Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration.

BACKGROUND: Postpartum hemorrhage (PPH) is the single most common cause of maternal death in the world, and oxytocin is known to be effective for its prevention and treatment. The use of syringes can be problematic in areas affected by HIV. The aim of this study was to introduce Uniject (a new disposable device for administration of 10 IU oxytocin) as part of active management of the third stage of labor (AMTL) and try to reduce PPH. METHODS: A prospective, comparative study was performed between March 1998 and May 2000 in Luanda. Seven hundred and eighty-two parturient women with physiological management were compared to 814 with AMTL. Postpartum lost blood was collected using a plastic sheet during labor and a bucket placed under a cholera bed for 2 h postpartum. Student's t-test and chi(2) test were used. RESULT: PPH was reduced from 40.4 to 8.2% and severe PPH (> or =1000 ml) from 7.5 to 1% in the AMTL group (P < 0.001). CONCLUSIONS: Uniject was well tolerated and offers an alternative for oxytocin administration. AMTL should be implemented also in resource-poor settings as a routine management to reduce PPH.

Use of cholera beds in the delivery room: a simple and appropriate method for direct measurement of postpartum bleeding.

Abundant obstetric bleeding is a predominant cause of maternal death, with the immediate postpartum period being the most critical time. Visual estimation of postpartum haemorrhage (PPH) often leads to severe underestimation and delay in treatment. Various methods have been developed in order to measure blood loss accurately, but none has proved appropriate in poor settings. The aim of this study was to present a method which is appropriate for measuring postpartum blood loss in a setting with limited resources. Parturient women (n = 814) with active management of third stage of labour in Luanda, Angola were studied. Vaginal bleeding immediately after birth and during the first 2 hours postpartum was collected using a combination of a plastic sheet and a bucket belowa cholera bed, in which the women rested during postpartum observation. Monitoring postpartum blood loss in the same way as cholera patients are monitored for loss of stool fluid was found to be a useful and practical way of measuring haemorrhage of parturient women after childbirth. The method described here is simple and appropriate, which makes it a good alternative to more costly methods in detecting and quantifying PPH.

Infectious aetiology of jaundice among pregnant women in Angola.

The contribution of viral hepatitis, human immunodeficiency virus (HIV) infection and malaria to jaundice among pregnant women in Luanda, Angola, was studied. 20 pregnant women with jaundice (cases) were identified in 2 large maternity hospitals and compared with 40 pregnant women without jaundice (controls). Among the cases 6 patients died, whereas no death occurred in the control group (p < 0.001). Five spontaneous abortions and 6 stillbirths were also noted among the cases, implying foetal loss in 55% and stillbirth in 30%. One stillbirth was registered among control women. Of the cases 40% had anti-hepatitis E virus antibodies compared with 13% of the controls (p = 0.02). Plasmodium falciparum parasitaemia occurred in 47.5% and 5% of cases and controls, respectively (p < 0.001). There was no difference in the prevalence of antibodies against hepatitis C or HIV among cases and controls. The carriership of hepatitis B surface antigen was 10% in both groups. In conclusion, jaundice during pregnancy is often associated with maternal mortality in Luanda, women suffering from jaundice during pregnancy have an extremely high case fatality rate, and P. falciparum and hepatitis E are associated with jaundice in the setting studied.