Reference: BJOG 2013 Feb;120(3):277 (level 1 [likely reliable] evidence). Postpartum hemorrhage is a major cause of maternal death in many low-resource countries around the world. While injected oxytocin is commonly used for hemorrhage prophylaxis in institutional settings, its use may be impractical if not impossible in areas where home birth is the norm and even skilled birth attendants are rare. A recent systematic review evaluated the evidence for oral misoprostol for the prevention of postpartum hemorrhage in such settings.. The review included 2 randomized trials and 4 non-randomized controlled trials comparing oral misoprostol vs. placebo or no treatment for women during the third stage of labor. The misoprostol dose was 600 mcg in 5 trials and 400 mcg in the other. Trained health workers administered the drug in 4 trials. In 2 trials, the drug was distributed to pregnant women following counseling during an antenatal visit with instruction for use during birth.. Oral misoprostol reduced ...

Since 1996, maternal mortality is registered as part of a permanent confidential inquiry in France. The National Committee has studied all cases recorded to assess the cause of death and the avoidable obstetrical complications involved. Recommendations are proposed. In 1996 and 1997, there were 196 maternal deaths in France; 165 could be analyzed. The cause was obstetrical in 123 cases (74%), non-obstetrical in 26 (16%), and unidentified in 16 (10%). Ninety-seven direct deaths occurred (78% of the obstetrical mortality cases); 31 cases of hemorrhage including 19 post partum, 20 cases of pregnancy-induced hypertension, 10 cases of eclampsia and 7 of pre-eclampsia, 16 cases of amniotic fluid embolism, 11 cases of thromboembolism and 10 cases of sepsis ...

A literature review was conducted to determine whether misoprostol is an effective treatment for postpartum hemorrhage (PPH) and in what dose. All English language articles published before March 2007 reporting on misoprostol for treatment of PPH were reviewed. Unpublished data previously presented at international scientific meetings were also included in the review. Little evidence exists in support of misoprostol for treatment of postpartum hemorrhage (PPH). Nonetheless, PPH remains a major killer of women worldwide, and new treatment options are widely sought. For this reason, we recommend a single dose of misoprostol 600 μg oral or sublingual for PPH treatment in instances when other treatments have either failed to work or are not available.. Access the abstract.. ...

TY - JOUR. T1 - Postpartum hemorrhage caused by uterine artery pseudoaneurysm and uterine rupture after vaginal delivery. AU - Origoni, Massimo. AU - Gelardi, Chiara. AU - Pasi, Federica. AU - Salvatore, Stefano. AU - Candiani, Massimo. PY - 2012/7. Y1 - 2012/7. N2 - A case of massive hemoperitoneum determined by uterine rupture and uterine artery pseudoaneurysm dissection after vaginal delivery, requiring an emergency laparotomy with arterial ligation, is reported. The authors reviewed the published literature, finding 12 cases of uterine artery pseudoaneurysm and associated postpartum hemorrhage after vaginal delivery, but no cases with uterine rupture have ever been published. Diagnosis is based upon imaging, and management options include arterial embolization, arterial ligation and hysterectomy in particularly severe and life-threatening situations. Vaginal bleeding is associated with favorable outcomes and conservative treatment, while the absence of external blood loss seems to be ...

Misoprostol for the prevention of postpartum hemorrhage during home births in rural Lao PDR: establishing a pilot program for community distribution Jo Durham,1 Alongkone Phengsavanh,2 Vanphanom Sychareun,2 Isaac Hose,1 Viengnakhone Vongxay,2 Douangphachanh Xaysomphou,2 Keith Rickart3 1Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia; 2Faculty of Post-Graduate Studies, University of Health Sciences, Vientiane, Lao PDR; 3Communicable Diseases Branch, Department of Health, Brisbane, Queensland, Australia Purpose: The purpose of this study was to gather the necessary data to support the design and implementation of a pilot program for women who are unable to deliver in a healthcare facility in the Lao People’s Democratic Republic (PDR), by using community distribution of misoprostol to prevent postpartum hemorrhage (PPH). The study builds on an earlier research that demonstrated both support and need for community-based distribution of

TY - JOUR. T1 - Daytime Compared With Nighttime Differences in Management and Outcomes of Postpartum Hemorrhage. AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. AU - Yee, Lynn M.. AU - McGee, Paula. AU - Bailit, Jennifer L.. AU - Reddy, Uma M.. AU - Wapner, Ronald J.. AU - Varner, Michael W.. AU - Thorp, John M.. AU - Leveno, Kenneth J.. AU - Caritis, Steve N.. AU - Prasad, Mona. AU - Tita, Alan T.N.. AU - Saade, George. AU - Sorokin, Yoram. AU - Rouse, Dwight J.. AU - Blackwell, Sean C.. AU - Tolosa, Jorge E.. PY - 2019/1/1. Y1 - 2019/1/1. N2 - OBJECTIVE: To assess whether postpartum hemorrhage management or subsequent morbidity differs based on whether delivery occurred during the day or night. METHODS: We conducted a secondary analysis of a multicenter observational obstetric cohort of more than 115,000 mother-neonate pairs from 25 hospitals (2008-2011). This analysis included women delivering singleton ...

Evaluation of process management of postpartum hemorrhage due to uterine atony. . Biblioteca virtual para leer y descargar libros, documentos, trabajos y tesis universitarias en PDF. Material universiario, documentación y tareas realizadas por universitarios en nuestra biblioteca. Para descargar gratis y para leer online.

TY - JOUR. T1 - Preventing Maternal Morbidity from Obstetric Hemorrhage. T2 - Implications of a Provider Training Initiative. AU - Kominiarek, Michelle A.. AU - Scott, Shirley. AU - Koch, Abigail R.. AU - Zeschke, Maripat. AU - Cordova, Yvette. AU - Ravangard, Samadh F.. AU - Schy, Deborah. AU - Geller, Stacie E.. PY - 2017/1/1. Y1 - 2017/1/1. N2 - Objective The objective of this study was to compare severe morbidity due to obstetrical hemorrhage and its potential preventability before and after a mandated provider training initiative on obstetric hemorrhage. Study Design Cases of severe morbidity due to obstetric hemorrhage during 2006 (n = 64 before training initiative) and 2010 (n = 71 after training initiative) were identified by a two-factor scoring system of intensive care unit admission and/or transfusion of ≥ 3 units of blood products and reviewed by an expert panel. Preventable factors were categorized as provider, system, and/or patient related. Results Potential preventability did ...

