• Title/Summary/Keyword: Postpartum hemorrhage

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Inferior Mesenteric Artery Embolization with N-Butyl Cyanoacrylate for Life-Threatening Postpartum Hemorrhage: A Report of Two Cases and Literature Review (치명적 산후출혈에서 N-Butyl Cyanoacrylate를 이용한 하장간막동맥 색전술: 두 개의 증례 보고와 문헌 고찰)

  • Hae Won Yoo;Min Jeong Choi;Bong Man Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.3
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    • pp.693-699
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    • 2021
  • The inferior mesenteric artery is a rare source of postpartum hemorrhage. We report two cases of primary postpartum hemorrhage that originated from the inferior mesenteric artery after vaginal delivery. Both patients showed signs of hypovolemic shock, and disseminated intravascular coagulation was suspected. The bleeding continued even after embolization of the uterine artery, a typical source of postpartum hemorrhage. Inferior mesenteric arteriography confirmed contrast extravasation from the superior rectal artery, and selective embolization was performed using N-butyl cyanoacrylate. This report highlights that the inferior mesenteric artery can be a source of bleeding in patients with intractable and persistent postpartum hemorrhage due to birth canal injury.

Simulation-based education program on postpartum hemorrhage for nursing students (산후출혈 산모 간호 시뮬레이션 교육 프로그램의 효과)

  • Kim, Miok;Ha, Juyoung
    • Women's Health Nursing
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    • v.26 no.1
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    • pp.19-27
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    • 2020
  • Purpose: This study was conducted to develop a simulation-based postpartum care education program for women with postpartum hemorrhage and to verify the effects of the program on postpartum care. Methods: This program was developed according to the ADDIE model of instructional system design, which consists of analysis, design, development, implementation, and evaluation phases. This quasi-experimental study used a non-equivalent control group pre- and post-test design, and data were collected from April 23 to May 4, 2015. To verify the effects of the program, 33 nursing students in the experimental group participated in a simulation program, whereas 31 students in the control group were given a case study. Results: The experimental group had statistically significantly higher scores for clinical performance (t=-4.80, p<.001), clinical judgment (t=-4.14, p<.001), and learning satisfaction (t=-10.45, p<.001) than the control group. Conclusion: The results of this study indicate that the simulation-based postpartum care education program for women with postpartum hemorrhage was effective for developing students' competency, implying that a similar program should be integrated into the clinical training component of the maternal nursing curriculum.

Intracranial Hemorrhage Developed from Patient Who Had Been Preeclampsia at Five Days Postpartum - A Case Report - (전자간이 있던 산모에서 분만 5일후 발생한 뇌실질내 출혈 - 증례보고 -)

  • Lee, Chang-Woo;Kim, Yong-Seog;Park, Moon-Sun;Ha, Ho-Guyn;Lee, Jong-Sun;Jung, Ho;Kim, Joo-Seung
    • Journal of Korean Neurosurgical Society
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    • v.30 no.3
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    • pp.371-375
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    • 2001
  • Intracranial hemorrhage due to preeclampsia in the postpartum woman is rarely documented. Generally, the incidence of stroke is increased during pregnancy and early postpartum. Preeclampsia is considered a main cause of both nonhemorrhagic and hemorrhagic stroke. We present a 32-year-old woman who had intracranial hemorrhage at 5 days postpartum. At admission, her consciousness was semicomatose with elevated blood pressure. Computerized tomography revealed intracranial hemorrhage on right frontal lobe. Additional angiography did not reveal abnormal vascular lesion. Emergency craniectomy with hematoma removal was done. However, the patient showed no recovery and died 2 weeks later. We conclude that postpartum care of preeclampsia is important to prevent intraparenchymal hemorrhage. Relative high risk of stroke during the postpartum period suggests a causal roles for the large decrease in blood volume or the rapid changes in hormonal status that follow a live birth or stillbirth, perhaps by means of hemodynamics, coagulative, or vessel wall changes.

