Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration. Appropriate management of postpartum hemorrhage requires prompt diagnosis and treatment. The Four T's mnemonic can be used to identify and address the four most common causes of postpartum hemorrhage (uterine atony [Tone]; laceration, hematoma, inversion, rupture [Trauma]; retained tissue or invasive placenta [Tissue]; and coagulopathy [Thrombin]). Rapid team-based care minimizes morbidity and mortality associated with postpartum hemorrhage, regardless of cause. Massive transfusion protocols allow for rapid and appropriate response to hemorrhages exceeding 1,500 mL of blood loss. The National Partnership for Maternal Safety has developed an obstetric hemorrhage consensus bundle of 13 patient- and systems-level recommendations to reduce morbidity and mortality from postpartum hemorrhage.

Postpartum Hemorrhage: Prevention and Treatment.

OBJECTIVE To provide evidence-based guidelines for the provision of a trial of labour after Caesarean section. OUTCOMES Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean and repeat Caesarean section. EVIDENCE MEDLINE database was searched for articles published from January 1, 1995, to October 31, 2017 using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. VALIDATION These guidelines were approved by the Clinical Practice Obstetrics Committee and the Board of the Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS

https://www.jogc.com/article/S1701-2163(18)30903-4/pdf

No. 382-Trial of Labour After Caesarean.

Uterine rupture rarely occurs during pregnancy, but it is a critical situation if so. It is already known that a history of uterine surgeries, such as cesarean section or myomectomy, is a risk factor for uterine rupture. Currently, the laparoscopic adenomyomectomy is a widely performed procedure, but associated risks have not been defined. We observed a case of spontaneous uterine rupture in a patient during the 35th week of gestation, after a laparoscopic adenomyomectomy. A 42-year-old, gravida 2, para 0 woman became pregnant after a laparoscopic adenomyomectomy and her pregnancy was conventional. At a scheduled date in the 35th week of gestation, after combined spinal epidural anesthesia and frequent uterine contractions, a weak pain suddenly ensued. After 13 minutes of uterine contractions, vaginal bleeding was evident. A cesarean section was performed, and the uterine rupture was found in the scar. After a laparoscopic adenomyomectomy, a pregnant uterus can easily rupture by rather weak and short uterine contractions, and is characterized by vaginal bleeding. When uterine bleeding is observed in pregnant women that have a history of adenomyomectomy, one should consider uterine rupture.

/pdf/spontaneous-uterine-rupture-in-the-35th-week-of-gestation-js6x5cfogc.pdf

Spontaneous uterine rupture in the 35th week of gestation after laparoscopic adenomyomectomy.

/pdf/searching-for-placenta-percreta-a-prospective-cohort-and-27cehnqi.pdf

Searching for placenta percreta: a prospective cohort and systematic review of case reports

Objective
To compare cardiotocographic abnormalities recorded during labour in women with prior caesarean delivery (CD) and complete uterine rupture with those recorded in controls with prior CD without uterine rupture.

/pdf/can-intrapartum-cardiotocography-predict-uterine-rupture-11rzrqdz4u.pdf

F. LeGoueff

Papers

Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery.