Mechanical and surgical interventions for treating primary postpartum haemorrhage.
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ABSTRACT:
SUBMITTER: Kellie FJ
PROVIDER: S-EPMC8407481 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
Mechanical and surgical interventions for treating primary postpartum haemorrhage.
Kellie Frances J FJ Wandabwa Julius N JN Mousa Hatem A HA Weeks Andrew D AD
The Cochrane database of systematic reviews 20200701
<h4>Background</h4>Primary postpartum haemorrhage (PPH) is commonly defined as bleeding from the genital tract of 500 mL or more within 24 hours of birth. It is one of the most common causes of maternal mortality worldwide and causes significant physical and psychological morbidity. An earlier Cochrane Review considering any treatments for the management of primary PPH, has been split into separate reviews. This review considers treatment with mechanical and surgical interventions.<h4>Objectives ...[more]
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Project description: Not available
| S-EPMC6491317 | biostudies-literature
Project description:BACKGROUND: Postpartum 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. METHODS: The 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 x 200 microg or similar placebo, which were given 1 orally, 2 sublingually and 2 rectally. RESULTS: With 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 degrees 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. CONCLUSIONS: Because 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.
| S-EPMC514549 | biostudies-literature
Project description:The aim of our study was to assess the theoretical and practical knowledge of French obstetricians about the surgical management of postpartum haemorrhage (PPH). Our study is a national anonymous self-administered survey. A total of 363 obstetricians responded to this questionnaire between December 2013 and April 2014. Questionnaire sent through email to all French obstetricians who are members of either of two federations of hospital-based obstetricians. Answers were collected until the end of June 2014. The main outcome measure was obstetricians' level of mastery of each surgical technique. The results were analysed descriptively (proportions). Only the 286 questionnaires fully completed were analysed; the complete response rate was 23% (286/1246). In all, 33% (95/286) of the responding obstetricians reported that they had not mastered sufficiently or even at all the technique for bilateral ligation of the uterine arteries, 37% (105/286) for uterine compression suture, 62% (178/286) for ligation of the internal iliac arteries, and 47% (134/286) for emergency peripartum hysterectomy. In all, 18% (52/286) of respondents stated that they had not mastered any of these techniques. Our study shows that a worrisome number of French obstetricians reported insufficient mastery of the surgical techniques for PPH management.
| S-EPMC4962082 | biostudies-literature
Project description:BackgroundPostpartum haemorrhage (PPH) is still a leading cause of maternal morbidity in the US. We aimed to reassess national trends in severe and non-severe PPH using recent data.Material and methodsWe performed a cross-sectional study using the 2001-2012 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Delivery-related hospitalisations with PPH were identified using the International Classification of Diseases (9th revision). Rates were calculated per 1,000 delivery hospitalisations. All statistical analyses accounted for the complex sampling design of the data source.ResultsRates of non-severe PPH did not change significantly from 2001-2002 to 2011-2012 (25.5 and 24.2 per 1,000; p=0.058). The rates of PPH requiring blood transfusions for caesarean deliveries more than doubled in this time period from 2.0 to 4.8 (p<0.001). The overall rate of PPH with a procedure other than blood transfusion has risen from 0.9 to 1.9. Specifically, rates of hysterectomy (0.5 to 0.7; p<0.001), embolisation (0.3 to 0.5; p<0.001), and uterine tamponade use (0.09 to 0.69; p<0.001) increased over the time period.DiscussionPopulation-based surveillance data show an increasing rate of only severe PPH in the US. Rates of medical/surgical intervention including hysterectomy, embolisation and uterine tamponade use are also rising.
| S-EPMC7375891 | biostudies-literature
Project description:BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal morbidity and one of the leading causes of maternal mortality worldwide. Many medical treatments and interventions are available nowadays, but surgical treatment is sometimes required when less invasive methods are unsuccessful. This study aimed to assess the theoretical and practical knowledge of French residents of Obstetrics and Gynecology concerning the surgical treatment of postpartum haemorrhage.Study designWe performed a questionnaire study for senior residents of Obstetrics and Gynecology in France (fourth and fifth year of training). An anonymous survey was sent by email. Between December 2013 and April 2014, a total of 370 residents responded.ResultThe response rate was 47.6% (176/370). Only 156 questionnaires were fully completed and included for analysis. In all, 74% (115/156) of residents reported not mastering sufficiently or at all the technique for bilateral ligation of uterine arteries, 79% (123/156) for uterine compression sutures, 95% (148/156) for ligation of the internal iliac arteries, and 78% (122/156) for emergency peripartum hysterectomy. More than half of respondents (55%, 86/156) stated that they had not mastered any of these techniques.ConclusionAn alarmingly high number of French senior residents in Obstetrics and Gynecology report that they have not acquired the sufficient surgical skills during their training to be able to perform the surgeries required for the management of PPH.
