ABSTRACT
La hemorragia puerperal produce el incremento en el número de ingresos en las unidades de cuidados intensivos, que a su vez requiere de una mayor y mejor atención por parte del personal de enfermería. Este trabajo tiene como objetivo, reflexionar sobre los principales elementos a tener en cuenta para el cuidado de enfermería de puérperas con hemorragia, en el contexto de la unidad de cuidados intensivos. El plan de cuidados en puérperas con hemorragia debe estar basado en los diagnósticos de enfermería, que logren un enfoque más hacia la enfermedad; en el que la planificación de acciones sea más específica a puérperas con hemorragia. Asimismo, combinar lo estandarizado con la individualización, para lograr una mayor efectividad en la atención a esta complicación grave principal causa de la mortalidad materna en el mundo. Por ello el cuidado de enfermería deberá asumir acciones frente a la seguridad de la paciente, desde la promoción del trabajo en equipo, hasta fortalecimiento de competencias para la implementación guías de prácticas que garanticen un accionar más rápido y eficiente(AU)
Puerperal hemorrhage causes an increase in the number of admissions to intensive care units, which in turn requires greater and better care from nursing staff. This work aims to reflect on the main elements to take into account for nursing care of postpartum women with hemorrhage, in the context of the intensive care unit. The care plan for postpartum women with hemorrhage should be based on nursing diagnoses that focus more on the disease; in which action planning is more specific to postpartum women with hemorrhage. Likewise, combine standardization with individualization, to achieve greater effectiveness in the care of this serious complication, the main cause of maternal mortality in the world. Therefore, nursing care must take actions regarding patient safety, from promoting teamwork to strengthening skills for the implementation of practice guides that guarantee faster and more efficient action(AU)
Subject(s)
Humans , Postpartum Period , Patient Safety , Postpartum Hemorrhage/nursing , Obstetric Labor Complications/diagnosis , Nursing Care , Nursing Care/methods , Nursing Diagnosis , Intensive Care UnitsABSTRACT
OBJETIVO: Mapear as evidências científicas sobre as ações dos enfermeiros obstétricos no gerenciamento clínico da hemorragia pós-parto. MÉTODO: Trata-se de uma revisão de escopo elaborada segundo as recomendações do JBI Institute Manual do Revisor para Scoping Review. As buscas serão realizadas nas bases de dados eletrônicas CINAHL, Cochrane Library, EMBASE, Literatura Latino-americana e do Caribe em Ciências da Saúde, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science e na literatura cinzenta. Os estudos que serão incluídos precisarão responder ao objetivo desta pesquisa e estar nos idiomas Português, Espanhol ou Inglês. Além disso, é necessário ter disponibilidade dos estudos na íntegra através de acesso remoto pelo acesso da CAFe. Os estudos que não serão incluídos serão os em formato de editorial e carta ao editor. Haverá a seleção por meio da leitura do título e resumo dos materiais encontrados nas buscas, sendo assim avaliados de maneira independente por dois revisores e nos casos de divergências por um terceiro avaliador. Os dados coletados estarão organizados e relacionados segundo a análise descritiva. Os resultados poderão estar dispostos em tabelas ou quadros, e serão discutidos com suporte de literatura acerca da temática, retratando a quinta etapa do método escolhido.
OBJECTIVE: To map the scientific evidence regarding the actions of obstetric nurses in the clinical management of postpartum hemorrhage. METHOD: This scoping review was developed according to the JBI Institute Reviewer's Manual for Scoping Reviews. The electronic databases CINAHL, Cochrane Library, EMBASE, Latin American and Caribbean Health Sciences Literature, MEDLINE/PubMed, SciELO, ScienceDirect, SCOPUS, Web of Science, and gray literature were searched. Included studies must address the research objective in Portuguese, Spanish, or English. In addition, full remote access to the studies via CAFe is required. Studies in editorial or letter format will be excluded. Selection will be based on the title and abstract of the materials found in the searches, independently assessed by two reviewers, with disagreements resolved by a third reviewer. Collected data will be organized and related through descriptive analysis. Results may be presented in tables or figures and discussed with support from literature, reflecting the fifth step of the selected methodology.
