Intra-uterine packing: an effective and affordable tool in the management of post-partum hemorrhage - cohort study.

Introduction: postpartum hemorrhage is the main cause of maternal death worldwide. Uterine balloon packing has shown promising outcomes in PPH management. Nevertheless, its usage is limited in low- and middle-income countries due to associated costs. Uterine packing using gauzes presents a potentially efficient and cost-effective alternative. This study aims to assess the safety and efficacy of intra-uterine packing with gauzes in managing postpartum hemorrhage. Methods: this was a retrospective study over a period of two years and six months. All patients who experienced PPH due to uterine atony during vaginal delivery, with no response to medical first-line treatment, were included. IUP using gauze was employed as a second-line intervention. The primary outcome was the success of postpartum hemorrhage management. Secondary outcomes included patient vitals, the need for blood transfusion, change in hemoglobin levels (delta Hemoglobin), and maternal morbidity (post-partum infection, Sheehan syndrome, and retained gauzes). Results: the study included 63 patients. The mean age was 30.06 ± 5.6, the mean gravida was 2.65 ± 1.9 and the mean para was 2.12 ± 1.31. None of these patients experienced major complications following gauze insertion. Three patients underwent laparotomy and conservative surgical management was performed. Hysterectomy was not required for any participant, and no maternal deaths were recorded.

Sepsis-associated encephalopathy and uterine necrosis revealing HIV infection after artery ligation and uterine compression sutures: Case report.

INTRODUCTION AND IMPORTANCE: Infection with the human immunodeficiency virus (HIV) targets immune cells and exposes infected patients to several diseases. For these reasons, HIV infection should be suspected in each situation where post-operative sepsis occurs, to afford therapy and improve the patient's prognosis. CASE PRESENTATION: We present a case of a pregnant woman at 39 weeks of gestation who missed her prenatal follow-up. She underwent an emergency caesarian section for severe abnormality in the fetal heart rate. The caesarian section was complicated by a post-partum hemorrhage (PPH). PPH was managed with uterine artery ligation and B-Lynch modified sutures. CLINICAL DISCUSSION: Postoperatively, there was the succession of the following events: purulent uterine necrosis, peritonitis, and encephalitis leading to a life-saving hysterectomy. Due to the worsening of the septic condition, HIV screening was performed, after obtaining the patient's consent, and came back positive. CONCLUSION: The aim of this case report is to push practicians to think about HIV infection when necessary because missing the diagnosis can seriously threaten patients' health.

Early versus late amniotomy during induction of labor using oxytocin: A randomized controlled trial.

OBJECTIVE: To assess the effect of early amniotomy on labor duration, maternal and neonatal outcomes during induction of labor (IOL). METHODS: This was a randomized controlled trial, conducted over a period of eight months at a monocentric site. Singleton pregnancies in nulliparous and parous patients with cephalic presentation and Bishop score ≥ 6 were enrolled in the study. One hundred participants were randomized into two groups: early amniotomy (initiating IOL with amniotomy followed by oxytocin) versus late amniotomy (initiating IOL with oxytocin followed by amniotomy 4 hours later). The primary endpoint was the time to active phase (cervical dilation ≥ 5 cm) during IOL. Secondary outcomes were time to vaginal delivery, mode of delivery, and maternal and fetal outcomes. RESULTS: Early amniotomy reduced time to active phase by 2 hours and 46 minutes compared to the late amniotomy group (3 h 42 min vs. 6 h 28 min; p<0.0001). It also reduced time to vaginal delivery by 2 hours and 52 minutes (5 h 17 min vs. 8 h 9 min; p = 0.0003). The rate of cesarean section (CS) for failed IOL was significantly lower in the early amniotomy group (31.2% vs. 70.0%; p = 0.02), without any significant difference in the overall rate of cesarean section between the two groups (32.0% vs. 40.8%; p = 0.36). There was no significant difference in maternal or fetal outcomes. CONCLUSIONS: Early amniotomy in IOL significantly shortens the time to active phase as well as the overall duration of labor without compromising maternal and neonatal safety.