sulprostone and Postpartum-Hemorrhage

Postpartum hemorrhage (PPH) remains a common cause of maternal mortality worldwide. Medical intervention plays an important role in the prevention and treatment of PPH. Prostaglandins (PGs) are currently recommended as second-line uterotonics, which are applied in cases of persistent bleeding despite oxytocin treatment.. PG agents that are constantly used in clinical practice include carboprost, sulprostone, and misoprostol, representing the analogs of PGF2α, PGE2, and PGE1, respectively. Injectable PGs, when used to treat PPH, are effective in reducing blood loss but probably induce cardiovascular or respiratory side effects. Misoprostol is characterized by oral administration, low cost, stability in storage, broad availability, and minimal side effects. It remains a treatment option for uterine atony in low-resource settings, but its effectiveness as a uterotonic for independent application may be limited. Key Messages: The present review article discusses the physiological roles of various natural PGs, evaluates the existing evidence of PG analogs in the prevention and treatment of PPH, and finally provides a reference to assist obstetricians in selecting appropriate uterotonics.

Topics: Carboprost; Dinoprostone; Drug Administration Routes; Drug Stability; Female; Humans; Misoprostol; Postpartum Hemorrhage; Prostaglandins; Receptors, Prostaglandin; Uterus

Postpartum haemorrhage (PPH) remains the leading cause for maternal mortality worldwide. Hypofibrinogenaemia has been identified as a major risk factor for progress towards severe PPH. The efficacy of fibrinogen concentrate supplementation in PPH has been shown in various clinical settings but the level of evidence is not sufficient to prove the benefit, evaluate the risks, and determine the value, timing and dose of fibrinogen supplementation in PPH. The FIDEL trial objective is to evaluate the impact of a therapeutic strategy based on the early administration of human fibrinogen concentrate compared to the current practice based on late administration in severe PPH patients requiring second line uterotonics.. This is a prospective multicentre, randomised, double-blind, placebo-controlled trial. A total of 412 patients will be randomised if they meet the following criteria: female patients≥18 years old, vaginal delivery, PPH requiring IV administration of prostaglandins (sulprostone) after 20 to 30minutes of oxytocin failure. The participants are assigned to receive either fibrinogen 3g or placebo infusions. The primary endpoint is a composite endpoint defined as the percentage of patients losing at least 4g/dL of Hb, and/or requiring a transfusion of at least 2 units of packed red blood cells, within the 48hours following fibrinogen administration.. The purpose of this study is to demonstrate the efficacy and safety of an early fibrinogen concentrate infusion in uncontrolled active PPH.

Topics: Adolescent; Adult; Blood Coagulation Disorders; Delivery, Obstetric; Dinoprostone; Double-Blind Method; Female; Fibrinogen; Hemostatics; Humans; Monitoring, Physiologic; Oxytocics; Oxytocin; Patient Safety; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Treatment Failure; Young Adult

Case reports on recombinant human factor VIIa (rhuFVIIa) use in women with severe postpartum hemorrhage (PPH) showed encouraging results, but no randomized controlled trial (RCT) is available.. Eighty-four women with severe PPH unresponsive to uterotonics were randomized to receive one early single rhuFVIIa infusion (n = 42) or standard care (no rhuFVIIa; n = 42). The primary efficacy outcome measure was the reduction of the need for specific second-line therapies, such as interventional hemostatic procedures, for blood loss and transfusions. The primary safety outcome measure was the number of deaths and thrombotic events during the 5 days following rhuFVIIa infusion.. rhuFVIIa was associated with a reduction in the number of patients who needed second-line therapies compared with controls (standard care). Specifically, 39/42 (93%) patients in the standard care arm received second-line therapies and 22/42 (52%) patients in the rhuFVIIa arm (absolute difference, 41%; range, 18-63%; relative risk RR, 0.56 [0.42-0.76]). The delivery mode (vaginal or Cesarean section) did not affect the primary outcome. No death occurred. Two venous thrombotic events were recorded in the rhuFVIIa arm: one ovarian vein thrombosis and one deep vein thrombosis with a non-severe pulmonary embolism.. This open RCT in women with severe PPH refractory to uterotonics shows that rhuFVIIa reduces the need for specific second-line therapies in about one in three patients, with the occurrence of non-fatal venous thrombotic events in one in 20 patients.

