Effect of a primary postpartum haemorrhage on the "near-miss" morbidity and mortality at a tertiary care hospital in rural bangalore, India.

AIM: To assess the risk factors, the mortality and the "near-miss" morbidity in primary PPH. SETTING AND DESIGN: A retrospective analysis of 124 women with PPH (within 24 hrs of delivery) over 4 consecutive years in a tertiary care hospital in rural bangalore. MATERIAL AND METHODS: The case sheets of the patients, which were identified by the labour record registers as having PPH were reviewed by the same person, to identify the actual impact of the condition. The data was analyzed by Chi-square analysis. RESULT: PPH (the loss of blood that caused significant alterations in the maternal condition or a blood loss of 500 cc in vaginal deliveries or of >1000 cc in caesarean sections) was recorded in 124 women; 60 had delivered in hospitals (Group-A) and 64 had been referred after their deliveries (Group-B) from various peripheral centres, i.e., maternity hospitals, nursing homes and district and community health centres. The maternal mortality ratio during this period was 71/100,000 (4 deaths/5600 live births). Of these 4 deaths, 0 were in group A and 4 were in group B. The "near-miss" morbidity was higher than the mortality (total 20/124; 6/60 in Group-A and 14/64 in Group-B). The delayed referrals and the lack of an active 3rd stage management in Group-B were responsible for most of the adverse events. CONCLUSION: Both the "near-miss" morbidity and the mortality in PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening the peripheral delivery facilities, the active 3rd stage management and the timely referrals.

Broad ligament fibroid mimicking as ovarian tumor on ultrasonography and computed tomography scan.

Giant fibroids are known to arise from the uterus, and very rarely from the broad ligament. Large fibroids often undergo hyaline, cystic, and at times, red degeneration. In the present case, cystic degeneration with intervening septations in an adnexal mass raised the suspicion of ovarian neoplasm as the ovaries were not seen as separate from the lesion. The ultrasonographic and contrast-enhanced computed tomographic findings of this case were characteristic of ovarian neoplasm. The differential diagnosis included rare possibility of giant fibroid with cystic degeneration. The diagnosis was confirmed on histopathological examination. The patient underwent excision of the broad ligament fibroid, hysterectomy, and bilateral salpingo-oophorectomy. Magnetic resonance imaging has a role in the diagnosis of such lesions.