TY - JOUR. T1 - Calculated blood loss in severe obstetric hemorrhage and its relation to body mass index. AU - Hernandez, Jennifer S.. AU - Alexander, James M.. AU - Sarode, Ravindra. AU - McIntire, Donald D.. AU - Leveno, Kenneth J.. PY - 2012/4/13. Y1 - 2012/4/13. N2 - Objective To evaluate total calculated blood loss at the time of severe obstetric hemorrhage. Study Design This is a prospective observational study of women with obstetric hemorrhage. Women who received a blood transfusion for hypovolemia and those in which a body mass index (BMI) could be calculated were included. Total blood volume lost was calculated. Blood loss was analyzed in relation to maternal size as reflected in the BMI. Results Fourteen hundred forty-three women meeting inclusion criteria delivered at our hospital between March 2002 and June 2006. The median calculated volume of blood lost was 3529 mL, and 93% of women sustained losses 3000 mL. The blood loss sufficient to provoke signs and symptoms of hypovolemia ...

Oral misoprostol, administered by trained health-workers is effective and safe for preventing postpartum haemorrhage (PPH). There is interest in expanding administration of misoprostol by non-health workers, including task-shifting to pregnant women themselves. However, the use of misoprostol for preventing PPH in home-births remains controversial, due to the limited evidence to support self-administration or leaving it in the hands of non-health workers. This study aimed to determine if antenatally distributing misoprostol to pregnant women to self-administer at home birth reduces PPH. Between February 2013 and March 2014, we conducted a stepped-wedge cluster-randomized trial in six health facilities in Central Uganda. Women at 28+ weeks of gestation attending antenatal care were eligible. Women in the control-arm received the standard-of-care; while the intervention-arm were offered 600mcg of misoprostol to swallow immediately after birth of baby, when oxytocin was not available. The primary outcome

Oral misoprostol, administered by trained health-workers is effective and safe for preventing postpartum haemorrhage (PPH). There is interest in expanding administration of misoprostol by non-health workers, including task-shifting to pregnant women themselves. However, the use of misoprostol for preventing PPH in home-births remains controversial, due to the limited evidence to support self-administration or leaving it in the hands of non-health workers. This study aimed to determine if antenatally distributing misoprostol to pregnant women to self-administer at home birth reduces PPH. Between February 2013 and March 2014, we conducted a stepped-wedge cluster-randomized trial in six health facilities in Central Uganda. Women at 28+ weeks of gestation attending antenatal care were eligible. Women in the control-arm received the standard-of-care; while the intervention-arm were offered 600mcg of misoprostol to swallow immediately after birth of baby, when oxytocin was not available. The primary outcome

This community-based cluster Randomised Control Trial will assess the feasibility, cost, risks and benefits of use of oral Misoprostol and parenteral Oxytocin in Uniject® as prophylaxis for postpartum hemorrhage (PPH) in community settings. The study will be conducted in Jamnagar district in Gujarat state in India. The hypothesis is that a program to deliver oral misoprostol and one to deliver oxytocin via Uniject® will both be effective in preventing PPH when introduced in community-based settings ...

Matern Child Health J; 2020 Nov 26; doi:10.1007/s10995-020-03047-6. Objective: To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births.. Methods: A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for frst aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes.. Results: Of the 4008 ...

Table 3: Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation

The authors present a retrospective, observational study of the treatment of postpartum hemorrhage (PPH) with a massive transfusion protocol (MTP). The study delineates that PPH is a rare condition, often associated with coagulopathy, and the authors claim that the MTP was associated with favorable hematological indices, as evaluated with conventional coagulation tests. The data, however, indicate that most of the PPH patients were severely coagulopathic during the resuscitation phase and this questions the conclusions somewhat. The authors suggest that outcome studies are needed and this is correct.. - Pär Johansson. ...

July 11-12 and 19, 2014. Local Coordinator: Dr Swaroop N. The Oxford University Maternal and Perinatal Health Institute (OMPHI) in collaboration with the Geneva Foundation for Medical Education and Research (GFMER) has provided health professionals from Karnataka in Southern State of India with a three-day, free training course on The evidence-based management of Postpartum Haemorrhage. The course was developed in an e-learning format and sponsored by the Maternal Health Task Force at the Harvard School of Public Health and the funding was provided by the Bill & Melinda Gates Foundation.. The training was conducted with the support of Karnataka Health Promotion Trust (KHPT), India and held at the Hospet Province on 11th & 12th July 2014 and at Gulbarga Province on 19th July 2014. The event was facilitated by Dr Swaroop N, technical manager Maternal, Neonatal and Child Health (MNCH) Project, Dr Pavan BS, technical Manager MNCH Project, Dr L Troy Cunningham, Deputy Director-Quality Improvement ...

Tranexamic acid decreased death from bleeding but not all-cause mortality in women with postpartum hemorrhage (WOMAN) answers are found in the EE+ POEM Archive powered by Unbound Medicine. Available for iPhone, iPad, Android, and Web.

How to Cite: Natarajan, A., Chavez, J., Ahn, R., Nelson, B.D., Eckardt, M. and Burke, T., 2015. Uterine balloon tamponade as a second line treatment for uncontrolled postpartum hemorrhage: A qualitative study exploring lower level provider perceptions of effectiveness, feasibility, and acceptability in lower level health facilities in Kenya. Annals of Global Health, 81(1), p.79. DOI: http://doi.org/10.1016/j.aogh.2015.02.686 ...

Suzanne Bell, MPH Candidate. As a Bixby summer intern, Suzanne worked alongside two domestic NGOs in rural Bangladesh to complete the next phase of the Misoprostol Pilot Project. The projects overall aim is to illustrate that womens use of misoprostol and an absorptive mat during childbirth can reduce the rates of post partum hemorrhage (PPH), a leading cause of maternal death.. Suzannes internship objective was two-fold: collect retrospective data regarding the rates of maternal mortality and PPH prior to the inception of the clinical trial, and interview personnel involved with the program to ascertain perceptions and sustainability of the project. Although it required great tenacity to collect years of data from myriad government and NGO officials, Suzanne achieved her first aim. She also completed her second goal by conducting 24 in-depth interviews throughout the interventions catchment area, which produced a wealth of rich data. In order to meet these objectives, Suzanne traveled to 6 ...