Subject(s)
Humans , Female , Pregnancy , Disease Management , Postpartum Hemorrhage , Nurse Midwives , Review Literature as TopicABSTRACT
@#Chronic Myeloid Leukemia, a chronic hematopoietic stem cell disorder, is uncommon among younger age group such as pregnant patients. Due to the rarity of this condition in pregnancy, there are no randomized controlled trials to address the optimal management of this condition. We are presented with a 26 year old patient, who had an unplanned pregnancy in the advanced phase of the disease. Due to the risk to the mother in delaying treatment, she was continued on Imatinib, a tyrosine kinase inhibitor, which is a known fetal teratogen. Her pregnancy was carried to term. The patient delivered via spontaneous vaginal delivery to a live, neonate, with findings of hydrocele and syndactyly on the 4" and 5™ digit of the right foot. Due to the maternal disease progression, she presented with postpartum hemorrhage, in contrast to an augmented procoagulant state among normal pregnancies. Obstetric adjunctive measures, such as intrauterine balloon tamponade and uterine artery ligation, were done. The patient was discharged stable.
Subject(s)
Pregnancy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Imatinib Mesylate , Postpartum HemorrhageABSTRACT
Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening .
Subject(s)
Infant, Newborn , Pregnancy , Female , Humans , Pregnancy Trimester, Third , Pregnancy, Twin , Postpartum Hemorrhage/etiology , Retrospective Studies , Labor, Induced/methods , Cervical RipeningABSTRACT
Introduction@#Obstetrical hemorrhage remains to be one of the most common causes of maternal morbidity and mortality. Postpartum hemorrhage occurs after delivery and is usually secondary to uterine atony, genital tract lacerations, and retained placental fragments.@*Case@#A case of a 21-year old, primipara, presented with profuse vaginal bleeding and hemoptysis at 3 weeks' postpartum. A clinical diagnosis of gestational trophoblastic neoplasia was established after an elevated serum beta human chorionic gonadotropin was obtained and an intrauterine mass was seen on ultrasonography, including metastasis to the lungs and liver seen through imaging studies.@*Discussion@#Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin (EMACO) is the mainstay treatment for Stage IV disease. However, complications such as hemorrhage and tumor rupture are best managed surgically. Although rare, a diagnosis of choriocarcinoma should be considered in patients with persistent bleeding after a normal pregnancy to institute proper management and avoid associated complications of tumor progression.
Subject(s)
Choriocarcinoma , Gestational Trophoblastic Disease , Postpartum HemorrhageABSTRACT
Abstract Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods: A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results: The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion: Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.
Subject(s)
Humans , Female , Pregnancy , Puerperal Disorders , Maternal Mortality , Risk Factors , Electronic Health Records , Postpartum HemorrhageABSTRACT
Abstract Objective Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Methods Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Results Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. Conclusion The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.
Subject(s)
Humans , Female , Infant, Newborn , Blood Transfusion , Clinical Protocols , Blood-Derivative Drugs , Postpartum HemorrhageABSTRACT
Abstract Objective To evaluate the risk factors for postpartum hemorrhage (PPH) according to the Robson Classification in a low-risk maternity hospital. Methods We conducted retrospective cohort study by analyzing the medical records of pregnant women attended in a low-risk maternity hospital, during from November 2019 to November 2021. Variables analyzed were: maternal age, type of delivery, birth weight, parity, Robson Classification, and causes of PPH. We compared the occurrence of PPH between pregnant women with spontaneous (Groups 1 and 3) and with induction of labor (2a and 4a). Chi-square and Student t-tests were performed. Variables were compared using binary logistic regression. Results There were 11,935 deliveries during the study period. According to Robson's Classification, 48.2% were classified as 1 and 3 (Group I: 5,750/11,935) and 26.1% as 2a and 4a (Group II: 3,124/11,935). Group II had higher prevalence of PPH than Group I (3.5 vs. 2.7%, p=0.028). Labor induction increased the occurrence of PPH by 18.8% (RR: 1.188, 95% CI: 1.02-1.36, p=0.030). Model including forceps delivery [x2(3)=10.6, OR: 7.26, 95%CI: 3.32-15.84, R2 Nagelkerke: 0.011, p<0.001] and birth weight [x2(4)=59.0, OR: 1.001, 95%CI:1.001-1.001, R2 Nagelkerke: 0.033, p<0.001] was the best for predicting PPH in patients classified as Robson 1, 3, 2a, and 4a. Birth weight was poor predictor of PPH (area under ROC curve: 0.612, p<0.001, 95%CI: 0.572-0.653). Conclusion Robson Classification 2a and 4a showed the highest rates of postpartum hemorrhage. The model including forceps delivery and birth weight was the best predictor for postpartum hemorrhage in Robson Classification 1, 3, 2a, and 4a.
