Manejo de la hemorragia posparto en una paciente con útero bicorne con la sutura B-Lynch. Reporte de caso y revisión de la literatura / Management of postpartum hemorrhage in a patient with bicornuate uterus using the B-Lynch suture. Case report and review of the literature

Objetivos: Describir un caso de manejo con sutura de B-Lynch en una mujer con útero bicorne que presenta hemorragia posparto (HPP), y realizar una revisión de la literatura acerca de las estrategias de control quirúrgico de la HPP en pacientes con malformaciones müllerianas, los resultados maternos en términos de control de la hemorragia, así como las complicaciones tempranas y tardías. Materiales y métodos: Se reporta el caso de una paciente con útero bicorne, atendida en un hopsital de referencia regional, que, posterior a parto por cesárea, presenta hemorragia posparto, la cual es controlada con éxito empleando la sutura de B-Lynch. Se realizó una búsqueda en las siguientes bases de datos: PubMed, Embase, Medline, Google Scholar y LILACS. Se emplearon los términos MeSh: "Uterine Atony", "Postpartum Hemorrhage", "Immediate Postpartum Hemorrhage", "Bicornuate Uterus", "Mullerian Anomalies", "Mullerian Ducts Abnormalities", "Uterine Compression Suture". Se incluyeron reportes y series de casos que hubieran incluido pacientes con malformaciones müllerianas con HPP que no respondieran al manejo farmacológico inicial, con uso de procedimientos quirúrgicos conservadores para el control de la hemorragia. Se hace análisis narrativo de los hallazgos respecto a las características de los estudios, técnicas utilizadas y complicaciones. Resultados: Se seleccionaron 5 estudios, 4 de tipo reporte de caso y 1 serie de casos, que corresponden a 12 mujeres con malformación uterina que desarrollaron HPP, en las cuales se empleó manejo quirúrgico (suturas de compresión uterina), y con dispositivo (tipo balón intrauterino) para el control de la hemorragia, logrando controlar el sangrado en 11 casos, solo una (8,3 %) requirió histerectomía. No se reportan complicaciones a largo plazo. Conclusiones: El manejo de la HPP en mujeres con malformaciones uterinas müllerianas cuenta con una literatura limitada a reportes de casos, con uso tanto de suturas compresivas como dispositivos médicos tipo balones intrauterinos. La sutura compresiva tipo B-Lynch parece ser una buena alternativa en el control de la HPP en estas mujeres con el fin de preservar la fertilidad, con baja tasa de complicaciones. Se requiere continuar documentando este tipo de casos con el fin de consolidar evidencia de la utilidad de esta técnica en el control del sangrado uterino posparto en esta población.

Objectives: To describe the use of the B-Lynch suture in a case of postpartum hemorrhage of a woman with bicornuate uterus, and to carry out a review of the literature on PPH control strategies in patients with müllerian anomalies, maternal outcomes in terms of hemorrhage control, as well as early and late complications. Material and methods: Case report of a patient with bicornuate uterus who presented to a regional referral hospital with postpartum hemorrhage following a cesarean section, which was successfully controlled using the B-Lynch suture. A search was conducted in the PubMed, Embase, Medline, Google Scholar and LILACS databases. The MeSh terms used were: "Uterine Atony," "Postpartum Hemorrhage," "Immediate Postpartum Hemorrhage," "Bicornuate Uterus," "Müllerian Anomalies," "Müllerian Duct Abnormalities". Case reports and case series of patients with müllerian malformations and PPH not responding to initial pharmacological management in whom conservative surgical procedures were used to control bleeding were included. A narrative analysis of the findings was carried out based on study characteristics, techniques used and complications. Results: Five studies were selected, 4 case reports and 1 case series which included 12 women with uterine malformations who developed PPH and in whom surgical management (uterine compression sutures) or devices (intrauterine balloon) were used for hemorrhage control. Bleeding was successfully controlled in 11 cases, with hysterectomy required only in one case (8.3 %). No long-term complications were reported. Conclusions: The literature on PPH management in women with müllerian uterine malformations is limited to case reports in which either compression sutures or medical devices such as intrauterine balloons were used. The B-Lynch-type compression suture appears to be a good option for controlling PPH in these women in order to preserve fertility, with a low rate of complications. Further documentation of these types of cases is needed in order to build the evidence regarding the usefulness of this technique for controlling postpartum uterine bleeding in this population.

