{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:24:28Z","timestamp":1777868668224,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T00:00:00Z","timestamp":1510185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T00:00:00Z","timestamp":1510185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl J Gynecology & Obste"],"published-print":{"date-parts":[[2018,2]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n \n To compare maternal morbidity before and after implementation of a postpartum hemorrhage (\n PPH<\/jats:styled-content>\n ) protocol that included misoprostol.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective analysis was performed using data from 34\u00a0631 deliveries recorded at a Spanish hospital between January 1, 2007, and December 31, 2014. The\n PPH<\/jats:styled-content>\n protocol was implemented in 2009 and included use of misoprostol and the Bakri balloon.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The pre\u2010implementation and post\u2010implementation groups comprised 9394 and 25\u00a0237 women, respectively. Women in the pre\u2010implementation group tended to have lower hemoglobin levels than did those in the post\u2010implementation group: 811 (8.6%) versus 1349 (5.3%) for levels less than 90\u00a0g\/L, and 272 (2.9%) versus 497 (2.0%) for levels less than 80\u00a0g\/L (both\n P<<\/jats:italic>\n 0.001). Implementation of the\n PPH<\/jats:styled-content>\n protocol was also associated with a decrease in the frequency of postpartum hysterectomies owing to uterine atony (0.11 cases per 1000 deliveries vs 0.53 cases per 1000 deliveries for the pre\u2010implementation group;\n P=<\/jats:italic>\n 0.063). Pregnancy length, maternal age, neonatal weight at delivery, multiple pregnancy, previous cesarean delivery, parity, operative vaginal delivery, induced labor, cesarean delivery, and not using the\n PPH<\/jats:styled-content>\n protocol were found to predict postpartum anemia in the multivariate analysis (all\n P<<\/jats:italic>\n 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Implementation of the\n PPH<\/jats:styled-content>\n protocol decreased rates of postpartum anemia and postpartum hysterectomy owing to uterine atony.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.12361","type":"journal-article","created":{"date-parts":[[2017,10,25]],"date-time":"2017-10-25T01:52:37Z","timestamp":1508896357000},"page":"198-204","source":"Crossref","is-referenced-by-count":4,"title":["Maternal morbidity after implementation of a postpartum hemorrhage protocol including use of misoprostol"],"prefix":"10.1002","volume":"140","author":[{"given":"Ricardo","family":"Savir\u00f3n\u2010Cornudella","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Villalba General Hospital Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis M.","family":"Esteban","sequence":"additional","affiliation":[{"name":"Engineering School of La Almunia Universidad de Zaragoza Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramiro","family":"Laborda\u2010Gotor","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n","family":"Rodr\u00edguez\u2010Solanilla","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bremen","family":"De Mucio","sequence":"additional","affiliation":[{"name":"Latin American Center for Perinatology PAHO\/WHO Montevideo Uruguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardo","family":"Sanz","sequence":"additional","affiliation":[{"name":"Department of Statistical Methods Universidad de Zaragoza Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Cast\u00e1n\u2010Mateo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Miguel Servet University Hospital Zaragoza Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,11,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_8_3_1","volume-title":"Essential Management of Obstetric Emergencies","author":"Baskett TF","year":"1999"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-12-108"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2010.02.030"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.02.001"},{"key":"e_1_2_8_7_1","unstructured":"WHO UNICEF UNFPA World Bank Group and the United Nations Population Division.Trends in Maternal Mortality: 1990 to 2015.http:\/\/www.who.int\/reproductivehealth\/publications\/monitoring\/maternal-mortality-2015\/en\/. 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