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 ...

Objective: The objective of the study was to assess the maternal and neonatal outcome in premature rupture of membranes. Material and Methods: A prospective study was carried out in the department of Obstetrics &Gynae in Ibn Sina Medical College hospital from October'15 to September'16. The sample size was 110. The maternal and neonatal outcome of pre-labour rupture of membranes in both term and preterm pregnancies was observed and statistically analyzed. Results: Incidence of PROM (premature rupture of membrane) was commonly in primigravida (62.7%). Term PROM was higher (70.92%) than PPROM (29.09%). Aetiological analysis revealed cause is unknown in most of the cases. Infection in 26.4% cases, previous history of PROM 16.3% and history of recent coitus 9.09% cases. Patient delivered by vaginal route 70.91% and LSCS 29.09%. The PROM had higher maternal morbidity (27.8%) like post partum fever 11.8%, wound infection 4.5% and chorioamnionitis 3.6%. Also higher perinatal mortality (4.5%) and morbidity (26.4%) like respiratory distress syndrome 9.09%, birth asphyxia 4.5%, septicemia 5.8%. Conclusion: Antenatal diagnosis to prevent PROM by identifying the risk factors is an important tool in management. Steroid for fetal lung maturity, antibiotics to prevent fetal and maternal infection, induction and/or augmentation of labour in due time and skilled NICU support will speed delivery, reduce hospital stay and infection as well as decrease maternal morbidity and perinatal morbidity and mortality.

Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients’ sufferings. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18295 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.135-139

Background: Postpartum haemorrhage (PPH) is a major cause of maternal mortality,accounting for one-quarter of all maternal deaths worldwide. Tranexamic acid (TXA), anantifibrinolytic agent, has therefore been investigated as a potentially useful complement toprevention and treatment of PPH. It has been proved to reduce blood loss in elective surgery,bleeding in trauma patients, and menstrual blood loss. Aims: To evaluate the effectiveness of TXA in reducing blood loss given just immediatelyafter delivery of baby in women undergoing cesarean section. Methods: This was a prospective, randomized, double blind, placebo controlled studyconducted in the Department of Gynaecology and Obstetrics unit of IBN SINA Medical CollegeDhaka, Bangladesh from June 2016 to May 2017. Participants were randomly assigned toTXA group or group A (n=60) and placebo group or group B (n=60). Randomization wasdone by residents using computer generated random numbers. Group A received 1 gram(10ml) of intravenous bolus dose of TXA just after delivery of the baby, Group B received 10ml of sterile distilled water for injection intravenously at the same time. Statistical analysishas been done by SPSS. Results: The subjective characteristics in the two groups were similar with respect to theirage, BMI, gestational age and gravidity. The duration of surgery was 40-50 minutes. Therewas no statistically significant difference in the heart rates (p>0.05) and blood pressuresbetween the two groups, after 2 hours of delivery. Blood losses from both placental deliveriesto the end of cesarean section and from end of CS to 2 hours postpartum were significantlylower in the study group (p<0.05). Change in hemoglobin concentration in study group wasalso significantly less than in the control group. Total amount of oxytocin required wassignificantly less in TXA group (p<0.05) also the number of women requiring other oxytocics(inj. Methyl ergometrine, inj carboprost and tab misoprostol per rectally) was significantlyless in TXA group (p< 0.05). The amount of intra-operative fluid required were significantlyless in TXA group (p<0.005); however post – operative fluid requirement and minor sideeffects in the form of nausea and vomiting were similar in both the groups. Conclusion: Tranexamic acid can effectively reduce blood loss in patients undergoing LSCSand its use was not associated with any side effects and or complications like thrombosis.The adoption of WHO guidelines for using uterotonic agents and prophylactically administeringTXA may significantly reduce the number of PPH incidents. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 125-130

Abstract:Background: Unani Medicine had its golden past in the middle age. Allopathic medicine evolved with simultaneous exploration of modern scientific development. Discovery of chemicals and antibiotics to deal infectious disease led foundation of epitome of modern medicine. There is however growing tendency among people to show their to depend on plant source and time old preparations. It is estimated that about 80 percent of population of the Asia and African countries uses herbal medicine for health care. This scenario opened the scope and merit to evaluate the preparation(s) which people are still using and the present study tested the usefulness and safety of 'Sarbat Misali' an Unani hematinic preparation in treating anemia. Materials and Methods: A total 31 women of age 24-40 yrs were enrolled in the study following ethical guidelines. The volunteers offered the choice and were free to refuse for not being included. Anthropometry recorded and blood sample obtained for biochemical test from the consenting subjects and prescribed with the preparation. Weight recorded and blood samples taken at the baseline end of four weeks. During study period they were in touch for their allegiance to taking the test preparation. Hemoglobin was estimated using autoanalyzer. Serum creatinine and SGPT were determined by standard biochemical method using autoanalyzer. Results: Blood hemoglobin level showed significant increase at the end of the supplementation (12.03±0.82) compared to the baseline level (10.78±1.08) (p<0.001). Serum creatinine and SGOT did not show any statistical difference between before and after supplementation. Conclusion: Data concluded that Sharbat Misali an Unani preparation of hematinics improved hemoglobin level and safety was supported by the fact of unaltered hepatic and renal functional status, however, to conclusively comment on adverse and toxic effect(s) chronic study needs to be undertaken with attention of inclusion of exhaustive biochemical markers.