Immediate postpartum IUCD [PPIUCD] insertion: an opportunity not to be missed

The present study was planned to evaluate the safety and efficacy of immediate postpartum IUCD insertion in women delivering vaginally or by caesarean section. This prospective study was carried out at Sobhraj Maternity Hospital from 1[st] July 2012 to 30[th] June 2013. Women delivering in the hospital fulfilling inclusion criteria were included in the study. Women with prelabour rupture of membranes for >18 hours, chorioamnionitis, temperature >380 [degree]C during or after labour, continued excessive postpartum bleeding were excluded from the study. The women included in the study underwent immediate postpartum insertion of Copper T 380A after delivery of placenta in vaginal or caesarean delivery. These women were followed up at 6 weeks and 6 months after delivery. A total of 1238 women were included in the study who underwent immediate postpartum IUCD insertion. 56% of insertions were performed after vaginal delivery and 44% insertions were done at caesarean sections. The follow up rate at 6 weeks was 51% and 14% at 6 months. There were no serious complications associated with immediate postpartum IUCD insertion. The expulsion rate at 6 weeks and 6 months were 5% and 6%. The removal rate was 5% at 6 weeks and 10% at 6 months. The continuation rates were 90% at 6 weeks and 84% at 6 months respectively. This study indicates that immediate PPIUCD insertion is safe and effective. However, the expulsion rate for immediate postpartum IUCD insertions are higher than for interval insertions, but the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country like ours where women have limited access to healthcare

Fetal transverse cerebellar diameter measurement; a useful predictor of gestational age in growth restricted fetuses

To determine the accuracy of fetal transverse cerebellar diameter measurement in the prediction of gestational age in growth restricted fetuses. This controlled was conducted at Sobhraj Maternity Hospital, Karachi from July 2012 to June 2013. A total of 100 pregnant women in the third trimester of pregnancy satisfying the eligibility criteria were included. Among these 50 were fetuses with normal fetal growth and 50 growth restricted fetuses. The mean transverse cerebellar diameter in the fetuses showing normal growth was not statistically different from the mean transverse cerebellar diameter in the growth restricted fetuses [p-value = 0.219]. Transverse cerebellar diameter measurement can be used reliably for accurate estimation of gestational age in growth restricted fetuses

Successful management of postpartum hemorrhage using B-lynch suture

Background: Postpartum haemorrhage [PPH] is a life threatening obstetric emergency. In Pakistan 25% of maternal deaths are due to PPH and majority is due to uterine atony. B-Lynch suture is a simple and effective method for control of PPH due to uterine atony as an alternative to more complicated surgery including hysterectomy with loss of fertility and associated psychological morbidity

Objective: To demonstrate the effectiveness of B-Lynch compression suture in patients with massive postpartum haemorrhage due to uterine atony refractory to medical treatment

Methods: Prospective observational study conducted at Sobhraj Maternity Hospital, Karachi, from January 1, 2012 to December 31, 2012. Data was collected during the 12 month period for all women who had massive primary postpartum haemorrhage [> 1500ml] due to uterine atony refractory to uterotonic agents in whom surgical haemostasis was initiated by applying B-Lynch suture. Patients were followed up at 6 weeks, 6 months and 12 months. The main outcomes evaluated were reduction or cessation of bleeding, whether hysterectomy was needed to control haemorrhage and whether minor or major complications of the procedure arose

Results: During the 12 months study period 3.1% [152/4782] women had primary postpartum haemorrhage, while massive postpartum haemorrhage occurred in 0.62% [30/4782] cases. Majority of these cases were due to uterine atony [20/30]. B-Lynch suture was applied to 16 women who had massive primary postpartum haemorrhage due to uterine atony refractory to uterotonic agents. Effective haemostasis was achieved in all cases. None of the women required hysterectomy. All women later resumed normal menstrual flow without any abnormality. One patient had spontaneous pregnancy after eleven months of her delivery

Conclusion: B-Lynch suture is effective in the control of massive postpartum haemorrhage as an alternative to hysterectomy, a lifesaving procedure preserving the uterus and thus fertility