Is there an association between postpartum hemorrhage, interventional radiology procedures, and psychological sequelae?
01 Jun 2021-Journal of Maternal-fetal & Neonatal Medicine (Taylor & Francis)-Vol. 34, Iss: 11, pp 1792-1796
TL;DR: Lack of proper professional support may have contributed to the development of post-traumatic psychological sequelae suggesting a need for debriefing in women who underwent IRP or were at high risk for PPH.
Abstract: Postpartum hemorrhage (PPH) may cause post-traumatic psychological sequelae. Interventional radiology procedures (IRP) have been established in the management of PPH when conventional management fa...
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TL;DR: In this paper, the authors conducted a systematic literature review through March 31, 2021, using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in compliance with the PRISMA guidelines and determined the effect of prior UAE for postpartum hemorrhage (PPH) by exploring the relationship between prior UAE and obstetric complications through a meta-analysis.
Abstract: This study aimed to review the obstetric complications during subsequent pregnancies after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) by exploring the relationship between prior UAE and obstetric complications through a meta-analysis. We conducted a systematic literature review through March 31, 2021, using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in compliance with the PRISMA guidelines and determined the effect of prior UAE for PPH on the rate of placenta accreta spectrum (PAS), PPH, placenta previa, hysterectomy, fetal growth restriction (FGR), and preterm birth (PTB). Twenty-three retrospective studies (2003-2021) met the inclusion criteria. They included 483 pregnancies with prior UAE and 320,703 pregnancies without prior UAE. The cumulative results of all women with prior UAE indicated that the rates of obstetric complications PAS, hysterectomy, and PPH were 16.3% (34/208), 6.5% (28/432), and 24.0% (115/480), respectively. According to the patient background-matched analysis based on the presence of prior PPH, women with prior UAE were associated with higher rates of PAS (odds ratio [OR] 20.82; 95% confidence interval [CI] 3.27-132.41) and PPH (OR 5.32, 95% CI 1.40-20.16) but not with higher rates of hysterectomy (OR 8.93, 95% CI 0.43-187.06), placenta previa (OR 2.31, 95% CI 0.35-15.22), FGR (OR 7.22, 95% CI 0.28-188.69), or PTB (OR 3.00, 95% CI 0.74-12.14), compared with those who did not undergo prior UAE. Prior UAE for PPH may be a significant risk factor for PAS and PPH during subsequent pregnancies. Therefore, at the time of delivery, clinicians should be more attentive to PAS and PPH when women have undergone prior UAE. Since the number of women included in the patient background-matched study was limited, further investigations are warranted to confirm the results of this study.
18 citations
TL;DR: More than half of pregnant women with an antenatally AIP diagnosis reported a high VAS score regarding anxiety, in particular when morbidity/mortality and long-term consequences on sexual activities were analyzed.
Abstract: Abstract Objectives To evaluate anxiety and psychological impact of abnormally invasive placenta (AIP) diagnosis during pregnancy. Methods A cross-sectional survey study was performed to assess the psychological response of pregnant women with an antenatally AIP diagnosis. The psychological impact was measured through a visual analogue scale (VAS) for anxiety, which ranged from 0 (not at all anxious) to 100 (extremely anxious) and was referred to three questions: (1) How anxious were you the first time they counselled you about AIP?; (2) How anxious were you the day of the planned cesarean delivery in terms of morbidity/mortality?; (3) How anxious were you in terms of future sexual activities? Results 48 singleton pregnancies that underwent planned cesarean hysterectomy for AIP, met the inclusion criteria and were surveyed for the study. Mean VAS was 41.6 ± 25.6, with 47.9% of women with VAS >50 for question 1 (p=0.015). Mean VAS was 52.9 ± 19.1, with 75.0% of women with VAS >50 for question 2 (p=0.02). Mean VAS was 49.6 ± 20.4, with 83.3% of women with VAS >50 for question 3 (p=0.006). Conclusions More than half of pregnant women with an antenatally AIP diagnosis reported a high VAS score regarding anxiety, in particular when morbidity/mortality and long-term consequences on sexual activities were analyzed. Our findings could be used to formulate timely psychological interventions to improve mental health and psychological resilience in women with AIP.
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TL;DR: Haemorrhage and hypertensive disorders are major contributors to maternal deaths in developing countries and these data should inform evidence-based reproductive health-care policies and programmes at regional and national levels.
3,593 citations
Nicholas J Kassebaum1, Amelia Bertozzi-Villa1, Megan Coggeshall1, Katya Anne Shackelford1 +349 more•Institutions (179)
TL;DR: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015, with evidence of continued acceleration in the MMR, and MMR was highest in the oldest age groups in both 1990 and 2013.
1,383 citations
01 Dec 2014
TL;DR: A welcome decrease in the overall rate of maternal death across the United Kingdom is shown, and a compelling message for the future has to be the importance of continuing the programme of vaccination against influenza in pregnancy in the UK and Ireland, working to maximise uptake and hence to ensure the authors prevent future influenza-related maternal deaths.
