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Louise T Day, Daniel Hruschka, Felicity Mussell, Eva Jeffers, Stacy L Saha, Shafiul Alam
BACKGROUND: Prior studies have shown that using uterotonics to augment or induce labor before arrival at comprehensive Emergency Obstetric and Neonatal Care (CEmONC) settings (henceforth, "outside uterotonics") may contribute to perinatal mortality in low- and middle-income countries. We estimate its effect on perinatal mortality in rural Bangladesh. METHODS: Using hospital records (23986 singleton term births, Jan 1, 2009-Dec 31, 2015) from rural Bangladesh, we use a logistic regression model to estimate the increased risk of perinatal death from uterotonics administered outside a CEmONC facility...
October 6, 2016: Reproductive Health
Zahra Dehbashi, Mahmood Moosazadeh, Mahdi Afshari
BACKGROUND: Each year, more than forty million abortions are occurred whole of the world. Misoprostol is a prostaglandin analogue with a strong uterotonic effect. The present study aimed to compare the efficacy of Misoprostol in first trimester abortion through two sublingual and vaginal routes of administration. METHODS: This randomized clinical trial was conducted on 52 consecutive women in first trimester candidate for pregnancy termination because of fetal IUFD or missed abortion in sonography reports...
July 24, 2016: Materia Socio-medica
C Malone, J R Acheson, J D Hinds, M H McComiskey
The aim was to assess the efficacy of Syntometrine (®) (500 micrograms ergometrine with 5 units oxytocin) as an appropriate alternative first-line uterotonic for use in elective caesarean section (CS) during a national shortage of UK-licensed IV oxytocin from April-June 2014. An observational study was performed involving 2 groups of 22 women undergoing elective CS in a UK DGH during this period. Primary endpoints included mean estimated blood loss (EBL), haemoglobin drop post-operatively and transfusion requirement...
September 2016: Ulster Medical Journal
Mohammad Ahmed Maher, Tarek Mohammad Sayyed, Nabih Ibrahim Elkhouly
OBJECTIVES: To compare between three different utertonics (oxytocin, carbetocin, and misoprostol) given via three different routes (intra-umbilical, intravenous, and sublingual, respectively) in reducing the need for manual removal of placenta. METHODS: A randomized trial for cases with retained placenta 30 minutes following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin, or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30 minutes following drug administration, and need for manual removal of placenta...
September 27, 2016: Journal of Maternal-fetal & Neonatal Medicine
Tamer Hanafy Said
BACKGROUND AND OBJECTIVE: To determine the safety and sustainability of operative laparoscopy in surgical management of cornual and interstitial ectopic pregnancy using a simple and practical method. DESIGN: Case series of five consecutive cases. SETTING: Endoscopy unit in Alexandria University Hospital and Alexandria New Medical Center. PATIENTS: Between July 2013 and May 2015, five women with interstitial and cornual ectopic pregnancies were admitted for laparoscopic surgical treatment...
October 2016: Journal of Obstetrics and Gynaecology of India
Priyankur Roy, M S Sujatha, Ambarisha Bhandiwad, Bivas Biswas
INTRODUCTION: Anti-fibrinolytic agents are used to reduce obstetric blood loss as the fibrinolytic system is known to get activated after placental delivery. OBJECTIVES: To evaluate the efficacy of parenteral tranexamic acid in reducing blood loss during normal labour and to compare it with the amount of blood loss in patients who received placebo in the third stage of labour. METHODOLOGY: Patients with spontaneous labour or planned for induction of labour and fulfilling the inclusion criteria were recruited for the study...
October 2016: Journal of Obstetrics and Gynaecology of India
Priyankur Roy, M S Sujatha, Ambarisha Bhandiwad, Bivas Biswas, Anumita Chatterjee
AIM: The third stage of labour commences after the delivery of the foetus and ends with the delivery of the placenta and its membranes. Postpartum haemorrhage is the most common cause of maternal mortality and accounts for about 25 % of maternal deaths in India. OBJECTIVES: The present study was designed to evaluate the effectiveness of placental blood drainage after spontaneous vaginal delivery as part of active management of third stage of labour in decreasing the duration, blood loss, and complications of the third stage, against no drainage of placental blood...
