Postpartum Hemorrhage: Excess blood loss from uterine bleeding associated with OBSTETRIC LABOR or CHILDBIRTH. It is defined as blood loss greater than 500 ml or of the amount that adversely affects the maternal physiology, such as BLOOD PRESSURE and HEMATOCRIT. Postpartum hemorrhage is divided into two categories, immediate (within first 24 hours after birth) or delayed (after 24 hours postpartum).Uterine Inertia: Failure of the UTERUS to contract with normal strength, duration, and intervals during childbirth (LABOR, OBSTETRIC). It is also called uterine atony.Oxytocics: Drugs that stimulate contraction of the myometrium. They are used to induce LABOR, OBSTETRIC at term, to prevent or control postpartum or postabortion hemorrhage, and to assess fetal status in high risk pregnancies. They may also be used alone or with other drugs to induce abortions (ABORTIFACIENTS). Oxytocics used clinically include the neurohypophyseal hormone OXYTOCIN and certain prostaglandins and ergot alkaloids. (From AMA Drug Evaluations, 1994, p1157)Labor Stage, Third: The final period of OBSTETRIC LABOR that is from the expulsion of the FETUS to the expulsion of the PLACENTA.Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties.Placenta, Retained: A placenta that fails to be expelled after BIRTH of the FETUS. A PLACENTA is retained when the UTERUS fails to contract after the delivery of its content, or when the placenta is abnormally attached to the MYOMETRIUM.Hemorrhage: Bleeding or escape of blood from a vessel.Cerebral Hemorrhage: Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA.Delivery, Obstetric: Delivery of the FETUS and PLACENTA under the care of an obstetrician or a health worker. Obstetric deliveries may involve physical, psychological, medical, or surgical interventions.Maternal Mortality: Maternal deaths resulting from complications of pregnancy and childbirth in a given population.Uterine Balloon Tamponade: Inflation of a balloon CATHETER within the uterine cavity to control UTERINE HEMORRHAGE.Home Childbirth: Childbirth taking place in the home.Pregnancy: The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.Subarachnoid Hemorrhage: Bleeding into the intracranial or spinal SUBARACHNOID SPACE, most resulting from INTRACRANIAL ANEURYSM rupture. It can occur after traumatic injuries (SUBARACHNOID HEMORRHAGE, TRAUMATIC). Clinical features include HEADACHE; NAUSEA; VOMITING, nuchal rigidity, variable neurological deficits and reduced mental status.Obstetric Labor Complications: Medical problems associated with OBSTETRIC LABOR, such as BREECH PRESENTATION; PREMATURE OBSTETRIC LABOR; HEMORRHAGE; or others. These complications can affect the well-being of the mother, the FETUS, or both.Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations.Methylergonovine: A homolog of ERGONOVINE containing one more CH2 group. (Merck Index, 11th ed)Midwifery: The practice of assisting women in childbirth.Ergonovine: An ergot alkaloid (ERGOT ALKALOIDS) with uterine and VASCULAR SMOOTH MUSCLE contractile properties.Administration, Sublingual: Administration of a soluble dosage form by placement under the tongue.Oxytocin: A nonapeptide hormone released from the neurohypophysis (PITUITARY GLAND, POSTERIOR). It differs from VASOPRESSIN by two amino acids at residues 3 and 8. Oxytocin acts on SMOOTH MUSCLE CELLS, such as causing UTERINE CONTRACTIONS and MILK EJECTION.Placenta Previa: Abnormal placentation in which the PLACENTA implants in the lower segment of the UTERUS (the zone of dilation) and may cover part or all of the opening of the CERVIX. It is often associated with serious antepartum bleeding and PREMATURE LABOR.Intracranial Hemorrhages: Bleeding within the SKULL, including hemorrhages in the brain and the three membranes of MENINGES. The escape of blood often leads to the formation of HEMATOMA in the cranial epidural, subdural, and subarachnoid spaces.Cesarean Section: Extraction of the FETUS by means of abdominal HYSTEROTOMY.Labor Stage, Second: The period of OBSTETRIC LABOR that is from the complete dilatation of the CERVIX UTERI to the expulsion of the FETUS.Placenta Accreta: Abnormal placentation in which all or parts of the PLACENTA are attached directly to the MYOMETRIUM due to a complete or partial absence of DECIDUA. It is associated with POSTPARTUM HEMORRHAGE because of the failure of placental separation.Hospitals, Maternity: Special hospitals which provide care to women during pregnancy and parturition.Uterine Artery Embolization: The use of embolizing agents to block the arterial blood supply to parts or all of the UTERUS. The procedures are done to control bleeding or to cause destruction of uterine tissues.Pregnancy Complications: Conditions or pathological processes associated with pregnancy. They can occur during or after pregnancy, and range from minor discomforts to serious diseases that require medical interventions. They include diseases in pregnant females, and pregnancies in females with diseases.Retinal Hemorrhage: Bleeding from the vessels of the retina.Medicine, Tibetan Traditional: A system of traditional medicine which is based on the beliefs and practices of the Tibetan culture.Empty Sella Syndrome: A condition when the SELLA TURCICA is not filled with pituitary tissue. The pituitary gland is either compressed, atrophied, or removed. There are two types: (1) primary empty sella is due a defect in the sella diaphragm leading to arachnoid herniation into the sellar space; (2) secondary empty sella is associated with the removal or treatment of PITUITARY NEOPLASMS.Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium.Uterine Artery: A branch arising from the internal iliac artery in females, that supplies blood to the uterus.Labor, Obstetric: The repetitive uterine contraction during childbirth which is associated with the progressive dilation of the uterine cervix (CERVIX UTERI). Successful labor results in the expulsion of the FETUS and PLACENTA. Obstetric labor can be spontaneous or induced (LABOR, INDUCED).Endotamponade: A method of stopping internal bleeding or blood flow, or the closure of a wound or body cavity, achieved by applying pressure or introducing an absorbent liquid, gel, or tampon.Parturition: The process of giving birth to one or more offspring.Eclampsia: Onset of HYPERREFLEXIA; SEIZURES; or COMA in a previously diagnosed pre-eclamptic patient (PRE-ECLAMPSIA).Labor, Induced: Artificially induced UTERINE CONTRACTION. Generally, LABOR, OBSTETRIC is induced with the intent to cause delivery of the fetus and termination of pregnancy.Uterus: The hollow thick-walled muscular organ in the female PELVIS. It consists of the fundus (the body) which is the site of EMBRYO IMPLANTATION and FETAL DEVELOPMENT. Beyond the isthmus at the perineal end of fundus, is CERVIX UTERI (the neck) opening into VAGINA. Beyond the isthmi at the upper abdominal end of fundus, are the FALLOPIAN TUBES.Balloon Occlusion: Use of a balloon CATHETER to block the flow of blood through an artery or vein.Pregnancy Outcome: Results of conception and ensuing pregnancy, including LIVE BIRTH; STILLBIRTH; SPONTANEOUS ABORTION; INDUCED ABORTION. The outcome may follow natural or artificial insemination or any of the various ASSISTED REPRODUCTIVE TECHNIQUES, such as EMBRYO TRANSFER or FERTILIZATION IN VITRO.Gastrointestinal Hemorrhage: Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM.Hypopituitarism: Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including LH; FOLLICLE STIMULATING HORMONE; SOMATOTROPIN; and CORTICOTROPIN). This may result from surgical or radiation ablation, non-secretory PITUITARY NEOPLASMS, metastatic tumors, infarction, PITUITARY APOPLEXY, infiltrative or granulomatous processes, and other conditions.Sutures: Materials used in closing a surgical or traumatic wound. (From Dorland, 28th ed)Vitreous Hemorrhage: Hemorrhage into the VITREOUS BODY.Blood Transfusion: The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed)Maternal Health Services: Organized services to provide health care to expectant and nursing mothers.Eye Hemorrhage: Intraocular hemorrhage from the vessels of various tissues of the eye.Perineum: The body region lying between the genital area and the ANUS on the surface of the trunk, and to the shallow compartment lying deep to this area that is inferior to the PELVIC DIAPHRAGM. The surface area is between the VULVA and the anus in the female, and between the SCROTUM and the anus in the male.PakistanFrance: A country in western Europe bordered by the Atlantic Ocean, the English Channel, the Mediterranean Sea, and the countries of Belgium, Germany, Italy, Spain, Switzerland, the principalities of Andorra and Monaco, and by the duchy of Luxembourg. Its capital is Paris.Hysterectomy: Excision of the uterus.British Columbia: A province of Canada on the Pacific coast. Its capital is Victoria. The name given in 1858 derives from the Columbia River which was named by the American captain Robert Gray for his ship Columbia which in turn was named for Columbus. (From Webster's New Geographical Dictionary, 1988, p178 & Room, Brewer's Dictionary of Names, 1992, p81-2)Postpartum Period: In females, the period that is shortly after giving birth (PARTURITION).Embolization, Therapeutic: A method of hemostasis utilizing various agents such as Gelfoam, silastic, metal, glass, or plastic pellets, autologous clot, fat, and muscle as emboli. It has been used in the treatment of spinal cord and INTRACRANIAL ARTERIOVENOUS MALFORMATIONS, renal arteriovenous fistulas, gastrointestinal bleeding, epistaxis, hypersplenism, certain highly vascular tumors, traumatic rupture of blood vessels, and control of operative hemorrhage.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Umbilical Cord: The flexible rope-like structure that connects a developing FETUS to the PLACENTA in mammals. The cord contains blood vessels which carry oxygen and nutrients from the mother to the fetus and waste products away from the fetus.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Morbidity: The proportion of patients with a particular disease during a given year per given unit of population.

