Role of blood transfusion in saving mothers

Background: Blood transfusion is recognised as one of the eight essential components of the comprehensive emergency obstetric care module which has been designed to reduce maternal morbidity and mortality rates after major obstetric hemorrhage and anemia.Methods: This is a prospective observational study conducted between April1, 2016 to September 30, 2018 in department of obstetrics and gynecology, Government Medical College, Patiala. The MNM cases given transfusion were analysed in respect of number of antenatal visits, type of admission, distance of place of first referral unit from tertiary health care facility, amount of blood transfused, indications of blood transfusion, causes of haemorrhage and intervention performed.Results: During this period, there were 123 cases of MNM, 90 patients required blood transfusion and were considered in this study. Maximum number of cases (94.45%) were between 20-35 years of age. Majority of cases were primipara (52.22%). 47.77% cases were in 3rd trimester, 33.33% postnatal cases and 16.66% cases were in first trimester. 88.88% cases requiring transfusion belong to low socioeconomic status. There was no antenatal visit in 80% cases who required blood transfusion. 78.8% patients required more than 4packed red cell transfusions. Haemorrhage was the indication in 60% cases for blood transfusion and anaemia in 40% cases. Postpartum haemorrhage (28.4%) was most common indication for blood transfusion followed by ruptured ectopic pregnancy (27.77%), antepartum haemorrhage (11.11%), rupture uterus (7.4%), rectus sheath hematoma (5.55%), placenta accreta (5.55%) and inversion uterus (3.7%).  Surgical interventions were performed in 51 cases.Conclusions: Prevention and timely treatment of anaemia must receive attention by more active participation in term of antenatal check-ups. Skilled management of patients at the first referral units is advocated. There should be familiarity with the local protocol of relevant members of staff for management of massive hemorrhage. All major hemorrhages should be reviewed to ensure that there is no delay in provision of blood products

Maternal mortality in a tertiary care hospital: a five-year review

Background: This study was aimed at analyzing the maternal mortality ratio over five years, the causes leading to maternal deaths in a tertiary care hospital and factors which are preventable.Methods: The records of maternal death from August 2010 to July 2015 (5 years) were collected and analyzed. Various factors like maternal age, parity, literacy, place of residence, antenatal registration, admission-death interval, mode of delivery and causes of deaths were reviewed.Results: The mean maternal mortality ratio (MMR) was 1039. The direct causes of maternal mortality were hemorrhage (22.4%), eclampsia (21.2%), sepsis (18.78%) and amniotic fluid embolism (8.48%). Indirect obstetric deaths were due to hepatitis (10.9%), anemia (3.6%), respiratory diseases (6.06%), heart diseases (3.03%), CNS disease (5.45%).  Most of the deaths (69.7%) occurred in age group 20 and30 years. 63.6% were multigravida and 85.4% were unbooked cases.Conclusions: Antenatal care, screening and management of high risk pregnancies are most important to prevent complications and maternal deaths by timely detection and intervention

Aggressive angiomyxoma of vagina: a rare entity

Aggressive angiomyxoma a soft tissue tumor arising in the pelvis and perineal regions of women in reproductive age group is a rare entity. It is slow growing locally aggressive myxoid mesenchymal tumor, with a marked tendency to local recurrence. Preoperative clinical diagnosis is usually difficult due to absence of diagnostic features as well as rarity of the disease. We describe a case of aggressive angiomyxoma of vagina in a 47-year-old para 4 woman with multiple fibromyoma (upto 22-week size of pregnant uterus) with 10*10 cms posterior vaginal cyst. Total abdominal hystrectomy with surgical excision of vaginal wall cyst done. A retrospective diagnosis-Aggressive Angiomyxoma of the vagina was made after histological confirmation. Surgical excision with wide margins and long term follow up remains treatment of choice

Ultrasonographic evaluation of antenatal umbilical cord coiling index (aUCI) in second trimester of gestation and pregnancy outcome

Background: To evaluate the role of antenatal umbilical cord coiling index (aUCI) obtained during routine second trimester ultrasound as a predictor of perinatal outcome.Methods: Fetal ultrasound of 100 pregnant women was done between 18-24 weeks of gestation. Antenatal UCI was calculated as a reciprocal value of the distance between a pair of coils. Patients were followed up till delivery for perinatal outcome. UCI was correlated with: (1) gestational age (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) APGAR scores and (5) birth weight.Results: aUCI was categorized as hypocoiled, normocoiled or hypercoiled. Hypocoiled cord was associated with LBW (1%), preterm delivery (1%) while hypercoiled cord was associated with LBW (4%). No statistical difference was found for birth weight, gestational age, APGAR scores and MSAF between the groups with normal and abnormal aUCI.Conclusions: In present study, no association was found between abnormal aUCI with higher prevalence of interventional delivery, presence of MSAF, preterm and LBW. Therefore, more specific parameters need to be developed as promising prognostic marker for predicting adverse perinatal outcome and further studies are needed to test this hypothesis