:Rupture uterus is a rare and often catastrophic condition. It is associated with a high incidence of fetal and maternal mortality and morbidity. Our objective in this study is to determine incidence, etiology, trend, management, maternal and fetal outcome of uterine rupture in Faridpur Medical College Hospital. This is a prospective cross-sectional study of patients with ruptured uterus from the period of January 2011 to December 2011 admitted at Faridpur Medical College Hospital. All the cases of ruptured uterus who were either admitted with uterine rupture or who developed it in hospital were included in the study. Patients having ruptured uterus due to congenital anomaly were excluded from the study. Patients were initially assessed in labour ward, relevant sociodemographic data, previous antenatal and surgical history recorded. Ways of management, maternal and fetal outcome were taken for analysis. There were 30 cases of ruptured uterus out of total 3606 deliveries (including 1809 caesarian sections) over a one year time period, with a prevalence of 0.83%. The most common age group was 21-30 years. A majority of patients 16(53.3%) were cases of unscarred uterus presenting with rupture; the common cause of rupture in scarred uterus was injudicious use of oxytocin (13,43.33%). Proper antenatal care, appropriate counseling of patients with history of previous caesarian section for hospital delivery, training of skilled birth attendant can reduce mortality and morbidity due to rupture uterus.

The first line antihypertensive treatment for severe hypertension of pregnancy includes labetalol, hydralazine, or nifedipine. Rapid but safe blood pressure control allows the definitive treatment, the delivery of baby to be carried out with minimal delay and good maternal and fetal outcomes. This non-randomized clinical trial was performed in Faridpur Medical College Hospital to compare the effectiveness and tolerability of oral nifedipine and intravenous labetalol in the acute control of severe hypertension of pregnancy. Total 50 admitted pregnant women with a viable fetus (>_ 24 weeks of gestation) having severe hypertension were allocated into two groups, Group A: 25 patients receiving oral nifedipine (10 mg), Group B: 25 patients receiving injectable labetalol (with incremental doses: 20, 40, 80mg). Up to 5 doses were tried for each drug at 15 minutes interval until target blood pressure (<_150/100 mmHg) was achieved. Baseline characteristics like mean age, mean weight, heart rate, systolic and diastolic pressures were similar in both labetalol and nifedipine groups. The average time required to achieve target blood pressure was 30.33 ± 10.44 minutes for labetalol and 25.63 ± 10.12 minutes for nifedipine (p=0.9129). Feto-maternal outcomes and adverse drug related effects were similar among the two groups. Both intravenous labetalol and oral nifedipine were found to be equally effective and well tolerated. Nifedipine may be preferable as it is a simple, flat dose schedule and an oral regimen. Faridpur Med. Coll. J. 2021;16(1):25-29

Abstract:Postpartum haemorrhage is the leading cause of maternal mortality worldwide. Total 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a long half-life which ensure more effective contraction and less adverse effects. It can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. Carbetocin is effective treatment for the prevention of postpartum haemorrhage not only following caesarean delivery but also after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.

Abstract:Emergency obstetric hysterectomy is removal of part or whole of the uterus done to save the life of a mother in complications in the intra partum or post-partum period. This study was done to assess the cases of emergency obstetric hysterectomy (EOH) in view to find out the indications, the patient profile, the risk factors, the morbidity and mortality associated with the procedure. It was a retrospective analysis of 40 cases of obstetric hysterectomy performed in Faridpur Medical College Hospital (FMCH) during the period of August 2012 to July 2014. Patients were evaluated from history and clinical observation records regarding maternal age, parity, indication of operation, associated risk factors, surgical procedure and complications during hospital stay. In maximum patient with EOH the overall incidence is in the age group of 25-29 years (42.5%) and parity of 2 nd -3 rd . The most common complication was ruptured uterus 50% and PPH 12.5%. Among the risk factors the most common was previous caesarean section (55%) then grand multipara (15%). Out of 40 cases 40% needed total hysterectomy and 60% was managed by subtotal hysterectomy. In most cases complications were hemorrhage and 100% patient needed blood transfusion among which 50% in the post-operative period. All the patients were discharged after treatment with no history of maternal death or referral to higher centers. Emergency obstetric hysterectomy is a lifesaving procedure when decision is taken at proper time, done rapidly by expert surgeon along with availability of blood and safe anesthesia. Thus it can play a vital role to reduce and prevent maternal death.

:After abdominal surgery some patient's needs relaparotomy for complications developed postoperatively. Aim of this study was to determine the risk factors causing re-laparotomy, the indications, management and outcomes of relaparotomy admitting in Obstetrics and Gynaecology department in Faridpur Medical College Hospital, a tertiary referral hospital where all complicated patients are referred for management from surrounding districts hospital. It was a cross sectional study done during the period of January 2011 to December 2011, All the cases among which relaparotomy were done after primary surgery were recorded using a protocol prepared for the study. Data was analyzed. Total 6304 patients were admitted in emergency way in Obstetrics and Gynaecology department of Faridpur Medical College Hospital. Among them 1864 patients undergone emergency operations, here 15 patients needed re-laparotomy. The incidence of re-laparotomy was 0.80%. Indications of relaparotomy included internal hemorrhage, postpartum hemorrhage (PPH), retained foreign body, incorrect diagnosis at first laparotomy, intraabdominal collection of pus and urine, Rectus sheath haematoma and burst abdomen. Often more than one procedure was needed to manage the cases. Re-laparotomy causes much morbidity & mortality with increase in hospital stay and cost. Careful selection of cases for primary operation, expertise of the surgeon, good surgical technique and careful postoperative follow-up can reduce the need for re-laparotomy.