A strategy for reducing maternal mortality. (1/254)

A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions.  (+info)

The presentation and management of post-partum choriocarcinoma. (2/254)

Post-partum choriocarcinoma is a rare complication of pregnancy. We have analysed a series of nine consecutive patients presenting with choriocarcinoma after a full-term non-molar pregnancy. All patients were managed at the Supraregional Trophoblastic Disease Screening and Treatment Centre at Weston Park Hospital, Sheffield between 1987 and 1996. All presented with persistent primary or secondary post-partum haemorrhage. Treatment with multiagent chemotherapy (initially methotrexate, dactinomycin and etoposide) was successful in all cases. Early diagnosis is important because this rare condition is potentially curable with appropriate chemotherapy.  (+info)

Simultaneous occurrence of multiple neoplasms and hyperplasias in the adrenal and thyroid gland of the horse resembling multiple endocrine neoplasia syndrome: case report and retrospective identification of additional cases. (3/254)

Neoplastic and hyperplastic disorders that affect multiple endocrine tissues in a single individual are well described in humans but less so in domestic animals. Multiple endocrine neoplasia (MEN) in humans is a genetically determined syndrome characterized by the appearance of benign or malignant proliferations within two or more endocrine glands. The primary endocrine tumors that are characteristic of MEN arise from cells that share the capacity for amine precursor uptake and decarboxylation. Here we describe the case of a 22-year-old Thoroughbred mare that died during an unattended parturition and subsequently was presented for necropsy at the University of California, Davis, Veterinary Medical Teaching Hospital. A C-cell (medullary) thyroid adenoma, pheochromocytoma, and multicentric bilateral nodular hyperplasia of the adrenal medulla were present, findings that are remarkably similar to those of human MEN syndrome. Mortality during pregnancy in women with undiagnosed pheochromocytoma is high (approximately 50%), typically because of hypertension and/or hemorrhage associated with catecholamine release from the tumor. Similarly, the mare in this report died of hemorrhage subsequent to parturition. A retrospective evaluation of endocrine tumors in horses that underwent necropsy at the Veterinary Medical Teaching Hospital from 1987 to 1997 was undertaken to identify additional possible cases of MEN in horses. Data from this retrospective evaluation suggest that coexistence of hyperplasias and neoplasias of the thyroid and adrenal glands, similar to MEN syndrome of humans, also occurs with some frequency in the horse.  (+info)

Complicated third stage of labor: time to switch on the scanner. (4/254)

This Editorial chronicles the current experience in ultrasound usage during pathologic events occurring in the third stage of labor. Further improvement in the technology for carrying out clinical research will improve our knowledge so that more information can be gleaned from this modality to bestow optimal management for such potentially dangerous conditions. Awareness of the capabilities of sonography may provide the motivation for its use, and obstetricians are encouraged to scan the third stage of normal deliveries for better recognition of normal findings and improved assessment of abnormal ones. Although final decisions should be based mainly upon sound clinical judgement, we contend that complicated third stage of labor warrants turning on the scanner.  (+info)

Fetal complications of obstetric cholestasis. (5/254)

Among 56 pregnancies complicated by obstetric cholestasis five intrauterine deaths and one neonatal death occurred between 33 and 39 weeks, and a further six infants required urgent delivery for intrapartum asphyxia. Eighteen spontaneous premature deliveries occurred. Five mothers required specific treatment for unexplained postpartum haemorrhage. Cholestasis of pregnancy is therefore not a condition benign to the fetus, and it may contribute to increased maternal morbidity.  (+info)

The influence of drugs on the kinin-forming system in relation to pregnancy and parturition in the rat. (6/254)

The duration of normal gestation and parturition in the rat can be changed by treatment with drugs which alter the equilibrium of the kallikrein-kinin system. The kallikrein inhibitor, aprotinin, when given from Days 19-22 of pregnancy prolongs gestation. Treatment with aprotinin from Days 20-22 of pregnancy prolongs the parturient process, as does a single dose given on the morning of Day 22. Kallikrein, when administered from Days 19-22 of pregnancy, results in a prolongation of gestation and abolishes the pre-parturient behaviour ('labour'). Parturition is prolonged and many fetuses are stillborn. Soya bean trypsin inhibitor when given from Days 19-22 of pregnancy delays and prolongs parturition; maternal haemorrhage occurs during birth and many fetuses are born dead or are abandoned at birth. It is suggested that the kallikrein-kinin system plays a functional role in the normal process of parturition in the rat.  (+info)

Use of methergine for the prevention of postoperative endometritis in non-elective cesarean section patients. (7/254)

