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Monday, 2 December 2013

Hemorrhaging: Postpartum hemorrhage- Managements and Diagnosis

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml,  following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all  randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
Prevention and management
According to the article of Active versus expectant management in the third stage of labour (Review) by Prendiville WJ, Elbourne D, McDonald S, routine ’active management’ is superior to ’expectant management’ in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in amaternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries)(10).
 
G.4. Diagnosis and Treatments 
1. Diagnosis
The aim of diagnosis is to determine the underlined causes of the disease, inmost cases , it is caused by 4Ts. Estimation of blood loss by calibrated bags has been shown to be significantly more accurate than visual estimation at vaginal delivery. Careful monitoring of the mother's vital signs, laboratory tests, in particular coagulation testing, and immediate diagnosis of the cause of PPH are important key factors to reduce maternal morbidity and mortality(11).
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Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(10) http://apps.who.int/rhl/reviews/CD000007.pdf
(11) http://www.ncbi.nlm.nih.gov/pubmed/21332452