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The Journal of Maternal-fetal &... 2016The aim of this study is to evaluate the diagnostic criteria, treatment options and progression of cases who have antenatal or postpartum hemorrhage due to internal... (Review)
Review
OBJECTIVE
The aim of this study is to evaluate the diagnostic criteria, treatment options and progression of cases who have antenatal or postpartum hemorrhage due to internal myometrial laceration (IML) and to review the literature.
STUDY DESIGN
The files of eight patients who were diagnosed to have IML between August 2012 and July 2015 were evaluated retrospectively.
RESULTS
The patient group consisted of four patients who had an emergency c-section due to massive bleeding during labor and four patients who had an emergency laparotomy due to uncontrolled bleeding after vaginal delivery after evaluation of the patient for signs of 4Ts (trauma, tissue retention, uterine tonus, and trombin). Primary suturation was the first-line treatment in all patients. In two of the patients, hysterectomy was performed after the defined surgical procedures were not successful in controling the bleeding.
CONCLUSION
The presented case series is a pioneering study that describes IM which is a poorly defined reason of postpartum hemorrhage, as the cause of bleeding during labor. Primary suturation is the first-step, further surgery might be required in order to treat this life-threathening condition and the decision should be based on the age and the fertility status of the patient.
Topics: Adolescent; Adult; Cesarean Section; Female; Humans; Hysterectomy; Lacerations; Ligation; Myometrium; Obstetric Labor Complications; Postpartum Hemorrhage; Pregnancy; Suture Techniques; Uterine Artery; Uterine Hemorrhage
PubMed: 26456511
DOI: 10.3109/14767058.2015.1094795 -
The Tokai Journal of Experimental and... Dec 2022Placenta previa complicates 0.3-0.5% of pregnancies and can cause sudden antepartum massive hemorrhage (APH). Previous studies have indicated that cervical length (CL)...
OBJECTIVE
Placenta previa complicates 0.3-0.5% of pregnancies and can cause sudden antepartum massive hemorrhage (APH). Previous studies have indicated that cervical length (CL) measured by transvaginal ultrasonography may be a predicting parameter for APH in patients with placenta previa; however, conflicting data exist. Thus, we investigated the association between CL and APH in patients with placenta previa.
METHODS
In total, 129 singleton pregnant women with placenta previa, who delivered at our institution from January 2010 to December 2016, were included in this study. The shortest CL measured throughout gestation was used for analysis, and we defined CL less or more than 30 mm as short or normal CL, respectively. We performed univariate and multivariate analyses, and a receiver-operating characteristics (ROC) curve was plotted to determine the cut-off CL value to predict APH.
RESULTS
APH occurred in 26 patients. The adjusted odds ratio for APH was 3.80 (95% CI, 1.36-10.65) in patients with short CL. ROC analysis was performed to determine a cut-off CL value of 35 mm to predict APH, with a sensitivity of 80.7% and a specificity of 60.2%.
CONCLUSIONS
Our data indicated that CL measurements may be useful in determining patients at high risk of APH.
Topics: Humans; Female; Pregnancy; Placenta Previa; Uterine Hemorrhage; Cervix Uteri; ROC Curve
PubMed: 36420554
DOI: No ID Found -
Reproductive Sciences (Thousand Oaks,... Sep 2023Placenta previa (PP) is one such complication related to several adverse pregnancy outcomes. Adverse outcomes are likely greater if PP coexists with antepartum...
