Severe postpartum hemorrhage from uterine atony: a multicentric study.

OBJECTIVE: Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management. STUDY DESIGN: The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals. RESULTS: Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy. CONCLUSIONS: In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.

Hemorragia severa post-parto en la región centroamericana: manejo de la hemorragia severa post-parto por atonia uterina en los hospitales formadores de ginecólogos y obstetras en la región centroamericana de marzo 2011 a febrero de 2012 / Severe postpartum hemorrhage in Central America: management of severe postpartum hemorrhage by uterine atony in hospitals forming gynecologists and obstetricians in Central America from March 2011 to February 2012

Los avances en el manejo de enfermedades del embarazo y la reducción de la mortalidad materna han sido puntos clave de conferencias internacionales desde finales de los años ochenta y de la Cumbre del Milenio del año 2000. Las estadísticas nacionales de MM a lo largo del tiempo son cruciales para orientar la planificación de programas de salud sexual y reproductiva, y guiar las labores de promoción y la investigaciòn a nivel internacional...

Use of active management of the third stage of labour in seven developing countries.

OBJECTIVE: To document the use of active management of the third stage of labour for preventing postpartum haemorrhage and to explore factors associated with such use in seven developing countries. METHODS: Nationally representative samples of facility-based deliveries were selected and observed to determine the use of active management of the third stage of labour and associated factors. Policies on active management were assessed through document review and interviews with relevant professionals. FINDINGS: Use of a uterotonic during the third or fourth stages of labour was nearly universal. Correct use of active management of the third stage of labour was found in only 0.5% to 32% of observed deliveries due to multiple deficiencies in practice. In every country except Indonesia, policies regarding active management were conflicting. CONCLUSION: Developing countries have not targeted decreasing postpartum haemorrhage as an achievable goal; there is little use of active management of the third stage of labour, and policies regarding such management often conflict. Studies are needed to identify the most effective components of active management so that the most efficient package of practices can be promoted.

Morbilidad materna extrema: las casi-muertas en la región Centroamericana julio a diciembre de 2007 / Extreme maternal morbidity: the almost-dead in Central America in July to December 2007

El estudio de la mortalidad materna ha sido el objetivo principal para la evaluación y monitoreo de las unidades responsables de ofrecer atención materna. Los eventos de pacientes obstétricas casi-muertas se han definido como mujeres embarazadas con una condición que complicó la gestación y que pudo haber culminado en una muerte materna. El término casi-muerta (near-miss) fue utilizado por primera vez en 1991 por Stones.