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 ...

Background: The clinical profiles and urinary albumin are very important for the prediction of preeclampsia among the pregnant women. Objective: The purpose of the present study was to assess the clinical and demographic profiles as well as the urinary albumin for the prediction of preeclampsia among the pregnant women. Methodology: This cohort study was conducted in the OPD of the Department of Obstetrics and Gynaecology at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2013 to December 2014 for a period of two (2) years. This study was carried on pregnant woman attending in outdoor department of Gynaecology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh before 20th weeks of pregnancy who were healthy normotensive primigravidae with singleton pregnancy. The details demographic profiles, edema were collected from the study population. Urinary albumin was estimated before 20th weeks and after 28th weeks of pregnancy. Result: In the present study, 75 women were included; all were before 20th weeks of pregnancy without any complication or any risk factor for developing PE. Among the study group incidence of PE was 16%. The population are 24(32.0%) low, 31(41.3%) middle and 20(26.7%) high in socio economic conditions. Education level of study population was 45% completed primary education level, illiterate (27%) and secondary education (28%). Edema was absent in 1st visit, in 2nd visit 6(+), 6(++) present who developed PE, 18(+) present who did not develop PE. Edema was absent in 1st visit and (+) 6(50.0%) and (++) in 6(50.0%) present who developed PE in 2nd visit. Urine albumin in 1st visit nil in 6(50.0%), trace in 3(25.0%) and (+) in 3(25.0%) who developed PE. Conclusion: In conclusion housewife living in urban area in middle income socioeconomic condition are the most commonly presented with preeclampsia and urinary albumin is the most commonly detected in the pregnant women presented with preeclampsia Journal of Science Foundation 2018;16(2):54-59

This was a hospital based case control study. The study included patients attending in outdoor and indoor Department of Obstetrics and Gynaecology of Rajshahi Medical College, Hospital since July 2014 to June 2016. The aim of this study was to determine thyroid antibodies is a risk factor for recurrent pregnancy loss. Sixty seven pregnant or non pregnant women with history of recurrent miscarriage during 1st trimester were selected as case group and another sixty seven pregnant women who reached their 12 weeks uneventfully with no history of recurrent miscarriage were selected as control group. Patients with other cause of recurrent miscarriage such as metabolic or endocrinologic disorders, genital organ anomaly, uterine fibroid were excluded from the study. Thyroid function test and thyroid antibodies (FT4, TSH and TPO-Ab) were measured for the two groups. The result of this study showed that the percentage of positive TPO-Ab in target and control group is 67.16% and 5.95% respectively. The study observed that the mean serum concentrations of FT4 in the control subject was significantly higher than the mean of the target group (p-value <0.05). The TSH concentration was increased in miscarriage women with positive antibodies compared with the concentration of TSH in the control group with positive antibodies. The conclusions are that there is a deficiency in thyroid hormones or thyroid’s functional capacity is unable to meet the extra demands of pregnancy which may be one of the causes of recurrent miscarriage. Moreover positive thyroid antibodies pregnant women can reach term and have babies when the concentration of TSH is low during the first trimester, so the risk of miscarriage could be high in positive thyroid antibodies.TAJ 2017; 30(1): 49-55

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Background: Lower uterine compression suture (Cervical-Isthmic apposition suture technique) is a new but effective method to arrest postpartum hemorrhage (PPH). The effectiveness of the suture is not only due to local compression of the anterior and posterior walls of the uterus but also related to the indirect compression of the intramyometrial vessels running from the lateral edge of the lower uterine segment to its media part.  Objectives: The aim of this study was to determine the outcome of uterine compression sutures for the management of PPH due to placenta previa during cesarean section. Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital from January 2016 to December 2017. A total of 45 women who developed severe postpartum hemorrhage due to placenta previa during cesarean section were selected peroperatively or postoperatively as the study case. A lower uterine compression suture was given to all the patients. If the bleeding was not well controlled, then other adjunctive procedures were performed. Patients with a bleeding disorder, type I placenta previa, cases other than placenta previa, and morbid adherents of placenta were excluded from the study. The patients were examined postoperatively and again in 2nd week and 6th week after hospital discharge for evaluation of any complications. Data regarding history, physical findings, and investigation were collected from the patient and the patient's record. Result: Among the total of 45 cases, PPH was controlled in 88.9%(40) cases with compression sutures in the lower uterine segment, and only 11.1% (5) cases required additional procedures. It was observed that higher age groups, multiparous women, patients with <37 weeks of pregnancy, and previous history of cesarean section were significantly associated with a higher amount of bleeding. Conclusion: Lower uterine compressive compression suture is an effective and safe method to control PPH due to placenta previa during cesarean section and can preserve the uterus for further pregnancy and menstruation. TAJ 2022; 35: No-2: 35-41

