ABSTRACT
Labour is an extremely painful process. Labour pain can have deleterious effects on the mother, on the foetus and on the labour outcome. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/safety ratio. The increased availability of epidural analgesia and the favourable experiences of women who have had painless labour with epidural block have reshaped the expectations of pregnant women entering labour. Compared with other forms of pain relief, epidural analgesia is associated with the highest level of maternal satisfaction. Taking into consideration this aspect, a study was performed in a tertiary care center over a period of 18 months.METHODS160 patients fulfilling the inclusion criteria were divided into two groups namely Group A and Group B. Group A was administered epidural analgesia while Group B was offered other analgesic agents (inj. tramadol hydrochloride) after obtaining well informed consent. Pain compliance is marked over VAS at this point of time. Once the effect of epidural starts waning off, top up dosages are administered by anaesthesiologists. Increments or derangements in pain compliance are noted timely. Any maternal side effects such as headache, hypotension, motor paralysis etc. are noted. Duration of first and second stage of labour is noted with the help of partogram. In the end, mode of delivery, indication of instrumental delivery/caesarean section, neonatal outcome in terms of APGAR scores were noted.RESULTSProlongation of first and second stage of labour, increase in the rate of instrumental/caesarean delivery was not statistically significant between both the groups. (p>0.05). p Value calculated using unpaired t test (p= 0.5116). Maternal requests for caesarean section were significantly higher in control group compared to epidural group (p<0.05). This may be due to non/less efficacy of other analgesic drugs than epidural analgesics. The difference in VAS score between both the study groups was statistically significant (p<0.001) indicating that pain was significantly less in epidural group.CONCLUSIONSEpidural analgesia provides excellent labour analgesia compared to other agents with no significant prolongation of first and second stage of labour or mode of delivery. Study also shows that there is no significant rise in the number of instrumental or caesarean deliveries due to epidural analgesia. There are no serious maternal or foetal side effects of the epidural analgesia. Hence, it can be safely recommended in labour. The analgesic effect can be maintained as long as needed and even after delivery to relieve postoperative pain.
ABSTRACT
Background: Obstetric hysterectomy remains a necessity in preventing maternal mortality in catastrophic rupture of the uterus or intractable postpartum hemorrhage when all the conservative management options fail. Uterine atony followed by abnormal placentation remains the primary indication of emergency obstratic hysterectomy worldwide. In majority of cases, anticipation, prompt resuscitation and earlier surgical intervention by skilled operator will reduce patient’s morbidity and mortality. The first successful operation was performed in 1876. The main objective of the study was to study frequency, indications and fetomaternal outcome of emergency obstetric hysterectomy in tertiary care center.Methods: Observational, retrospective and analytical study was done over 2 years from January 2017 to January 2019. A total of 11 cases of emergency obstretic hysterectomy (EOH) were recorded.Results: The overall incidence was 1.47 per 1000 deliveries. Atonic postpartum hemorrhage (54%) was the most common indication followed by placenta previa (18%) and placenta accreta (9%). Second gravida were mostly involved (45%) with previous LSCS (45%) as a common risk factor in commonest age group of 20-25 years (46%) amongst them. The most frequent squeal was disseminated intravascular coagulation (45%). Maternal mortality was nil while neonatal mortality being 9%. The decision of performing total or subtotal hysterectomy along with bilateral internal iliac ligation was influenced by patient’s condition.Conclusions: Emergency obstretic hysterectomy is the most demanding obstretic surgery performed in circumstances of life threatening hemorrhages where conservative surgical modalities fail and interventional radiology is not immediately available. Antenatal anticipation of the risk factors, involvement of experienced obstetrician at the early stage of management and prompt hystrectomy after adequate rescuitation will reduce fetomaternal mortality and morbidity.