Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes

Objective: To evaluate the effects of patent ductus arteriosus (PDA) on postprandial superior mesenteric artery blood flow velocities (SMA BFV)s and feeding tolerance in extremely low birth weight (ELBW) neonates.

Methods: Appropriate for gestational age, ELBW preterm neonates, tolerating bolus enteral feedings were eligible to participate in this prospective observational study. Pulsed Doppler was used to measure preprandial and postprandial (at 30 and 60?min) time-averaged mean velocity (TAMV), peak systolic velocity (PSV) and end diastolic velocity (EDV) once during the day of life 5–7; at the same time, PDA size was estimated using the PDA: left pulmonary artery (LPA) ratio.

Results: A total of 38 infants were studied, 16 in small, 13 in moderate and 9 in large PDA groups. The postprandial SMA BFVs were lower in the large PDA group, although not reaching statistical significance. Importantly, infants in the large PDA group reached full enteral intake later (p?=?0.02) and had higher incidence of death secondary of necrotizing enterocolitis (NEC; p?=?0.04).

Conclusions: ELBW preterm neonates with large PDA may have attenuated intestinal blood flow responses to feedings. There was also an association with higher rates of necrotizing enterocolitis and feeding intolerance in the large PDA group.     

Effect of caffeine on superior mesenteric artery blood flow velocities in preterm neonates

Objective: To investigate the effect of caffeine infusion on superior mesenteric artery (SMA) blood flow velocities (BFV) in preterm infants.

Methods: Prospective observational study on 38 preterm neonates 28–33⁺⁶ weeks gestation, who developed apnea on their first day of life, and caffeine citrate infusion was initiated at a loading dose of 20?mg/kg, followed by a maintenance dose of 5–10?mg/kg/day. Duplex ultrasound measurements of SMA BFV were recorded: peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI), at 15?min before, 1-, 2- and 6-h after caffeine loading dose, and 2?h after two maintenance doses.

Results: There was a significant reduction in PSV 1-h (p?=?.008), a significant decrease in EDV 1- and 2-h (p?=?.000 and p?=?.005, respectively) and a significant increase in RI 1- and 2-h (p?=?.003 and p?=?.005, respectively) following caffeine loading dose, as compared to values before caffeine infusion. No significant effect of caffeine maintenance doses on SMA BFV was observed (p?>?.05).

Conclusion: Blood flow in SMA is significantly reduced after caffeine citrate infusion at a loading dose of 20?mg/kg. This effect continues for at least 2?h. Meanwhile, SMA BFV seems not affected by maintenance doses.     

Physiological changes in blood flow velocities in the superior mesenteric and coeliac artery in healthy term fetuses and newborns during perinatal period

Objective.?The aim was to describe the course of physiological changes in coeliac artery (CA) and superior mesenteric artery (SMA) blood flow velocities (BFVs) during the perinatal period in healthy term fetuses and infants as it has not been studied in detail so far.

Methods.?This prospective Doppler ultrasound study included 50 infants. The examinations were performed in a fetus after the completion of 36.0 gestation weeks before the onset of labor and in infants postnatally at the ages of 2, 24, and 72?h.

Results.?The end-diastolic velocity (EDV) in the CA was generally higher than in the SMA (p?<?0.001). The EDV in the SMA decreased postnatally (8.4 vs.??7.2, p?<?0.001) and showed negative values in 92% of infants. By 24?h of postnatal age, EDV in the SMA had become positive in all of the infants (mean 13.8 cm/s, p?<?0.001). The EDV in CA had only positive values. The changes in EDV in both vessels were reflected by changes in the resistance index in inverse manner.

Conclusions.?BFV in the CA and SMA changed dramatically in the perinatal period; the most remarkable changes occurred within the first 24?h of life.     

The early postnatal blood flow characteristics in the superior mesenteric and coeliac arteries in late preterm neonates

Objectives: The objective of this study is to evaluate intestinal blood flow changes within the first 72?h in the late preterm infants in comparison with the healthy term neonates.