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Effects of Simulation-based Practice using Standardized Patients for the Care of Women with Postpartum Hemorrhage on Nursing Student's Clinical Performance Competence and Critical thinking Deposition (표준화 환자를 활용한 산후출혈 산모 간호 시뮬레이션 실습이 간호학생의 임상수행능력과 비판적 사고 성향에 미치는 효과)

  • Kim, Sun-Hee
    • Korean Parent-Child Health Journal
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    • v.15 no.2
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    • pp.71-79
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    • 2012
  • Purpose: This study was conducted to examine the effects of simulation-based practice using standardized patients for the care of woman with postpartum hemorrhage as related to clinical performance competence and critical thinking deposition of nursing students. Methods: A nonequivalent control group pre-post test experimental design was used. Fifty four third year students were recruited, 29 students for the experimental group and 25 students for the control group. The simulation-based practice about nursing care related to postpartum hemorrhage included skill training, team-based practice, and debriefing. It was implemented with the experimental group for about 30 minutes in October 6, 2011. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability, and t-test using the SPSS/WIN program. Results: The experimental group who had the simulation-based practice showed significantly higher knowledge and skills of clinical performance competence than the control group (t=2.19, p=.003). But the experimental group who had the simulation-based practice did not show significantly higher critical thinking deposition than the control group (t=-0.32, p=.748). Conclusion: The results indicate that a simulation-based practice is an effective teaching method to improve knowledge and skills for clinical performance competence of nursing students. Further study is needed to identify the effect of a simulation-based practice on nursing attitudes.

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Development of algorithms for the home care of postpartum mothers and infants (산욕기 산모와 신생아의 가정간호 알고리즘 개발)

  • Bang, Kyung-Sook
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.4
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    • pp.65-75
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    • 1997
  • The needs for the home care of postpartum mothers and their infants are increasing, but the quality control of home care nurses is not developed yet. The objective of this study is to develop assessment - intervention algorithms for the home care of postpartum mothers and their infants. We can use these algorithms when we assess the client's condition, and find appropriate nursing interventions. Also, these algorithms can offer guidelines for home care nurses, so that standardization of home care can be attained. Common problems for postpartum mothers are postpartum hemorrhage, abnormal vaginal discharge(endometritis), episiotomy pain, breast problems, breastfeeding difficulty, edema, urinary dysfunction and defecation difficulties. Also, commom problems for infants are abnormal body temperature, tarchycardia, respiratory problem, neonatal jaundice, cord problem, abnormal stool, breast feeding, and bathing. These algorithms can be used as a basis for the development of computerized infomation system for the home health care.

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Uterine Artery Embolization as an Effective Management and Diagnostic Tool for Puerperal Uterine Inversion with Severe Postpartum Bleeding: A Case Report (자궁내번증으로 인한 중증 산후 출혈 환자에서 효율적인 조치 및 진단적 도구로서의 자궁동맥색전술: 증례 보고)

  • Seong Ju Kim;Youngjong Cho;Sung-Joon Park;Sangjoon Lee;Hyoung Nam Lee;Da Hye Ju
    • Journal of the Korean Society of Radiology
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    • v.83 no.3
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    • pp.699-704
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    • 2022
  • Acute puerperal uterine inversion is a rare postpartum obstetric complication; however, without rapid diagnosis and appropriate management, it is life-threatening. Substantial bleeding hinders the verification of a partially inverted uterus, possibly delaying the treatment. Herein, we present the report of a 32-year-old female presenting with massive postpartum bleeding managed by uterine artery embolization. The peculiar course of the uterine artery bowing inferiorly along the inverted fundus during embolization could uncover the uterine inversion, which was not diagnosed by physical examination and CT. In conclusion, uterine artery embolization is not only an effective therapeutic strategy for postpartum hemorrhage but also a valuable tool for diagnosing uterine inversion.

