Pelvic pressure packing for intractable obstetric and gynaecological hemorrhage in a tertiary care hospital

Background: Haemorrhage is one of the most common complication of any surgery. Haemorrhage can be arterial, venous or capillary ooze. Massive haemorrhage if not timely managed may lead to fatal consequences. There are various medical and surgical methods to control haemorrhage. This study aims to achieve hemostasis with the help of pelvic pressure pack in Obstetric and Gynaecologic surgeries when standard methods are failed and to evaluate efficacy of simple and modified technique of pack preparation.Methods: This is an observational study of 11 cases conducted over a period of 4yrs. This study reports modification of standard packing techniques which overcomes some of its limitations. Here the pack was used in different gynaecologic and Obstetric cases, where intractable haemorrhage was the major problem and standard methods to control haemorrhage had failed. Here a simple foley’s catheter rolled with condom and filled with normal saline was used to prepare a pack and kept over the bleeding surface. This specific pack will adopt the shape of the body cavity it is inserted into, thereby causing pressure tamponade against bleeding surfaces. Pack was removed after 48-72 hours of insertion. Postoperative control of bleeding, patient stability and morbidity were studied.Results: The pelvic pressure pack successfully controlled bleeding in 100% of cases without any morbidity and mortality.Conclusions: In the contemporary management of post-hysterectomy or adhesiolysis induced uncontrolled pelvic bleeding and venous oozes, the pelvic pressure pack appears to be valuable and effective option, affording correction of coagulopathy and further stabilization. We believe all Obstetricians and Gynaecologists should be familiar with this simple safe and cheap potentially lifesaving technique

An analysis of the levels of delay seen in maternal near miss cases in India

Background: The measure of progress of maternal health has usually been a reduction in maternal mortality but if you look at maternal health as an iceberg – maternal deaths are only seen as the tip, with maternal morbidity as the base. As for every woman that dies of maternal causes, 20-30 others experience severe maternal morbidity, sometimes with permanent consequences affecting their daily functioning.Methods: We conducted a prospective observational and clinical study at D. Y. Patil Hospital in Navi Mumbai, India from November 2018 to October 2020 from critically ill, pregnant, laboring, post-partum or post-abortal women that were admitted to the hospital and the levels of delay and barriers to health were carefully asked from the proforma and tabulated.Results: The most common cause of delay was delay 1 in 48.6% cases followed by delay 2 in 31.9% patients. 18.1% patients had no delay noted followed by 1.4% patients that had a level 3 delay. This study found significant association with antenatal care with type of delay experienced during maternal near miss. Women that had not taken appropriate antenatal care in pregnancy had a higher association to type 1 delay.Conclusions: We have learnt that social determinants are important contributors to the causes of near miss delays and eventual maternal mortalities and these social determinants depend on many social levels. Addressing maternal deaths requires action at every level, not just medical or health services. Understanding the delays in receiving care helps analyze patterns of maternal near miss cases and consequently maternal deaths

A prospective study to compare the efficacy and safety of tioconazole and clotrimazole vaginal gel in patients suffering from vulvovaginal candidiasis

Background: Vulvo vaginal candidiasis is an extremely common gynaecological condition. While clotrimazole has been the mainstay of treatment of this pathology, newer medications are now available. The study aims to compare the efficacy, compliance and safety of tioconazole single dose intravaginal gel application and clotrimazole vaginal gel for 3 days in patients suffering from vulvovaginal candidiasis.Methods: A prospective, multicentric, open label, randomized, controlled, parallel group clinical trial of 220 women with 110 in each group for the evaluation of the effects of tioconazole vaginal gel in patients suffering from candidial vaginitis. Patients were divided into two groups; Group I received tioconazole vaginal gel as topical single dose therapy administered by the treating doctor and Group II received clotrimazole vaginal gel self-administered by the patient for three days. Response to therapy in both groups was studied and compared.Results: At the end of day 7, mean score of vaginal discharge quantity had a fall of 93.3% and 92.3% in tioconazole and clotrimazole group respectively but difference was statistically insignificant. Microbiological cure rate in both the groups was similar. Reduction of vaginal irritation, vaginal itching, vaginal burning, pain in the vulval area, pain during urination or during sexual intercourse, vaginal erythema, tenderness and swelling were also comparable in both the groups.Conclusions: Tioconazole gel single dose intravaginal application is as effective as clotrimazole gel three day intravaginal application. tioconazole is safe, well accepted and tolerated by the patients and will be useful in the treatment of vulvovaginal candidiasis

A multicenter, randomized, equivalence trial of a new recombinant human chorionic gonadotropin preparation versus ovitrelle® for ovulation in women undergoing intrauterine insemination following ovarian stimulation

Context: A new indigenous recombinant human chorionic gonadotropin (r-hCG) has been developed in India with a comparable pharmacological profile to that of Ovitrelle® (Merck Serono). Aims: This study aims to compare the efficacy and safety of the new r-hCG with that of Ovitrelle for induction of ovulation in women undergoing intrauterine insemination (IUI). Settings and Design: Randomized (2:1), multicenter, open-label, equivalence clinical trial conducted in India. Subjects and Methods: A total of 217 women, aged 20–37 years, undergoing IUI were administered the new r-hCG (test) 250 mcg or Ovitrelle 250 mcg (comparator) after ovarian stimulation with gonadotropins. The ovulation rate was compared as the primary outcome. In addition, pregnancy rates, incidence of adverse events (AEs), and development of immunogenicity were assessed. Statistical Analysis Used: The ovulation and pregnancy rates were compared using Chi-squared test with statistical significance at P < 0.05. Results: With 144 women in the test group and 73 in the comparator group, the ovulation rate (85.4% vs. 78.1%; P = 0.17) and pregnancy rate (serum β hCG test) (11.8% vs. 12.3%; P = 0.91) were similar in both groups. A total of 15 AEs were reported (11 in the test r-hCG group and 4 in the comparator group) in 11 women; none of these were serious, and all were judged to be unrelated to the study drug. No subject developed immunogenic reaction to the test drug. Conclusions: The new preparation of r-hCG was equivalent to the conventional preparation of r-HCG in the induction of ovulation in patients undergoing IUI