Dystocia Due to Secondary Uterine Inertia and its Obstetrical Management- A Case Report

Background: A full-term pregnant Ongole cow was presented to the Large Animal Obstetrical Ward with a history of reduced feed intake, dull and ruptured foetal membranes 24 hours before presentation without progress in parturition. The temperature was within the normal physiological range. Per-vaginal examination revealed second-degree cervical dilation, lack of uterine and abdominal contractions and the vaginal discharges were reddish brown and putrid. Methods: The case was diagnosed as secondary uterine inertia and treated with an intracervical application of misoprostol and intravenous calcium therapy. Results: Three hours after the application of misoprostol and calcium therapy, full dilatation of the cervix was achieved to facilitate the delivery of the dead male emphysematous foetus by traction. Uneventful recovery of the dam was noticed. Conclusion: Usage of misoprostol along with CMC massage and calcium therapy resulted in speedy recovery of dystocia suffering with incomplete cervical dilation.

Factores asociados a atonía uterina

La hemorragia postparto (HPP) es la patología de mayor transcendencia con respecto a mortalidad materna, siendo esta una de las principales preocupaciones de la salud pública. La atonía uterina es la principal causa de HPP. Objetivo : Determinar los factores asociados al desarrollo de atonía uterina. Métodos : Estudio observacional analítico de casos y controles de 4,148 pacientes puérperas inmediatas atendidas en el servicio de Obstetricia del Hospital Regional Docente de Trujillo, Perú, entre los años 2009 y 2019; 1,037 pacientes presentaron atonía uterina y 3,111 fueron los controles. Resultados : Al realizar el análisis bivariado, las variables que presentaron significancia estadística como factores asociados para el desarrollo de atonía uterina fueron el parto por cesárea [OR 1,98 (IC 95%: 1,71 a 2,29)], proceder de la sierra [OR 1,38 (IC 95%: 1,12 a 1,70)], el embarazo múltiple [OR 4,48 (IC 95%: 3,43 a 5,83)], parto disfuncional [OR 1,82 (IC 95%: 1,44 a 2,31)] y feto macrosómico [OR 1,37 (IC 95%: 1,08 a 1,73)]. Por otro lado, se mostraron como factores no asociados con significancia estadística el haber sido primípara [OR 0,79 (IC 95%: 0.65 a 0,94)] y el ser multípara [OR 0,82 (IC 95%: 0,69 a 0,97)]. Conclusiones : Los factores asociados al desarrollo de atonía uterina fueron la cesárea como vía de culminación del parto, el ser procedente de la sierra, y haber tenido un feto macrosómico, polihidramnios y embarazos múltiples.

Postpartum hemorrhage (PPH) is the most important pathology in terms of maternal mortality, being one of the main public health concerns. Uterine atony is the main cause of PPH. Objective : To determine the factors associated with the development of uterine atony. Methods : Observational analytical case-control study of 4,148 immediate postpartum patients attended at the Obstetrics Department of the Hospital Regional Docente de Trujillo, Peru, between 2009 and 2019; 1,037 patients presented uterine atony and 3,111 were controls. Results : When performing the bivariate analysis, the variables that presented statistical significance as associated factors for the development of uterine atony were cesarean delivery [OR 1.98 (95% CI: 1.71-2.29)], being from the highlands [OR 1.38 (95% CI: 1.12-1.70)], multiple pregnancy [OR 4.48 (95% CI: 3.43-5.83)], dysfunctional delivery [OR 1.82 (95% CI: 1.44-2.31)] and macrosomic fetus [OR 1.37 (95% CI: 1.08-1.73)]. On the other hand, having been primiparous [OR 0.79 (95% CI: 0.65-0.94)] and being multiparous [OR 0.82 (95% CI: 0.69-0.97)] were shown as factors not associated with statistical significance. Conclusions : Factors associated with the development of uterine atony were cesarean section as the route of delivery, being from the highlands, and having had a macrosomic fetus, polyhydramnios and multiple pregnancies.

Laparohysterotomy for Managing Dystocia due to Uterine Inertia in a Sow: A Case Report

A nondescript sow with the history of delivering eight piglets and one remain in uterus since three days but unable to deliver was reported. The case was diagnosed as dystocia due to uterine inertia and laparohysterotomy was performed under general anesthesia, one male dead piglet was recovered successfully. The animal showed uneventful recovery.