Methods: In this prospective study, we analyzed Doppler flow velocity waveforms of superior mesenteric artery (SMA) and coeliac trunc (TC) in 20 late preterm and 20 term infants at the age of 2, 24, and 72?h.

Results: Significant end-diastolic velocity (end-diastolic velocity (EDV)_SMA) rise up to 24?h was documented in all patients (late preterm: ?9.32?±?9.48 to 17.01?±?6.94; p?p?SMA), end-diastolic velocities (EDV_SMA) at 24?h and PSV_TC at 72?h than term infants (p?SMA. Mean PI_AMS at 2?h was significantly higher in term neonates.

Conclusion: Late preterm neonates show similar progressive postnatal increase in blood flow velocities accompanied with a decrease in vascular resistance in SMA and TC then term neonates.     

Intestinal blood flow by Doppler ultrasound: the impact of clarithromycin treatment for feeding intolerance in preterm neonates

Objective: To compare the blood flow velocities of superior mesenteric artery (SMA) before versus after clarithromycin treatment for feeding intolerance in very low-birth weight infants.

Methods: A prospective study was conducted in a group of infant <1500?g with feeding intolerance who received clarithromycin 7.5?mg/kg/dose bid. Before and at the third day of the clarithromycin therapy, SMA blood flow velocity was measured with Doppler ultrasound.

Results: SMA peak systolic velocity (PSV) and mean systolic velocity (MV) on the third day of the treatment was found significantly higher than the initial measurement (p?=?0.013 and p?=?0.027, respectively). End diastolic velocity of the SMA did not change with clarithromycin therapy (p?=?0.113). There were no significant changes about pulsatility and resistive index of SMA with regard to clarithromycin therapy.

Conclusion: Clarithromycin effects the splanchnic circulation. The rise in PSV and MV in SMA is remarkable. These results suggest that the splanchnic blood flow increases significantly after clarithromycin usage.     

Fluid management during the first postnatal day in very low birth weight neonates and rates of patent ductus arteriosus requiring treatment

Purpose: Previous studies have suggested an association between high maintenance fluid volumes during the first several postnatal days and patent ductus arteriosus (PDA) requiring treatment in very low birth weight (VLBW) neonates. However, no studies have specifically examined fluid administration during the first postnatal day with regard to PDA-related outcomes. We seek to determine whether additional intravenous fluid administration beyond prescribed goals during the first postnatal day is associated with PDA requiring treatment.

Materials and methods: Retrospective data were collected from neonates with birth weight <1250?g. Infants receiving fluids beyond initially documented goals, stratified by relative degree of additional fluids, were compared to those receiving no additional intravenous fluids for the primary outcome of PDA requiring treatment and secondarily for other neonatal morbidities.

Results: Two hundred VLBW neonates were included. Controlling for birth weight and gestational age, fluid administration beyond prescribed goals during the first postnatal day was not associated with increased PDA requiring treatment. Additionally, no statistically significant associations between additional fluids and secondary outcomes were observed.

Conclusions: No significant relationship between fluid volumes during the first postnatal day and PDA requiring treatment were observed. Further prospective analysis of early fluid management in VLBW neonates is warranted.     

Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates

The purpose of this study was to determine an association between packed red blood cell (PRBC) transfusions for anemia and necrotizing enterocolitis (NEC) in a subset of stable, growing, premature neonates. As part of a survey of current clinical practices over a 17-month period from June 1999 to October 2000, a chart review was performed to determine the relationship between elective PRBC transfusions and the occurrence of NEC. Demographic data were tabulated and compared between the NEC patients with a prior history of immediate blood transfusion (within 48 hours of onset of symptoms) and those NEC patients without a prior history of immediate blood transfusion. A total of 908 (inborn) neonatal admissions had received 751 PRBC transfusions during the study period; of these, 17 patients (1.8%) had developed radiographic, clinical, or surgical signs of NEC. Six cases of NEC (35%; six of 17 patients) were associated with PRBC transfusions (0.8%; six of 751 transfusions). The transfusion-associated NEC group developed presenting signs within 22 +/- 5 hours (median, 19; range, 12 to 38) of a PRBC transfusion at a mean age of 32 +/- 7 days. In contrast, the non-transfusion-associated NEC group (n = 11) had onset of NEC at a mean age of 12 +/- 7 days ( P < 0.05) after 185 +/- 91 hours (median, 180; range, 96 to 312; P < 0.02] of a transfusion. Prior to the onset of NEC, all of the neonates in the transfusion-associated NEC group were stable, growing, not ventilated, receiving full enteral feedings, and had no other active medical problems except anemia (hematocrit, 24 +/- 3%). In contrast, the nontransfusion NEC group was more often ventilated, was receiving < 50% of fluids by mouth, had lower Apgar scores, and was transfused for an average hematocrit of 37 +/- 7% ( P < 0.05). There was no significant difference in the type, storage, volume, or preservative used between the blood products in the two groups. We identified an unanticipated relationship between late-onset NEC in stable, growing, premature neonates who were transfused electively for anemia of prematurity.     

