Use of intramyometrial carbetocin in caesarean myomectomy to reduce hemorrhage

Traditionally myomectomy is avoided during caesarean delivery because of potential excessive blood loss. As the size increases, blood supply of leiomyomas also increases in pregnancy, and specifically at term due to the effect of human chorionic gonadotropin. Carbetocin is an oxytocin analog. It is long acting and is effective in preventing blood loss. It has been used in myomectomy to prevent blood loss in non-pregnant uterus. We present a case report where it is used intramyometrial route during caesarean section. A 30-year-old multigravida of 38 weeks period of gestation with previous caesarean section, presented in labor. Her recent ultra sound report showed single live intrauterine fetus of 35 weeks 3 days with a single posterior wall fibroid. The woman requested for myomectomy along with caesarean delivery as she had heavy menstrual bleeding caesarean section was done and myomectomy was planned along with the caesarean section. Intramyometrial carbetocin 100 mcg was used to prevent excessive blood loss. The patient had an uneventful post-operative period. Intramyometrial carbetocin is an effective method to reduce blood loss in myomectomy during caesarean delivery

Why do mothers die? A retrospective analysis of maternal mortality over 7 years in a tertiary care teaching Hospital in North Karnataka, India

 Background: Maternal mortality ratio (MMR) is still high in many developing countries. In Southern India, the maternal mortality is highest in the state of Karnataka. Therefore, a study was conducted at BLDE (DU) Shri BM Patil medical college, hospital and research centre to study the causes of maternal deaths, and to make recommendation to reduce the maternal mortality.Methods: A retrospective analysis of all the maternal deaths between 2012 to 2019 was done.Results: A total of 58 women died due to pregnancy and its complications during the period of 2012-2019. Average age of death was 25.42 years. It was noted that 70.7% of the patients travelled over 30 km to reach Vijayapura city. The predisposing causes of death were post-partum haemorrhage (44.8%) eclampsia (18.9%), anaemia (17.2%), pulmonary or amniotic fluid embolism (12.1%), sepsis (10.3%) antepartum haemorrhage (3.4%) and cardiac disease (6.9%). A death each occurred in patients suffering cholestasis and adult respiratory distress syndrome. A majority of the deaths were post-partum deaths (84%). Most of the deaths of the occurred during the first 12 hours of admission (82.76). A total of 11 patients received blood and blood components. Of the 58 deaths, 56(96%) required ventilatory support., 47 (81%) patients received ionotropic support. 11 (19%) patients underwent peripartum hysterectomy.Conclusions: Timely intervention can save maternal lives. Services of well-equipped hospitals with obstetric intensive care units having a dedicated team of well-trained obstetricians, intensivists and anaesthesiologist are recommended in a facility which is near the residence of the pregnant women. Facilities for quick transfer of the cases who are high risk are required

A study of hypertensive disorders of pregnancy and the fetal outcome in a tertiary care hospital: a prospective study

Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant women with hypertensive disorder of pregnancy were enrolled in the study. Most of the participants were in the age group of 20 to 30 years. The PIH was seen mostly in primigravida, lower socioeconomic status and with lower educational levels. Emergency LSCS is the most common mode of delivery.Conclusions: The hypertensive disorder in pregnancy affects the majorly younger age group. It is most commonly seen in low socio-economic and uneducated population. Hence, there should be provided with proper antenatal care, early detection of hypertensive disorders for better feto-maternal outcome

Menstrual Morbidities, Menstrual Hygiene, Cultural Practices during Menstruation, and WASH Practices at Schools in Adolescent Girls of North Karnataka, India: A Cross-Sectional Prospective Study

Background. Issues of menstrual morbidities, menstrual hygiene, and cultural practices are rarely discussed by adolescents. The burden of menstruation and cultural practices which the adolescent girls have to face has been less quantified. This study aims to assess the issues related to menstruation in school girls. Method. A cross-sectional prospective study was conducted on 1016 school-going adolescent girls in January 2020. A questionnaire in English and in Kannada was distributed to girls of class 8–12 of ages between 10 and 19 years. Results. 70.5% of the girls attained menarche by 12 to 14.9 years, 37.2% of the girls had their periods every 28–34 days, and 12.2% of the girls said they have heavy periods. 61.95% of the girls had dysmenorrheal, and 9.7% of the girls said that they required medications for the pain. 70.7% of the girls were using commercial sanitary napkins, 12.7% were using cloth, and 15.3% were using both. 55.5% of the girls who were using cloth as an absorbent were not drying the cloth in sunlight. 57.1% of the girls were washing their genitals more than 2 times a day. 93.8% were having bath during menses and 87.2% were using soap along with water. 37.7% of the girls disposed their pads by burning them, 50.8% of then disposed them in the dust bin, and 4.9% of them buried them. 8.6% of the girls said that they remained completely absent from school during periods. 17.85% said that they remained absent for a day. 53.4% of the respondents said that they have difficulty in concentrating at school. 76.1% said that they had adequate water and sanitation facilities at school. 22.3% said that there was adequate facility to change their pads at school. 73.2% said that they could get a spare pad at school. 43.3% of the girls said they avoided cultural functions during their periods, and 38.5% said that they avoided religious ceremonies and practices during their periods. 8.7% of the girls were made to sit outside the house during their periods. The girls from rural areas had poorer hygienic habits, in comparison to the urban girls. Cultural restrictions such as sitting outside the house during menstruation and restricting play were more in the rural girls than the urban girls. Conclusion. Menstrual morbidities, menstrual hygiene management, and cultural beliefs all play a role in school absenteeism in adolescent girls. Improvement of facilities at school and conducting awareness programs can help adolescent girls to attend schools