A New Maneuver for Prevention of Postpartum Haemorrhage

Abstract

Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new nonpharmacologic maneuver in decreasing its rate. Methods This case series study was conducted in one center in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant women, aged 18 years or more and candidate for normal labor, were enrolled to this study. High risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90 s. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6 h. Results The rate of PPH, defined as more than 500 ml, was eight cases (2 %) with 95 % CI (0.63-3.37 %). The rate of PPH was not affected by parity, gestational age, episiotomy, or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p \ 0.001). The range of estimated blood loss was 550-600 ml in cases with PPH and 150-450 ml in cases without PPH. Severe PPH more than 1,000 ml did not occur. Conclusion This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of postpartum blood loss. Further RCT is recommended to investigate it.

Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

“…Amr H et al, conducted a similar study in Egypt on 400 participants and showed reduced amount of blood loss and reduced incidence of PPH. 6 Our results were also similar to the results of a study conducted in India that reported a decrease in mean blood loss with the use of cervical traction method. 7 Along with AMTSL, the cervical traction has significantly reduced blood loss after delivery, but the difference in the incidence of PPH was insignificant in groups because of the small sample size.…”

Multicenter randomized controlled trial assessing the impact of a cervical traction maneuver (Amr's maneuver) on the incidence of postpartum hemorrhage

“…Three studies have reported on the use of Amr's maneuver: a case‐series study by the maneuver's creator, a nonrandomized comparative study with a sample size of 200 women, and a randomized controlled study that recruited 500 women . Both comparative studies used the blood collecting drape method to estimate blood loss.…”

“…In 2014, Hamdy described a new maneuver (Amr's maneuver) for the prevention of PPH, which applied sustained cervical traction after placental delivery. 11 The aim of the present multicenter randomized controlled trial was to test the hypothesis that using Amr's maneuver in conjunction with AMTSL would decrease the incidence of PPH after vaginal delivery more than that achieved by AMTSL alone, and reduce the amount of blood loss.…”

Uterine artery hemodynamic changes due to a Cervical Traction maneuver (Amr’s maneuver); Randomized Controlled Study

“…In the last two decades, many efforts and researches were conducted to improve the preventive measures for PPH which finalized in 2012 by the addition of misoprostol as an alternative for oxytocin [11] . In 2014, Hamdy Amr described his new maneuver by applying the sustained cervical traction for the prevention of PPH [12] . In addition, his maneuver proved effective when added to AMSTL in reduction of the amount of postpartum blood loss [12][13][14][15] .…”

“…In 2014, Hamdy Amr described his new maneuver by applying the sustained cervical traction for the prevention of PPH [12] . In addition, his maneuver proved effective when added to AMSTL in reduction of the amount of postpartum blood loss [12][13][14][15] . Thus, the rationale intended for this current randomized controlled trial was to measure the effects of Amr' Maneuver on the uterine artery hemodynamics indices.…”