Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

Abstract

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies.The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect. However, carbetocin seems to be the most effective in certain situations.Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine tamponade should be considered due to its high effectiveness.Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment. It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

Severe Postpartum Hemorrhage in an Asymptomatic COVID-19 Patient: A Call to Be on Guard

“…Placental anomalies such as retained placental fragments (4–36%), and coagulopathies such as Von Willebrand disease (7.4%) can cause postpartum hemorrhage. 8 Some of the risk factors of PPH include antepartum hemorrhage, augmented labour, chorioamnionitis, fetal macrosomia, maternal anemia, maternal obesity, multifetal gestation, preeclampsia, primiparity, prolonged labour. However, in about 20% of postpartum hemorrhage cases, there are no manifestations of these risk factors.…”

“…However, a combination of IV tranexamic acid and carboprost/misoprostol are also accepted. 8 Due to the relative degree of hypercoagulability in COVID-19, the use of drugs like tranexamic acid without co-administration of anticoagulants in these patients can exacerbate thrombotic events. 14 Although it was part of our management, it is an oversight, and use should be prudently spared in COVID-19 patients until concrete data are available.…”

A novel solution for finding postpartum haemorrhage using fuzzy neural techniques

“…Stepan Feduniw et al has addressed the risk factor based on uterine atony and also mentioned the effective treatment for PPH [25]. Abir Saha et al had discussed the possible Social Networking Sites (SNS) based interventions and design implications that can effectively and feasibly reduce Postpartum Depression (PPD) in women in developing countries [26].…”

Prophylactic Dose of Oxytocin for Uterine Atony during Caesarean Delivery: A Systematic Review

“…Minimizing the amount of blood lost during caesarean delivery has a great benefit to decrease postoperative morbidity and to decrease the risks associated with blood transfusions. The routine use of oxytocin correlates with a significant reduction in the occurrence of postpartum hemorrhage (PPH) [ 5 , 6 , 7 ].…”