dinoprost and Postpartum-Hemorrhage

Bernard-Soulier Syndrome is a rare hereditary thrombocytopathy that manifests clinically by excessive bleeding out of proportion to the degree of thrombocytopenia. Only eight reports of Bernard-Soulier Syndrome in pregnancy have been previously described. In some patients the pregnancy course was smooth while in others post-partum haemorrhage was the most common complication. We present a primiparous female who had immediate and delayed post-partum haemorrhage that was managed conservatively. Review of the literature is also included.

Topics: Adult; Bernard-Soulier Syndrome; Consanguinity; Crystalloid Solutions; Dinoprost; Female; Humans; Isotonic Solutions; Oxytocin; Plasma Substitutes; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic

Topics: Dinoprost; Dinoprostone; Dose-Response Relationship, Drug; Female; Humans; Postpartum Hemorrhage; Pregnancy; Prostaglandins; Prostaglandins E, Synthetic; Prostaglandins F, Synthetic; Puerperal Disorders; Uterine Inertia

Prostaglandins, particularly PGE2 vaginally, can be valuable for cervical ripening or induction of labour in some women. Ease of use must not be allowed to result in unjustified intervention. Amniotomy followed by oxytocin infusion are the methods of choice for induction of labour. Careful monitoring of the maternal and fetal condition are vital, especially if an epidural block is in place. Augmentation of labour is only appropriate for inefficient primigravid labour. Failure to progress in a multiparous woman is more likely to be due to obstruction. Low residue, easily digested foodstuffs are not necessarily contraindicated during normal labour. When properly used, Entonox can provide analgesia equivalent to 75-100 mg pethidine. Sodium citrate is the antacid of choice during labour and should be combined with an H2-receptor blocking agent for caesarean section, or other procedure involving anaesthesia. The routine injection of Syntometrine at delivery of the anterior shoulder to prevent PPH is widespread in the UK but has not been properly tested. Oxytocics are invaluable in the treatment of PPH.

Topics: Anesthesia, General; Anesthesia, Obstetrical; Antacids; Dinoprost; Dinoprostone; Drug Combinations; Ergonovine; Female; Fluid Therapy; Histamine H2 Antagonists; Humans; Labor, Induced; Meperidine; Nitrous Oxide; Oxygen; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prostaglandins E; Prostaglandins F

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.

Topics: Adolescent; Adult; Dinoprost; Female; Humans; Methylergonovine; Oxytocics; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third

Topics: Administration, Rectal; Dinoprost; Female; Humans; Injections, Intramuscular; Labor Stage, Third; Misoprostol; Oxytocics; Postpartum Hemorrhage; Pregnancy

In a prospective, open-label, assessor-blind, randomised parallel group study the efficacy and safety of Hemabate (Pharmacia-Upjohn Pharmaceuticals, Milton Keynes, Buckinghamshire) an analogue of 15-methyl-prostaglandin (PGF2alpha) analogue was compared with Syntometrine (Alliance Pharmaceuticals, Chippenham, Wilts) the standard combination of ergometrine and syntocinon used for the active management of the third stage of labour and the prevention of primary postpartum haemorrhage (PPH). The study was set in a district general hospital with approximately 4,000 deliveries annually. The study was discontinued at the time of the interim analysis because of unacceptable gastrointestinal side effects. At the time of the interim analysis, a total of 529 women had completed the study with 263 randomised to receive PGF2alpha and 266 to receive ergometrine and syntocinon. In a pre-specified subgroup analysis, women delivered vaginally were further subdivided into those considered to be at high or low risk of primary PPH. The measured blood loss and incidence of PPH was similar in both treatment groups whether delivered by caesarean section or vaginally independent of whether women were considered to be at high or low risk. Adverse gastrointestinal events were recorded more often in the Hemabate group. The most common symptom was diarrhoea which occurred in 21% of women who received Hemabate compared to only 0.8% of Syntometrine users. PGF2alpha is as effective as Syntometrine in the prophylaxis of primary PPH in all groups studied but there was a statistically significantly increased risk of diarrhoea among users of PGF2alpha.

