Placental drainage significantly reduces the duration of third stage of labour in vaginal deliveries.
BackgroundThe CORONIS Trial was a 2×2×2×2×2 non-regular, fractional, factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes, the primary outcome being a composite of maternal death or infectious morbidity. The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies. Such outcomes include those related to subsequent pregnancy: mode of delivery; abnormal placentation (e.g. accreta); postpartum hysterectomy, as well as longer term pelvic problems: pain, urinary problems, infertility. The Coronis Follow-up Study aims to measure and compare the incidence of these outcomes between the randomised groups at around three years after women participated in the CORONIS Trial.Methods/DesignThis study will assess the following null hypotheses: In women who underwent delivery by caesarean section, no differences will be detected with respect to a range of long-term outcomes when comparing the following five pairs of alternative surgical techniques evaluated in the CORONIS Trial:1. Blunt versus sharp abdominal entry2. Exteriorisation of the uterus for repair versus intra-abdominal repair3. Single versus double layer closure of the uterus4. Closure versus non-closure of the peritoneum (pelvic and parietal)5. Chromic catgut versus Polyglactin-910 for uterine repairThe outcomes will include (1) women’s health: pelvic pain; dysmenorrhoea; deep dyspareunia; urinary symptoms; laparoscopy; hysterectomy; tubal/ovarian surgery; abdominal hernias; bowel obstruction; infertility; death. (2) Outcomes of subsequent pregnancies: inter-pregnancy interval; pregnancy outcome; gestation at delivery; mode of delivery; pregnancy complications; surgery during or following delivery.DiscussionThe results of this follow-up study will have importance for all pregnant women and for health professionals who provide care for pregnant women. Although the results will have been collected in seven countries with limited health care resources (Argentina, Chile, Ghana, India, Kenya, Pakistan, Sudan) any differences in outcomes associated with different surgical techniques are likely to be generalisable throughout the world.Trial registrationISRCTN31089967
Jehovah's Witness persons don't accept blood transfusion due to religious objections. Hence, alternative should be used to avoid blood transfusion for surgery on them. We present, a case in which iron sucrose and erythropoietin was successfully used to raise Hb level and blood transfusion could be avoided. IntroductionJehowa witness is religious sects who don't accept blood transfusion due to religious objections [1]. Alternatives to blood transfusion have to be used for surgeries in them [1]. Recombinant erythropoietin therapy with intravenous sucrose may be an appropriate therapy for them to raise hemoglobin levels for coping up blood loss during surgery [2]. Traditionally erythropoietin is used for renal disease with anemia but has also been tried for non renal disease where iron therapy alone fails to give adequate results [2,3]. Alterations in various hematological indices and in erythropoietin levels have been observed in anemia and in pregnancy [4]. Case ReportMrs. S.B., 25 year old staff nurse a Jehowa witness by religion was admitted with 23 weeks pregnancy with large fibroid uterus with leaking per vaginum. On examination she had no pallor, jaundice, edema or lymphadenopathy. Her temperature was 37.2°C. Her cardiovascular and respiratory systems were normal. Abdominal examination revealed uterus to be 28 weeks size with palpable fetal parts with no tenderness. On speculum examination there was clear amniotic fluid coming out through cervix. Her investigation and ultrasound reports are shown in Table 1. She was started on intravenous antibiotics using amoxicillin 500 iv 8 hourly with metronidazole 500mg iv 8 hourly. However, her condition worsened. She had fever (38.2°C). Her pulse was 82 beats per minute. Her leucocytes count increased and C Reactive protein also increased. High vaginal swab grew Streptococcus β hemolytic and mixed bacterial growth. As she and her husband refused to accept blood transfusion due to religious objection, she was started on intravenous iron sucrose 400mg twice a week. She was also given subcutaneous recombinant erythropoietin therapy on alternative days (6000 units for 3 doses: total 18000 units). Her hemoglobin was raised to 13.3g/dl (2.5 g/dl rise).Patient was counseled about prognosis of fetus and risk of chorioamnionitis. She agreed for termination of pregnancy. As cervix was unfavorable, Dinoprosterone gel was inserted in cervix and repeated after 6 and 12 hours. Oxytocin drip was also started. However, cervix did not dilate and there was no progress of labor. As her condition was deteriorating and signs of chorioamnionitis had developed, decision to perform hysterotomy was taken.She was started on intravenous coamoxyclav and metronidazole therapy. Hysterotomy was performed. However, while performing hysterotomy, the large fibroid came in incision line. Though myomectomy was not planned, but it was not possible to perform hysterotomy as fibroid was occupying whole of anterior wall of uterus. Myomectomy had to be performed and a 10×8 cm myoma was easily enuclea...
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