A COMBINED ULTRASOUND AND CLINICAL SCORING MODEL FOR THE PREDICTION OF PERIPARTUM COMPLICATIONS IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

Introduction: Patients with placenta previa are at an increased risk of uncontrolled hemorrhage. Various clinical and ultrasound parameters can predict the risk of bleeding in these patients. Hence, the objective of our study is to develop a combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Methods: Fifty singleton pregnant women with placenta previa who underwent cesarean delivery in our hospital were included in the study. We collected clinical and ultrasound data prospectively, and the score was given to each parameter, and total score correlated with the occurrence of peripartum complications. Clinical parameters included age, parity, history of dilatation and evacuation, previous cesarean delivery, history of placenta previa, antepartum hemorrhage, and ultrasound parameters included type of previa, no. of lacunae in placenta, uteroplacental hypervascularity. The peripartum complications noted were the need for blood transfusion, uterine artery ligation, and cesarean hysterectomy. Results: According to the composite scoring done, uterine artery ligation was needed in more than 50% of patients at a score of 9–10. It increased to 100% as the score increased to ≥11. At a score of ≥12, hysterectomy was needed in around 75% of patients, and 100% of patients needed a blood transfusion. Univariate analysis using the Pearson Chi-square test was also done to know whether individual parameters and peripartum complications were significantly related that is p<0.05 with one another. Conclusion: The scoring system may serve to predict peripartum complications in pregnancies complicated by placenta previa.

The Efficiency of Temporary Uterine Artery Ligation on Prevention of the Bleeding in Cesarean Section

<b><i>Objective:</i></b> We aimed to evaluate the effect of temporary ligation of the uterine artery on postpartum bleeding during uncomplicated cesarean section. <b><i>Design:</i></b> This was a prospective, randomized, and controlled study. We recruited a total of 200 patients, including 100 cases and 100 controls. <b><i>Methods:</i></b> The bilateral uterine artery was temporarily clamped 2 cm below the uterine incision in the study group and compared with controls. Patient demographics, the amount of intraoperative bleeding, the duration of the operation, the closure time of the uterine incision, the need for additional uterotonics, the need for additional sutures, and the hemoglobin values before and after birth were assessed. <b><i>Results:</i></b> The mean value of the amount of bleeding in the clamped and control groups was 267.3 ± 131.8 mL and 390.2 ± 116.4 mL, respectively. The amount of bleeding was significantly decreased for clamped group (<i>p</i> &#x3c; 0.001). A significant reduction occurred in the results of pre- and postoperative values of hemoglobin and hematocrit difference, operation duration, and the closing time of the uterine incision in the experimental group which has temporary uterine artery clamping. <b><i>Limitations:</i></b> The cases of recurrent cesareans were not included in this study. <b><i>Conclusion:</i></b> Temporary uterine artery ligation can be used to reduce the amount of bleeding during uncomplicated cesarean delivery and prevent postpartum hemorrhage.

Dying uterus, uterine artery ligation-a curse or a blessing? a rare case report

Uterine necrosis is a rare life-threatening condition reported in few case reports associated with uterine artery embolization for uterine fibroids or postpartum hemorrhage. We report a case of hemorrhagic uterine necrosis in a 22-year-old primipara day 4 post emergency caesarean section who presented with breathlessness, abdominal distension and severe anaemia. Patient underwent emergency exploratory laparotomy 2 hours after the caesarean section with intraoperative findings suggestive of rectus muscle hematoma, bilateral uterine artery ligation was done for atonic PPH. On clinical examination uterus was corresponding to 28-30 weeks gestation size with guarding and tenderness. Ultrasonography revealed bulky uterus. CT abdomen with pelvis with contrast was done with findings suggestive of hemorrhagic ischaemic myometrial necrosis. An emergency exploratory laparotomy was performed with intraoperative findings of uterus size of 30 weeks gestation with diffuse congestion, gangrene of bilateral tubes and ovaries. Obstetric hysterectomy with bilateral salpingo-oovarectomy was done. Patient was discharged on postoperative day 9. High index of clinical suspension, prompt CT imaging and exploratory laparotomy on time proved life-saving.

A case report on decidual cast following B-lynch compression suture

In case of atonic postpartum haemorrhage (PPH) and traumatic PPH or cervical tear extended deep up to lower uterine segment exploratory laparotomy is the last resort to control PPH. It was a case of 20 years old female admitted in labour room with chief complain of bleeding per vaginum and something coming out of vagina after 6 weeks of post laprotomy for atonic postpartum hemorrhage. Compression sutures were applied and bilateral uterine artery ligation was done at time of laparotomy. After 6 weeks post laparotomy the patient was presented with complain of something coming out from vagina. An examination was performed under short general anesthesia in the operation theater, the mass was removed without any resistance. A provision diagnosis of decidual cast was made which was later confirmed by histopathological report which shows autolytic changes in decidual tissue. Women which are undergoing bilateral uterine artery ligation or compression suture for management of postpartum hemorrhage, should be informed about potential complication. Postoperative follow-up is necessary for any complications.