Factors associated with non-response to second course indomethacin for PDA treatment in preterm neonates

Background: Failure of first course of indomethacin (FCI) for patent ductus arteriosus (PDA) treatment in preterm neonates often prompts clinicians to consider a second course (SCI).

Objective: To identify factors including baseline characteristics and response to FCI that are associated with non-response to SCI for PDA treatment in preterm neonates.

Methods: In this retrospective observational study, neonates ≤32?weeks admitted to a tertiary NICU over 5?years who received two indomethacin courses for PDA treatment were reviewed. Only neonates with echocardiograms (ECHO) immediately before and after receipt of each indomethacin course were included. Primary outcome was non-response to SCI. Baseline characteristics and response to FCI were compared between responders and non-responders of SCI.

Results: Of the 98 neonates enrolled, 47 (48%) had non-response to SCI. Of them, 27 patients (57%) had prior non-response to FCI, while of the 51 neonates who responded to SCI, 24 neonates (47%) had prior non-response to FCI. The adjusted risk of non-response to SCI in patients who had non-response to FCI was 37% higher (relative risk?=?1.37, 95%CI: 0.87–1.80; p?=?.07) compared to those who had response to FCI. Multivariable analysis showed that increasing gestational age (AOR: 1.6, 95%CI: 1.1–2.3, p?=?.03) was associated with a higher odds of non-response to SCI while the odds of non-response to SCI increased by 90% in patients with non-response to FCI (AOR: 1.9, 95%CI: 0.8–4.5; p?=?.15) compared to those with success of FCI, although no statistical significance was observed.

Conclusions: Advanced gestational age was the predictor of non-response to SCI in preterm neonates.     

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).

Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30?IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.

Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p?=?.06 and 0.24 respectively) and hematocrit values (p?=?.12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7?±?90.6 versus 588.9?±?96.3?mL respectively, p?=?.001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p?=?.002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.

Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.     

Factors affecting the severity of necrotizing enterocolitis

Abstract

Objective: The severity of necrotizing enterocolitis (NEC) ranges from mild to rapidly fatal. However, the factors determining the severity are not known. Our objective was to identify statistical associations with NEC severity using a large database.

Method: We conducted a retrospective, multi-institutional, multiyear, study of neonates with confirmed NEC.

Results: Two-hundred-twenty neonates with Bell’s stage?≥?II NEC had 225 NEC episodes (157 stage II and 68 stage III). In the 3?d before NEC was diagnosed, those who went on to stage III disease were more likely to have elevations in C – reactive protein (p?<?0.0001), immature to total neutrophil ratio (p?=?0.0005), and mean platelet volume (p?=?0.0001), and low pH (p?<?0.0001) and platelet count (p?<?0.0001). Regression analysis indicated higher odds that NEC would be severe if there was an antecedent RBC transfusion (p?<?0.0001) or if the first feedings were not colostrum (p?=?0.017). The two factors best predicting death from NEC were; (1) a low pH (p?=?0.0005) and (2) lack of early colostrum (p?=?0.003).

Conclusions: Strategies that reduce the severity of NEC would lower costs and improve outcomes. This study suggests that testable theories to accomplish this include means of; (1) reducing transfusions and (2) assuring early colostrum feedings.     

