Cases reported "Postpartum Hemorrhage"

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1/24. perinatal mortality and maternal mortality at the Provincial Hospital, Quang Ngai, South vietnam, 1967-1970.

    The perinatal mortality, maternal mortality, infant mortality rates, and the complications of delivery at the Provincial Hospital of Quang Ngai, South vietnam are described. The perinatal mortality is the only valid statistic available as the infant usually leaves the hospital within three days of delivery. knowledge pertaining to the 4th to 28th day after birth is scanty and there is insufficient knowledge about the first year of life. infant mortality is estimated at 277 per 1,000 live births. The perinatal mortality 64.6 per 1,000 live births, and maternal mortality, 106 per 10,000 live births are extremely high in contrast to Western countries. The high perinatal mortality is attributable to deaths during birth, the neonatal and immediate postnatal period. The high maternal mortality is primarily due to caesarean section, anemia, uterine rupture, toxemia, post-partum hemorrhage and puerperal infection.
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ranking = 1
keywords = death
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2/24. postpartum hemorrhage and intrauterine balloon tamponade. A report of three cases.

    BACKGROUND: postpartum hemorrhage can become rapidly catastrophic. If medical management fails, then, according to recent reports, the use of an intrauterine inflated Foley catheter balloon for tamponade gives excellent results and can help avoid invasive procedures. CASE: We present one case of profuse hemorrhage following evacuation of the fetus after intrauterine fetal death at 17 weeks' gestation controlled with intrauterine balloon tamponade and two cases of severe postpartum hemorrhage (one immediate and one late) following normal vaginal deliveries, both controlled with Foley catheters. In either case the patient required no blood transfusions, and major surgery was avoided. CONCLUSION: Intrauterine balloon tamponade is highly effective. The catheter is readily available, is not expensive, does not require special training for insertion and, extremely important, can avoid major surgery.
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ranking = 1
keywords = death
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3/24. Survey of amniocentesis for fetal sex determination in hemophilia carriers.

    A study was designed to determine whether there is an increased risk of complications when amniocentesis for fetal sex determination is performed on hemophilia carriers. questionnaires were sent to 112 medical centers providing this service in the united states, and to 19 outside the united states. Responses were received from 76% of the centers in the united states. Data on 11,819 taps were obtained. Only 75 taps (0.64%) were performed for the indication of hemophilia. The frequency of fetal deaths in the general sample (1.84%) was not significantly different from that in the subsample of hemophilia carriers (1.33%). The results of this survey correspond very closely to data from a National Registry on amniocentesis for various indicaions in such variables as the number of taps needed for diagnosis, color of the fluid obtained, and number of dry taps. Carrier women who had bleeding problems during the monitored pregnancy are described. The problems might have been related to the amniocentesis in three women. It is calculated that only 2-4% of hemophilia carrier women who might have amniocentesis are utilizing the service.
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keywords = death
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4/24. Management in intractable obstetric haemorrhage: an audit study on 61 cases.

    OBJECTIVE: To refine the indications of bilateral hypogastric artery ligation (BHAL) and angiographic selective embolisation (ASE) in intractable obstetric haemorrhage. DESIGN: an audit study. SETTING: Tertiary care university hospital. population AND methods: Retrospective analysis of 61 cases of obstetric intractable post partum haemorrhage (PPH) initially managed either by hysterectomy or a conservative approach in a tertiary referral centre between 1983 and 1998. Procedures were reviewed as a primary (P) or secondary (S) attempt to arrest the haemorrhagic process. RESULTS: Ten hysterectomies (5 P, 5 S), 49 BHAL (48 P, 1 S) and 9 ASE (8 P, 1S) were successfully performed in arresting the haemorrhagic process. There were 7 maternal deaths, 5 following hysterectomy and 2 following a conservative approach. Atony of the uterus was the main cause of haemorrhage (n=21) and genital tract laceration was associated with the worst prognosis. Time-elapse between delivery and surgery appears to be the main prognostic factor. Nine patients became pregnant 1 to 4 years later following a conservative approach. CONCLUSIONS: ASE seems to be indicated in haemodynamically stable patients with birth canal trauma or uterine atony and clotting anomalies. BHAL is indicated when haemorrhage occurs after a cesarean section or when the patient is haemodynamically unstable. BHAL should be taught to Junior doctors in an attempt to decrease the number of patients transferred in tertiary referral centers for intractable PPH. This might also decrease the number of hysterectomies in intractable PPH.
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ranking = 10425.597340291
keywords = maternal death, death
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5/24. Acute fatty liver of pregnancy: a case report.

    The third trimester of pregnancy has several unique disease entities that challenge the anesthetist. Acute fatty liver of pregnancy (AFLP) is an increasingly recognized metabolic disorder found late in pregnancy. Current research estimates the incidence of AFLP at 1 per 6,659 births. Improved maternal morbidity and mortality is credited to early recognition and termination of the pregnancy. The decline in hepatic cellular activity is evident by the deterioration in metabolic, synthetic, and excretory functions of the liver. This obstetrical emergency can lead to death of both mother and child if not diagnosed in time to prevent coagulopathic complications.
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ranking = 1
keywords = death
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6/24. Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases.

