Bakri postpartum balloon: an obstetrician’s armamentarium in managing post-partum haemorrhage

Background: Post-partum haemorrhage (PPH), an obstetric emergency that can complicate vaginal or cesarean deliveries and associated with serious complications. Guidelines for the management of PPH involve a stepwise escalation of pharmacological and eventual surgical approaches. In women who do not respond to uterotonics or medical treatment, a variety of procedures, such as arterial embolization, surgical ligation of the uterine arteries or obstetric hysterectomy, may be used. The Bakri balloon is an intrauterine device indicated to reduce or control PPH temporarily when conservative treatment is warranted. Here, we are presenting case series of primary atonic PPH and which were managed by Bakri Balloon Tamponade (BBT).Methods: This case series included five women with PPH managed by Bakri balloon as a conservative therapeutic option.Results: All five women were in age group between 23 years to 34 years. The causes of PPH were uterine atony, retained placenta and central placenta previa. The Bakri balloon was successful in controlling hemorrhage in all women (five of five) who did not respond to medical uterotonic treatment.Conclusions: Bakri balloon is a simple, easy to use and effective method for conservative management of acute PPH. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.

Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun, India

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.

Broad ligament ectopic pregnancy: a dilemma to diagnose

Broad ligament ectopic pregnancy is a rare and serious form of extrauterine pregnancy with a high risk of maternal mortality. There are no specific clinical features. Ultrasonography may help in diagnosis, but definitive diagnosis is made only during surgery. Authors are reporting a case of 30 years female G3P1L1A1 seven weeks pregnancy with previous lower segment cesarean section and previous history of right sided salpingectomy with no complaints. Ultrasound was advised to know the location of sac this time, in which, she was diagnosed as a case right sided unruptured live ovarian ectopic pregnancy. On examination, signs and symptoms of ectopic pregnancy were absent. On laparoscopy, she was diagnosed as a case of right sided live unruptured broad ligament ectopic pregnancy as her right ovary was absent because of previous surgery.  With advances in sonography and laparoscopic skills, more cases can be diagnosed in the first trimester and can be safely managed laparoscopically.

prospective study of immediate postpartum intra uterine device insertion in a tertiary level hospital.

Background: In India there is an unmet need for contraception. Intrauterine device is a long acting reversible method. This study was done to determine the efficacy and safety of immediate Post-Partum Intrauterine Device (PPIUD) and to compare the outcome of PPIUD insertion after vaginal delivery and caesarean section. Methods: A total of 113 women who underwent PPIUD insertion were followed up at 6 weeks and 6 months post-partum. Outcome in term of side effects, removal and expulsion was compared in vaginal delivery and caesarean section insertions. Results: In 61.45% women there was no complaint. Menstrual disturbances were found in 16.66% women and pelvic pain in 13.54% women. The expulsion rate was 5.20% and IUD removal was done in 13.54% women. Incidence of removal was more in vaginal insertions than in caesarean insertions and this difference was statistically significant. Continuation rate at 6 months was 81.25%. Conclusion: Immediate postpartum IUD insertion is a safe, convenient and effective method.

Colposcopic evaluation of cervical lesions: a prospective study.

The present study was undertaken to evaluate the role of colposcopy as a screening and diagnostic tool for cervical cancer and other cervical lesions in high risk women. Methods: All the women included in the study were subjected to colposcopic examination. Colposcopic findings were compared with cytology and histopathological examination. Accuracy of colposcopic examination was calculated by standard statistical methods. Sensitivity, specificity, Positive Predictive Valve (PPV) and Negative Predictive Valve (NPV) of colposcopic examination was calculated. Results: Three hundred patients underwent colposcopic examination. The overall sensitivity and specificity of colposcopy was 85.85% and 87.65% respectively. Positive predictive value was 75.83% and negative predictive value was 95.38%. The percentage of false negative as well as that of false positive was calculated to be 13.74%. The accuracy of colposcopy was found to be more for high grade lesions as composed to low grade lesions. Conclusions: Colposcopy gives immediate and accurate results and its value as diagnostic modality is undisputed. It should also be considered as a primary screening test for high risk women living in remote areas where women cannot visit the doctor repeatedly as the ideal screening triage cannot be implemented in such situations.