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Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Obstetric haemorrhage remains one of the major causes of maternal death in developing countries and is the cause of up to 50% of the estimated 500,000 maternal deaths that occur globally each year. Obstetric haemorrhage includes both antepartum and postpartum bleeding.
Pregnancy
Published in T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen, Diagnostic Endometrial Pathology, 2019
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng
Retained placental fragment is a better term than placental polyps as the former term is accurate and readily understood by both obstetrician and pathologist. A polyp implies the presence of a neoplastic lesion arising from a stalk with stroma and blood vessels; that is evidently not the case. Retained placental fragment is likely to be the largest cause of secondary postpartum bleeding.22 The placental fragments may vary in viability, ranging from viable to necrotic fragments with dystrophic calcification. The accompanying inflammatory response is also variable and can be acute or chronic. Very often, subinvoluted vessels are seen either in adjacent or contiguous endometrial tissue. Bleeding is exacerbated by stenting of these maternal vessels by the placental fragments (Figure 3.27). It is appropriate, therefore, that the diagnosis of retained placental fragments takes precedence over subinvolution of the placental bed as the diagnosis in these women.
Characterization and treatment of lochia
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Miranda A. Farage, Ninah Enane-Anderson, Narlha Munoz, Orlando Ramirez-Prada, William J. Ledger
Postpartum bleeding is a normal part of recovery from childbirth. Yet the duration of postpartum bleeding is not well characterized (2,17). The old textbook description of duration of lochia ranges from 18 days (18) to 6 weeks (19). Several other studies have reported a mean or median duration of postpartum bleeding or lochia of 21–35 days (1,2,11,17,20). The World Health Organization (WHO) conducted a study in 3955 breastfeeding women at seven different WHO study centers (21). The overall median of postpartum bleeding was 27 days, with significant variability across the globe. The shortest duration was a median of 22 days (2–56 days) and the longest duration was a median of 34 days and the range was from 2 to 90 days (see Table 8.2). A recent study conducted in the United Kingdom reported that the median duration of lochia in women without a bleeding disorder was 31 days (range, 10–62 days), whereas in women with an inherited bleeding disorder, it was 39 days (range, 21–58 days) (13). About a third of the women participating in this study had lochia lasting longer than 6 weeks post-delivery. The same study reported that the duration of lochia was not influenced by covariates such as maternal age, booking weight, parity, gestational age at delivery, birth weight, estimated blood loss at delivery, perineal tear/episiotomy, or the method of feeding (13).
Successful mast-cell-targeted treatment of chronic dyspareunia, vaginitis, and dysfunctional uterine bleeding
Published in Journal of Obstetrics and Gynaecology, 2019
Lawrence B. Afrin, Tania T. Dempsey, Lila S. Rosenthal, Shanda R. Dorff
A 34-year-old G3P2A1 woman with nearly a lifetime of multisystem inflammatory, allergic and connective tissue issues delivered a healthy infant via her second Caesarean section (C-section) following a third pregnancy complicated by many issues (gastrointestinal, neurologic, etc.) thought to be consequential to her MCAS, diagnosed 2 years earlier (Table 2). She had been chronically using H1/H2 antihistamines and oral cromolyn; oral budesonide, too, helped control MCAS flares during her pregnancy. Idiopathic urticaria emerged a day after her delivery, and required budesonide and topical triamcinolone to permit discharge on post-op day 4. However, her post-partum bleeding persisted (eight pads per day) for 6 weeks after delivery. Cyclic progesterone was proposed, but this had not worked well for the DUB she had experienced in her adolescence, so the patient was instead administered a 25 mg diphenhydramine douche. Bleeding stopped 4 h later and has not recurred since.
Inhibitor eradication and bleeding management of acquired hemophilia A: a single center experience in China
Published in Hematology, 2019
Naifang Ye, Zhenzhen Liu, Guanqun Xu, Xuefeng Wang, Fang Wu, Xiaoqian Xu, Wenman Wu
All the 42 patients had prolonged APTT values (mean ± SD, 81.8 ± 18.4 seconds), decreased FVIII: C (median 1.5%; IQR: 0.9–3.5) and FVIII inhibitor of various titers (median 8.0 BU/mL; IQR: 4.0–16.0). The ecchymosis was the most frequent bleeding presentation (76.2%), followed by muscular hematoma (28.8%); urologic (23.8%); hemarthrosis (19.1%); gastrointestinal (9.5%) and retroperitoneal (4.8%). Eight patients (19.0%) had life-threatening bleeding upon diagnosis with two patients experience hemorrhagic shock due to postpartum bleeding and uncontrolled post-surgical retroperitoneal hemorrhaging. There was no significant difference in FVIII inhibitor titers between patients with severe hemorrhage and patients with non-severe bleeding presentations (median 12 BU; IQR: 8–16 vs. median 8 BU; IQR: 4–16, p = .459).
The effectiveness of the double B-lynch suture as a modification in the treatment of intractable postpartum haemorrhage
Published in Journal of Obstetrics and Gynaecology, 2018
Hanifi Şahin, Oya Soylu Karapınar, Eda Adeviye Şahin, Kenan Dolapçıoğlu, Ali Baloğlu
Uterine atony is the most common reason for intractable postpartum bleeding. Despite the availability of effective medical interventions, atony is still a condition that threatens maternal life. There are a large number of known risk factors, but atony can also develop in women without any risk factors (Nyfløt et al. 2017). Thus, it is difficult to anticipate atony, which is an obstetric emergency that any obstetrician may encounter. In these cases, the likelihood of long-term morbidities such as a severe anaemia, renal failure and respiratory problems are increased (Leung et al. 2010). In a study by Sousa et al. (2008), it was found that the risk of a sudden death for the subsequent year was higher in the atony patients who had a severe blood loss than in the normal population.