Esike's three-brace suture technique for controlling life-threatening postpartum hemorrhage - A report of two cases.

Postpartum hemorrhage is a great cause of maternal morbidity and mortality worldwide with these effects being worse in developing countries. Uterine atony is the commonest cause. Esike's three brace suture technique is a novel simple but effective method that was used to successfully control life-threatening postpartum hemorrhage due to uterine atony in two women with the preservation of their uterus. Vicryl or chromic catgut 2 was used to apply compression sutures on the atonic uterus. This simple, effective, less invasive, easy to learn uterine-sparing technique is presented for further evaluation and possible wider use in saving the lives of our PPH patients and sparing their uteri.

Résumé L'hémorragie du post-partum est une cause importante de morbidité et de mortalité maternelles dans le monde, ces effets étant pires dans les pays en développement. L'atonie utérine est la cause la plus fréquente. La technique de suture à trois accolades d'Esike est une nouvelle méthode simple mais efficace qui a été utilisée avec succès contrôler l'hémorragie post-partum potentiellement mortelle due à l'atonie utérine chez deux femmes avec la préservation de leur utérus. Vicryl ou chromique catgut 2 a été utilisé pour appliquer des sutures de compression sur l'utérus atone. Cette technique d'épargne utérine simple, efficace, moins invasive et facile à apprendre est présenté pour une évaluation plus approfondie et une utilisation plus large possible pour sauver la vie de nos patientes souffrant d'HPP et épargner leur utérus.

Efficacy of nifedipine versus hydralazine in the management of severe hypertension in pregnancy: A randomised controlled trial.

BACKGROUND: Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. AIM: The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. MATERIALS AND METHODS: An open-label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks' gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140-150 mmHg systolic and 90-100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. RESULTS: The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. CONCLUSION: Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy. CLINICALTRIALS.GOV: (Identification number: NCT04435210).

A Uterus-Preserving Treatment for Uncontrollable Postpartum Hemorrhage: Esike's Technique.

BACKGROUND: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with uterine atony responsible in 80% of cases. In intractable cases, hysterectomy is the final treatment, but it has complications. Many doctors in developing countries with high maternal mortality rates from postpartum hemorrhage can perform cesarean deliveries but cannot perform hysterectomy. Patients with postpartum hemorrhage who need hysterectomy in these countries will die in such cases, whereas, if doctors know this simple, easily learned technique, such patients may survive. TECHNIQUE: Esike's technique is a uterine-compression method that uses supplies generally available at delivery hospitals. Six sutures are placed in the lower uterine segment, three anteriorly and three posteriorly. Starting with the middle sutures, the sutures are tied at the fundus with the help of an assistant to provide uterine compression. The more laterally placed sutures are then tied similarly, resulting in uterine compression and stoppage of postpartum hemorrhage. EXPERIENCE: Esike's technique was used in controlling life-threatening, uncontrollable postpartum hemorrhage in 18 women and was successful in 16 (89%) without requiring hysterectomy. CONCLUSION: Esike's technique is effective in controlling life-threatening postpartum hemorrhage and can be used in low-resource settings with commonly available supplies and performed by doctors with a common level of training.

Eclampsia in rural Nigeria: The unmitigating catastrophe.

INTRODUCTION: Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work. MATERIALS AND METHODS: This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria. RESULTS: The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9% of the women were delivered by emergency lower segment cesarean section. Fifteen or 17.9% babies were dead giving a perinatal mortality rate of 174 per 1,000After delivery, and 3 (3.8%) of the women had postpartum hemorrhage. Two women (2.6%) died giving a maternal mortality ratio of 2564 per 100,000 deliveries. CONCLUSION: Eclampsia is a dreaded obstetric disease with adverse fetal and maternal consequences that are not mitigating, and no effort should be spared in managing it effectively including public enlightenment.