ABSTRACT
Objective: Aim of the study was to control life threatening post partum haemorrhage [PPH] in women till blood and blood products were made available or the women transferred to a better equipped centre
Study Design: A prospective interventional consecutive case series
Place and Duration of Study: It was conducted in three hospitals; Heavy Industries Taxila [HIT] hospital Apr 2005 to Sep 2010, Pakistan Ordinance Factories [POF] hospital Wah cantt Oct 2011 to Dec 2014 and Combined Military Hospital [CMH] Tarbela Dec 2014 to Dec 2015
Material and Methods: Abdominal binder was used in 22 consecutive women, having moderate to severe primary PPH due to uterine atony, where despite uterotonics [i.v oxytocin, rectal misoprostol] and bimanual compression, uterine tamponade was performed but complete control of haemorrhage was not achieved. Protocols for the treatment of obstetric haemorrhage and hypotensive shock were observed, including administration of intravenous crystalloid fluids and blood transfusion. If required, surgery was performed in the form of uterine arteries ligation or B-Lynch sutures. Obstetric hysterectomy was performed to save the woman's life if conservative procedures failed
Results: Bleeding and hypotension were controlled successfully in 19 [86.4%] of these women. In 03 [14.6%] women, bleeding persisted and so hysterectomy had to be resorted to. There was no maternal mortality. At 06 weeks postnatal follow up, none of the patients were found to suffer from long term debility; physical or psychological
Conclusion: Abdominal binder was found to be very effective in controlling bleeding and hypotensive crisis due to significant PPH due to uterine atony, as an adjunct to uterine tamponade
ABSTRACT
To assess the role of vaginal misoprostol in cervical ripening in term pregnancies with minimum effective dose, and evaluating any side effects or complications in the mothers and fetuses in comparison with a placebo group. Experimental study. This study was conducted at Heavy Industries Taxila [HIT] hospital, Taxila, from July 2002 to May 2004. Cervical ripening was done in term pregnancies in 307 women with vaginally placed misoprostol. All subjects were monitored closely in labour using partograms. Fetal heart rate monitoring was done by intermittent auscultation using sonic aid / fetoscope. Control group consisted of 103 women. They were given no treatment. The subjects were randomly selected. Cervical ripening occurred in 99% of the 307 women in the experimental group. Induction-delivery time reduced significantly. Uterine hyperstimulation was not observed in any case. There was no marked difference in instrumental vaginal delivery in either group. Caesarean section rate was significantly reduced in the experimental group. 92.5% delivered vaginally while 7.5% underwent caesarean section. In the control group, 87.12% women delivered vaginally while 12.88% delivered by caesarean section. There were no significant side effects or complications in subjects or fetuses. The results prove that it is the safest and the most effective labour inducing agent to date. The dose in which it was used in the stud, is the optimum dose for its use vaginally. It achieved maximum results with minimal side effects in the mother and the fetus. Low cost, easy availability, stability at room temperature and excellent results give it an advantage over other induction agents