Topics: Adult; Coagulants; Compassionate Use Trials; Dinoprostone; Drug Administration Schedule; Factor XIIa; Female; France; Hemostatic Techniques; Humans; Hysterectomy; Infusions, Intravenous; Postpartum Hemorrhage; Pregnancy; Risk Factors; Severity of Illness Index; Switzerland; Time Factors; Treatment Failure; Venous Thrombosis

We conducted a double-blind randomized controlled trial to compare a conventional regimen of oxytocin and ergometrine with administration of the prostaglandin E2 analogue, sulprostone, for prophylaxis of postpartum hemorrhage in high-risk women.. Women with a history of postpartum hemorrhage > or = 1000 were assigned to two coded prophylactic regimens. Drugs, given respectively at delivery of the anterior shoulder and after delivery of the placenta, were oxytocin and ergometrine in the control group, and sulprostone and placebo in the experimental group. Eighty-one women, 69 of whom actually participated in the trial, were investigated. Both the women and the caregivers were unaware of treatment allocation.. Although the trial was terminated prematurely there was a slight, but not statistically significant, preference for the sulprostone regimen in terms of blood loss and use of blood transfusion. No serious adverse effects were noted with either of the two regimens.. Prostaglandins may be more effective for preventing recurrence of severe postpartum hemorrhage than the oxytocin and ergometrine combination, but they do not eliminate the risk entirely.

Topics: Abortifacient Agents, Nonsteroidal; Dinoprostone; Double-Blind Method; Drug Therapy, Combination; Ergonovine; Female; Humans; Muscle Tonus; Oxytocin; Postpartum Hemorrhage; Pregnancy; Recurrence; Risk Factors; Treatment Outcome

To assess intravenous use of sulprostone (Nalador), a prostaglandin E2 analogue, is case of post-partum haemorrhage due to uterine atonia.. A retrospective study on 315 cases of post-partum haemorrhage (PPH) from 1st January 1990 to 31st December 1992 in Baudelocque maternity. In 91 cases of PPH due to uterine atonia, usual oxytocin drugs were not sufficient and intravenous sulprostone was used. Characteristics of the patients, mode of sulprostone administration, side effects and treatment failures are reported.. One or two dose of 500 micrograms were sufficient in 71% cases. Mean perfusion rate was 8.3 micrograms/mn. Success of treatment was 89% with few side effects (5.5%). No serious complication due to sulprostone was observed. Risk of treatment failure was 8.3 times greater when the delay between diagnosis of uterine atonia and sulprostone administration was more than 30 mn.. Prostaglandins treatment, and particularly sulprostone, could be used more frequently and earlier in case of PPH due to uterine atonia. Further controlled studies are necessary to know if they should be used as a first line treatment instead of oxytocin in this indication.

Topics: Adult; Dinoprostone; Female; Humans; Infusions, Intravenous; Oxytocin; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Treatment Failure; Uterine Inertia

Atonic postpartum hemorrhage constitutes a dramatic clinical situation, with acute danger to the life of the mother. The present report is a 3 yrs prospective study using a Prostaglandin E2 analogue (Sulprostone) in the management of 22 cases with severe postpartum hemorrhage due to uterine atony unresponsive to conventional therapy. Successful control of hemorrhage in cases of blood loss more than 1,500 ml occurred in 83 per cent. Precipitated labour was the most common predisposing factor encountered in this group of atonic postpartum hemorrhage. Side effects of the prostaglandin therapy was tolerable and self-limited. The use of intramuscular administered Sulprostone appears to be an adjunctive treatment in uncontrollable atonic postpartum hemorrhage.

Topics: Adult; Dinoprostone; Female; Humans; Postpartum Hemorrhage; Pregnancy; Treatment Outcome

To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage.. Randomized, placebo controlled, double-blind trial.. Radboud University Hospital, Nijmegen (67 women) and Lievensberg Hospital, Bergen op Zoom (10 women).. 77 women entered the trial (three were excluded).. The intramuscular injection, immediately after the birth of the baby, of either oxytocin 5 IU, sulprostone 500 micrograms or 0.9% saline.. Quantitative postpartum blood loss and length of third stage.. Postpartum blood loss was reduced almost equally, by about 35%, by oxytocin (P = 0.02), or sulprostone (P = 0.05). The mean length of the third stage was shorter in both groups receiving the active treatment, this effect was significant in the sulprostone group (P = 0.01).. Prophylactic administration of oxytocin or sulprostone directly after delivery followed by expectant management of the third stage reduces post partum blood loss and shortens the third stage.

