BACKGROUND Post-Partum Haemorrhage (PPH) is one of the five leading causes of maternal death in the developed and developing countries. PPH less than up to 1000 ml is well tolerated by a healthy pregnant woman particularly due to physiological increase in the plasma and the red cell mass during pregnancy. We wanted to determine efficacy of uterovaginal packing and its sequelae in low resource settings. METHODS After ethical committee permission and informed patient consent, a four-year retrospective study was conducted in the department of Obstetrics and Gynaecology of Malda Medical College, West Bengal, India. Total number of vaginal deliveries was 41990 in last four years (2014-2018). Total fifty-three (n-53) cases of primary PPH following vaginal deliveries who were hemodynamically stable after initial resuscitation with crystalloid and blood but unresponsive to bimanual compression and medical therapy were managed with uterovaginal packing for 24 hours. Traumatic PPH, PPH due to retained placental tissue or PPH following caesarean deliveries were excluded. RESULTS Out of fifty-three (53) cases, PPH was arrested in forty-eight (48) cases only five (5) cases required further surgical therapy. Combined utero-ovarian artery ligation (quadruple ligation) was done in one patient, and two patients responded to bilateral internal iliac artery ligation (BIIL) or hypogastric artery ligation (HAL). Two patients needed peri partum hysterectomies they continued to lose blood in spite of all conservative uterus saving methods. CONCLUSIONS Uterovaginal packing is a convenient and effective procedure for controlling intractable PPH if detected and managed promptly, when patient is hemodynamically stable. It is very much effective procedure in low resource setting particularly in rural India. Based on our study 90% of woman responded to utero vaginal roller gauze packing. In life threatening haemorrhage uterine packing will not only halt the blood loss and preserve the uterus but also gives an opportunity to reverse and correct any consumptive coagulopathy. By using the uterine roller packing one would expect the total blood loss to be reduced and blood products are avoided. Every obstetrician must be familiar with this simple method in order to avoid having to perform a hysterectomy and preserving the reproductive capability as well as diminishing the operative morbidity and mortality. Uterovaginal packing is a useful technique for control of post-partum haemorrhage in any set up with low resource setting. It is simple, easy technique requiring less skill which can be taught easily to the trainee residents.
BACKGROUND Obstetric trauma to the female genital tract being more common, non-obstetric genital tract trauma remains neglected. Reports of non obstetric traumatic injuries to the vagina specially laceration have been infrequent in the literature and offers only generalised approach to this problem with lack of an organised treatment protocol of such patients. Recently knowledge of NOGTI has become important due to modern life style such as high-speed road transportation, recreational activity and increase sexual assault which often leads to vulvovaginal injuries. The objectives of this study were to determine the incidence, age distribution, site, type of injuries, mechanism of injuries and different management protocols. MATERIALS AND METHODS A descriptive study was carried out in the department of obstetrics and gynaecology of Malda Medical College and Hospital, West Bengal, India, for a duration of one year from January 2013 to 31 st December 2014. Details of site, type, mechanism of injuries and management protocol were recorded from the operation theatre registration book of department of obstetrics and gynaecology. Total no. of cases studied during this period was 39. RESULTS Incidence of non-obstetric genital tract injuries (NOGTI) in Malda medical college was 2.537% of total emergency gynaecological admissions in the study period. The commonest sufferers belong to the age group of 20-30 years (43.59%). Commonest variety of NOGTI in the study was vulval haematoma (41.02%) and the commonest mechanism of injury was non coital injury like bicycle/ automobile/fall from height/ cattle horn (66.66%). We have not encountered any anorectal injury in this time period. Management option included immediate resuscitation along with primary repair, incision and drainage of vulval haematoma, packing only and removal of foreign bodies from genital tract. Only seven cases required blood transfusion and there was no mortality. CONCLUSION Non-obstetric genital tract injury is a serious problem which may involve significant loss of blood, and it may be life threatening in rural areas in some cases if there is delay in referral and necessary intervention.
Most of the cases of rupture of uterus occurs in the third trimester of pregnancy or during labour but here we report a thirty five year old women G3, P1+1, LCB 10 years back , mode of delivery by LSCS was admitted in MG ward of Malda medical college, West Bengal, India at 16 weeks of pregnancy with complain of acute abdominal pain, vomiting with clinical sign of shock without vaginal bleeding. Haemoperitoneum and dead fetus outside the uterus was discovered by urgent USG of whole abdomen. Emergency laparotomy was carried out and it revealed haemoperitoneum due to spontaneous rupture of uterine fundus through which fetus and placenta were extruded in peritoneal cavity. Though spontaneous fundal rupture is very rare in early second trimester of pregnancy, it should be taken into consideration in the differential diagnosis of acute abdomen during pregnancy specially if there is predisposing factors.
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