Topics: Adult; Blood Pressure; Body Height; Body Weight; Carboprost; Cesarean Section; Dinoprost; Disease Susceptibility; Drug Combinations; Ergonovine; Female; Gastrointestinal Diseases; Humans; Nausea; Oxytocin; Parity; Postpartum Hemorrhage; Pregnancy; Random Allocation; Single-Blind Method; Tromethamine

Severe postpartum hemorrhage is a significant contributor to maternal morbidity and mortality. The use of prostaglandin F2-alpha to control severe postpartum hemorrhage may avert surgery for the control of bleeding.. After ruling out the possibility of genital tract injuries, 18 patients with severe postpartum hemorrhage caused by uterine atony were enrolled in the study. None of the patients responded to treatment with oxytocin, methylergonovine, or uterine massage. A Foley catheter was introduced into the uterine cavity and the balloon was inflated with 5 ml sterile saline solution. The catheter was connected to an infusion line of 500 ml saline solution containing 20 mg prostaglandin F2-alpha. The solution was infused at a rate of 3-4 ml/minute for the first 10 min, and then reduced to 1 ml/minute for a period of 12 24 hours.. In 17 patients (94.4%) bleeding ceased within several minutes of initiation of intrauterine prostaglandin F2-alpha infusion, the uterus was firmly contracted and uterine bleeding did not recur. In one patient with placenta increta bleeding continued and hysterectomy was performed. None of the patients had any side effects.. Intrauterine irrigation with low concentrations of prostaglandin F2-alpha is a simple, rapid and effective treatment for severe postpartum hemorrhage and facilitates constant and continuous hemostasis. Moreover, the minute dosage used eludes potentially complicating side effects.

Topics: Dinoprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Therapeutic Irrigation; Treatment Outcome; Uterine Inertia; Uterus

Topics: Abortion, Induced; Clinical Trials as Topic; Dinoprost; Female; Humans; India; Multicenter Studies as Topic; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Random Allocation

To describe the management and outcomes of placenta accreta, increta, and percreta in the UK.. A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS).. All 221 UK hospitals with obstetrician-led maternity units.. All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011.. Prospective case identification through the monthly mailing of UKOSS.. Median estimated blood loss, transfusion requirements.. A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001).. Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.

Topics: Blood Transfusion; Cesarean Section; Cohort Studies; Dinoprost; Ergonovine; Female; Humans; Hysterectomy; Misoprostol; Oxytocics; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Treatment Outcome; United Kingdom; Uterine Artery Embolization

To determine whether the introduction of a postpartum hemorrhage (PPH) patient safety program was associated with changes in patient care or outcomes.. A multipronged patient safety program regarding PPH was instituted at a tertiary care maternity hospital. Patient care and outcomes were assessed for 6 months prior to (period A) and 6 months after (period B) program institution.. In all, 278 and 341 women were diagnosed with PPH during periods A and B, respectively. Women who had a PPH after the program were more likely to receive more than one dose of prostaglandin F2 α (24% versus 9%, p = 0.01) and more than one type of uterotonic (34% versus 25%, p = 0.02) and to have a B-lynch suture placed (9.4% versus 4.7%, p = 0.03). The frequency of blood transfusion, hysterectomy, and intensive care unit admission were similar between periods.. Introduction of a PPH safety program resulted in several indications of a more quickly escalated response.

Topics: Blood Transfusion; Checklist; Clinical Protocols; Dinoprost; Female; Hospitals, Maternity; Humans; Hysterectomy; Intensive Care Units; Patient Safety; Postnatal Care; Postpartum Hemorrhage; Pregnancy; Program Evaluation; Retrospective Studies; Treatment Outcome

Topics: Adult; Contraindications; Dinoprost; Dinoprostone; Female; France; Guidelines as Topic; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Uterus

Topics: Blood Transfusion; Cesarean Section; Dinoprost; Female; Humans; Postpartum Hemorrhage; Pregnancy

Postpartum atony remains the most common cause life-threatening haemorrhage in obstetrics. In a case of postpartum atony unresponsive to medical treatment after Caesarean section haemorrhage was controlled and satisfactory uterine tonus was achieved by inverted sutures of the uterine fundus. Imminent hysterectomy could thus be avoided.

Topics: Adult; Cesarean Section; Combined Modality Therapy; Dinoprost; Ergonovine; Female; Humans; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy, Prolonged; Sutures; Uterine Inertia

In the authors' group of patients with haemorrhage during childbirth, in 1990-1994 a total of 28 atonic haemorrhages were recorded, 15 of them were controlled by uterotonic treatment, in the remaining 13 cases haemostasis using PG F2 alpha was applied after ruling out post-partum injury. Some patients were given moreover saline infusions. According to initial results and consistent with the literature analogues of PG F2 alpha are effective uterotonic preparations of a new generation. With regard to their simple and rapid administration they are becoming the drug of first aid in the treatment of acute atonic haemorrhage.

