dx.doi.org/10.18203/2320-1770.ijrcog20211139.

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Background: Inherited bleeding disorders are not common but they are lifelong. Their effects on women are far greater than previously realised. Many clinicians are not familiar with these disorders but may encounter such women under acute conditions. Objectives were to study various obstetric and gynaecological problems in females with bleeding disorders and to assess the type of management given for these disorders.Methods: This was a prospective observational study carried out at Department of Obstetrics and Gynaecology at a tertiary care hospital in which 30 women of known bleeding disorder were studied and various obstetric and gynaecological problems including menorrhagia, metrorrhagia, dysmenorrhoea, mid-cycle pain, conception, haemorrhagic ovarian cyst, etc. were identified and studied in them.Results: 30 patients of known bleeding disorder who were found to have obstetric and gynaecological problem were studied. Idiopathic thrombocytopenic purpura constituted the major bleeding disorder (23%), followed by von Willebrand’s disease (17%) in our study. 21 patients had gynaecological problem and the most common gynaecological problem was menorrhagia (62%), followed by hemoperitoneum (10%), mid cycle pain (10%), persistent haemorrhagic cyst (7%), dysmenorrhea (7%) and endometriosis (4%). 20 patients had obstetric problems of which postpartum haemorrhage (59%) was a major problem followed by recurrent pregnancy loss (33%) and infertility (8%). The study concluded that both obstetric and gynaecological problems are common in patients of bleeding disorders and occur in distribution 66.66% and 70% respectively.Conclusions: The study conducted shows that obstetric and gynaecological problems are very common in patients of bleeding disorders and thus optimal management of these problems requires a multidisciplinary team of approach.

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Saha, R., and P. Gautam. "Obstetric Emergencies: Feto-maternal Outcome at a Teaching Hospital." Nepal Journal of Obstetrics and Gynaecology 9, no. 1 (September 28, 2014): 37–40. http://dx.doi.org/10.3126/njog.v9i1.11186.

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Aims: This study was done to know the pattern of obstetric emergencies and its influence on maternal and fetal outcome. Methods: A descriptive study was carried out in the department of obstetrics and gynecology at Kathmandu Medical College Teaching Hospital from 1st June 2013 to 31st May 2014. Cases were categorized as early pregnancy emergencies (ruptured ectopic pregnancy, complications of abortion), ante-partum emergencies and intra-partum emergencies (antepartum haemorrhage, preeclampsia, eclampsia, preterm prelabor rupture of membranes, rupture uterus), post-partum emergencies (postpartum haemorrhage, retained placenta, placenta accreta, uterine inversion), puerperal emergencies (postpartum sepsis), fetal emergencies (cord prolapse, shoulder dystocia). Outcome noted were type of emergency, obstetric intervention done, maternal and perinatal morbidity and mortality. Results: A total of 80 (4.45%) obstetric emergencies occurred among 1796 deliveries .The most common obstetric emergencies were obstetric hemorrhage (62.5%), severe preeclampsia (23.5%) and preterm prelabor rupture of membranes (10%). The obstetric interventions done were cesarean section (43.75%), exploratory laparotomy (33.75%) and blood transfusion (40%). Obstetric emergencies were responsible for 66.6% of total maternal death and 24.56% of total perinatal death. Conclusions: In spite of best efforts, some obstetric emergencies do occur. Obstetric hemorrhage and severe preeclampsia are the frequent obstetric emergencies. Cesarean section, exploratory laparotomy and blood transfusion were the commonly performed interventions. A better outcome can be achieved by national policy of promoting utilization of antenatal care, institutional deliveries, skilled birth attendance at delivery, liberal blood transfusion and regular training of doctors and nurses. DOI: http://dx.doi.org/10.3126/njog.v9i1.11186 NJOG 2014 Jan-Jun; 2(1):37-40

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Cheng, Shang-Ming, and Eileen Lew. "Obstetric haemorrhage – Can we do better?" Trends in Anaesthesia and Critical Care 4, no. 4 (August 2014): 119–26. http://dx.doi.org/10.1016/j.tacc.2014.04.007.

