Misoprostol in addition to routine treatment of postpartum hemorrhage: A hospital-based randomized-controlled trial in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.</p> <p>Methods</p> <p>A randomized controlled trial was conducted in four Karachi hospitals from December 2005 – April 2007 to assess the benefit of a 600 mcg dose of misoprostol given sublingually in addition to standard oxytocics for postpartum hemorrhage treatment. Consenting women had their blood loss measured after normal vaginal delivery and were enrolled in the study after losing more than 500 ml of blood. Women were randomly assigned to receive either 600 mcg sublingual misoprostol or matching placebo in addition to standard PPH treatment with injectable oxytocics. Both women and providers were blinded to the treatment assignment. Blood loss was collected until active bleeding stopped and for a minimum of one hour after PPH diagnosis. Total blood loss, hemoglobin measures, and treatment outcomes were recorded for all participants.</p> <p>Results</p> <p>Due to a much lower rate of PPH than expected (1.2%), only sixty-one patients were diagnosed and treated for their PPH in this study, and we were therefore unable to measure statistical significance in any of the primary endpoints. The addition of 600 mcg sublingual misoprostol to standard PPH treatments does, however, suggest a trend in reduced postpartum blood loss, a smaller drop in postpartum hemoglobin, and need for fewer additional interventions. Women who bled less overall had a significantly smaller drop in hemoglobin and received fewer additional interventions. There were no hysterectomies or maternal deaths among study participants. The rate of transient shivering and fever was significantly higher among women receiving misoprostol</p> <p>Conclusion</p> <p>A 600 mcg dose of misoprostol given sublingually shows promise as an adjunct treatment for PPH and its use should continue to be explored for its life-saving potential in the care of women experiencing PPH.</p> <p>Trial Registration</p> <p>Clinical trials.gov, Registry No. NCT00116480</p

Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso

BACKGROUND: Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS: Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS: Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS: Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication

Uterine fibroids in LAUTECH Teaching Hospital, Osogbo: A five year review

Background: Uterine fibroids otherwise known as leiomyomas or myomas are the commonest tumour of the uterus. Leiomyomas are frequently seen in the black than in white women. It is commoner in nulliparous and relatively infertile women than the parous and fertile women. Objective: To determine the incidence, mode of presentation, management and complications of uterine fibroid among women in Osogbo. Materials and method: This is a retrospective analysis of the patients seen in our clinic at LAUTECH Teaching Hospital Osogbo, diagnosed as having uterine fibroids. The study was conducted over a period of five years. The variables considered in the study were patients’ age, parity, occupations, level of education, fertility status, clinical presentation, management and complications. Results: A total of 1,288 patients were seen at the gynaecological clinic out of which145 were clinically diagnosed as having uterine fibroids. The ages of the patients ranged between 20-65 years with the largest number 64 occurring in the age group of 40-49 years. The patients’ complaints were abdominal swellings in 70 patients, infertility 56, menorrahgia and recurrent abortion in20 patients. Surgical management was the main option of treatment. The most common complication was uterine bleeding. Conclusion: The proportion of gynaecological patients in our clinic with uterine fibroids is still remarkable. The definitive management for large fibroids in our unit remains surgical removal. Anaemia is the most common complication in the review. Key words: Uterine fibroids, infertility, presentation, management and complications

Surgical complications of unsafe abortion: a 10-year review in South Western Nigeria

No Abstract.Nigerian Medical Journal Vol. 46 (3) 2005: pp. 75-7

Acquired gynaetresia in pregnancy: Successful delivery and viginoplasty

No Abstract