Background: Post partum haemorrhage (PPH) is one of the most common causes ofmaternal mortality worldwide. Primary PPH (which occurs within 24 hours of delivery) hasbeen studied a lot. But data regarding secondary PPH (which occurs 24 hours after deliveryupto to 6 weeks post partum) is sparse. Our aim was to find out the risk factors and maternaloutcome of secondary PPH. Materials and Methods: A cross sectional analytic study of 32 cases admitted with secondaryPPH in Gynae and Obstetric department of Rangpur Medical College Hospital during 1 yearstudy period was carried out. Result: Frequency of secondary PPH was 0.58%. Mean age of the patient was 25.23±2.79years; 22(69%) patients were multi para; 17 (53%) patients had education up to primarylevel. Maximum patients [18 (56%)] were from low socio economic status. Mean time ofpresentation was 13.5±2.78 days after delivery; 14(44%) patients delivered vaginally and18(56%) patients delivered by caesarean section. Most of the vaginal delivery 9 (28%) wereconducted by untrained dai or other family member. Among 32 patients, 31 were referredfrom outside the Hospital. Retained bits of placenta was the leading cause (15,47%) andcaesarean wound dehiscence was the second cause (13,41%); 13 (40%) patients had feveron presentation. All were anemic with mean hemoglobin concentration 7.4±1.4gm and 24(75%) of them required blood transfusion. Four patients was in shock. Antibiotic was givento all patients. DE&C was done in 15(47%) cases and laparotomy followed by total abdominalhysterectomy was done in 12 cases and repair in 1 case. Among 15 patients who underwentsurgical evacuation there was histological evidence of placental tissue in only 6(40%) patients. Conclusion: In present study retained bits of placenta and caesarean wound dehiscenceare found as main cause of secondary postpartum hemorrhage So care should be takenduring active management of third stage of labour (AMTSL). Choosing appropriate suturematerial, maintaining personal hygine of patient and sterility of operation theate, usingappropriate antibiotic to combat microbials and last but not list improving skillness of surgeonare the key to reduce the rate of secondary PPH. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 107-112
Background: Postpartum hemorrhage is the leading cause of maternal mortality; uterineatony is the most important cause. Uterotonics are used to prevent uterine atony. Carbetocin,a synthetic anallague of oxytocin seems to be an effective and safe new drug for preventionof PPH after caesarean The Aim of Study:To find out the efficacy and safety of carbetocin over oxytocin for theprevention of PPH during caesarean section.Patients and Methods: A randomized-controlled trial was conducted in the Dept. of Obs &Gyane, Rangpur Medical College and Hospital, Rangpur, Bangladesh over a period of twelvemonths from June 2016 to June 2017. One hundred admitted patients undergoing cesareansection at term were randomized into two groups receiving either 10 IU oxytocin or 100 μgcarbetocin after caesarean section. Outcome measures such as primary PPH, massiveblood loss, need for additional uterotonic drug, additional blood transfusion as well as adverseeffects were all documented. Results: Massive blood loss occurred in 6% patients, blood transfusion needed in 20% patientsand additional uterotonic needed for 36% patients in Oxytocin group but in Carbetocin groupno massive blood lossoccurred, only 2%patients needed immediate blood transfusion and4% patients were required additional uterotonics. There were no major adverse effectsobserved in both the groups. No patients had developed PPH in carbetocin group. But 8%(4)patients had developed PPH in oxytocin group. Conclusion: Carbetocin appears to be an effective new drug than Oxytocin for the preventionof postpartum hemorrhage following caesarean section. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 113-118
Background: Prevention of cervical cancer is the easiest with regular screening tests and follow up. CIN is a pre-malignant condition, detection of which is possible by VIA and colposcopy. Objective: To identify the performance of Cervical Cancer Screening Program in Rangpur Medical College Hospital through 11 Years. Methods and materials: Apparently healthy, married or sexually active women (>10 years) and women aged >30 years attending Gynae OPD were included in this study. After counseling and informed consent a speculum examination was performed for direct visualization of cervix to identify the squamo-columner junction. Freshly prepared 5% acetic acid was applied to the cervix for one minute. All the VIA positive women were further evaluated by colposcopy. Women with negative VIA were advised for 3 yearly VIA test. Suspected CIN cases were evaluated by colposcopy guided punch biopsy or LEEP biopsy and histopathology. Results: VIA screening was provided for 11,792 women from August 2005 to August 2016 and 932 (7.9%) were positive VIA. From November 2007 to August 2016, total women underwent colposcopy were 1548. Among them 632 (40.8%) were normal, out of abnormal cases 730 (80.3%) were CIN-1, 147 (16.1%) were CIN-2, 14 (1.5%) were CIN-3, 17 (1.8%) were invasive and 8 (0.5%) were unsatisfactory. From November 2007 to August 2016 punch biopsy was taken in 384 women and total 568 women were treated by LEEP. Conclusion: In a low resource setting like Bangladesh VIA and colposcopy can detect 80% pre-invasive cervical lesion and may be one of the most important tool to prevent cervical cancer and its mortality. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 11-16
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