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Howell, C. J., and N. W. B. Clowes. "The management of major obstetric haemorrhage." Current Anaesthesia & Critical Care 6, no. 4 (October 1995): 218–23. http://dx.doi.org/10.1016/s0953-7112(95)80017-4.

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Harrity, C., S. Ahmed, H. O’Reilly, M. Cheah, and B. Byrne. "Consultant presence during major obstetric haemorrhage." Archives of Disease in Childhood - Fetal and Neonatal Edition 97, Suppl 1 (April 2012): A95.3—A96. http://dx.doi.org/10.1136/fetalneonatal-2012-301809.311.

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Wong, Wai-Chung, Ka-Yan Kun, and Chark-Man Tai. "Emergency Obstetric Hysterectomies for Postpartum Haemorrhage." Journal of Obstetrics and Gynaecology Research 25, no. 6 (December 1999): 425–30. http://dx.doi.org/10.1111/j.1447-0756.1999.tb01188.x.

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Glynn, J. C., and F. Plaat. "Prothrombin complex for massive obstetric haemorrhage." Anaesthesia 62, no. 2 (February 2007): 202–3. http://dx.doi.org/10.1111/j.1365-2044.2007.04972.x.

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Wise, Arlene, and Vicki Clark. "Strategies to manage major obstetric haemorrhage." Current Opinion in Anaesthesiology 21, no. 3 (June 2008): 281–87. http://dx.doi.org/10.1097/aco.0b013e3282f8e257.

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Stones, R. William, Catherine M. Paterson, and Nigel J. StG Saunders. "Risk factors for major obstetric haemorrhage." European Journal of Obstetrics & Gynecology and Reproductive Biology 48, no. 1 (January 1993): 15–18. http://dx.doi.org/10.1016/0028-2243(93)90047-g.

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Singh, Rajesh Kumar, Sirisha Anne, and Sruthi Ravindran P. "Changing trends of blood transfusion requirement in obstetrics and gynaecology." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 5 (April 28, 2018): 2018. http://dx.doi.org/10.18203/2320-1770.ijrcog20181949.

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Background: With the advent of the new pharmacological drugs and surgical advances compared to yesteryears, that the requirement of blood transfusion in obstetrics and gynaecology has decreased. Earlier obstetrical haemorrhage had been the commonest reason for blood transfusion. This trend seems to be changing. To evaluate this an observational study was done at a peripheral hospital to assess various indications for blood transfusion in maternity ward over a period of one year. Methods: A total of 129 transfusions were studied in a period of one year and requirement of transfusion was assessed by the same team of doctors as per AABB guidelines for blood transfusion. Results: A total of 87 obstetric patients required transfusion out of which 51.2% patients were transfused for anaemia near term. Postpartum haemorrhage constituted only 1.15% and ante partum haemorrhage only 4.6%. 17.24% of patients were transfused for incomplete abortion after taking medical abortion. 42 patients were transfused blood for various gynaecological reasons of which puberty menorrhagia constituted 19.01% and patients with perimenopausal bleeding were 28.57%.Conclusions: This study highlights the changing trends in requirement of blood transfusion and the need to emphasise on antenatal nutrition, supplements and contraception.

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Tasneem, Fasiha, and Vijayalakshmi Shanbhag. "Obstetric hysterectomy: a receding trend." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 1 (December 26, 2018): 353. http://dx.doi.org/10.18203/2320-1770.ijrcog20185452.

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Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed. Hemorrhage due to uterine atony, adherent placenta and PPH are still the causes of maternal death in developing countries. Although advances have been made in the development of conservative medical and surgical treatment of obstetric haemorrhage like brace sutures, internal iliac artery ligation, selective arterial embolization etc emergency obstetric hysterectomy remains a lifesaving procedure in the management of intractable haemorrhage unresponsive to conservative management.