Subject(s)
Humans , Female , Pregnancy , Risk Factors , Postpartum Period , Postpartum Hemorrhage , Hospitals, MaternityABSTRACT
Abstract Objective In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO). Methods A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU. Results The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO. Conclusion The principal factors associated with poor maternal outcome were being multiparous and placental abruption.
Subject(s)
Maternal Mortality , Postpartum Hemorrhage , Intensive Care UnitsABSTRACT
Background The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings. Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia. Study design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul's Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients' medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results. RESULTS: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit. Majority (318/355, 89.6%) from the study participants were transferred to other wards with im-provement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU. Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.
Subject(s)
Humans , Female , Shock, Septic , Cause of Death , Eclampsia , Emergencies , Heart Diseases , Postpartum HemorrhageABSTRACT
La histerectomía obstétrica es un evento centinela de morbilidad materna extremadamente grave (MMEG) o near miss. Objetivos: Caracterizar la población sometida a histerectomía obstétrica en el Hospital Pereira Rossell en el período 2017-2022. Calcular la tasa de histerectomía obstétrica en el CHPR; observar su frecuencia tras parto vaginal y cesárea; analizar las complicaciones vinculadas, detectar fallas en el sistema de atención a fin de mejorar la calidad del cuidado obstétrico. Métodos: Se realizó un estudio retrospectivo, longitudinal y descriptivo mediante análisis de historias clínicas del sistema de registro hospitalario. Se incluyeron pacientes sometidas a histerectomía obstétrica, cursando estado grávido puerperal, con embarazo mayor de 20 semanas. Resultados: Se realizaron 30 histerectomías obstétricas en el período, con una incidencia 0.84 por 1000 nacimientos siendo más frecuente en mujeres menores de 35 años, multíparas,con cesárea previa. Todos los casos ocurrieron tras cesárea. Las principales complicaciones observadas fueron la necesidad de transfusión sanguínea y el ingreso a CTI. No hubo muertes maternas. Hubo 2 muertes perinatales. Conclusiones: La caracterización de la población sometida a histerectomía obstétrica aporta datos fundamentales en vistas a mejorar la asistencia. Se observó mayor incidencia en pacientes sometidas a cesárea, multíparas. Frecuentemente requieren transfusión de hemoderivados, poniendo de manifiesto la necesidad protocolos de atencián a hemorragia obstétrica y transfusión masiva. No hubo muertes maternas, siendo esto un marcador de calidad de los cuidados. Las limitaciones del estudio fueron el bajo número de casos, y la mala calidad de los registros médicos que dificultaron la obtención de información.
Obstetric Hysterectomy is a sentinel event of Near Miss. Objectives: To characterize the population undergoing obstetric hysterectomy at Pereira Rossell Hospital during the period 2017-2022. To calculate the obstetric hysterectomy rate at CHPR; observe its frequency after vaginal delivery and cesarean section; analyze related complications; and detect system failures to improve the quality of obstetric care. Methods: A retrospective, longitudinal, and descriptive study was conducted through the analysis of medical records from the hospital registry system. Women undergoing obstetric hysterectomy during pregnancy or the puerperal state, with pregnancies of more than 20 weeks, were included. Results: Thirty obstetric hysterectomies were performed during the period, with an incidence of 0.84 per 1,000 births, being more frequent in women under 35 years old, multiparous, and with a previous cesarean section. All cases occurred after cesarean delivery. The main observed complications were the need for blood transfusion and admission to the ICU. There were no maternal deaths. There were 2 perinatal deaths. Conclusions: Characterizing the population undergoing obstetric hysterectomy provides fundamental data for improving care. A higher incidence was observed in patients who had cesarean sections and were multiparous. They frequently required blood transfusions, highlighting the need for protocols on obstetric hemorrhage and massive transfusion. There were no maternal deaths, which is a marker of the quality of care. The study's limitations were the low number of cases and the poor quality of medical records, which hindered information retrieval.
