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Page 1 of 6

  • Chapter 57 - Management of Postpartum Haemorrhage
  • from Section 5 - Intrapartum Care
  • Edited by Tahir Mahmood, Charles Savona Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book: The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
  • Published online: 20 November 2021
  • Print publication: 02 December 2021, pp 452-461
  • View extract

    Summary

    Postpartum haemorrhage (PPH) is the one of the leading causes of maternal morbidity and mortality worldwide, with the World Health Organization (WHO) estimating 140 000 maternal deaths every year due to PPH [1]. Between 1990 and 2015 there has been a decrease in the number of women dying in the perinatal period (all-cause mortality) with 385 death per 100 000 live births in 1990 decreasing to 216 per 100 000 live births; however, a significant gap in the mortality in developed and developing countries persists [2]. In 2015, the maternal mortality rate in low-income countries was 479 per 100 000 live births versus 13 per 100 000 births in high-income countries [2]. In the UK, PPH is the third most common direct cause of maternal death and was attributable for 0.78 deaths per 100 000 maternities between 2014 and 2016 [3]. Maternal death, however, can only be seen as the tip of the iceberg, with 492 cases of morbidities reported in Scotland during 2012 and many other unreported cases of morbidities such as post-traumatic stress syndrome [4].

  • Chapter 40 - Failed Operative Vaginal Delivery
  • from Section 8 - Management of Anticipated and Non-anticipated Emergencies in Pregnancy
  • Edited by Edwin Chandraharan, Sir Sabaratnam Arulkumaran
  • Book: Obstetric and Intrapartum Emergencies
  • Published online: 06 May 2021
  • Print publication: 03 June 2021, pp 292-296
  • View extract

    Summary

    Operative vaginal birth rate has been stable in the United Kingdom at about 10%–13% [3, 4]. The caesarean section at full dilation as an alternative approach to instrument delivery has a high maternal and neonatal morbidity, but failed instrument vaginal deliveries (FID), which lead to caesarean sections, are associated with potentially serious maternal and fetal complications such as angular tears, postpartum haemorrhage, difficulty in delivery of the fetal head, fetal ischaemic-hypoxic injuries, birth trauma and perinatal deaths. Therefore, it is important to identify factors which can help to predict successful operative vaginal delivery.

    There are various established risk factors which increase the chances of instrument delivery, including advanced maternal age, high body mass index (BMI; >30), high birth weight (>4.0 kg) and epidural analgesia.

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