ABSTRACT
Background: Obstetric hemorrhage is one of the most important causes of maternal mortality. Severe postpartum hemorrhage is known to raise the mortality rate. There is a higher incidence of death from obstetric hemorrhage in developing countries as opposed to developed countries
Objective: To emphasize the role of interventional radiology in the management of obstetric and gynaecological haemorrhage in under developed countries like Pakistan
Methods: The retrospective data of all patients requiring pelvic artery embolization for the control of pelvic hemorrhage was studied at Ziauddin University Hospital during the period from April 2011 to June 2014. Main outcome measure was the effectiveness to control hemorrhage. Technical success was defined as the cessation of bleeding on the post embolization angiogram and cessation of vaginal bleeding at speculum inspection performed immediately after PAE. Clinical success was said when the bleeding stopped completely after the first course of PAE and no additional PAE or surgery was required
Results: A total of 13 patients underwent pelvic artery embolization [PAE] during this period. Five patients had primary postpartum haemorrhage [PPH], in which 3 patients had PPH after caesarean sections, one due to uterine atony secondary to triplets delivery, second had placenta praevia and third had placenta accreta. Two patients had uterine rupture, one following the normal vaginal delivery and other had previous 2 caesarean sections, uterine scar ruptured at 28 weeks of gestation. Two patients had secondary PPH, one due to uterine artery pseudo aneurysms after caesarean section and other had normal vaginal delivery. Six patients underwent pelvic artery embolization due to gynaecological cause i.e. heavy menstrual bleeding and pain secondary to fibroids. One patient had total abdominal hysterectomy and bilateral salpingoopherectomy due to fibroids but she continued to have bleeding from vaginal vault .Laparotomy was done twice but she continued to bleed so finally underwent pelvic arterial embolization after which bleeding stopped. All patients underwent selective embolization of the uterine artery or anterior divisional branch of the internal iliac artery with successful haemorrhage control and no immediate complications. PAE when done, in Gynae patients with fibroid resulted in severe abdominal pain immediately after the procedure for which analgesic medicines were given and the pain settled. These patients were followed in clinics and found to have significant decrease in their symptoms like 88% reduction in menorrhagia and 100% improvement in pain in six months period after procedure. Imaging scans were also done to follow the size of fibroid that were found reduced 17-63%
Conclusion: Selective pelvic embolization is a safe and effective treatment for acute obstetric or gynaecological haemorrhage and should be part of the management algorithm for PPH and for the treatment of symptomatic fibroids in females who especially want to conserve their uterus
ABSTRACT
To determine the frequency of labour dysfunction and associated feto-maternal outcome in primigravidas. Descriptive case series. Obstetrics and Gynaecology Unit II Civil Hospital Karachi, from January 2007 to August 2007. A total of 100 primigravidas were included, having term singleton foetus in active phase of labour. The process of labour was recorded on partogram with maternal and foetal parameters. Among the study participants, partogram curve of 74% primigravidas showed labour dysfunction and required augmentation. Median duration of first stage of labour was 9 hours, second stage of 30 minutes and third stage of 8 minutes. Out of total patients, 82% neonates were observed with good Apgar score and 18% had poor Apgar score. There were 2% cases of puerperal pyrexia but no case of PPH, ruptured uterus and obstructed labour. Partogram is an inexpensive and efficient method of labour monitoring which depicts any dysfunction in labour timely so that early intervention could take place. With the use of partogram the mean duration of labour was reduced.