Correlation analysis between echocardiographic flow pattern and N-terminal-pro-brain natriuretic peptide for early targeted treatment of patent ductus arteriosus

Abstract

Objective: Echocardiographic flow patterns of patent ductus arteriosus (PDA) are useful to predict the development of hemodynamically significant ductus in premature infants. N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations seem to be useful to detect PDA. We investigated how NT-proBNP levels change on the basis of different flow patterns during the first day of life, and whether NT-proBNP might represent a reliable decision tool in PDA management.

Methods: Neonates with gestational age <32 weeks were assessed prospectively, using paired Doppler-echocardiographic evaluation and NT-proBNP values, at T0 (6–24?h of life), and daily until ductal closure.

Results: At T0, NT-proBNP concentrations of 41 neonates correlated to the kind of pattern (p?=?0.018) with the highest values in neonates with pulsatile or growing patterns. A value <9854?pg/ml identified neonates with spontaneous closure (sensitivity 71.8%, specificity 100%). Overall, 32 infants needed treatment. Pre-treatment NT-proBNP values increased compared to those at T0, significantly in neonates with growing pattern at T0 (p?=?0.001). After treatment, NT-proBNP concentrations decreased compared to pre-treatment values (p?=?0.0024), more markedly in the responders than in the non-responders (p?=?0.042).

Conclusions: NT-proBNP concentrations at T0 show a good agreement with different flow patterns and represent a useful tool to identify neonates at risk of developing hemodynamically significant PDA.     

The evaluation of polycythemic newborns: efficacy of partial exchange transfusion

Objectives.?To evaluate the clinical characteristics and risk factors of symptomatic and asymptomatic polycythemic neonates performed partial exchange transfusion (PET) and to determine the time of resolution of symptoms and effect of PET on short-term morbidity.

Methods.?This prospective cohort study was conducted with symptomatic (hematocrit; Hct?>65% plus a clinical symptom) and asymptomatic (Hct level?>70% without any symptoms) neonates who underwent PET due to polycythemia.

Results.?Among the patients performed PET, 43 (69.3%) were symptomatic and 19 (30.7%) asymptomatic. Persistent pulmonary hypertension and minor problems like hypoglycemia, hypocalcemia, hyperbilirubinemia, and thrombocytopenia improved in all patients within 24?h, 2.5?±?1.0, 3.1?±?1.4, 56.2?±?16.9, and 53.5?±?10.5?h, respectively, after PET (in except one symptomatic neonate with hypoglycemia). In symptomatic group, in three patients with suspected necrotizing enterocolitis (NEC) prior to PET stage IIa NEC developed. No other clinical and ultrasonographic findings were observed after PET.

Conclusions.?Early morbidities, due to polycythemia may be reversed with PET within a short time. PET did not increase or cause any complications except NEC. The issue that either NEC was a sign of polycythemia or a complication of PET could not be definitely outlined.     

Circulating Dickkopf-1 in hypoxic ischemic neonates

Objective: The current study aimed to determine the serum level of Dickkopf-1 (Dkk-1) in peripheral blood of neonates with hypoxic ischemic encephalopathy (HIE).

Methods: We measured serum levels of Dkk-1 by ELISA in neonates with HIE (n?=?20) within 24?h from symptom onset and in healthy controls (n?=?20).

Results: Dkk-1 serum levels increased significantly in HIE neonates than in healthy control. DKK-1 serum levels increased significantly in HIE neonates with convulsion, using multiple anti-convulsant drugs and those complicated with cranial ultrasound changes. Serum DKK-1 levels increased significantly in severe HIE patients.

Conclusion: Our study provides for the first time the evidence of releasing Dkk-1 into the circulation of neonates with HIE with higher level in severe degree.     

Efficacy of tranexamic acid in reducing blood loss after cesarean section

Aim. To assess the efficacy and safety of tranexamic acid in reducing blood loss at caesarian section (CS).

