Intrauterine balloon tamponade for the control of postpartum haemorrhage.

OBJECTIVE: To evaluate the effectiveness of balloon temponade in the management of postpartum haemorrhage. METHODS: The study was conducted at the Dow University of Health Sciences and Civil Hospital Karachi from January to July 18, 2012, and comprised women aged 18-35 years, parity 1-6 and gestational age 31-41 weeks, who developed or were admitted with primary postpartum haemorrhage due to uterine atony in whom medical treatment had failed. SPSS 10 was used to analyse the data. RESULTS: The mean age, parity, gestational age of 139 women was 26.4±4.2 years, 3.4±1.3, 37.81±1.67 respectively. Mean estimated blood loss was 1155.8±350.6 ml, mean systolic blood pressure 90.96±18.1 mmHg, diastolic blood pressure 55±7.5 mmHg and mean pulse was 108.3±10.89 bpm. Balloon tamponade was effective in 126(90.4%) cases. CONCLUSIONS: Condom catheter balloon tamponade was an effective means of controlling postpartum haemorrhage. There should be a low threshold for use of balloon tamponade as it is effective, easy to use, easily available, has low complication rate, and an inexpensive modality to manage non-traumatic postpartum haemorrhage, especially in resource-limited settings, and still maintain reproductive ability.

Frequency of preterm delivery in proteinuric verses non proteinuric pregnancy induced hypertension.

OBJECTIVE: To compare the frequency of preterm labour associated with gestational proteinuric hypertension versus gestational non-proteinuric hypertension. METHODS: The prospective cohort study was conducted at the Department of Obstetrics & Gynaecology, Dow University of Health Sciences and Civil Hospital Karachi, from April 1 to September 30, 2012, and comprised primigravidas of more than or equal to 20th weeks of gestation having blood pressure >140/90 mm Hg. Those with gestational hypertension with proteinuria represented the exposed group, while the non-exposed group had primigravidas with gestational hypertension without proteinuria. SPSS 10 was used to analyse data. RESULTS: There were 112 subjects, with 56(50%) in each of the two groups. Mean maternal age in exposed group was 28.3±4.49 years and in the non-exposed group 26.08±0.04 years. Mean gestational age in the exposed group was 36.89±4.04 weeks and in the non-exposed group 37.75±3.428 weeks. Women with gestational hypertension with proteinuria were more likely to deliver preterm infants compared to women with gestational hypertension without proteinuria (p=0.009). CONCLUSIONS: Gestational proteinuric hypertension increased the risk of preterm labour, therefore vigilant monitoring of gestational proteinuric hypertension is important.

Neonatal resuscitation: a knowledge gap amongst obstetrical trainees. A cross-sectional survey amongst medical graduates of Civil Hospital Karachi.

OBJECTIVE: To evaluate the neonatal resuscitation competence of obstetrical trainees to assess the gap in knowledge and to determine training needs. METHODS: The cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Civil Hospital, Karachi, from January to March 2013 and comprised House Officers and Postgraduate trainees. A questionnaire was used to test the evaluation skills of different conditions and choice of appropriate action required during neonatal resuscitation. Data was collected and analysed through SPSS 17.0. RESULTS: Of the 102 obstetrical trainees, 44 (43.1%) were House Officers and 58 (56.9%) were Postgraduate trainees with an overall mean age 25.69 +/- 2.3 years. Only 19 (18.6%) subjects cleared the test; 8 (42.1%) of them were House Officers and 11 (57.9%) were Postgraduate trainees. The result did not show any significant difference between those who had previous training or those who had performed neonatal resuscitation and those who had no such exposure. Majority, 92 (90.2%) considered their knowledge inadequate and 99 (97%) favoured that updated neonatal resuscitation programmes should be periodically arranged. CONCLUSION: The study showed inadequate level of knowledge on neonatal resuscitation amongst obstetrical trainees. There is urgent need of formal training programmes which can make doctors skilful enough to face any adverse neonatal outcome professionally.

Oral misoprostol versus oxytocin in the management of third stage of labour.