Topics: Dinoprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Uterine Inertia

A case report is presented of a parturient who suffered severe hypotension and pulmonary oedema following an overdose of intramyometrial prostaglandin F2 alpha. Oxytocin induction of labour in this patient led to a rapid delivery, followed by a hypotonic uterus and postpartum haemorrhage. After resuscitation with blood and crystalloid fluids, the uterus was explored under general anaesthesia. The uterus was free of retained products but the lower uterine segment failed to contract despite bimanual uterine compression and intravenous oxytocin. Prostaglandin F2 alpha was injected into the lower uterine segment via a transvaginal approach. This was rapidly followed by cardiovascular collapse and later by pulmonary oedema. The differential diagnosis and subsequent management are discussed.

Topics: Adult; Cardiac Output, Low; Dinoprost; Female; Humans; Hypotension; Injections; Myometrium; Postpartum Hemorrhage; Pregnancy; Pulmonary Edema

The authors report on five cases of massive atonic uterine haemorrhage which could be influenced neither by repeated application of oxytocin nor by methylergometrin. Intramyometrial application of PGF2 alpha succeeded in inducing a satisfactory uterine tone and stopping the haemorrhage. With regard to own experiences and data from only few publications dealing with the use of prostaglandin in atonic haemorrhage, the authors consider transvaginal intramyometrial application of PGF2 alpha to be an effective method to circumvent an emergency hysterectomy. However, this should occur sufficiently early and in a dose of not less than 1 mg.

Topics: Abortion, Induced; Adult; Dinoprost; Female; Humans; Myometrium; Postpartum Hemorrhage; Pregnancy; Prostaglandins F; Uterine Inertia; Uterine Perforation

Topics: Dinoprost; Female; Humans; Myometrium; Postpartum Hemorrhage; Pregnancy; Prostaglandins F; Prostaglandins F, Synthetic

Topics: Dinoprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Prostaglandins F; Uterine Inertia

Topics: Dinoprost; Dinoprostone; Embolization, Therapeutic; Female; Humans; Ligation; Ovary; Postpartum Hemorrhage; Pregnancy; Prostaglandins E; Prostaglandins F; Uterine Hemorrhage; Uterus

Topics: Abortion, Induced; Arachidonic Acids; Cervix Uteri; Dinoprost; Female; Humans; Labor, Induced; Maternal-Fetal Exchange; Postpartum Hemorrhage; Pregnancy; Prostaglandins; Prostaglandins F, Synthetic; Structure-Activity Relationship; Uterine Contraction; Uterine Rupture

Topics: Adult; Dinoprost; Female; Humans; Postpartum Hemorrhage; Pregnancy; Prostaglandins F; Time Factors

Five patients with severe postpartum hemorrhage due to uterine atony and unresponsive to oxytocin, ergonovine, and massage were treated with intramyometrial injection of 250 micrograms of prostaglandin (15S)-15-methyl PGF2 alpha-Tham. Four patients received 2 injections (500 micrograms), and 1 patient required 1 injection (250 micrograms). Three (60%) of 5 patients responded successfully with an increase in uterine tone and cessation of uterine hemorrhage, thus obviating the need for hysterectomy. Two patients had no uterine response, possibly because of delayed use of the drug, excessive blood loss, and accompanying shock; they required hysterectomy. Intramyometrial injection of prostaglandin is an effective and safe method of managing severe postpartum hemorrhage unresponsive to oxytocin and ergonovine, but it must be used early during the management of atony to obtain maximum effect. This method should precede surgical management of uterine atony.

Topics: Adolescent; Adult; Cesarean Section; Dinoprost; Female; Humans; Injections, Intramuscular; Myometrium; Postpartum Hemorrhage; Pregnancy; Prostaglandins F; Uterine Inertia

Severe intractable atonic postpartum hemorrhage can be treated by either uterine packing or surgical techniques. However, certain prostaglandins possess properties of potential value for the control of postpartum uterine atony. Two hundred fifty micrograms 15-methyl prostaglandin F2 alpha (15-methyl PGF2 alpha) was given intramuscularly to 16 subjects for whom a uterine pack of operative management was the only other alternative. Fifteen patients responded satisfactorily following a mean of 1.75 injections (437.5 microgram); only 1 patient required hysterectomy. The latter had a case of severe intrauterine infection. The incidence of side effects was very low. The use of intramuscularly administered 15-methyl PGF2 alpha in uncontrollable atonic postpartum hemorrhage appears to be a valuable lifesaving medical tool in critical cases.

Topics: Diarrhea; Dinoprost; Female; Humans; Hypertension; Injections, Intramuscular; Postpartum Hemorrhage; Pregnancy; Prostaglandins F, Synthetic; Uterine Contraction