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Massive obstetric Hemorrhage

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https://www.readbyqxmd.com/read/28640786/a-standardized-approach-for-transfusion-medicine-support-in-patients-with-morbidly-adherent-placenta
#1
Anil K Panigrahi, Amanda Yeaton-Massey, Sara Bakhtary, Jennifer Andrews, Deirdre J Lyell, Alexander J Butwick, Lawrence Tim Goodnough
BACKGROUND: The incidence of placenta accreta (PA) has increased from 0.8 to 3.0 in 1000 pregnancies, driven by increased rates of cesarean deliveries (32.2% in 2014) of births in the United States. The average blood loss for a delivery complicated by PA ranges from 2000 to 5000 mL, frequently requiring substantial transfusion medicine support. We report our own institutional multidisciplinary approach for managing such patients, along with transfusion medicine outcomes, in this setting over a 5-year period...
June 20, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28540073/viscoelastic-testing-inside-and-beyond-the-operating-room
#2
REVIEW
Liang Shen, Sheida Tabaie, Natalia Ivascu
Hemorrhage is a major contributor to morbidity and mortality during the perioperative period. Current methods of diagnosing coagulopathy have various limitations including long laboratory runtimes, lack of information on specific abnormalities of the coagulation cascade, lack of in vivo applicability, and lack of ability to guide the transfusion of blood products. Viscoelastic testing offers a promising solution to many of these problems. The two most-studied systems, thromboelastography (TEG) and rotational thromboelastometry (ROTEM), offer similar graphical and numerical representations of the initiation, formation, and lysis of clot...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28409600/postpartum-hemorrhage-prevention-and-treatment
#3
Ann Evensen, Janice M Anderson, Patricia Fontaine
Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration...
April 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#4
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
June 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28306583/successful-resuscitation-following-massive-obstetric-hemorrhage-in-a-patient-of-the-jehovah-s-witness-faith-a-case-report
#5
Richard M Hubbard, Jonathan H Waters, Mark H Yazer
Hemorrhage is a leading cause of maternal morbidity and mortality worldwide. It is especially difficult to treat in patients of the Jehovah's Witness faith because they refuse certain blood products. This case report describes the resuscitation of a parturient Jehovah's Witness whose postcesarean delivery course was complicated by massive hemorrhage from unrecognized arterial bleeding in the intensive care unit with significant hemodynamic instability that necessitated an emergency bedside laparotomy. Her hemoglobin nadir was 1...
June 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28231684/emergency-peripartum-hysterectomy-a-challenge-or-an-obstetrical-defeat
#6
Aneta Malinowska-Polubiec, Ewa Romejko-Wolniewicz, Julia Zareba-Szczudlik, Agnieszka Dobrowolska-Redo, Agnieszka Sotowska, Roman Smolarczyk, Jan Wilczynski, Krzysztof Czajkowski
OBJECTIVES: Peripartum hysterectomy remains an obstetric nightmare. Most obstetricians consider it a defeat. The aim of our study was to assess the prevalence, indications, procedures and complications of emergency peripartum hysterectomy (EPH) in the 2nd Department of Obstetrics & Gynecology, Medical University of Warsaw during a 7 year period (2007-2013). METHODS: A retrospective evaluation of 21,144 deliveries was performed. We analyzed all cases of EPH, including the maternal characteristics, obstetrical history, course of pregnancy and delivery, type of surgery and complications...
October 2016: Neuro Endocrinology Letters
https://www.readbyqxmd.com/read/28229990/clinical-analysis-of-postpartum-hemorrhage-requiring-massive-transfusions-at-a-tertiary-center
#7
Jun Hu, Zhu-Ping Yu, Peng Wang, Chun-Yan Shi, Hui-Xia Yang
BACKGROUND: The reports on massive transfusions (MTs) in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage (PPH) and the frequency trends over the past 10 years. METHODS: We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015...
March 5, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28209484/successful-provision-of-inter-hospital-extracorporeal-cardiopulmonary-resuscitation-for-acute-post-partum-pulmonary-embolism
#8
C McDonald, J Laurie, S Janssens, C Zazulak, P Kotze, K Shekar
Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived...
May 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28098575/obstetric-anesthesia-liability-concerns
#9
Joanna M Davies, Linda S Stephens
Obstetric practice carries a high risk of medical liability and involves both obstetricians and anesthesiologists. Analysis of data from the Anesthesia Closed Claims Project database shows an increase in the proportion of anesthesia claims for maternal death and brain damage between the 1990s and 2000 and later, primarily due to hemorrhage. The proportion of claims for newborn brain damage remained unchanged while those for maternal nerve injury and minor injuries decreased. Use of massive transfusion protocols and clinical drills have been shown to improve outcomes from hemorrhage...
June 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27998318/management-of-severe-dengue-hemorrhagic-fever-and-bleeding-complications-in-a-primigravida%C3%A2-patient-a-case-report
#10
Hori Hariyanto, Corry Quando Yahya, Primartanto Wibowo, Oloan E Tampubolon
BACKGROUND: The incidence of dengue hemorrhagic fever is increasing among the adult population living in endemic areas. The disease carries a 0.73% fatality rate for the general population, but what happens when the disease strikes a special subpopulation group, the obstetrics? Perhaps the important question specific to this special subpopulation revolves around the right time and mode of delivery under severe coagulopathy and plasma leakage in conditions of imminent delivery. CASE PRESENTATION: A 24-year-old primigravid Sundanese woman presented to our intensive care unit due to acute pulmonary edema secondary to massive plasma leakage caused by severe dengue...
