ABSTRACT
Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.
ABSTRACT
Placement of CVC can lead to complications such as, malposition of the catheter and complications relating to perforation and/or injury of nearby blood vessels and structures. We present a case report is about malposition of central venous catheter (CVC) from right internal jugular vein (IJV) into right subclavian and axillary vein. It is advisable to check free venous outflow in all the ports of CVC, central venous waveform should obtained with transducer in place and following placement of CVC catheter, chest radiograph should be completed to confirm the position.
ABSTRACT
Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass (CPB) circuit is one of the important reasons for blood transfusion in cardiac surgery, especially in patients with low body surface area (BSA). A prospective study was performed to investigate the technique of intraoperative blood donation (IAD) and retrograde autogous priming (RAP) to limit haemodilution and transfusion requirements. Forty patients with low BSA (<1.7m2) undergoing primary valvular cardiac surgery were assigned to either RAP group or a control group (C). The RAP group (n=20) was subjected to IAD by collecting a calculated volume of blood (272+/-44.3 mL) after induction of anaesthesia. Prior to initiation of CPB the prime volume was reduced by discarding some of it and the CPB reservoir was filled retrogradely through the aortic cannula draining 482+/-78.4 mL of blood. In group C (n=20) only IAD was carried out collecting 295.0+/-62.6 mL of blood. Anaesthetic technique was similar in both groups. Strict transfusion thresholds were observed. There were no significant difference between the groups with respect to baseline characteristics, BSA, type of procedure, perfusion technique and haematologic profile. The haematocrit on CPB was significantly higher in the RAP group as compared with group C (24.2+/-1.3% and 22.1+/-2.5% respectively, p=0.009). Transfusion of allogenic blood during and after surgery was significantly lower in the RAP group (143.6+/-117mL) versus 405.2+/-358.1mL in group C (p=0.02). Postoperative chest tube drainage was 218+/-67.4 mL in the RAP group and 300+/-191 mL in group C which was not significantly different (p=0.18). The technique of intraoperative autologous donation and retrograde priming is simple, safe and cost effective procedure for blood conservation in patients with small BSA undergoing primary valvular surgery.