October 2016: Journal of Obstetrics and Gynaecology of India
K S Sunil Kumar, Sundar Shyam, Pavitra Batakurki
BACKGROUND AND OBJECTIVES: Postpartum hemorrhage is the single largest and leading cause of maternal morbidity and mortality not only in developing countries but also in developed countries. The present study is an attempt to evaluate the scope of using prophylactic intramuscular carboprost tromethamine 125 μg in comparison with intramuscular oxytocin 10 units for the active management of third stage of labor. MATERIALS AND METHODS: Two hundred pregnant women at term with spontaneous onset of labor were included in the study and were randomly divided into 2 groups of 100 women each...
October 2016: Journal of Obstetrics and Gynaecology of India
Stéphanie Corriveau, Simon Blouin, Elyse Burt, Eric Rousseau, Jean-Charles Pasquier
OBJECTIVE: The potency of acute montelukast treatment, a leukotriene receptor antagonist, has been demonstrated as tocolytic on in vitro myometrial contractility. This study assessed the ability of a 48h montelukast treatment to modify in vitro contractions under inflammatory conditions in a pregnant rat model. STUDY DESIGN: Pregnant Sprague-Dawley rats were injected intraperitoneally (gestational days 20-22) with lipopolysaccharides (LPS) 200μg/kg (4 treatments at 12h intervals) alone or combined with montelukast 10mg/kg/day or a saline solution for a 48h period...
August 9, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Heiko Lier, Dietmar Schlembach, Wolfgang Korte, Christian von Heymann, Susanne Steppat, Maritta Kühnert, Holger Maul, Wolfgang Henrich, Werner Rath, Jürgen Wacker, Franz Kainer, Daniel Surbek, Hanns Helmer
Worldwide, post-partum haemorrhage (PHH) remains one of the leading causes for maternal mortality. The German Society of Gynaecology and Obstetrics, the German Midwifes' Society, the German Society of Thrombosis and Haemostasis and the German Society of Anaesthesiology and Intensive Care updated the former guideline. The resulting recommendations are the results of a structured literature search and a formal consensus process and contain all aspects of PPH including diagnosis, causes, risk factors and therapy...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Mohamed Kandeel, Zakaria Sanad, Hamed Ellakwa, Alaa El Halaby, Mohamed Rezk, Ibrahim Saif
OBJECTIVE: To evaluate uterine balloon tamponade using a condom catheter for the management of early postpartum hemorrhage (PPH). METHODS: In a prospective observational study at Menoufia University Hospital, Shebin Elkom, Egypt, women with early PPH were enrolled between May 2011 and September 2012. Uterine balloon tamponade with a condom catheter was applied in women who were unresponsive to uterotonics and bimanual compression; patients with successful catheter placement were included in analyses...
August 21, 2016: International Journal of Gynaecology and Obstetrics
Edward Springhall, Euan M Wallace, Lynne Stewart, Michelle Knight, Joanne C Mockler, Miranda Davies-Tuck
BACKGROUND: Postpartum haemorrhage (PPH) rates are increasing worldwide. The rate is particularly high in women undergoing an induced or augmented labour. In response to this, we altered our hospital's protocol for the management of the third stage of labour to recommend Syntometrine, in preference to oxytocin alone, for women being induced or augmented. We set out to assess the impact of the protocol change on the PPH rate. MATERIALS AND METHODS: A random sample of 1200 women who had a singleton, term vaginal birth before and after the protocol change was taken...
September 5, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
Ann K Blanc, Claudia Diaz, Katharine J McCarthy, Karla Berdichevsky
BACKGROUND: The majority of births in Mexico take place in a health facility and are attended by a skilled birth attendant, yet maternal mortality has not declined to anticipated levels. Coverage estimates of skilled attendance and other maternal and newborn interventions often rely on women's self-report through a population-based survey, the accuracy of which is not well established. METHODS: We used a facility-based design to validate women's report of skilled birth attendance, as well as other key elements of maternal, newborn intrapartum, and immediate postnatal care...
2016: BMC Pregnancy and Childbirth
Jonathan W Paul, Susan Hua, Marina Ilicic, Jorge M Tolosa, Trent Butler, Sarah Robertson, Roger Smith
BACKGROUND: The ability to provide safe and effective pharmacotherapy during obstetric complications, such as preterm labor or postpartum hemorrhage, is hampered by the systemic toxicity of therapeutic agents leading to adverse side effects in the mother and fetus. Development of novel strategies to target tocolytic and uterotonic agents specifically to uterine myocytes would improve therapeutic efficacy while minimizing the risk of side effects. Ligand-targeted liposomes have emerged as a reliable and versatile platform for targeted drug delivery to specific cell types, tissues or organs...
