oxytocin and Abruptio-Placentae

Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol. Preventive measures for post-partum haemorrhage include routine active management of the third stage of labour. Treatment involves a cascade of increasingly invasive interventions in rapid sequence until the bleeding is stopped. These interventions include fluid resuscitation, removal of the placenta, bimanual uterine compression, uterotonics, tranexamic acid, suturing of lower genital tract injury, blood product replacement, balloon tamponade, laparotomy, stepwise uterine devascularization, uterine compression sutures and hysterectomy. Emergency temporizing measures include application of the non-pneumatic anti-shock garment, and at laparotomy, aortic compression and uterine tourniquet application. The effectiveness of treatment methods and the optimal dosage of misoprostol are research priorities. Interesting new approaches include transvaginal uterine artery clamping and suction uterine tamponade.

Topics: Abruptio Placentae; Antifibrinolytic Agents; Blood Transfusion; Cesarean Section; Crystalloid Solutions; Ergonovine; Female; Fluid Therapy; Gravity Suits; Health Facilities; Home Childbirth; Humans; Hysterectomy; Isotonic Solutions; Labor, Induced; Massage; Maternal Death; Misoprostol; Oxytocics; Oxytocin; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Tourniquets; Tranexamic Acid; Uterine Artery Embolization; Uterine Balloon Tamponade; Uterine Hemorrhage; Uterine Rupture

To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score.. This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-microg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed.. The mean time from induction to delivery was 9.36+/-1.97 hours in the misoprostol plus oxytocin group and 11.08+/-3.23 in the oxytocin alone group (P=0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia.. A 50-microg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.

Topics: Abruptio Placentae; Administration, Intravaginal; Adult; Apgar Score; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Time Factors

Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome.. Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks' gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death.. The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14].. Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.

Topics: Abruptio Placentae; Adult; Blood Transfusion; Cesarean Section; Cohort Studies; Female; Humans; Hysterectomy; Incidence; Maternal Health; Near Miss, Healthcare; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Risk Factors; South Africa; Uterine Inertia

A case of Couvelaire uterus with placenta accreta found during scheduled repeat low transverse Cesarean section will be discussed within this article. First described in the 1900s, Couvelaire syndrome, also known as uteroplacental apoplexy, is a rare form of nonfatal placenta abruption complication. The case involves a 30-year-old gravida 3 para 2 otherwise healthy female with an uncomplicated pregnancy and two previous cesarean deliveries without complication. She received routine prenatal care. During her pregnancy, she did not experience any symptoms such as vaginal bleeding or abdominal pain. After delivering a healthy female, there were several unsuccessful attempts to remove the placenta from the uterus. Upon inspection, the uterus was found have dark purple patches with ecchymosis and indurations, diagnostic of Couvelaire uterus. Furthermore, there was high clinical suspicion for placenta accreta as the 30-minute mark approached without placenta detachment. A telephonic emergency review with the wet desk radiologist of the 18-week ultrasound revealed high suspicion for placenta accreta. A Cesarean hysterectomy was performed for prevention of significant hemorrhage. This case report may be the first documented association of Couvelaire uterus with placenta accreta. Providers should be vigilant in monitoring for antenatal bleeding, timing of placenta separation, and postpartum hemorrhage.

Topics: Abruptio Placentae; Adult; Cesarean Section; Female; Humans; Oxytocics; Oxytocin; Parturition; Placenta Accreta; Pregnancy; Ultrasonography; Uterus

To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH.. Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses.. PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006).. Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.

Topics: Abruptio Placentae; Adolescent; Adult; Cesarean Section; Delivery, Obstetric; Female; Humans; Labor, Obstetric; Maternal Age; Multivariate Analysis; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prenatal Care; Regression Analysis; Retrospective Studies; Risk Factors; Severity of Illness Index; Uterine Inertia; Young Adult

