Optimization of the management of the third stage of labor and early postpartum period in women with uterine leiomyoma
DOI:
https://doi.org/10.15574/PP.2025.4(104).4549Keywords:
uterine leiomyoma, labor, third stage of labor, postpartum period, blood loss, uterine involutionAbstract
Aim - to optmize the management of the third stage of labor and the early postpartum period in women with uterine leiomyoma through the implementation of a modified preventive algorithm.
Materials and methods. A prospective study was conducted involving 120 women with term pregnancy and uterine leiomyoma (types 3-5 according to the International Federation of Gynecology and Obstetrics classification with nodules larger than 5 cm). The participants were divided into two groups: Group І - 60 women who received standard management of the third stage of labor and the postpartum period in accordance with the protocols of the Ministry of Health of Ukraine; Group ІІ - 60 women who received the proposed algorithm (intravenous administration of 1 g tranexamic acid during the third stage of labor and remodeling of the lower uterine segment in the early postpartum period). The study compared the following indicators: the volume of blood loss during childbirth and during the early postpartum period, the frequency of postpartum bleeding (more than 500 ml), the dynamics of hemoglobin levels before childbirth and within 5 days after childbirth, and indicators of uterine involution in the postpartum period.
Results. In women of Group 2, a reduction of up to 30% in the mean blood loss was observed, along with a threefold decrease in the incidence of postpartum hemorrhage, significantly higher hemoglobin level in the postpartum period (p<0.05) and faster uterine involution compared to standard management.
Conclusions. The proposed algorithm significantly reduces the frequency and severity of postpartum hemorrhage in women with uterine leiomyoma. The combination of tranexamic acid and lower uterine segment remodeling represents an effective preventive strategy for patients at high obstetric risk. The implementation of this approach allows to increase the effectiveness of primary prevention of obstetric bleeding in women with uterine leiomyoma without the use of uterotonic agents and without the need for other invasive interventions.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee. Written informed consent was obtained from all participants.
The authors declare no conflict of interest.
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