The effect of nifedipine used as tocolytic agent on postpartum blood loss among Filipino pregnant patients in a tertiary hospital: A prospective cohort study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.</p><p style="text-align: justify;"><strong>METHODS:</strong> A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher's exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.</p><p style="text-align: justify;"><strong>RESULTS:</strong> There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.</p>

Postpartum blood loss: visual estimation versus objective quantification with a novel birthing drape

<p><b>INTRODUCTION</b>Immediate postpartum haemorrhage (PPH) is the most common cause of maternal mortality worldwide. Most recommendations focus on its prevention and management. Visual estimation of blood loss is widely used for the early detection of PPH, but the most appropriate method remains unclear. This study aimed to compare the efficacy of visual estimation and objective measurement using a sterile under-buttock drape, to determine the volume of postpartum blood loss.</p><p><b>METHODS</b>This study evaluated patients aged ≥ 18 years with low-risk term pregnancies, who delivered vaginally. Immediately after delivery, a birth attendant inserted the drape under the patient's buttocks. Postpartum blood loss was measured by visual estimation and then compared with objective measurement using the drape. All participants received standard intra- and postpartum care.</p><p><b>RESULTS</b>In total, 286 patients with term pregnancies were enrolled. There was a significant difference in postpartum blood loss between visual estimation and objective measurement using the under-buttock drape (178.6 ± 133.1 mL vs. 259.0 ± 174.9 mL; p < 0.0001). Regarding accuracy at 100 mL discrete categories of postpartum blood loss, visual estimation was found to be inaccurate, resulting in underestimation, with low correspondence (27.6%) and poor agreement (Cohen's kappa coefficient 0.07; p < 0.05), compared with objective measurement using the drape. Two-thirds of cases of immediate PPH (65.4%) were misdiagnosed using visual estimation.</p><p><b>CONCLUSION</b>Visual estimation is not optimal for measurement of postpartum blood loss in PPH. This method should be withdrawn from standard obstetric practice and replaced with objective measurement using the sterile under-buttock drape.</p>

Effect of injection Tranexamic acid on peri-operative blood loss during Cesarean section

Background: The achievement of safe child birth by caesarean delivery (CD) was one of the greatest medical advances of the 20th century. Indeed, CD is now the most frequent operation performed, consulting approximately one third of all deliveries annually. Aim: To evaluate the effect of preoperative administration of Injection tranexamic acid on blood loss during and 2 hrs after elective caesarean delivery. Materials and methods: This study was a prospective observational study for a period of 15 months; randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. Results: A comparative study was undertaken to study the effect of inj. TXA on blood loss during and after Cesarean delivery. The mean age in tranexamic group was 23.40±3.06 while in control group was 23.59±3.56. 64% fall in age group 21-25 years. In Gravida Distribution, majority of the patients in both the groups are of Gravida 2 (Group A 65% and Group B 64%). The mean ± SD was 2.17 ± 0.65 in study group and 2.2 ± 0.56 in control group. Comparison of blood loss between two groups, intra-operative blood loss was lower in the study group than in the control group 375±69 vs 410±79.9 and is statistically significant. The mean postpartum blood loss was also in the study group than in the control group 52±30 Vs 131±42 and was statistically significant. Conclusion: Tranexamic acid injection significantly reduces the perioperative blood elective Cesarean section, if given prior to the skin incision, without significant adverse effects.