Background: Creating negative pressure inside the uterine cavity results in shrinking of uterus which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhage. Methods: Sixteen women who had normal vaginal delivers, and 4 women who underwent caesarean sections, who developed atonic postpartum hemorrhage, and who did not respond well for routine use of Inj. methergine, oxytocin, and Carboprost were included in this study. A specially designed uterine cannula measuring 25cm long and with 12/18mm diameter, with uterine angle, and with multiple perforations on uterine portion was used. When bleeding did not stop due to uterine atony in vaginal deliveries in spite of routine measures, the uterine portion of the cannula was inserted in to uterine cavity up to fundus, and the outer end was connected to suction machine with thick walled flexible tubing. A negative pressure of 650mmHg was created inside the uterine cavity and maintained for 10mns. This procedure wasrepeated every hour for 3hrs. After this the negative pressure was created whenever there was recurrence of bleeding. In case of caesarean section, the cannula was inserted through the uterine wound and brought outside through vagina. Negative pressure was applied after closure of uterine wound. The cannula was removed in all women6hrs after initiation of procedure. Results: complete cessation of bleeding which was associated with contraction and firm retraction of uterus was observed in all women within 4mns after initiation of procedure. The amount of blood collected in suction bottle ranged from 150ml to 250ml. Conclusion: Vacuum shrinking of uterus is a very effective physical method which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhage. This simple, cost effective, life-saving, and fertility saving technique, which can avoid laparotomy can be made available in any setting, and can become the first defense against atonic PPH.
Background:S.Ramet.al reported: Onset of spontaneous labor occurs at completion of fetal functional maturity at AFOD value of 0.98±0.27 (at 650nm). All these events together occurring at any time from 35+wks to 42+wks indicateindividual term for each fetus 1, 2 .Preterm labors with AFOD 0.98±0.27 are mature and cannot be stopped by any means, as labor cascades are already established. Babies born with AFOD <0.40 arefunctionally premature 1, 2 , and we expected thesepremature laborswouldrespond well for tocolysis and other methods for continuation of pregnancies as labor cascades are not fully established. Methods:In thiscase series study, 22 singleton pregnant women who were inpreterm labor (PTL),and who underwent CRL gestational age estimations, 5 of them PTL with membrane rupture and17 without membrane rupture were included. USG guided amniocentesis was performed as per the ACOG guidelines, and AFOD estimations were done for fresh uncentrifuzed samples. Antenatal corticosteroids, low dose Isoxsuprine Hcl rapid infusion tocolysis, and weekly 17-alphahydroxy progesterone caproate were given. After successful tocolysis and continuation of pregnancies, AFOD estimations were repeated when women presented with labor pains again before 37w+6days. Women were allowed to deliver if mature or near mature AFOD values were observed. AFOD estimations were also done at spontaneous labor or at caesarean sections after 38wks. Babies were observed for functional maturity in terms of color of skin, adherence of vernix, and development of RDS. Results were presented in two tables and analyzed. Results:In non-membrane rupture group (N=17), pregnancies could be continued for 1 to 7 wks. In membrane rupture group, in N=2/5 women leak could be stopped and pregnancies could be continued for 3 to 6 wks. Except one, in both groups all babies could attain mature or near mature AFOD values irrespective of GA and birth weight,noRDS was observed, and all babies survived. Conclusion:WithAFOD guided PTL management coupled with low dose Isoxsuprine Hcl rapid infusion tocolysis, pregnancies could be continued to completion of fetal functional maturity in 21/22 women with good neonatal outcome.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.