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Background: Postpartum haemorrhage is one of the dreadful complications that occur during delivery. It is often un-anticipated and occurs suddenly and un-expectedly. It is responsible for 20 percent of maternal deaths in developing countries. These deaths are largely preventable. The objective of the study was to find out the clinical profile, associated co-morbid conditions and contributory factors and treatment modalities used in the management.Methods: Retrospective observational study of maternal deaths due to postpartum haemorrhage (PPH) was carried out at tertiary care hospital. The data of maternal deaths for seven years from year 2013 to 2019 was reviewed, compiled and analyzed to draw conclusions.Results: There were 18 maternal deaths (19%) due to PPH out of total 86 maternal deaths. The average age of the woman who died due to PPH was 24 years. Ninety five percent of the cases of PPH were due to atonic uterus. Seventy percent of the cases had reported in advanced stage of shock with average blood loss of more than two to three litres. Poor general condition due to delay in reaching to tertiary care hospital was predominant feature. Sixty percent women underwent obstetric hysterectomy. Massive blood transfusion was given in fifty percent cases. Severe pregnancy induced hypertension, severe anaemia and severe concealed accidental haemorrhage were common associated factors in sixty percent of maternal deaths.Conclusions: Postpartum haemorrhage is still a common cause of maternal death. Early detection, prompt aggressive management, adequate blood replacement, use of uterine balloon tamponade and non-pneumatic anti-shock garment, timely transfer to higher centre and timely decision for surgical interventions can prevent maternal deaths.
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Objective: To explore the potential material basis of Shengmai Injection for the treatment of coronavirus disease 2019 (COVID-19) through network pharmacology and molecular docking technology. Methods : The active compounds of Shengmai Injection were screened by TCMSP and BATMAN-TCM database. The action target was predicted by TCMSP and Targetnet online database, and the active component-action target network diagram was constructed by Cytoscape 3.7.1; Taking "coronavirus pneumonia" as the keyword, coronavirus-related disease targets were searched in GeneCards database and OMIM database. The common target was selected by intersection with the target of Shengmai Injection as the research target. The common target was imported into STRING database to obtain data, and then the protein-protein interaction network map was constructed in Cytoscape 3.7.1 software; The enrichment analysis of GO function and KEGG pathway was carried out by using R language to predict its action mechanism and construct the "component-target-pathway" network diagram; Molecular docking analysis of key targets was carried out by DiscoveryStudio 2.5 software. Results: A total of 22 active compounds were obtained from Shengmai Injection. They were DNOP, β-sitosterol, angeloylgomisin O, gomisin A, gomisin R, wuweizisu C, interiotherin B, changnanic acid, kadsulactone, kadsulignan B, neokadsuranic acid A, neokadsuranic acid B, neokadsuranic acid C, neokadsuranin, schisanlactone A, schisanlactone E, schizandronic acid, uridine, diosgenin, guanosine, N-trans-feruloyltyramine and stigmasterol. There were 224 corresponding targets and 16 common targets with COVID-19, namely CASP3, CASP8, PTGS2, BCL2, BAX, PRKCA, PTGS1, PIK3CG, F10, NOS3, DPP4, NOS2, TLR9, ACE, ICAM1 and PRKCE. The key targets were CASP3, PTGS2, NOS2, NOS3 and ICAM1. GO functional enrichment analysis showed that there were 771 entries for biological processes, 11 entries for cell composition and 79 items for molecular function. A total of 67 signal pathways were screened by KEGG pathway enrichment analysis, which were mainly related to AGE-RAGE signaling pathway in diabetic complications, apoptosis-multiple species, p53 signaling pathway, small cell lung cancer, and so on. The results of molecular docking showed that the components with better docking with the key targets were schisanlactone E, stigmasterol and N-trans-feruloyltyramine. Conclusion: The active compounds in Shengmai Injection, such as schisanlactone E, stigmasterol, N-trans-feruloyltyramine, can act on CASP3, PTGS2, NOS2, NOS3 and other targets to regulate multiple signaling pathways for anti-inflammatory, immune regulation, anti-shock and increasing blood oxygen saturation. This may play a role in the treatment of COVID-19.