| S-EPMC6415489 | biostudies-literature
Project description:In Gabon, the proportion of maternal deaths directly related to Primary PostPartum Haemorrhage (PPPH) is 15 to 25%, despite the different means that the World Health Organization has made available to the providers of Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of Primary PostPartum Haemorrhage to improve its management and reduce the rate of maternal deaths. An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. Sociodemographic variables were expressed using percentage. The relationship between the etiologies of PPPH and certain characteristics of the women was established using the ORs with their 95% confidence intervals. The difference was significant if p < 0.05. The prevalence of PPPH was 1.6%. Delivery haemorrhages accounted for 65.5% of PPPH. The main factors associated with delivery haemorrhages were pauci parity and multiparity (p = 0.003 and 0.051), post-term (p = 0.042), and birth weight >4,000 g (p = 0.006). Those associated with genital tract injuries were young maternal age (p = 0.008) and multiparity (p = 0.028). The most common etiology was haemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the primary postpartum period as well as capacity building of health providers on EmONC.
| S-EPMC8452036 | biostudies-literature
Project description:Background Primary hyperparathyroidism is the third most common endocrine disorder for which surgical procedure called parathyroidectomy is the most effective treatment. Since the early 20th century, parathyroid surgery has improved extensively. With the advances in preoperative imaging and with understanding the causes of disease, new and minimally invasive surgical approaches overrode the standard bilateral exploratory operations. Directed parathyroidectomy is currently the standard technique for treatment of primary hyperparathyroidism worldwide. Conclusions Surgery is the only definitive treatment of primary hyperparathyroidism. The most appropriate type of surgical procedure depends on the number and localization of the hyperactive parathyroid glands, availability of modern imaging techniques, limitation of each type of procedure and expertise.
| S-EPMC7087427 | biostudies-literature
Project description:BackgroundPrimary congenital glaucoma (PCG) manifests within the first few years of a child's life and is not associated with any other systemic or ocular abnormalities. PCG results in considerable morbidity even in developed countries. Several surgical techniques for treating this condition, and lowering the intraocular pressure (IOP) associated with it, have been described.ObjectivesTo compare the effectiveness and safety of different surgical techniques for PCG.Search methodsWe searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), (January 1982 to June 2014), PubMed (January 1946 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 June 2014.Selection criteriaWe included all randomized and quasi-randomized trials in which different types of surgical interventions were compared in children under five years of age with PCG.Data collection and analysisWe used standard methodological procedures specified by The Cochrane Collaboration.Main resultsWe included a total of six trials (four randomized and two quasi-randomized) with 102 eyes in 61 children. Two trials were conducted in the USA and one trial each in Egypt, Israel, Lebanon and Saudi Arabia. All trials included children aged younger than one year when diagnosed with PCG, and followed them for periods ranging from six months to five years.No two trials compared the same pair of surgical interventions, so we did not perform any meta-analysis. One trial compared trabeculotomy versus goniotomy; a second trial compared combined trabeculectomy-trabeculotomy with mitomycin C versus trabeculectomy-trabeculotomy with mitomycin C and deep sclerectomy; a third trial compared combined trabeculotomy-trabeculectomy versus trabeculotomy; a fourth trial compared one goniotomy versus two goniotomies; a fifth trial compared trabeculotomy versus viscocanalostomy; and the sixth trial compared surgical goniotomy versus neodymium-YAG laser goniotomy. For IOP change and surgical success (defined by IOP achieved), none of the trials reported a difference between pairs of surgical techniques. However, due to the limited sample sizes for all trials (average of 10 children per trial), the evidence as to whether a particular surgical technique is effective and which surgical technique is better still remains uncertain. Adverse events, such as choroidal detachment, shallow anterior chamber and hyphema, were reported from four trials. None of the trials reported quality of life or economic data.These trials were neither designed nor reported well overall. Two trials were quasi-randomized trials and judged to have high risk of selection bias; four trials were at unclear or high risk for performance bias and detection bias; and we judged one trial to have high risk of attrition bias due to high proportions of losses to follow-up. Due to poor study design and reporting, the reliability and applicability of evidence remain unclear.Authors' conclusionsNo conclusions could be drawn from the trials included in this review due to paucity of data. More research is needed to determine which of the many surgeries performed for PCG are effective.
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Project description: Not available
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