Topics: Dinoprostone; Double-Blind Method; Female; Humans; Labor Stage, Third; Oxytocin; Postpartum Hemorrhage; Pregnancy; Time Factors

The Shock Index (SI) is used in emergency medicine to assess the severity of active bleeding and in the postpartum context for postpartum haemorrhage (PPH). We investigated the diagnostic value of haemodynamic parameters (SI, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP)) in predicting subsequent use of uterotonic sulprostone treatment.. This was a retrospective study including parturients with PPH ≥ 500mL between January 2017 and December 2018. Hemodynamic parameters at the diagnosis of PPH were compared according to whether the patient required subsequent sulprostone treatment (sulprostone(+) group) or not (sulprostone(-) group).. We included in the analysis 147 patients. The SI was significantly higher in the sulprostone(+) group (0.92±0.28 vs. 0.83±0.22; p=0.04). The SBP (107.2±17.5 vs. 113.8±17.7mmHg; p=0.03), DBP (56.8±12,2 vs. 61.5±13,2mmHg; p=0.04), MAP (73.6±12.6 vs. 78.5±13.4mmHg; p=0.03) were significantly lower in the same group. No difference between AUC of these parameters to predict the use of sulprostone was found (AUC between 0.59 and 0.61). No significant difference was found for the HR between the two groups.. The diagnostic value of SI appeared to be low and similar to other haemodynamic parameters in predicting the use of sulprostone.

Topics: Dinoprostone; Female; Humans; Postpartum Hemorrhage; Retrospective Studies; Shock

Twin pregnancy has a high risk for developing uterine atony (UA). This study aimed to evaluate efficacy and clinical outcomes of prophylactic compression sutures to treat UA during twin cesarean section (CS).. All patient records of twin deliveries by CS after gestational age of 24 weeks in a large maternity hospital in South Korea between January 2013 and June 2018 were reviewed. Patients with monochorionic monoamniotic twins were excluded from data analysis. In total, 953 women were eligible for data analysis.. Of the 953 patients, compression sutures were applied to 147 cases with postpartum bleeding that were refractory to uterine massage and uterotonics. Out of the 147, two patients (1.4%) proceeded to additional uterine artery ligation to achieve hemostasis, yielding a success rate of 98.6%. The rate of transfusion after the first 24 h of delivery in the suture group was not significantly different from that in the non-suture group, suggesting that both groups achieved hemostasis at an equal rate after the first 24 h of delivery. The difference in the operation time between the two groups was only 8.5 min. The rate of subsequent pregnancy among the patients who received compression sutures was 44.4%.. Overall, our findings suggest that with early and fast implementation of compression sutures, UA can be treated in the setting of twin cesarean delivery without significantly increasing maternal morbidity.

Topics: Adult; Blood Transfusion; Cesarean Section; Dinoprostone; Female; Hemostasis, Surgical; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy, Twin; Suture Techniques; Treatment Outcome; Uterine Artery Embolization; Uterine Inertia

Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately. A rapid recourse to prostaglandins (sulprostone in France) may reverse uterine atony. Invasive approach with surgery or radiology should be promptly implemented (uterine artery or internal iliac artery ligations±uterus plication) and hysterectomy should then be timely considered. Simultaneously, early and aggressive resuscitation with large-bore venous accesses should be implemented for rapid and massive transfusion (4:4:1 RBC:FFP:platelets ratio), along with an early use of fibrinogen concentrates and tranexamic acid. This transfusion strategy may be then guided by thromboelastography or thromboelastometry and bedside hemoglobin measurements. Activated factor VII remains indicated only before or after hysterectomy in case of uncontrolled bleeding. Management of placentation abnormalities (placenta previa, accreta, increta, percreta) must be well mastered as these etiologies may generate cataclysmic hemorrhages that can be and have to be anticipated.

