ABSTRACT
To determine the frequency, risk factors and existing practice for the management of massive primary postpartum hemorrhage [PPH]. Retrospective cross-sectional study. Department of Obstetrics and Gynaecology at Kuwait Teaching Hospital, Peshawar. this study was performed from June 2008 to June 2010. Women who developed massive primary PPH after admission or were admitted with it, were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum hemorrhage, supportive medical and surgical intervention. Data was entered in the pre-structured proforma. Estimates of blood loss were made on history, visual parameters and patient's condition. All the data was analyzed by using statistical computer soft ware SPSS 6. During the study period total number of obstetrical admissions were 2944. Forty nine out of 2769 [1.76%] deliveries, developed massive primary PPH. The highest frequency of massive primary PPH was observed in grand multiparous patients. Uterine atony was the most common cause of the complication. Birth attendants other than doctor and delivery outside the study unit were significantly associated with the adverse outcome in these patients. Seventy five percent patients,[36/49] who had massive PPH, delivered vaginally. High dependency unit [HDU] was required in 12% [6/49] of women. Only one caesarian hysterectomy was done. There was one maternal mortality. Blood transfusions were required in 82% [40/49] of the patients. Postpartum hemorrhage can be a preventable condition if early identification and timely management of this complication and its risk factors is observed. Uterine atony is the leading cause of immediate PPH. The main risk factors for PPH due to uterine atony are high parity, a large fetus, multiple fetuses, hydramnios, or past history of PPH. Determining the frequency, risk factors and management of primary postpartum hemorrhage will help design stepwise protocols for prevention and management of primary PPH in our setup
ABSTRACT
To determine the frequency of G6PD deficiency in the etiology of anaemia and jaundice and to determine the most common age of presentation with anaemia and jaundice due to G6PD deficiency in adults. We did a hospital based study in the department of Medicine Khyber Teaching Hospital Peshawar from June 2003 to December 2003. The data of adult patients with signs and symptoms of anaemia and jaundice was collected on structured proforma. The clinical presentation and laboratory investigation results were documented. Out of 200 patients studied, 24 [12%] patients were found to be deficient in G6PD enzyme. The male to female ratio was 21:3 [87.5% and 12.5%] respectively. The age of appearance of jaundice in adults varied [most common age from 13 to 17 years]. The most common signs and symptoms were jaundice, anaemia and haemoglobinuria. All G6PD deficient patients except one recovered spontaneously when the offending precipltating factor were stopped or treated. One [0.5%] died because of rapid fall of haemoglobin and delayed recognition of the condition and subsequent blood transfusion. G6PD deficiency is not an uncommon cause of jaundice and anaemia in our patients. The jaundice due to G6PD mainly affects the adults in 2nd or 3rd decade. Therefore all the children and adults with jaundice and anaemia should be screened for G6PD status