Background: POSTPARTUM HEMORRHAGE is the leading cause of severe maternal morbidity and death. A prompt management of uterine artery embolization (UAE) is important for a good outcome. UAE is generally accepted to be a safe and reliable procedure.Objective: To estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary POSTPARTUM HEMORRHAGE.Materials and Methods: This was a cross sectional study that reviewed 121 patients who were diagnosed primary POSTPARTUM HEMORRHAGE between February 2002 and December 2009 at a tertiary treatment center among 4,022 deliveries. We evaluated patient clinical characteristics associated with a successful surgical outcome of UAE. Results: The success rate for UAE was 96%. For two cases, UAE complication was associated with fever (>38.5oC). Five patients had problems that required admission to the intensive care unit (ICU).Conclusion: To increase the surgical success rate and lower the number of ICU admissions, the decision to treat primary POSTPARTUM HEMORRHAGE using UAE should be based on individual patient clinical findings under the direction of obstetrics staff and an interventional radiologist.

Introduction: In developing countries, HEMORRHAGE accounts for 30% of the maternal deaths. POSTPARTUM HEMORRHAGE has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of POSTPARTUM HEMORRHAGE occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of POSTPARTUM HEMORRHAGE using the weighting method and the National Guideline for POSTPARTUM HEMORRHAGE estimation.Materials and Methods: This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six‑month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For POSTPARTUM HEMORRHAGE estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t‑test.Results: According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68±16.858 cc vs. National Guideline 45.31±13.484 cc in the first hour after delivery) (P=0.000) and (weighting method 41.26±10.518 vs. National Guideline 30.24±8.439 in second hour after delivery) (P=0.000).Conclusions: Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than ‘sheet weighing’. Consequently, usage of symptoms and the weighing method is recommended in cases of POSTPARTUM bleeding.

Objectives: To report the authors’ experience in suction and evacuation with cannula followed by maintenance of negative pressure in the uterine cavity by keeping the cannula inside for 20-30 minutes, which was performed for controlling intractable POSTPARTUM HEMORRHAGE (PPH) in a tertiary care hospital.Materials and Methods: This is a retrospective observational study carried out from July 2011 to December 2012 at Batra Hospital and Medical Research Centre, New Delhi, India. Nine patients who delivered either vaginally or via caesarian section and developed primary PPH refractory to conventional medical treatment, were included in the study. Suction and evacuation of the uterine cavity was done and then the cannula was kept inside the uterine cavity for 20-30 minutes thereby maintaining negative pressure (400-600 mmHg) in the cavity. Data were retrieved from patients’ hospital records.Results: Intractable primary HEMORRHAGE was encountered in 9 patients of whom 6 had bleeding after caesarian section and 3 after vaginal deliveries. Uterine atony due to prolonged labour was the commonest cause. HEMORRHAGE was effectively controlled in 8 out of 9 cases (88.9%) and hysterectomy was avoided. In one patient (11.1%) the procedure failed and life saving hysterectomy was done to control the bleeding. This approach not only controls PPH but also preserves the woman’s reproductive functions and avoids hysterectomy and its related complications and consequences.Conclusion: This is a simple conservative surgical method to treat PPH in low resource settings. It requires minimal training, conserves the uterus, and is technically less challenging and associated with less blood loss than hysterectomy.

A 32-year-old primigravid woman developed acquired factor VIII inhibitor after delivery. She presented with POSTPARTUM HEMORRHAGE and large hematoma in episiotomy site. Laboratory examinations showed markedly prolonged activated partial thromboplastin time, low levels of factor VIII (8%), and factor VIII inhibitor (2 Bethesda units). The bleeding was controlled successfully using combined treatment with factor VIII, intravenous immunoglobulin, steroids, and recombinant factor VIIa. Six months after delivery, factor VIII inhibitor was not present and factor VIII concentration increased to normal range.Acquired hemophilia is a life-threatening disorder. Precise screening of coagulation factors is essential for diagnosis of persisting POSTPARTUM HEMORRHAGE.