A histerectomia obstétrica é um evento sentinela de morbidade materna extremamente grave (MMEG) ou near miss. Objetivos: Caracterizar a população submetida a histerectomia obstétrica no Hospital Pereira Rossell no período de 2017 a 2022. Calcular a taxa de histerectomia obstétrica no CHPR; observar sua frequência após parto vaginal e cesárea; analisar as complicações vinculadas, detectar falhas no sistema de atendimento a fim de melhorar a qualidade do cuidado obstétrico. Métodos: Foi realizado um estudo retrospectivo, longitudinal e descritivo mediante análise de prontuários do sistema de registro hospitalar. Foram incluídas pacientes submetidas a histerectomia obstétrica, em estado grávido puerperal, com gravidez maior de 20 semanas. Resultados: Foram realizadas 30 histerectomias obstétricas no período, com uma incidência de 0,84 por 1000 nascimentos, sendo mais frequente em mulheres com menos de 35 anos, multíparas, com cesárea prévia. Todos os casos ocorreram após cesárea. As principais complicações observadas foram a necessidade de transfusão sanguínea e a internação em CTI. Não houve mortes maternas. Houve 2 mortes perinatais. Conclusões: A caracterização da população submetida a histerectomia obstétrica fornece dados fundamentais visando melhorar a assistência. Observou-se maior incidencia em pacientes submetidas a cesárea, multíparas. Frequentemente requerem transfusão de hemoderivados, evidenciando a necessidade de protocolos de atendimento à hemorragia obstétrica e transfusão massiva. Não houve mortes maternas, sendo isso um marcador de qualidade dos cuidados. As limitações do estudo foram o baixo número de casos e a má qualidade dos registros médicos, que dificultaram a obtenção de informações.
Subject(s)
Hysterectomy , Quality of Health Care , Obstetric Surgical Procedures , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Morbidity , Delivery, Obstetric , Maternal Health , Postpartum HemorrhageABSTRACT
Introducción: La hemorragia obstétrica es considerada una causa mayor de mortalidad materna. El reconocimiento de las mujeres con riesgo de desarrollar complicaciones durante la hemorragia obstétrica, es la primera acción para promover un tratamiento optimizado y evitar la muerte. Objetivo: Identificar los factores de riesgo de complicaciones en pacientes con hemorragia obstétrica. Métodos: Estudio observacional, analítico de casos y controles, con 12 casos (con complicaciones) y 24 controles (sin complicaciones). Se aplicó las medidas resúmenes para cada tipo de variables y la determinación de los factores de riesgos mediante la aplicación del odds ratio (OR), se utilizó el paquete estadístico SPSS versión 26.0, con un intervalo de confianza (IC) del 95 por ciento. Resultados: La combinación del choque hipovolémico, más la insuficiencia renal aguda, fue la complicación más frecuente para un 13,8 por ciento. Predominó la atonía uterina para un 50,0 por ciento como causa de hemorragia.Las variables predictivas de complicaciones fueron: el valor de creatinina ≥ 113 µmol/L (OR= 19,08; IC: 2,75-138,36), índice internacional normalizado ≥ 2 (OR= 4,66; IC: 1,46-14,90), hematocrito < 0,23 (OR= 4,00; IC: 1,76-9,08) y hemoglobina < 70 g/L (OR= 2,22; IC: 1,25-3,95). Conclusiones: La creatinina ≥ 113 µmol/L, índice internacional normalizado ≥ 2, hematocrito < 0,23 y hemoglobina < 70 g/L son los principales factores de riesgo identificados para el desarrollo de complicaciones durante la hemorragia obstétrica(AU)
