ABSTRACT
Background: Globally and especially in the under developing nations Postpartum Hemorrhage (PPH) is the most common cause of maternal mortality. All women who deliver are at risk of complications of third stage of labor. Multiple researches have been done to compare active vs expectant management of third stage of labor. Placental Cord Drainage (PCD), one of the active method for control of third stage of labor, incudes opening of clamp from mother’s side of umbilical cord thereby allowing the blood from placenta to flow freely immediately after clamping and cutting of the umbilical cord. Aim: Thus, the following study was conducted to assess the effect of PCD via umbilical cord in decreasing the time period of third stage of labor and incidence of PPH. Materials and Methods: This hospital based comparative study was conducted in the department of Obstetrics and Gynecology, National Institute of Medical Sciences & Research, Jaipur. A total of 300 consecutive patients with term pregnancy (>37 weeks) fulfilling the inclusion criteria were taken after informed consent. These were divided into two groups of 150 cases each, study group (PCD group) and control group. The various parameters like blood loss, need for transfusion, duration of third stage of labor, manual removal of placenta, hospital stay, secondary PPH (after 24 hours and before 6 weeks) were noted for every female. Statistical analysis was done using t-test for quantitative data, nonparametric data was analyzed by Mann Whitney test and categorical data was analyzed using chisquare test. The significance threshold of p-value was set at <0.05. All analysis was carried out by using SPSS software version 21. Results: Average blood loss was significantly less in subjects of drainage group as compared to control group (273.8 ml vs 391.2 ml; p<0.05). Also, average duration of third stage of labor was significantly less in drainage group (4.1 vs 7.7 mins; p<0.05). No difference was observed between two groups based on placenta weight (p-0.121). Conclusion: In the present study, PCD had a beneficial effect on the duration of third stage of labor and on postpartum blood loss. Thus, use of PCD is recommended in active management of labor by trained professionals
ABSTRACT
Background: : The quest to improve diagnostic and therapeutic capabilities has led to the widespread acceptance of modern gynaecological endoscopy. Hysterolaparoscopy is a basic skill in the advanced scientific era and an effective and safe tool in comprehensive evaluation of infertility with an added advantage of treatment of some pathologies in same sitting. Methods: This clinical study is a prospective study of 100 selected cases of infertility. Patients who fulfills the inclusion and exclusion criteria were subjected to diagnostic laparoscopy and hysteroscopy in NIMS Infertility and Research centre, Jaipur over a period of one and half years from Jan 2014 – June 2015. Observation of pelvic and intrauterine cavity and chromopertubation test was done under general anaesthesia during hysterolaparoscopy. Surgical interventions were carried out whenever required and further treatment plan was decided. Results: A total of 100 women underwent hysterolaparoscopy. Age ranged from 21 to 40 years and mean age was 30.03 years. Prevalence of primary infertility was 64% and of secondary infertility was 36%. Among cases with primary infertility commonest pathology responsible were ovarian 20 (31.25%) followed by unexplained 19 (29.69%), uterine 11 (17.18%), tubal 8 (12.50%) and peritoneal 8 (12.50%) whereas in secondary infertility commonest pathology responsible were uterine 14 (38.88%), followed by tubal 13 (36.11%), peritoneal 9 (25%), ovarian 8 (22.22%) and unexplained being the least 2(5.55%). Therapeutic procedures were performed in the same sitting amongst 84.61% cases with primary infertility and 92% cases with secondary infertility.Conclusion: When done by experienced hands, with proper selection of patients, hysterolaparoscopy is an indispensable tool which can be considered as a definitive day care procedure for evaluation and treatment of female infertility.