POSTPARTUM HEMORRHAGE is an important cause of maternal morbidity and mortality after delivery. Active management of POSTPARTUM HEMORRHAGE by an uterotonic drug decreases the rate of POSTPARTUM HEMORRHAGE. The aim of this study is to evaluate the efficacy of rectal misoprostol for prevention of POSTPARTUM HEMORRHAGE. This double blind randomized clinical trial was performed on full term pregnant women candidate for vaginal delivery, referred to Zahedan Imam Ali Hospital during 2008-2009. They were randomly divided into two groups of rectal misoprostol and oxytocin. The women in misoprostol group received 400 mg rectal misoprostol after delivery and the women in oxytocin group received 3 IU oxytocin in 1 L ringer serum, intravenously. Rate of bleeding, need to any surgery interventions, rate of transfusion and changes in hemoglobin and hematocrite were compared between two groups. A total of 400 patients (200 cases in misoprostol group and 200 in oxytocin group) entered to the study. Rate of bleeding>500 cc was significantly higher in oxytocin group than misoprostol group (33% vs.19%) (p=0.005). Also, need to excessive oxytocin for management of POSTPARTUM HEMORRHAGE was significantly lower in misoprostol group than oxytocin group (18% vs.30%) (p=0.003). Decrease in hematocrite was significantly more observed in oxytocin group than misoprostol group (mean decrease of hematocrite was 1.3 ±1.6 in misoprostol group and 1.6±2.2 in oxytocin group). Two groups were similar in terms of side-effects. Rectal misoprostol as an uterotonic drug can decrease POSTPARTUM HEMORRHAGE and also can prevent from decrease of hemoglobin as compared to oxytocin.

Background and Objectives: POSTPARTUM HEMORRHAGE (PPH) is one of the major causes of maternal mortalities, and it needs to be management in a high quality center. The aim of this study was to evaluate the outcome of patients with POSTPARTUM HEMORRHAGE who admitted to the obstetric ICU of Alzahra Hospital of the Tabriz University of Medical Sciences.Materials and Methods: In this retrospective study, one year records of all patients with PPH were studied their demographic data, details of their primary admission or referral, duration between onset of PPH and arrival, their condition at admission, resuscitative measures, procedures to manage PPH, presence or abscenss of disseminated intravascular coagulation (DIC) and its management, duration of ICU stay, and finall outcome were recorded and evaluated.Results: from the total 43 patients with PPH, 29 were admitted to the ICU. 6 were referred from other hospitals and the remaining were admitted in ordinary ward. The time interval between the onset of PPH and arrival was ranged between 2-72 hours. All patients were conscious on arrival. Five patients were hypotensive. Resuscitative measures were included oxygen supplementation, fluid resuscitation and blood transfusion. HEMORRHAGE was controlled with uterine massage and drug administration in 6 patients, 23 patients underwent surgery. 5 patients had DIC which was managed with blood component therapy. Mean Duration of stay in ICU was 3 days. We didn’t detected in this retrospective study any registered mortality.Conclusion: PPH is one of the most common causes of obstetric ICU admission. If the management of patients with PPH is carried out in a unit with high therapeutic qualities quality, it would lead to low maternal mortality.

Introduction: POSTPARTUM HEMORRHAGE is considered as one of the major causes of maternal mortality in the world. Identification of women at risk of POSTPARTUM HEMORRHAGE prepares the medical team for faster therapeutic decisions which can reduce maternal complications. This study was performed with aim to identify the risk factors of vaginal delivery POSTPARTUM HEMORRHAGE. Methods: This cross-sectional analytic study was performed on 600 women referred to Omol-Banin Hospital of Mashhad in 2017. After delivery, the researcher measured and recorded lost blood volume in mothers via plastic blood collection bags and pads within 4 hours after delivery. Data were analyzed by SPSS software (version 25) and Mann-Whitney, independent t, Chi-square, and Fisher Exact tests. P<0. 05 was considered statistically significant. Results: PPH occurred in 33. 3% of deliveries in this study. The results of the logistic regression test showed significant relationship between PPH and nulliparity (OR: 5. 987، CI: 1. 870-8. 821)، hemoglobin level (OR: 1. 849، CI: 1. 677-2. 890)، platelet levels (OR: 2. 955، CI: 1. 989-3. 001)، Afghan race (OR: 3. 645، CI: 1. 141-8. 644)، Barbarian race (OR: 5. 958، CI: 3. 452-6. 645)، history of PPH(OR: 4. 562، CI: 1. 570-6. 597)، preeclampsia(OR: 20. 126، CI: 3. 831-21. 114)، duration of the second stage (OR: 4. 452، CI: 2. 265-5. 674)and third stage(OR: 3. 620، CI: 1. 857-6. 325) of labor، consumption of Magnesium sulfate(OR: 67. 107، CI: 60. 471-69. 101)، uterine fundal pressure(OR: 4. 941، CI: 3. 305-5. 903)، use of vacuum(OR: 14. 123، CI: 10. 003-18. 831)، episiotomy(OR: 2. 143، CI: 2. 136-3. 349)، genital tract tears(OR: 17. 889، CI: 14. 152-18. 950), neonatal birth weight(OR: 4. 025، CI: 3. 641-6. 850)، placenta weight(OR: 3. 988، CI: 2. 980-3. 997)، and courage (OR: 15. 005، CI: 13. 520-15. 224) were each associated with an increased odds of PPH. Conclusion: The most important cause of POSTPARTUM HEMORRHAGE is uterine atony and the most important risk factors are nulliparity، Afghan and Barbarian race، history of PPH، preeclampsia، increased duration of the second and third stage of labor، consumption of Magnesium sulfate، uterine fundal pressure، use of vacuum، genital tract tears، placenta weight، neonatal birth weight and courage.