Method. A prospective randomised study conducted on 90 primiparas divided into two groups who underwent CS. The study group, 45 women, received tranexamic acid immediately before CS, whereas the control group, 45 women received placebo. Blood loss volume was measured from the end of CS to 2 h postpartum and compared between the two groups. Hemoglobin (Hb) and hematocrit (Hct) were tested 24 h after CS and compared between the two groups.

Results. Tranexamic acid significantly reduced the blood loss from the end of CS to 2 h postpartum; 28.02 ± 5.53 mL in the tranexamic group versus 37.12 ± 8.97 mL in the control group (p = 0.000). Hb 24 h after CS was significantly greater in tranexamic group than control group (12.57 ± 1.33 in the tranexamic group and 11.74 ± 1.14 in the control group, p = 0.002). No complications or side effects were reported in either group.

Conclusions. Tranexamic acid statistically reduces blood loss from end to 2 h after CS and its use was not associated with any side effects or complications. Consequently, tranexamic acid can be used safely and effectively to reduce bleeding resulting from CS.     

A different first-choice drug in the medical management of patent ductus arteriosus: oral paracetamol

Abstract

Background and objectives: Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in preterm infants. This case series was conducted to investigate the usefulness of paracetamol as a first choice for the treatment of PDA in preterm infants.

Subjects and methods: Preterm infants were prospectively enrolled. Treatment with oral paracetamol was started at a dose of 15?mg/kg every 6?h for 3?d, with echocardiographic evaluation performed at the end of the treatment and 2?d after the treatment. Serum paracetamol levels were also evaluated for 24?h after the first dose to ensure the absorption and reaching the therapeutic level.

Results: A total of six preterm infants were prospectively enrolled. Five infants with PDA were successfully treated with oral paracetamol. Only one patient did not respond to paracetamol treatment whereas another one received a second cure due to reopening of the ductus.

Conclusion: Paracetamol may be a useful treatment option for the primer treatment of PDA in preterm infants. If paracetamol is shown to be effective in a large series, because of low risk of side effects, low cost and preparation is available in enteral form, it may be an advantageous alternative at PDA treatment.     

Amnion protective cesarean section – method for gentle delivery of preterm and/or VLBW neonates

Abstract

More than 50 percent of preterm neonates below 28 gestational weeks in our institution are delivered by cesarean section (CS).

Aim: To present advantages of less used method of delivery of premature and/or very low birth weight (VLBW) neonates by Amnion Protective Cesarean Section (APCS) when indicated and to review our experience with the method. It can be used in all deliveries by CS with unruptured amniotic membranes, at all gestational ages.

Materials and methods: Including criteria were singleton pregnancies, gestation of 26 to 35 weeks and birth body weight between 700 to 1500?g. According to the criteria, during the studied period 10 neonates were delivered by APCS. We compared the outcomes of APCS neonates with ones delivered by coventional CS who matched them in mentioned criteria.

Results: Compared to CS cases, APCS neonates had statistically significant better first minute AS. Stay in NICU was shorter for APCS neonates but not statistically significant. From our experience APCS neonates had clinically better appearance (less bruises and hematomas).

Conclusion: APCS is promising method for delivery of preterm and/or VLBW neonates when indicated, although prospective studies are needed in order to prove its effectiveness compared to conventional CS.     

High blood carbon dioxide variability and adverse outcomes in neonatal hypoxic ischemic encephalopathy

Objective: Hypocarbia during the first 12?h of life is associated with mortality and disability in neonatal hypoxic ischemic encephalopathy (HIE). Notable variation in arterial carbon dioxide tension (PaCO₂) during the first 4?d of life is related to severe intraventricular hemorrhages in preterm infants. We examined the association between PaCO₂ during 72?h of whole-body therapeutic hypothermia for neonatal HIE and 2-year neurodevelopmental outcomes.

Methods: A retrospective review of 23 term neonates treated with whole-body hypothermia documented clinical, demographic and arterial blood gas data. Comparisons were made across good and severe neurodevelopmental outcome groups at 2 years of age.

