This document summarizes a presentation on postpartum hemorrhage (PPH) in Sudan given by Dr. Waled Amen Mohammed and Dr. Dina Sami Khalifa. It defines PPH as bleeding over 500 ml within 24 hours of delivery. PPH is a major contributor to maternal mortality in Sudan, accounting for 25.1% of maternal deaths. Risk factors for Sudanese women include high rates of home births without skilled birth attendants. The document recommends developing national PPH prevention and management guidelines, training village midwives, and introducing low-cost interventions like misoprostol to reduce PPH mortality in Sudan.
Breast problems after delivery and their management.sunil kumar daha
Please find the power point on Breast problems after delivery and their management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Breast problems after delivery and their management.sunil kumar daha
Please find the power point on Breast problems after delivery and their management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Abstract: Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
Keywords: Obstetrics, Referrals, Haemorrhage, Infection, Outcome.
Government Schemes in India are launched by the government to address the social and economic welfare of the citizens of this nation. These schemes play a crucial role in solving many health-related and socio-economic problems that beset Indian society, and thus their awareness is a must for any concerned citizen.
Uterus (womb) as an organ is pivotal not only to giving birth, but also to the overall well-being of women and their physical, emotional, and sexual health.
FGM or female genital cutting, also known as female circumcision comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons, there are 4 types of FGM with different complications varies between the early, late, acute and chronic complications .
In Sudan FGM figures and data shows there is real problem regarding this issue, different studies show that FGM is supported or mandated by religion, so it is important to study FGM in many ways including possible causes and factors which may support FGM prevention .
The religious leader can make a real change in this issue, if we understand their perception and possible potential role in this problem .
This research will use a qualitative approach ( in which there will be documentation to all previous religious leaders' talks in different media and structured face-to-face interviews will be conducted .
By the end of this presentation you should be able to:
Describe the common qualitative research approaches
Demonstrate how and when to conduct different types of qualitative research
Understand that focus group discussion and interview are not qualitative research methods or designs. They are just tools for data collection.
By the end of this presentation you should be able to:
Describe different types of data collection techniques
Demonstrate dimensions , type of observations and how to prepare and conduct observation
Understand the practical communication skills for interviews to ask good questions , probe and follow up questions .
Able to prepare for interview
Understand the characteristics and uses of focus group discussions
Conduct focus group discussions
By the end of this presentation you should be able to:
Describe the justification of qualitative Sampling Techniques
Understand different types of Sampling Techniques
By the end of this presentation you should be able to:
Describe what is qualitative research
Demonstrate the differences between Qualitative & Quantitative research
Understand the basic concepts of Qualitative studies:
Characteristics of qualitative research
Bias
Triangulation
Trustworthiness
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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1. Postpartum Hemorrhage in Sudan:
Magnitude and implications
By:
Dr: Waled Amen Mohammed
Dr. Dina Sami Khalifa
Geneva Foundation for Medical
Education and Research
GFMER Sudan 2012
Forum No: ( 1 )
2. Name of presenter
Name Position Institution
Waled Amen Mohammed Head, Community Health UMST
Nursing
Name of contributors
Name Position Institution
Waled Amen Mohammed Head, Community Health UMST
Nursing
Dina Sami Khalifa Epidemiologist Ahfad University for
Women
3. Content of the presentation
• Background
• Definition of PPH
• Etiology : 4Ts
• Contribution of PPH in MMR in Sudan
• Factors that put Sudanese women at added risk
• Protocols and guidelines for management of PPH (FIGO)
• Benefits of effective prevention and treatment of PPH
• Sudan health Policy implications on PPH
• Problem In Sudan
• Success stories for combating PPH from developing
countries
• Recommendations for PPH prevention and management
in Sudan
• Conclusion
4. Background
Despite efforts and activities, maternal mortality rate is still high
in developing countries (WHO, 2007).
MMR in Sudan is (1107 in 2006 and 750 in 2010) ¹
Three quarters of maternal deaths occur during delivery and
immediate postpartum period. ²
¹ SHHS, 2006 &SHHSII, 2010
² Abdel-Tawab N, El-Rabbat M, 2010.