Topics: Blood Component Transfusion; Combined Modality Therapy; Dinoprostone; Factor VIIa; Female; Fibrinogen; Humans; Hysterectomy; Iliac Artery; Ligation; Maternal Mortality; Operative Blood Salvage; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Recombinant Proteins; Tranexamic Acid; Uterine Artery; Uterine Artery Embolization; Uterine Hemorrhage; Uterine Inertia

Guidelines for the management of post-partum haemorrhage (PPH) were defined by the "Collège National des Gynécologues Obstétriciens Français (CNGOF)" since 2004. The aim of this work was to assess whether the management of PPH before and during the transfer was in accordance with national recommendations.. This is an observational monocentric prospective study concerning 84 patients transferred for PPH in a referent centre in 2011.. In 62 cases (73.8%), transfusionnal files were found. Time noted PPH for 60 (71.4%) and amount of blood loss in 55 cases (65.5%) were notified. Evacuation of retained placenta was always performed; the broad-spectrum antibiotic prophylaxis covered only 21 cases of intra uterine procedures. Less than 5% of the patients received intravenous sulprostone before the transfer; 72.6% (n=61) of the patients were transfused before transfer 25% of the patients (n=21) had a very high risk of PPH in ante partum and were not addressed to a centre with appropriate medical and technical facilities.. Thus improvement can be made in the communication between the health care centre during transfer for PPH and the ante partum transfer of patients with high risk of PPH.

Topics: Adult; Antibiotic Prophylaxis; Blood Transfusion; Dinoprostone; Female; Gynecology; Humans; Middle Aged; Obstetrics; Patient Transfer; Placenta, Retained; Postpartum Hemorrhage; Practice Guidelines as Topic; Pregnancy; Prospective Studies

Topics: Adult; Cardiomyopathy, Dilated; Cardiovascular Agents; Dinoprostone; Echocardiography; Female; Heart Failure; Humans; Peripartum Period; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Treatment Outcome

A 32 year old parturient with a history of Tako-tsubo cardiomyopathy, who suffered from postpartum hemorrhage for which sulprostone was administered without any adverse events, is reported. Anesthetic considerations related to the management of patient with a history of Tako-tsubo cardiomyopathy, especially triggers that may cause a recurrence, are described. The potential deleterious effects of sulprostone in a patient with a history of Tako-tsubo cardiomyopathy are discussed.

Topics: Adult; Anesthetics; Dinoprostone; Female; Humans; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Takotsubo Cardiomyopathy

To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period.. Retrospective observational study.. University teaching hospital.. 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011.. Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed.. Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery.. The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity.. Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Dinoprostone; Female; Finland; Humans; Infusions, Intravenous; Male; Placenta, Retained; Postnatal Care; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Retrospective Studies; Treatment Outcome; Young Adult

Postpartum hemorrhage is the leading cause of maternal death worldwide. Recent data from trauma patients and patients with hemorrhagic shock have suggested that an increased fresh frozen plasma:red blood cell (FFP:RBC) ratio may be of benefit in massive bleeding. We addressed this issue in cases of severe postpartum hemorrhage.. We reviewed data from all patients diagnosed with severe postpartum hemorrhage during a 4-year period (2006-2009). Patients who were treated with sulprostone and required transfusion within 6 hours of delivery were included in the study and were divided into 2 groups according to their response to sulprostone: bleeding controlled with sulprostone alone (sulprostone group) and bleeding requiring an additional advanced interventional procedure including arterial angiographic embolization and/or surgical procedures (arterial ligation, B-Lynch suture, or hysterectomy; intervention group). The requirement or no requirement for advanced procedures constituted the primary end point of the study. Propensity scoring was used to assess the effect of a high FFP:RBC ratio on bleeding control.. Among 12,226 deliveries during the study period, 142 (1.1%) were complicated by severe postpartum hemorrhage. Bleeding was controlled with sulprostone alone in 90 patients (63%). Advanced interventional procedures were required for 52 patients (37%). Forty-one patients were transfused with both RBCs and FFP. The FFP:RBC ratio increased over the study period (P < 0.001), from 1:1.8 at the start to 1:1.1 at the end of the study period. After propensity score modeling (inverse probability of treatment weighting), a high FFP:RBC ratio was associated with lower odds for advanced interventional procedures (odds ratio [95% confidence interval], 1.25 [1.07-1.47]; P = 0.008). There were no deaths, severe organ dysfunction, or other complications as a consequence of severe postpartum hemorrhage.. In this retrospective study, a higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage. The benefits of transfusion using a higher FFP:RBC ratio should be confirmed by randomized-controlled trials.