Reproductive diseases in captive Agoutis (Dasyprocta leporina) / Doenças reprodutivas em cutias em cativeiro (Dasyprocta leporina)

Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normal presentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding management and space allowance given to the agouti in late gestation may be contributing factors.

As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical., Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi o de uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal., A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Reproductive diseases in captive Agoutis (Dasyprocta leporina) / Doenças reprodutivas em cutias em cativeiro (Dasyprocta leporina)

Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normalpresentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding [...].

As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical. Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi ode uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal. A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Reproductive diseases in captive Agoutis (Dasyprocta leporina)

Abstract Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normal presentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding management and space allowance given to the agouti in late gestation may be contributing factors.

Resumo As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical., Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi o de uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal., A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Effect of Anrou-pressing and kneading Hegu (LI 4) and Sanyinjiao (SP 6) on uterine inertia during painless parturition / 针灸推拿医学（英文版）

Objective: To observe the effect of Anrou-pressing and kneading Hegu (LI 4) and Sanyinjiao (SP 6) on uterine inertia during painless parturition. Methods: A total of 100 cases of patients with uterine inertia during painless parturition were randomized into an acupoint group and a medicine group by the SPSS programming, with 50 cases in each group. Patients in the acupoint group received the treatment of Anrou-pressing and kneading bilateral Hegu (LI 4) and Sanyinjiao (SP 6), while patients in the medicine group received intravenous oxytocin. The labor time and maternal-child safety were evaluated, and the labor stage was compared. Results: The latent and active phases in the 1st labor stage and the 2nd labor stage in the acupoint group were substantially shorter than those in the medicine group, and the between-group comparisons showed statistical significance (all P<0.05). The between-group comparison of the 3rd labor stage showed no statistical significance (P>0.05). The postpartum hemorrhage amount in both groups was within the safe range, and the between-group comparison showed no statistical significance (P>0.05). The newborn 1 min Apgar score was ranged 8-10 points, and the between-group comparison showed no statistical significance (P>0.05). The between-group comparison of the labor stage efficacy showed statistical significance (P<0.01), with a better progression in the acupoint group. Conclusion: Anrou-pressing and kneading Hegu (LI 4) and Sanyinjiao (SP 6) is both effective and safe for uterine inertia during painless parturition.

Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony in 50 cases / 中国基层医药

Objective:To investigate the clinical efficacy of uterine compression suture in the treatment of postpartum hemorrhage resulting from uterine atony.Methods:100 patients with postpartum hemorrhage due to uterine atony who received treatment between May 2017 and May 2018 in the First People's Hospital of Yongkang were included in this study. They were randomly assigned to undergo either conventional uterine suture (control group, n = 50) or uterine compression suture (observation group, n = 50). Clinical efficacy was compared between the observation and control groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [94.0% (47/50) vs. 68.0% (34/50), χ2 = 12.421, P < 0.01]. There was no significant difference in operative time between observation and control groups [(62.99 ± 10.87) minutes vs. (60.98 ± 8.12) minutes, t = 1.048, P > 0.05]. The amount of blood loss within 2 and 24 hours postpartum, abdominal circumference, and uterine height in the observation group were (216.85 ± 16.85) mL, (356.19 ± 25.71) mL, (98.56 ± 5.86) cm and (35.17 ± 2.33) cm respectively, which were significantly less or lower than those in the control group [(485.29 ± 28.41) mL, (596.38 ± 34.18) mL, (108.59 ± 2.65) cm, and (38.45 ± 4.19) cm, t = 85.652, 65.325, 16.584, 3.256, all P < 0.05]. The incidence of complications in the observation group was significantly lower than that in the control group [4.0% (2/50) vs. 28.0% (14/50), χ2 = 12.032, P < 0.01]. Conclusion:Uterine compression suture for the treatment of postpartum hemorrhage resulting from uterine atony has greater clinical efficacy and leads to lower incidence of complications than conventional suture technique.

Indicadores clínico epidemiológicos y materno-fetales de atonía uterina en puérperas post cesárea primaria en una clínica privada de agosto 2017 ­ agosto 2018 / Materno-fetal clinical epidemiological and indicators of uterine atony in puerarpas post primary cesárea in a private clinic of august 2017 - august 2018

Objetivo: Determinar la asociación entre indicadores clínico ­ epidemiológicos materno - fetales y la presencia de atonía uterina en puérperas post cesárea primaria en la clínica privada durante el período de Agosto 2017 ­ Agosto 2018. Métodos: Se realizó un estudio observacional, analítico, retrospectivo y cuantitativo, tipo casos y controles. La variable dependiente fue la atonía uterina, y las variables independientes fueron edad materna, gestación múltiple, polihidramnios, gestación, paridad, anemia materna, enfermedades concomitantes, peso fetal, presentación fetal e indicación de cesárea. La población estuvo conformada por 106 casos y 212 controles (ratio 2:1). Para la estadística inferencial se utilizó el análisis bivariado para hallar los Odds Ratio, intervalos de confianza al 95%. Se consideró a los valores p<0,05 como estadísticamente significativos. Resultados: De los 318 pacientes del estudio, la media de la edad fue de 30,87 ± 0,298 años, de los controles fue de 28 ± 0,423 años mientras que de los casos 33 ± 0,168 años. Las variables asociadas en el análisis bivariado a atonía uterina fueron la edad mayor de 30 años, gestación múltiple, polihidramnios, bajo peso al nacer y macrosomía. Mientras que en análisis multivariado fueron polihidramnios (OR: 5,973 IC95%: 2,443-14,603) y macrosomía (OR: 6,280 IC95%: 2,307-17,095). Conclusión: Se concluye que, se encontró asociación de atonía uterina con los indicadores de polihidramnios y macrosomía fetal.

Objective: To determine the association between maternal - fetal clinical - epidemiological indicators and the presence of uterine atony in post - caesarean primary puerperae at the Good Hope clinic during the period of August 2017 - August 2018. Methods: An observational, analytical, retrospective and quantitative study, type of cases and controls was carried out. The dependent variable was uterine atony, and the independent variables were maternal age, multiple gestation, polyhydramnios, pregnancy, parity, maternal anemia, concomitant diseases, fetal weight, fetal presentation and indication of cesarean section. The population consisted of 106 cases and 212 controls (ratio 2: 1). For the inferential statistics, the bivariate analysis was used to find the Odds Ratio, 95% confidence intervals. The values p <0.05 were considered statistically significant. Results: Of the 318 patients in the study, the mean age was 30.87 ± 0.298 years. Associated variables to uterine atony in the bivariate analysis were age over 30 years, multiple gestation, polyhydramnios, low birth weight and macrosomia. In multivariate analysis were polyhydramnios (ORa: 5,973, 95% CI: 2,443-14,603) and macrosomia (ORa: 6.280, 95% CI: 2.307-17.095). Conclusion: It is concluded that, association of uterine atony with polyhydramnios indicators and fetal macrosomia was found.

The application timing and curative effect of carprostol tromethamine in the treatment of postpartum hemor-rhage due to uterine atony / 中国基层医药

Objective To explore the application timing of carprostol tromethamine in the treatment of postpartum hemorrhage due to uterine atony ,and to observe the clinical efficacy.Methods From January 2016 to June 2018,62 patients with uterine atony and postpartum hemorrhage admitted to the Second People 's Hospital of Lianyungang were selected as study objects ,and they were randomly divided into two groups according to the digital table,with 31 cases in each group.In the control group,after the delivery of the fetus ,20U of oxytocin was intrave-nously injected.If there was active hemorrhage on the dissection surface of the placenta ,40U of oxytocin was contin-ued.If there was still hemorrhage,the uterus was injected with 250μg of carprostol tromethamine.In the observation group,after the delivery of the fetus ,20U of oxytocin was intravenously injected.If there was active hemorrhage on the dissection surface of the placenta ,250μg of carprostol tromethamine was injected immediately.If the patients in the two groups still had active bleeding in the uterus after the above treatments ,the uterine cavity was filled with gauze or uterine artery ligation was performed to stop bleeding.The blood loss during the operation ,2h and 24h after surgery were recorded and compared between the two groups.The 24h postpartum hemoglobin (Hb) decreased value,treatment efficacy and the incidence of adverse reactions were also recorded and compared between the two groups . Results The intraoperative blood loss was (1 066.1 ±71.3) mL in the observation group,which was significantly lower than that in the control group [(1 163.6 ±70.9) mL],the difference was statistically significant ( t＝5.393, P＜0.001).There were no statistically significant differences in 2h and 24h postoperative blood loss between the two groups (all P＞0.05).The decrease of Hb in the observation group at 24h after birth was (20.80 ±6.25)g／L,which was lower than that in the control group [(26.90 ±9.21) g／L],and the difference was statistically significant ( t＝ 3.033,P＜0.01).The treatment effective rate of the observation group was 87%(27／31),which of the control group was 77%( 24／31 ), there were no statistically significant differences between the two groups ( P ＞0.05 ). Conclusion Postpartum hemorrhage caused by uterine atony can be treated by early use of carprostol tromethamine , which can effectively reduce postpartum bleeding and promote the rehabilitation of patients .The curative effect is better than oxytocin,and it is worthy of clinical application.