OBJECTIVE: Methergine increases constriction of uterine musculature which may facilitate sloughing of endometrial debris, close uterine vessels, and prevent post-cesarean endometritis. The objective of this study was to evaluate the efficacy of methergine in preventing endometritis in patients undergoing non-elective cesarean section delivery. METHODS: Eighty patients undergoing non-elective cesarean section were enrolled in a prospective randomized clinical trial of methergine (41) versus no methergine (39) administration during the postpartum period. The hospital records were abstracted after discharge to compare the postpartum course. RESULTS: There were no significant demographic differences between the two groups. The women receiving methergine had a significant reduction in the rate of postoperative endometritis (10% vs. 36%, P < 0.005). In addition, the mean postoperative hemoglobin was significantly higher in the methergine treated group (P < 0.001). CONCLUSIONS: The use of methergine postpartum in women undergoing non-elective cesarean sections significantly reduces the incidence of postoperative endometritis and blood loss.  (+info)

A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour. (8/254)

Postpartum haemorrhage accounts for nearly 28% of maternal mortality in developing countries. Syntometrine is an effective and commonly used oxytocic in preventing postpartum haemorrhage, but it requires a controlled storage environment and i.m. administration. Misoprostol is an orally active uterotonic agent. A total of 2058 patients having a singleton pregnancy, low risk for postpartum haemorrhage and vaginal delivery were randomized to receive either 1 ml syntometrine or 600 microgram misoprostol for the management of the third stage of labour. There were no significant differences between the two groups in the mean blood loss, the incidence of postpartum haemorrhage and the fall in haemoglobin concentration. The need for additional oxytocic injection was significantly higher in the misoprostol group [relative risk (RR) 1.62, 95% confidence interval (CI) 1.34-1.96], but that of manual removal of placenta was reduced (RR 0.29, 95% CI 0.09-0.87). Shivering and transient pyrexia were more common in the misoprostol group. Oral misoprostol might be used in the management of the third stage, especially in situations where the use of syntometrine is contraindicated and facilities for storage and parenteral administration of oxytocics are limited.  (+info)

  • Community-based distribution of misoprostol to prevent postpartum hemorrhage at home births in rural Ghana. (
  • Choose from either the Standard or Advanced PROMPT Flex before adding on additional modules, allowing you to extend the use for cervical assessment, performing caesarean section births and postpartum hemorrhage (PPH). (
  • The take home messages is that induction of labor will decrease the risk of adverse perinatal outcome, including mortality, without increasing the morbidity risk for the woman including cesarean delivery, perineal laceration grade III-IV and postpartum hemorrhage -- especially in nulliparous women," said lead study author Dr. Marten Alkmark of the University of Gothenburg in Sweden. (
  • They assessed a composite primary outcome of perinatal mortality, including stillbirth or neonatal mortality within 28 days of birth, and neonatal morbidity including: five-minute Apgar score below 4, hypoxic ischemic encephalopathy, intracranial hemorrhage, neonatal convulsions, respiratory distress, mechanical ventilation within 72 hours of birth, and obstetric brachial plexus injury. (
  • I searched the literature and retrieved an elegant study in Obstetrics and Gynecology which found: 'For third stages of labor more than 10 minutes compared with third stages less than 10 minutes there was twice the risk of postpartum hemorrhage. (
  • Adjuvant invests in companies developing promising new vaccines, therapeutics, diagnostics and medical devices for historically overlooked indications such as malaria, cholera, Lassa fever, and postpartum hemorrhage, with a commitment to make these interventions accessible to those who need them most in low- and middle-income countries. (
  • Outcomes included a decrease in the postpartum hemorrhage rate and decreased usage of additional uterotonic medications during the immediate recovery period. (
  • A partner's experience of birth trauma can often be dismissed in the buzz of the postpartum period. (
  • My Labor Day was quite laborless which is a good thing since I was only 1 week postpartum! (
  • For a third stage of labor more than 20 minutes compared with less than 20 minutes there was four times the risk of postpartum hemorrhage, and for third stages over 30 minutes compared to those less than 30 minutes there was 6 times the risk of PPH. (
  • PostPartum Care in the Context of a Developing Country by Vicki Penwell In past articles I wrote in this series, I mentioned that while visiting Thailand years ago, I found that they have a charming expression that translates in English to "same same but different" (vendors in the market will say this to you repeatedly as they show you different products in the same basic grouping). (
  • But One Heart Worldwide, a maternal health aid group and long-term Direct Relief partner, was asking for something else entirely: misoprostol, a lifesaving drug that's used to stop postpartum hemorrhage, and that plays an essential role in preventing maternal deaths. (
  • 3 g litre, measured early during PPH, is associated with progression to massive haemorrhage, red blood cell (RBC) and fresh frozen plasma (FFP) transfusion, invasive procedures and level 2/3 admission. (