Obstetric Hemorrhage II: Postpartum Hemorrhage
Lauren A. Plante in Expecting Trouble, 2018
The management of PPH includes two primary components: (a) identifying and controlling the cause of the bleeding and (b) assessing and stabilizing the hemodynamic status of the patient. Anticipation and preparedness are critical components in the management of this life-threatening condition. PPH can be preceded by antepartum hemorrhage; see Chapter 13. Antepartum hemorrhage from placenta previa and placental abruption can continue, even after delivery. Although there are risk factors that can be identified both antepartum and intrapartum to help clinicians anticipate hemorrhage (Table 14.1), unfortunately, PPH often occurs in women without identifiable risk factors and can be life threatening. Therefore, all delivery units and providers should be prepared to respond to this true obstetric emergency.
Placental Abruption
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
MaternalSerious maternal complications (pulmonary edema, acute respiratory failure, acute heart failure, acute myocardial infarction, cardiomyopathy, puerperal cerebrovascular disorder, coma, and amniotic fluid embolism) occur at a higher ratio for women with severe abruption (141.7/10,000 births) compared to those with a mild abruption (33.3/10,000 births) or nonabruption (15.4/10,000 births) (Table 30.3) [5].Antepartum hemorrhage remains a leading cause of maternal mortality. For pregnancies ending in stillbirth, hemorrhage related to placental abruption is the leading cause of maternal mortality [52].DIC was first reported to occur in association with placental abruption by De Lee in 1901 [19]. The development of DIC is thought to be due to a release of thromboplastins, as well as consumption of coagulation factors secondary to an enlarging hematoma. Nearly 30% of patients who present with a severe abruption develop DIC.Acute renal failure is a potential maternal complication associated with abruption. Fortunately, the incidence of acute renal failure appears to be decreasing, possibly due to improved medical management.Postpartum hemorrhage secondary to uterine atony is associated with abruption, as is postpartum anemia and infection.
Postnatal Sequelae of Fetal Growth Retardation
Asim Kurjak, John M. Beazley in Fetal Growth Retardation: Diagnosis and Treatment, 2020
Barker and Edwards32 using the Birmingham data on 50,000 children, achieved more precise results when they related verbal reasoning scores, at 11 years of age, to specified pregnancy and perinatal events. They described five obstetric complications which seemed to be associated with impaired developmental outcome. These were a short gestation period, a prolonged gestation period, toxemia of pregnancy, occipito-posterior presentation, and delivery in an ambulance. Neligan et al.33 noted a possible association with antepartum hemorrhage, breech delivery, and fetal distress in labor.
Quadruplet Pregnancy with Complete Mole and Three Viable Fetuses
Published in Fetal and Pediatric Pathology, 2022
Cem Yener, N. Cenk Sayın, Fatma Elif Usturalı Keskin, Esra Altan, Sinan Ateş, Füsun Varol
Complete hydatidiform mole in a quadruplet pregnancy has been reported seven times between January 1994 to June 2021 [13–19]. Six out of seven cases ended up before 25 weeks, either due to obstetric or maternal complications. In four of the six reports, the pregnancies were electively terminated between 12th and 19th weeks of gestation [14, 16–18]. Persistent trophoblastic disease developed in four cases [14–17]. One case had clinical symptoms of severe preeclampsia at the 14th week [14]. In another, massive antepartum hemorrhage precipitated preterm delivery at 25 weeks’ gestation [15]. In their case, Tariq et al. [19] presented quadruplets with complete molar pregnancy which all three fetuses were successfully delivered at the 33rd weeks of gestation and persistent trophoblastic disease did not develop. Due to the limited number of cases in the literature, it is difficult to estimate perinatal outcome and malignant potential of quadruple pregnancies with complete hydatidiform mole. Quadruplet pregnancies naturally carry an increased risk of preterm labor and preeclampsia.
Uterine electromyography (EMG) measurements to predict preterm caesarean section in patients with complete placenta previa
Published in Journal of Obstetrics and Gynaecology, 2021
Jinying Yang, Xiuyu Pan, Robert E. Garfield, Huishu Liu
The cause of antepartum bleeding in placenta previa is the frequent uterine contraction combined with the uterine lower segment formation and cervical effacement in late pregnancy, makes the blood vessels connecting the placenta to the uterus to tear which can cause massive bleeding and require emergency CS. It is plausible to monitor uterine contraction to predict the antepartum bleeding in placenta previa. Currently, clinicians depend on the patient self-report contraction and sometimes the contraction detected from TOCO of foetal heart rate tracing. It has been reported that cervical length measurement by ultrasound to predict antepartum bleeding in placenta previa (Shin et al. 2016). However, these methods are not reliable and the cervical length measurement is not recommended by latest ACOG guideline regarding placenta previa management (Gyamfi-Bannerman 2018). Our group has applied non-invasive uterine Electromyographic (EMG) to assess uterine contraction during preterm labour and labour (Lucovnik et al. 2011). Uterine EMG has been proved effective in predicting preterm labour and uterine contraction intensity during the first stage of labour (Qian et al. 2017a).
The clinical management of factor XI deficiency in pregnant women
Published in Expert Review of Hematology, 2020
Allison P. Wheeler, Celeste Hemingway, David Gailani
The general impression is that antepartum bleeding, defined as any bleeding prior to delivery, is similar in women with FXI deficiency and in women without bleeding disorders. Several studies reported rare antepartum bleeding in FXI-deficient women, with clinically significant bleeding occurring only in the presence of additional complications such as pre-eclampsia or placental abruption (Table 1) [26,30,35]. Other studies focusing on FXI-deficient women simply reported uncomplicated pregnancies in the majority of subjects [28,36]. In one study, antepartum bleeding occurred in 14% of pregnancies in FXI-deficient individuals [29], which is comparable to reported rates for first trimester bleeding in the general population (7–27%) [37], but lower than the incidence in women with von Willebrand disease (33%) [29].