This research was conducted to study all the causes leading to postpartum hemorrhage in order to implement all the appropriate treatments, according to all reason and thus avoiding the complications of postpartum hemorrhage and death, and study of th
e risk of bleeding factors in order to reach the best method of prevention of bleeding . This research included on 77 patient acceptable in Al Assad University Hospital in Lattakia, with primary postpartum hemorrhage occurred after vaginal delivery, including (12) patient after vaginal birth outside the hospital, during the extended study period: from 1/1/2014 until 1/1 / 2016, and excluded all patients who were born cesarean delivery. We determine the percentage of postpartum hemorrhage occurring between vaginal deliveries in the hospital, and the ratio was (3.52%), and we could not determine this percentage outside the hospital.
Postpartum Hemorrhage (PPH) is the leading cause of maternal death worldwide. In the developing countries, it is responsible for the death of about 125 000 women each year. In most cases 67-80% are caused by uterine atony.
Uterine massage would re
present a simple intervention with the potential to have a major effect on PPH and maternal mortality in under resourced settings.
Aim: The aim of the present study is to study the effect of uterine massage on the immediate postpartum hemorrhage among primiparae.
Materials and Methods: The study was conducted of al-Assad Hospital and Children & Obstetrics Hospital (Lattakia), a convent sample of 40 primiparae women. Checklist application form was used to assess the postpartum hemorrhage by hemoglobin and hematocrit measurement before applying uterine massage and after the end of procedure.
Results: This study demonstrated that the rate of hemorrhage decreased in the experimental group, hemoglobin and hematocrit was higher (10.4 mg/dl, 32.3%) (P=0.029*) (P=0.015*) among primipara who received uterine massage.
Conclusions and Recommendations: Our present study results advice to apply uterine massage for all women after labor and delivery because its effective in reducing blood loss. It is also recommended to learn nurses how to apply uterine massage.
This search included 150 pregnant women who had gestational age of 36 weeks or more, and had been admitted to the Department of Obstetrics and Gynecology at Al – Assad University Hospital in Lattakia for the spontaneous vaginal delivery during the st
udy period
( 1\1\2012 to 1\7\ 2013). Exclusion criteria were patients undergoing cesarean section, patients with placenta previa, or abruptio placenta, patients with hemoglobin<9 gm%, pregnancy-induced hypertension or pre eclampsia–eclampsia, grand multiparty, coagulation abnormalities, positive history of PPH, expensive hemorrhage or other medical disorders.
Patients were randomly divided into three groups: ( 1: uterine massage group, 2: 10 units oxytocin in 500 cc glucose 5% intravenously with delivery of the anterior sholder\ control group, 3: three 200µg rectal misoprostol tablets\study group).
No significant differences were observed between the groups regarding baseline characteristics. There was blood loss of ≥500 ml occurred in 18% in the first group, 6% in the second group, 8% in the third group. Routine use of 600 µg of rectal misoprostol was effective in reducing blood loss after delivery ل gm%, pregnancyts with hemoglobin}ergoing cesarean section, patients with placenta pre and g (RR 0.44 ; CI 0.32 – 1.53), but not as effective as intravenous oxytocin (RR 1.33 ; CI 0.4 – 3.39).
Although these were differences, they were not significant (No significant differences were observed between the control and study groups for the length of the third stage of labor, the estimated blood loss, the changes in Hb and Hct concentrations, need for additional uterotonics, manual removal of placenta, blood transfusion…..).
This dose of misoprostol and route of administration were well tolerated, and usual side effects such as shivering and fever were transient, resolved on their own, and were not threatening. Because PPH is the most significant direct cause of maternal mortality and because most of these maternal mortality occurs in low resource countries, misoprostol offers several advantages over oxytocin in such settings. It is formulated as a tablet, widely available and affordable, and it does not need require special storage conditions (i.e. it is stable at ambient room temperature and does not require specific conditions for transfer and has a shelf-life of several years). It also does not require any special skills, equipment, or facilities for its use. So misoprostol can fill a service delivery gap in settings where women and providers are unable to access oxytocin.ل gm%, pregnancyts with hemoglobin}ergoing cesarean section, patients with placenta pre and g
Placenta accreta is one of the most serious uncommon causes of
postpartum hemorrhage which carries high morbidity and mortality
risk for mother and fetus.
Objective
1- to assess the incidence of placenta accreta .
2- to ideNtify The occurrence o
f risk factors of placenta accreta :
maternal age , multiparity , placenta praevia, previous cesarean
section and/or previous curettage .
3- to find the ideal management of placenta accreta to reduce the risk of
maternal and neonatal morbidity and mortality .
