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Viscoelastometric Point-of-Care Testing for Vascular Surgery and Obstetrics: A Review of Clinical Utility and Guidelines [Internet]

The purpose of this report is to identify and summarize the evidence for clinical utility, as well as evidence-based clinical guidelines, on the use of viscoelastometric point-of-care testing (POCT) for vascular surgery and obstetrical hemorrhage patients.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 4, 2016
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Acute Upper Gastrointestinal Bleeding: Management

The incidence of acute upper gastrointestinal haemorrhage in the United Kingdom ranges between 84–172 /100,000/year, equating to 50–70,000 hospital admissions per year. This is therefore a relatively common medical emergency; it is also one that more often affects socially deprived communities.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012
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Management of Postpartum Hemorrhage [Internet]

To systematically review evidence addressing the management of postpartum hemorrhage (PPH) ), including evidence for the benefits and harms of nonsurgical and surgical treatments, interventions for anemia after PPH is resolved, and effects of systems-level interventions.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2015
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Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007

Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. 3rd edition

Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice (3rd edition) (PCPNC), has been updated to include recommendations from recently approved WHO guidelines relevant to maternal and perinatal health. These include pre-eclampsia & eclampsia; postpartum haemorrhage; postnatal care for the mother and baby; newborn resuscitation; prevention of mother-to- child transmission of HIV; HIV and infant feeding; malaria in pregnancy, interventions to improve preterm birth outcomes, tobacco use and second-hand exposure in pregnancy, post-partum depression, post-partum family planning and post abortion care.

World Health Organization.

Version: 2015
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Do vaginal packing, tranexamic acid, interventional radiology or other interventions control vaginal bleeding in women with advanced cervical cancer?

Background: Cervical cancer (cancer of the neck of the womb) is the second most common cancer among women throughout the world, accounting for about 500,000 new detected cases and 273,000 deaths every year. Women more commonly present with advanced disease in the developing world, where access to cervical screening programmes is limited. Advanced cancer of the cervix may not be curable and women often need treatment to control distressing symptoms (palliation), such as vaginal bleeding. Bleeding can be severe enough to be life threatening in women with advanced cervical cancer. Management of vaginal bleeding often poses a challenge, especially in the developing world, where access to radiotherapy is limited. Options for palliative treatment of severe vaginal bleeding include interventional radiology treatment (using x‐rays to guide the insertion of 'plugs' into blood vessels supplying the cancer) or vaginal packing (where gauze is compacted into the vagina to absorb the blood and apply pressure directly to the cervix), although these are often only partly effective and may cause harm. Vaginal packs can be soaked with formalin, which is a preservative chemical. Other options for treating severe vaginal bleeding include tranexamic acid (a medicine that reduces bleeding that can be given by mouth or by injection) and radiotherapy (high‐energy x‐ray treatment).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period

Haemorrhage following childbirth (postpartum haemorrhage) is a major cause of maternal death and health problems in resource‐poor settings in both low‐ and high‐income countries. Postpartum haemorrhage is defined as blood loss from the genital tract of more than 500 mL, generally occurring within the first 24 hours after delivering the placenta and occasionally between 24 hours and six to 12 weeks. Possible causes are the uterus (womb) failing to contract after delivery (uterine atony), a retained placenta, inverted or ruptured uterus, and cervical, vaginal, or perineal lacerations. To address these issues, the joint policy statements between the International Confederation of Midwives, the International Federation of Gynecology and Obstetrics, and the World Health Organization recommend 'active management of third stage of labour', which includes the administration of a uterotonic drug (intravenous oxytocin), just before or just after delivery in order to help the uterine muscles to contract. The use of oral uterotonic drugs such as methylergometrine for the prevention of postpartum haemorrhage after delivery of the placenta is not recommended in the joint policy statements. Yet orally delivered uterotonic drugs, such as ergot alkaloids (including methylergometrine), herbal therapies, or homeopathic remedies are easy‐to‐administer agents that may be considered as possible alternatives after delivery of the placenta in developing countries, as in Japan. We set out to determine whether such agents are effective in preventing haemorrhage after childbirth. We found a total of five randomised clinical trials (involving 1466 women). In three of the trials (involving 1268 women), oral methylergometrine was compared with placebo (two trials) or the Japanese traditional herbal medicine Kyuki‐chouketsu‐in (one trial). The other two trials (involving 198 women) did not report information on relevant outcomes of interest for this review. Overall, there was no clear evidence that prophylactic oral methylergometrine was effective in reducing haemorrhage after childbirth. The trials were not of good quality and adverse events were not well‐reported. We did not find any completed trials looking at the effectiveness of homeopathic remedies in reducing haemorrhage after childbirth. The effectiveness of such remedies warrants further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hysterectomy, Endometrial Ablation and Mirena® for Heavy Menstrual Bleeding: A Systematic Review of Clinical Effectiveness and Cost-Effectiveness Analysis

The aim of this project was to determine the clinical effectiveness and cost-effectiveness of hysterectomy, first- and second-generation endometrial ablation (EA), and Mirena® (Bayer Healthcare Pharmaceuticals, Pittsburgh, PA, USA) for the treatment of heavy menstrual bleeding.

Health Technology Assessment - NIHR Journals Library.

