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

A study of transobturator tape in stress urinary incontinence

Background: Stress urinary incontinence (SUI) is commonly encountered in gynecological practice. Nowadays, midurethral sling surgeries in the form of transobturator tape (TOT) surgery are recommended in its treatment. Aims and Objectives: To assess the outcome and patient satisfaction of TOT surgery in the treatment of SUI. Materials and Methods: A prospective study was undertaken for patients of SUI who underwent TOT surgery by the outside in method and followed up for 5 years. The patients were assessed clinically and by the Patient Global Impression of Improvement (PGI-I) preoperatively and at postoperative day 3, discharge and 3 months follow-up. Results: Successful surgical treatment with TOT was seen in all patients at the time of discharge. There was no recurrence of SUI seen up to 1 year, but at 5-year follow-up two patients had a recurrence of SUI on examination though they did not complain of SUI. Urinary retention, tape extrusion, and groin stitch infection were the commonly seen complications following surgery. On subjective assessment, 61 patients were completely satisfied at day 3, and all patients were completely satisfied at discharge and 3 months follow-up as per the PGI-I score. Conclusion: TOT gives an excellent outcome in the treatment of SUI