Obstetric hemorrhage

Summary. An obstetric hemorrhage may occur before or after delivery, but more than 80% of cases occur postpartum. Worldwide, a massive obstetric hemorrhage, resulting from the failure of normal obstetrical, surgical and/or systemic hemostasis, is responsible for 25% of the estimated 358 000 maternal deaths each year. Most women will not have identifiable risk factors. Nonetheless, primary prevention of a postpartum hemorrhage (PPH) begins with an assessment of identifiable risk factors. Women identified as being at high risk of a PPH should be delivered in a center with access to adequately trained staff and an onsite blood bank. A critical feature of a massive hemorrhage in obstetrics is the development of disseminated intravascular coagulation (DIC), which, in contrast to DIC that develops with hemorrhage from surgery or trauma, is frequently an early feature. Data from clinical trials to guide management of transfusion in PPH are lacking. There are likely to be similarities in the management of transfusion in severe PPH to that of major bleeding in other clinical situations, but the pathophysiological processes that contribute to a massive PPH may necessitate different transfusion strategies such as the ratio of red blood cells to plasma components, in particular fibrinogen. Caution should be exercised when considering the appropriate place for recombinant activated factor VII (rFVIIa) in the management of a major PPH. An early hysterectomy is recommended for severe bleeding as a result of placenta accreta or uterine rupture. However, in women with uterine atony who have ongoing bleeding in spite of an adequate transfusion, it may be reasonable to consider a trial of rFVIIa before a hysterectomy.     

Obstetric haemorrhage

Few obstetric emergencies cause greater concern than haemorrhage in late pregnancy and the immediate postpartum period. Massive haemorrhage can occur without forewarning with few reliable clinical indicators available to predict those at greatest risk. Patients may remain haemodynamically stable until a sudden deterioration in condition takes place. In many cases the extent of the bleeding can be unclear as the haemorrhage may be concealed behind the placenta. This article reviews the common causes of ante and postpartum haemorrhage, their associated factors and the immediate and subsequent management of the conditions. A variety of uterotonic agents is available for the treatment of postpartum haemorrhage and a structured approach for their use is required.     

Obstetric Care

Physicians know that thrombolysis has marked benefits in patients with certain classic findings after acute myocardial infarction. However, some do not realize that thrombolysis has relatively limited risks and can be administered to many more patients than it is at present. The authors review current indications and contraindications and summarize results of major clinical studies that compare currently available thrombolytic agents.     

Obstetric analgesia

Several analgesic options are available for patients during labor. Selection of the appropriate technique must be individualized. Education and preparation begins during prenatal care. If medications are to be used, the risks and benefits to the mother and infant must be considered. Continued patient-doctor communication throughout labor is essential. Patient preferences, tempered by sound medical judgement, should guide the selection of the optimal modality for pain control during labor.     

Obstetric Care

Yes, our patients pay us their fees only so long as they keep well! When they aren't, the cash-box shuts! So isn't it to our own interest to see they never get ill? So, no more epidemics, or hardly any! Everywhere a flourishing health that we tend with pious care, like [a] farmer keeping up his farm. Illness! But with this new system that would ruin the doctors….     

Three-Dimensional Obstetric Ultrasound

Three-dimensional ultrasound has gained a significant popularity in obstetrical practice in recent years. The advantage of this modality in some cases is in question, however. This article provides a basic review of volume acquisition, mechanical positioning, and display modalities. Multiple uses of this technique in obstetrical care including first trimester applications and its utility in clarification of fetal anatomy such as brain, face, heart, and skeleton is discussed.