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Background: Postpartum haemorrhage (PPH) is a life-threatening complication, that occurs suddenly and unexpectedly. Institutional delivery by skilled birth attendant who are trained in active management of third stage of labour and those who can use of Uterine Balloon Tamponade and Non-pneumatic anti shock garment can reduce incidence and morbidity related to PPH. The objective of the paper was to share the experiences of the training programmes held for maternal health care workers in the newer modalities of PPH management.Methods: During one and a half year period, 32 Continuation of Medical Education (CME) programmes, with the theme of “Managing Obstetric Emergencies and Obstetric Trauma”, covering important topics related to high risk pregnancies like Hypertension, Eclampsia ,Anaemia and Haemorrhage at 32 health institutions, spread over 11 states and 2 union territories in India, were conducted .In addition,42 hands on workshops at various health facilities were conducted with training of more than 2575 maternal health care providers.Results: The pre and post test scores revealed that 95 percent of the maternal health care providers were unaware about the use of Uterine Balloon Tamponade (Bakri balloon) in PPH and Non-pneumatic anti shock garment (NASG). Seventy percent were unaware about the proper sequence of steps of active management of third stage of labour. Training programmes helped to improve the knowledge, whereas hands on workshop, helped in skill development of the health care providers. The participants expressed great satisfaction regarding the knowledge and skills they acquired through training programme on management of post-partum haemorrhage. They gave positive feedback about the quality, contents and conduct of training programme.Conclusions: There is need for refresher training of maternal health care providers in newer modalities like AMTSL, NASG and Bakri balloon, which have potential to save lives.
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Background: Non-pneumatic anti-shock garment (NASG) is a first-aid device that reverses hypovolemic shock and decreases obstetric haemorrhage. It consists of articulated neoprene segments that close tightly with Velcro, shunting blood from the lower body to the core organs, elevating blood pressure and increasing preload and cardiac output. The use of an NASG can stabilize a patient while awaiting transport, during transport, or during delays in receiving care at referral facilities.Methods: A prospective observational study of use of non-pneumatic anti shock garment (NASG) in cases with obstetric hemorrhagic shock was carried out at a tertiary referral center. As soon as severe shock was recognized in the hospital, the anti-shock garment was placed. Data on various parameters related to use of NASG was collected and interpreted to draw conclusions.Results: NASG was used in 25 cases of hemorrhagic shock during one-year period. Post-partum hemorrhage (36%) was the commonest indication for NASG use, followed by ruptured tubal ectopic pregnancy (28%). It was observed that 68% and 32 % of women had shock index of 1-1.5 and above 1.5 respectively at the time of application of NASG. The shock index rapidly improved to 0.5-0.9 in 92% and 1-1.5 in 8 percent of cases respectively after the application of NASG. The NASG was mainly used in labour room (40%) and emergency department (36%). NASG was applied by nurses and doctors together in 64% of cases. NASG was kept for a period 24 hours in 92% cases. The survival rate was 96% following use of NASG.Conclusions: NASG is a temporizing alternative measure in hemorrhagic shock management that shows a trend to reduce hemorrhage related deaths and severe morbidities. NASG should be made available at all health facilities that deal with high risk pregnancies and deliveries.
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Background: Non-pneumatic Anti-shock garment (NASG) has been identified as a device for effective management of postpartum haemorrhage especially in developing countries where maternal mortality is high. Hence, it is important that midwives are skilled and knowledgeable about its use. This study therefore assessed the midwives’ skills in the application of Non-Pneumatic Anti-Shock Garment (NASG) in the management of postpartum hemorrhage.Methods: This study adopted quasi-experimental research design. The study was done in two secondary health facilities in the state. Sixty-eight midwives participated in the study. Simple random sampling technique was used to select 37 and 31 midwives into experimental and control groups respectively. Written consent was obtained from all the participants. The study involved three stages; Pre-test, an intervention and a post test. Questionnaire and observation rating scale that elicited demographic characteristics, knowledge and skills on the application and removal of NASG was used to collect data pre and post intervention. Data was analyzed using descriptive and inferential statistics.Results: Mean knowledge score of midwives in the control group in the use of NASG in the management of PPH was found to be 10.32±4.17 compared with 12.24±5.05 in experimental group pre-intervention. There was a significant increase in knowledge and skills of NASG application, nonetheless the post intervention from experimental group had the highest increase from 6.32±4.97 to 17.14±0.95.Conclusions: Educational intervention enhanced skills of midwives in the use of NASG. Therefore, continuous education units in hospitals should include periodic training of midwives on the use of NASG.
