Bleeding During Pregnancy: A Comprehensive Guide
Abstract
Bleeding during pregnancy is not a rare phenomenon and has been associated with significant maternal and fetal morbidities and even mortality. Although vaginal bleeding occurs mainly during the first trimester, it can appear at any stage of pregnancy and during the post-partum period. This sometimes life-threatening event requires an extensive work-up in order to recognize its cause and establish a rapid and effective therapeutic approach. Bleeding During Pregnancy: A Comprehensive Guide draws on evidence-based data and brings together updated information on all aspects of pregnancy-related bleeding. Chapters were contributed by a multidisciplinary team of international experts, including obstetricians, gynecologists, anesthesiologists, hematologists, oncologists and epidemiologists. Topics covered include: bleeding during early pregnancy (early pregnancy loss, ectopic pregnancy, gestational trophoblastic disease, and cancer of the reproductive tract during pregnancy; bleeding in late pregnancy (preterm delivery, placental abruption, placenta previa, vasa previa and uterine rupture); and post partum-hemorrhage. Intensive care of a patient with excessive bleeding and coagulotherapy during pregnancy or the post-partum period are also discussed. This book is an essential guide for a broad spectrum of clinicians and health care professionals who treat pregnant patients.
Chapters (12)
Vaginal bleeding is a common event during pregnancy. The incidence varies, ranging from 1 to 22% [1–3]. The source of bleeding
is mostly maternal. The significance, initial diagnosis, and clinical approach to vaginal bleeding depend on the gestational
age and the bleeding characteristics. Vaginal bleeding during early pregnancy is associated with a 1.6-fold increased risk
of many adverse outcomes, including preterm labor (PTL) and preterm premature rupture of membranes (PPROM) [3]. As bleeding
persists or recurs later in pregnancy, the risk of associated morbidities grows [4]. Although 50% of the women who suffer
from vaginal bleeding during early pregnancy go on to have a normal pregnancy [3], vaginal bleeding in the second half of
pregnancy is linked to perinatal mortality, disorders of the amniotic fluid, premature rupture of membranes (PROM), preterm
deliveries, low birth weight, and low neonatal Apgar scores [1].
Pregnancy is a significant event in a woman’s life, and emotional attachment to the pregnancy and developing baby may begin
early in the first trimester. For most women, experiencing a first trimester loss is a difficult and vulnerable time. When
it occurs, the grief can be as profound as for any perinatal or other major loss [1]. Spontaneous abortion (a pregnancy that
ends spontaneously before the fetus has reached a viable gestational age) is among the most common complications of pregnancy.
Approximately 12–15% of recognized pregnancies and 17–22% of all pregnancies end in spontaneous abortion [2, 3].
Ectopic pregnancy is defined as an implantation of a fertilized ovum at a site other than within the endometrium. Ectopic pregnancies are responsible for approximately 10% of all maternal mortality and are the leading cause of pregnancy-related death during the first trimester [1], mainly related to hemorrhage [2]. In addition to maternal mortality and ectopic pregnancy-related complications, ectopic pregnancy is an economic burden. The total cost associated with ectopic pregnancy in the USA in 1990 was estimated at $1.1 billion [3].
Molar pregnancy and gestational trophoblastic neoplasia (GTN) comprise a group of interrelated diseases, including complete
and partial molar pregnancy, placental-site trophoblastic tumor (PSTT), and choriocarcinoma, that have varying propensities
for local invasion and distal spread. Vaginal bleeding is a common presenting sign, seen in as many as 97% of women with a
complete molar pregnancy; it is also a frequent symptom of all types of GTN [1].
Vaginal blood loss during pregnancy can, rarely, be caused by an underlying gynecological malignancy. Cancer is the second
leading cause of death in women during the reproductive years and complicates 0.06–0.10% of all pregnancies [1]. In Europe,
this number translates into 3,000–5,000 new cases of cancer during pregnancy. As women in developed societies delay childbearing
to the third or fourth decade of life, and the incidence of several malignancies rises with increasing age, this coincidence
of cancer and pregnancy is likely to become more common in future [2].
