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
Background: Hypertensive disorders of pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy, proteinuria and in some cases convulsions. The most serious consequences for the mother and the baby result from pre-eclampsia and eclampsia. These are associated with vasospasm, pathologic vascular lesions in multiple organ systems, increased platelet activation and subsequent activation of the coagulation system in the micro-vasculature. It is a multisystem disease and many theories are proposed for pathophysiology. So there is a constant search for better prognostic factors to predict the progression and severity of disease. The fall in platelet count is most frequently found in preeclampsia and is probably due to consumption during low grade intravascular coagulation. The major adverse outcomes of pre-eclampsia and eclampsia include central nervous system injuries such as seizures (eclampsia), ischemic heart disease, stroke, type II diabetes, and venous thromboembolism hemorrhagic and ischemic strokes, hepatic damage, HELLP syndrome, renal dysfunction as well as increased frequency of cesarean delivery, preterm delivery, and abruptio placenta, in comparison with women without history of the disease.Methods: Total 100 subjects, 50 control and 50 cases were taken for study. Samples for platelet count were collected and estimation was carried out by the auto-analyzers. The statistical evaluation is done using SPSS version 22 along with Anova and student t-test.Results: There was a significant difference in platelet count in patients with preeclampsia as compared to control group. Mean platelet diameter was significantly increased in cases with preeclampsia.Conclusions: Thrombocytopenia is directly proportional to the severity of PIH. Platelet count less than 1 lakh/cumm indicate increasing risk of DIC and HELLP syndrome. In this study we noted significant association was established when the platelet counts of PIH cases were compared with the normotensive control patients. Strong association was made out between the platelet count and MPD and MPV and the severity of PIH.