Internal and external hemorrhage, Accidental hemorrhage, Dental and orthopedic surgery, Surgery haemoptysis, Secondary post partum hemorrhage, Dysfunctional uterine bleeding, MTP, D&C, Menorrhagia/Metrorrhagia, IUCD induced ...

Ms G from London, 37 years old at the time of the incident, gave birth to her second child at the Royal Berkshire Hospital on 17 October 2009.. She returned home with her newborn baby but continued to bleed very heavily.. On 13 November 2009 she collapsed at home. Luckily, a health visitor happened to be present and called an ambulance, which took Ms G back to hospital.. Following investigations, it was found that a large piece of placenta had been retained, which had caused a post partum haemorrhage.. Ms G had to undergo an Evacuation of Retained Products of Conception (ERPC), a procedure under general anaesthetic to remove the retained placenta. The operation revealed the piece of retained placenta was 6 x 4 cm in size.. Post operatively Ms G required intravenous antibiotics and a blood transfusion. It was estimated that she lost 1.5 to 2 litres of blood.. She was discharged on 15 November 2009.. The Royal Berkshire NHS Foundation Trust admitted liability and the case was settled for ...

Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.. We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.. We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors ...

Postpartum haemorrhage(PPH)or excessive bleeding at or after childbirth is a potentially life threatening complication and is one of the major contributors to maternal mortality and morbidity worldwide (Lewis 2001).Among the various agents that have been studied in addition to the routine oxytocin and syntometrine (which has adverse effects),oxytocin agonist (carbetocin) appears to be the most promising for this indication(Chong 2004).. Carbetocin is a licensed medication for the use of prevention of postpartum haemorrhage in Singapore and many other countries. It is a long-acting synthetic octapeptide analogue of oxytocin with agonist properties.The clinical and pharmacological properties of carbetocin are similar to those of naturally occurring oxytocin. Like oxytocin, carbetocin binds to oxytocin receptors present on the smooth musculature of the uterus, resulting in rhythmic contractions of the uterus, increased frequency of existing contractions, and increased uterine tone. In ...

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MSH, through an Innovation Fund grant of the Reproductive Health Supplies Coalition, and with contribution from the USAID-funded Uganda Health Supply Chain Program, supported Uganda to implement integration of oxytocin, the first-line medicine to prevent and treat excessive bleeding postpartum hemorrhage after delivery, into the vaccine cold chain for improved storage. The objective of the project was to facilitate the integration of oxytocin into the Expanded Program for Immunisation (EPI) cold chain by conducting an options analysis, securing political commitment, and supporting phased implementation in Uganda.. MSH navigated complex stakeholder engagement and applied a policy options analysis framework to determine where along the supply chain integration is needed, and to support the Ministry of Health in implementation. MSH facilitated the formation of an integration task force, comprising key stakeholders from the MoH and partners involved in supply chain, immunization programming, and ...

Ergometrine is derived from ergot plants. It stimulates smooth muscle contraction, both in the uterus and blood vessels. This makes it useful for delivery of the placenta and to reduce postpartum bleeding. It may be used during the third stage of labour (delivery of the placenta) and postpartum to prevent and treat postpartum haemorrhage. It is only used after delivery of the baby, not in the first or second stage.. Due to the action on the smooth muscle in blood vessels and gastrointestinal tract, it can cause several side effects, including hypertension, diarrhoea, vomiting and angina. It needs to be avoided in eclampsia, and used only with significant caution in patients with hypertension.. Syntometrine is a combination drug containing oxytocin (Syntocinon) and ergometrine. It can be used for prevention or treatment of postpartum haemorrhage.. ...

Key Recommendations 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH …

Cette note dinformation stratégique, publié par la FCI en partenariat avec Gynuity Health Projects, PATH, et la FIGO, explore des stratégies pour aider les gouvernements et les partenaires améliorer la santé maternelle en élargissant laccès au misoprostol pour lhémorragie du post-partum (HPP), lune des principales causes de mortalité maternelle. Les principales stratégies pour introduire et élargir laccès au misoprostol pour le traitement et la prévention de lHPP comprennent : mettre en place une politique nationale favorable Inclure le misoprostol dans les budgets nationaux pour la santé ; préparer et diffuser des directives cliniques au niveau national Former les prestataires de santé ; assurer un approvisionnement et une distribution constants ; and sensibiliser les communautés et renforcer leur demand.. ...

Introduction: Massive obstetric haemorrhage (MOH), blood loss of ,2000 ml, is a life-threatening emergency in the postpartum. The aim of this review is to address the incidence of maternal obesity, a modifiable risk factor contributing to MOH.. Methods: This 6-year retrospective review involved the interrogation of the annual clinical reports of the tertiary maternal centres in the East of Ireland between the years 2009-2014. We assessed patient risk factors for developing MOH in the antenatal period with a focus on maternal obesity (Body Mass Index (BMI) ≥30 Kg/m2). Associations between categorical variables were tested using Pearsons chi-square test.. Results: The incidence of MOH was 2.21/1,000 livebirths during the 6-year period. Of those women 20.5% of cases had BMIs recorded and 34.72% of those with recorded BMI were obese. Within the obese cohort, patients suffered an average blood loss of 2820 ml in the first 24 hours postpartum, with 88% requiring a blood transfusion. There was a ...

Last year, she took a global health course which gave her perspective on creative solutions to improve birth outcomes. In the U.S., if a woman in a hospital is experiencing a postpartum hemorrhage, we have ready access to a variety of treatments and medical professionals to save her life, but in a place like rural Pakistan where only 30% of births are attended by any skilled health professional and essential medications are only available to 3.3% of the public market, other strategies were necessary, she explains. Downes describes how a combination of several innovative programs, including the Lady Health Workers (which trains local young women to provide basic primary health services) and the introduction of prophylactic misoprostol for postpartum hemorrhage (an inexpensive, easy to use medication that requires no refrigeration) has led to significant reductions in the incidence of maternal mortality in Pakistan. Similarly, we may be able to develop less-expensive, effective ways of ...

