Anesthesia
Maryam Sadat Hosseini; Dariush Abtahi; Ardeshir Tajbakhsh; Farah Farzaneh; Shahram Sayadi; Nooshin Amjadi; Maral Hosseinzadeh
Volume 8, Issue 2 , January and February 2023, , Pages 157-166
Abstract
Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels ...
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Background and Objective: Delayed diagnosis and treatment of postpartum hemorrhage could result in mortality. Today, there is a strong desire to determine the factors affecting postpartum hemorrhage, particularly fibrinogen levels. This study aimed to investigate the role of plasma fibrinogen levels in postpartum hemorrhage and severe postpartum hemorrhage.Methods: This cross-sectional study was conducted on 169 term pregnant women who were candidates for an elective Cesarean section. Fibrinogen and other coagulating factors were measured before and at the end of the surgery, and twenty-four hours after surgery. Bleeding volume was also measured during and at the end of the surgery, and twenty-four hours after that. The relationship between coagulation factors and the amount of bleeding was examined using statistical tests.Results: Mean plasma fibrinogen levels measured before, at the end of, and 24 hours after surgery were 247.65±91.07 mg/dl, 219.4±75.60 mg/dl, and 223.91±65.44 mg/dl, respectively. Sixty-five patients (38.5%) had postpartum hemorrhage (1000-2000mL) and seven patients (4.1%) had severe postpartum hemorrhage (>2000mL). Of the cases with preoperative fibrinogen levels less than 200mg/dl, 72% had postpartum hemorrhage and 14% had the severe form. There was a strong association between the patient's plasma fibrinogen level with PPH and sPPH (P=0.000).Conclusion: This study showed a strong correlation between plasma fibrinogen levels and postpartum hemorrhage and severe postpartum hemorrhage. In addition, it has been shown that low plasma fibrinogen levels could be a direct prognostic factor for postpartum hemorrhage and severe postpartum hemorrhage. Younger women and preoperative anemia were other strong predictors.
Anesthesia
Dariush Abtahi; Mehrdad Feizi; Shahram Sayadi; Ardeshir Tajbakhsh; Samira Abbaspour; Sara Salarian; Alireza Mirkheshti
Volume 7, Issue 4 , March and April 2022, , Pages 314-322
Abstract
Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response ...
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Background and Objective: This study was performed to determine and compare the ED90 of prophylactic oxytocin (OX) infusion after delivery of the placenta during cesarean section (CS) in low- and high-risk parturients for uterine atony.Methods: This experimental study was a single-blind and dose-response study using a 9:1 biased-coin sequential allocation method to estimate the ED90 of prophylactic infusion of OX in women with high and low risk for uterine atony who underwent CS. The total administrated OX dose of each patient was determined in the two study groups. The primary outcome was the ED90 for desirable uterine tone based on the opinion of the in-charge obstetrician. The number of subjects receiving supplemental uterotonics was compared.Results: In the low-risk group, three (3.7%), out of the 41 parturients, did not achieve a satisfactory suitable response to OX dose of 9; on the other hand, 24 high-risk parturients (58%) did not achieve a satisfactory and reasonable response to OX dose of 9. The OX ED90 was significantly greater for the high risk-group (11.55 units, 10.39-14.86) than the low-risk group (8.13 units, 8.31-9.56). Fisher’s exact probability test showed a significant difference in ED90 of OX between the two groups (P < /em>=0.02).Conclusion: The present study results showed that the mean ED90 of OX in low-risk parturients was significantly lower than that of high-risk ones. We suggest differentiation between low-risk and high-risk parturients in the guidelines of OX administration.
Leila Pourali; Sedigheh Ayati; Atiyeh Vatanchi; Anis Darvish
Volume 4, Issue 1 , March and April 2019, , Pages 42-44
Abstract
Introduction: Postpartum hemorrhage has different etiologies. One of the rare causes is inner myometrial laceration that makes the diagnosis more difficult. This report aimed to introduce a case of massive postpartum hemorrhage following an inner myometrial laceration.
Case Report: A 24-year-old primigravid ...
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Introduction: Postpartum hemorrhage has different etiologies. One of the rare causes is inner myometrial laceration that makes the diagnosis more difficult. This report aimed to introduce a case of massive postpartum hemorrhage following an inner myometrial laceration.
Case Report: A 24-year-old primigravid woman referred to an academic Hospital due to hypertension of 140/90 and diagnosis of preeclampsia. Her pregnancy was terminated at 39th gestational week. She received two doses of 25 μg misoprostol sublingually. Subsequently, an induction was performed and normal vaginal delivery occurred. A 2800 gr infant was born. After the delivery, the patient suffered from massive postpartum hemorrhage which continued in spite of all medical treatments. With regard of unstable vital signs, laparotomy was done. By transverse uterine incision, a longitudinal inner myometrial laceration was found in the lower uterine segment, which was repaired, thus, hemorrhage was controlled.
Conclusion: An inner myometrial laceration is one of the differential diagnoses of postpartum hemorrhage which should be taken into consideration. Laparotomy and hysterotomy for repairing the inner myometrial laceration would control postpartum hemorrhage and could avoid hysterectomy.
Afsaneh Amirabi; Nashmil Amjadipour; Leyla Dinparast
Volume 3, Issue 1 , March and April 2018, , Pages 23-28
Abstract
Aims: Morbidly adherent placenta/Placenta accreta syndrome refers to morbid implantation, invasion, and/or adhesion of a placenta, whose incidence rate has increased due to the growing trend of cesarean section. Diagnosing placenta accreta before delivery plays a crucial role in reducing morbidity and ...
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Aims: Morbidly adherent placenta/Placenta accreta syndrome refers to morbid implantation, invasion, and/or adhesion of a placenta, whose incidence rate has increased due to the growing trend of cesarean section. Diagnosing placenta accreta before delivery plays a crucial role in reducing morbidity and mortality of the mother and fetus. This study aimed at evaluating the diagnostic value of the Doppler ultrasonography in diagnosis of morbidly adherent placenta.
Instruments and Methods: In this descriptive-analytical study, 150 singleton pregnant women with gestational age of ≥24 weeks with a history of uterine incision (C/S, myomectomy, or metroplasty), underwent a Doppler ultrasonography to detect the position of placenta and evidence for adherent placenta. The data were analyzed by SPPS 21 software.
Findings: Twelve patients underwent the cesarean-hysterectomy during their cesarean sections due to severe bleeding and morbidly adherent placenta. In terms of pathologic findings, placenta accreta, placenta increta, and placenta percreta were reported in 7 cases, 3 cases, and 1 case, respectively. The Doppler ultrasonography had a sensitivity of 91.67%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.28% in the diagnosis of morbidly adherent placenta.
Conclusion: The thinning or absence of the retroplacental myometrial thickness and the large retroplacental lacunae are the most powerful ultrasonographic markers in the diagnosis of the placenta accreta such that the negativity of these markers can be interpreted as the absence of placenta accreta and the positivity of them can be interpreted as the presence of the placenta accreta.
