SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

Objectives: To compare the frequency of effectiveness of postpartum IUCD(PPIUCD) with interval IUCD at Tertiary care Hospital in Hyderabad. Study Design: Randomizedcontrolled trial. Setting: Gynaecological and Obstetrical Department, Liaquat UniversityHospital, Hyderabad. Period: Six months from February 2016 to July 2016. Material andMethods: Total 100 women were studied. All the women with age 18 to 40 years, having atleast one alive child were included in the study. Women were divided in two groups according tocontraception methods of IUCD (50 women in each group). In Group-A IUCD were inserted afterplacental delivery within 10 minutes to 48 hours (PPIUCD) and in group-B IUCD were insertedany time of women’s menstrual cycle (Interval IUCD). All the women were followed for 6 months.All the data regarding effectiveness among both groups was recorded. Results: Mean ± SDage of group-A (PPIUCD) patients was 26.02 ± 5.87 years while group-B (Interval IUCD) was26.34 ± 5.95 years. Majority of patient’s i-e; 76.0% of group-A and 68.0% of group-B were fromurban areas. IUCD was successfully place among 94.0% women of group-A and among 98.0%women in group-B. At the end of 6 months follow-up, 86.0% patients of group-A continuedPPIUCD while in group-B, 96.0% women continued Interval IUCD. After 6 months follow-up,effectiveness of IUCD was 90.0% in group-B and 80.0% in group-A. Stratified analysis revealedthat there was a non-significant effect of age on effectiveness of IUCD among both groups (Pvalues= 0.094 & 0.223 respectively) so was the parity (P values= 0.384 & 0.747 respectively).Conclusion: It was concluded that interval IUCD found to be effective method as compare topost postpartum IUCD (PPIUCD). While women have recently given birth to neonate were moreagreed to practice of PPIUCD, due to its quick insertion.

Objective: To assess the efficacy of manual vacuum aspiration (MVA) in terms of complications and complete uterine evacuation of the product of conception. Study design: Descriptive cross-sectional study. Place and duration: Department of Obstetrics and Gynecology, Bilawal Medical College, DHQ Hospital Kotri and CDF Hospital Hyderabad, from April 2020 to March 2021. Patient and method: All the patients with gestational of <14 weeks, and the diagnosis of missed miscarriage, blighted ovum, partial miscarriage, or RPOCs, who were undergone MVA was carried out. Primary outcome measures were efficacy and secondary outcome measures were to assess prevalence of complications including pain and cramps, infection and bleeding. Effectiveness was considered in terms of complete or incomplete evacuation. All the information was documented via a self-made study proforma. Results: A total of 83 patients were scheduled to undergo MVA. Majority of the cases 41.0% were presented with gestation age of 9 to 12 weeks. Most of the cases 56.6% had incomplete miscarriage, 31.3% were with missed miscarriage and 12.0% women had RPOCs. Mild to moderate pain and cramps were present in 91.60% of the cases, while only 6.0% of the cases had bleeding, and infection developed in 2 cases. According to effectiveness, complete evacuation was achieved in 81.9% of the cases. Conclusion: MVA is effective in the complete emptying of the uterine cavity and has high rates of acceptability and satisfaction. It reduces the waiting time for surgery, hospital stays, and GA complications. It is gradually gaining acceptability as a standard surgical procedure for safe early pregnancy termination. Keywords: Efficacy, safety, MVA, uterine evacuation, conception