Results: Severe neurodevelopmental outcomes were documented in 8 of 23 toddlers. There were no significant differences between outcome groups with regard to the number of patients with hypocarbic means or measurements. There were also no significant differences with mean PaCO₂, PaO₂, pH, time-weighted cumulative hypocarbia, and PaCO₂ range. The severe neurodevelopmental outcomes group had a significantly higher mean PaCO₂ standard deviation (p?=?0.04; 95% CI, ?5.46 to ?0.39).

Conclusion: Severe neurodevelopmental outcomes were significantly associated with high PaCO₂ variability over 72?h in whole-body-cooled HIE neonates. Mitigating these fluctuations may be a potential management strategy.     

Efficacy of tranexamic acid in decreasing blood loss in elective caesarean delivery

Objective: To evaluate the efficacy of tranexamic acid (TA) in decreasing blood loss during and after elective caesarean section (CS).

Methods: This prospective randomized trial was conducted among 124 pregnant women subjected to term elective CS. Patients were equally divided into two groups. Study group received 10?mg/kg TA intravenously 5?min before skin incision while the control group did not. In addition, both groups received 10 units oxytocin and 1?ml ergometrine after delivery of the fetus. Blood loss in both groups was measured from placental delivery to end of the surgery and from end of the surgery to 2?h postpartum. Hemoglobin and hematocrit values were determined preoperatively and on the third day postpartum (before discharge) for all cases. Maternal and neonatal adverse effects in study groups were recorded.

Results: TA group showed lower amount of blood loss (391?ml) when compared to control group (597?ml). Risk estimation has revealed that treatment with TA resulted in decrease in risk of postpartum blood loss by 30%. Hemoglobin and hematocrit levels were significantly lower in the control group on the third post-operative day.

Conclusion: TA reduces blood loss during and immediately after CS. Its use in caesarean delivery may be considered especially in cases where blood loss is expected to be high or in anemic patients.     

Fluid supplementation in management of neonatal hyperbilirubinemia: a randomized controlled trial

Objective: To evaluate the efficacy of oral or intravenous fluid supplementation in accelerating the decline of serum bilirubin with intensive phototherapy among healthy term and late preterm neonates with hyperbilirubinemia.

Study design: This open-label randomized controlled trial randomized neonates with severe hyperbilirubinemia (serum total bilirubin ≥18?mg/dL or within 2?mg/dL of threshold for exchange transfusion) to receive 50?mL/kg of intravenous fluid over 8?h (IVF group, n?=?51), 50?mL of oral rehydration solution over 8?h (oral rehydration solution (ORS) group, n?=?50) or only standard therapy (control group, n?=?49). Intensive phototherapy was administered in all the three study groups.

Result: Over 8?h of intervention, serum bilirubin declined by 15.5% (95% CI: 11.7–19.4%) in IVF group, by 9.1% (95% CI: 7.3–10.9%) in ORS group and by 8.0% (95% CI: 6.2–9.7%) in control group (p?Conclusions: Intravenous fluid supplementation may result in a faster decline of STB in first few hours of treatment. However, with the use of intensive phototherapy, there was no effect on overall duration of phototherapy or need of exchange transfusion.

Clinical Trial Registration: Clinical trial registry of India: REF/2015/09/009775     

Effect of postpartum oxygen inhalation on vaginal blood loss

Aim.?To assess the efficacy of oxygen inhalation immediately after normal delivery on blood loss.

Method.?A prospective randomised study conducted on 104 primiparas divided into two groups who underwent normal vaginal delivery. The study group (O₂ inhalation group), 52 women, received 8 l/min oxygen via a facemask for 2 h after the third stage of labour, whereas the control group, 52 women breathed room air in addition to conventional management. All women were evaluated hourly for vaginal blood loss. Blood loss volume was measured from the end of placenta delivery to 2 h postpartum and compared between the two groups.

Results.?The study and the control groups were similar in age, gestational age, body weight and induction rate. The mean vaginal blood loss 2 h postpartum was 27.7 ± 5.8 ml in O₂ inhalation group and 48.8 ± 8.4 ml in the controls (P < 0.05).

Conclusion.?Postpartum oxygen inhalation appears to reduce blood loss after normal vaginal delivery.