Version: April 2011
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Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage

This review concluded that pelvic arterial embolisation offered a safe and conservative alternative to surgical intervention for post-partum haemorrhage in women who desired to preserve future fertility. As this did not appear to be a systematic review and the evidence was from retrospective studies and case reports, these conclusions need to be considered with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Hysteroscopy in women with abnormal uterine bleeding: a meta-analysis on four major endometrial pathologies

PURPOSE: To determine the accuracy of hysteroscopy in diagnosing endometrial cancer, hyperplasia, polyps and submucous myomas.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails

We performed a systematic review to identify all studies evaluating the success rates of treatment of major postpartum hemorrhage by uterine balloon tamponade, uterine compression sutures, pelvic devascularization, and arterial embolization. We included studies reporting on at least 5 cases. All searches were performed independently by 2 researchers and updated in June 2006. Failure of management was defined as the need to proceed to subsequent or repeat surgical or radiological therapy or hysterectomy, or death. As the search identified no randomized controlled trials, we proceeded to search for observational studies. This identified 396 publications, and after exclusions, 46 studies were included in the systematic review. The cumulative outcomes showed success rates of 90.7% (95% confidence interval [CI], 85.7%-94.0%) for arterial embolization, 84.0% (95% CI, 77.5%-88.8%) for balloon tamponade, 91.7% (95% CI, 84.9%-95.5%) for uterine compression sutures, and 84.6% (81.2%-87.5%) for iliac artery ligation or uterine devascularization (P = 0.06). At present there is no evidence to suggest that any one method is better for the management of severe postpartum hemorrhage. Randomized controlled trials of the various treatment options may be difficult to perform in practice. As balloon tamponade is the least invasive and most rapid approach, it would be logical to use this as the first step in the management.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Risk of fever after misoprostol for the prevention of postpartum hemorrhage: a meta-analysis

OBJECTIVE: To estimate the incidence and risk of misoprostol-induced fever with different doses and routes when used for the prevention of postpartum hemorrhage.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Uterine necrosis following pelvic arterial embolization for post-partum hemorrhage: review of the literature

Uterine necrosis is one of the rarest complications following pelvic arterial embolization for postpartum hemorrhage (PPH). With the increasing incidence of cesarean section and abnormal placental localization (placenta previa) or placental invasion (placenta accreta/increta/percreta), more and more cases of uterine necrosis after embolization are being diagnosed and reported. Pelvic computed tomography or magnetic resonance imaging provides high diagnostic accuracy, and surgical management includes hysterectomy. We performed a Medline database query following the first description of uterine necrosis after pelvic embolization (between January 1985 and January 2013). Medical subheading search words were the following: "uterine necrosis"; "embolization"; "postpartum hemorrhage". Seventeen citations reporting at least one case of uterine necrosis after pelvic embolization for PPH were included, with a total of 19 cases. This literature review discusses the etiopathogenesis, clinical and therapeutic aspects of uterine necrosis following pelvic arterial embolization, and guidelines are detailed. The mean time interval between pelvic embolization and diagnosis of uterine necrosis was 21 days (range 9-730). The main symptoms of uterine necrosis were fever, abdominal pain, menorrhagia and leukorrhea. Surgical management included total hysterectomy (n=15, 78%) or subtotal hysterectomy (n=2, 10%) and partial cystectomy with excision of the necrotic portion in three cases of associated bladder necrosis (15%). Uterine necrosis was partial in four cases (21%). Regarding the pathophysiology, four factors may be involved in uterine necrosis: the size and nature of the embolizing agent, the presence of the anastomotic vascular system and the embolization technique itself with the use of free flow embolization.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis

OBJECTIVE: To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource-poor settings: a systematic review

BACKGROUND: Effective interventions addressing postpartum haemorrhage (PPH) are critically needed to reduce maternal mortality worldwide. Uterine balloon tamponade (UBT) has been shown to be an effective technique to treat PPH in developed countries, but has not been examined in resource-poor settings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

What measured blood loss tells us about postpartum bleeding: a systematic review

BACKGROUND: Meta-analyses of postpartum blood loss and the effect of uterotonics are biased by visually estimated blood loss.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence

BACKGROUND: Using misoprostol to prevent postpartum haemorrhage (PPH) in home-birth settings remains controversial.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

[Anesthetic management of severe or worsening postpartum hemorrhage]

INTRODUCTION: Risk factors of maternal morbidity and mortality during postpartum hemorrhage (PPH) include non-optimal anesthetic management. As the anesthetic management of the initial phase is addressed elsewhere, the current chapter is dedicated to the management of severe PPH.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Oxytocin for reducing operative births in women with epidurals in labour

The rate of operative births (caesarean sections, forceps and vacuum extraction) continues to rise throughout the world. All three types of delivery are associated with significant complications for both the mother and her baby such as traumatic birth injuries, increased blood loss and placental complications in future pregnancies. One of the most common reasons for a woman to require an operative birth is because the labour does not progress adequately. Increasingly, epidurals are used to manage the pain during labour, however, epidurals may also slow the progression of labour. Oxytocin is a hormone that stimulates uterine contractions in labour and is given to women who are slow to progress in labour. By giving oxytocin to all women with epidurals during labour, the rate of operative deliveries, and the associated complications, could be reduced.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Applying negative pressure rapidly or in steps for vacuum extraction assisted vaginal delivery

Assisted vaginal delivery is an important part of obstetric care. Indications for its use include prolonged second stage of labour, actual or potential fetal compromise or distress, and to shorten labour. The established methods facilitate the descent and birth of the infant. A vacuum extractor is becoming the method of choice as it is less likely to injure the mother although failure of attempted vacuum extraction may occur more often than with forceps. Rapid application addresses the benefit of vacuum extraction that can be used when rapid delivery is required. Two good quality randomized controlled trials involving 754 women were identified. Rapid negative pressure application reduced the duration of the procedure without any evidence of differences in outcomes for the mother or infant. Rapid method of negative pressure application should be recommended for vacuum extraction assisted vaginal delivery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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