comparison of placental removal methods on operative blood loss

On an average 1 litre of blood is lost during Caesarean Section. Many variable techniques have been tried to reduce this blood loss. Many study trials have shown the spontaneous delivery of placenta method to be superior over manual method because of reduced intra operative blood loss and reduced incidence of post operative endometritis. The main objective of our study was to compare the risk of blood loss associated with spontaneous and manual removal of the placenta during caesarean section. Quasi Experimental. September 2004 to September 2005, a 13 months study at Islamic International Medical Complex Islamabad. This study was conducted at Department of Obstetrics and Gynaecology, Islamic International Medical Complex, Islamabad from September 2004 to September 2005. All Women undergoing elective or emergency caesarean section were included in the study. Exclusion criteria were pregnancy below 37 weeks, severe maternal anemia, and prolonged rupture of the membranes with fever, placenta praevia, placenta accreta and clotting disorders. Patients were allocated to the two groups randomly. Group A comprised of women in whom the obstetrician waited a maximum of 5 minutes till the placenta delivered spontaneously. In group B the obstetrician manually cleaved out the placenta as soon as the infant was delivered. The primary outcome measures noted were difference in haemoglobin of >2 gm/dl [preoperatively and postoperatively], time interval between delivery of baby and placenta, significant blood loss [>1000 cc], additional use of oxytocics, total operating time and blood transfusions. Data was analysed by SPSS. Statistical tests used for specific comparison were chi 2-test and Student's t-test. One hundred and forty-five patients were allocated to two groups randomly. Seventy-eight patients were allocated to group A and 67 patients allocated to group B. Mean maternal age, birth weight, and total operating time were the same in two groups, but blood loss as measured by a difference in haemoglobin of greater then 2 grams/dl was statistically significant. Significant blood loss [>1000 cc] and time interval between delivery of infant and placenta were also statistically significant between the two groups. Spontaneous delivery of placenta has significant reduction of blood loss as compared to manual removal at caesarean section

Do cardiotocographic changes alone determine fetal outcome?

To compare fetal outcome in fetal distress on CTG with clear liquor versus CTG changes of fetal distress with meconium stained liquor. A cross sectional study. The Department of Obstetrics and Gynecology Islamic International Medical Complex. September2004 to December 2005[16 month]. During the study period 111 patients delivered in which fetal distress was diagnosed clinically and on cardiotocography [CTG]. Vaginal delivery [spontaneous or instrumental] was accomplished in 17 [15%] patients while the rest of 94 [85%] patients underwent emergency caesarean section for fetal distress. Irrespective of the mode of delivery, the patients were divided into two Groups; Group A and Group B. Group A comprised of those patients who had fetal distress on CTG with clear liquor and Group B included those patients who had fetal distress on CTG along with meconium staining of liquor. There were 67 patients in Group A and 44 patients in Group B. Out of the 94 patients who underwent caesarean section, 57 patients were operated for fetal distress on CTG with clear liquor and 37 patients had CTG changes with meconium staining of liquor. CTG changes noted included loss of beat to beat variability, tachycardia, bradycardia and decelerations. Demographic details noted were maternal age, parity, fetal weight and mode of delivery. Main outcome measures noted were CTG, Apgar score at 1 and 5 minutes, baby resuscitation measures and neonatal complications. The main outcome measures were expressedas numbers and percentages. Mean maternal age in Group A and Group B was 26.10 years and 25.57 years respectively Mean gestational age was 38 weeks in Group A and 39 weeks in Group B. Birth weight was 3.2 kg and 3.1 kg in Group A and Group B respectively. Main outcome measures showed more variable and late decelerations, [23% vs 8%] more babies with lower apgar scores [18% vs 6%] and more neonatal complications in Group B. There were two neonatal deaths in Group B. Meconium staining with CTG changes is a more significant sign of fetal distress than CTG changes alone

Suppression of pre-term labour with salbutamol [ventolin]

Over a period of nine months, 33 patients with pre-mature labour were treated with salbutomal, for it's sympthomymetic effect. Seventeen patients [51.1%] required intravenous infection for 24 to 48 hours to suppress acute episode of pre-term labour while in 16 patients [48.9%] uterine contractions stopped with oral therapy only. All patients however required salbutomal tablets as maintenance therapy till 37 weeks of gestation. The results showed that this therapy was successful in lengthening gestation for a period of more than weeks in 79% of cases [26 patients], whereas the therapy was prolonged for 8 to 12 days in 15% of cases [5 patients]. The absolute failure rate was 6% [2 patients] only