Efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section

Background: In India, caesarean section rate is rising, so the impact of prophylactic injection of tranexamic acid in decreasing blood loss during caesarean section would be more beneficial in terms of having minimal blood loss intra operatively and post operatively and thereby decreasing maternal morbidity. The objective of the study was to evaluate the efficacy of prophylactic tranexamic acid in reducing blood loss during and after caesarean section.Methods: A randomized controlled trial among 200 term women with singleton pregnancy for a period of 2 years was carried out. They were randomized by computer generated numbers into two groups: study group-100 women receiving prophylactic tranexamic acid women and control group-100 women receiving placebo.Results: The blood loss during caesarean section was less in the tranexamic acid group compared to the placebo group. Similarly blood loss measured 6hrs after caesarean section was less in the tranexamic acid group compared to placebo group. 20-40min before the time of incision was the ideal time gap for administering the injection tranexamic acid for its optimum efficacy. Tranexamic acid group had lesser requirement of uterotonic when compared to placebo, but need for blood transfusion was similar in both the groups. Greater fall in the hemoglobin and haematocrit occurred in placebo group compared to tranexamic acid group. No changes in the post-operative vitals or side effects were seen in the tranexamic acid group. Even no change in birth weight and Apgar scores was seen in neonates of tranexamic acid group.Conclusions: Injection tranexamic acid is the, antifibrinolytic agent that can be used for prophylactic administration before caesarean section for decreasing blood loss during surgery

A study of risk factors of postpartum hemorrhage and indications for caesarean section

Background: To prevent post-partum hemorrhage the concept of active management of third stage of labour has been proposed which decreases the blood loss by 40-68%. The best preventive strategy is active management of the third stage of labour. The objective of the study was to study risk factors of postpartum hemorrhage and indications for caesarean section.Methods: A hospital based cross sectional study was carried out among 100 women at term for a period of one year. Pregnant women who are at term i.e. at 38-39 weeks of gestation were included in the study. Detailed history, clinical examination and investigations were carried out.Results: The mean pre pregnancy BMI in study group was 22.4±3.96. The majority of patients recruited were primiparous. Socio-demographic data shows that there was no statistical difference in place of residence, occupation and level of literacy between two groups. The prevalence of anemia among women at term was found to be 43%. The most common obstetric high risk factor was gestational diabetes mellitus in 10% followed by gestational hypertension in (6%). 71% of women underwent the emergency LSCS. The most common indication for LSCS was fetal distress in 29% of cases followed by mal-presentation in 12% of cases.Conclusions: The prevalence of anemia among women at term was found to be 43%. The different medical high risk factors were human immunodeficiency virus positive (asymptomatic diagnosed during pregnancy), Hepatitis B antigen positive, cardiovascular risk, hypothyroidism, epilepsy observed in the groups. Other high risk factors included asthma, Crohns disease, and systemic sclerosis

Prevalence of various urogynaecological problems and their subsequent management with outcome amongst women attending a tertiary care hospital of a developing Country

Background: The prevalence of urogynaecological problems may be significantly underestimated since the physicians rarely ask women about these problems and women seldom initiate discussion about these symptoms on their own with the physician.Methods: The present study was conducted from March 2006 to August 2008. All the women between 20 to 80 years of age with varying parity attending gynecological outpatient department were evaluated for urogynaecological and bowel problems, based on a questionnaire incorporating demographic and urogynaecological symptoms (IUGA terminology). The frequency of various urinary problems was correlated with the demographic data, urodynamic studies and cystoscopic findings, whenever appropriate and available. Exclusion criteria: The women with disorders of central nervous system, retention urine and pregnancy were excluded from the study.Results: During this period, 15100 women attended outpatient department of gynecology. Out of these, 376 women had urogynaecological and bowel problems. The prevalence of urogynaecological and bowel problems was 24.9 per 1000 women. The incidence of symptoms was dysuria in 38.5 % women, increased frequency of micturition in 38% women; feeling of something coming out per vaginum in 37% women, nocturia in 27.6 % women and pain lower abdomen in 25 % women.Conclusions: Amongst incontinence, 31.3% women had stress incontinence, 25% women had urge incontinence, 14.6% women had urgency, 8.7% women had continuous urinary incontinence and 2.12% women had anal incontinence

Management of Secondary Glaucoma, a Rising Challenge

Secondary glaucoma has increased exponentially in recent times. This is partially due to the increase in complex eye surgeries like corneal transplantation and vitreoretinal surgery and partly due to the increase in life style related diseases like diabetes causing an increase in the prevalence of neovascular glaucoma. The other leading causes of secondary glaucoma are post-trauma, post-cataract surgery, and lens-induced glaucoma. Secondary glaucoma is an important cause of visual morbidity. The management of this complex glaucoma is difficult as they are mostly intractable and do not respond to anti-glaucoma medications. Many patients who are not managed by medical management may require surgical intervention along with vigilant control of their primary pathology. This course would address the stepwise approach to the management of these glaucomas and the tips and tricks to tackle the nuances during management. This chapter would specifically address the management of neovascular glaucoma, Post-PK glaucoma, lens-induced glaucoma, traumatic glaucoma, and uveitic glaucoma