5. Definition of PPH
WHO defines PPH as:
Primary PPH: bleeding from the genital tract in excess
to 500 ml in the first 24 hours after delivery
Secondary PPH: bleeding from the genital tract in
excess to 500 ml in the after 24 hours after delivery
till end of puerperium. (WHO, 1989).
6. Etiology : 4Ts
Tone : Uterine atony
Trauma : Uterine, cervical or vaginal lacerations
Tissue : Retained placental tissue
Thrombin : Coagulopathy
delay in recognition & referral Maternal Near Miss or
Mortality
7. Contribution of PPH in MMR in
Sudan
Out of 535164 live births in 2010, 957 were maternal
deaths.¹
Out of 957 maternal deaths, 806 cases (84.2%) occurred
in health facilities, while 151 cases (15.8%) occurred at
community settings.¹
Maternal death from obstetric hemorrhage affects 225
cases (25.1%), PPH is 183 (81.4%).¹
¹ (FMoH, Sudan, 2010).
8. Contribution of PPH in MMR in
Sudan
• Study conducted in Kassala State-Eastern Sudan to
assess MMR found that the case fatality rate of PPH is
2.6%).¹
Proper management of PPH reduction of 25% of
MM in Sudan i.e. reduce more than 90,000
deaths/year
¹ Mohammed AA, 2009
9. Factors that put Sudanese women
at added risk:
• Home deliveries by Village Midwives (VMWs) and
Traditional Birth Attendants (TBA) 79 %. ¹
• High unmet need for family planning 29%. ¹
• Anaemia (nutritional, malaria)
• Early marriage
• FGM and de-infibulation
• Routine episiotomy performed as standard
¹ (SHHS II 2010)
10. Protocols and guidelines for
management of PPH (FIGO):
• Prevention Utero-tonic drugs + Active Management of
Third Stage of Labour (AMTSL)
• Treatment Utero-tonic drugs +/- Blood transfusion +/-
Surgical interference;
11. Protocols and guidelines for
management of PPH (FIGO):
• Currently no standard protocol and guidelines in FMoH for
management of PPH had been implemented.
• All protocols require highly skilled birth attendants at level
of Health facility
• Both accurate knowledge about AMTSL and its correct use
remains low in developing countries.
12. Benefits of effective prevention
and treatment of PPH ¹
• Less maternal deaths
• Fewer admissions to intensive care unit
• Less blood loss
• Less use of blood transfusion
• Less use of additional utero-tonics
• Less postpartum anemia
• Earlier establishment of breastfeeding
• Less anemia in infancy
¹ WHO Recommendations, 2007.
13. Sudan health Policy implications on
PPH:
• RH Policy encourages home delivery for low risk
women; PPH can happen in low risk pregnancy
• Village Midwives are not empowered by policy
makers to deal with emergency cases and use of
active management of third stage of labour (use of
oxytocine).
14. Sudan health Policy implications on
PPH:
• Low quality of health services and inequity in
distribution; delay in referral and delay in proper
management at health facilities are key reasons
for high PPH mortality.
15. Problem In Sudan:
• Women are delivering at home (79%) Village
Midwives not equipped with prevention
mechanisms Policy does not support VMWs to
perform PPH prevention and treatment late
recognition of PPH late referral to health facilities
( delay in decision making/inequity in distribution of
Emergency & Comprehensive facilities) delay in
service and/or inappropriate management low
availability of drugs/blood banks exacerbation of
haemorrhage Maternal Death.
16. Success stories for combating PPH
from developing countries:
1. Anti Shock devices (Life-wrap suit): to treat
PPH. Evidence so far; decrease fatality in PPH
cases by 69% in Egypt, Nigeria, Zambia &
Zimbabwe. Stabilizes bleeding at community
till referral to an EmOC facility.
