An unexpected cause of vaginal hemorrhage.
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ABSTRACT:
SUBMITTER: Kosoko A
PROVIDER: S-EPMC9337841 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
Publications
An unexpected cause of vaginal hemorrhage.
Kosoko Adeola A Chisowa Mutinta M
Journal of the American College of Emergency Physicians open 20220729 4
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Project description: Not available
| S-EPMC5965124 | biostudies-literature
Project description:The association between coronavirus disease 2019 (COVID-19) vaccination and vaginal bleeding among nonmenstruating women is not well studied. The Norwegian Institute of Public Health followed several cohorts throughout the pandemic and early performed a systematic data collection of self-reported unexpected vaginal bleeding in nonmenstruating women. Among 7725 postmenopausal women, 7148 perimenopausal women, and 7052 premenopausal women, 3.3, 14.1, and 13.1% experienced unexpected vaginal bleeding during a period of 8 to 9 months, respectively. In postmenopausal women, the risk of unexpected vaginal bleeding (i.e., postmenopausal bleeding) in the 4 weeks after COVID-19 vaccination was increased two- to threefold, compared to a prevaccination period. The corresponding risk of unexpected vaginal bleeding after vaccination was increased three- to fivefold in both nonmenstruating peri- and premenopausal women. In the premenopausal women, Spikevax was associated with at 32% increased risk as compared to Comirnaty. Our results must be confirmed in future studies.
| S-EPMC10516485 | biostudies-literature
Project description:IntroductionPostpartum hemorrhage (PPH) is an important contributor to maternal morbidity and mortality. Predicting which laboring women are likely to have a PPH is an active area of research and a component of quality improvement bundles. The purpose of this study was to identify phenotypes of labor processes (ie, labors that have similar features, such as duration and type of interventions) in a cohort of women who had vaginal births, estimate the likelihood of PPH by phenotype, and analyze how maternal and fetal characteristics relate to PPH risk by phenotype.MethodsThis study utilized the Consortium for Safe Labor dataset (2002-2008) and examined term, singleton, vaginal births. Using 16 variables describing the labor and birth processes, a latent class analysis was performed to describe distinct labor process phenotypes.ResultsOf 24,729 births, 1167 (4.72%) women experienced PPH. Five phenotypes best fit the data, reflecting labor interventions, duration, and complications. Women who had shorter duration of admission after spontaneous labor onset (admitted in latent or active labor) had the lowest rate of PPH (3.8%-3.9%). The 2 phenotypes of labor progress characterized by women who had complicated prolonged labors (spontaneous or induced) had the highest rate of PPH (8.0% and 12.0%, respectively). However, the majority of PPH (n = 881, 75%) occurred in the phenotypes with fewer complications. Prepregnancy body mass index did not predict PPH. Overall, the odds of PPH were highest among nulliparous women (odds ratio [OR], 1.52; 95% CI, 1.30-1.77), as well as Black women (OR, 1.39; 95% CI, 1.13-1.73) and Hispanic women (OR, 1.85; 95% CI, 1.56-2.20). Within phenotypes, maternal race and ethnicity, nulliparity, macrosomia, hypertension, and depression were associated with increased odds of PPH.DiscussionWomen who were classified into a lower-risk labor phenotype and still experienced PPH were more likely to be nulliparous, a person of color, or diagnosed with hypertension.
| S-EPMC7554079 | biostudies-literature
Project description: Not available
| S-EPMC8274890 | biostudies-literature
Project description:Chronic cough is a frequently encountered condition with multiple etiologies. In patients with neurogenic chronic cough, peripheral laryngopharyngeal hypersensitivity of the vagus nerve stimulates the cough reflex. We present three cases of "Oto-tricho-tussia," describing hair within the ear canal stimulating Arnold's branch of the vagus nerve and triggering the urge-to-cough. All three patients experienced significant improvement or complete resolution of their cough symptoms after removal of the hair resting on their tympanic membrane and external auditory canal. We encourage ear canal examination and promotion of proper ear cleaning habits as this is an easily treatable consideration for the cause of chronic cough.
| S-EPMC7150714 | biostudies-literature
Project description:QuikClot combat gauze is a synthetic hemostatic dressing used for hemorrhage control. There is a paucity of data describing the clinical use and hemostatic results of combat gauze in the obstetric and gynecologic setting. This case series demonstrates the use of combat gauze as an effective hemostatic agent when used as vaginal packing in cervical and vaginal hemorrhage. Hemostasis was achieved rapidly in all cases and further interventions were avoided. The combat gauze remained in place for a mean time of 15 h with no adverse side effects observed. The use of combat gauze as vaginal packing may provide an alternative option in the treatment of cervical and vaginal hemorrhage when other traditional conservative and surgical interventions fail or are unavailable.
| S-EPMC5554919 | biostudies-other
Project description:The zebrafish is a powerful model for studying vascular development, demonstrating remarkable conservation of this process with mammals. Here, we identify a zebrafish mutant, redhead (rhd(mi149)), that exhibits embryonic CNS hemorrhage with intact gross development of the vasculature and normal hemostatic function. We show that the rhd phenotype is caused by a hypomorphic mutation in p21-activated kinase 2a (pak2a). PAK2 is a kinase that acts downstream of the Rho-family GTPases CDC42 and RAC and has been implicated in angiogenesis, regulation of cytoskeletal structure, and endothelial cell migration and contractility among other functions. Correction of the Pak2a-deficient phenotype by Pak2a overexpression depends on kinase activity, implicating Pak2 signaling in the maintenance of vascular integrity. Rescue by an endothelial-specific transgene further suggests that the hemorrhage seen in Pak2a deficiency is the result of an autonomous endothelial cell defect. Reduced expression of another PAK2 ortholog, pak2b, in Pak2a-deficient embryos results in a more severe hemorrhagic phenotype, consistent with partially overlapping functions for these two orthologs. These data provide in vivo evidence for a critical function of Pak2 in vascular integrity and demonstrate a severe disease phenotype resulting from loss of Pak2 function.
