Uterotonic drugs use for post partum hemorrhage: An audit of the third stage of labor management

Etedafe P. Gharoro, Ehigha J. Enabudoso, Edafe E. Gharoro, Abieyuwa P. Osemwenkha

Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Nigeria.

DOI: 10.4236/ojog.2013.33065                

Abstract

Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.

Keywords

Post Partum Hemorrhage; Uterotonic Drugs; Visual Estimation of Blood Loss; Shock Index; Active Management of Third Stage of Labor

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Wise, A. and Clark, V. (2010) Challenges of major obstetric hemorrhage. Best Practice & Research Clinical Obstetrics & Gynaecology, 24, 353-365. doi:10.1016/j.bpobgyn.2009.11.011
[2]	Selo-Ojeme, D.O. (2002) Primary postpartum hemorrhage. Journal of Obstetrics & Gynaecology, 22, 463-469. doi:10.1080/0144361021000003555
[3]	World Health Organization (2009) WHO guidelines for the management of postpartum hemorrhage and retained placenta. www.who.int/entity/pmnch/topics/maternal/2009_who9789241598514/en/
[4]	Knight, M., Callaghan, W.M., Berg, C., Alexander, S., Bouvier-Colle, M.H., Ford, J.B., Joseph, K.S., Lewis, G., Liston, R.M., Roberts, C.L., Oats, J. and Walker, J. (2009) Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth, 9, 55. doi:10.1186/1471-2393-9-55
[5]	Al-Zirqi, I., Vangen, S., Forsen, L. and Stray-Pedersen, B. (2008) Prevalence and risk factors of severe obstetric hemorrhage. BJOG: An International Journal of Obstetrics & Gynaecology, 115, 1265-1272. doi:10.1111/j.1471-0528.2008.01859.x
[6]	Leduc, D., Senikas, V., Lalonde, A.B., Ballerman, C., Biringer, A., Delaney, M., Duperron, L., Girard, I., Jones, D., Lee, L.S., Shepherd, D. and Wilson, K. (2009) Active management of the third stage of labor: Prevention and treatment of postpartum hemorrhage. Journal of Obstetrics and Gynaecology Canada, 31, 980-993.
[7]	Ijaiya, M.A., Aboyeji, A.P. and Abubakar, D. (2003) Analysis of 348 consecutive cases of primary postpartum hemorrhage at a tertiary hospital in Nigeria. Journal of Obstetrics & Gynaecology, 23, 374-377. doi:10.1080/0144361031000119529
[8]	Bibi, S., Danish, N., Fawad, A. and Jamil, M. (2007) An audit of primary post partum hemorrhage. Journal of Ayub Medical College Abbottabad, 19, 102-106.
[9]	Ajenifuja, K.O., Adepiti, C.A. and Ogunniyi, S.O. (2010) Post partum hemorrhage in a teaching hospital in Nigeria: A 5-year experience. African Health Sciences, 10, 71-74.
[10]	Soltani, H., Hutchon, D.R. and Poulose, T.A. (2010) Timing of prophylactic uterotonics for the third stage of labor after vaginal birth. Cochrane Database of Systematic Reviews, 8, Article ID: CD006173.
[11]	Begley, C.M., Gyte, G.M., Devane, D., McGuire, W. and Weeks, A. (2011) Active versus expectant management for women in the third stage of labor. Cochrane Database of Systematic Reviews, 11, Article ID: CD007412.
[12]	Gharoro, E.P. and Enabudoso, E.J. (2009) Relationship between visually estimated blood loss at delivery and postpartum change in hematocrit. Journal of Obstetrics and Gynecology, 29, 517-520. doi:10.1080/01443610903003159
[13]	Cohain, J.S. (2010) The dangers of planned hospital births. Midwifery Today with International Midwife, 94, 30-32, 67-68.
[14]	WHO (2012) Millennium Development Goals (MDGs). www.who.int/entity/ mediacentre/factsheets/ fs290/en/
[15]	Patel, A., Goudar, S.S., Geller, S.E., Kodkany, B.S., Edlavitch, S.A., Wagh, K., Patted, S.S., Naik, V.A., Moss, N. and Derman, R.J. (2006) Drape estimation vs. visual assessment for estimating postpartum hemorrhage. International Journal of Gynecology & Obstetrics, 93, 220-224. doi:10.1016/j. ijgo.2006.02.014
[16]	Razvi, K., Chua, S., Arulkumaran, S. and Ratnam, S.S. (1996) A comparison between visual estimation and laboratory determination of blood loss during the third stage of labor. Australian and New Zealand Journal of Obstetrics and Gynaecology, 36, 152-154. doi:10.1111/j.1479- 828X.1996.tb03273.x
[17]	Dildy 3rd, G.A., Paine, A.R., George, N.C. and Velasco, C. (2004) Estimating blood loss: Can teaching significantly improve visual estimation? Obstetrics & Gynecology, 104, 601-606. doi:10.1097/01.AOG. 0000137873.07820.34
[18]	Toledo, P., McCarthy, R.J., Burke, C.A., Goetz, K., Wong, C.A. and Grobman, W.A. (2010) The effect of live and web-based education on the accuracy of bloodloss estimation in simulated obstetric scenarios. American Journal of Obstetrics and Gynecology, 202, 400.e1-400.e5.
[19]	Yoong, W., Karavolos, S., Damodaram, M., Madgwick, K., Milestone, N., Al-Habib, A., Fakokunde, A. and Okolo, S. (2010) Observer accuracy and reproducibility of visual estimation of blood loss in obstetrics: How accurate and consistent are health-care professionals? Archives of Gynecology and Obstetrics, 281, 207-213. doi:10.1007/s00404-009-1099-8
[20]	Sukprasert, M., Choktanasiri, W., Ayudhya, N.I., Promsonthi, P. and O-Prasertsawat, P. (2006) Increase accuracy of visual estimation of blood loss from education programme. Journal of the Medical Association of Thailand, 89, S54-S59.
[21]	Buckland, S.S. and Homer, C.S. (2007) Estimating blood loss after birth: Using simulated clinical examples. Women and Birth, 20, 85-88. doi:10.1016/j.wombi.2007.01.001
[22]	Joy, S.D., Sanchez-Ramos, L. and Kaunitz, A.M. (2003) Misoprostol use during the third stage of labor. International Journal of Gynecology & Obstetrics, 82, 143-152. doi:10.1016/S0020-7292(03)00146-2
[23]	Stanton, C.K., Newton, S., Mullany, L.C., Cofie, P., Agyemang, C.T., Adiibokah, E., Darcy, N., Khan, S., Levisay, A., Gyapong, J., Armbruster, D. and OwusuAgyei, S. (2012) Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via UnijectTM by peripheral health care providers at home births: Design of a community-based cluster-randomized trial. BMC Pregnancy & Childbirth, 12, 42. doi:10.1186/1471-2393-12-42
[24]	Irita, K. and Inada, E. (2011) Guideline for management of critical bleeding in obstetrics. Masui, 60, 14-22.