Placenta previa (PP) is one such complication related to several adverse pregnancy outcomes. Adverse outcomes are likely greater if PP coexists with antepartum hemorrhage (APH). This study aims to evaluate the risk factors and pregnancy outcomes of APH in women with PP. This retrospective case-control study included 125 singleton pregnancies with PP who delivered between 2017 and 2019. Women with PP were divided into two groups: PP without APH (n = 59) and PP with APH (n = 66). We investigated the risk factors associated with APH and compared the differences between both groups in placental histopathology lesions due to APH and the resulting maternal and neonatal outcomes. Women with APH had more frequent antepartum uterine contractions (33.3% vs. 10.2%, P = .002) and short cervical length (< 2.5 cm) at admission (53.0% vs. 27.1%, P = .003). The placentas from the APH group had lower weight (442.9 ± 110.1 vs. 488.3 ± 117.7 g, P = .03) in the gross findings, and a higher rate of villous agglutination lesions (42.4% vs. 22.0%, P = .01) in the histopathologic findings. Women with APH in PP had higher rates of composite adverse pregnancy outcomes (83.3% vs. 49.2%, P = .0001). Neonates born to women with APH in PP had worse neonatal outcomes (59.1% vs. 23.9%, P = .0001). Preterm uterine contractions and short cervical length were the most significant risk factors for APH in PP.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Outcome; Placenta Previa; Placenta; Retrospective Studies; Case-Control Studies; Uterine Hemorrhage; Risk Factors
PubMed: 36940086
DOI: 10.1007/s43032-023-01191-2 -
Acta Obstetricia Et Gynecologica... Jan 2015To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.
DESIGN
Multicenter cross-sectional study.
SETTING
Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.
POPULATION
A total of 9555 women categorized as having obstetric complications.
METHODS
The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.
MAIN OUTCOME MEASURES
The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.
RESULTS
Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).
CONCLUSION
Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.
Topics: Adolescent; Adult; Brazil; Cause of Death; Confidence Intervals; Cost of Illness; Cross-Sectional Studies; Delivery, Obstetric; Female; Hospitals, Maternity; Humans; Logistic Models; Maternal Mortality; Middle Aged; Multivariate Analysis; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Prenatal Care; Risk Assessment; Severity of Illness Index; Socioeconomic Factors; Uterine Hemorrhage; Young Adult
PubMed: 25327163
DOI: 10.1111/aogs.12529 -
Journal of Zhejiang University.... May 2017Postpartum hemorrhage (PPH), a leading cause of maternal mortality, can occur within 24 h of delivery (primary PPH), or during the period from 24 h after delivery to...
Postpartum hemorrhage (PPH), a leading cause of maternal mortality, can occur within 24 h of delivery (primary PPH), or during the period from 24 h after delivery to Week 6 of puerperium (secondary PPH). It requires health professionals to be alert to the symptoms to ensure prompt diagnosis and treatment, especially in the case of rupture of a uterine artery pseudoaneurysm (UAP) due to its life-threatening consequence (Baba et al., 2014). Most of the published case reports or case serials describe UAP as a possible cause of delayed PPH after traumatic procedures during delivery or pregnancy termination, including cesarean section (CS), manual removal of the placenta, or dilation and curettage (D&C) (Wald, 2003). Herein, we report a case of prior CS-related UAP manifesting as primary PPH after an uncomplicated vaginal delivery. This case required emergency embolization and is notable for several reasons. Antepartum hemorrhage of the previously scarred uterus was a potential sign of the ruptured UAP, and color Doppler sonography sometimes deceived the physician as the characteristic features of UAP did not appear to be present.
Topics: Adult; Aneurysm, False; Cesarean Section; Female; Humans; Postpartum Hemorrhage; Pregnancy; Treatment Outcome; Uterine Artery
PubMed: 28471117
DOI: 10.1631/jzus.B1600528 -
Transfusion May 2023To adequately predict significant postpartum hemorrhage (PPH) at hospital admission, we evaluated and compared the accuracy of three risk assessment tools: 1. California...
BACKGROUND
To adequately predict significant postpartum hemorrhage (PPH) at hospital admission, we evaluated and compared the accuracy of three risk assessment tools: 1. California Maternal Quality Care Collaborative (CMQCC), 2. American College of Obstetrics and Gynecology Safe Motherhood Initiative (ACOG SMI) and 3. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN).
STUDY DESIGN AND METHODS
This is a retrospective cohort study of people who delivered liveborn infants from January 2018 to June 2021 at our center. Patients with comorbidities necessitating higher hemoglobin values, those who refused blood transfusions, and missing pertinent data were excluded. Significant PPH was defined as a blood transfusion within 48 hours following delivery. Diagnostic statistics were calculated for each tool.