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Sebghati, Mercede, and Edwin Chandraharan. "An update on the risk factors for and management of obstetric haemorrhage." Women's Health 13, no. 2 (July 6, 2017): 34–40. http://dx.doi.org/10.1177/1745505717716860.

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Obstetric haemorrhage is associated with increased risk of serious maternal morbidity and mortality. Postpartum haemorrhage is the commonest form of obstetric haemorrhage, and worldwide, a woman dies due to massive postpartum haemorrhage approximately every 4 min. In addition, many experience serious morbidity such as multi-organ failure, complications of multiple blood transfusions, peripartum hysterectomy and unintended damage to pelvic organs, loss of fertility and psychological sequelae, including posttraumatic stress disorders. Anticipation of massive postpartum haemorrhage, prompt recognition of the cause and institution of timely and appropriate measures to control bleeding and replacement of the lost blood volume and restoration of oxygen carrying capacity (i.e. haemoglobin) and correction of the ‘washout phenomenon’ leading to coagulopathy will help save lives. Obstetric shock index may help in avoidance of underestimation of blood loss and the use of tranexamic acid, oxytocics and timely peripartum hysterectomy, if appropriate, will help save lives. Triple P procedure has been recently developed as the conservative surgical alternative for women with abnormal invasion of the placenta and has been shown to significantly reduce the blood loss and to reduce inpatient stay.

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Bomken, Charlotte, Sue Mathai, Tina Biss, Andrew Loughney, and John Hanley. "Recombinant Activated Factor VII (rFVIIa) in the Management of Major Obstetric Haemorrhage: A Case Series and a Proposed Guideline for Use." Obstetrics and Gynecology International 2009 (2009): 1–8. http://dx.doi.org/10.1155/2009/364843.

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Major obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. Previous case reports suggest the potential benefit of recombinant activated factor VII (rFVIIa: ) as a haemostatic agent. We performed a retrospective review of the use of rVIIa in major obstetric haemorrhage in the Northern Region between July 2004 and February 2007. Fifteen women received rFVIIa. The median patient age was 34 years. Major haemorrhage occurred antepartum (5 patients), intrapartum (1), and postpartum (9). All women received an initial dose of 90 mcg/kg rFVIIa and one received 2 further doses. Bleeding stopped or decreased in 12 patients (80%). Additional measures included antifibrinolytic and uterotonic agents, Rusch balloon insertion, uterine curettage/packing, and vessel embolisation. Eight patients required hysterectomy. All women survived to discharge from hospital. No adverse events, including thrombosis, were recorded. This study provides further support for the safety and efficacy of rFVIIa as adjunct therapy in major obstetric haemorrhage.

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Vandenberghe, Griet, Marine Guisset, Iris Janssens, Virginie Van Leeuw, Kristien Roelens, Myriam Hanssens, Erika Russo, Joachim Van Keirsbilck, Yvon Englert, and Hans Verstraelen. "A nationwide population-based cohort study of peripartum hysterectomy and arterial embolisation in Belgium: results from the Belgian Obstetric Surveillance System." BMJ Open 7, no. 11 (November 2017): e016208. http://dx.doi.org/10.1136/bmjopen-2017-016208.