Weekly iron folic acid supplementation plays differential role in maintaining iron markers level in non-anaemic and anaemic primigravida: A randomized controlled study

AbstractAnaemia during pregnancy is most commonly observed and highly prevalent in South-East Asia. Various effective programmes have been laid down for its management, mainly daily supplementation of iron folic acid (IFA) tablets. Following the same, standard obstetrical practice has included the IFA supplementation without requiring the determination of iron deficiency. In this study, a total of 120 primigravida (N=60; non-anaemic (Hb>11g/dl) and N=60 anaemic (Hb=8–11g/dl)) were selected among those attending the Antenatal Clinic in Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. They were supplemented with daily and weekly IFA tablets till 6weeks postpartum. Corresponding changes in haemoglobin level on advance of pregnancy, side effects and compliance associated with daily and weekly IFA supplementation and its associations with iron status markers were studied. The inflammatory markers were also estimated. The statistical significance level (p<0.05) between the groups were assessed by applying unpaired t-test using SPSS (version 16.0). The obtained results publicized the salutary role of daily IFA supplementation in improving the haemoglobin level and iron status markers in anaemic pregnant women though the levels could not reach up to the non-anaemic haemoglobin levels. However, weekly IFA supplementation seems to be a better approach in non-anaemic pregnant women where almost comparable results were obtained in terms of haematological parameters, gestation length and birth weight.ConclusionWeekly IFA supplementation found to be as effective as daily supplementation in iron sufficient non-anaemic pregnant women whereas anaemic pregnant women should be prescribed daily IFA supplementation irrespective of iron replete/deplete state

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health

ObjectiveTo investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries.DesignSecondary analysis of a cross-sectional study.SettingTwenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health.Population29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37–41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour.MethodsWe compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age.Main Outcome MeasuresSevere maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality.ResultsOdds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39–0.60) and 0.31 (95% CI 0.16–0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age.ConclusionsElective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups

A rare case of primary mesenteric gastrointestinal stromal tumor with metastasis to the cervix uteri

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors are CD117 (C Kit) positive mesenchymal neoplasms, that may arise anywhere in the gastrointestinal tract. Their current therapy is imatinib mesylate before or after surgery.</p> <p>Case presentation</p> <p>We describe a case of 17-year-old female with metastasis to the cervix uteri of a primary mesenteric gastrointestinal tumor.</p> <p>Conclusion</p> <p>Surgery remains the mainstay of known curative treatment. The manifestations of GIST are not restricted to the typical locations within the bowel; may have very unusual metastatic sites or infiltrations per continuitatem.</p

Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health

Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium-or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (<= 6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth < 37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)World Health Organization (WHO)United States Agency for International Development (USAID)Ministry of Health, Labour and Welfare of JapanGynuity Health ProjectsJapan Agency for Medical Research and Development, AMEDNatl Res Inst Child Hlth & Dev, Dept Allergy & Clin Immunol, Tokyo, JapanUniv Tsukuba, Dept Global Hlth Nursing, Fac Med, Tsukuba, Ibaraki, JapanNatl Ctr Child Hlth & Dev, Dept Educ Clin Res, Tokyo, JapanSt Lukes Int Univ, Grad Sch Nursing Sci, Global Hlth Nursing, Tokyo, JapanWHO, UNDP UNFPA UNICEF WHO World Bank Special Programm, Dept Reprod Hlth & Res, Geneva, SwitzerlandUniv Fed Sao Paulo, Evidence Based Healthcare Postgrad Programme, Dept Internal Med, Sao Paulo, BrazilMinist Hlth, Family Hlth Bur, Maternal & Child Morbid & Mortal Unit, Colombo, Sri LankaSora No Mori Clin, Yaese, Okinawa, JapanFortis Mem Res Inst, Obstet & Gynecol, Gurgaon, IndiaNatl Ctr Dis Prevent & Control, Dept Hlth, Manila, PhilippinesKochi Univ, Kochi Med Sch, Dept Pediat, Kochi, JapanUniv Abdou Moumouni Niamey, Niamey, NigerAmer Univ Beirut, Beirut, LebanonUniv Nairobi, Obstet & Gynaecol, Sch Med, Nairobi, KenyaUniv Sao Paulo, Ribeirao Preto Med Sch, Dept Social Med, Sao Paulo, BrazilNatl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, JapanUniv Fed Sao Paulo, Evidence Based Healthcare Postgrad Programme, Dept Internal Med, Sao Paulo, BrazilWeb of Scienc