A Study on the Nursing Needs and Satisfactions of Early Postpartum Women (초기 산욕부의 간호요구도와 만족도에 관한 연구)

  • Yoo, Youn-Ja;Lee, Eun-Ju
    • Women's Health Nursing
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    • v.5 no.3
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    • pp.389-409
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    • 1999
  • This study was carried out to identify the differences between nursing needs and levels of satisfaction of postpartum women during the early postpartum period. The goal of this study was to obtain needed to develope the nursing quality for postpartum women. The subjects were 87 postpartum women who had vaginal delivery at 2 general hospital and 2 maternity hospital in the Ulsan City. The period for the data collection was from June 1 to 29, 1999. The data was gathered using an 98 items questionnaire which was a modified version of a questionnaire the developed by Y. J. Chun. Results found are as follows : 1. The general characteristics of the subjects : The majority of subjects were 25-29 yrs. (57.5%), high school and college graduates(96.5%), unemployed(75.9%), middle ranged economics(93.1%), had no religion(43.7%), male baby(52.9%), birth weight 3-3.5Kg(49.4%), wanted pregnancy(96.6%), no abortion history(50.6%), had antenatal care(89.7%), had prenatal education(32.2%), postnatal education(42.5%), intended breast feeding (46.0%), had resonable self confidence about self(20.7%), infant care(36.8%) and nuclear family pattern(82.3%). 2. The level of nursing needs of overall nursing care(3.93) and the levels of satisfaction(3.86) was relatively high. The nursing needs by category of nursing care, the highest need was in the emotional and psychological care(4.09), and the lowest need was in physical need(3.73). The satisfactions by category of nursing care, the highest satisfaction was in emotional and psychological care(4.11) and the lowest satisfaction was in education in self care(3.64). The significant differences between nursing needs and satisfactions were found on education in infant care(p=.005), and education in self care(p=.020). 3. Among items of physical care, 'accurate medication and treatment(4.21)', 'control of postpartum hemorrhage(4.13)', 'pain control and care of episiotomy wound (4.12)' and 'regular observation of postpartum conditions(4.09)' showed high nursing needs. 'Accurate medication and treatment(4.31)', 'regular observation of postpartum condition(4.24)', 'control of postpartum hemorrhage(4.22)' and 'pain control and care of episiotomy wound(4.12)' showed high satisfaction levels. 4. Among items of emotional and psychological care, 'personal treatment(4.32)', kind and faithful care(4.30)', 'detailed explanation on the treatment or nursing care(4.25)', 'adequate draping during the care and treatment(4.23)' and detailed explanation on a doubt(4.13)', showed high nursing needs, 'personal treatment(4.52)', 'kind and faithful care(4.45)', 'detailed explanation on a doubt(4.24)', 'detailed explanation on the treatment or nursing care(4.21)' and 'adequate draping during the care and treatment(4.18)' showed high satisfaction of nursing care. Difference between the level of nursing needs and satisfaction was significant except item of 'early contacts with their baby and breast feeding'. 5. Among items of environmental care, the highest level of need and satisfaction were on the items of 'neat bedding and clothes(4.05, 4.21)' and 'room cleansing or care of room(4.01, 4.28)'. Differences between the level of nursing care and satisfaction were 'room cleansing of care of room'. 6. Among items of educational needs on self care, 'sitz bath method(4.22)', 'high risk symptoms to immediate clinic visits(4.13)', 'the timing of tub bath(4.05)' and 'good secretion of breast milk(4.03)', showed high nursing needs, 'sitz bath method(4.22)' showed high satisfaction of nursing care. Differences between the level of nursing care and satisfaction were 'the timing of hair shampoo', 'the timing of tub bath', ' the method of pad change', 'postpartum exercise', 'good secretion of breast milk', 'maintenance of breast figure', 'contraindicated drugs in postpartum women', 'kegel exercise' and 'breast self examination'. 7. Among items of educational needs on infant care, 'immunization of infants(4.36)', 'symptoms of sickness to immediate clinic visits(4.28)'. 'safety and emergency care(4.28)', 'umbilical care(4.26)', 'feeding times and intervals(4.24)', 'normal growth and development of infant(4.24)' and 'infection control(4.22)', showed high level of nursing care, 'immunization of infants(4.21)', 'feeding times and intervals(4.17)', were high satisfaction items showed significant differences between the level of nursing care and satisfaction. 8. Relationship between nursing needs and levels of satisfaction among postpartum women were as follows : 1) Physical area : There were no significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'working mothers', 'baby's weights', 'baby's sex', 'planning of feeding' and 'routes of receiving postpartum informations'. 2) Emotional and psychological area : The level of nursing needs were significantly different in the area of 'confidence in self care'. Satisfaction levels were significantly different among 'baby's sex', 'baby's weights', 'the confidence of infant care' and 'working mother'. 3) Environment area : There were on significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'maternal age' and 'baby's weights'. 4) Education in self care : The level of nursing needs were significantly different among 'parity history' and 'type of family formation'. Satisfaction levels were significantly different among 'working mother', 'baby's sex', 'antenatal care', 'postpartum education', 'planning of feeding', 'routes of receiving postpartum informations'. 5) Education in infant care area : The level of nursing needs were significantly different among 'parity history'. Satisfaction levels were significantly different among 'baby's sex', 'receiving postpartum education or not' and 'working mother'.

