Clinical profile of maternal deaths due to postpartum haemorrhage

Background: Postpartum haemorrhage is one of the dreadful complications that occur during delivery. It is often un-anticipated and occurs suddenly and un-expectedly. It is responsible for 20 percent of maternal deaths in developing countries. These deaths are largely preventable. The objective of the study was to find out the clinical profile, associated co-morbid conditions and contributory factors and treatment modalities used in the management.Methods: Retrospective observational study of maternal deaths due to postpartum haemorrhage (PPH) was carried out at tertiary care hospital. The data of maternal deaths for seven years from year 2013 to 2019 was reviewed, compiled and analyzed to draw conclusions.Results: There were 18 maternal deaths (19%) due to PPH out of total 86 maternal deaths. The average age of the woman who died due to PPH was 24 years. Ninety five percent of the cases of PPH were due to atonic uterus. Seventy percent of the cases had reported in advanced stage of shock with average blood loss of more than two to three litres. Poor general condition due to delay in reaching to tertiary care hospital was predominant feature. Sixty percent women underwent obstetric hysterectomy. Massive blood transfusion was given in fifty percent cases. Severe pregnancy induced hypertension, severe anaemia and severe concealed accidental haemorrhage were common associated factors in sixty percent of maternal deaths.Conclusions: Postpartum haemorrhage is still a common cause of maternal death. Early detection, prompt aggressive management, adequate blood replacement, use of uterine balloon tamponade and non-pneumatic anti-shock garment, timely transfer to higher centre and timely decision for surgical interventions can prevent maternal deaths.

Use of non-pneumatic anti shock garment in hemorrhagic shock

Background: Non-pneumatic anti-shock garment (NASG) is a first-aid device that reverses hypovolemic shock and decreases obstetric haemorrhage. It consists of articulated neoprene segments that close tightly with Velcro, shunting blood from the lower body to the core organs, elevating blood pressure and increasing preload and cardiac output. The use of an NASG can stabilize a patient while awaiting transport, during transport, or during delays in receiving care at referral facilities.Methods: A prospective observational study of use of non-pneumatic anti shock garment (NASG) in cases with obstetric hemorrhagic shock was carried out at a tertiary referral center. As soon as severe shock was recognized in the hospital, the anti-shock garment was placed. Data on various parameters related to use of NASG was collected and interpreted to draw conclusions.Results: NASG was used in 25 cases of hemorrhagic shock during one-year period. Post-partum hemorrhage (36%) was the commonest indication for NASG use, followed by ruptured tubal ectopic pregnancy (28%). It was observed that 68% and 32 % of women had shock index of 1-1.5 and above 1.5 respectively at the time of application of NASG. The shock index rapidly improved to 0.5-0.9 in 92% and 1-1.5 in 8 percent of cases respectively after the application of NASG. The NASG was mainly used in labour room (40%) and emergency department (36%).  NASG was applied by nurses and doctors together in 64% of cases. NASG was kept for a period 24 hours in 92% cases. The survival rate was 96% following use of NASG.Conclusions: NASG is a temporizing alternative measure in hemorrhagic shock management that shows a trend to reduce hemorrhage related deaths and severe morbidities. NASG should be made available at all health facilities that deal with high risk pregnancies and deliveries.

Re-orientation of gynaecology residents on pelvic surgical anatomy using human cadaver.

Background and Objectives: The residents of gynaecology should have sound knowledge on pelvic anatomy and have to be adequately trained on common surgical procedures. The training programme was conducted in the dissection hall of Anatomy department of Rural Medical college Loni .During residency, they may not receive adequate training on common surgical procedures for various reasons like shortage of cases, infrequent performance of certain procedures, inability of the faculty to give time ,attention for training in OT and fear of possible complications and medico legal litigations. Material and methods: Twelve residents in Gynaecology and two senior faculty members each from the department of Gynaecology and Anatomy participated in training programme. Five training sessions of dissection of a single human female cadaver ,each lasting for two and half hour duration, were conducted. Pretest and post test were performed with prevalidated and pre tested questionnaire and results compared to assess the impact of training. Level of satisfaction of residents about this innovative method of teaching and training was assessed through 7 point Likert scale. Results: Training programme resulted in significant improvement in the residents knowledge on pelvic surgical anatomy and common surgical gynaecological Procedures. Faculty members identified new insights into the interdisciplinary process of teaching . Conclusion: Surgical training using human cadaver was effective and feasible .It made the teaching process interactive and interesting. Residents expressed happiness about the innovative method of teaching.