مجله زنان مامائی و نازائی ایران
سال شانزدهم شماره 62 (هفته چهارم امرداد 1392)

Postpartum hemorrhage is one of the maternal mortality and morbidity etiologies. Recognizing predisposing factors، forecasting the risk of hemorrhage، preparing for that and using perfect medical and surgical interventions on appropriate time can decrease in mortality and morbidity of pregnant women. This study was done aimed to investigate the causes of hemorrhage and treatments of postpartum hemorrhage. This descriptive analytical and retrospective study was conducted on all women who have had delivery in two governmental hospitals of Mashhad، Iran، 2010-2011. Women who needed to transfusion or reservation of two units of packed cells were included in this study. The predisposing factor، delivery method، therapeutic methods of controlling hemorrhage and maternal complications were evaluated. Data were analyzed using SPSS software version 14. P value less than 0. 05 was considered significant. 21181 deliveries have performed during 2010-2011 and only 248 cases (11. 8%) needed to transfusion or reservation of packed cells. Cause of hemorrhage were atony in 138 cases (55. 6%)، residue in 66 cases (26. 6%)، genital rupture in 42 cases (16. 9%) and myoma in 2 cases (0. 08%). Pregnancy termination techniques were cesarean in 66 cases (48%) and normal vaginal delivery in 71 cases (52%). Medical interventions that used to control hemorrhage were administration of oxytocin، methergine، misoprostol، bimanual massage and revision، and only one patient needed ten medical and surgical procedures to control hemorrhage. No case of maternal death was observed due to hemorrhage. There are various medical and surgical procedures to control postpartum hemorrhage، and if the intervention was done correctly and timely، the need for invasive procedures، complications and mortality is reduced.

The rate of preterm labor in twin pregnancy is 7 times more than singleton pregnancy. Due to applying cerclage as prophylaxis for preventing preterm labor in some centers، we decided to compare the outcome of twin pregnancies between a group who were applied cerclage and a group who were not applied cerclage. This case-control study was done on 115 cases of twin pregnancy with gestational age of 20-40 weeks who referred to Ayatollah Rouhani hospital in Babol، Iran in 2010-2012. Cases were divided into two groups. 80 cases without cerclage (group 1) and 35 cases with the use of MacDonald cerclage (group 2). The clinical and demographic data were recorded in questionnaires. Data were analyzed using SPSS software version 18 and t-test، chi-square and Fisher''s exact test. P value less than 0. 05 was considered significant. The mean of gestational age in time of delivery was 34. 36±3. 65 weeks in group 1 and 34. 11±5. 05 weeks in group 2، that the difference was not significant (p=0. 794). The rate of preterm labor was 52 women (65%) in group 1 and 20 women (57. 1%) in group 2، that the difference was not significant (p=0. 089). No significant difference was found regarding maternal and neonatal outcomes in two groups (p=0. 514). Cerclage has no effect on preventing preterm labor and complication of prematurity in twin pregnancy.