To determine whether the use of uterotonics, including oxytocin and prostaglandins, increases the risk of abruptio placentae and eclampsia.. A retrospective analysis was conducted among 260,174 Japanese women at term. Demographic characteristics were studied as possible candidates for risk factors of abruptio placentae and eclampsia using multivariate logistic regression analyses.. A total of 1,058 (0.41 %) and 147 (0.06 %) women developed abruptio placentae and eclampsia, respectively. Abruptio placentae and eclampsia occurred in 177 (0.29 %) and 42 (0.07 %) of the 61,857 women treated with uterotonics, respectively. Multivariate regression analyses indicated that uterotonics did not increase risk of developing either abruptio placentae or eclampsia. Primiparity [odds ratio (95 % confidence interval) 1.41 (1.24-1.60)], age ≥35 years [1.17 (1.03-1.33)], and presence of hypertension [2.42 (1.93-3.03)] were significant independent risk factors for abruptio placentae, while advancing gestation [0.67 (0.63-0.71)] decreased risk of abruptio placentae. Primiparity [odds ratio (95 % confidence interval) 4.06 (2.49-6.63)], age <20 years [2.44 (1.07-5.58)], presence of hypertension [28.7 (20.5-40.1)], and advancing gestation [1.28 (1.11-1.47)] were significant independent risk factors for eclampsia.. The use of uterotonics did not increase the risk of abruptio placentae and eclampsia.

Topics: Abruptio Placentae; Administration, Intravaginal; Adult; Asian People; Confidence Intervals; Eclampsia; Female; Humans; Hypertension; Japan; Labor, Induced; Logistic Models; Multivariate Analysis; Odds Ratio; Oxytocics; Oxytocin; Parity; Pregnancy; Prostaglandins; Retrospective Studies; Risk Factors; Socioeconomic Factors

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.

Topics: Abruptio Placentae; Adult; Blood Coagulation Disorders; Blood Component Transfusion; Cesarean Section; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Pregnancy Trimester, Third; Prostaglandins; Uterine Hemorrhage

During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.

Topics: Abruptio Placentae; Delivery, Obstetric; Female; Fetal Death; Fetal Heart; Heart Rate; Humans; Infant Mortality; Oxytocin; Placenta Diseases; Placental Function Tests; Placental Insufficiency; Pregnancy; Uterine Contraction

Topics: Abruptio Placentae; Adult; Female; Humans; Oxytocin; Pregnancy; Uterine Contraction

Topics: Abruptio Placentae; Female; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Respiratory Distress Syndrome, Newborn; Time Factors; Uterine Rupture

Topics: Abruptio Placentae; Adult; Afibrinogenemia; Amnion; Antifibrinolytic Agents; Blood Transfusion; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Fetal Death; Hematocrit; Hemorrhage; Humans; Labor, Induced; Maternal Age; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Puerperal Disorders; Time Factors

Topics: Abruptio Placentae; Alcohols; Amnion; Cervix Uteri; Dilatation; Ergonovine; Female; Humans; Labor, Induced; Labor, Obstetric; Muscle Contraction; Obstetric Labor, Premature; Oxytocin; Posture; Pregnancy; Pressure; Socioeconomic Factors; Sparteine; Sulfates; Uterine Inertia; Uterus

Topics: Abruptio Placentae; Acute Kidney Injury; Afibrinogenemia; Blood Platelets; Female; Fetal Death; Fibrinogen; Hemoglobinometry; Humans; Oxytocin; Pregnancy

Topics: Abruptio Placentae; Adult; Afibrinogenemia; Blood Transfusion; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Fetal Death; Fetal Heart; Fibrinogen; Humans; Infusions, Parenteral; Oxytocin; Placenta Previa; Pregnancy; Prognosis; Uterine Hemorrhage

Topics: Abruptio Placentae; Blood Group Incompatibility; Dystocia; Female; Fetal Death; Humans; Labor, Induced; Muscles; Obstetric Labor, Premature; Oxytocin; Placenta Previa; Pregnancy; Pregnancy, Prolonged

Topics: Abruptio Placentae; Anesthesia; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Infant; Infant Mortality; Infant, Premature; Maternal Mortality; Minnesota; Morbidity; Obstetric Labor Complications; Oxytocin; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Statistics as Topic; Sterilization; Sterilization, Reproductive; Umbilical Cord; Uterus

Topics: Abruptio Placentae; Amniotic Fluid; Female; Fetal Death; Humans; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Hemorrhage; Uterus

Topics: Abruptio Placentae; Castration; Estradiol; Estrogens; Female; Humans; Ischemia; Kidney; Kidney Cortex Necrosis; Kidney Diseases; Necrosis; Ovary; Oxytocin; Pharmacology; Pregnancy; Pregnancy, Animal; Progesterone; Rats; Research; Toxicology

Topics: Abruptio Placentae; Diabetes Mellitus; Drug Therapy; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged; Rh-Hr Blood-Group System

Topics: Abruptio Placentae; Blood Transfusion; Cesarean Section; Female; Humans; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Uterine Hemorrhage