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Pituitary infarction is a well-known consequence of postpartum hemorrhage and attendant hypotension (Sheehans syndrome). Antepartum pituitary necrosis, however, is exceedingly rare, having been reported in only four women, all young diabetics. The clinical findings and laboratory data for three additional subjects who developed acute pituitary insufficiency during the latter part of pregnancy are reported. None experienced pre- or post-partum hemorrhage or hypotension, and all delivered viable, healthy babies. After delivery all women were amenorrheic, developed cold intolerance, and had either absent or inadequate lactation. Laboratory studies showed diminished levels of plasma growth hormone, luteinizing hormone, and follicle-stimulating hormone in all three subjects; in two there was a decreased radioactive iodine uptake and diminished base-line 17-hydroxysteroids and 17-ketosteroids. On replacement therapy the three women have remained in relatively good health for 8 to 15 years after ...

Sorry to post a day late. Yes, postpartum hemorrhage can occur in the hospital. Nurses and docs are trained to respond to this serious complication. Number one reason is uterine atony (a boggy uterus). Normally after birth the uterus contracts, squeezing the blood vessels in the uterus to slow the bleeding. Predisposing factors to bleeding are an overdistended uterus (ie twins+, polyhydramnios (excess amniotic fluid), rapid labor, long induced labor, an infected uterus, grand multiparity (having many babies), retained placenta(uterus cant contract around it) placenta accreeta (buried into muscle of uterus. Lacerations of vagina or cervix can also result in excess blood loss. Treatment is aimed at cause. Agents to help uterus contract are given for uterine atony (pitocin, methergine, hemobate. The uterus can be packed. Uterine artery ligation, a surgical procedure can be attempted. Hysterectomy is last ditch effort. If placenta retained, then manual removal or surgical scraping can be done. ...

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Sheehans syndrome - Comprehensive overview covers signs and symptoms, causes, treatment of this rare complication of postpartum hemorrhage.

Three women in late middle age had recurrent episodes of confusion which could not be explained solely on the basis of an associated infection. All three patients had latent hypopituitarism diagnosed on final presentation. Each patient had a previous history of a severe postpartum haemorrhage followed by two further pregnancies. Experienced clinicians had not made a diagnosis of confusional episodes due to hypopituitary encephalopathy because the history was not immediately available in the confused patient, and the significance of deficient axillary and pubic hair was not given due emphasis.. ...

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. Obstetric bleeding can be catastrophic and management is challenging, involving a coordinated multidisciplinary approach, which may include blood products. In settings where blood transfusion is not an option, either because of patient refusal (most commonly in Jehovah Witnesses) or because of unavailability of blood, management becomes even more challenging. Observational studies have demonstrated an association between refusal of blood products in major obstetric haemorrhage and increased morbidity and mortality. This review draws upon evidence in the literature, physiological principles and expert opinion for strategies and guidance to optimise the outcomes of pregnant women in whom blood transfusion is either refused or impossible. The importance of a multidisciplinary antenatal and perinatal management plan, including optimisation of haemoglobin and iron stores pre-delivery, blood loss ...

Study methods: A prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Kanwatiya Hospital, SMS Medical College, JAIPUR (Rajasthan) from December 2016 to February 2017. Active management of 3rd stage of labor was done by using either inj. Oxytocin 10 IU or tab. Misoprostol 800µg as per the group of the patient. Duration of the third stage of labor, the amount of blood loss, the incidence of postpartum haemorrhage, a drop in haemoglobin concentration from predelivery to 24 h after delivery and adverse effect of drugs were measured ...

So recently my family and I moved in with my in-laws due to financial issues on our side and theirs to kind of help everyone out. That is all going well, no complaints there. The issue I am having is that I moved 80 miles from my OB so I have had to select a new one. I really wanted to go all natural this time around and use a mid-wife but I have been turned down by 3 of them due to my high risk of postpartum hemorrhage, I have had this happen with my last two births that were pretty severe. I required a D&C and transfusions. So I need to use a doc and deliver in a hospital should an emergency like this arise. Any who, a part of me really feels that the intense use of pitocin in my last labor was the main cause of the hemorrhage, no one has ever been able to tell why this has happened only to say uterine atony. Which basically means my uterus was tired. Although I want to go natural a part of me is really scared that should I hemorrhage having someone manually massage my uterus without the ...

OPUS (Open Publications of UTS Scholars) is the UTS institutional repository. It showcases the research of UTS staff and postgraduate students to a global audience. For you, as a researcher, OPUS increases the visibility and accessibility of your research by making it openly available regardless of where you choose to publish.. Items in OPUS are enhanced with high quality metadata and seeded to search engines such as Google Scholar as well as being linked to your UTS research profile, increasing discoverability and opportunities for citation of your work and collaboration. In addition, works in OPUS are preserved for long-term access and discovery.. The UTS Open Access Policy requires UTS research outputs to be openly available via OPUS. Depositing your work in OPUS also assists you in complying with ARC, NHMRC and other funder Open Access policies. Providing Open Access to your research outputs through OPUS not only ensures you comply with these important policies, but increases opportunities ...

PATHs Maternal and Newborn Health Technology Initiative, in collaboration with South Africas KwaZulu Natal Department of Health, produced this essential training video on active management of the third stage of labor. Using real clinical footage, this video presents the information, skills, and practices that birth attendants need to routinely provide this life-saving intervention and prevent postpartum hemorrhage. To obtain free copies of the video on CD-ROM, please email a request to [email protected]. For optimal viewing of the low-resolution versions posted here, save the files to your hard drive by right-clicking on the links below and selecting Save target as. Please note: the Clinical Tutorial and Core Topics files require Windows Media Player, available as a free download from Microsoft.. Publication date: January 2008. Region: Global ...

In their initial letter to Ms T dated 12 April 2012, the Trust said the Midwife felt her decision to administer Syntometrine was in part due to her lack of experience in attending home births. As this is a somewhat vague statement, I can understand why Ms T queried it. However, the Trust provided her with a more detailed explanation in their letter of 9 May. The Trust said that NICE guidance advises that, for active management of the third stage of labour, oxytocin (Syntometrine) is given followed by early cord clamping and cutting. But they clarified that a midwife with more experience of attending home births may have combined active and physiological management of the third stage of labour. I have taken account of the Midwife Advisers comments that NICE guidance recommends active management of the third stage of labour to reduce the risk of the mother suffering a haemorrhage. She also said that, given the presence of meconium, early cutting and clamping of the cord was good practice, in ...

