Comparative Study on Prevention of Postpartum Hemorrhage by Routine Active Management of Third Stage of Labor versus Active Management of Third Stage of Labor with AMR’S Maneuver in Madurai Medical College, Tamil Nadu, India
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 1
Abstract
Background: Postpartum hemorrhage (PPH) is responsible for around 25% of maternal mortality worldwide (WHO, 2007) reaching as high as 60% in some countries. In resource-poor settings, many uterotonics known to be effective in reducing PPH in tertiary care settings may not be useful in community settings because they require refrigeration and/or skilled administration (Patel et al. 2006). The rationale behind this study is to investigate the applicability and effectiveness of a new simple maneuver in decreasing the rate of PPH and the amount of postpartum blood loss in such setup. Materials and Methods: This is a prospective comparative study conducted in Government Rajaji Hospital Madurai, Department of Obstetrics and Gynaecology between January 2016 and July 2016. A total of 500 patients eligible for vaginal delivery were divided into 2 groups: Study Group - 250 patients AMR’S maneuver done, by stretching the cervix for 90 s with ovum forceps, with active management of the third stage of labor (AMSTL). Control group - 250 patients with routine AMSTL alone. The amount of blood loss was calculated by under buttock calibrated drape. All patients were followed up for 6 h. Results: The mean age in the study group was 23.5 years and control group was 23.6 years. Overall 52.5% were primigravida. About 61% belong to normal body mass index. Nearly 59.8% had spontaneous labor. Almost 91% had labor natural. Maximum number of patients had blood loss in the range of 200-400 ml which was 58.8% in the study group and 59.2% in control group. Severe PPH, i.e., >1000 ml did not occur in both groups. The rate of PPH defined as >500 ml was 3.2% in study group and 3.6% in control group. The difference of which is statistically not significant. Mean blood loss in study group is 263.22 ml and in control group is 285.76 ml which is significant. Eight patients had PPH in the study group, and 9 patients had PPH in control group. In PPH range mean blood loss in cases is 615 ml and in controls is 713.3 ml which is also statistically significant. The mean predelivery hemoglobin (Hb) in the study group was 10.44 g and in control group was 10.47 g. Post-delivery fall in Hb was significant in control group but not in study group. Conclusions: This randomized control study compared routine AMSTL and AMR’S maneuver with AMSTL. The maneuver is found to decrease amount of blood loss due to PPH when done along with the AMSTL
Authors and Affiliations
Chitra Subramaniyam
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