August 24, 2016: American Journal of Obstetrics and Gynecology
I Dedes, L Schäffer, R Zimmermann, T Burkhardt, C Haslinger
AIM: To evaluate the outcome of a cesarean myomectomy (CM) versus a cesarean delivery (CD) alone in women with uterine myomas and the risk factors for adverse outcomes. METHODS: A retrospective cohort study of all women undergoing CDs with uterine leiomyomatas and singleton pregnancies was performed. Patients with known risk factors for hemorrhage were excluded. Measured adverse outcome parameters included estimated blood loss, drop in hemoglobin levels (pre/postoperatively), operation time, and the use of additional uterotonics...
August 24, 2016: Archives of Gynecology and Obstetrics
Ruta J Nadisauskiene, Paulius Dobozinskas, Justina Kacerauskiene, Mindaugas Kliucinskas, Ismailov Zhumagali, Madina Kokenova, Jesengeldy Bekeshov, Saltanat Dzabagijeva, Aigul Sapargalijeva, Inna Glazebnaja, Gulmyra Konyrbajeva, Zijas Uteshova, Aina Tasbulatova
BACKGROUND: Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC). METHODS: Between 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC...
2016: BMC Pregnancy and Childbirth
John W Downing, Curtis L Baysinger, Raymond F Johnson, Ray L Paschall, Matthew S Shotwell
BACKGROUND: Vasoactive agents administered to counter maternal hypotension at cesarean delivery may theoretically intensify the hypoxemic fetoplacental vasoconstrictor response and, hence, negatively impact transplacental oxygen delivery to the fetus. Yet, this aspect of their pharmacodynamic profiles is seldom mentioned, let alone investigated. We hypothesized that vasopressin, a potent systemic vasoconstrictor, and oxytocin, a uterotonic agent administered routinely at cesarean delivery, which, in contrast to vasopressin, possesses significant systemic vasodilator properties, would not influence distal stem villous arteriolar resistance...
September 2016: Anesthesia and Analgesia
Ndola Prata, Karen Weidert
BACKGROUND: A myriad of interventions exist to treat postpartum hemorrhage (PPH), ranging from uterotonics and hemostatics to surgical and aortic compression devices. Nonetheless, PPH remains the leading cause of maternal mortality worldwide. The purpose of this article is to review the available evidence on the efficacy of misoprostol for the treatment of primary PPH and discuss implications for health care planning. DATA AND METHODS: Using PubMed, Web of Science, and GoogleScholar, we reviewed the literature on randomized controlled trials of interventions to treat PPH with misoprostol and non-randomized field trials with controls...
2016: International Journal of Women's Health
Shaun Patel, Krystal L Weierstahl, Sonalee Shah, Christina W Fidkowski
The maternal mortality rate for parturients with severe pulmonary hypertension is 30% to 50%. General, epidural, and combined low-dose spinal-epidural anesthesia have been used successfully for cesarean deliveries in patients with pulmonary hypertension. We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea...
October 1, 2016: A & A Case Reports
Mathieu Nadeau-Vallée, Amarilys Boudreault, Kelycia Leimert, Xin Hou, Dima Obari, Ankush Madaan, Raphael Rouget, Tang Zhu, Lydia Belarbi, Marie-Ève Brien, Alexandra Beaudry-Richard, David M Olson, Sylvie Girard, Sylvain Chemtob
Uterine labor requires the conversion of a quiescent (pro-pregnancy) uterus into an activated (pro-labor) uterus, with increased sensitivity to endogenous uterotonic molecules. This activation is induced by stressors, particularly inflammation in term and preterm labor. Neuromedin U (NmU) is a neuropeptide known for its utero-contractile effects in rodents. The objective of the study was to assess the expression and function of neuromedin U receptor 2 (NmU-R2) and its ligands NmU and the more potent neuromedin S (NmS) in gestational tissues and the possible implication of inflammatory stressors in triggering this system...
August 10, 2016: Biology of Reproduction
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