Introduction: Obstetric hemorrhage is considered a major cause of maternal mortality. Recognition of women at risk of developing complications during obstetric hemorrhage is the first action to promote optimized treatment and avoid death. Objective: Identify risk factors for complications in patients with obstetric hemorrhage. Methods: Observational, analytical case-control study, with 12 cases (with complications) and 24 controls (without complications). The summary measures were applied for each type of variables and the determination of the risk factors by applying the odds ratio (OR), the SPSS statistical package version 26.0 was used, with a confidence interval (CI) of 95 percent. Results: The combination of hypovolemic shock, plus acute renal failure, was the most frequent complication for 13.8 percent. Uterine atony predominated for 50.0 percent as the cause of hemorrhage. The predictive variables of complications were: creatinine value ≥ 113 µmol/L (OR= 19.08; CI: 2.75-138.36), international normalized ratio ≥ 2 (OR= 4.66; CI: 1. 46-14.90), hematocrit < 0.23 (OR= 4.00; CI: 1.76-9.08) and hemoglobin < 70 g/L (OR= 2.22; CI: 1.25-3.95). Conclusions: Creatinine ≥ 113 µmol/L, international normalized ratio ≥ 2, hematocrit < 0.23 and hemoglobin < 70 g/L are the main risk factors identified for the development of complications during obstetric hemorrhage(AU)
Subject(s)
Humans , Risk Factors , Postpartum Hemorrhage/diagnosis , Obstetric Labor Complications/etiology , Case-Control Studies , Observational Study , Intensive Care UnitsABSTRACT
A mortalidade materna é inaceitavelmente alta. A hemorragia pós-parto encontra- se na primeira posição no mundo, tendo como principal causa específica a atonia uterina. Eventualmente, as medidas iniciais e a terapia farmacológica não são efetivas no controle do sangramento, impondo a necessidade de tratamentos invasivos, cirúrgicos ou não. Entre esses, o tamponamento uterino com balão requer recursos locais mínimos e não exige treinamento extensivo ou equipamento muito complexo. Entretanto, algumas dificuldades podem ocorrer durante a inserção, infusão ou manutenção do balão na cavidade uterina, com especificidades relacionadas à via de parto. Após o parto vaginal, a dificuldade mais prevalente é o prolapso vaginal do balão. Na cesárea, as principais dificuldades são a inserção e o posicionamento do balão na cavidade uterina, principalmente nas cesáreas eletivas. Este artigo revisa e ilustra as principais dificuldades e especificidades relacionadas ao tamponamento uterino com balões.
Maternal mortality is unacceptably high. Postpartum hemorrhage is ranked first in the world, with the main specific cause being uterine atony. Eventually, initial measures and pharmacological therapy are not effective in controlling bleeding, imposing the need for invasive treatments, surgical or not. Among these, uterine balloon tamponade requires minimal local resources and does not require extensive training or very complex equipment. However, some difficulties may occur during insertion, infusion, or maintenance of the balloon in the uterine cavity, with specificities related to the mode of delivery. After vaginal delivery, the most prevalent difficulty is vaginal balloon prolapse. In cesarean section, the main difficulty is the insertion and positioning of the balloon in the uterine cavity, especially in elective cesarean sections. This article reviews and illustrates the main difficulties and specificities related to uterine balloon tamponade.