The application timing and curative effect of carprostol tromethamine in the treatment of postpartum hemorrhage due to uterine atony / 中国基层医药

Objective@#To explore the application timing of carprostol tromethamine in the treatment of postpartum hemorrhage due to uterine atony, and to observe the clinical efficacy.@*Methods@#From January 2016 to June 2018, 62 patients with uterine atony and postpartum hemorrhage admitted to the Second People′s Hospital of Lianyungang were selected as study objects, and they were randomly divided into two groups according to the digital table, with 31 cases in each group.In the control group, after the delivery of the fetus, 20U of oxytocin was intravenously injected.If there was active hemorrhage on the dissection surface of the placenta, 40U of oxytocin was continued.If there was still hemorrhage, the uterus was injected with 250μg of carprostol tromethamine.In the observation group, after the delivery of the fetus, 20U of oxytocin was intravenously injected.If there was active hemorrhage on the dissection surface of the placenta, 250μg of carprostol tromethamine was injected immediately.If the patients in the two groups still had active bleeding in the uterus after the above treatments, the uterine cavity was filled with gauze or uterine artery ligation was performed to stop bleeding.The blood loss during the operation, 2h and 24h after surgery were recorded and compared between the two groups.The 24h postpartum hemoglobin(Hb) decreased value, treatment efficacy and the incidence of adverse reactions were also recorded and compared between the two groups.@*Results@#The intraoperative blood loss was (1 066.1±71.3)mL in the observation group, which was significantly lower than that in the control group [(1 163.6±70.9)mL], the difference was statistically significant(t=5.393, P<0.001). There were no statistically significant differences in 2h and 24h postoperative blood loss between the two groups (all P>0.05). The decrease of Hb in the observation group at 24h after birth was (20.80±6.25)g/L, which was lower than that in the control group [(26.90±9.21)g/L], and the difference was statistically significant(t=3.033, P<0.01). The treatment effective rate of the observation group was 87%(27/31), which of the control group was 77%(24/31), there were no statistically significant differences between the two groups(P>0.05).@*Conclusion@#Postpartum hemorrhage caused by uterine atony can be treated by early use of carprostol tromethamine, which can effectively reduce postpartum bleeding and promote the rehabilitation of patients.The curative effect is better than oxytocin, and it is worthy of clinical application.

Study on risk factors of postpartum hemorrhage in elderly parturients after cesarean section / 中国基层医药

Objective@#To investigate the risk factors of postpartum hemorrhage in elderly parturients after cesarean section based on logistic regression analysis and to explore nursing strategies.@*Methods@#From January 2018 to March 2019, a total of 210 elderly women with cesarean section and postpartum hemorrhage in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected as the study group.And 420 elderly women who underwent cesarean section and did not have bleeding were selected as the control group, which may cause postoperative bleeding.Factors were analyzed and multivariate logistic regression analysis was performed on the factors that caused significant effects.@*Results@#The incidence of pregnancy hypertension, abortion history, uterine atony, macrosomia and placenta previa in the observation group was significantly higher than that in the control group (t=4.118-83.345, P=0.000-0.042). There were no statistically significant differences in gestational diabetes mellitus, postpartum hemorrhage, coagulation function and depression between the two groups(t=0.006-0.788, P=0.375-0.938). Multivariate logistic regression analysis showed that gestational hypertension, history of abortion, uterine atony, macrosomia and placenta previa were risk factors for postpartum hemorrhage in elderly parturients after cesarean section (OR=2.114-19.521, P=0.035-0.001).@*Conclusion@#Pregnancy-induced hypertension, history of abortion, uterine atony, macrosomia and placenta previa are the main factors affecting postpartum hemorrhage in elderly women with cesarean section.This provides an effective basis for the nursing of cesarean section postpartum hemorrhage in elderly women.