Abstract: This report continues the longest running programme of Confidential Enquiries into maternal deaths worldwide, and shows a welcome decrease in the overall rate of maternal death across the United Kingdom. In addition, it includes, for the first time, Confidential Enquiries into maternal deaths occurring in Ireland. The importance of this report lies in going “beyond the numbers” and recognising the death of every woman during or after pregnancy as a tragedy from which it is incumbent upon us, as health professionals, service planners or policymakers to learn lessons to improve future care. We must recognise that each woman included in this report leaves behind a bereaved family on whom the impact of her death will be lifelong. We owe it to those left behind to learn from the death of their mother, partner, daughter or friend and to make changes for the future to prevent other women from dying. The focus of this report is therefore clearly to the future, on the actions, small and large, that we as a community or an individual can make to continue to improve the quality of maternity care across the UK and Ireland. As such, it is also enhanced by the inclusion, for the first time, of Confidential Enquiries into the care of women with severe complications in pregnancy, but who survived, thus broadening the messages to improve care yet further. As always, the focus is not in attributing blame, but on improving future mothers’ care. Maternal deaths from genital tract sepsis have fallen significantly, but as this report shows, infections from all causes are an important cause of maternal death. This report spans the period of the influenza A/H1N1 pandemic, which severely affected pregnant women in particular. Some women died before immunisation was introduced, but a number of unvaccinated women died after the vaccination programme began, and, more recently, some women died from non-pandemic type seasonal influenza. The compelling message for the future has to be the importance of continuing the programme of vaccination against influenza in pregnancy in the UK and Ireland, working to maximise uptake and hence to ensure we prevent future influenza-related maternal deaths. At the same time, and as highlighted across many areas of the health service, early identification of pregnant and postpartum women whose medical condition is deteriorating and rapid actions to diagnose and treat pregnant and postpartum women with suspected sepsis will save lives. The importance of routine measurements such as pulse, temperature, respiratory rate and blood pressure in any ill pregnant women cannot be over-emphasised. Pregnant women can appear relatively well and yet become seriously ill with sepsis very quickly. Midwives, doctors and other health professionals need to “think sepsis” and implement sepsis bundles, including giving antibiotics within an hour of the diagnosis being suspected. The consistent year on year decrease in direct maternal deaths is evidence of commitment to and success in improving the care of women with obstetric complications in pregnancy throughout the health service. However, we still need to plan for the care of women with known co-existing medical complications in pregnancy. The majority of women who die during or after pregnancy in the UK and Ireland die from indirect causes, that is, from an exacerbation of their pre-existing diseases. Commitment to improve care for these women is needed across all professional organisations and groups, working alongside researchers to provide the evidence to ensure that we can provide the best care for women pre-pregnancy, during and after pregnancy. Throughout the report, areas of guidance where care can be improved have been clearly highlighted; an obvious area in which specific guidance is lacking is for the care of women with epilepsy in pregnancy. As Chief Medical and Nursing Officers we are committed to ensuring the development of such guidance and hence optimal care for mothers with epilepsy. This report would not be possible without the dedication and commitment of health professionals throughout the UK and Ireland. In particular, we would like to thank the dedicated assessors who review each individual woman’s death in order to identify actions to improve care in the future. This work is carried out without remuneration and in the assessors own time, because of their commitment to continuous quality improvement. It behoves health service provider organisations including hospitals, health boards, executives and trusts to continue to recognise the importance of this work at both a national and local level and allow assessors dedicated time for it to continue. We therefore welcome the findings in the report that will ultimately help improve outcomes for mothers and their families across the UK and Ireland.
595 citations
TL;DR: Antenatal diagnosis of placenta accreta may reduce peripartum blood loss and the need for blood transfusion and women with antenatal diagnosis more often haveplacenta previa and history of previous cesarean section, and the clinical diagnosis is more often placente percreta.
Abstract: Objective. Placenta accreta is one of the most devastating pregnancy complications. We sought to compare outcomes between women with placenta accreta when diagnosed antenatally or intrapartum, and to define predictors of the antenatal diagnosis. Design. Retrospective case–control study. Setting. University teaching hospital. Population. Twenty-four women with placenta accreta diagnosed antenatally and 20 women discovered intrapartum. Methods. Chart review of historical and delivery-associated variables. Rates were compared between the groups. Main Outcome Measures. Placenta accreta diagnosed antenatally or intrapartum. Results. Women with antenatal diagnosis had a lower estimated blood loss of a median of 4500ml (range 100–15000ml) compared with 7800ml (range 2500–17000ml, p=0.012) and required fewer units of packed red blood cells transfused (median 7; range 0–27 compared with 13.5; range 4–31, p=0.026). Nineteen (79%) women diagnosed antenatally had balloon catheter occlusion carried out during the cesarean section. Five (21%) had the entire placenta left in situ. There was no difference in the rate of surgical complications or duration of hospitalization. The clinical diagnosis among women with antenatal diagnosis was more often placenta percreta (p=0.013). The risk factor profile of women with antenatal diagnosis of placenta accreta included higher gravidity (p=0.014) and parity (p<0.0001), history of cesarean section (p=0.004), and placenta previa in the current pregnancy (p<0.001). Conclusions. Antenatal diagnosis of placenta accreta may reduce peripartum blood loss and the need for blood transfusion. Women with antenatal diagnosis more often have placenta previa and history of previous cesarean section, and the clinical diagnosis is more often placenta percreta.
153 citations
TL;DR: PAE is safe and effective for managing primary PPH and factors related to clinical outcomes, including cesarean section delivery, disseminated intravascular coagulation (DIC), and massive transfusion of more than 10 red blood cell units were related to failed PAE.
Abstract: Pelvic arterial embolization for primary postpartum hemorrhage was safe and effective, although patients with disseminated intravascular coagulation and those who have received a massive transfusion should be carefully monitored during embolization because of the potential need for repeat embolization or additional surgery.
114 citations