Managing postpartum haemorrhage (PPH) using lessons learned from previous Confidential Inquiries into maternal deaths will be discussed by Professor Sir Sabaratnam Arulkumaran, President of FIGO and Professor Emeritus of Obstetrics and Gynaecology, St George’s, University of London, in a special lecture in Qatar today.
The RCOG has collaborated with Sidra Medical and Research Center in Qatar to deliver a joint meeting on ‘Hot Topics in Obstetrics and Gynaecology’ from 30 November to 2 December 2014.
Primary postpartum haemorrhage (PPH) is the most common form of major obstetric haemorrhage. The traditional definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. PPH can be minor (500–1000 ml) or major (more than 1000 ml).
The vast majority (more than 90%) of massive PPH are due to failure of the uterine muscles to contract normally after the baby and placenta are delivered, known as uterine atony.
The Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008 report showed a decrease in deaths from haemorrhage compared to previous reports.
Professor Sir Arul will give an overview of the best way to manage patients with PPH. If medical therapy fails to stop the haemorrhage, this should be followed by aortic compression, antishock garment and the Tamponade Test, he will say.
The Tamponade Test involves inserting a balloon with warm saline till the balloon is just visible at the cervical canal. If the bleeding stops the balloon can be taken out the next day and the patient should have broad spectrum antibiotics and an oxytocin infusion. If bleeding still continues a laparotomy and vertical compression sutures should be applied and at times the balloon and compression suture can be used simultaneously. If the bleeding does not stop or if the patient’s condition deteriorates clinicians should perform a sub-total or total hysterectomy.
Professor Sir Arul will say that PPH is best managed by using the below algorithm of ‘HAEMOSTASIS’:
- H – ask for Help
- A – Assess (vital parameters, blood loss) and resuscitate
- E – Establish the cause, ensure availability of blood
- M – Massage uterus
- O – Oxytocin infusion
- S – Shift to theatre/anti-shock garment – bimanual compression
- T – Tamponade test
- A – Apply compression sutures
- S – Systematic pelvic devascularisation
- I – Interventional radiologist – if appropriate, uterine artery embolisation
- S – Subtotal/total abdominal hysterectomy
Professor Sir Arul says:
“New knowledge on use of tranexamic acid, one-to-one blood to plasma transfusion and advances in technology and techniques have reduced morbidity and mortality for postpartum haemorrhage.
“It is a very serious condition if not treated properly and promptly. It is vital to establish the cause of the bleeding and early on to alert all medical staff in the team. Medical therapy should be undertaken first and if this fails surgical options should be carried out.”
To view the symposium programme please visit: http://sidraevents.org/symposium-information/program/
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About Sidra Medical and Research Center
Sidra Medical and Research Center, currently under construction in Doha, Qatar, will be a groundbreaking hospital, research and education institution, focusing on the health and wellbeing of women and children regionally and globally. Sidra will be a fully digital facility, incorporating the most advanced information technology applications in clinical, research and business functions. Sidra will initially have 400 beds with infrastructure to enable expansion to 550 beds in a subsequent phase.
Sidra represents the vision of Her Highness Sheikha Moza bint Nasser who serves as its Chairperson. The high-tech facility will not only provide world-class patient care but will also help build Qatar's scientific expertise and resources. Sidra will be funded by a US$7.9 billion endowment from Qatar Foundation, one of the largest endowments of its kind in the world.
Sidra is part of a dynamic research and education environment in Qatar that includes leading international institutions, such as Sidra’s academic partner Weill Cornell Medical College in Qatar. Through strong partnerships with leading institutions around the world, Sidra is creating an intellectual ecosystem to help advance scientific discovery through investment in medical research.
Sidra will have a unique working structure with inter-professional collaboration at the heart, providing the best holistic care for patients and an unparalleled learning environment for its medical professionals. Sidra will combine the best in design, technology, operations and practices from medical centers around the world – to offer its employees an environment that is at once familiar and extraordinary.
Doha, Qatar (EST +7 hours)
Tel: +(974) 4404-2176