Study on risk factors of postpartum hemorrhage in elderly parturients after cesarean section / 中国基层医药

Objective To investigate the risk factors of postpartum hemorrhage in elderly parturients after cesarean section based on logistic regression analysis and to explore nursing strategies .Methods From January 2018 to March 2019, a total of 210 elderly women with cesarean section and postpartum hemorrhage in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected as the study group .And 420 elderly women who underwent cesarean section and did not have bleeding were selected as the control group ,which may cause postoperative bleeding.Factors were analyzed and multivariate logistic regression analysis was performed on the factors that caused significant effects.Results The incidence of pregnancy hypertension ,abortion history,uterine atony, macrosomia and placenta previa in the observation group was significantly higher than that in the control group (t＝4.118-83.345,P＝0.000-0.042).There were no statistically significant differences in gestational diabetes mellitus , postpartum hemorrhage,coagulation function and depression between the two groups (t＝0.006-0.788,P＝0.375-0.938).Multivariate logistic regression analysis showed that gestational hypertension , history of abortion, uterine atony,macrosomia and placenta previa were risk factors for postpartum hemorrhage in elderly parturients after cesarean section (OR＝2.114 -19.521,P ＝0.035 -0.001 ).Conclusion Pregnancy -induced hypertension,history of abortion,uterine atony,macrosomia and placenta previa are the main factors affecting postpartum hemorrhage in elderly women with cesarean section.This provides an effective basis for the nursing of cesarean section postpartum hemorrhage in elderly women.

Indicaciones del factor VII recombinante activado en hemorragia obstétrica grave / Use of recombinant activated Factor VII in severe obstetric hemorrhage

Resumen OBJETIVO: Describir la situación final de salud de las pacientes con hemorragia obstétrica grave (≥ 1000 mL) en quienes se indicó factor VII recombinante activado como parte del tratamiento e identificar las complicaciones atribuibles a este medicamento. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo efectuado en pacientes con hemorragia obstétrica grave atendidas en el Hospital Civil de Guadalajara Dr. Juan I Menchaca entre 2001 y 2017 y tratadas con factor VII recombinante activado. Se identificaron los antecedentes de importancia y se calculó la dosis promedio y cantidad de dosis de factor VII recombinante activado; se valoró la respuesta hemostática y se determinó si la diferencia en cantidad de sangrado, administración de hemoderivados y parámetros hematológicos antes y después de utilizar factor VII recombinante activado fue significativa. RESULTADOS: Se identificaron 10 pacientes en quienes se aplicó factor VII recombinante activado. La causa de hemorragia obstétrica grave fue atonía uterina en seis casos. La dosis promedio de factor VII recombinante activado fue de 91 mcg/kg. En 8 pacientes se administró una dosis y 2 dosis en 2 pacientes. En todas las pacientes se logró la hemostasia; el sangrado disminuyó significativamente posterior a la administración del factor VII recombinante activado (5075 vs 928 mL; p = 0.000) lo mismo que la cantidad de concentrados eritrocitarios trasfundidos (7 vs 3; p = 0.006). Una paciente no requirió histerectomía, otra tuvo tromboembolia pulmonar, que se trató sin problemas y ninguna paciente falleció. CONCLUSIÓN: El factor VII recombinante activado como hemostático en hemorragia obstétrica grave mostró resultados favorables y evitó la histerectomía en una paciente. Requiere vigilancia estrecha de las complicaciones trombóticas.

Abstract OBJECTIVE: To describe outcome of patients with severe obstetric hemorrhage (≥ 1000 mL) treated with rFVIIa as part of the management and to detect complications related to its use. MATERIALS AND METHODS: Retrospective, cross-sectional and descriptive study carried out in patients with severe obstetric hemorrhage treated at the Hospital Civil de Guadalajara Dr. Juan I Menchaca between 2001 and 2017 and treated with activated recombinant factor VII. We identified relevant antecedents, average dose and number of doses of rFVIIa, and hemostatic response. We determined if quantity of bleeding, administration of blood products and hematological parameters before and after using rFVIIa was significantly different. RESULTS: We identified ten patients with rFVIIa administration. The cause of severe obstetric hemorrhage was uterine atony in six cases. The average dose of rFVIIa was 91 mcg/kg; one dose was administered in eight patients and two doses in two patients. Hemostasis was achieved in all patients, bleeding decreased significantly after administration of rFVIIa (5075 mL vs 928 mL, p = 0.000) and the number of erythrocyte concentrates required 7vs 3, p = 0.006). One patient did not require a hysterectomy after rFVIIa administration; one patient presented pulmonary thromboembolism and recovered without complications, no patient died. CONCLUSION: rFVIIa administration as a hemostatic in severe obstetric hemorrhage had favorable results, preventing hysterectomy in one patient. Follow-up requires close monitoring of thrombosis.

