Intrauterine balloon tamponade in the management of postpartum hemorrhage: experience at the royal medical services in Jordan

To describe the practice and efficacy of intrauterine balloon tamponade catheter in two obstetric units and to highlight uterine tamponade as an integral part of the management options of severe post partum hemorrhage in labour ward. Fourteen cases of severe post partum hemorrhage had persistent bleeding despite the available conservative measures. At this point, the Bakri balloon [Cook Medical] was inserted into the uterine cavity. The balloon was inflated with 300-500 ml of normal saline and left for a maximum of 24 hours, when it was gradually deflated. The procedure was covered by cefoxitin [Mefoxin] 1g three times daily for 48 hours. Simple descriptive statistics [mean, frequency and percentage] were used to describe the study variables. The mean age was 28 [21-35] years. Six patients were primigravidas [43%]. The causes of post partum hemorrhage were as follows: Six cases of uterine atony, six cases of placenta praevia accreta and two cases of fibroids. Eight cases followed cesarean section and six cases followed vaginal delivery. The average blood loss was 1.9 L [1.5-3.5 L]. In total, 59 units of whole blood, 45 units of FFP and 22 units of platelets were given. On average each patient received 4.2 units of blood, 3.2 units of Fresh frozen plasma and 1.6 units of platelets. Two cases had evidence of disseminated intravascular coagulation and received Factor VII [two doses each]. The balloon was inflated to an average of 420 ml of Normal Saline [300-500 ml] according to uterine capacity. In 12 cases [86%], the trial was successful and no further surgery was required. In two cases [14%] the trial failed and both of these women underwent hysterectomy. No cases of endometritis were reported in hospitalized patients or on follow up one week after discharge. Intrauterine balloon tamponade is a valid alternative to less conservative surgical procedures in managing women with post partum hemorrhage. It is easy, safe, and effective and preserves fertility. It should be an integral part of labour ward protocols for management of post partum hemorrhage. Suitable catheters should be available on the labour ward theatres

Intravenous iron sucrose ersus blood transfusion in the management of symptomatic post partum iron deficiency anaemia

To compare the efficacy and safety of intravenous iron with blood transfusion in post partum women with symptomatic iron deficiency anaemia. Ninety women were included in the study. The inclusion criteria were: hemoglobin <9g/dl and/or haematocrit <28%, mean corpuscular volume <80fl, ferritin level <15ng/ml, and symptoms of anaemia within 48 hours of delivery. Women with postpartum haemorrhage and haemodynamic instability were excluded. Women were divided into two groups, group B received blood transfusion and group I received intravenous iron sucrose [400mg infusion in 250ml Normal Saline over half an hour] [Venofer, Vifor St Gallen's, Switzerland]. The outcome measures were relief of symptoms of anaemia. Hemoglobin, haematocrit, mean corpuscular volume and ferritin levels were measured before and one week after the treatment. The two groups were comparable in terms of age, mode of delivery and symptoms. Group B had a mean age of 31.1 years [22-39] vs. 32.3 years [20-43]. Twenty four women from group B had C/S vs. 23 women in group I. However, women in group B had a lower baseline mean hemoglobin [6.8 g/dl [4-8] vs. 7.7g/dl [6.1-9 g/dl] and lower haematocrit [23.2%[18-26] vs. 25.3%[18-28]. At one week post treatment the mean rise in hemoglobin was 2.35 g/dl [34%] in group B vs. 2.15g/dl [27%] in group I. The mean rise in haematocrit was 7.0% and 6.3% respectively. The mean rise in ferritin level was higher in group I [220%] vs. 150% in group B. Symptoms relief occurred in 29 cases in group B and in 28 cases in group I. No serious side effects occurred in either group. Intravenous iron sucrose is an effective and safe treatment for postpartum iron deficiency anaemia. It is hoped that this treatment will reduce the need for blood transfusion

Neural tube defects at prince Rashid Bin Al-Hassan Hospital

To determine the frequency of neural tube defects among patients who were delivered at Prince Rashid Bin Al-Hassan Military Hospital and to discuss possible ways to reduce them. This descriptive review study of 11,852 medical records was conducted over a period of two years between the 1[st] of August 2005 and end of July 2007 at Prince Rashid Bin-Al-Hassan Military Hospital in Irbid-Jordan. During the study period, there were 17 cases of neural tube defects [1.4/1000 births], of these there were five cases of spina bifida [0.42/1000 births], three cases of encephalocele [0.25/1000 births], and nine cases of anencephaly [0.76/1000 births]. The overall female to male ratio was 1: 0.89. The most common neural tube defect was anencephaly [52.9%], and the commonest site of spina bifida was the lumbosacral region in 2/5 [40%]. One case of encephalocele was associated with malformations while four cases [80%] of spina bifida were associated with other malformations. The frequency of neural tube defects is high and probably on the decreasing in Jordan. We may be able to reduce such defects by recommending women of childbearing age to take daily Folic acid [400mcg] for at least three months before they become pregnant and throughout the first trimester

Multiple cesarean section. the impact on maternal and fetal outcome

To evaluate the complications, and to determine maternal and fetal risks in women who undergo 3 or more cesarean sections [CS], compared to those with one or 2 cesarean deliveries. A retrospective analysis of 2276 CS performed between 1 January 2003 and 31 April 2005. We divided patients into 3 groups: Group 1 = with 1 previous CS [n=1183]; Group 2 = 2 previous CS [n=781]; and Group 3 = >3 previous CS [n=312]. Compared to women with one or 2 cesarean deliveries, women who had >3 CS show significant increase in terms of prolonged operative time, uterine scar dehiscence, uterine rupture, placenta previa, placental adherence, and mild adhesion formation. We found no significant differences between the 3 study groups in terms of injury to surrounding structures, need for blood transfusion, anesthesia complications, hematoma formation, thromboembolism, and incisional hernia. Apgar score >7 at one and 5 minutes, neonatal intensive care unit, multiple pregnancy rate, premature delivery rate and perinatal death rate, all were similar in the 3 groups. Women with multiple CS [>3] are significantly prone to have uterine scar rupture and abnormal placentation in the subsequent pregnancies compared to those with one or 2 previous cesarean deliveries. Despite that, maternal and neonatal outcome did differ from patients with lower-order cesarean sections