Prevención de la hemorragia posparto / Post partum hemorrhage prevention

OBJETIVO: evaluar los cambios en la pérdida estimada de sangre y tasas de Hemorragia Posparto [HPP] derivados del entrenamiento en el Manejo Activo de la Tercera Etapa del Parto [MATED] en cinco Clínicas Materno Infantiles del departamento de Yoro, Honduras. METODOLOGÍA: durante nueve meses, el equipo de investigación enseña las habilidades sobre la pérdida estimada de sangre, establece una tasa base para la HPP y enseña el manejo activo de la tercera etapa del parto. En cada nacimiento se registran la pérdida estimada de sangre, los resultados para la madre y el neonato, así como el uso calculado de Oxitocina en el periodo posnatal. Los datos obtenidos se analizan estadísticamente con SPSS descriptivo, prueba-T y Chi-cuadrado. RESULTADOS: el periodo de estudio previo al entrenamiento en MATEP incluye 178 casos, el periodo posterior al entrenamiento incluye 392 casos. La pérdida estimada de sangre durante el periodo previo es de 109 ml en promedio, comparado con 81 ml en promedio que se obtiene durante el periodo posterior al entrenamiento (p=.004). En la fase previa y posterior a/ entrenamiento, el uso de Oxitocina en el periodo posparto es de 99.5%, aunque en el 17% de los casos reportados la administración de Oxitocina se realiza después de la expulsión de la placenta. Después del entrenamiento en MATER la tasa de hemorragia posparto disminuye del 7.3% al 3.8%, dato que no es estadísticamente significativo.

AIM: evaluate the changes in estimated blood loss and Post Partum Hemorrhage [PPH] rates with dissemination of Active Management of Third Stage of Labor [AMTSL] training to five Clinicas Materno Infantiles in the state of Yoro, Honduras. METHODS: over a nine month period, the research team utilized a two part training module to first teach the skills of estimated blood loss to establish a baseline rate for PPH and then in the second phase teach skills of active management of third stage labor. Estimated blood loss, outcomes for mother and neonate as well as the use and timing of Oxytocin in the postpartum period were recorded for each birth for the research team. The collected data were analyzed with SPSS for descriptive, t-test and chi-square statistics. RESULTS: pre-AMTSL training period N= 178, post AMTSL training N=392. Estimated blood loss pre-AMTSL training was a mean of 109 ml compared with post-training period of 81ml (p=.004). The use of Oxytocin in the postpartum period was 99.5% in both pre and post AMTSL training, though 17% of the cases reported Oxytocin administration after delivery of the placenta. The postpartum hemorrhage rate decreased from 7.3% to 3.8% after the AMTSL training, but was not statistically significant. CONCLUSION: AMTSL training reduced estimated blood loss though did not significantly change PPH rates in this study. Use of Oxytocin postpartum has become a regular component of care provided.

Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania.

The study sought to identify determinants of blood loss at childbirth and 24 hours postpartum. The study was nested in a community-based randomized trial of treatments for anaemia during pregnancy in Wete Town, Pemba Island, Zanzibar, United Republic of Tanzania. Status of anaemia during pregnancy, nutritional information, obstetric history, and socioeconomic status were assessed at enrollment during routine antenatal care. Pregnant women presented for spontaneous vaginal delivery, and nurse-midwives collected information on labour and delivery via partograph. Blood-stained sanitary napkins and pads from childbirth and 24 hours postpartum were quantified using the alkaline hematin method. Moderate-to-severe anaemia (Hb <90 g/L) at enrollment was strongly associated with blood loss at delivery and the immediate postpartum period, after adjusting for maternal covariates and variables of biological relevance to blood loss. Greater blood loss was associated (p<0.10) with duration of the first stage of labour, placental weight, receipt of oxytocin, preterm birth, and grand multiparity. The findings provide unique evidence of a previously-suspected link between maternal anaemia and greater blood loss at childbirth and postpartum. Further research is needed to confirm these findings on a larger sample of women to determine whether women with moderate-to-severe anaemia are more likely to experience postpartum haemorrhage and whether appropriate antenatal or peripartum care can affect the relationships described here.

Cervico-vaginal bacteria of retained foetal membrane cows after parturition with special reference to some blood biochemical changes and reproductive performance in Gharbih governorate

The study aimed to through a light on the bacteria of the servico-vaginal mucous from retained foetal membrane cases, measurement of some blood constituents and hormones and its relationship to reproductive performance in parturited cows in modern farm near Tanta. 10 retained placental cases and other 10 cases with normal dropped placenta [control]. The bacteriological investigation of uterine swabs in control group revealed that [21.9%] were positive, yielded 49 bacterial isolates. The most higher percent was E. coli [32.65%] and followed by Staphylococcus aureus [20.40%], from obligate anaerobic pathogens, Bacteriodes spps [4.08%] and Fusobacterium necrophorum [2.04%].In retained placenta cases there were [68.8%] positive swabs yielded 169 isolates. The higher percent was E.coli [18.39%], followed by Staphylocacus aureus [14.69%], Corynebacterum pyogens [11.25%], Proteus spps [8.87%], and Enterococcus faecalis [7.69%]. From obligate anaerobic pathogens, there were Bacteriodes spps [4.78%], Fusobacterum necrophorum [3.55%] and Clostridium perfringens [2.95%]. Although it was evidence that Escherichia. coli, Staphylococcus aureus and Corynebacterium pyogens shared in most mixed infected cultures. Yet most isolates were very sensitive to Ceftiofur, Enrofloxacin and moderately sensitive to Oxyteteracyllin and ampicillin and weakly sensitive to Amoxycillin and Pencillin. The blood analysis showed significant lower level of calcium, phosphorous, magnesium and oesteradiol- 17 B and higher level of progesterone than normal dropped placental cows. Subsequently reproductive performance was affected as it had long time of uterine involution, appearance of 1[st] post partium heat, calving interval as well as high number of services per conception as compared with normal ones

