Primary postpartum haemorrhage

Selo-Ojeme, DO

doi:10.1080/0144361021000003555

Cited by 49 publications

(36 citation statements)

References 46 publications

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“…Without the presence of a skilled provider to recognize and treat the conditions leading to postpartum hemorrhage (uterine atony, uterine rupture, and/or genital lacerations) and to manage postpartum hemorrhage if it occurs, women rapidly experience shock and death, resulting in approximately 125,000 deaths per year due to primary postpartum hemorrhage 12 . Primary or early postpartum hemorrhage occurs in the first 24 hours after delivery, and uterine atony is the most common cause 13 . Lacerations of the vagina and cervix are another common cause of postpartum hemorrhage.…”

Section: Etiology Of Postpartum Hemorrhage In Developing Countriesmentioning

confidence: 99%

CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low‐Resource Settings

Miller¹,

Lester²,

Hensleigh

2004

J Midwife Womens Health

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Postpartum hemorrhage due to uterine atony is the primary direct cause of maternal mortality globally. Management strategies in developed countries involve crystalloid fluid replacement, blood transfusions, and surgery. These definitive therapies are often not accessible in developing countries. Long transports from home or primary health care facilities, a dearth of skilled providers, and lack of intravenous fluids and/or a safe blood supply often create long delays in instituting appropriate treatment. We review the evidence for active management of third-stage labor and for the use of specific uterotonics. New strategies to prevent and manage postpartum hemorrhage in developing countries, such as community-based use of misoprostol, oxytocin in the Uniject delivery system, the non-inflatable antishock garment to stabilize and resuscitate hypovolemic shock, and the balloon condom catheter to treat intractable uterine bleeding are reviewed. New directions for clinical and operations research are suggested.

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Section: Etiology Of Postpartum Hemorrhage In Developing Countriesmentioning

confidence: 99%

CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low‐Resource Settings

Miller¹,

Lester²,

Hensleigh

2004

J Midwife Womens Health

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“…A major component of active management of the third stage of labor is the administration of a prophylactic uterotonic agent [4]. Available evidence supports the routine administration of oxytocin [5] or ergot alkaloids [6] for the prevention of postpartum hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

A double‐blind, randomized, placebo‐controlled trial of misoprostol and routine uterotonics for the prevention of postpartum hemorrhage

Fawole

Sotiloye

Hunyinbo

et al. 2010

Intl J Gynecology & Obste

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“…The global estimate is 125,000 deaths per year [1]. In South Africa, 240 of 2,445 maternal deaths reported between 1999 and 2001 were due to postpartum haemorrhage, the third most common cause [2].…”

Section: Introductionmentioning

confidence: 99%

Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357]

Hofmeyr¹,

Ferreira²,

Nikodem

et al. 2004

BMC Pregnancy Childbirth

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BackgroundPostpartum haemorrhage remains an important cause of maternal death despite treatment with conventional therapy. Uncontrolled studies and one randomised comparison with conventional oxytocics have reported dramatic effects with high-dose misoprostol, usually given rectally, for treatment of postpartum haemorrhage, but this has not been evaluated in a placebo-controlled trial.MethodsThe study was conducted at East London Hospital Complex, Tembisa and Chris Hani Baragwanath Hospitals, South Africa. Routine active management of the third stage of labour was practised. Women with more than usual postpartum bleeding thought to be related to inadequate uterine contraction were invited to participate, and to sign informed consent. All routine treatment was given from a special 'Postpartum Haemorrhage Trolley'. In addition, participants who consented were enrolled by drawing the next in a series of randomised treatment packs containing either misoprostol 5 × 200 μg or similar placebo, which were given 1 orally, 2 sublingually and 2 rectally.ResultsWith misoprostol there was a trend to reduced blood loss ≥500 ml in 1 hour after enrolment measured in a flat plastic 'fracture bedpan', the primary outcome (6/117 vs 11/120, relative risk 0.56; 95% confidence interval 0.21 to 1.46). There was no difference in mean blood loss or haemoglobin level on day 1 after birth < 6 g/dl or blood transfusion. Side-effects were increased, namely shivering (63/116 vs 30/118; 2.14, 1.50 to 3.04) and pyrexia > 38.5°C (11/114 vs 2/118; 5.69, 1.29 to 25). In the misoprostol group 3 women underwent hysterectomy of whom 1 died, and there were 2 further maternal deaths.ConclusionsBecause of a lower than expected incidence of the primary outcome in the placebo group, the study was underpowered. We could not confirm the dramatic effect of misoprostol reported in several unblinded studies, but the results do not exclude a clinically important effect. Larger studies are needed to assess substantive outcomes and risks before misoprostol enters routine use.

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Primary postpartum haemorrhage

Cited by 49 publications

References 46 publications

CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low‐Resource Settings

CEU: Prevention and Treatment of Postpartum Hemorrhage: New Advances for Low‐Resource Settings

A double‐blind, randomized, placebo‐controlled trial of misoprostol and routine uterotonics for the prevention of postpartum hemorrhage

Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357]

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