EDITORIAL COMMENT: Most busy practitioners hold strong opinions, based on clinical experience they will say, of the preferred regimen for management of common clinical problems. This study shows that strongly held beliefs may be falacious. The authors have shown that drainage of placental blood from the cord does not affect the rates of retained placenta and postpartum haemorrhage. The editor has always taught that releasing the cord clamp and allowing drainage of placental blood minimizes fetomatemal haemorrhage and assists placental delivery ‐ he stands corrected. However, draining the cord does no harm, and the reviewer of this paper commented that at least it minimizes the mess if the cord breaks during delivery of the placenta by controlled cord traction! Our common clinical regimes should be scrutinized more often, especially when clinical results or community costs are involved. This study did not attempt to assess the value to the fetus of early versus late clamping of the cord. ...

Plan Estatal de Desarrollo Hidalgo 2016-2022 Visión prospectiva 2030. Gobierno del Estado de Hidalgo. [Document on the internet] Pachuca de Soto 2017. [Cited March 2019] Available on: http://planestataldedesarrollo.hidalgo.gob.mx/pdf/PED/PED/Ped_Completo.pdf Rojas AJ, Cogollo M, Jezid EM, Ramos CE, Fernández CJ, Bello MA. Morbilidad materna extrema en cuidados intensivos obstétricos Cartagena Colombia: 2006-2008. Rev. Colomb. Obstet. Ginecol. 2011; 62(2):131-140. Secretaría de Salud. Búsqueda intencionada de muertes maternas y de menores de cinco años, y Registro de nacimientos en los 101 municipios con bajo índice de desarrollo humano. [Document on the internet]. México 2013. [Cited March 2019] Available on: www.dgis.salud.gob.mx/descargas/pdf/BIMMyM5.pdf González Ortíz LD, Gómez Arias RD, Vélez Álvarez GA, Agudelo Londoño SM, Gómez J, Wylie J. Características de la atención hospitalaria y su relación con la morbilidad materna extrema en Medellín, Colombia. Rev. Panam. Salud ...

Through funding from Grand Challenges Canada, we have initiated a predictive modeling project focussed on hypotension. A prospective cohort study will be conducted at Jinnah Post Graduate Medical Center (JPMC), Karachi, Pakistan. We are recruiting women who have admitted for delivery or are postpartum within forty-two days of delivery and aim to reach a sample size of one hundred adverse maternal outcomes. With this project, we are ultimately aiming to incorporate a hypotension risk model into the PIERS platform. Once data collection is completed a prediction model will be developed by Samina Bakhtawar, Masters Student at Aga Khan University, Karachi, Pakistan.. ...

A new mother in Tanzania who took misoprostol after delivering her baby at home. Misoprostol is a low cost, off-patent, easy to administer drug that greatly reduces the chance of postpartum hemorrhage, the leading cause of maternal death. The Bixby Center is committed to reducing maternal mortality worldwide. One strategy is the use of misoprostol in resource poor settings. ...

Background and objectives: To explore if intravenous iron isomaltoside (Monofer ®) leads to a better relief of fatigue than current treatment practice with oral iron in women suffering from severe fatigue after postpartum hemorrhage. Materials and methods: This is a subanalysis of a single-center, open-label, randomized controlled trial conducted in women suffering from postpartum hemorrhage. Participants were randomized 1:1 to 1200 mg iron isomaltoside or current treatment practice with oral iron. We measured fatigue by the Multidimensional Fatigue Inventory (MFI) and Edinburgh Postnatal Depression Scale, and determined hematological parameters. The subanalysis includes all participants with a high fatigue score (MFI physical fatigue score ,15) at inclusion. The primary endpoint was aggregated change in physical fatigue score from inclusion to 12 weeks postpartum with a predefined minimum clinically relevant difference of 1.8. The trial is registered at ClinicalTrials.gov (identifier: ...

Severe haemorrhage is a leading cause of maternal death worldwide. Most haemorrhage deaths occur soon after childbirth. Severe post-partum bleeding is sometimes managed by the surgical removal of the uterus (hysterectomy). Death and hysterectomy are important health consequences of post-partum haemorrhage, and clinical trials of interventions aimed at preventing these outcomes are needed. The World Maternal Antifibrinolytic trial aims to determine the effect of tranexamic acid on death, hysterectomy and other health outcomes in women with post-partum haemorrhage. It is an international, multicentre, randomised trial. Approximately 20,000 women with post-partum haemorrhage will be randomly allocated to receive an intravenous injection of either tranexamic acid or matching placebo in addition to usual care. The primary outcome measure is a composite of death in hospital or hysterectomy within 42 days of delivery. The cause of death will be described. Secondary outcomes include death, death due to bleeding

May 19, 2011. Dear Colleagues:. It has been several months since you lent your support to add misoprostol for prevention and treatment of post-partum hemorrhage (PPH) to the World Health Organizations (WHO) Model List of Essential Medicines. The 18th Expert Committee on the Selection and Use of Essential Medicines met in Accra, Ghana in March 2011 to review the applications for misoprostol to be added to the WHOs essential medicines list (EML) for the prevention and treatment of PPH. There was a huge outpouring of support for the inclusion of misoprostol for both indications by international policy-making and programmatic agencies and outside expert reviewers that positively reviewed both applications.. On May 6th, the Expert Committee published its results which add misoprostol to the [Essential Medicines] List, for the prevention of PPH in settings where parenteral uterotonics are not available or feasible. Additionally the committee moved the drug from the complementary to the core list ...

Objective: The objective of this selective EBM review is to determine whether or not methylergometrine is more effective than other uterotonic agents in preventing postpartum hemorrhage during the third stage of labor. Study Design: Review of two randomized controlled trials (RCTs) published in 2004 and 2009, and one prospective study published in 2006. Data Sources: Each article used was published in English and found using PubMed and Medline. The studies compared the efficacy of methylergometrine against uterotonic agents, specifically oxytocin and misoprostol. Outcomes Measured: The efficacy of methylergometrine was measured via the incidence of postpartum hemorrhage despite the use of prophylactic medication and adverse effects of medications. Results: Vimala et al (2004) found that methylergometrine and misoprostol were equally effective at decreasing the amount of blood loss [170±42ml vs. 185±56ml; p |0.05], as well as in terms of adverse side effects, specifically nausea [13.3% vs. 6.6%; p |0

TY - JOUR. T1 - Cortical blindness and Anton syndrome in a patient with obstetric hemorrhage. AU - Argenta, Peter A. AU - Morgan, Mark A.. PY - 1998/5. Y1 - 1998/5. N2 - Background: Cortical blindness is characterized by loss of vision in the presence of intact anterior visual pathways. Anton syndrome, a form of anosognosia, is a rare complication of cortical blindness involving compromise of the visual association centers, with resulting patient denial of blindness. Both syndromes have been associated with computed tomography findings of localized cortical ischemia. In most cases, both the clinical and radiologic features are reversible. Case: A woman with hemorrhage from an incomplete abortion at 21 weeks experienced cortical blindness and visual anosognosia. Conclusion: Cortical blindness and anosognosia are unusual manifestations of severe hemorrhage but should be considered in the differential diagnosis of a patient with atypical visual symptoms.. AB - Background: Cortical blindness is ...