Vaginal bleeding during gestation is an ominous sign indicating an adverse pregnancy outcome. Bleeding can occur during all
stages of gestation. It complicates up to 20% of pregnancies during the first trimester and is regarded as a sign of threatened
abortion. During the second and third trimesters, vaginal bleeding was found to be a risk factor for adverse maternal and
neonatal outcomes including preterm labor (PTL), preterm prelabor rupture of membranes (PROM), placental abruption, placenta
previa, and stillbirth.
In normal pregnancies placental separation occurs immediately following birth, but in cases of abruption the placental detachment
occurs prematurely [1]. There are no standard criteria for diagnosing placental abruption, but the clinical hallmarks of the
condition are vaginal bleeding and abdominal pain accompanied by uterine hypertonicity, tachysystole, and a nonreassuring
fetal heart rate pattern. Abruption is strongly associated with disproportionately increased risks of stillbirth and neonatal
and infant mortality, as well as preterm delivery and intrauterine growth restriction.
Vasa previa is characterized by the presence of a blood vessel or vessels that are not supported by the umbilical cord or
placenta and traverse the fetal membranes, which are covering the internal cervical os, in front of presenting fetal part
[1]. Vasa previa remains a challenging obstetrical complication with a significant risk of both fetal morbidity and mortality
due to fetal exsanguination secondary to rupture of these vessels with the onset of labor or rupture of the membranes [2].
These complications, however, can be minimized if an appropriate and timely prenatal diagnosis is obtained.
Uterine rupture may be defined as a disruption of the uterine muscle extending to and involving the uterine serosa or disruption
of the uterine muscle with extension to the bladder or broad ligament [1]. Uterine dehiscence is defined as disruption of
the uterine muscle with intact uterine serosa [1]. Uterine rupture is associated with severe maternal and perinatal morbidity
and mortality, and it remains one of the most catastrophic obstetrical emergencies. It has consequences not only for the index
pregnancy but also, if it is possible to conserve the uterus, for further fertility and pregnancy outcomes. In the developed
world, most cases occur in women with a uterine scar [2–4]. In less and least developed countries, cephalopelvic disproportion
causing obstructed labor is the major cause of uterine rupture [5–7]. The prevalence of uterine rupture is likely to increase
in the developed world reflecting increasing rates of cesarean section, and it continues to contribute significantly to maternal
mortality among women giving birth in the developing world.
Simply put, postpartum hemorrhage (PPH) is excessive bleeding after childbirth. It is a leading cause of maternal mortality
worldwide, but most of the deaths occur in low-income countries. Specifically, PPH is defined as blood loss of >500 ml after
vaginal delivery or >1,000 ml after cesarean delivery. “Early” PPH occurs within 24 h after delivery, and “late” PPH occurs
between 24 h and 6 weeks after delivery. In most parts of the world, PPH accounts for 35–55% of maternal deaths. In rural
regions and low-income countries, where access to quick medical attendance is limited, it is a major health concern. Even
in industrialized countries, what may be considered a low-risk birth can rapidly deteriorate into hypovolemic shock and death
through PPH. Therefore, although it is considered a treatable obstetrical emergency, delayed treatment results in significant
morbidity and mortality [1].
Women may have disordered hemostasis associated with pregnancy due to an underlying congenital bleeding disorder or to acquired
thrombocytopenia or coagulopathy arising from problems in the pregnancy itself. Bleeding associated with these disorders remains
an important cause of maternal death worldwide [1].
Obstetrical hemorrhage can be defined in many ways. Any blood loss >500 ml for a vaginal delivery or >1,000 ml following cesarean
section is considered abnormal. Definitions of major obstetrical hemorrhage vary, but it can be defined as a blood loss in
excess of 1,500 ml, a hemoglobin drop of >4 g/dl, or an immediate transfusion of four units of red blood cells [1].