Role of the Uterine Artery Ligation (UAL) In Control of Postpartum Hemorrhage

Objective: To determine the efficacy and safety of uterine artery ligation (UAL) in control of Postpartum Hemorrhage. Methodology: This case series study was conducted at Department of Gynecology and Obstetrics Peoples University of Medical & Health Sciences for Women Nawabshah. All the women age between 20-45 years, gestation duration at and beyond 34 weeks, antepartum hemorrhage; intraoperative atonic postpartum hemorrhage and discovery of a placenta accreta; or an adherent placental part after piecemeal removal of the placenta, with bleeding from the placental site were included. After failure of treatment from medical measures, the initial surgical approach of uterine artery ligation (UAL) was done. Efficacy was defined as positive when patient improves or clinically doesn’t develop any complication throughout admission after UAL. Safety was assessed by appearance of side effects if any occurred after procedure. Data was recorded via study proforma and analysis was done by using SPSS version 20. Results: Out of 76 patients admitted of postpartum hemorrhage mean age was 58 years. Most of the patients 59.2% were multiparous and 40.8% were primiparous. The most common cause of postpartum hemorrhage was uterine atony 56.5% and adherent Placenta accreta 43.42%. Most of the patients 81.6% had no postoperative complications except for 11 patients, who had developed gaping of the wound from which they recovered and discharged. The patients required hysterectomy due to intractable hemorrhage and 2.3% mortality was observed due to DIC. Conclusion: Uterine devascularization by bilateral uterine artery ligation is a simple, effective and the safest initial surgical option with less blood loss and less surgical time for controlling postpartum hemorrhage during cesarean section. It should be used as the first surgical step of choice after medical managements fail in controlling postpartum hemorrhage due to minimal rate of complications and mortality.

COMPARATIVE STUDY BETWEEN PATWARDAN TECHNIQUE OF DELIVERY AND TRADITIONAL WAY OF DELIVERING BABIES BY PULL OR PUSH METHOD AT MMCH, MADHUBANI, BIHAR

In this paper we discuss the after math of two different approaches of delivering the babies during caesarean section in advanced labour. The two techniques are “Patwardans Technique” and “Traditional way of delivering the babies by Pull or Push method”. The post-operative factors that were monitored include uterine extensions, broad ligament haematoma formation relaparotomy, uterine artery ligation and need for blood transfusions. It was concluded only after studying 200 patients that Patwardans technique is relatively a better technique.

Echocardiographic assessment of fetal cardiac function in the uterine artery ligation rat model of IUGR

Background Intrauterine growth restriction (IUGR) leads to cardiac dysfunction and adverse remodeling of the fetal heart, as well as a higher risk of postnatal cardiovascular diseases. The rat model of IUGR, via uterine artery ligation, is a popular model but its cardiac sequelae is not well investigated. Here, we performed an echocardiographic evaluation of its cardiac function to determine how well it can represent the disease in humans. Methods Unilateral uterine artery ligation was performed at embryonic day 17 (E17) and echocardiography was performed at E19 and E20. Results Growth-restricted fetuses were significantly smaller and lighter, and had an higher placenta-to-fetus weight ratio. Growth-restricted fetal hearts had reduced wall thickness-to-diameter ratio, indicating left ventricular (LV) dilatation, and they had elevated trans-mitral and trans-tricuspid E/A ratios and reduced left and right ventricular fractional shortening (FS), suggesting systolic and diastolic dysfunction. These were similar to human IUGR fetuses. However, growth-restricted rat fetuses did not demonstrate head-sparing effect, displayed a lower LV myocardial performance index, and ventricular outflow velocities were not significantly reduced, which were dissimilar to human IUGR fetuses. Conclusions Despite the differences, our results suggest that this IUGR model has significant cardiac dysfunction, and could be a suitable model for studying IUGR cardiovascular physiology. Impact Animal models of IUGR are useful, but their fetal cardiac function is not well studied, and it is unclear if they can represent human IUGR fetuses. We performed an echocardiographic assessment of the heart function of a fetal rat model of IUGR, created via maternal uterine artery ligation. Similar to humans, the model displayed LV dilatation, elevated E/A ratios, and reduced FS. Different from humans, the model displayed reduced MPI, and no significant outflow velocity reduction. Despite differences with humans, this rat model still displayed cardiac dysfunction and is suitable for studying IUGR cardiovascular physiology.