Subject(s)
Humans , Female , Pregnancy , Uterine Balloon Tamponade/instrumentation , Cervix Uteri/injuries , Postpartum Hemorrhage/mortality , Natural Childbirth , ObstetricsABSTRACT
PONTOS-CHAVE O misoprostol é um análogo da prostaglandina E1 (PGE1) que consta na Lista de Medicamentos Essenciais da Organização Mundial da Saúde (OMS) desde 2005 O Brasil possui uma das regulações mais restritivas do mundo relacionadas ao uso do misoprostol, estabelecendo que o misoprostol tem uso hospitalar exclusivo, com controle especial, e venda, compra e propaganda proibidas por lei Atualmente, o misoprostol é a droga de referência para tratamento medicamentoso nos casos de aborto induzido, tanto no primeiro trimestre gestacional quanto em idades gestacionais mais avançadas O misoprostol é uma medicação efetiva para o preparo cervical e indução do parto O misoprostol é um medicamento essencial para o manejo da hemorragia pós-parto
Subject(s)
Humans , Female , Pregnancy , Misoprostol/adverse effects , Misoprostol/pharmacokinetics , Pharmaceutical Preparations/administration & dosage , Abortion, Legal , Carcinogenic Danger , Parturition/drug effects , Gastrointestinal Diseases , Postpartum Hemorrhage/drug therapyABSTRACT
Introducción: La estrategia de código rojo permite la atención inmediata, sistematizada y coordinada de la hemorragia posparto. Es un esquema de trabajo organizado que contribuye a un tratamiento oportuno y pertinente de la hemorragia obstétrica. Con esta herramienta, el equipo asistencial puede seguir los pasos indicados sin desviarse del objetivo, trabajar de manera ordenada y aplicarlo en cada situación específica, para disminuir la morbilidad y mortalidad materna. Objetivo: Caracterizar los resultados de la estrategia de código rojo en la atención a pacientes con hemorragia posparto en Villa Clara. Métodos: Se realizó un estudio de desarrollo, observacional, de corte transversal y retrospectivo de las pacientes con hemorragia posparto en Villa Clara, durante el período de enero 2018 a junio de 2021. La muestra no probabilística quedó conformada por 127 pacientes. Se utilizaron medidas de resumen para la descripción de las variables. En las cuantitativas se emplearon medidas de tendencia central y de dispersión (media y desviación estándar), para las variables cualitativas se mostraron frecuencias absolutas y relativas. Para establecer las relaciones entre variables se aplicó la prueba de independencia basada en la distribución Ji cuadrado. Resultados: En la evaluación del cumplimiento del protocolo de código rojo resultaron incorrectos algunos parámetros como: el diagnóstico de las etapas del choque y el tiempo de accionar. Conclusiones: Cada institución debe contar con protocolos y guías de atención de pacientes obstétricas con bases científicas que se correspondan a las posibilidades de cada país; estos protocolos deben facilitar y perfeccionar las acciones del médico.
Introduction: the red code strategy allows immediate, systematized and coordinated care of postpartum hemorrhage. It is an organized work scheme that contributes to timely and relevant treatment of obstetric hemorrhage. The healthcare team can follow with this tool the indicated steps without deviating from the objective, work in an orderly manner and apply it in each specific situation to reduce maternal morbidity and mortality. Objective: to characterize the results of the red code strategy in the care of patients with postpartum hemorrhage in Villa Clara. Methods: a retrospective, cross-sectional, observational and developmental study was carried out in patients with postpartum hemorrhage in Villa Clara from January 2018 to June 2021. The non-probabilistic sample consisted of 127 patients. Summary measures were used to describe the variables. Measures of central tendency and dispersion (mean and standard deviation) were used in the quantitative variables as well as absolute and relative frequencies were shown for the qualitative ones. The independence test based on the Chi-square distribution was applied to establish the relationships between variables. Results: some parameters were incorrect in the evaluation of compliance with the red code protocol such as the diagnosis of the stages of shock and the time to act. Conclusions: each institution must have protocols and guidelines for the care of obstetric patients with scientific bases that correspond to the possibilities of each country; these protocols should facilitate and improve the doctor's actions.
Subject(s)
Shock , Evaluation Study , Postpartum HemorrhageABSTRACT