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Shengmai San was first recorded in Medical Origin and Insights, a medical book written by ZHANG Yuan\|su. Shengmai San composed of Ginseng Radix et Rhizoma, Ophiopogonis Radix and Schiandrae Chinensisin Fructus. Ginseng Radix et Rhizoma as the monarch drug in the prescription has effects in invigorating vigour potently, and promoting production of body fluid to quench thirst. Ophiopogonis Radix as a sweet-cold minister drug has effects in nourishing yin, clearing heat and generating fluid and moistening lung to stop cough in the prescription. Both medicines are combined to have a good effect in replenishing Qi. Schiandrae Chinensisin Fructus is an adjuvant medicine, with effects in acid astringency, retaining Yin with astringent and hidroschesis. Ginseng Radix et Rhizoma has effects in strengthening the healthy energy, and Ophiopogonis Radix has a effect in retaining yin with astringent. It is a classic prescription for treating deficiency of Qi and Yin. With the in-depth research of modern medical experts, it is found that Shengmai San not only has a significant therapeutic effect on cardiovascular diseases, central nervous system diseases and endocrine system diseases, but also a good effect on digestive system diseases, immune system and hematopoietic system diseases and shock. As China's aging population, irregular diet and other problems become increasingly serious, the incidences of cardiovascular diseases, senile dementia, cerebral infarction, diabetes, liver dysfunction and other diseases have become higher and younger, which is a serious threat to human health. Therefore, by consulting a large number of domestic literatures, the authors respectively elaborated the therapeutic effect and mechanism of Shengmai San and its modified prescriptions on the above diseases, with the aim to reveal the target and mechanism of this prescription on the above diseases, provide theoretical basis for better treatment of the above diseases and promote the clinical application of this prescription. In addition, it provides reference ideas for the research of other classical famous formula.
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Resumen OBJETIVO Revisar la experiencia con el traje antichoque no neumático y su integración a los protocolos de atención médica de la paciente con hemorragia obstétrica. MÉTODO Estudio retrospectivo consistente en la búsqueda de artículos en español e inglés que aluden a la hemorragia obstétrica y al traje antichoque no neumático indizados en las bases de datos de PubMed, Cocharne, Embase, Ebsco y Lilacs que reunieran los siguientes requisitos: contenter los términos relacionados: traje antichoque no neumático, non-pneumatic anti-shock garment, hemorragia posparto, postpartum haemorrhage, hemorragia obstétrica, obstetric haemorrhage, choque hipovolémico, hipovolemic shock. CONCLUSIONES La hemorragia obstétrica sigue siendo una de las principales causas de morbilidad y mortalidad materna. La innovación e integración de fármacos y tecnologías, acompañadas de la acumulación de experiencia son decisivas en la resolución de las complicaciones maternas. Está ampliamente demostrada la efectividad y seguridad del traje antichoque no neumático en el tratamiento de la hemorragia obstétrica; sin embargo, hoy día poco se ha utilizado en México.
Abstract OBJECTIVE Conduct a review of the results of the NASG/TANN and its integration into the management of obstetric hemorrhage protocols. Disseminate knowledge of its effectiveness, characteristics, indications, and appropriate use through continuing medical education activities. METHOD Research was conducted on the existence of items that meet the following requirements: Reviewed both English and spanish terms associated with the non-pneumatic anti-shock suit (NASG/TANN). Postpartum Hemorrhage (PPH). Hemorragia postparto. Obstetric hemorrhage (HO). Hemorragia obstétrica. Hypovolemic shock, Choque hipovolémico, whether published in English or Spanish, with reference to human patients. Analysed all the items found in Spanish and English in the following search engines: PubMed, Cocharne, Embase, Ebsco, and Lilacs; and all that reveal a relation between obstetric hemorrhage and the non-pneumatic anti-shock costume. None has been published in a Mexican journal. CONCLUSIONS Obstetric hemorrhage continues to be one of the leading causes of morbidity and mortality. Innovation and integration of drugs and technology, accompanied by the acquisition of proficiency in their use, have been and are fundamental to the management of maternal complications. There is enough scientific evidence to demonstrate the effectiveness and safety of the non-pneumatic anti-shock garment in the management of obstetric hemorrhage; unfortunately, up to the present, little has been implemented in Mexico.
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This paper introduces a novel trousers,whose theory is to drive blood by inflated pressure.Being light-weight,small and effective,easy to carry,store and operate,it is postured for first aid and resuscitation of hospital patients with severe shock,and also can be applied to bleeding remission,hemorrhagic as well as fracture immobilization.
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In this experiment, paired comparisons were made between 32 pairs of selected rats. Each pair was randomly divided into electroacupuncture and control groups. The alterations of noradrenaline in "Zusanli" (S 36, 足三里) area were observed by fluorescence histochemical technique of De La Torre "SPG" to visualize catecholamine during electro-acupuncture analgesia and anti-shock, and the possible role of the above effects was studied.1. When bilateral "Zusanli" point area was stimulated by electro-acupuncture for 30 minuts, the pain threshold of this group was markedly incerased (P