RESUMEN
An ideal contraceptive is the one having features like being safe, effective, acceptable, inexpensive, reversible, simple to administer, independent of coitus, long lasting and requires little or no medical supervision.(1) Couple protection rate (CPR) of India currently is 54.8% among the eligible couples in the age group of 15-44 years.(2)In view of low CPR, National Health Mission has intensified the PPIUCD program. According to India’s Vision FP 2020’, emphasis is laid on training of more nurses to deliver the service in a 24 hour mode to the women opting for the method. In addition to this, women are highly motivated and most receptive towards family planning during the postpartum period but dilemma and conflict begins if any complication is met with, as in this case scenario.Intra-Uterine Copper Device (IUCD) is a safe, reversible and a cost-effective long-term contraceptive method. According to the WHO Eligibility criteria, post-placental and immediate Postpartum Intra uterine Copper Device insertion is done immediately after delivery of the placenta, within ten minutes to 48 hours respectively.(3) In a study, it was shown that IUCD insertion rate was as high as 95% in patients willing for immediate postpartum insertion, as compared this rate declined to only 45% in those consenting for a later insertion.(4)Although this method provides effective contraception, it is associated with complications, with uterine perforation being the rare but potentially devastating complication that can cause severe morbidity.(5) There are many incidences reported of uterine perforation due to postpartum IUCD insertion after interval IUCD technique, but none reported after post-placental or immediate postpartum IUCD insertion. We present a case report of uterine perforation after post-placental IUCD insertion.
RESUMEN
Arterial ulcers are caused by inadequate perfusion of skin and subcutaneous tissues. The key treatment is correcting the underlying medical problem and re-perfusion of the affected tissue. Interventional procedures like angiography, transluminal angioplasty, and stenting have hazards like bleeding, hematoma formation, false aneurysm formation etc. This study was conducted to investigate the effect of platelet-rich plasma (PRP) on the rate of healing of peripheral arterial wounds. MethodsA randomized controlled trial was conducted with 80 participants admitted with peripheral arterial disease in Acharya Vinoba Bhave Rural Hospital, Wardha district, Maharashtra, from September 2017 - August 2019. Data was entered into MS Excel and was analysed for descriptive statistics. 40 patients each were allotted randomly to control group and treatment group. In the control group, conventional dressings was done with hydrogen peroxide and betadine. Wounds were treated with PRP infiltration in the treatment group. Outcome was compared between both groups. ResultsMean surface area of wound in control group reduced from baseline 2262.5 mm2 to 1758.4 mm2 (29.89% reduction) in ulcer surface area, and 2298.9 mm2 to 1158.1 mm2 (66.22% reduction) in treatment group (p= 0 at the end of study) at the end of two months. Standard deviation of the same (Control: 1739.2 mm2 to 1566.3 mm2 vs Treatment: 1906.5 mm2 to 1402.4 mm2). Rate of epithelization was faster in treatment group (8.92 mm2/day vs 17.27 mm2/day, p=0 at the end of study). PRP resulted in early healing of ulcers with earlier reduction in wound surface area. ConclusionsPRP is an effective method for healing of wounds resulting from peripheral arterial disease.