Objetivo: Evaluar la eficacia de la sutura de B-Lynch profiláctica en la prevención de la hemorragia posparto en pacientes con alto riesgo para atonía uterina, del Servicio de Sala de Partos de la Maternidad Concepción Palacios. Métodos: Estudio prospectivo, comparativo y longitudinal, que incluyó 30 pacientes con factores de riesgo para atonía uterina, distribuidas aleatoriamente en dos grupos: con y sin sutura compresiva de B-Lynch. Se realizó seguimiento ecosonográfico, clínico y paraclínico a las 12 y 24 horas del posoperatorio. Se consideró un contraste estadísticamente significativo si p < 0,05. Resultados: La reducción de hemoglobina en pacientes con sutura compresiva fue 0,5 ± 0,4 g/dl y de hematocrito fue 1,4 ± 1,1 %; en el grupo control fue 1,6 ± 1,6 g/dl y 4 ± 4,7 %, respectivamente (p = 0,014/p = 0,058). El sangrado a las 12 y 24 horas fue escaso en 73,3 % y 93,3 % de las pacientes con sutura compresiva y moderado o abundante en 100 % y 93,4 % del grupo control (p = 0,000). La reducción del tamaño del útero fue mayor en el grupo experimental que en el grupo control (p = 0,000); 33,4 % de las pacientes con sutura de B-Lynch y 93,4 % sin sutura, tuvieron dolor grave o insoportable a las 12 horas (p = 0,007) y a las 24 horas no hubo casos con dolor grave o insoportable en el primer grupo, pero en el segundo la frecuencia fue de 60 %. Conclusiones: La sutura de B-Lynch profiláctica es eficaz para la prevención de la hemorragia posparto por atonía uterina(AU)
Objective: To evaluate the effectiveness of prophylactic B-Lynch suture in the prevention of postpartum bleeding in patients at high risk for uterine atony, from the Concepción Palaces Maternity Delivery Room Service. Methods: Prospective, comparative and longitudinal study, which included 30 patients with risk factors for uterine atonia, randomly distributed in two groups: with and without B-Lynch compression suture. Echosonographic, clinical and paraclinical follow-up was performed at 12 and 24 hours after the postoperative period. A statistically significant contrast was considered if p < 0.05. Results: Haemoglobin reduction in patients with compressive suture was 0.5 ± 0.4 g/dl and hematocrit was 1.4 ± 1.1%; in the control group it was 1.6 ± 1.6 g/dl and 4 ± 4.7%, respectively (p-0.014/p-0.058). Bleeding at 12 and 24 hours was scarce in 73.3% and 93.3% of patients with compressive and moderate sutures or abundant in 100% and 93.4% of the control group (p-0.000). The reduction in the size of the uterus was greater in the experimental group than in the control group (p-0.000); 33.4% of patients with B-Lynch sutures and 93.4% without sutures had severe or unbearable pain at 12 hours (p-0.007) and at 24 hours there were no cases with severe or unbearable pain in the first group but in the second the frequency was 60%. Conclusions: Prophylactic B-Lynch suture is effective for preventing postpartum uterine atonia hemorrhage(AU)
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Sutures , Aftercare , Postpartum Hemorrhage , Patients , Risk Factors , Postpartum PeriodABSTRACT
La colestasis intrahepática del embarazo es producida por una disfunción de los hepatocitos, propia de la gestación. Las concentraciones elevadas de hormonas sexuales y la predisposición genética parecen ser factores importantes para su desarrollo. La incidencia depende de la composición étnica de la población y de los criterios diagnósticos utilizados. Está caracterizada por prurito creciente y persistente, aumento de las concentraciones de ácidos biliares, generalmente a finales del segundo o tercer trimestre del embarazo. Lleva a la aparición de hipoxia uteroplacentaria que aumenta el riesgo de líquido amniótico meconial, parto pretérmino, preeclampsia, hemorragia posparto, síndrome de dificultad respiratoria del neonato y muerte perinatal. El manejo terapéutico está dirigido a reducir los síntomas clínicos, normalizar los cambios bioquímicos maternos y prevenir complicaciones fetales. El tratamiento farmacológico principal consiste en la administración de ácido ursodesoxicólico. El objetivo de esta investigación es evaluar el diagnóstico y manejo de la colestasis intrahepática del embarazo(AU)
Intrahepatic cholestasis of pregnancy is caused by a dysfunction of the hepatocytes, typical of pregnancy. High concentrations of sex hormones and genetic predisposition appear to be important factors for their development. The incidence depends on the ethnic composition of the population and the diagnostic criteria used. It is characterized by increasing and persistent pruritus, increased concentrations of bile acids, usually in the late second or third trimester of pregnancy. It leads to the occurrence of uteroplacental hypoxia that increases the risk of meconium amniotic fluid, preterm delivery, preeclampsia, postpartum hemorrhage, neonatal respiratory distress syndrome, and perinatal death. Therapeutic management is aimed at reducing clinical symptoms, normalizing maternal biochemical changes, and preventing fetal complications. The main pharmacological treatment consists of the administration of ursodeoxycholic acid. The objective of this research is to evaluate the diagnosis and management of intrahepatic cholestasis of pregnancy(AU)