... Traditionally, early PPH is defined as blood loss exceeding 500 ml within 24 h after vaginal delivery, or blood loss exceeding 1000 ml following cesarean section (CS) [12]. ...
... A. Takang et al. Open Journal of Obstetrics and Gynecology quately after birth, responsible for 70% -90% of all PPH cases [12] [15] [16]. Postpartum hemostasis is based on powerful and prolonged hormonally mediated contractions that decrease the blood flow to the placental bed [17] [18]. ...
... The major risk factors for PPH include over-distended uterus (i.e. macrosomia, multiple gestations, hydramnios, etc.), prolonged or precipitous labor and chorioamnionitis [12]. Nevertheless, atonic PPH occurs in more women without known risk factors than those with identifiable risk factors [19] [20]. ...
... It accounts for 35– 55% of peripartum maternal deaths worldwide [1]. Traditionally, early PPH is defined as blood loss exceeding 500 ml within 24 h after vaginal delivery, or blood loss exceeding 1000 ml following cesarean section (CS) [2]. PPH may cause short-and long-term maternal morbidity, including acute renal failure, hypovolemic shock, consumptive coagulopathy , disseminated intravascular coagulation (DIC), blood transfusion related complications, or hysterectomy leading to loss of childbearing potential [3,4]. ...
... Approximately 12% of women who survive a PPH event will suffer from anemia [4]. The most common cause of PPH is uterine atony, i.e. failure of the uterus to contract adequately after birth, responsible for 70–90% of all PPH cases [2,5,6]. Postpartum hemostasis is based on powerful and prolonged hormonallymediated contractions that decrease the blood flow to the placental bed [7,8]. ...
... The major risk factors for PPH include over-distended uterus (i.e. macrosomia, multiple gestations, hydramnios, etc.), prolonged or precipitous labor and chorioamnionitis [2]. Nevertheless, atonic PPH occurs in more women without known risk factors than those with identifiable risk factors [9,10]. ...
Abstract Objective: To investigate risk factors for postpartum hemorrhage (PPH) in vaginal deliveries and the influence of previous PPH on the subsequent pregnancy. Study design: A retrospective cohort study including first singleton deliveries between the years 1988 and 2012 was performed comparing deliveries with and without PPH. In addition, perinatal outcomes of the subsequent pregnancy were evaluated. Multivariable analysis was performed to control for confounders. Results: PPH complicated 0.8% of all first vaginal deliveries. Significant risk factors for PPH in vaginal delivery, using a multiple logistic regression model, were: post-term pregnancy, fertility treatments, hypertensive disorders, labor dystocia during the 2nd, and perineal tears grade 2 and 3 respectively. Previous PPH was found to be an independent risk factor for PPH in the subsequent pregnancy. Moreover, previous PPH was found to be a significant risk factor for CS deliver, to complicate delivery with revision of uterus cavity, anemia, and to require blood transfusion. Conclusion: Previous PPH poses a risk for recurrent PPH in subsequent delivery and an increased risk for CS. As PPH remains one of the major causes of maternal morbidity, this study strengthens the need for a comprehensive evaluation of prior PPH as a major risk factor for PPH recurrence.
... Furthermore, the table helps to frame the research methodology, guiding the data collection process to ensure that all relevant variables are included. This is essential for developing robust machine learning models that can accurately identify the factors most predictive of early pregnancy loss [30]. By clearly outlining the potential variables in this structured manner, the research team, stakeholders, and scientific community can easily comprehend the scope of this research and the complexity of the factors being analyzed. ...
... In the MLP model setup, the architecture included 16 hidden layers. The hidden_layer_sizes parameter, which defines the size (number of neurons) of each layer in the network, was set to (120, 100, 90, 80, 70, 60, 50,40,30,25,20,15,10,5,3,1). This parameter directly translates to the model having 16 distinct hidden layers, with the number of neurons in each layer decreasing from 120 in the first hidden layer to 1 in the last hidden layer. ...