    OBJECTIVE: To assess the current place of embolization of the uterine arteries in the treatment of severe post-partum haemorrhages. MATERIALS AND methods: A retrospective study of 13,160 deliveries in a level III maternity unit between January 1996 and December 2001. Five hundred and forty-nine post-partum haemorrhages were diagnosed. Seventeen (0.13%) patients had a haemorrhage which did not respond to treatment using obstetric manoeuvres and uterotonic drugs. Twelve patients aged between 19 and 34 years old benefited from embolization of the uterine arteries. Nine patients had delivered by Caesarian section and three vaginally. The aetiologies found were uterine atony (n=8), placenta praevia (n=1), placenta accreta (n=1), abruptio placentae (n=1) and uterine myomas (n=1). RESULTS: The success rate of embolization was 91.6%. One failure, resulting from cardiovascular shock during the procedure, led to the patient being transferred as an emergency to the operating theatre for a haemostasis hysterectomy. It was due to placenta increta. No maternal deaths were reported. No complications because of the technique used were noted. One patient successfully delivered, following a normal pregnancy, one year after embolization. CONCLUSION: Embolization of the uterine arteries is indicated in severe post-partum haemorrhage, irrespective of the aetiology or the type of delivery. It should be offered as soon as primary management measures undertaken for haemorrhage are judged as ineffective. Its place in the treatment strategy, is in all cases before embarking on surgery, which is the final recourse in the case of failure. It is a fairly uninvasive procedure, which preserves the potential for future pregnancies.
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ranking = 10425.597340291
keywords = maternal death, death
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7/24. Obstetric and gynecologic complications in women with marfan syndrome.

    OBJECTIVE: To analyze the maternal and fetal outcomes of pregnancy and gynecologic problems in women with marfan syndrome. STUDY DESIGN: The outcomes of 14 pregnancies in 4 women with marfan syndrome were prospectively observed between January 1988 and December 2000. The cardiovascular and obstetric complications were analyzed. During pregnancy all the patients were carefully monitored with serial echocardiography and close attention to symptoms. RESULTS: Of the 14 pregnancies, 5 (35.7%) ended in abortion, and 3 of them occurred in the early second trimester due to cervical incompetence. Premature onset of labor occurred in 2 pregnancies at 31 and 34 weeks. postpartum hemorrhage complicated 3 deliveries, and inversion of the uterus occurred in 1 patient. Significant cardiovascular complications occurred in 2 patients, who required surgical correction of the aortic aneurysm and replacement of the aortic valve. In one patient the operation was performed within hours of vaginal delivery, and the other patient underwent surgery 8 weeks postpartum. No maternal death occurred in the study. One infant in the series was diagnosed as having marfan syndrome. A premature infant delivered at 31 weeks died on the second day of life. CONCLUSION: women with marfan syndrome are at high risk of aortic dissection in pregnancy even in the absence of preconceptional aortic root dilatation. Obstetric complications in patients with this condition have been underreported in the past. women with aortic root dilatation of < 40 mm usually tolerate pregnancy well, with good maternal and fetal outcomes. women with marfan syndrome should be counseled regarding the risk of pregnancy to both mother and fetus. patients who have cardiac decompensation or aortic dilatation > 40 mm are advised to avoid pregnancy.
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ranking = 10425.597340291
keywords = maternal death, death
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8/24. Fatal connection: death caused by direct connection of oxygen tubing into a tracheal tube connector.

    During cardiopulmonary resuscitation, oxygen extension tubing was mistakenly connected into the tracheal tube connector. As a result, the patient recovering from hypovolemic cardiac arrest died because of pulmonary barotrauma. Similar cases have been reported. We suggest that a worldwide equipment performance standard be developed to prevent future occurrences and describe an example of connectors that would prevent such misconnections.
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ranking = 4
keywords = death
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9/24. A non-inflatable anti-shock garment for obstetric hemorrhage.

    OBJECTIVES: maternal death from hemorrhage in low resource settings is frequently due to long delays in transportation to referral centers and/or in obtaining blood and surgical interventions. This case series was designed to demonstrate the feasibility, efficacy and safety of the non-inflatable anti-shock garment (NI-ASG) for resuscitation and hemostasis in the initial management of obstetric hemorrhage and shock. methods: Fourteen cases of obstetric hemorrhage and hypovolemic shock at Memorial Christian Hospital, Sialkot, pakistan were managed with a specific clinical protocol based on using NI-ASG as the primary intervention. RESULTS: The NI-ASG was used to resuscitate and stabilize women with hypovolemic shock from 18 to 57 h. Thirteen patients survived without evidence of morbidity, but one had prolonged shock followed by multiple organ failure and death. CONCLUSIONS: This study confirmed that the NI-ASG quickly restored the vital signs of most women in severe hemorrhagic shock and stabilized them while awaiting blood transfusion.
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ranking = 2
keywords = death
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10/24. Acute fatty liver of pregnancy complicated with disseminated intravascular coagulation and haemorrhage: a case report.

    Acute fatty liver of pregnancy (AFLP) is a rare disorder of unknown aetiology that is diagnosed typically in the third trimester or early postpartum period. The incidence is estimated to be 1/6692-1/13,328. The obstetric team must have a high index of suspicion of this pathology, particularly in the presence of clinical and laboratory findings, such as nausea, vomiting, jaundice, increased serum transaminase levels, increased prothrombin time and hypoglycaemia. early diagnosis followed by prompt delivery and supportive care provides significantly improved maternal and perinatal outcome. Delay in diagnosis of this obstetric emergency may lead to rapid progression to hepatic failure, disseminated intravascular coagulation (DIC), haemorrhage, encephalopathy, multiple organ failure and finally death. The case of a 34-year-old woman, gravida 3, para 2, with AFLP complicated with DIC is presented herein with a review of literature and discussion of its origin.
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ranking = 1
keywords = death
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