Inability to predict postpartum hemorrhage: insights from Egyptian intervention data

<p>Abstract</p> <p>Background</p> <p>Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.</p> <p>Methods</p> <p>From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.</p> <p>Results</p> <p>We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.</p> <p>Conclusions</p> <p>The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.</p

Plants of Sabkha Ecosystems of the Arabian Peninsula.

Sabkhas are unique ecosystems that are highly saline and where specially adapted plants are able to grow, flower, and fruit. In general, saline environments are poor in species – for the Arabian Peninsula about 120 taxa are recorded as halophytes which constitute about 4% of the total flora of the Arabian Peninsula. Key halophytes of Arabia are nearly always perennial; predominant life-forms are somewhat succulent, semiwoody dwarf shrubs belonging to the families Amaranthaceae, Zygophyllaceae, and Plumbaginaceae and hemicryptophytes belonging to the Poaceae, Cyperaceae, and Juncaceae; annuals are exceptions. Coastal species are either obligate halophytes or salt-tolerant genera from unspecialized families, such as Sporobolus and Aeluropus (Poaceae), or salt-secreting species such as Avicennia (Acanthaceae) and Limonium (Plumbaginaceae). The submerged coastal vegetation, e.g., seagrasses, is one of the most important vegetation types of the Gulf coast and is of great importance to marine fauna. The north-south distribution of coastal species is more distinct on the Red Sea coast, with the border lying near Jeddah, than on the Persian Gulf coast where there is a broad transitional zone between Qatar and northern Oman. The east-west distribution of coastal species is not as distinct. The eastern elements are either restricted to the coasts around the Arabian Gulf or are Irano-Turanian species extending into the Gulf region. Several vicariant species groups of halophytes are represented in the Arabian Peninsula. Halophytes have developed strategies for seed germination such as high germination levels and fast germination speed. These traits are found in the sabkha plants of the Arabian Peninsula. Some halophytes have been investigated for their potential for phytoremediation in their ability to survive weathered oil-contaminated soils. They have been found to have a set of micoorganisms around their root system that are related to the degradation of oil in contaminated soils. Sabkha ecosystems are being degraded and altered throughout the Gulf countries as they appear to be nonproductive. Over the last two decades, there has been a growing concern in protecting and restoring mangroves, and programs do to so have seen promising results. But, on the whole, coastal and inland sabkhas are neglected, and these unique ecosystems require urgent protection