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Register a new userCausal study of the postpartum hemorrhage after vaginal delivery
دراسة سببية لنزوف الخلاص للولادات الطبيعية
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Tishreen University ورقة بحثية
Publication date
2016
fields
Medicine
and research's language is
العربية
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Shamra Editor
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أجري هذا البحث لدراسة جميع الأسباب المؤدية لنزوف الخلاص بهدف تطبيق كافة المعالجات المناسبة حسب كل سبب و بالتالي تجنب اختلاطات نزوف الخلاص و الوفاة ، و دراسة عوامل الخطورة لحدوث النزف بهدف الوصول لأفضل طريقة للوقاية و الاستعداد له و منع حدوث النزف أو الإقلال منه . اشتمل هذا البحث على 77 مريضة مقبولة في مشفى الأسد الجامعي باللاذقية و شخص لديها نزف خلاص بدئي حدثت بعد ولادة مهبلية ، منها ( 12 ) حالة نزف خلاص بعد ولادة مهبلية تمت خارج المشفى ، خلال فترة الدراسة الممتدة : من 1/1/ 2014 حتى 1/1/ 2016 ، و استبعدنا فقط المريضات اللواتي ولدن بقيصرية . حيث تم تحديد نسبة حدوث نزوف الخلاص بين الولادات المهبلية في المشفى ، و بلغت النسبة (3,52 %) ، و لم نتمكن من تحديد نسبة حدوث نزوف الخلاص خارج المشفى.
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 the 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.
References used
ARTHER , J. M ; EVANS , M.D ; KENNETH , R . Manual of Obstetrics .sixth edition , The Puerperium , Postpartum Complications , postpartum haemorrhage , 2000 , Page 482-484
HOMER, G. OncallObstetrics and Gynecologic . Chapter (8) , postpartum haemorrhage ,1997 , Page 142- 148
MAAME, Y. A ,B Yiadom , MD , MPH Staff Physician ,Department of Emergency Medicine , Cooper University Hospital ,2002 , Page 676-688
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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
The study covered 30 cases of patellar fractures in persons who were accepted and treated surgically at Al-Assad University Hospital in Lattakia from 2008 to 2013.Ages of patients ranged between 16-70 years. Average load of clinical and radial conti
nuation was six months. The smaller age of traumatism amounted 16 years and larger age 70 years; average load of age was 37.66 years. The number of traumatism in male was amounted 12 and female 18. In estimating the results, we depend on Lysholm scale scoring. Functional results were studied after 6 months and we had excellent result in 27% of cases and good results in 47% of other cases
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.
A study was done about bleeding in first trimester of pregnancy including 816
patients from 3104 pregnant women(26.28 %) .
The causes was abortion ( %96.07), ectopic pregnancy (%2.69) and hyditidiform
mole (%1.22).
In patients with abortion 486 p
atients suffered from pain with bleeding(%61.09) and
when happeded together the rate of complete abortion elevated .
(%78.18) had early abortion whereas(%21.81) had late abortion.The most common
high risk factors in patients with abortion were poor and low level of life also the age -35
40 years old(%47.44).
The tubal ectopic pregnancy was the most common and the privious pelvic operation
is one of the most important high risk factors for ectopic pregnancy.
All patients with ectopic pregnancy had amenorrhea with low or no changes in β-
HCG levels and (%86.36) had abdominal pain with changes and pain in the cervixs.
16 patients (%72.72) needed surgical therapy.
The bleeding after delivery (Postpartum Hemorrhage-PPH) is the most important complications that occur after a natural or cesarean delivery, and represents about a quarter of maternal mortality around the world. Midwives play a basis role in preventi
on of bleeding after birth. So This research aims to evaluate the knowledge of midwives about using strategies to prevention and management the bleeding after delivery. Its sample included all midwives in obstetrics departments in Alasad University, Children and Obstetric, and Tishreen University Hospital all in Lattakia city. Data were collected using a questionnaire developed by researcher. The results according to strategies used in prevention and management of bleeding after delivery showed that 60% of the level of knowledge of midwives were "inappropriate". There were significant inverse relationship (P = 0.006) between ages of midwives and level of knowledge. Also showed a significant inverse relationship between number of years of experience with the midwives and level of knowledge (P = 0.01). So we suggest conducting training sessions and educational lectures for midwives with respect to the strategies used in prevention and management of bleeding after delivery, and must evaluate the midwives information about prevention and management of bleeding after delivery periodically and continuously.
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