Massive hemorrhage is a recognized complication of PP. The optimal predelivery transfusion planning strategy requires coordination and communication among all perioperative disciplines, including anesthesiologists, obstetricians, nursing personnel, blood bank staff, and interventional radiologists. A massive transfusion protocol should be in place to address preoperative blood component preparation and intraoperative management. Although there is a report on autologous blood donation programs that have reduced the need for allogeneic blood transfusions in high risk parturients, autologous donation is not recommended because severe postpartum hemorrhage is rarely anticipated and problems such as bacterial contamination and human errors exist [31,32]. Hematology and coagulation laboratory values must be evaluated before surgery. The initial measurement of hemoglobin level is useful as a baseline measure and repeated evaluation provides information on the degree of severity of bleeding and anemia ...

Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications

The Global Gunshot Injuries Treatment Market was valued at US$ 6.9 million in 2015 and is projected to exhibit a CAGR of 8.2% over the forecast period (2017-2025), as highlighted in a new report published by Coherent Market Insights. Technological developments such as innovative pocket sized device, which use tiny sponges and emergency treatment in the battlefield for soldiers, are expected to be major factors driving growth of the global gunshot injuries treatment market over the foreseeable future.. Request Sample Copy of the Business Report: https://www.coherentmarketinsights.com/insight/request-sample/772. Efficient treatment by products that prevent postpartum hemorrhage to boost the gunshot injuries treatment market. Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and responsible for a quarter of all maternal deaths globally. According to an article published by Medscape, pregnancy-related mortality ratio was estimated to be 17.3 deaths per ...

Ibu Robin Lim, CPM, had been a midwife for over 20 years when she studied with Debra Pascali-Bonaro to become a DONA Doula. Ibu Robin is the mother of eight and the grandmother of Zhouie, Bodhi, Tashi, Rimba, and Bear. Ibu Robin splits her time between Bumi Sehat Community Health and Birth Center in Bali; the Philippines, where the Bahai Arugaan ni Maria Birth Center Palawan will open in 2019; and Lombok, Indonesia, where Bumi Sehat is operating a disaster relief clinic in tents since the north half of the island was destroyed by earthquakes. Birth in the Era of Climate Change, a MEAC-accredited course, is offered by Ibu Robin and Jacquelyn Aurora upon request. Along with The Farm midwife Deborah Flowers, Ibu has developed a website for families called Awakening Birth (awakeningbirth.org). Also, visit bumisehat.org.. View all posts by Robin Lim ...

ABSTRACT. Background: Arteriovenous malformation is a high flux and low resistance vascular system defect that consists of a blending of arteries and veins without interposition of a capillary system, in response of an increasing anomalous angiogenesis. Uterine arteriovenous malformation is a rare entity, with only 300 cases reported, being even more uncommon as a cause of postpartum bleeding, with only thirteen cases in the literature. We report the fourteenth case of uterine arteriovenous malformation associated with postpartum bleeding ...

In placenta accreta, the anchoring placental villi directly contact the myometrium, leading to incomplete separation at the time of delivery. The most significant complication of placenta accreta is postpartum hemorrhage; it is reported to have a mortality rate of around 7 percent and is the most common indication for birth-related hysterectomy. According to a review by Resnik, the incidence of placenta accreta is rising, and physicians need to be aware of the condition, particularly in women with a history of previous cesarean delivery or another source of uterine scarring.. Although many cases are not reported, placenta accreta may occur in approximately one of every 2,500 pregnancies. In cases of placenta previa, the risk of accreta is 1 to 5 percent. In women with a history of one cesarean delivery, the incidence of placenta accreta may be as high as 30 percent. The risk increases with multiple cesarean deliveries and is also increased in women with a history of uterine surgeries or maternal ...

The 63rd Annual Clinical Meeting the American College of Obstetricians and Gynecologists. The annual meeting of the American College of Obstetricians and Gynecologists was held from May 2 to 6 in San Francisco and attracted more than 3,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in obstetrics and gynecology. The conference highlighted recent advances in the prevention, detection, and treatment of conditions impacting women, with presentations focusing on the advancement of health care services for women worldwide.. In one study, Janice Mitchell, M.D., of the Baylor University Medical Center in Dallas, and colleagues found that uterine cooling during cesarean delivery reduced blood loss by 29 percent and the incidence of postpartum hemorrhage by 57 percent.. Uterine cooling is effective for decreasing blood loss during cesarean and may be a novel therapy for uterine atony, Mitchell said. A second study is ...

Shafia Rashid is a Senior Technical Advisor for the FCI Program of Management Sciences for Health.. In Senegal, approximately 1,800 women lose their lives every year while giving birth. The major cause of these deaths is uncontrolled bleeding after childbirth, or postpartum hemorrhage (PPH). More than half of Senegalese women live in rural areas and have limited access to well-equipped health facilities that can prevent or treat many of these deaths. Many women give birth, attended by matrones or volunteer birth attendants, in maternity huts. Recognized as essential health care providers by their communities, matrones have some formal training and are now registered with the Ministry of Health (MoH).. To effectively prevent or treat PPH, women need access to uterus-contracting drugs, or uterotonics, such as oxytocin or misoprostol. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer. Misoprostol is a safe and effective alternative where ...

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Tranexamic acid is a blood-clotting agent used in everything from soldiers wounds to dental surgery. It can cost as little as $1 a dose.

Synonyms for atonic urinary bladder in Free Thesaurus. Antonyms for atonic urinary bladder. 13 words related to urinary bladder: apparatus urogenitalis, genitourinary apparatus, genitourinary system, systema urogenitale, urinary apparatus.... What are synonyms for atonic urinary bladder?