| S-EPMC1955825 | biostudies-other
Project description:BackgroundThis study is aimed to introduce a new technique used in controlling the postpartum bleeding during normal vaginal delivery.MethodsThis study was conducted on 150 pregnant women aged 18 years or more who were eligible for normal vaginal delivery. After placental delivery, Mostafa Maged maneuver was applied. The amount of blood loss was estimated by counting the number of pads immediately before applying the maneuver compared to the number of pads immediately after applying the maneuver to determine the effectiveness of the Mostafa Maged maneuver.ResultsThe study revealed that 15.3% of the study group had atony, and 23.3% were complicated with postpartum hemorrhage. In terms of blood loss, the average number of pads used before Mostafa Maged compression was (2.8) pads, with a range of 1 to 6 pads. The mean blood loss volume was (353.3±158.5) ml ranging between 125 and 750 ml. we should consider that Mostafa Maged maneuver is immediately applied after placental delivery. That is why small amount of 125 ml of blood loss in few patients is estimated, which decreased to (0.54±0.14) pads ranging between 0.5 and 1 pad with a mean (65.2±17.7) ml blood loss ranging between 60 and 125 ml after applying Mostafa Maged maneuver during normal vaginal delivery. There was a statistical decrease in the number of pads and volume of blood loss after Mostafa Maged maneuver.ConclusionMostafa Maged maneuver was found to be effective in stopping and preventing postpartum bleeding during vaginal delivery as this maneuver is used as a prophylaxis against post-partum hemorrhage in patients with risk factors of postpartum hemorrhage. It is also used to control post-partum hemorrhage during vaginal delivery. It has been proven to be tolerable, easy to learn and easy to perform.
| S-EPMC10416331 | biostudies-literature
Project description:Postpartum hemorrhage is the leading cause of maternal morbidity. Clinical prediction of postpartum hemorrhage remains challenging, particularly in the case of a vaginal birth. We studied machine learning models to predict postpartum hemorrhage. Women who underwent vaginal birth at the Tokyo Women Medical University East Center between 1995 and 2020 were included. We used 11 clinical variables to predict a postpartum hemorrhage defined as a blood loss of > 1000 mL. We constructed five machine learning models and a deep learning model consisting of neural networks with two layers after applying the ensemble learning of five machine learning classifiers, namely, logistic regression, a support vector machine, random forest, boosting trees, and decision tree. For an evaluation of the performance, we applied the area under the curve of the receiver operating characteristic (AUC), the accuracy, false positive rate (FPR) and false negative rate (FNR). The importance of each variable was evaluated through a comparison of the feature importance calculated using a Boosted tree. A total of 9,894 patients who underwent vaginal birth were enrolled in the study, including 188 cases (1.9%) with blood loss of > 1000 mL. The best learning model predicted postpartum hemorrhage with an AUC of 0.708, an accuracy of 0.686, FPR of 0.312, and FNR of 0.398. The analysis of the importance of the variables showed that pregnant gestation of labor, the maternal weight upon admission of labor, and the maternal weight before pregnancy were considered to be weighted factors. Machine learning model can predict postpartum hemorrhage during vaginal delivery. Further research should be conducted to analyze appropriate variables and prepare big data, such as hundreds of thousands of cases.
| S-EPMC8604915 | biostudies-literature
Project description:ObjectiveHigher-dose oxytocin is more effective than lower-dose regimens to prevent postpartum hemorrhage after cesarean delivery. We compared two higher-dose regimens (80 units and 40 units) to our routine regimen (10 units) among women who delivered vaginally.MethodsIn a double-masked randomized trial, oxytocin (80 units, 40 units, or 10 units) was administered in 500 mL over 1 hour after placental delivery. The primary outcome was a composite of any treatment of uterine atony or hemorrhage. Prespecified secondary outcomes included outcomes in the primary composite and a decline of 6% or more in hematocrit. A sample size of 600 per group (N=1,800) was planned to compare each of the 80-unit and 40-unit groups to the 10-unit group. At planned interim review (n=1,201), enrollment in the 40-unit group was stopped for futility and enrollment continued in the other groups.ResultsOf 2,869 women, 1,798 were randomized as follows: 658 to 80 units; 481 to 40 units; and 659 to 10 units. Most characteristics were similar across groups. The risk of the primary outcome in the 80-unit group (6%; relative risk [RR] 0.93, 95% confidence interval [CI] 0.62-1.40) or the 40-unit group (6%; RR 0.94, 95% CI 0.61-1.47) was not different compared with the 10-unit group (7%). Treatment with additional oxytocin after the first hour was less frequent with 80 units compared with 10 units (RR 0.41, 95% CI 0.19-0.88), as was a 6% or more decline in hematocrit (RR 0.83, 95% CI 0.69-0.99); both outcomes declined with increasing oxytocin dose. Outcomes were similar between the 40-unit and 10-unit groups.ConclusionCompared with 10 units, 80 units or 40 units of prophylactic oxytocin did not reduce overall postpartum hemorrhage treatment when administered in 500 mL over 1 hour for vaginal delivery. Eighty units decreased the need for additional oxytocin and the risk of a decline in hematocrit of 6% or more.Clinical trial registrationClinicalTrials.gov, www.clinicaltrials.gov, NCT00790062.Level of evidenceI.
| S-EPMC3282278 | biostudies-literature