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Objective:To explore the application effects of a new self-designed device for measuring postpartum blood loss in women with postpartum hemorrhage after vaginal delivery, so as to provide a basis for early identification and treatment of postpartum hemorrhage.Methods:The research was a quasi-experiment study. A total of 12 824 women who delivered vaginally in Women's Hospital of Nanjing Medical University from July 2021 to June 2022 were conveniently selected. Among them, the pregnant women enrolled from January to June 2022 were selected as the experimental group, and the pregnant women enrolled from July to December 2021 were included in the control group, with 6 412 cases in each group. The self-designed new postpartum blood loss measuring device was used to evaluate the blood loss in the experimental group, while the traditional blood collecting basin was taken in the control group.The differences between the two groups in the assessment error of 24 hours postpartum blood loss, postpartum blood loss at 2 hours and 24 hours, postpartum hemorrhage rate, severe postpartum hemorrhage rate and midwives′ satisfaction with the assessment of blood loss were compared.Results:The assessment error of 24 hours postpartum blood loss in the experimental group was 180.00 (80.00, 300.00) ml, which was lower than 192.00 (80.00, 310.00) ml in the control group, and the difference was statistically significant ( Z = - 2.04, P<0.05). The postpartum blood loss at 2 hours and 24 hours in the experimental group was 312.00 (290.00, 330.00) ml and 415.00 (385.00, 440.00) ml, respectively, which was higher than 310.00 (280.00, 330.00) ml and 407.00 (380.00, 435.00) ml in the control group, and the differences were statistically significant ( Z = - 9.86, - 5.42, both P<0.001). The rates of postpartum hemorrhage and severe postpartum hemorrhage in the experimental group were 6.50% (417/6 412) and 2.21% (142/6 412), respectively, higher than 4.71% (302/6 412) and 1.59% (102/6 412) in the control group, and the differences were statistically significant ( χ2 = 19.49, 6.69, both P<0.05). Midwives′ satisfaction score with the assessment of blood loss in the experimental group was (18.17 ± 1.02) points, higher than that in the control group (17.78 ± 1.17) points, and the difference was statistically significant ( t = 2.33, P<0.05). Conclusions:The use of a new device for measuring postpartum bleeding during vaginal delivery can reduce errors in evaluating postpartum blood loss within 24 hours, improve the detection rate of postpartum hemorrhage and severe postpartum hemorrhage, and midwives are satisfied with it.
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Background: Abnormal uterine bleeding (AUB) is a common gynecological disorder among women of reproductive age, interfering with their day-to-day activity. A better understanding of commonly used drugs in the medical management reduces the need of unnecessary surgical procedures and benefits both the patient and health-care providers. Aims and Objectives: This study aims to study the patient characteristics and prescription pattern in the medical management of AUB and to assess the menstrual blood loss by pictorial blood loss assessment chart (PBAC) and the association between different treatment groups with PBAC score. Materials and Methods: A cross-sectional study was conducted at gynecology OPD, Vanivilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, from January 2019 to January 2020 with approval from the Institutional Ethics Committee, BMCRI, Bengaluru. A total of 200 AUB patients on medical treatment were included for the study, demographic data and relevant data on drug prescription were recorded in the case record form. Menstrual blood loss was assessed using PBAC. Association between PBAC score and different medical treatment groups was determined. Results: AUB was observed mostly in the age group of 21–30 years (35.5%), multiparous women (69.5%) were at higher risk of developing AUB, ovulatory dysfunction (44.5%) was the common cause of AUB in reproductive age group. Medical management included hormonal (36.3%), non-hormonal (21%), combined (9.3%), and concomitant medications (33.4%). Median of PBAC score was 75. There was no significant association among different treatment groups and PBAC score. Conclusion: Majority of AUB patients received hormonal treatment had functional causes with normal PBAC score. This study gives an overview of medical management of AUB in a tertiary care hospital.