Abstract: Early pregnancy loss (EPL) is a prevalent health concern with significant implications globally for gestational health. This research leverages machine learning to enhance the prediction of EPL and to differentiate between typical pregnancies and those at elevated risk during the initial trimester. We employed different machine learning methodologies, from conventional models to more advanced ones such as deep learning and multilayer perceptron models. Results from both classical and advanced machine learning models were evaluated using confusion matrices, cross-validation techniques, and analysis of feature significance to obtain correct decisions among algorithmic strategies on early pregnancy loss and the vitamin D serum connection in gestational health. The results demonstrated that machine learning is a powerful tool for accurately predicting EPL, with advanced models such as deep learning and multilayer perceptron outperforming classical ones. Linear discriminant analysis and quadratic discriminant analysis algorithms were shown to have 98 % accuracy in predicting pregnancy loss outcomes. Key determinants of EPL were identified, including levels of maternal serum vitamin D. In addition, prior pregnancy outcomes and maternal age are crucial factors in gestational health. This study's findings highlight the potential of machine learning in enhancing predictions related to EPL that can contribute to improved gestational health outcomes for mothers and infants.
... Furthermore, the table helps to frame the research methodology, guiding the data collection process to ensure that all relevant variables are included. This is essential for developing robust machine learning models that can accurately identify the factors most predictive of early pregnancy loss [30]. By clearly outlining the potential variables in this structured manner, the research team, stakeholders, and scientific community can easily comprehend the scope of this research and the complexity of the factors being analyzed. ...
... In the MLP model setup, the architecture included 16 hidden layers. The hidden_layer_sizes parameter, which defines the size (number of neurons) of each layer in the network, was set to (120, 100, 90, 80, 70, 60, 50,40,30,25,20,15,10,5,3,1). This parameter directly translates to the model having 16 distinct hidden layers, with the number of neurons in each layer decreasing from 120 in the first hidden layer to 1 in the last hidden layer. ...
Early pregnancy loss (EPL) is a prevalent health concern with significant implications globally for gestational health. This research leverages machine learning to enhance the prediction of EPL and to differentiate between typical pregnancies and those at elevated risk during the initial trimester. We employed different machine learning methodologies, from conventional models to more advanced ones such as deep learning and multilayer perceptron models. Results from both classical and advanced machine learning models were evaluated using confusion matrices, cross-validation techniques, and analysis of feature significance to obtain correct decisions among algorithmic strategies on early pregnancy loss and the vitamin D serum connection in gestational health. The results demonstrated that machine learning is a powerful tool for accurately predicting EPL, with advanced models such as deep learning and multilayer perceptron outperforming classical ones. Linear discriminant analysis and quadratic discriminant analysis algorithms were shown to have 98 % accuracy in predicting pregnancy loss outcomes. Key determinants of EPL were identified, including levels of maternal serum vitamin D. In addition, prior pregnancy outcomes and maternal age are crucial factors in gestational health. This study’s findings highlight the potential of machine learning in enhancing predictions related to EPL that can contribute to improved gestational health outcomes for mothers and infants.
... Placental abruption is the strongest known trigger of spontaneous preterm labour, increasing the risk four-to six-fold. 24 In women in stable condition at early gestational ages, close surveillance in hospital is recommended because of the unpredictable nature of recurrent episodes of bleeding. 24 In contrast, women admitted with bleeding of cervical origin were not at as high a risk for these outcomes; they had the latest median gestational age at delivery and delivered most often vaginally and after spontaneous labour. ...
... 24 In women in stable condition at early gestational ages, close surveillance in hospital is recommended because of the unpredictable nature of recurrent episodes of bleeding. 24 In contrast, women admitted with bleeding of cervical origin were not at as high a risk for these outcomes; they had the latest median gestational age at delivery and delivered most often vaginally and after spontaneous labour. Twenty-three women were classified as having bleeding of unknown origin or other cause. ...