17. 2. Misoprestol (at the community level):
For preventing PPH, oral misoprostol (600 mcg)
and for treatment sublingual (800 mcg) can be
safely and effectively administered by lower-
level health providers. Trails proved
effectiveness & acceptability of drug by
women in (Burkina Faso, Ecuador, Egypt,
Turkey, and Vietnam)
18. Misoprestol (at the community level):
Cheap
Needs no refrigeration
Oral and needs no injection
VMW can easily be trained to administer it.
Its a good solution for low income settings.
19. Recommendations for PPH prevention
and management in Sudan:
• Setting specific standard guidelines and protocols for
PPH prevention and treatment AT FACILITY &
COMMUNITY level with massive dissemination and
implementation.
• Targeted and evidence based capacity building of
VMW SKILLED birth attendants
20. • Community awareness raising for recognition of
danger signs during and after delivery.
• Introduction of effective evidence based
interventions that help in reduction of the impact of
PPH ( e.g. uterotonic drugs by VMWs)
21. • Developing countries experiences for prevention and
treatment of PPH should be analysed and studied and then
modified for national application.
• Focusing on Health services providers (VMWs) to raise
community awareness.
22. CONCLUSION
• Postpartum hemorrhage is still one of the leading causes of
maternal near miss & maternal mortality in Sudan.
• Sudanese women are at higher risk for postpartum
hemorrhage due to many social determinants.
• There are no standard guidelines for prevention and
treatment for PPH in Sudan.
23. References
• WHO. Reducing the Global Burden: Postpartum Haemorrhage. A n e w s Le t t e r o f Wo r l d w i d e A c t i v i t y. 2007.
• Abdel-Tawab N, El-Rabbat M. Maternal and Neonatal Health Services in SUDAN: Results of a Situation Analysis. Sudan;
2010.
• World Health Organization. The prevention and management of postpartum haemorrhage. Report of a technical working
group of the WHO. Geneva: WHO; 1989 Contract No.: Document Number|.
• Federal Ministry of Health-Sudan. National Maternal Death Review report Khartoum: Federal Ministry of Health-Sudan;
2010 Contract No.: Document Number|.
• Mohammed AA. Postpartum haemorrhage, hospital experience in high maternal. World Congress of Gynaecology &
Obstetrics International Federation of Gynecology & Obstetrics and South African Obstetrical & Gynaecological Society of 4-
9 October 2009; 2009; Cape Town- South Africa. Researchgate; 2009.
• Miller S, Ojengbede O, Turan JM, Morhason-Bello IO, Martin HB, Nsima D. A comparative study of the non-pneumatic anti-
shock garment for the treatment of obstetric hemorrhage in Nigeria. Int J Gynaecol Obstet. Volume 107, Issue 2, Pages 121-
125 (November 2009) PubMed PMID: 19628207
• A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt. Int J
Gynaecol Obstet. 2010 Jan 21. [Epub ahead of print] PubMed PMID: 20096836
24. • Winikoff, B., Dabash, R., Durocher, J., Darwish, E., Ngoc, N.T.N., León, W., Raghavan, S., Medhat, I., Chi, H. T. K.,
Barrera, G., and Blum, J. “Treatment of Post-partum Haemorrhage with Sublingual Misoprostol Versus
Oxytocin in Women Not Exposed to Oxytocin During Labour: A Double-Blind, Randomised, Non-inferiority
Trial.” Lancet 375, no. 9710 (2010): 210–16.
• Oladapo OT, Akinola OI, Fawole AO, Adeyemi AS, Adegbola O, Loto OM, et al. Active management of third
stage of labour: evidence versus practice. Acta Obstetricia et Gynecologica 2009;88:1252-1260.
• Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, et al. Use of active management of
the third stage of labour in seven developing countries. Bulletin of the World Health Organization
2009;87:207-215.
• Festin MR, Lumbiganon P, Tolosa JE, Finney KA, Ba-Thike K, Chipato T, et al. International survey on variations
in practice of the management of third stage of labour. Bulletin of the World Health Organization 2003; 81:
286 – 291.
• Karoshi M, Keith L. Challenges in managing postpartum hemorrhage in resource-poor countries. Clinical
Obstetrics and Gynecology 2009;52:285-298.