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Background: Heavy menstrual bleeding (HMB) is one of the commonest presenting complaints in reproductive age group. Although combined oral contraceptives (COCs) are commonly used in such patients, combined hormones by intravaginal route has been found acceptable and effective. Aim of the study is to compare the efficacy and side effects of combined intravaginal hormonal ring (IHR) with COCs in control of HMB in these patients.Methods: Hundred women with HMB fulfilling inclusion criteria were randomized into two equal groups and treated with either IHR or COCs for three cycles. Each cycle consisted of three weeks of IHR/COC use followed by 1-week ring-free/non-hormonal pills period. Outcome measures were change in PBAC score (pictorial blood loss assessment chart), hemoglobin rise, side effects and overall patient satisfaction.Results: The percentage reduction in PBAC score, the duration of menses and increase in hemoglobin levels were statistically significant at the end of study in each group. The PBAC score reduction was 87.37% vs 61.52%, menses duration was 4.24±0.74 versus 5.16±1.67, and hemoglobin increase was 3.16 (95% CI:0.142-1.412) and 1.24 (95% CI:1.048-1.640) in the IHR versus COC group. However, the intergroup reduction of mean PBAC score was not statistically significant. Significantly more ring users were satisfied and elected to continue with treatment.Conclusions: Both the IHR and COCs are effective treatments for HMB in reproductive age group. IHR may be an attractive option for HMB due to better compliance and lesser systemic side-effects.
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Background: Dysfunctional uterine bleeding is one of the most often encountered gynecologic problems causing anemia, reduced quality of life and unnecessary hysterectomies. A prospective study was conducted on women with DUB to study the effect of ormeloxifene versus combined oral contraceptive pills in controlling blood loss in them.Methods: 100 Women with DUB were enrolled randomly in three groups. After baseline assessment each patient in group A was treated with iron tablets, containing 100 mg elemental iron and folic acid 1.5 mg, for three months and were termed as control group. Group B patients were treated with ormeloxifene in dose of 60 mg twice a week for twelve weeks. Group C patients were treated with combined oral contraceptive pills for twenty- one days starting from third day of their LMP. The treatment was continued for three consecutive cycles. The efficacy of the studied drugs was analyzed by comparing the baseline and post treatment PBAC score, haemoglobin level and endometrial thickness, using appropriate statistical tests.Results: Ormeloxifene was more effective than only iron or combined oral contraceptive therapy in controlling menstrual blood loss (79.11% versus 58.57%). There was a reduction in endometrial thickness in group receiving ormeloxifene as well as in the group receiving combined oral contraceptive pills (p=0.486), however this was statistically not significant.Conclusions: Ormeloxifene was significantly better than combined OCP in reduction of menstrual blood flow in cases of DUB. It has better compliance and marked improvement in subjective symptoms as compared to OCP.
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Background: Abnormal uterine bleeding affects 50% women of perimenopausal age group. The use of ormeloxifene (SERMS) in management of AUB is well known. The objective of the present study was aimed to see the effects of ormeloxifene on different types of endometrium.in the medical management of Abnormal Uterine Bleeding (AUB).Methods: It was Prospective, interventional study. A total of 90 women who attended Outpatient Gynaecology Department, Guwahati with complain of AUB in perimenopausal age group (37-48) were prescribed 60mg ormeloxifene twice weekly for 3 months followed by once weekly for next 3 months after preliminary D and C.Results: Ormeloxifene was found to be more effective in reducing PBAC score and ET in patients with proliferative and secretory endometrium The reduction in mean PBAC score with ormeloxifene (175.3 to 20.93)(p value 0.0001) and ET (9.6 to 2.9 mm) (p value 0.0001) in proliferative endometrium, (179.2 to 14.8 (p value 0.0001) ) and ET 11.1 to 1.9 mm (p value 0.0003)in secretory endometrium was observed after 6 months. However, it was found not to be effective in reducing PBAC score and ET in patients with atrophic endometrium. Change in PBAC SCORE from 176.4 to 150.8 (p value 0.08) and in ET from 2.8 to 2.1mm( p value 0.3) was observed. No major side effects were reported.Conclusions: Ormeloxifene is effective in AUB with proliferative and secretory endometrium.
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Emerging large-scale epidemics not only cause heavy casualties , but have a huge impact on economy .This paper analyzes the characteristics and manners of the economic impact of emerging large -scale epidemics .Economic losses and the national economic impact of emerging large-scale epidemics are analyzed at three levels: microscopic , supply and demand , and macroscopic .Then the relationship between the these levels is discussed .This research is expected to play an important role in the construction of an appropriate economic model for analysis and calculation of economic losses of emerging large-scale epidemics , and in the formulation of the best cost-effective ratio for preventin and control measures against emerging large-scale epidemics .