Topic
Obstetrical bleeding
About: Obstetrical bleeding is a research topic. Over the lifetime, 35 publications have been published within this topic receiving 976 citations.
Papers
TL;DR: Severe obstetrical morbidity may be a more sensitive measure of pregnancy outcomes than mortality by itself, and lowering the risk will require attention to the best ways of managing these complications.
Abstract: Records at 25 maternity units in London covering a 1-year period during 1997-1998 were reviewed to determine the frequency of severe obstetrical morbidity and to identify predictors. The study population of 48,865 women delivering infants during this period included 588 who met criteria for severe obstetrical morbidity. Four conditions were considered: severe bleeding; severe preeclampsia, including hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and eclampsia; severe sepsis: and uterine rupture. Four control subjects were chosen for each case subject to better detect differences in predictive factors. The incidence of severe obstetrical morbidity in this review was 12 per 1000 deliveries (95% confidence interval, 11.2-13.2). Five maternal deaths were ascribed directly to the study conditions: three to sepsis and one each to bleeding and HELLP syndrome. The ratio of severe morbidity to mortality was 118:1. Disease-specific morbidity rates per 1000 deliveries were 6.7 for severe hemorrhage, 3.9 for severe preeclampsia, ().2 for eclampsia, 0.5 for HELLP syndrome. 0.4 for severe sepsis, and 0.2 for uterine rupture. After adjustment for confounding factors, characteristics independently associated with severe obstetrical morbidity as a whole included age greater than 34 years, nonwhite ethnicity, past or current hypertension, previous postpartum bleeding, emergency cesarean delivery, antenatal hospital admission, multiple pregnancy, and taking iron or an antidepressant before delivery. Few risk factors were independently and significantly associated with the occurrence of severe sepsis or uterine rupture. These findings suggest that severe obstetrical morbidity may be a more sensitive measure of pregnancy outcomes than mortality by itself. Most of these events are related to obstetrical bleeding and severe preeclampsia, and lowering the risk will require attention to the best ways of managing these complications.
585 citations
TL;DR: Epsilon-aminocaproic acid has been used in numerous clinical situations to control bleeding and has been claimed to be an effective agent in subarachnoid hemorrhage, genitourinary bleeding from many causes, and in dental surgery in hemophiliacs.
Abstract: Epsilon-aminocaproic acid (EACA) is a synthetic inhibitor of the plasmin-plasminogen system. It is the only potent antifibrinolytic agent which is commercially available in the United States. Effective blood levels of the drug are readily obtainable with either oral or intravenous administration, with very high levels of the drug being found in the urine since the drug is greatly concentrated during excretion. EACA has been used in numerous clinical situations to control bleeding and has been claimed to be an effective agent in subarachnoid hemorrhage, genitourinary bleeding from many causes, and in dental surgery in hemophiliacs. It may also be effective in several less well studied situations such as prophylaxis of bleeding episodes in hemophiliacs, control of menorrhagia, gastrointestinal bleeding, obstetrical bleeding and in bleeding following cardiac and thoracic surgery. Major side effects from EACA include hypotension, cardiac arrhythmias, rhabdomyolysis, and generation of thrombi. The incidence of thrombotic events secondary to the inhibition of the fibrinolytic system by EACA is unknown, but may be particularly increased in those patients who have some underlying predisposition to develop thrombosis. The potential benefit from the use of EACA must be weighed against the possible serious complications, particularly the development of widespread thrombi.
62 citations
TL;DR: The BS and the PBAC are simple tools to evaluate the severity of general bleeding symptoms and menorrhagia in women with inherited bleeding disorders and may help to identify those women for whom a therapeutic intervention is warranted.
Abstract: The aim of this case-control study was to analyse the prevalence of gynaecological, obstetrical and other more general bleeding symptoms in 114 women affected by various inherited bleeding disorders, who were compared with 114 apparently healthy women. Retrospective information were collected by means of two specific questionnaires, one on gynaecological and obstetrical bleeding symptoms, with special focus on the presence of menorrhagia as defined by a pictorial blood loss assessment chart (PBAC); and the other on general bleeding symptoms, whose severity was graded by means of the bleeding score (BS). Compared to normal women, the whole group of women with inherited bleeding disorders had a higher prevalence of excessive bleeding at menarche (25% vs. 5%, P or = 12 (49% vs. 0%, P < 0.0001). In affected women, the BS increased according to the severity of the haemostasis defect. In conclusions, the BS and the PBAC are simple tools to evaluate the severity of general bleeding symptoms and menorrhagia in women with inherited bleeding disorders. These instruments may help to identify those women for whom a therapeutic intervention is warranted.