Endometriosis is a common gynaecological condition and presents mainly with involvement of the pelvic organs. However umbilical endometriosis is uncommon. A correct differential diagnosis can be difficult and the use of epiluminescence and MRI is suggested for the accuracy of preoperative diagnosis. This case report was experienced at a tertiary care hospital at Rajshahi. The patient was 42 years old multigravid woman presented with umbilical swelling and pain during menstruation for last 6 years with cyclical bleeding from the umbilical region for same duration. The patient had regular menstrual bleeding since the time of menarche. The patient had no previous history of endometriosis, dysmenorrhea or dyspareunia. Physical examination showed a hyperpigmented tender paraumbilical swelling with bloody discharge through umbilicus. Clinical examination together with the use of high resolution ultrasonography and fine needle aspiration cytology led to an accurate pre-operative diagnosis of umbilical endometriosis. The surgical approach to umbilical endometriosis represented an important step in achieving a satisfying result. The lesion to be excised and adequate umbilical repositioning was done. The patient was asymptomatic at the follow-up visit (12 months after surgery). A natural-looking umbilicus was observed with minimal visible scars.TAJ 2015; 28(1): 48-51

This experience was based on ten cases of caesarean section. After spinal anesthesia within few minutes-these patients become cyanosed and there was profound bradycardia and hypotension. Ventilatory support was given by IPPV and I/V bolus vasopressor was given. The BP was improved spontaneous respiration returns. The artificial ventilatory support was with drawn again. So artificial ventilation was reinstituted and vasopressor was given both intermittently and as infusion. The patient began to take spontaneous respiration and the blood pressure became static. There was no further fall of BP and no further deterioration of respiration. doi: 10.3329/taj.v20i2.3077 TAJ 2007; 20(2): 144-146

This is a hospital-based cross sectional descriptive study was carried out during January 2015 to June 2015 in the Department of Obstetrics and Gynaecology of Rajshahi Medical College Hospital to determine pregnancy outcome in placenta praevia cases with delayed child bearing age.  Total 8107 patients were admitted during the study period and among them 82 patients were diagnosed as placenta praevia. Patients were categorized into two groups as above 35 years & below 35 years and relationship between advanced maternal age and placenta praevia was seen. Socio-demographic condition, clinical condition, course of management, maternal and perinatal outcome were observed and recorded.  Proportion of placenta praevia was 1.01% during the study time. Among 82 patients of placenta praevia, 25 were advanced maternal age group (30.49%). Prevalence of placenta praevia in advanced maternal age group in comparison to below 35 years among total admitted patient was seen 9.73% and 0.73% respectively. So, incidence is more in advanced maternal age group which is statistically significant (p<0.05). Most of the patients of placenta praevia came from middle class family 42(51.21%) and most women were multi gravida 75(91.5%). 42.68% patient had history of caesarean section and 47.56% patients had history of menstrual regulation (MR), abortion & dilatation, evacuation & curettage (DE & C). Major placenta praevia was more in advanced maternal age group (64%) which is statistically significant (<0.05) and mode of delivery was caesarean section 62(75.60%). Maternal and perinatal complications were more in advanced maternal age group. Maternal mortality rate 9(10.97%) and perinatal mortality rate 14(17.07%).  Advanced maternal age has a relation with placenta praevia and associated with more adverse maternal and perinatal outcome. So, pregnancy in advanced age should be considered as a risk factor for developing placenta praevia. TAJ 2019; 32(2): 48-55