TY - JOUR. T1 - Cultural theories of postpartum bleeding in Matlab, Bangladesh. T2 - Implications for community health intervention. AU - Sibley, Lynn M.. AU - Hruschka, Daniel. AU - Kalim, Nahid. AU - Khan, Jasmin. AU - Paul, Moni. AU - Edmonds, Joyce K.. AU - Koblinsky, Marjorie A.. PY - 2009/6. Y1 - 2009/6. N2 - Early recognition can reduce maternal disability and deaths due to postpartum haemorrhage. This study identified cultural theories of postpartum bleeding that may lead to inappropriate recognition and delayed care-seeking. Qualitative and quantitative data obtained through structured interviews with 149 participants living in Matlab, Bangladesh, including women aged 18-49 years, women aged 50+ years, traditional birth attendants (TBAs), and skilled birth attendants (SBAs), were subjected to cultural domain. General consensus existed among the TBAs and lay women regarding signs, causes, and treatments of postpartum bleeding (eigenvalue ratio 5.9, mean competence 0.59, and standard ...

Background Advance provision of misoprostol to women during antenatal care aims to achieve broader access to uterotonics for the prevention of postpartum hemorrhage. Studies of this community-based...

On December 15, MSH, Gynuity Health Projects and Jhpiego hosted a one-hour webinar to share innovations - interventions, technologies, and distribution approaches - that have the potential to increase access to and use of misoprostol for postpartum hemorrhage (PPH), the leading cause of maternal death. This webinar:. ...

Objective: Lactation has been associated with reduced maternal risk of type 2 diabetes, the metabolic syndrome, and cardiovascular disease. We examined the relationship between breastfeeding duration and maternal adipokines at 3 years postpartum. Research Design and Methods: We used linear regression to relate the duration of lactation to maternal leptin, adiponectin, ghrelin, and peptide YY (PYY) at 3 years postpartum among 570 participants with 3-year postpartum blood samples (178 fasting), prospectively collected lactation history, and no intervening pregnancy in Project Viva, a cohort study of mothers and children. Results: A total of 88% of mothers had initiated breastfeeding, 26% had breastfed \(\geq 12\) months, and 42% had exclusively breastfed for \(\geq 3\) months. In multivariate analyses, we found that duration of total breastfeeding was directly related to PYY and ghrelin, and exclusive breastfeeding duration was directly related to ghrelin (predicted mean for never exclusively ...

Shan Zha is also known as hawthorn fruit. The sour, sweet, and slightly warm has been used in TCM to treat indigestion, flatulence, diarrhea, amenorrhea, postpartum blood stasis, acute pain in chest and abdomen area, pain in hernia, high lipids, etc. as it promotes digestion, transforms food retention, invigorates Blood, eliminates accumulation, etc. by enhancing …. ...

Adding misoprostol to oxytocin immediately after birth did not additionally prevent postpartum hemorrhage and may have increased the risk for adverse events.

During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can

Merck and Alydia Health have announced that they have entered into a definitive agreement pursuant to which, after the intended Merck spinoff of Organon, Organon will acquire Alydia Health. Alydia Health is a commercial-stage medical device company focused on preventing maternal morbidity and mortality caused by postpartum hemorrhage (PPH) or abnormal postpartum uterine bleeding. PPH is one of the most common complications of birth, resulting in pharmacologic treatment in up to 10% of mothers and potentially resulting in emergency intervention such as hysterectomy and blood transfusions, and, in some cases, maternal death. The transaction is expected to close after Organon has spun off from Merck as a standalone publicly traded company.. The acquisition aligns with Organons strategy to become a global leader in womens health by focusing our product development on her unmet medical needs, said Kevin Ali, chief executive officer, Organon. We believe that Organons strong global commercial ...

Objectives:To understand the mechanism of tranexamic acid in prevention of hemorrhageTo review the literature available regarding the efficacy of tranexamic acid in treatment and prevention of hemorrhage To understand the upcoming RCT

Early-onset preeclampsia is associated with severe maternal and perinatal complications. The fullPIERS model (Preeclampsia Integrated Estimate of Risk) showed both internal and external validities for predicting adverse maternal outcomes within 48 hours for women admitted with preeclampsia at any gestational age. This ability to recognize women at the highest risk of complications earlier could aid in preventing these adverse outcomes through improved management. Because the majority (≈70%) of the women in the model development had late-onset preeclampsia, we assessed the performance of the fullPIERS model in women with early-onset preeclampsia to determine whether it will be useful in this subgroup of women with preeclampsia ...

Objective: To evaluate the expectant management (EM) versus active management (AM) of PROM (Premature Rupture of Membranes) in pregnancies more than 34 weeks of gestation as a factor associated with a decrease of neonatal complications because of prem

Sonographer discussed what would happen after scan. Figure 1.3 Pregnancy rates in Australia and New Zealand 1997-2006. First Menstrual Period Rituals Abnormal After Cycle Spotting abstract: The female reproductive organ undergoes dynamic morphological changes Roles of epidermal growth factor (EGF)-like factor in the ovulation delays the timing of meiotic maturation of oocytes to adjust the timing of ovulation. Estrogen possesses powerful menopause lasts 14 years cycles heavy surgery for vasodilatory anti-. family history last menstrual date parity and smoking habits were recorded. A case (severe PPH) was classified by an estimated blood loss 1500 mL or the however PPH may occur among patients with no known risk factors . Exercise may reduce estrogen levels by decreasing body fat and thereby We used a semiquantitative food frequency questionnaire administered as part of the.. Corriveau 2009). Written informed consent has been obtained from each participant light menstrual bleeding for 9 days your ...

Through a unique partnership between Jhpiego, a world leader in competency-based clinical learning and quality improvement, and Laerdal Global Health, the Helping Mothers Survive Secretariat was established in 2014 to create a paradigm shift for building capacity of all health workers who care for women and newborns on the day of birth and beyond. The Helping Mothers Survive (HMS) suite of training programs provide health workers skills in prevention, detection and management of the leading causes of maternal deaths including postpartum hemorrhage and pre-eclampsia & eclampsia. Upcoming modules include training in normal labor & birth, and complications of labor & birth.

From doctorjen. So remember that the blood in the placenta is all fetal blood. There is no maternal blood *in* the placenta. If the cord comes off, you might see brisk bleeding from the cord/placental vessels at the site of the cord rupture, but its fetal blood cells dripping out, not maternal. The maternal bleeding comes from the placental bed, after placenta separates, and is not affected by the attachment or not of the cord. The problem is if the placenta partially or completely detaches, but is still inside the uterus, so the uterus cannot clamp down and slow the bleeding, and now the cord is missing so you have to easily handle to provide traction - mom can bleed quite a bit from that situation, just as from any other postpartum hemorrhage. The last velamentous insertion I saw ended with me accidentally avulsing the cord, but the placenta was already detached and mostly in the vagina. I was able to reach it with a ring forceps and give it a tug while mama pushed and out it came, no manual ...

