Objectives: To study the effectiveness of B-Lynch suture to control postpartum hemorrhage. To know the effect of this extreme degree of compression (produced by B- Lynch suture) on uterine anatomy three months after delivery.
Method: B-Lynch suture (Classical / modified form) was applied in 75 cases. A No. 2 chromic catgut suture was used on a big size round body needle. During the placement of suture, patient was placed in frog-leg position to assess the compression effect of B-Lynch suture. In 62 cases (82.66%) B-Lynch suture was the only intervention. In 8 cases (10.66%) uterine arteries (O’Leary method) were also ligated and in five cases (6.66%) cervico–isthmic apposition suture was also applied in addition to B-Lynch suture.
Result: Failure rate was 2.67%. Hysterectomy was required in two cases
Conclusion: B-Lynch suture technique is a simple, effective, safe, life saving and fertility preserving method to control atonic postpartum hemorrhage.
postpartum hemorrhage, B-Lynch suture, placenta previaIntroduction: Despite the availability of prophylactic rhesus immune globulin, hemolytic disease of the newborn and fetal death (hydrops fetalis) due to rhesus alloimmunization, is still a major contributor to perinatal morbidity and mortality in India. Pregnancy outcome after fetal therapy with ultrasound guided intrauterine transfusion (IUT) for fetal anemia was studied.
Methods: Aprospective cohort study of 99 Rh isoimmunized pregnancies, Indirect Coomb’s test Positive (ICT > 1:16) was conducted from July 2002 to June 2007. Intensive fetal monitoring by serial ultrasound and middle cerebral artery peak systolic velocity using Color Doppler was performed to detect fetal anemia.When necessary, invasive testing with cordocentesis for Hb, PCV was performed if pregnancy was less than 32–34 weeks gestation. If PCV was <30, or there was fetal hydrops, Ultrasound guided intrauterine transfusion was carried out by the intravascular (IVT) or the intraperitoneal (IPT) routes. Primary outcome variables were fetal survival in relation to gestational age and procedure related factors.
Result: Of 99 pregnancies, 43 cases (25 – hydropic, 18-nonhydropic fetuses) required 135 intrauterine blood transfusions. The rest 56 pregnancies were managed conservatively and did not need IUT. IUTs were performed when indicated starting from 16 weeks (IPT) and 21 weeks (IVT) of gestation by the intraperitoneal / intravascular routes respectively. Pre-transfusion Hb ranged from 3g% to 8g%. The amount of blood transfused varied from 10 ml to > 110 ml depending on the period of gestation and degree of fetal anemia. The number of transfusions per pregnancy was 1-7, at intervals of 1-4 weeks, till delivery at 28 to 36 weeks of gestation. Survival of hydropic babies (88%) was almost similar to those without hydrops (83.3%) Prognosis was slightly better in Rh isoimmunized pregnancies not requiring IUT (94%) compared to fetuses receiving transfusions (85.6%)
Conclusion: Intrauterine fetal blood transfusion was found to be the only life saving therapy, and very effective in the management of preterm Rh isoimmunized pregnancies. Results are comparable with the best centers in the world, hence early referral to specialized centers with expertise of specialized intensive fetal monitoring for early diagnosis of fetal anemia, and of intrauterine fetal blood transfusion are important for optimal perinatal outcome.
Rh isoimmunsation, Intrauterine transfusion, fetusObjective(s): To evaluate the predictive value of risk factors for spontaneous preterm labor.
Method(s): This prospective study was conducted on 390 pregnant women, of which 290 in preterm labor were taken as the study group and 100 in term labor were taken as controls. Risk factors were studied and various risk factors were identified. Statistical analysis was done by logistic regression analysis using SPSS software.
Result(s): Presence of factors like chorioamnionitis, bacterial vaginosis, urinary tract infection, heavy work, prior preterm labor, medical disorders and placental abnormalities were significantly associated with preterm labor.
Conclusion(s): Risk factors like previous preterm birth and placental abnormalities can not be modified hence preventive efforts should be directed towards modifying working conditions during current pregnancy, good antenatal care, and appropriate management of infections and medical disorders.
Objective: To find out the safety and effectiveness of vaginal misoprostol for second trimester termination of pregnancy.
Methods: This is a prospective study involving 30 women with 12-20 weeks gestation requesting termination. Four hundred microgram misoprostol was inserted in the vagina followed by 200μg every four hourly.Mean age of the women was 25.96 years. Mean gestational age was 15.66 weeks. Chi-square test was used for statistical analysis.
Results: 93.3% of women aborted within 16 hours without any significant side effects.
Conclusion: Vaginal misoprostol is a very effective and safe method for second trimester pregnancy termination. It reduces the time and the cost of second trimester pregnancy termination.
misoprostol, second trimester termination of pregnancy, prostaglandin, medical termination of pregnancyObjective: This study was undertaken to ascertain whether large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia (CIN) has any adverse effect on subsequent pregnancy and labor.
Method: Twenty five women who became pregnant following LLETZ were prospectively followed up and their case notes were analyzed for pregnancy and labor outcome.
Results: There were 30 pregnancies in 25 women. The mean age was 26.2 years. Of the 30 pregnancy episodes, six were primigravidae and 24 were multigravidae. 46.7% of the pregnancies occurred within 6 months of LLETZ. Of the 23 cases where pregnancy continued after 12 weeks, cervical length was assessed by scan in 11 cases. The cervical length was less than 3cm in two cases. Cervical encerclage was carried out in six cases. 91.3% of the women delivered at term and 8.7% had preterm delivery.
Conclusion: This study showed that LLETZ of the cervix was not associated with adverse pregnancy outcome. Key Words: Large loop excision of transformation zone, pregnancy outcome, excisional methods
Large loop excision of transformation zone, pregnancy outcome, excisional methods