OBJECTIVES: To compare oral misoprostol versus intramuscular oxytocin in the management of third stage of labour. METHODS: The quasi-experimental study was conducted at the Obstetrics and Gynaecology Unit II, Civil Hospital, Karachi, from June 20 to December 19, 2006. A total of 70 patients diagnosed in active phase of labour who fulfilled the inclusion criteria were selected by non-probability convenience sampling. These patients were divided into 2 groups of 35 patients each, for Oxytocin (Group 1) and misoprostol (Group 2). Main and secondary outcome measures were analysed. SPSS 10 was used for statistical analysis. RESULTS: Average amount of blood loss(ml) was 267.14 +/- 140.35 with Oxytocin versus 302.86 +/- 160.4, with Misoprostol, this difference was statistically insignificant (p = 0.236). Average drop in haemoglobin concentration (g/dl) with Oxytocin was 1.55 +/- 0.38 vs 1.66 +/- 0.61 with Misoprostol (p = 0.684). Drop in haematocrit (%) was 4.18 +/- 0.64 with Oxytocin vs. 4.50 +/- 0.92 with Misoprostol (p = 0.133). There was also insignificant difference in duration of third stage of labour, between oxytocin and Misoprostol groups (5.37 +/- 2.20 vs. 5.23 +/- 2.46, p = 0.451) Shivering, in Misoprostol group occured in n = 11 (31.4%) vs n = 3 (8.6%) with Oxytocin (p = 0.017) and pyrexia in n = 6 (17.1%) with misoprostol vs n = 0, with oxytocin (p = 0.025) thus significantly higher in misoprostol group. CONCLUSION: There were no major differences in oral misoprostol and intramuscular oxytocin in the management of third stage of labour.

Maternal and foetal outcome in HELLP syndrome at tertiary care hospital.

OBJECTIVE: To determine maternal and foetal outcome in patients of Haemolysis, Elevated Liver enzyme and Low Platelet Cont syndrome. METHODS: The descriptive case series was conducted at the Gynae Unit II of Civil Hospital, Karachi, over a period of 12 months in two episodes; first from December 28, 2006, to February 28, 2007, and then from September 1, 2007, to June 30, 2008. It comprised 40 consecutive women with pre-ecampsia and eclampsia along with altered platelet count who met the syndrome criteria. A pre-designed proforma was administered for data collection. Maternal and foetal outcomes were noted. SPSS 10 was used for statistical analysis. RESULT: Among the 40 mothers, cesarean section was the most common outcome (n=24; 60%). Pulmonary oedema was found in 2 (5%) cases, acute renal failure in 10 (25%), disseminated intravascular coagulation in 6 (15%), and abruptio placenta in 5 (12.5%). Intrauterine growth restriction as a foetal outcome was observed in 18 (45%) cases. Pre-term birth was the result in 20 (50%) cases, and perinatal mortality was high (n=23; 57.5%). CONCLUSION: Management and delivery of HELLP syndrome patients should be performed at tertiary care centres, where highly trained obstetrician, neonatal intensive care unit personnel and Multi-disciplinary facilities are available. Correct diagnosis and timely intervention can decrease the risk of maternal and perinatal mortality.

Control of postpartum and post abortal haemorrhage with uterine packing.

OBJECTIVE: To determine safety and effectiveness of uterine packing to stop hemorrhage in postpartum and post abortal cases. METHODS: Patients who delivered either vaginally or via Caesarian section who developed primary post partum haemorrhage and post abortal patients developing primary post partum haemorrhage refractory to conventional medical treatment, were included in the study. Packing was done using 8-10 meters sterilized gauze from the fundus to cervix and was left for 12-24 hours or removed earlier in cases of failure to control hemorrhage. Morbidity and effectiveness was assessed. RESULTS: Intractable primary hemorrhage was encountered in 20 patients of whom 2 had bleeding after caesarian section, 14 after vaginal delivery and 4 patients had post abortal haemorrhage. Uterine atony was the commonest cause. Failure of packing to control haemorrhage was seen in 3 cases. It was successful in 17 cases. CONCLUSION: Whether used early or late in the management of post partum haemorrhage, uterine packing is a safe, quick and effective procedure.