EC Gynaecology

Introduction

As a reflection on the management after 50 years of birth and delivery as an Obstetrician and Consultant, from the UK and most of my professional life in Canada, and having spent the last few years reviewing research, opinion papers, conferences, and personal networking, there seems to be the need for some more focus on what matters in different environments for Post-Partum Hemorrhage or PPH. The seriousness of the severe condition from WHO statistics, suggests that 25% of maternal death can be attributable to PPH [1,2]. Do we really need complex devices when we all know when we have a severe PPH? That is a question many ask. But hopefully, the answer is yes but modifications in different environments.

1. FIGO PPH Technical Working Group., et al. “FIGO and the International Confederation of Midwives endorse WHO guidelines on prevention and treatment of postpartum hemorrhage”. International Journal of Gynecology and Obstetrics 1 (2022): 6-10.
2. Loïc Sentilhes., et al. “Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR)”. European Journal of Obstetrics and Gynecology and Reproductive Biology 198 (2016): 12-21.
3. Anne-Sophie Bouthors., et al. “The role of tranexamic acid in the management of postpartum haemorrhage”. Best Practice and Research Clinical Anaesthesiology 3-4 (2022): 411-426.
4. Postpartum Hemorrhage. An AOM Clinical Practice Guideline Summary.
5. Postpartum haemorrhage: What is the most effective treatment for primary postpartum haemorrhage?
6. M E Hannah., et al. “Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group”. Lancet9239 (2000): 1375-1383.
7. Loïc Sentilhes., et al. “Study protocol. TRAAP - Tranexamic Acid for Preventing postpartum hemorrhage after vaginal delivery: a multicenter randomized, double-blind, placebo-controlled trial”. BMC Pregnancy Childbirth 15 (2015): 135.
8. Loïc Sentilhes., et al. “TRAAP2 - Tranexamic Acid for Preventing postpartum hemorrhage after cesarean delivery: a multicenter randomized, double blind, placebo- controlled trial - a study protocol”. BMC Pregnancy Childbirth1 (2020): 63.
9. Roberto Picetti., et al. “The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries”. BMC Pregnancy Childbirth1 (2020): 409.
10. There is worrying amount of fraud in medical research.
11. Janice M Anderson and Duncan Etches. “Prevention and management of postpartum hemorrhage”. American Family Physician 6 (2007): 875-882.
12. New WHO recommendations Help to Focus Implementation. Active management of the third stage of labor (2012).
13. Sherif Hanafia., et al. “Impact of controlled cord traction in the management of the third stage of labor on postpartum hemorrhage: a randomized controlled trial”. Evidence Based Women’s Health Journal2 (2014): 78-81.
14. Ioannis Gallos., et al. “Uterotonic drugs to prevent postpartum haemorrhage: a network meta-analysis”. Health Technology Assessment 9 (2019): 1-356.
15. Frances E Likis., et al. “Management of postpartum hemorrhage”. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 15-EHC013-EF (2015).
16. WHO recommendation on Uterine balloon tamponade for the treatment of postpartum haemorrhage (2021).
17. Fast control of abnormal postpartum uterine bleeding.
18. Mary D’Alton., et al. “Profile of the Jada^® System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage”. Expert Review of Medical Devices9 (2021): 849-853.
19. Sangeeta Kumaraswami and Alexander Butwick. “Latest advances in postpartum hemorrhage management”. Best Practice and Research Clinical Anaesthesiology 1 (2022): 123-134.
20. S H Lee., et al. “Tranexamic acid, as an adjunct to oxytocin prophylaxis, in the prevention of postpartum haemorrhage in women undergoing elective caesarean section: A single-centre double-blind randomised controlled trial”. BJOG: An International Journal of Obstetrics and Gynaecology 9 (2023): 1007-1015.
21. Rachel Collis and Sarah Bell. “The role of thromboelastography during the management of postpartum hemorrhage: background, evidence, and practical application”. Seminars in Thrombosis and Hemostasis 2 (2023): 145-161.
22. Military Communication System. Objective Analysis. Effective Solutions.
23. Michaela Kolbe., et al. “Team debriefings in healthcare: aligning intention and impact”. British Medical Journal 374 (2021): n2042.
24. https://www.uptodate.com/login
25. Loïc Sentilhes., et al. “Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial”. American Journal of Obstetrics and Gynecology 6 (2022): 889.e1-889.e17.
26. Katharine Ker., et al. “Tranexamic acid for the prevention of postpartum bleeding in women with anaemia: study protocol for an international, randomised, double-blind, placebo-controlled trial”. Trials 1 (2018): 712.
27. Alexander Butwick., et al. “How do I manage severe postpartum hemorrhage?” Transfusion5 (2020): 897-907.
28. Virtual Workshop: Technology to Improve Maternal Health.
29. Cutler Abigail., et al. “Critical incident debriefing: impact of a teaching module for OB/GYN residents”. Obstetrics and Gynecology1 (2016): 43S-44S.
30. https://weerteaching.com
31. https://www.6ds.org
32. Boujarzadeh B., et al. “Machine learning approach to predict postpartum haemorrhage: a systematic review protocol”. BMJ Open1 (2023): e067661.
33. Shah SY., et al. “Prediction of postpartum hemorrhage (PPH) using machine learning algorithms in a Kenyan population”. Frontiers in Global Women's Health 4 (2023): 1161157.
34. Xu L., et al. “Development and validation of an artificial neural network prediction model for postpartum hemorrhage with placenta previa”. Minerva Anestesiologica 11 (2023): 977-985.