December 20, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27902772/relation-between-birth-weight-and-intraoperative-hemorrhage-during-cesarean-section-in-pregnancy-with-placenta-previa
#11
Hiroaki Soyama, Morikazu Miyamoto, Hiroki Ishibashi, Masashi Takano, Hidenori Sasa, Kenichi Furuya
BACKGROUND: Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa. MATERIALS AND METHODS: We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015...
2016: PloS One
https://www.readbyqxmd.com/read/27651584/use-of-condom-tamponade-to-manage-massive-obstetric-hemorrhage-at-a-tertiary-center-in-rajasthan
#12
Rakesh Hasabe, Kumud Gupta, Pallavi Rathode
INTRODUCTION: Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al...
October 2016: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/27592155/major-obstetric-hemorrhage
#13
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
November 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/27488384/how-do-we-manage-blood-product-support-in-the-massively-hemorrhaging-obstetric-patient
#14
Kerry L O'Brien, Lynne Uhl
Obstetric hemorrhage remains a leading cause of maternal mortality with more than 140,000 deaths annually worldwide. Abnormal placentation has increased to become the most common diagnosis requiring massive blood transfusion in obstetrics, with uterine atony a close second. At our institution, as well as nationwide, there has been a steady increase in pregnancies complicated by abnormal placentation, including accreta, increta, and percreta. Providers at our facility created the New England Center for Placental Disorders in May 2015 to address these complex patients...
September 2016: Transfusion
https://www.readbyqxmd.com/read/27290833/-obstetric-hysterectomy-in-the-general-hospital-dr-aurelio-valdivieso-three-year-review
#15
O Calvo-Aguilar, Vásquez-Martínez J, P Hernández-Cuevas
BACKGROUND: Post-cesarean hysterectomy is the most extensive procedure used during the postpartum stage. This is an indicator of quality substantially associated with extreme obstetric morbidity. OBJECTIVE: To determine the incidence, indications, and complications associated with obstetric hysterectomy in a hospital, after three years to implement the program of prevention and management of massive obstetric hemorrhage. MATERIALS AND METHODS: Observational, transversal, retrospective and descriptive study conducted from January 2011 to November 2013...
February 2016: Ginecología y Obstetricia de México
https://www.readbyqxmd.com/read/27193989/should-warm-fresh-whole-blood-be-the-first-choice-in-acute-massive-hemorrhage-in-emergency-conditions
#16
Pınar Kendigelen, Zeynep Kamalak, Deniz Abat
Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section...
March 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/27184441/massive-obstetric-hemorrhage-current-approach-to-management
#17
E Guasch, F Gilsanz
Massive obstetric hemorrhage is a major cause of maternal mortality and morbidity worldwide. It is defined (among others) as the loss of>2,500ml of blood, and is associated to a need for admission to critical care and/or hysterectomy. The relative hemodilution and high cardiac output found in normal pregnancy allows substantial bleeding before a drop in hemoglobin and/or hematocrit can be identified. Some comorbidities associated with pregnancy can contribute to the occurrence of catastrophic bleeding with consumption coagulopathy, which makes the situation even worse...
June 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27075198/pre-delivery-fibrinogen-predicts-adverse-maternal-or-neonatal-outcomes-in-patients-with-placental-abruption
#18
Liangcheng Wang, Shigetaka Matsunaga, Yukiko Mikami, Yasushi Takai, Katsuo Terui, Hiroyuki Seki
AIM: Placental abruption is a severe obstetric complication of pregnancy that can cause disseminated intravascular coagulation and progress to massive post-partum hemorrhage. Coagulation disorder due to extreme consumption of fibrinogen is considered the main pathogenesis of disseminated intravascular coagulation in patients with placental abruption. The present study sought to determine if the pre-delivery fibrinogen level could predict adverse maternal or neonatal outcomes in patients with placental abruption...
July 2016: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/26995947/-placenta-percreta-a-severe-obstetric-complication-despite-correct-diagnosis-a-case-report
#19
Karolina Gruca-Stryjak, Mariola Ropacka-Lesiak, Grzegorz Breborowicz
This paper presents a case of a pregnant woman with a history of two cesarean sections. The patient was admitted to the hospital because of vaginal bleeding. The ultrasound revealed a placenta covering the internal os. The placenta was characterized by heterogeneous echogenicity with visible irregular hypoechogenic areas and blurred border between the placenta and the cervix. Rich vascularity was observed on the border of the placenta, urethra and the urinary bladder. Cystoscopy showed severe congestion around the urethra...
December 2015: Ginekologia Polska
https://www.readbyqxmd.com/read/26866844/fetomaternal-hemorrhage-complicated-pregnancy-risks-identification-and-management
#20
REVIEW
Vedran Stefanovic
PURPOSE OF REVIEW: This article aims not only to review recent literature about the clinical features of massive fetomaternal hemorrhage (FMH) and identification of risk factors, but also to alert obstetricians and pediatricians to this underdiagnosed and underestimated severe obstetrical issue. In addition, a simplified flow chart for the antenatal management of suspected FMH is proposed. RECENT FINDINGS: Improvements in obstetrical and neonatal care have decreased perinatal morbidity and mortality and the rate of stillbirth...
April 2016: Current Opinion in Obstetrics & Gynecology
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