Topics: Adult; Anesthesia, Obstetrical; Angiography; Birth Weight; Cesarean Section; Dinoprostone; Embolization, Therapeutic; Erythrocyte Count; Erythrocytes; Female; Humans; Infant, Newborn; Menstruation-Inducing Agents; Odds Ratio; Plasma; Postpartum Hemorrhage; Pregnancy; Propensity Score; Risk Factors

Cheap and simple interventions that are intended to minimize postpartum hemorrhage are of major public health concern. We report a case of postpartum hemorrhage in which conservative interventions had failed. The use of a chitosan-covered gauze that originally was developed for combat trauma allowed us to achieve hemostasis, and a seemingly inevitable hysterectomy was avoided.

Topics: Adult; Bandages; Cesarean Section; Chitosan; Dinoprostone; Female; Hemostasis, Surgical; Hemostatics; Humans; Oxytocin; Postpartum Hemorrhage; Pregnancy; Sutures

Uterine atony is the most frequent cause of post-partum haemorrhage. In France, the management is based on early administration of oxytocic agents and prostaglandin analogues (sulprostone-Nalador®). We report the case of a 30-year-old woman who presented soon after administration of sulprostone, a severe hyperthermia with neurological disorders. A complete reversibility was observed a few hours after discontinuation of sulprostone administration. Other causes were eliminated by biological and radiological findings.

Topics: Adult; Anesthesia, Obstetrical; C-Reactive Protein; Cesarean Section; Dinoprostone; Female; Fever; Hemodynamics; Humans; Infant, Newborn; Nervous System Diseases; Oxytocin; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Uterine Inertia

Topics: Adult; Cesarean Section; Dinoprostone; Female; Heart Arrest; Humans; Oxytocics; Postpartum Hemorrhage; Pregnancy; Shock, Cardiogenic

Use of prostaglandins, including sulprostone (an E2 analog), is recommended for second-line uterotonic treatment of atonic postpartum hemorrhage and might be considered as an indicator of quality of care in severe atonic postpartum hemorrhage management. Our objective was to estimate whether sulprostone was appropriately used and how it was tolerated in women with atonic postpartum hemorrhage.. This large population-based study (146,781 deliveries) included 4,038 women with clinically assessed atonic postpartum hemorrhage in 106 French hospitals during 1 year. Severe postpartum hemorrhage was defined as one of the following: hemoglobin decline of 4 g/dL or more, transfusion, arterial embolization, surgical procedures, transfer to intensive care unit, or death. Sulprostone use in severe atonic postpartum hemorrhage was analyzed according to the mode of delivery and the characteristics of the maternity units.. Rates of sulprostone use were only 33.9% (n = 1,370) and 53.5% (n = 657) among women with atonic (n = 4 ,038) and severe atonic (n = 1,227) postpartum hemorrhage, respectively. In the latter population, sulprostone administration was less frequent after vaginal delivery than after cesarean delivery (45.6% compared with 86.5%, P<.01) in units performing fewer than 1,500 annual deliveries in public nonuniversity hospitals and in units where the obstetrician or anesthesiologist was not present 24 hours per day, 7 days per week. Fifty-one of the 1,370 women with sulprostone-treated atonic postpartum hemorrhage (3.7%, 95% confidence interval [CI] 2.7-4.7) experienced side effects, including seven (0.5%, 95% CI 0.2-1.0) with severe cardiovascular or respiratory symptoms that resolved when the hypovolemic shock was corrected and drug administration was stopped.. Sulprostone is underused for treating severe atonic postpartum hemorrhage after vaginal delivery, despite low rates of severe side effects in this population-based study.. : III.

Topics: Delivery, Obstetric; Dinoprostone; Female; Humans; Postpartum Hemorrhage; Pregnancy; Uterine Inertia

