title: A New Maneuver for Prevention of Postpartum Haemorrhage.
abstract: BACKGROUND
  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new non-pharmacologic maneuver in decreasing its rate.
  
  
  METHODS
  This case series study was conducted in one center in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant women, aged 18 years or more and candidate for normal labor, were enrolled to this study. High risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90 s. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6 h.
  
  
  RESULTS
  The rate of PPH, defined as more than 500 ml, was eight cases (2 %) with 95 % CI (0.63-3.37 %). The rate of PPH was not affected by parity, gestational age, episiotomy, or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p < 0.001). The range of estimated blood loss was 550-600 ml in cases with PPH and 150-450 ml in cases without PPH. Severe PPH more than 1,000 ml did not occur.
  
  
  CONCLUSIONS
  This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of postpartum blood loss. Further RCT is recommended to investigate it.
authors.affiliation: Department of Gynecology and Obstetrics, MOH, Building 3, 287 St., New Maadi, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Hamdy
keywords: Maternal mortality; New maneuver; Postpartum hemorrhage; Sustained cervical traction; Uterine atony