Tiempo de alumbramiento con drenaje y sin drenaje de sangre del cordón umbilical en pacientes anémicas y no anémicas en el Hospital Vicente Corral Moscoso / Delivery time with drainage and no drainage of blood from the umbilical cord in anemic and nonanemic patients in the Vicente Corral Moscoso Hospita

Comparar el tiempo del tercer período del parto de las pacientes anémicas y no anémicas sujetas al procedimiento de drenaje de sangre del cordón umbilical versus pinzamiento del cordón, en los ambientes del Centro Obstétrico del Hospital Vicente Corral Moscoso.Con un diseño experimental se realizó un estudio clínico, controlado, aleatorizado La muestra incluyó 200 pacientes, el grupo experimental comprendió 100 pacientes en las que se drenó la sangre de cordón umbilical 50 anémicas y 50 no anémicas, y el grupo de control con pinzamiento del cordón lo integraron 100 pacientes, 50 anémicas y 50 no anémicas. Al comparar la duración del tercer período del parto del grupo con drenaje se obtuvo una media de 4,6 ± 1,4 min y en el grupo con pinzamiento 9,07 ± 2,5 min. La diferencia fue significativa (P = 0,0001). Cuando se comparó la duración del tercer período del parto de 1 a 5 min vs 6 a 10 min, la mayoría de las pacientes del grupo con drenaje, estuvo entre 1 a 5 min, con un RR 0.239 (IC 95: 0.188 – 0.358), RRA 70.1%, RRR 76.1%, NNT 1.426, en las anémicas, y un RR 0.250 (IC 95: 0.179 – 0.383), RRA 66.1%, RRR 75%, NNT 1.513 en las no anémicas. El volumen de drenaje en el grupo de estudio, tuvo una media de 60.3 ± 19.5 ml en las anémicas y 56.9 ± 18 ml en las no anémicas (P = 0.369). La hemorragia del tercer período del parto del grupo con drenaje tuvo una media de 197.6 ± 36 ml vs el grupo con pinzamiento 277.4 ± 49 ml con un valor (P = 0,0001) lo cual es estadísticamente significativo a favor del drenaje. Cuando se comparó la hemorragia del tercer período del parto de < 250 ml vs 250 a 500 ml la mayoría de las pacientes del grupo con drenaje, estuvo en < 250 ml, con un RR 0.070 (IC 95: 0.025 – 0.168), RRA 80%, RRR 93%, NNT 1.25, en las anémicas, y un RR 0.074 (IC 95: 0.020 – 0.246), RRA 50%, RRR 92.6 %, NNT 2 en las no anémicas.

Calcium metabolism in cows receiving an intramuscular injection of 1,25-dihydroxyvitamin D3 combined with prostaglandin F2alpha closely before parturition

To determine the effect of exogenous 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] combined with induced parturition on calcium (Ca) metabolism, cows received a single intramuscular injection of 1,25(OH)2D3 and prostaglandin F2alpha (PGF2alpha) closely before calving. Ten late-pregnant, multiparous Holstein cows were assigned to 1,25(OH)2D3 group (five treated with both 1,25(OH)2D3 and PGF2alpha) and control group (five treated with PGF2alpha). 1,25(OH)2D3 group showed an increase in plasma Ca concentration around parturition, whereas control group revealed a decrease in plasma Ca level. Plasma Ca concentration in 1,25(OH)2D3 group were significantly higher than that in control group during .0.5 to 3 days after parturition.

Influência da parição e do puerpério no leucograma de caprinos (Capra hircus) da raça Saanen, criados no Estado de São Paulo / Influence of parturition and puerperium in the leucogram of Saanen goats (Capra hircus), raised in the State of São Paulo - Brazil

Com o objetivo de avaliar a influência da parição e do puerpério no leucograma de caprinos da raça Saanen foram colhidas 360 amostras de sangue de 20 cabras, sendo os resultados apresentados em 18 grupos experimentais: 32, 16,8,4,3,2, 1 e ½ dias antes do parto, imediatamente após aparição, ½, 1,2,3,4,8,16,32 e 64 dias após o parto. Nas amostras de sangue colhidas em frascos contendo EDTA, foram realizadas as seguintes provas: contagem do número total de leucócitos, em câmara de Neubauer modificada, utilizando-se o liquído de Thoma como diluidor e contagem diferencial de leucócitos, efetuada em esfregaços sangüíneos, corados pelo método de Rosenfeld. A avaliação dos resultados obtidos demonstrou que o leucograma sofreu influência da parição e do puerpério, sendo que durante todo o experimento o quadro leucocitário foi predominantemente neutrofilico. Nos últimos três dias de gestação observou-se gradual aumento do número de leucócitos, em decorrência das variações observadas no número de neutrófilos. No momento do parto o leucograma era caracterizado por leucocitose devido à neutrofilia associado a linfopenia. Nas primeiras 24 horas após o parto foi observado a existência de leucocitose por neutrofilia que desapereceu nos dias subseqüentes, passando o quadro leucocitário a assemelhar-se entre o 2° e 64° dia após o parto àquele observado na fase final da gestação.