Emergency Obstetrical Hysterectomy

This study was designed to determine the incidence, indications and complications of emergency obstetrical hysterectomy. The cases were analyzed from January 2003 to December 2008 in the obstetric unit of Fatima Hospital, Baqai Medical University, Karachi. The Demographic and clinical variables were obtained from the maternal records. Incidence of emergency obstetrical hysterectomy was found out to be 1:238 deliveries. Out of these 6(40%) of patients were in the age group between 31-35 years. Average age was 31years. Multiparous patients were 7(46.6%) and grand multiparous were 6(40%) with mean parity of 5. The most common indication leading to obstetrical hysterectomy was Atonic uterus causing postpartum hemorrhage in 7(46.6%) of patients. Ruptured uterus was responsible for this procedure in 2(13.3%) patients. Regarding complications, deep venous thrombosis developed in 1(6.6%) patient. The maternal deaths occurred in 3(20%) patients. The incidence of emergency obstetrical hysterectomy is not very much high. Majority of the patients were referred by traditional birth attendants (TBA’s) with complications of labor and delivery. To further reduce the incidence, education of TBA’s and early referral along with community awareness are essential

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The frequency of gestational diabetes mellitus & its responsible factors among pregnant women presenting at a tertiary care hospital, Karachi

Controlling the related factors implicated in the development of GDM may help to mitigate the sharp rise in the prevalence of GDM and its detrimental effects on maternal and newborn problems. Maternal age (over 30 years), prior history of gestational diabetes, increased BMI, family history of diabetes, parity, belonging to an ethnic group with a high correlation with GDM and prior birth of a large baby are the key related factors of GDM. Aim: The main goal is to determine the frequency of gestational diabetes mellitus among pregnant women and its causing factors. Place and Duration: This Descriptive, cross-sectional study was held in Department of Gynecology, Liaquat National Hospital, Karachi from 16th January 2017 to 15th July 2017. Methods: 250 pregnant women with gestational diabetes mellitus between the 18-45 years of age were included. Multiple gestations, unbooked cases, and cases of known DM were not included. Development of gestational diabetes is the primary outcome factor which was determined. Maternal age, parity, gestational age, grand multiparity, BMI (for obesity), prior GDM, prior experience of macrosomic infant, family history of DM & PCOS are additional study variables (responsible factors).&nbsp