Objective:
Antepartum hemorrhage is associated with preterm birth and operative delivery. Since the Canadian Perinatal Network records obstetric interventions for women admitted to tertiary care hospitals with antepartum hemorrhage, our objective was to describe the delivery characteristics of this cohort.
Methods:
Trained abstractors collected data by chart review from women admitted with antepartum hemorrhage between 22+0 and 28+6 weeks' gestation. We included all women with complete follow-up postpartum and used descriptive statistics to report the indications for, timing of, and modes of delivery.
Results:
The study cohort included 806 women from 13 tertiary perinatal centres in six provinces. The most common causes of bleeding were placental abruption (n = 256) and placenta previa (n = 171). The median gestational age at delivery was 30 weeks, and 497 (61.7%) births occurred at less than 34 weeks. Over one half of the women began labour spontaneously, and 238 (29.5%) were delivered prior to the onset of labour. Overall, 370 (45.9%) women delivered vaginally, including 98 who had induction of labour. Of the 436 Caesarean sections (54.1%), 345 (79.1%) were emergencies. The most common indications for Caesarean section were placenta previa, abnormal fetal presentation, and placental abruption or vaginal bleeding.
Conclusion:
This inpatient cohort of women with antepartum hemorrhage had high rates of spontaneous labour, preterm birth, and emergency Caesarean section. These results can be used as current Canadian benchmark rates of preterm delivery, induction of labour, and Caesarean section in women admitted to tertiary care centres with antepartum hemorrhage between 22+0 and 28+6 weeks' gestation, and can aid in the counselling of similar women.
... Kebutuhan dan kecukupan vitamin D selama trimester pertama menjadi kunci kesuksesan kehamilan sekaligus mencegah abortus spontan. [24][25][26] Vitamin D berperan dalam proses implantasi embrio. Ketika proses implantasi, sel stromal yang mengelilingi embrio bertransformasi menjadi desidua (proses desidualisasi). ...
Latar Belakang: Abortus masih merupakan masalah besar dalam pelayanan obstetri karena merupakan salah satu penyebab kematian ibu dan janin sampai saat ini. Kekurangan vitamin D mempengaruhi kehamilan dan dapat berdampak terhadap risiko komplikasi pada ibu hamil dan pada pertumbuhan janin. Tumor necrosis factor-alpha (TNF-α) adalah sitokin Th1 multifungsi dan sangat penting untuk kontrol awal kejadian abortus. Tujuan penelitian ini melihat apakah terdapat perbedaan kadar vitamin D, dan TNF-α pada pasien kehamilan normal trimester 1 dan pasien dengan kejadian abortus.Metode: Desain penelitian adalah potong-lintang. Penelitian ini dilakukan pada Maret 2022 hingga selesai penelitian di Poliklinik Obstetri dan Ginekologi, PONEK RSUP Dr. M. Djamil Padang, Rumah Sakit Universitas Andalas, Rumah Sakit dr. Reksodiwiryo Padang, RSUD M Zein Painan, RSUD Pariaman untuk pengambilan sampel darah. Pemeriksaan kadar 1,25 dihidroksi vitamin D3, TNF-α serum maternal dilakukan di Laboratorium Biomedik Universitas Andalas Padang. Sampel penelitian ini adalah seluruh ibu hamil trimester 1 dan ibu dengan abortus berjumlah 44 orang. Teknik pengambilan sampel dengan consecutive sampling. Analisis data univariat dan bivariat dengan menggunakan uji T-independen (p<0,05) pada taraf signifikansi dan uji Mann-whitney berdasarkan distribusi data. Hasil: primipara lebih banyak pada kehamilan normal yaitu 19 orang (86,4%) dan abortus paritas multipara lebih banyak yaitu 12 orang (54,5%). Rerata kadar serum 1,25 dihidroksi vitamin D3 sebesar 52,81 ng/ml dan rerata kadar TNF-α sebesar 351,07 ng/ml. Terdapat perbedaan bermakna pada kadar 1,25 dihidroksi vitamin D3 antara kehamilan normal dengan kehamilan abortus dengan p value 0,047. Perbedaan kadar TNF-α antara abortus dan kehamilan normal didapatkan p value 0,108.Kesimpulan: Terdapat perbedaan bermakna pada kadar vitamin D antara kehamilan normal dengan kehamilan abortus. Tidak terdapat perbedaan bermakna pada kadar TNF-α antara kehamilan abortus dengan kehamilan normal.