Progress in the interventional therapy of pernicious placenta previa / 中国基层医药

With the opening of the second child policy,the incidence of pernicious placenta previa increases, which is dangerous and seriously endangers the life of pregnant and parturition. The main way of delivery is cesarean section. Reducing the risk of pernicious placenta previa is the goal of obstetrician. At present,several methods of adju-vant therapy for the pernicious placenta previa are summarized,including drug and non-drug treatment,non-drug therapy including pressurized uterine cavity filling, vascular ligation and interventional therapy. Among them, the development of interventional therapy is particularly rapid and the treatment options are varied.

Analysis of risk factors of 72 cases with postpartum hemorrhage / 中国基层医药

Objective To explore the risk factors of postpartum hemorrhage .Methods From January 2015 to January 2017,72 cases with postpartum hemorrhage in Rongjun Hospital of Lyuliang were selected in the present study.Logistic regression analysis was used to screen the risk factors of postpartum hemorrhage ,and put forward corre－sponding preventive measures according to different risk factors ,in order to reduce the incidence of postpartum hemor－rhage.Results Age[the incidence rate of postpartum hemorrhage in patients more than 33 years old was 15.63%(5/32)],childbirth way [ the incidence rate of postpartum hemorrhage in cesarean section patients was 28.57%(4/14),gestational age[the incidence rate of postpartum hemorrhage in patients with gestational age ＜41 weeks was 7.41%(4/54)],placenta previa [the incidence rate of postpartum hemorrhage was 23.08%(6/26)],the birth canal injury[the incidence rate of postpartum hemorrhage was 14.29%(5/35)],uterine inertia[the incidence rate of postpartum hemorrhage was 37.93%(22/58)],blood coagulation dysfunction [the incidence rate of postpartum hemorrhage was 8.33%(2/24)] and placenta conglutination [the incidence rate of postpartum hemorrhage was 23.08%(3/13)]had influence on postpartum hemorrhage ,through the study of the statistical analysis of a single risk factor,found that the differences were statistically significant (χ2＝15.125,22.034,15.125,22.034,7.114,25.147, 26.301,8.226,all P＜0.05).Through the analysis of single factor and multiple factors unconditioned logistic regres －sion analysis,established risk factor model and found that cesarean section ,uterine inertia,placenta conglutination conformed to the analysis results (β＝2.868,1.484,1.173,E.(β)＝0.088,0.086,0.175,S.95%CI＝3.499－22.734,2.889－6.834,1.368－3.894),but statistically significant differences were observed among different factors (OR＝16.746,4.0123,2.379,all P＜0.05).Conclusion Age,childbirth way,gestational age,placenta previa, birth canal injury, uterine inertia, blood coagulation dysfunction and placenta adhesion all can affect postpartum hemorrhage,in the process of childbirth pregnant women ,should have the possibility of various factors are positive and effective prevention,ready to related work and measures ,in patients with postpartum should also increase the intensity of nursing,preventing postpartum hemorrhage occurs .

Clinical research of carboprost methylate suppository combined with romethamine in the treatment of post-partum hemorrhage in contractions fatigue / 中国基层医药

Objective To analyze the effect of carboprost methylate suppository combined with romethamine in the treatment of postpartum hemorrhage in contractions fatigue.Methods 120 cases of postpartum hemorrhage contractions fatigue were randomly divided into control group and observation group,60 cases in each group.The control group was given carboprost methylate suppository treatment,the observation group was given romethamine com-bined with carboprost methylate suppository.The 2h,12h postpartum blood loss,clinical treatment effect and adverse reaction were compared between the two groups.Results Compared with the control group,the hemostatic time of the observation group shortened,postpartum haemorrhage amount within 2h and postnatal within 12h blood loss of the observation group were reduced,the differences were statistically significant (t=4.56,5.92,6.12,all P<0.05).The total effective rate of the control group was 73.33%,which was significantly lower than 91.67% of the observation group,the difference was statistically significant (χ2 =6.12,P <0.05 ).Compared with the control group,the incidence rates of digestive tract symptoms,disposable blood pressure fluctuations,facial blushing,puerperal infection in the observation group were lower,the differences were statistically significant (χ2 =4.71,4.98,4.34,5.43,all P<0.05).Conclusion The clinical effect of carboprost methylate suppository combined with romethamine in the the treatment of contractions fatigue postpartum hemorrhage is remarkable,with less postpartum haemorrhage amount, better treatment effect,low incidence of adverse reactions and higher security.

