Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Mar 2010
ReviewPostpartum hemorrhage: epidemiology, risk factors, and causes.
Postpartum hemorrhage (PPH) is a leading cause of death and morbidity relating to pregnancy. Uterine atony is the leading cause of PPH, and trauma, including iatrogenic trauma, increases the risk for postpartum hemorrhage. ⋯ Awareness of these facts, and anticipation and prevention of uterine atony, as well as avoiding unnecessary cesareans, episiotomies, and other genital tract trauma have the potential to significantly reduce the mortality and morbidity from postpartum hemorrhage. The epidemiology of postpartum hemorrhage, including the incidence and temporal trends as well as the causes and risk factors associated with it are presented.
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Obstetric hemorrhage remains the most important cause of maternal mortality worldwide, accounting for 30% of all direct maternal deaths. As the method of management depends on multiple concurrent and sequential evaluations of the patient's status, it is helpful to have an evaluation strategy prepared for when a postpartum hemorrhage is encountered to facilitate interventions. This review describes an etiology-based approach to the clinical evaluation of postpartum hemorrhage and a suggested systems process that allows both a timely and appropriate evaluation of the hemorrhaging mother.
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Placenta accreta is the abnormal adherence of the placenta to the uterine wall. Where placenta accreta is present, the failure of the placenta to separate normally from the uterus after delivery is accompanied by severe postpartum hemorrhage. ⋯ Management should take place in centers with special expertise. All obstetric units should have an obstetric hemorrhage protocol in place.
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Clin Obstet Gynecol · Mar 2010
ReviewPostpartum hemorrhage: evidence-based medical interventions for prevention and treatment.
Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality throughout the world. The majority of research on this topic has focused on efforts to prevent PPH. ⋯ Misoprostol may be a reasonable option where parenteral administration of an uterotonic is not feasible. There is little evidence to guide treatment decisions should PPH occur.
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Hemorrhage requiring blood transfusion is a common occurrence in obstetrics. This article reviews each step in the transfusion process, including laboratory preparation of blood, indications for various blood components, complications of blood transfusion, massive transfusion, and alternatives to homologous blood. Current thinking regarding transfusion-related acute lung injury, transfusion-related immunomodulation, early use of plasma for massive transfusion, and the use of adjuvant agents such as activated recombinant factor VII are also discussed.