Child birth; comparison of complications between lithotomy position and squatting position during

The purpose of the study was to compare the complications of delivery in squatting and lithotomy position of mother. Randomized controlled trial. Gynecology/Obstetrics Unit-II, Sandeman Provincial Teaching Hospital, Quetta. 6 months [05 Oct, 2011 to 05 April, 2012]. Hundred and fifty one patients with lithotomy position in delivery were compared with hundred and fifty one patients with squatting position in delivery regarding risks of perineal tears, periurethral tear, extended episiotomy, instrumental delivery, caesarean section and primary postpartum hemorrhage. Data was recorded on a specially designed Performa and was analyzed by using SPSS.V. 10. Results were compared using Chi-square test by keeping the p-value of < 0.05 as significant. 151 patients in lithotomy position and 151 patients in squatting position were compared and studied for complications during delivery. Extension of the episiotomy was observed in [7%] of non-squatting groups. There were no extensions of episiotomy in squatting group. There were no second degree, or third degree perineal tears in squatting group which were encountered in [9%] patients in the lithotomy position group [P<0.05]. Forceps application was also less in squatting position group 11% patients, whereas 24% patients were delivered by forceps in lithotomy group, [P<0.05]. One patient in the lithotomy position had to have a caesarean section due to persistent occipito-posterior position. There was no case of retained placenta or postpartum hemorrhage in squatting group whereas there were 4% cases of retained placenta and 1 case of postpartum hemorrhage due to atony of the uterus in lithotomy position group. It appears that the routine use of lithotomy position may have some disadvantages in terms of more instrumental deliveries and episiotomies. Moreover women experience significant pain in this position. It is suggested that more trials should be conducted and the position at the moment of birth should be registered to measure its influence on birth outcome

Atonic uterus; risk factors and management as a cause of primary postpartum hemorrhage

This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage [PPH] and to point out risk factors for it and observe different ways of management for control of atonic primary [PPH]. Prospective cross sectional study. This prospective cross sectional study was conducted in Obstetrics and Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 [one year]. The study was conducted on 80 patients. The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done. All the data was analyzed by SPSS version 10. Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony [37.5%] was found in women aged 26-30 years, followed by [27.5%] women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 [56.3%], 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins [PGF2-alpha and PGE2] were administered in 32 cases and successful in 22 [68.7%] cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled [62.5%]. Ligation of uterine arteries was performed in 5 cases, it proved successful in 4[80%] and hysterectomy was done in 7.5% cases. Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg and prolonged labour