Subject(s)
Humans , Female , Pregnancy , Pruritus , Pregnancy , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/etiology , Signs and Symptoms , Bile Ducts , Hepatocytes , Fetal Death , Postpartum Hemorrhage , Amniotic FluidABSTRACT
La hemorragia posparto es una de las complicaciones más frecuentes en obstetricia, siendo la segunda causa de mortalidad materna a nivel mundial. La atonía uterina es su principal causa. Instaurada la hemorragia, el tiempo y el manejo de la misma dependerá de la experticia del obstetra. Inicialmente el tratamiento se enfoca en el uso de fármacos uterotónicos, pero al no existir una respuesta adecuada se puede optar por un manejo quirúrgico conservador. Las suturas compresivas uterinas son consideradas una buena opción de tratamiento. Una técnica quirúrgica efectiva y sencilla es la descrita por Hayman, una herramienta valiosa para el control de la hemorragia posparto. Se presenta el caso de una paciente de 17 años, con embarazo de 37 semanas y diagnóstico de preeclampsia grave, quien presenta desprendimiento prematuro de placenta y atonía uterina posterior, a quien se le realizó sutura compresiva uterina por técnica de Hayman, con evolución satisfactoria(AU)
Postpartum hemorrhage is one of the most frequent complications in obstetrics, being the second cause of maternal mortality worldwide. Uterine atony is its main cause. Once the hemorrhage is established, the time and management of it will depend on the expertise of the obstetrician. Initially, treatment focuses on the use of uterotonic drugs, but in the absence of an adequate response, conservative surgical management may be chosen. Compressive uterine sutures are considered a good treatment option. An effective and simple surgical technique is described by Hayman, a valuable tool for the control of postpartum hemorrhage. We present the case of a 17-year-old patient, 37 weeks pregnant and diagnosed with severe preeclampsia, who presents placental abruption and posterior uterine atony, who underwent uterine compressive suture by Hayman technique, with satisfactory evolution(AU)
Subject(s)
Humans , Female , Pregnancy , Adolescent , Pharmaceutical Preparations , Maternal Mortality , Abruptio Placentae , Postpartum Hemorrhage , Pre-Eclampsia , Sutures , Therapeutics , Infant, PrematureABSTRACT
Objective: To analyze associated factors and adverse pregnancy outcomes of postpartum hemorrhage in the caesarean section of puerperae with different types of placenta previa. Methods: This retrospective research was a case-control study. Puerperae with cesarean section of placenta previa from January 2019 to December 2020 in Women's Hospital, School of Medicine, Zhejiang University were collected and divided into the<1 000 ml control group or ≥1 000 ml postpartum hemorrhage group according to the amount of blood loss during cesarean section. Differences in continuous variables were analyzed by t-test and categorical variables were analyzed by χ2 test. The risk factors of postpartum hemorrhage were analyzed by logistic multivariate regression. Results: A total of 962 puerperae were enrolled with 773 cases in the control group and 189 cases in the postpartum hemorrhage group. The incidence of gestational weeks, gravidity, parity, induced abortion, placental accreta and preoperative hemoglobin<110 g/L was significantly different between two groups in different types of placenta previa (P<0.001). Logistic multivariate regression model analysis showed that the independent risk factors of postpartum hemorrhage in the caesarean section of low-lying placenta included placental accreta (OR=12.713, 95%CI: 4.296-37.625), preoperative hemoglobin<110 g/L (OR=2.377, 95%CI: 1.062-5.321), and prenatal vaginal bleeding (OR=4.244, 95%CI: 1.865-9.656). The independent risk factors of postpartum hemorrhage in the caesarean section of placenta previa included once induced abortion (OR=2.789, 95%CI:1.189-6.544), induced abortion≥2 (OR=2.843, 95%CI:1.101-7.339), placental accreta (OR=6.079, 95%CI:3.697-9.996), HBsAg positive (OR=3.891, 95%CI:1.385-10.929), and placental attachment to the anterior uterine wall (OR=2.307, 95%CI:1.285-4.142). The rate of postpartum hemorrhage and premature delivery in puerperae with placenta previa was higher than that in puerperae with low-lying placenta (P<0.001). Conclusions: The associated factors of postpartum hemorrhage in puerperae with different types of placenta previa are different. Placenta accreta is the common risk factor of postpartum hemorrhage in puerperae with low-lying placenta and placenta previa.