Hi, This article appeared in last week's Sydney Morning Herald. I think it's amazing and it appears that some of the information is incorrect in that the article states that NSW Health implemented active thrid stage and early cord clamping in 2002. Surely syntometrine and syntocinon have been used for many more years than just the last four, in which case this study is a real eye-opener if you believe we are stopping women from bleeding by using drugs in third stage. What do you think? Sue Transfusions soar for women giving birth
Julie Robotham Medical Editor The number of women diagnosed with post-partum hemorrhage has
rocketed by
nearly 30 per cent, and almost one in nine births was affected in 2002,
compared to one in 12 in 1994, Of those, the proportion whose condition was severe enough to
warrant a
blood transfusion increased sixfold, from 2 per cent to 12 per cent. "It's extremely important," said Ken Clark, the president of the
Royal Australian and New Zealand College of Obstetricians and
Gynaecologists.
Bleeding was "still a very real cause of the death of women but also a
great deal of [ill health] that has a tremendous impact on women and
their
families". In the worst cases mothers had to undergo emergency hysterectomies
to save
their lives, but even less dramatic surgery to clamp blood vessels or
anaemia
could be debilitating. "To have that on top of all the other stresses and strains of
motherhood … it's the last thing people need," Dr Clark said. The NSW findings are the first large-scale confirmation of the
impression
among individual doctors and hospitals across Carolyn Cameron, who led the statewide analysis, said neither the
well-documented rise in caesarean section births nor the growing number
of
older mothers could explain the increase in hemorrhages. It was
possible more
borderline cases were being identified, but this alone was unlikely to
account
for the increase. "We have to search for something else. It's a mystery," said Ms
Cameron, a research officer at the Centre for Perinatal Health Services
Research. The group would now look at how many previous pregnancies women had
and the
length of their labours to see whether these offered clues to the
reasons for
hemorrhage - diagnosed when more than 500 millilitres of blood is lost
after a
vaginal birth, or more than 750 millilitres after a caesarean. Blood loss - usually from the site where the placenta detaches - is
currently
the single largest cause of pregnancy-related death in Between 1997 and 1999 - the most recent period for which figures are
available - eight women died as a consequence, including two who
refused
transfusions for religious reasons. Ms Cameron's research, published in the Australian and New
Zealand
Journal of Public Health, was based on the medical records of more
than
52,000 women who had a birth-related hemorrhage in NSW between 1994 and
2002. It is not yet clear whether the pattern has continued since 2002,
when NSW
Health recommended the use of drugs to expel the placenta and early
clamping of
the umbilical cord to limit bleeding. David Ellwood, professor of obstetrics and gynaecology at the Women who gave birth vaginally after a previous caesarean, or those
carrying
twins, might be at increased risk, he said. Rising birthweights might
also contribute
to the trend. Increasing transfusion numbers indicated that the severest bleeding
was also
rising, Professor Ellwood said - because doctors were reluctant to
transfuse
women with less serious hemorrhages. A group of maternity hospitals was researching women's recovery from
birth
hemorrhages to see whether they affected breastfeeding or triggered
post-natal
depression, he said. |
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