50 citations
TL;DR: Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal or cesarean delivery, and use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.
Abstract: This study aimed to examine obstetric bleeding outcomes after exposure during pregnancy to selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic (TCAs), and other antidepressants (OADs).The Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway constituted the data source for the present study. We included 57,279 pregnant women, of which 1.02% reported use of antidepressants during pregnancy, mostly SSRIs/SNRIs (0.92%). We categorized exposure according to antidepressant use in pregnancy (SSRIs/SNRIs, n = 527; TCAs/OADs, n = 59; nonexposed, nondepressed, n = 55,411) with inclusion of a disease comparison group (nonexposed, depressed, n = 1282). We used logistic regression to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for vaginal bleeding outcomes in pregnancy and postpartum hemorrhage.Compared with nonexposed subjects, first trimester exposure to SSRIs/SNRIs or TCAs/OADs did not confer any increased risk of vaginal bleeding in early pregnancy (aOR, 0.91; 95% CI, 0.72-1.16 and aOR, 0.83; 95% CI, 0.36-1.92, respectively). No increased risk for vaginal bleeding in midpregnancy was observed among users of SSRIs/SNRIs (aOR, 0.81; 95% CI, 0.50-1.31) or TCAs/OADs (aOR, 0.96; 95% CI, 0.26-3.53) in second trimester. Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal (aOR, 0.90; 95% CI, 0.47-1.74) or cesarean (aOR, 1.47; 95% CI, 0.51-4.22) delivery. Women in the disease comparison group presented a significant moderate increased risk of vaginal bleeding in early pregnancy (aOR, 1.22; 95% CI, 1.06-1.39) and midpregnancy (aOR, 1.28; 95% CI, 1.07-1.55) but not postpartum.Among this Norwegian cohort of pregnant women, use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.
41 citations
TL;DR: The following guidelines for the perinatal management are proposed: decidual bleeding usually begins from 5 weeks of gestation and spontaneous abortion always occurs subsequently without substitute therapy, and the plasma level of FXIIIA must be at least 2 approximately 3%, however, if possible, higher than 10% to prevent bleeding and miscarriage.
Abstract: Transglutaminases are at least 9 enzymes which cross-link a number of proteins. This type of reaction not only enhances the original functions of substrate proteins, but also adds new functions to them. Factor XIII (FXIII) is a plasma transglutaminase circulating in blood as a heterotetramer and consisting of two catalytic A subunits and two non-catalytic B subunits. It is a proenzyme activated by thrombin in the blood coagulation cascade. It plays an important role(s) in hemostasis, wound healing, and maintenance of pregnancy. Accordingly, a lifelong bleeding tendency as well as abnormal wound healing and recurrent spontaneous miscarriage are common symptoms of FXIII deficiency. Genetic and molecular mechanisms of congenital deficiencies have been analyzed in vitro. The mechanisms of these defects have also been studied in detail by using FXIII gene knock-out mice in vivo. We analyzed eight successful outcomes of pregnancy in patients with congenital deficiency of FXIIIA, in which the plasmatic level of maternal FXIIIA and/or the precise substitute therapies were mentioned. Then we propose the following guidelines for the perinatal management: (i) decidual bleeding usually begins from 5 weeks of gestation and spontaneous abortion always occurs subsequently without substitute therapy; (ii) the plasma level of FXIIIA must be at least 2∼3%, however, if possible, higher than 10% to prevent bleeding and miscarriage; (iii) the administration of 250 IU of FXIIIA concentrate each 7 days is enough to keep the level of plasma FXIIIA more than 10% in the early gestation, however 500 IU each 7 days is adequate in the later period to keep that level; (iv) during labor, the desired level is higher than 20%, if possible, higher than 30% to avoid any risk of strong obstetrical bleeding.
39 citations
Related Topics (5)
Performance Metrics
| Year | Papers |
|---|---|
| 2021 | 1 |
| 2020 | 5 |
| 2019 | 2 |
| 2016 | 4 |
| 2015 | 4 |
| 2014 | 5 |