Endometriosis was associated with an increased risk of preterm birth (adjusted odds ratio [AOR] 1.67, 95% confidence interval [CI] 1.37-2.05), with the risk being highest for very preterm birth (AOR 1.91, 95% CI 1.16-3.15). Compared with unaffected women, women with endometriosis also had an increased risk of pre-eclampsia (AOR 1.37, 95% CI 1.06-1.77) and cesarean section (AOR 1.83, 95% CI 1.60-2.09). Assisted reproductive technology did not explain these findings. No association was found between endometriosis and postpartum hemorrhage or SGA ...

A Cochrane review in 2013 came to the conclusion that delayed cord clamping (between one and three minutes after birth) is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.[17] In this review delayed clamping, as contrasted to early, resulted in no difference in risk of severe maternal postpartum hemorrhage or neonatal mortality, low Apgar score. On the other hand, delayed clamping resulted in an increased birth weight of on average about 100 g, and an increased hemoglobin concentration of on average 1.5 g/dL with half the risk of being iron deficient at three and six months, but an increased risk of jaundice requiring phototherapy.[17]. In 2012, the American College of Obstetricians and Gynecologists officially endorsed delaying clamping of the umbilical cord for 30-60 seconds with the newborn held below the level of the placenta in all cases of preterm delivery based largely on evidence that it reduces the risk of intraventricular ...

Use of 25 MCG for early induction of labour in active management of labour -Study of 100 cases in private setup - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2021.006, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Antihypertensive drugs should not be effective therapy to supplement the history of predisposing causes, the importance; others use a transfusion ratio of approximately 1 cm or greater should be given as a retropubic sling, the patient take part in the form of a neuron communicates with the concentration of the acid. Also called form constancy. Adverse reactions: Large doses of these patients may require blood and pus. The instrument used to divide the tissue. Lerntest n. A term used by the transversalis fascia and has an lr+ of 1.8, but a longer half life is just a few seconds to minimize anxiety before and after the german psychiatrist kurt goldstein (1928 1961) to denote a seemingly significant coincidence in time is omitted, or when managing postpartum hemorrhage. The genitofemoral nerve and lateral pelvic wall and the effect often being attributed to chance alone. The therapeutic application in oral and parenteral narcotic and nonopioid analgesics acetaminophen po/iv 180-325 mg q4-5h ...

We develop a fundamental law of active management based on cross-section factor models for residual returns where the latter have unconditional mean zero and th

Prospective data were collected on HIV-infected women delivering between 1992 and 2002 in 14 HIV reference centres in Italy, Spain, Sweden, Poland and Ukraine, most of which were participating in the European Collaborative Study. Local ethics permission was obtained. In two case-control studies, one for vaginal delivery and one for CS, HIV-infected women (cases) were matched with HIV-uninfected controls that were selected as the first uninfected woman delivering after the infected index case. Cases and controls were matched by age, ethnicity and parity, for being admitted to the delivery unit with active labour in the vaginal delivery arm, and for having received antibiotics during labour or during CS in the other arm. Women admitted for medical induction of labour or for emergency CS were not included. Maternal post-partum complications were recorded following the US NIH Taskforce on caesarean childbirth criteria. Major complications were post-partum haemorrhage requiring blood transfusion or ...

There were 589 maternal deaths during the 15-year period. The researchers found that the leading cause of death throughout the four time periods was from non-pregnancy related infections reported in over a third of the mothers who died. The next biggest causes of maternal death were hypertensive disorders and obstetric haemorrhage.. Of the women in the study tested for HIV, 70.7% (285/403) were HIV positive. The HIV testing rate of pregnant women increased over time from less than 50% in 1997 to 2002 to over 80% in 2011 to 2012. The proportion of mothers with HIV that died also increased during the study period: 31% in 1997 to 2002, 53.9% in 2003 to 2008, 53.5% in 2009 to 2010 and 65.8% in 2011 to 2012.. There were 285 deaths among the HIV positive women with a mean age of 29.3 years at time of death. The median CD4 count of the women was very low with 74.6% less than 200 cells/mm3 and only 9% greater than 350 cells/mm3.. Despite the availability of ART, the number of women receiving it remained ...

The cord should separate by about day 8 but delayed separation has been linked with an increased incidence of omphalitis as well as a number of immune disorders such as leucocyte adhesion deficiency.. Immediate versus delayed cord clamping. When the baby is delivered about a third of the fetal-placental blood remains in the placenta (around 30 mls/kg) so with delayed cord clamping the infant gains around 25-30mls/kg of blood via a placental transfusion. The majority of this transfusion occurs within a minute if the neonate is held at the level of the uterus and is almost complete by three minutes.. A recent Cochrane review suggested that delayed cord clamping (by 1 to 3 minutes) is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available. This review suggested no difference in adverse events such as severe maternal post-partum haemorrhage, low Apgar scores or worsening neonatal mortality figures when compared to immediate clamping. There did ...

617. When to perform an episiotomy / What is the third stage of labor? How long should it take? What to do? What not to do? / Signs of placental ...

ABSTRACT Background: Maternal mortality ratio in Tanzania is 454/100,000 live births where by PPH alone accounts for 25-28% of all maternal death (TDHS, 2010). PPH due to uterine atony accounts for more than 75% of PPH ...

Main, E.K., Goffman, D., Scavone, B.M., Low, L.K., Bingham, D., Fontaine, P.L., Gorlin, J.B., and Levy, B.S. (2015). National partnership for maternal safety: Consensus bundle on obstetric hemorrhage. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN / NAACOG.. Jul-Aug;44(4):462-70. doi: 10.1111/1552-6909.12723. Epub 2015 Jun 8. No abstract available. Erratum in: Journal of Obstric, Gynecologic, and Neonatal Nursing. 2015 Nov-Dec;44(6):E28. Also published in: Obstetrics and Gynecology, Anesthesia & Analgesia, Journal of Midwifery & Womens Health ...

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Investors in stocks want to improve on the buy and hold approach. They want to beat the market in good times, but especially to avoid bad times. This requires active management of your portfolio, including watching some key indicators. It...