The aim of the study is to assess the compliance rate of treatment of postpartum hemorrhage (PPH) according to guidelines developed by the CNGOF within our network by a first audit, and evaluate the impact of this first audit by conducting a second audit.. An initial audit of resources and management of postpartum hemorrhage (PPH) was conducted in 2006-2008 in 24 maternity hospitals of the Pays-de-la-Loire. The audit had identified six areas for improvement. A second audit was implemented in 2009-2010 to evaluate the actions of prevention and measure changes in the management of PPH. Two interns have distributed the 24 maternity homes and moved in each hospital to see 10 cases of vaginal delivery (VD) (section "Prevention"), and the last cases of PPH following a VD. The results are in compliance rate compared to the repository of the HAS in 2004.. The first audit was conducted on 101 PPH in total. It has allowed us to propose corrective actions to the 24 maternity hospitals: leaf specific monitoring, reporting amounts of blood loss, transfusion on these clinical criteria without waiting for the blood cell counts, indicating more frequent and rapid sulprostone, set for maternity hospitals without surgical skill an agreement with a visceral surgery department, and avoid maternal transfers for PPH. For the second audit, the compliance rate of the preventive aspect was 73% (95: 71-75%) of 239 cases of BA with variations according to maternity from 48 to 93%. Compliance rates according to the criteria were: 99% obstetric consultations, 98% for anesthesia, 92% for hemoglobin, 77% for the group card available in the record, 89% agglutinins, 35% for the notification of the installation of bag, 36% for the notification of the amount of blood lost, 69% for the supervisor within two hours, and 64% for the directed delivery. For component "Support", the overall compliance rate was 81% (95: 79-83%) of 118 PPH AVB, and 85% in the 71 uterine atonies in 21 pregnancies (3 had no HPP during the period) with variations according to maternity from 51 to 93%. Conformities compared with the first audit were: improvement of time noted PPH (66 and 85%), initiation of a leaf-specific monitoring (0% and 87%), equivalence of appeals responders (86 and 88%), improving the amount of blood noted (51 and 67%), equivalent to the practice of evacuation of retained placenta (88 and 91%), decreased prescription of antibiotics (83 and 71%). For only uterine atony (n=71), there was a slight improvement in the prescription of sulprostone within 30 minutes (53 and 58%), and improved decision within 2 hours (47 and 69%). Finally, there was no connection rates in the two components (r=0.32, p=0.15). Criteria associated with good compliance were calculated.. There is a general improvement in prevention and care, with critical points and persistent disparities between pregnancies. In the aftermath of the completion of the audit, the overall results were sent to officials with the rank of each maternity, inviting each responsible to analyze weaknesses and implement corrective actions. Further action is planned within the network.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Anti-Bacterial Agents; Delivery, Obstetric; Dinoprostone; Female; France; Hospitals, Maternity; Humans; Medical Audit; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Uterine Inertia

Topics: Adult; Dinoprostone; Female; Humans; Intraoperative Complications; Jehovah's Witnesses; Postpartum Hemorrhage; Pulmonary Edema

To evaluate the effectiveness of a multifaceted intervention on practices for prevention, diagnosis and management of postpartum haemorrhage (PPH) and on the prevalence of major PPH in a French perinatal network.. Quasi-experimental before-and-after survey.. All maternity units (n = 19) of a French administrative region, operating as a perinatal network.. One representative sample of all women delivering in the network, one representative sample of women with PPH deliveries and an exhaustive sample of women with major PPH.. The multifaceted intervention took place between February 2003 and March 2004. Information was retrospectively collected for two periods, 2002 (before the intervention) and 2005 (after).. Practices for prevention, diagnosis and management of PPH and prevalence of major PPH.. After the intervention, the pharmacological prevention of PPH increased from 58.8% to 75.9% of vaginal deliveries (P < 10(-4)), and the use of blood collecting bags from 3.9% to 76.3% (P < 10(-4)), but initial PPH management did not change significantly. However, the median delay for second-line pharmacological treatment was significantly shortened [from 80 min (35-130) in 2002 to 32.5 min (20-75) in 2005]. An increase was observed in the use of surgery for PPH (0.06% versus 0.12% of deliveries; P = 0.03) and in blood transfusions (0.18% versus 0.33%; P = 0.01). The prevalence of major PPH did not change (0.80% versus 0.86% of deliveries; P = 0.62).. The intervention was effective at improving PPH-related preventive and diagnostic practices in a perinatal network. Improving management practices and reducing the prevalence of major PPH might require a different intervention design.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Clinical Protocols; Dinoprostone; Female; Hospitals, Maternity; Humans; Infusions, Intravenous; Oxytocics; Oxytocin; Postpartum Hemorrhage; Practice Guidelines as Topic; Pregnancy; Professional Practice; Prospective Studies; Specimen Handling; Treatment Outcome

