Comparative study of oxytocin bolus and oxytocin infusion during caesarean section

Background: The incidence of postpartum haemorrhage varies from 2-11%. Postpartum haemorrhage complicates approximately 4% of deliveries in most large obstetric services. Postpartum haemorrhage is the third major cause of maternal mortality next to pregnancy induce hypertension (pre-eclampsia) and infection. Prevention, early recognition and prompt appropriate intervention are keys to minimizing its impact. Conventionally loss of more than 500 ml of blood following vaginal delivery and 1000 ml of blood following caesarean section is defined as postpartum haemorrhage. In this study we compared the efficacy of intravenous oxytocin bolus (2 IU) dose followed by infusion (160 mIU/minute) and only i.v. oxytocin infusion following delivery of fetus in elective and emergency LSCS with regard to uterine tone.Methods: This study was a prospective observational study. 200 low risk patients scheduled to undergo elective and emergency caesarean section under spinal anaesthesia in Department of obstetrics and gynecology, SSMC, Tumkur. Group A included i.v. bolus + i.v. injection, group B: i.v. infusion.Results: There was significant drop in haemoglobin and PCV in both group A and group B. But it was comparable among two groups. At 15th minute MBP was 77.2 mm of Hg and 80.04 mm of Hg in Group B. In group A better uterine tone was achieved earlier compared to group B at 2, 5, 10, 20 minutes.Conclusions: It was concluded from this study that oxytocin i.v. bolus with infusion causes earlier attainment of better uterine tone when compared with only infusion.

Fibrinogen levels helps in early detection of abnormal pregnancies

Background: Haemostatic failure as an end result of various complications of pregnancy is an important cause of maternal mortality in India. The main aim of this study is to detect the levels of fibrinogen in abnormal pregnancy i.e. Pregnancy induce hypertension (PIH), Intra uterine fetal death (IUFD), Missed abortion, Abruptio placenta.Methods: Study was conducted on 150 in patients joined in Obstetrics ward private hospital, Andhra Pradesh, 50 are control subjects and 100 are study patients, Out of hundred (100) cases, 40 are PIH, 25 are IUFD, 25 are Missed abortion, and 10 are Abruptio placentae. Estimated for fibrinogen, D-Dimer, total proteins, Albumin.Results: The fibrinogen levels in present study decreased significantly. PIH (Control mean 442.0, S.D ±43.38, Test mean 296.0, S.D ±48.03, p<0.001). IUFD (Control mean 442.0, S.D±43.38, Test mean 262.4, S.D±20.06, p<0.001). Missed abortion (Control mean 442.0, S.D ±43.38, Test mean 250.80, S.D±26.13, p<0.001). Abruptio placentae (Control mean 442.0, S.D±43.38, Test mean 210.5, S.D±87.38, P<0.001). D-dimer levels are estimated semi quantitatively and the levels were found to be increased. Total proteins and albumin are decreased in all the cases, but significantly in PIH (T.P-Control mean6.25, S.D±0.65, Test mean 5.25, S.D±1.57, p<0.001, Albumin- Control mean 2.79, S.D±0.34, Test mean 2.23, S.D±0.59, p<0.001).Conclusions: The estimation of plasma fibrinogen is helpful not only in the early diagnosis of haemostatic failure but also to guide replacement therapy during the fibrinopenic state.