Showing posts with label ACOG updates on PPH. Show all posts
Showing posts with label ACOG updates on PPH. Show all posts

Monday, October 30, 2017

In case you missed it: Here are the top 5 posts this month


Finally, an oral drug found effective in treatment of Uterine Fibroids following successful phase-3 trial
Relugolix successfully reduced heavy menstrual blood loss among Japanese women in a Multicenter, Randomized, Double-Blind, Parallel-Group, Phase 3 Study to Evaluate the Efficacy and Safety of Oral relugolix 40 mg as compared with injectable leuprolide  in the Treatment of Uterine Fibroids.
Relugolix is an oral, once-daily, small molecule GnRH receptor antagonist that has been evaluated in almost 1,600 study participants in Phase 1, Phase 2 and Phase 3 clinical trials. In these trials, it has shown to suppress estrogen and progesterone levels in women and testosterone levels in men. (It is also being evaluated in advanced prostate cancer via ongoing phase-3 HERO study).


Now ‘Switch’ the way you suture: Reinventing suturing technique with the new device
Mellon Medical, a Dutch MedTech developer has reinvented suturing by developing a device which enables the surgeon to suture with only one hand, the other hand remaining free to use as needed. The product is named Switch®, a single use precision instrument that allows the surgeon to suture tubular structures or skin with twice the speed of conventional suturing.


ACOG updates its guidelines on LARC
The American College of Obstetricians and Gynecologists (ACOG) today updated its guidelines on Long-Acting Reversible Contraception(LARC): Implants and Intrauterine Devices. These updated guidelines were published online October 24 in Obstetrics & Gynecology and replaces the old practice bulletin published in July 2011.


ACOG updates guidance on postpartum hemorrhage- calls for standard, coordinated, protocol based intervention
The American College of Obstetricians and Gynecologists (ACOG) recently released expanded guidelines for management of postpartum hemorrhage (PPH)—the leading cause of maternal mortality worldwide.
PPH is defined as total blood loss of 1000 ml or more along with signs or symptoms of hypovolemia within 24 hours after the labor, but can occur up to 12 weeks postpartum. Although Maternal Mortality Rates(MMR) have decreased worldwide in last 4 decades, it still accounts for 10% of all pregnancy related mortality.



Endometriosis fertility index can accurately predict a women’s chances of conception after laparoscopy
The Endometriosis fertility index can accurately predict the possibility of non-ART conception or the need of ART for achieving pregnancy after surgical resection of moderate-severe (Stage III–IV) endometriosis reports the results of study published in Human Reproduction. The study confirmed that adnexal function is deciding factor in evaluation of fertility prognosis after the surgery.
There is no evidence based guidelines about post-surgery fertility management of women who have undergone surgery for severe endometriosis. Physicians differ in their approach about the length of conservative treatment and that sometimes add years and causes unnecessary delays.





Friday, October 13, 2017

ACOG updates guidance on postpartum hemorrhage- calls for standard, coordinated, protocol based intervention


The American College of Obstetricians and Gynecologists (ACOG) recently released expanded guidelines for management of postpartum hemorrhage (PPH)—the leading cause of maternal mortality worldwide.

PPH is defined as total blood loss of 1000 ml or more along with signs or symptoms of hypovolemia within 24 hours after the labor, but can occur up to 12 weeks postpartum. Although Maternal Mortality Rates(MMR) have decreased worldwide in last 4 decades, it still accounts for 10% of all pregnancy related mortality.

Incidence varies, but 1-5% is reasonable estimate, with uterine atony accounting for 70-80% of cases PPH.

This practice bulletin discusses the risk factors along with evaluation, prevention, and management of maternal hemorrhage.

It also calls upon all obstetricians and other obstetric care providers to formulate standard protocols for recognizing, evaluating and management of maternal hemorrhage by multidisciplinary approach and implement it in every center.

Multidisciplinary teams, including physicians, nurses and midwives, should be trained to implement key elements in four categories, including readiness to respond; recognition and prevention measures; multidisciplinary response; and data reporting and systematic learning, including drills like simulation-based training.

ACOG also has partnered with multiple organization to implement the care bundle suggested by  Alliance for Innovation on Maternal Health (AIM), which many states have are already adapted.

It also lays emphasis on identifying the patients at risk of developing PPH, prenatally, during admission and during labor. It includes patients with vaginal lacerations, retained placenta, abnormally adherent placenta with previous cesarean section. All Ob-gyn should be aware of high risk of PPH in placenta previa with previous uterine scar.

Uterotonic agents should be the first line of treatment in case of atonic PPH, choice of a specific agent is at the discretion of the provider as none is identified as superior over other. Active management of third stage of labor should be implemented.

All hospitals, especially those in rural areas should be able to escalate the efforts quickly, and have a specific plan to go to next level of treatment or quickly refer patient to a specialty hospital.

Tranexamic acid can be given when primary line of therapy fails, it is especially found effective if given within 3 hours of birth.

Surgical approach includes Intrauterine balloon tamponade, but less invasive methods should always be used first. 

All hospitals should have functioning massive transfusion protocols and ‘hemorrhage carts’, with all the necessary medication in place.

The Practice Bulletin #183, "Postpartum Hemorrhage" is published in October issue of Obstetrics and Gynecology.