In France obstetric haemorrhage is the leading cause of maternal death. The aim of this study was to evaluate if the management of postpartum haemorrhage at individual maternity units followed guidelines established by the Aurore Network.. A descriptive study was carried out in 16 maternity units of the Aurore network between October 2004 and September 2005. Cases and data were prospectively identified and collected.. Postpartum haemorrhage occurred in 1144 of 21 350 deliveries, an overall incidence of 5.4+/-0.3%. Of these, 316 cases were rated as severe. Diagnosis was clinical in 82.5% of severe cases and 77.5% of non-severe cases; the remainder were detected by postpartum laboratory tests. Uterotonic agents were given prophylactically to 46.7% of the 896 patients following vaginal delivery. In cases in which postpartum haemorrhage was due to uterine atony, 83.1% of women underwent examination of the uterine cavity and 96.3% received oxytocin, which proved therapeutic. Sulprostone was administered to 39.5% cases of persistent postpartum haemorrhage. A uterotonic was given prophylactically to 85.4% of the 247 patients at caesarean delivery. Oxytocin was therapeutic in 94.8% of cases of uterine atony. Sulprostone was administered in 84.4% of cases of persistent postpartum haemorrhage.. The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage.

Topics: Adolescent; Adult; Cesarean Section; Delivery, Obstetric; Dinoprostone; Female; France; Guideline Adherence; Guidelines as Topic; Hemoglobins; Humans; Infant, Newborn; Menstruation-Inducing Agents; Oxytocics; Oxytocin; Postpartum Hemorrhage; Practice Guidelines as Topic; Pregnancy; Prospective Studies; Young Adult

Postpartum hemorrhage (PPH) is a major source of maternal morbidity.. This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its severity.. We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter.. At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration

Topics: Adult; Biomarkers; Blood Coagulation Tests; Dinoprostone; Female; Fibrinogen; Humans; Postpartum Hemorrhage; Predictive Value of Tests; Pregnancy; Severity of Illness Index; Time Factors; Treatment Outcome

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

Topics: Adult; Anaphylaxis; Dinoprostone; Female; Humans; Postpartum Hemorrhage; Pregnancy

To evaluate a post-partum hemorrhage treatment guideline, using rectally administered misoprostol.. A descriptive study was carried out in a tertiary referral center from January 2002 to March 2003. During this period, 2670 patients delivered and 41 (1.5%) with severe post-partum hemorrhage unresponsive to oxytocin received 1000 microg of misoprostol (five tablets) rectally while awaiting sulprostone. Twenty-eight had delivered by the vaginal route and 13 by cesarean section.. Hemorrhage was controlled among 63% (26/41) of the patients within 10 min of the administration of rectal misoprostol. Fifteen (37%) patients received both misoprostol and sulprostone and no major adverse effects were noted when combining these two prostaglandins. Overall, hemorrhage was controlled among 87% (36/41) of the patients when oxytocics were combined with misoprostol and sulprostone. Five patients (12%) did not respond to the combination of uterotonics and required a conservative surgical treatment.. Rectal misoprostol may be an effective second line treatment for the management of post-partum hemorrhage unresponsive to oxytocin. We did not observe major side effects when combining misoprostol with sulprostone. Our findings encourage further research on rectal misoprostol in the treatment of postpartum hemorrhage.

Topics: Administration, Rectal; Adult; Dinoprostone; Female; Humans; Misoprostol; Postpartum Hemorrhage

A case of chest pain in a 31-year-old woman after vaginal delivery with epidural analgesia during sulprostone administration is described. Chest pain occurred shortly after sulprostone was started and disappeared when sulprostone was stopped. Ischaemia related data were negative. Angiographically coronary arteries were normal. Coronary artery spasm aetiology was retained. Sulprostone pharmacology is summarized. Coronary artery effects are compared with literature reports. Recommendations before sulprostone use are underlined.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Chest Pain; Coronary Angiography; Dinoprostone; Female; Humans; Postpartum Hemorrhage; Pregnancy

Topics: Adult; Anesthesia, Epidural; Delivery, Obstetric; Dinoprostone; Drug Therapy, Combination; Female; Heart Arrest; Hemodynamics; Humans; Labor, Obstetric; Norepinephrine; Oxytocics; Postpartum Hemorrhage; Pregnancy; Respiration, Artificial

The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations.. Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously.. All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant.. The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Congenital Abnormalities; Dinoprostone; Female; Gestational Age; Humans; Labor, Induced; Linear Models; Parity; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Time Factors; Uterine Rupture; Uterus