B-Lynch suture in the treatment of postpartum hemorrhage due to uterine atony and impact on long-term fertility / 中华围产医学杂志

Objective To evaluate the effects of B-Lynch suture for postpartum hemorrhage due to uterine atony,and to clarify its influence on long-term fertility and next pregnancy outcome.Methods We retrospectively collected the medical records of 150 women who underwent B-Lynch suture during cesarean section due to intra-operative bleeding caused by uterine atony from January 1,2006 to December 31,2013 in Peking University First Hospital.Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes.Results All the cases underwent B-Lynch suture which successfully retained the uterus.Satisfactory hemostasis was achieved in 131 women (87.3％) who underwent B-Lynch suture only,and in eighteen women (12.0％) who had bilateral uterine artery ascending branch ligation at the same time;and in one patient (0.7％) who underwent B-Lynch suture and uterine artery embolization four hours later due to poor uterine contraction.Of the 141 (94.0％) cases followed up after surgery,menstrual cycle was assessed in a total of 104 women:no changes in the menstrual cycle and bleeding volume were noted in 67 cases (64.4％),prolonged menstruation was observed in five cases (4.8％),menorrhagia in ten cases (9.6％),and hypomenorrhea in 22 cases (21.2％).Eleven women (23.9％) became pregnant and delivered in two to four years after the surgery,and all were full-term abdominal delivery.Conclusions B-Lynch suture is a simple,safe,and effective treatment for postpartum hemorrhage due to uterine atony,without significant change of menstruation.B-Lynch suture is not associated with infertility,and the postoperative pregnant outcome is good.

Treatment analysis of 118 patients with postpartum hemorrhage due to uterine inertia / 中国医师进修杂志

Objective To observe the curative effects of carboprost tromethamine injection in treatment of postpartum hemorrhage due to uterine inertia.Methods The clinical data of 118 patients with postpartum hemorrhage due to uterine inertia were analyzed retrospectively.The patients were divided into control group (68 cases) and observation group (50 cases) by treatment method.The patients in control group were given conventional treatment while the patients in observation group were given carboprost tromethamine injection on basis of conventional treatment.The postpartum blood loss after 2,24 h after treatment,the third labor time and therapeutic effects in two groups were recorded and compared.The patients in control group took carboprost tromethamine injection if conventional treatment did not work and all patients should have surgery immediately if repeatedly carboprost tromethamine injection were invalid; adverse reactions of using carboprost tromethamine injection were closely watched.Results The postpartum blood loss after 2,24 h after treatment in control group was (676 ± 86),(751 ± 70) ml,which was higher than that in observation group [(238 ± 62),(281 ± 56) ml],and there was significant difference (P ＜ 0.05).The third labor time in control group was (5.1 ± 1.9) h,which was longer than that in observation group [(2.1 ± 1.4) h],and there was significant difference(P＜ 0.05).After conventional treatment with 47 patients stopped bleeding in control group,and the effective rate was 69.1％ (47/58),while the effective rate in observation group was 96.0％ (48/50),and there was significant difference (P ＜ 0.05).Twenty-one patients in control group accepted carboprost tromethamine injection after treatment,while the traditional therapy did not work,and the effective rate increased to be 95.2％ (20/21).Among carboprost tromethamine injection treatment of 71 patients,2 cases' blood pressure increased,2 cases had facial blushing,1 case with mild headache,3 cases of diarrhea and 3 cases of nausea and vomiting (a total of 11 cases),and the incidence rate was 15.5％ (11/71),which was relatively minor.All patients were given symptomatic treatment and all rell eased within 24 h,and there were no other serious adverse reactions.Conclusion Using carboprost tromethamine injection to treat postpartum hemorrhage due to uterine inertia has more remarkable curative effects and higher clinical safety,which is worthy of clinical promotion.