... Berg cites a very broad range of 22% to 89%. The 22% figure is incorrect: the study she cites (Weintraub and Sheiner 2011) is actually citing a study on early pregnancy loss, which it defines as 'reproductive loss that occurs ?14 days after conception, at around the time of the next expected menstrual period' (Ellish et al. 1996, p. 406). This will certainly be lower than the overall spontaneous abortion rate. ...
A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities.
... D ünya Sağlık örgütü (WHO) tarafından düşük, 22. gebelik haftasından önce, 500 gramdan daha düşük ağırlığa sahip embriyo/fetus ve eklerinin tamamının veya bir kısmının uterus kavitesi dışına atılması olarak tanımlanmaktadır. [1] Tüm dünyada gebeliklerin %15-20'si spontan düşük nedeniyle kaybedilmektedir. [2][3][4] Türkiye Nüfus ve Sağlık Araştırması (TNSA 2013)'na göre, ülkemizde evlenmiş kadınların 1/5'inin (%23) kendiliğinden düşük yaptığı, %14'ünün ise en az bir kez isteyerek düşük yaptığı görülmektedir. ...
... Eine postpartale Hämorrhagie (PPH) ist eine lebensbedrohliche Geburtskompli kation und weltweit eine der Hauptursachen mütterlicher Morbidität und Mortalität [21]. Die Prävalenz in den Industrienationen beträgt rund 0,5-5 % Eine PPH kann primär (früh) also in den ersten 24 Stunden postpartum oder sekundär (spät) ab 24 Stunden postpartum bis 12 Wochen postpartum auftreten [28]. ...
Verschiedene Studien belegen die steigenden Raten an postpartalen Hamorrhagien (PPH). Der massive
Blutverlust stellt ein schwerwiegendes Ereignis dar und kann zu tiefgreifenden physischen und psychischen
Folgen fuhren, in gravierenden Fallen sogar todlich verlaufen. In ihrer Bachelorarbeit stellt unsere
Autorin anhand evidenzbasierter Literatur die Folgen einer PPH dar und legt Empfehlungen fur die optimale
Nachbetreuung der betroffenen Frau vor.
... 10 Evaluation of the fetus can be done rapidly. 11 In diagnosing fetal anencephaly using POCUS, a very important finding is absence of the fetal calvarium. Two diagnostic signs have been described to aid in diagnosis: the "Mickey Mouse" sign and the "frog eye" sign. ...
Background:
Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding.
Case report:
A 33-year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside US was performed. The EP noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal US. Making the diagnosis at the point of care allowed earlier detection and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, thus decreasing maternal risk. If this diagnosis would not have been recognized by the EP at the point of care, it may not have been diagnosed until the second trimester, and lower-risk maternal options would not have been available.
Abdominal Ultrasound (US) is used in clinical practice to diagnose a multitude of pathologies. It is used to evaluate the liver, gall bladder, pancreas, appendix, kidney, bladder, aorta and the uterus. The Focused Assessment with Sonography in Trauma (FAST) exam first introduced in the 1970s is still an integral part of the examination of trauma patients in the (Emergency Department) ED. Newer applications such as the use of ultrasound to image the stomach to assess gastric contents prior to surgery are emerging. Easy availability, lack of adverse effects and quick results has made it an important tool for physicians to diagnose acute abdominal diseases and provide prompt management. In this chapter we provide a wide array of questions focused on principles of US for the abdomen and interpretation of ultrasound images of common abdominal pathologies.
