![]() ![]() ![]() ![]() Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Risk factors for severe postpartum hemorrhage: a case-control study. Nyflot LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, Jacobsen AF, Vangen S. doi: 10.1111/j.Ĭoviello EM, Grantz KL, Huang CC, Kelly TE, Landy HJ (2015) Risk factors for retained placenta. Prevalence and risk factors of severe obstetric haemorrhage. Global causes of maternal death: a WHO systematic analysis. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L. Manual removal of the placenta Postpartum hemorrhage Retained placenta Third stage of labor Uterine atony. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Uterine atony was significantly associated with greater decrease in hemoglobin (p < 0.001), higher measured blood loss (p < 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p < 0.001). ![]() A shorter third stage (< 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology.Ĭorrelation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics. Retained placenta accounts for nearly 20% of severe cases. A questionable sonographic result is not an effective tool for distinguishing between placental fragments and blood clots.Postpartum hemorrhage is the major cause of maternal mortality worldwide. Normal sonographic findings might obviate the need for manual exploration of the uterine cavity. Sonography is an effective tool for evaluating postpartum patients thought to have retained placental fragments. In 15 of these patients, pathologic examination confirmed residual trophoblastic tissue, and in the remaining 6, the uterus contained blood clots, decidua, or both. In 21 patients, sonography suggested retained placental tissue. One of these patients had residual trophoblastic tissue, which was of minimal quantity and clinically unimportant. In 17 of these patients, the uterus was empty on manual uterine exploration. In 18 patients, no suspected contents were observed on sonography. Causes of late postpartum hemorrhage (from 24 hours to six weeks after delivery) include infection, placental site subinvolution, retained placental fragments and hereditary coagulopathy. The sonographic patterns were then correlated with the presence or absence of retained placental fragments as found on uterine manual exploration and pathologic examination. The second group consisted of those in whom sonography showed echoes of what might appear as residual trophoblastic tissue, that is, echogenic, hypoechoic, or mixed echo intracavitary patterns. The first group comprised women who were judged to have had an empty uterus or nothing but intrauterine fluid collection. Before the procedure, all patients had two-dimensional sonographic imaging, after which they were divided into 2 groups. All these women underwent manual exploration of the uterine cavity. The study group consisted of 39 postpartum women in whom inspection of the placenta brought up suspicion of retained placental fragments. The pathologic diagnosis of RPOC is made based on the presence of chorionic villi, which indicates persistent placental or trophoblastic tissue. To evaluate the diagnostic accuracy of sonography in postpartum patients thought to have retained placental fragments. Retained products of conception (RPOC) are a common and treatable complication after delivery or termination of pregnancy. ![]()
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