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6 results

  • Chapter 14 - Sex with Bleeding in the Second and Third Trimesters

  • from Section 2 - Specific Issues
  • Edited by Dan Farine, Pablo Tobías González
  • Book:
    Sex and Pregnancy
    Published online:
    09 November 2022
    Print publication:
    27 October 2022, pp 97-103

  • Summary

    This chapter addresses the issue of what advice to give pregnant women who are at risk of bleeding or who have experienced vaginal bleeding (antepartum hemorrhage) during pregnancy. Topics covered include local causes of bleeding (e.g cervix), abruption, and placenta previa. We review the published evidence, which is very limited, for the basis of any recommendations regarding sex and bleeding in pregnancy. The recommendations provided in the chapter regarding sexual activity are tailored to the various clinical presentations of antepartum hemorrhage. This includes advice for patients who are at risk of bleeding as well as those who have already experienced an episode of antepartum hemorrhage. In a unique approach using the classification of placenta previa by transvaginal ultrasound, recommendations for sexual activity are related to the risks of hemorrhage based on distance of the placental edge from the internal cervical os.

  • Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

  • Seiji Kanazawa, Katsusuke Ozawa, Jin Muromoto, Rika Sugibayashi, Yuka Wada, Seiji Wada, Yushi Ito, Haruhiko Sago
  • Journal:
    Twin Research and Human Genetics / Volume 24 / Issue 1 / February 2021
    Published online by Cambridge University Press:
    26 April 2021, pp. 42-48
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  • We evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin–twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. The incidence rates of recurrent TTTS (Solomon vs. selective: 0% vs. .9%, p = .510) and twin anemia–polycythemia sequence (.6% vs. .4%, p = .670) were very low in both groups. The incidence rates of placental abruption (Solomon vs. selective: 10.7% vs. 3.5%, p = .007) and preterm premature rupture of the membranes (pPROM) with subsequent delivery before 32 weeks (20.2% vs. 7.1%, p < .001) were higher in the Solomon group. The median birth recipient weight was significantly smaller in the Solomon group (1790 g vs. 1933 g, p = .049). The rate of survival of at least one twin was significantly higher in the Solomon group (98.2% vs. 93.8%, p = .046). The Solomon technique and total laser energy were significant risk factors for pPROM (odds ratio: 2.64, 1.07, 95% CI [1.32, 5.28], [1.01, 1.13], p = .006, p = .014, respectively). These findings suggest that the Solomon technique led to superior survival outcomes but increased risks of placental abruption, pPROM and fetal growth impairment. Total laser energy was associated with the occurrence of pPROM. Close attention to adverse events is required for perinatal management after FLS to treat TTTS using the Solomon technique.

  • Loss of a close family member the year before or during pregnancy and the risk of placental abruption: a cohort study from Denmark and Sweden

  • K. D. László, C. V. Ananth, A. K. Wikström, T. Svensson, J. Li, J. Olsen, M. Vestergaard, C. Obel, S. Cnattingius
  • Journal:
    Psychological Medicine / Volume 44 / Issue 9 / July 2014
    Published online by Cambridge University Press:
    26 September 2013, pp. 1855-1866
  • Background

    Maternal stress during pregnancy is associated with a modestly increased risk of fetal growth restriction and pre-eclampsia. Since placental abruption shares similar pathophysiological mechanisms and risk factors with fetal growth restriction and pre-eclampsia, we hypothesized that maternal stress may be implicated in abruption risk. We investigated the association between maternal bereavement during pregnancy and placental abruption.

    Method

    We studied singleton births in Denmark (1978–2008) and Sweden (1973–2006) (n = 5 103 272). In nationwide registries, we obtained data on death of women's close family members (older children, siblings, parents, and partners), abruption and potential confounders.