Przedmiotem opracowania jest biomedyczny wymiar poronienia klinicznego. W pracy przyjęto założenie, że analiza biomedyczna poronienia klinicznego stanowi niezbędne wprowadzenie do jego dalszej charakterystyki tanatologicznej. Za cel badań postawiono wykazanie, że już sama eksploracja uwarunkowań biomedycznych pozwala określić podstawowe predyktory odsłaniające fenomen poronienia spontanicznego jako zdarzenia tanatycznego w aspekcie psychospołecznym. W toku badań omówiono kryteria definicyjne poronienia i diagnostyczne wczesnej ciąży dla odróżnienia strat klinicznie potwierdzonych od ciąż biochemicznych. Przedłożono szacunkową częstotliwość niepowodzeń w obu kategoriach: przedklinicznych i klinicznych. Syntezę fizjologii poronienia przedstawiono na podstawie szczegółowej charakterystyki jego wielokryterialnych typologii, deskrypcji symptomatologii i patomechanizmu procesu poronnego, opisu metod diagnostycznych i form postępowania terapeutycznego. Wskazano najczęściej komentowane w literaturze położniczej czynniki etiologiczne poronień. Ze względu na przygotowanie małżonków do poczęcia dziecka po wcześniejszym niepowodzeniu wyróżniono prymarne zasady profilaktyki poronień możliwe do prostego wdrożenia w okresie prekoncepcyjnym i na początkowych etapach nowej ciąży. W wyniku przeprowadzonych analiz wyciągnięto wniosek, że sytuacja kliniczna, w której śmierć na skutek poronienia spontanicznego się dokonuje, modeluje osobliwe warunki kształtowania relacji rodziców z dzieckiem po rozpoznaniu symptomów zagrożenia jego życia, w trakcie procesu diagnostycznego, potwierdzenia śmierci i procedury terapeutycznej kończącej ciążę oraz usunięcia zwłok lub szczątków płodowych.
Background:
To determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan.
Methods:
An observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH.
Results:
Among the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%).
Conclusions:
According to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.
Some opponents of abortion claim fetuses are persons from the moment of conception. Call these “Personhood-At-Conception” (or PAC), opponents of abortion. Amy Berg (2017, Philosophical Studies 174:1217–26) argues that if fetuses are persons from the moment of conception, then miscarriage kills far more people than abortion. Thus, PAC opponents of abortion must “immediately” and “substantially” shift their attention, resources, etc., toward preventing miscarriage or admit they do not believe that personhood begins at conception (or, at least, they should recognize they are not acting in ways consistent with this belief). Unfortunately, Berg’s argument fails at every step. After outlining her argument, I show that her claim—that “miscarriage . . . is much deadlier than abortion”—is false (when taken literally) and misleading otherwise. Further, Berg’s argument is identical in structure to a criticism sometimes levied against the “Black Lives Matter” movement. In the latter context, the argument has been vehemently rejected. Berg’s argument should be rejected for the same reasons. Finally, Berg cites no evidence when claiming that PAC opponents of abortion are “not doing enough” to prevent miscarriage. And, even if PAC opponents of abortion are not diverting substantial funds toward miscarriage prevention, Berg fails to notice that this may be for good reason.
Problem:
To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population.
Methods:
A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH.
Results:
Fifteen had a major PPH >1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44±0.45 in PPH cases and 1.00±0.59 in controls (P-value .008). This difference was still significant even after adjustment for neonatal weight that represented a confounding variable.
Conclusion:
Higher PP13 levels are independently associated with major PPH >1000 mLs.
ResearchGate has not been able to resolve any references for this publication.