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ObjectivesTo assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place, the management of the obstetric haemorrhage, the outcome and additional morbidity of these women.DesignNationwide population-based prospective cohort study.SettingEmergency obstetric care. Participation of 97% of maternities covering 98.6% of deliveries in Belgium.ParticipantsAll women who underwent peripartum hysterectomy and/or IR procedures in Belgium between January 2012 and December 2013.ResultsWe obtained data on 166 women who underwent peripartum hysterectomy (n=84) and/or IR procedures (n=102), corresponding to 1 in 3030 women undergoing a peripartum hysterectomy and another 1 in 3030 women being managed by IR, thereby preserving the uterus. Seventeen women underwent hysterectomy following IR and three women needed further IR despite hysterectomy. Abnormal placentation and/or uterine atony were the reported causes of haemorrhage in 83.7%. Abnormally invasive placenta was not detected antenatally in 34% of cases. The interventions were planned in 15 women. Three women were transferred antenatally and 17 women postnatally to a hospital with emergency IR service. Urgent peripartum hysterectomy was averted in 72% of the women who were transferred, with no significant difference in need for transfusion. IR procedures were able to stop the bleeding in 87.8% of the attempts. Disseminated intravascular coagulation secondary to major haemorrhage was reported in 32 women (19%).ConclusionThe prevalence in Belgium of major obstetric haemorrhage requiring peripartum hysterectomy and/or IR is estimated at 6.6 (95% CI 5.7 to 7.7) per 10 000 deliveries. Increased clinician awareness of the risk factors of abnormal placentation could further improve the management and outcome of major obstetric haemorrhage. A case-by-case in-depth analysis is necessary to reveal whether the hysterectomies and arterial embolisations performed in this study were appropriate or preventable.

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Ganvir, Priti Pralhad, and Sarika Thakare. "A study on maternal near miss cases in tertiary care center, Chandrapur, Maharashtra, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 9 (August 27, 2020): 3602. http://dx.doi.org/10.18203/2320-1770.ijrcog20203532.

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Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and the causes of maternal near miss cases due to severe obstetrics complications.Methods: This is a retrospective study done in department of obstetrics and gynecology in GMC Chandrapur. The study was done during a period from 1st January 2019 to 31st December 2019.Results: In this study the hospital maternal near miss incidence ratio was 13.11%. In this study authors found the most common morbidity was (36.06%) hypertensive disorders of pregnancy, (28.68%) cases of major obstetric haemorrhage, (7.37%) severe systemic infection or sepsis, (2.45%) labour related disorders. In medical disorders very severe anaemia, (13.11%) was most common cause of near miss. The most common cause of death was post-partum haemorrhage (41.66%) and most of the patients referred from periphery in very critical condition.Conclusions: Haemorrhage and hypertension disorders are the leading causes of MNM. Prompt diagnosis and adequate management of near miss cases can reduce mortality rates.

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Bayo, Pontius, Imose Itua, Suzie Paul Francis, Kofi Boateng, Elijo Omoro Tahir, and Abdulmumini Usman. "Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study." BMJ Open 8, no. 2 (February 2018): e018739. http://dx.doi.org/10.1136/bmjopen-2017-018739.

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ObjectiveTo determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication.DesignThis was a retrospective cross-sectional study.SettingFour primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan.ParticipantsAll admissions in the obstetrics and gynaecology wards (a total of 2466 patient admission files) in 2015 in all the facilities designated to conduct deliveries in the study area were reviewed to identify obstetric complications.Primary and secondary outcome measuresThe primary outcome was met need for EmOC, which was defined as the proportion of all women with direct major obstetric complications in 2015 treated in health facilities providing EmOC services. The frequency of each complication and the interventions for treatment were the secondary outcomes.ResultsTwo hundred and fifty four major obstetric complications were admitted in 2015 out of 390 expected from 2602 pregnancies, representing 65.13% met need. The met need was highest (88%) for Nyong Payam, an urban area, compared with the other two rural payams, and 98.8% of the complications were treated from the hospital, while no complications were treated from three PHCCs. The most common obstetric complications were abortions (45.7%), prolonged obstructed labour (23.2%) and haemorrhage (16.5%). Evacuation of the uterus for retained products (42.5%), caesarean sections (32.7%) and administration of oxytocin for treatment of postpartum haemorrhage (13.3%) were the most common interventions.ConclusionThe met need for EmOC in Torit County is low, with 35% of women with major obstetric complications not accessing care, and there is disparity with Nyong Payam having a higher met need. We suggest more support supervision to the PHCCs to increase access for the rural population.

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