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Body mass index and massive hemorrhage after cesarean section in patients with placenta previa

  • Changrock Na;Hyun Jung Kim
    • Journal of Medicine and Life Science
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    • v.19 no.2
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    • pp.39-45
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    • 2022
  • This study was undertaken to assess the potential of body mass index (BMI) as a risk factor for massive hemorrhage (MH) after cesarean section (CS) in patients with placenta previa. We retrospectively reviewed the medical records of patients who underwent CS for placenta previa between January 2010 and December 2018. MH was defined as an estimated blood loss ≥2,000 mL during surgery. Clinical characteristics, including BMI, were compared between the groups with and without MH. Subsequently, multivariable logistic regression analysis was conducted to identify the independent risk factors for MH. A total of 189 patients were included in this study. MH was observed in 28 patients (14.8%). According to the multivariable logistic regression analysis results, the risk factors independently associated with MH were BMI at delivery (adjusted odds ratio [aOR], 1.19; 95% confidence interval [CI], 1.04-1.35; P=0.012), placenta accrete (aOR, 24.55; 95% CI, 2.75-219.02; P=0.004), and total previa degree (aOR, 9.86; 95% CI, 2.71-35.96; P=0.001). The study findings showed that maternal obesity, namely a higher BMI at delivery, was an independent risk factor for MH after CS in patients with placenta previa. Close attention should be paid to the potential risk of hemorrhage associated with maternal obesity as well as the well-known risk factors of placenta accreta and total previa degree.

Diagnosis and Management of Post-Partum Hemorrhage Caused by Acquired Hemophilia A: A Case Report

  • Rashid, Nawshirwan G.;Amin, Shaema Salih;Abdulqader, Aveen M. Raouf
    • Korean Journal of Clinical Laboratory Science
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    • v.54 no.2
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    • pp.163-166
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    • 2022
  • Acquired hemophilia A (AHA) is an uncommon autoimmune bleeding disorder in which autoantibodies that affect the functions of factor VIII (FVIII) are present in the blood. The initial diagnosis of AHA is difficult as the presentations of AHA differ from those of congenital hemophilia A. Moreover, the treatment of AHA is more complex due to the presence of autoantibodies against FVIII. Here, we present a case report of postpartum AHA, to increase the perception and knowledge regarding the recognition and management of such cases. We present a young female with the chief complaint of vaginal bleeding and upper arm ecchymosis. Laboratory results exhibited isolated prolonged activated partial thromboplastin time (APTT) and FVIII inhibitors. The patient was treated with corticosteroids, FVIII concentrates, and a bypassing agent. In conclusion, unexplained postpartum bleeding, unmanageable with basic hemostatic measures, should lead to clinical suspicion of an acquired bleeding disease.