In a woman aged 39 cardiac arrest occurred 3.5 hours after administration of 250 micrograms sulprostone directly into the uterine wall for a post-partum haemorrhage after manual removal of the placenta. A long period of resuscitation was necessary. After further evaluation the woman demonstrated specific contraindications to the administration of sulprostone. as formulated by the French authorities: age > 35 years, heavy cigarette smoking, and cardiovascular risk factors. In the Netherlands sulprostone is registered for intravenous administration only. We would strongly advise against administration directly into the uterine wall.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Coronary Vasospasm; Dinoprostone; Female; Heart Arrest; Humans; Postpartum Hemorrhage; Pregnancy; Resuscitation; Risk Factors; Ventricular Fibrillation

Sulprostone, a synthetic prostaglandin with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case in which a bolus intravenous injection of sulprostone 30 micrograms was administered to treat postpartum haemorrhage during caesarean section. The 38-year-old patient with no previous cardiac or smoking history developed complete heart block, ventricular fibrillation and subsequent asystole. Cardiopulmonary resuscitation was successful after 45 minutes. Post resuscitation there was no myocardial infarction and she had complete neurological recovery. We postulate that the bolus of sulprostone resulted in possible coronary spasm that resulted in cardiac arrest.

Topics: Adult; Anesthesia, General; Cesarean Section; Dinoprostone; Epinephrine; Female; Heart Arrest; Heart Block; Humans; Injections, Intravenous; Postpartum Hemorrhage; Pregnancy; Resuscitation; Sympathomimetics; Ventricular Fibrillation

A 34-year-old patient was treated with constant intravenous infusion of sulprostone because of postpartum hemorrhage from a hypotonic uterus. The arm in which sulprostone had been infused was painful 23 h after infusion. A day later, the arm was found to be blueish, edematous and extremely painful as a result of arterial spasm. The vasospasm was probably caused by accidental subcutaneous infusion of sulprostone as a result of a displaced intravenous catheter. A diagnosis of critical limb ischemia was made. Treatment with the prostacyclin-analogue iloprost resulted in full recovery. Critical limb ischemia as a serious complication of sulprostone has not been previously reported.

Topics: Adult; Arm; Diabetes, Gestational; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Iloprost; Ischemia; Obstetric Labor, Premature; Postpartum Hemorrhage; Pregnancy; Vasodilator Agents

Forty-three patients at the University Gynecology Clinic in Charlottenburg were given the prostaglandin E2 derivative sulprostone for severe postpartal hemorrhage. It was administered intravenously in a dose of 1.7 mcg/min (100 mcg/100 ml/h), with short-term increases to three times this amount in isolated cases. The drug proved highly efficacious (rapid onset and lasting effect). In 80% of the cases there were no side effects. Rises in body temperature occurred in six patients and in one patient a venous irritation developed in the arm into which the drug was infused. An RDS occurred, though it was considered that there was not necessarily a causal connection between this and the sulprostone infusion. In the authors' experience this drug has an established place in the treatment of atonic postpartal hemorrhage emergencies.

Topics: Adult; Dinoprostone; Female; Humans; Infusions, Intravenous; Postpartum Hemorrhage; Pregnancy; Prostaglandins E, Synthetic; Uterine Contraction; Uterine Inertia

A PGE2 analogue, Sulprostone was administered to control the postpartum haemorrhage, immediately after the baby was born, to 74 healthy patients, who had normal pregnancy and delivery. Divided into three groups they received 50 or 100 micrograms intravenously, or 200 micrograms intramuscularly. The results were compared with those of a group of 54 patients, which received 0.2 mg methylergometrine i.m. and 5 IU oxytocin i.v. respectively. The blood loss was measured during the third stage of labour and during two hours thereafter. The pilot dose of 50 micrograms was not effective enough. The blood loss in the group of 100 micrograms i.v. was 386 +/- 175 ml, in the group of 200 micrograms i.m. 325 +/- 197 ml, and in the methylergometrine-oxytocin group 302 +/- 202 ml. Sulprostone 200 micrograms i.m. seems to be effective treatment to control the postpartum haemorrhage. Only four patients had mild side-effects after Sulprostone administration.

Topics: Dinoprostone; Female; Humans; Infusions, Intravenous; Injections, Intramuscular; Labor Stage, Third; Methylergonovine; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prostaglandins E, Synthetic