    Results

    A total of 30 312 (6/1000) pregnancies in the cohort were diagnosed with placental abruption. Among normotensive women, death of a child the year before or during pregnancy was associated with a 54% increased odds of abruption [95% confidence interval (CI) 1.30–1.82]; the increased odds were restricted to women who lost a child the year before or during the first trimester in pregnancy. In the group with chronic hypertension, death of a child the year before or in the first trimester of pregnancy was associated with eight-fold increased odds of abruption (odds ratio 8.17, 95% CI 3.17–21.10). Death of other relatives was not associated with abruption risk.

    Conclusions

    Loss of a child the year before or in the first trimester of pregnancy was associated with an increased risk of abruption, especially among women with chronic hypertension. Studies are needed to investigate the effect of less severe, but more frequent, sources of stress on placental abruption risk.

  • 17 - Acute puerperal uterine inversion

  • from Section 4 - PostpartumEmergencies
  • Edited by Edwin Chandraharan, Sabaratnam Arulkumaran
  • Book:
    Obstetric and Intrapartum Emergencies
    Published online:
    05 November 2012
    Print publication:
    11 October 2012, pp 120-125

  • Summary

    This chapter describes the types, key implications and management strategies of massive obstetric haemorrhage. Antepartum haemorrhage due to placental abruption and intrapartum haemorrhage due to uterine rupture are associated with increased perinatal mortality. Visible blood loss greater than 2 litres, ongoing bleeding are some key pointers of massive obstetric haemorrhage. Immediate management involves active resuscitation to ensure a patient airway, breathing and maintaining circulation with intravenous fluids, blood and blood products as well as correction of coagulopathy. In women who are not acutely compromised or bleeding severely, interventional radiology can be considered. If the bleeding is predominantly from the lower segment, a total abdominal hysterectomy is warranted. Women with massive obstetric haemorrhage often need multi-organ support. Hence, transfer to an intensive care unit or high dependency unit should be considered for monitoring. Thromboprophylaxis should be considered once the coagulation parameters return to normal.

  • 9 - Obstetric haemorrhage

    • By Alexander Heazell, Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book:
    Obstetrics for Anaesthetists
    Published online:
    21 August 2009
    Print publication:
    06 March 2008, pp 107-119

  • Summary

    Obstetric haemorrhage results in massive blood loss endangering the life of the mother, and the infant in the case of antepartum haemorrhage (APH). This chapter discusses placenta praevia, vasa praevia, postpartum haemorrhage (PPH), uterine atony, genital tract trauma, clotting disorders, and uterine inversion. The Confidential Enquiry into Maternal and Child Health (CEMACH) recommends that all obstetric units have a protocol for the management of obstetric haemorrhage; all individuals working in delivery units should be familiar with local guidelines. APH is a major cause of perinatal morbidity and mortality, including an increased risk of premature delivery. Placental abruption may be partial or complete separation and can occur at any stage of pregnancy. The intervention following placental abruption is dependent upon the severity of the abruption and the presence of fetal compromise. General anaesthesia with relaxation by volatile agents is the most proven anaesthetic technique to correct the inversion.

  • 4 - Massive obstetric haemorrhage

  • Edited by Ann Harper
  • Book:
    Haemorrhage and Thrombosis for the MRCOG and Beyond
    Published online:
    05 October 2014
    Print publication:
    01 June 2005, pp 42-58

  • Summary

    Massive obstetric haemorrhage is usually due to placenta praevia, premature placental separation or postpartum causes and is often associated with coagulopathy. Most maternal deaths associated with ectopic pregnancy, which is the most common cause of death in early pregnancy, are due to haemorrhage. Many women who have died from ectopic pregnancy presented with symptoms of urinary or gastrointestinal conditions. The main causes of antepartum haemorrhage are placenta praevia and placental abruption. A high incidence of false positive diagnosis of placenta praevia is associated with second-trimester transabdominal ultrasound scans. The most common cause of primary postpartum haemorrhage is uterine atony. The signs and symptoms of secondary postpartum haemorrhage include a rising pulse rate, falling blood pressure, pallor, sweating, restlessness and oliguria. Haemorrhage can occur suddenly and unexpectedly in any woman. However, some women are at increased risk of bleeding.