RESULTS
Of the 11,679 included pregnancies, 232 (1.9%) people had significant PPH. Amongst those diagnosed as high-risk by the CMQCC tool, 67/1485 (4.5%) had significant PPH; 62/1672 (3.7%) by the ACOG SMI tool, and 85/1864 (4.6%) by the AWHONN tool had significant PPH. All tools have low sensitivity and high negative predictive values. The area under the receiver operating characteristics curve of the three tools is moderately poor (CMQCC: 0.58, ACOG SMI: 0.55, AWHONN:0.61).
DISCUSSION
Upon admission to labor and delivery, all three studied tools are poor predictors of significant PPH. The development and validation of better PPH risk stratification tools are required with the inclusion of additional important variables.
Topics: Infant; Infant, Newborn; Pregnancy; Humans; Female; Postpartum Hemorrhage; Retrospective Studies; Family; Hospitalization; Risk Assessment
PubMed: 36988059
DOI: 10.1111/trf.17320 -
The Journal of Obstetrics and... Dec 1952
Topics: Female; Fetus; Hemorrhage; Humans; Pregnancy; Uterine Hemorrhage
PubMed: 13000537
DOI: 10.1111/j.1471-0528.1952.tb14761.x -
Clinics in Obstetrics and Gynaecology Dec 1982
Review
Topics: Abruptio Placentae; Cesarean Section; Female; Folic Acid Deficiency; Humans; Hypertension; Infant, Newborn; Labor, Obstetric; Maternal Age; Placenta Previa; Pregnancy; Recurrence; Tobacco Use Disorder; Uterine Hemorrhage
PubMed: 6756747
DOI: No ID Found -
The Journal of International Medical... Nov 2021The aim of this study was to examine the risk factors for antepartum hemorrhage (APH) in women with placenta previa.
OBJECTIVE
The aim of this study was to examine the risk factors for antepartum hemorrhage (APH) in women with placenta previa.
METHODS
In this retrospective cohort study, we analyzed the medical records of 233 women with singleton pregnancies presenting with placenta previa whose deliveries were performed at our hospital between January 2009 and July 2018.
RESULTS
Of the 233 women included in this study, 130 (55.8%) had APH. In the APH group, the gestational age and neonatal birth weight were significantly lower compared with the no hemorrhage group. Maternal age <30 years and multiparity were identified as significant risk factors for APH in both the univariate and multivariate analyses. Focusing on the previous route of delivery in multiparous women, the risk of APH was significantly higher in multiparous women who had experienced at least one vaginal delivery compared with nulliparous women (adjusted odds ratio (OR): 3.42 [95% confidence interval: 1.83-6.38]).
CONCLUSION
We showed that women with placenta previa who were under 30 years old and who had a history of vaginal delivery may be at significant risk of experiencing APH.
Topics: Adult; Female; Humans; Infant, Newborn; Parity; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors; Uterine Hemorrhage
PubMed: 34738473
DOI: 10.1177/03000605211054706 -
American Family Physician Apr 2022Venous thromboembolism (VTE) recurrence rates are three times higher in patients with chronic or no risk factors compared with those who have transient risk factors...
Venous thromboembolism (VTE) recurrence rates are three times higher in patients with chronic or no risk factors compared with those who have transient risk factors after stopping anticoagulation therapy. In patients with unprovoked VTE, age-appropriate screening is sufficient evaluation for occult malignancy. Thrombophilia evaluation should be considered only in selected patients because routine evaluation has not been shown to improve outcomes. Patients with VTE should receive three months of anticoagulation therapy. The context of the initial VTE, risk of bleeding and recurrence, and patient preference should be considered when determining whether to continue treatment beyond the initial three months. There is growing evidence regarding the use of risk assessment models to determine risk of recurrence, but this has not been incorporated into guidelines. All pregnant patients with a prior VTE should receive postpartum prophylaxis for six weeks. Antepartum prophylaxis should be used in pregnant people with a history of unprovoked or hormonally induced VTE. High-risk patients undergoing surgery may require extended VTE prophylaxis postoperatively.
Topics: Anticoagulants; Female; Hemorrhage; Humans; Pregnancy; Recurrence; Risk Assessment; Risk Factors; Venous Thromboembolism
PubMed: 35426644
DOI: No ID Found