Introduction: The third and forth stages of labor which involve the separation and expulsion of the placenta and an hour immediately following delivery are the two critical phases. Many maternal deaths in the developing countries result from complications of the third stage of labor and POSTPARTUM HEMORRHAGE. Active management of labor and use of oxytocic drugs can reduce POSTPARTUM HEMORRHAGE. This study compares the effects of oxytocin and syntometrine in preventing POSTPARTUM HEMORRHAGE which is an important problem causing maternal morbidity and mortality after delivery.Materials and Methods: A clinical trial was designed to study 618 patients admitted to Zahedan Ghods Birth Center in 2001 for normal delivery. The patients were ran randomly divided into two groups. All Pregnancies were singleton, normotensive (BP<140/90) and free from medical disease. After exiting the anterior shoulder of fetus, 5 IU of oxytocin in the first group and 0.5 mg ergometrine plus 5 IU of oxytocin in the second group was injected intramuscularly. The abnormal POSTPARTUM HEMORRHAGE by obstetrician's estimation, the need for repeated oxytocic or other interventions and less than 100 mm Hg fall in systolic blood pressure was determined. The length of third stage was determined for all of the patients.Results: Among the first group there were 20 cases (%6.47) with abnormal HEMORRHAGE, compared to 8 cases (%2.58) in the second group. There was a significant difference between the two groups in POSTPARTUM HEMORRHAGE (p<0.05) (using Chi-square test, CI=%95). There was no significant difference between two groups concerning the duration of third stage and the need for manual removal of placenta. The side effects were uncommon and the incidence of hypertention (Bp>140/90) was not different between two groups. Conclusion: some studies do not recommend the use of syntometrine, believing that there is no clinical difference in the effectiveness of oxytocin and syntometrine, whereas syntometrine can case hypertention and retained placenta. Our results similar to other researches show that syntometrine is more effective than oxytocin in preventing POSTPARTUM HEMORRHAGE.

Background & Objective: POSTPARTUM HEMORRHAGE is the most common cause of maternal morbidity, especially in developing countries, and a major cause of direct maternal death worldwide. Considering the importance of timely POSTPARTUM HEMORRHAGE management and access to low-risk methods, assessing the efficacy of uterine artery embolization (UAE) is essential. Therefore, the present study was conducted to evaluate the success rate and outcomes of UAE in the treatment of delayed POSTPARTUM HEMORRHAGE.Materials & Methods: This cross-sectional study was performed on women with delayed POSTPARTUM HEMORRHAGE who were referred to the gynecology and obstetrics clinic of a referral hospital in Urmia city under treatment of UAE. The census method was used for choosing the patients and all women with delayed POSTPARTUM HEMORRHAGE between April 2019 and March 2020 were entered into the study.Results: During the study period, he number of 22 women with delayed POSTPARTUM HEMORRHAGE were entered into the study. The mean age of the women was 29.36±5.09 years. The success rate of UAE was 95.6%. The number of 20 (90.9%) cases did not report complications. For one case, UAE complication was associated with amenorrhea and for the other one with vaginal bleeding.Conclusion: The results showed that the UAE method as an effective method with high efficacy and low complications can be considered a suitable choice for the treatment of delayed POSTPARTUM HEMORRHAGE.