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 ...

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Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.

We reviewed 76 climate change adaptation projects that were operational between 2010 and 2020. The review was followed by office and field visits for verification. The office visit helped crosscheck the findings, and the field observations carried out between December 2020 and April 2021 asked 24 key informants and collected supplementary information appraisal and indicator development. Of the CCA projects studied, the most (n = 48, 32%) were community-based initiatives, while the least (n = 12, 8%) were ecosystem-based interventions. The main environment-centered projects were Ecosystem-based Adaptations and Ecosystems Protecting Infrastructure and Communities (EPIC) while Enhanced Action of Inclusive CSOs for Participation in Climate Resilient Economic Growth (UTHAN), Initiative for CCA (ICCA), Support to Rural Livelihoods and Climate Change Adaptation in the Himalayas (HIMALICA), etc., adaptation projects were community-based. Capacity building and awareness-raising were the major thrust of the CbA projects, while the abatement of climate vulnerabilities and risks through nature-based solutions were priorities of EbA. Payment for Ecosystem services is a nature-based solution that can play a role in enhancing adaptation to climate change at a local scale by adopting community-based and culturally appropriate methods and enhancing and incentivizing adaptation measures and capacities. A set of 11 criteria and 40 indicators comprised the institutional and behavioral responses and the use of technologies, and the design of climate-resilient plans and climate-smart practices were proposed as appraisal measures to evaluate the success of CCA interventions. The importance of criteria and indicators lies in the fact that such a comprehensive assessment would lead to effective and efficient adaptation projects, which could help benefit beyond the borders. It also furthers ongoing adaptation interventions and is set to be an integral part of associated studies and monitoring and review of new adaptation interventions.