The Current Status in Obstetrics in North Korea and Strategies for Establishing a Better Healthcare System

The women's healthcare in North Korea is in poor condition. The present study explored the current state of women's healthcare, especially in the field of obstetrics, in the region with a number of considerations in regards to establishing a better healthcare system. Peer-reviewed journal articles and reports from intergovernmental organizations were reviewed. Data show that many healthcare facilities suffer from shortages of basic amenities. The maternal mortality ratio was 82 deaths per 100,000 live births. The leading cause of maternal death was postpartum hemorrhage. It was also found that many hospitals were unable to provide adequate obstetrical emergency care such as anticonvulsants, antibiotics, and blood products. A long-term roadmap that is sustainable with clear principles and that is not disturbed by political tensions should be established.

Role of SR vacuum cannula as novel technique for atonic PPH management study at Pannadhay Rajkiya Mahila Chikitsalaya and RNT Medical College, Udaipur

Background: Postpartum hemorrhage is a major obstetrical emergency and one of the important but preventable causes of maternal morbidity and mortality. It is often sudden, frequently unpredictable and catastrophic. In this study SR vacuum cannula will be applied to create negative pressure inside the uterine cavity with a specially designed uterine cannula, which is a simple, safe and cost-effective technique. The aim and objective of the study was to analyse the incidence, effectiveness of suction cannula in management of atonic PPH after failure of medical management over tamponade and the maternal outcome after suction technique.Methods: This observational study was conducted in Department of Obstetrics and Gynecology, RNT Medical College and Panna Dhay Rajkiya Mahila Chikitsalaya, Udaipur, Rajasthan. Patients requiring PPH management admitted to the obstetrics ward between August 2019 – December 2020. The Uterine Vacuum Retraction System consists of SR Suction cannula to control PPH after vaginal delivery. SR suction cannula for atonic PPH at caesarean delivery and High vacuum suction machine was used.Results: In majority of the patients bleeding was stopped within three minutes. 60 women (50%) bleeding was stopped within 3 minutes, in 38 women (31.7%) bleeding was stopped between 3-4 minutes and in 22 women (18.3%) bleeding was stopped >4 minutes. In 75 (62.5%) women negative pressure was applied only once, in 20 (16.7%) was applied two times and 25 women (20.8%) negative pressure was applied three times to stop bleeding. Blood collected in bottle after SR Cannula Application ranged from 100-150 ml.Conclusions: Vacuum suction cannulas should be made part and parcel of normal delivery tray to facilitate quick application. This simple and cost-effective technique takes very little time to organize and can stop bleeding within 3 minutes in atonic PPH as shown in this study.

Pregnancy Outcomes and Associated Factors for Uterine Rupture: An 8 Years Population-based Retrospective Study

Background: Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods: This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were retrospectively reviewed.Results: A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10 000 births. 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all case, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcome. 24 (59%) of the ruptures occurred in anterior lower uterine segment. Fetal heart rate monitoring changes were the most reliable signs for rupture.Conclusions: Incidence of uterine rupture in the study area was consistent with developed countries. Further improvement in obstetric care and strong collaboration with referring health facilities was needed to ensure maternal and perinatal safety.

Study of Maternal and Foetal Outcome in Abruptio Placentae

Study of Maternal and Foetal outcome in Abruptio Placentae Introduction: Abruptio placentae (AP) is a significant obstetrical emergency and as per WHO 2009 maternal mortality rates reported due to AP worldwide was 2.1% and fetal perinatal mortality rate was 15%. AP cannot be prevented but maternal and perinatal morbidity and mortality due to AP can be reduced significantly by aggressive management. Methods: The present prospective study was conducted to evaluate the outcome of treatment on the perinatal and maternal outcome in Abruptio Placentae patients in a tertiary care hospital from January 2015 to January 2016 amongst 54 pregnant women diagnosed to have abruptio placentae from 28 weeks of gestation and above and all babies delivered. Face-to-face interviews was conducted. Results: Maximum no. of abruptio placentae were unbooked - 37 (69%) and 85% of patients belonged to the less than 30 years of age group. An abruptio placenta was more common in multipara. Anaemia was seen in 21 patients (38%). Anaemia and PIH was seen in 12 patients (23%). 7 patients had fetal distress at the time of admission (13%). Regarding mode of delivery, 50% of patients delivered vaginally by artificial rupture of membrane (ARM) and oxytocin augmentation and 50% underwent caesarean section. Conclusion: It was concluded that abruptio placentae is still a leading cause of maternal morbidity and mortality that can be reduced with modern management of abruptio placentae, but timely diagnosis and intervention is necessary. Key Words: Abruptio placentae, maternal mortality, fetal distress, anaemia

Concurrent occurrence of vagino-cervical and rectal prolapse in a doe and its successful management

Vaginal prolapse is a common reproductive problem during their last trimester of pregnancy. Protrusion of single or more layers of rectum through the anus is rectal prolapse. Rectal prolapse is also a common problem in cattle and small ruminants. Rectal prolapse occurs following straining which may be related with many conditions. In late gestation, vaginal prolapse may occur due to hormonal shift, decline in progesterone and rise in estrogen. Because of vaginal prolapse the animal may strain continually and end up with rectal prolapse and leads to a serious obstetrical emergency. A two and half years old pluriparous non descriptive doe was presented with the history of a mass protruding through the vulva and anal opening for the past five hours. Based on the initial clinical observation, the case was diagnosed as vagino-cervical prolapse coupled with rectal prolapse. The prolapsed vaginal mass and rectal mass was reduced and replaced in its anatomical position. Since the rectal straining was persistent, parturition was induced using cloprostenol (125 µg) and dexamethasone sodium phosphate (16 mg) as intramuscular injection. Following the induction, the doe delivered two live male kids after 36 hrs. After parturition straining was not observed. The animal made an uneventful recovery without any recurrence. Keywords: Doe, Rectal Prolapse Vagino-cervical prolapse, Parturition, Induction

A ruptured cornual pregnancy: a case report

A cornual gestation is a rare form of ectopic gestations accounting for 2-4% of all tubal pregnancies with a high rate of mortality among to 2%-2.5%. A 25 years old woman prima gravida was presented to the obstetrical emergency department with 8 weeks amenorrhea, lower abdominal pain and vaginal bleeding. A clinical diagnosis of ectopic pregnancy was made and confirmed using Ultrasonography and serum beta-hCG test. On laparotomy exploration authors found a left cornual ruptured ectopic pregnancy then authors made a left cornual resection with left salpingectomy. There were no postoperative complications.

Management of Dystocia Due to Uterine Torsion in a Murah Buffalo Using ‎Schafer’s Technique

Uterine torsion is considered an obstetrical emergency and should be corrected as soon as it is diagnosed. It occurs frequently in buffaloes as compared to other species of animals, mainly due to their peculiar anatomy and physiology. This case report describes the occurrence of uterine torsion in a pregnant pluriparous buffalo. The buffalo was presented with history of persistent straining for over 6 hours. The cervix was fully dilated and obstetrical examination revealed dystocia due to a left sided uterine torsion. Haematological results revealed a normal PCV but with an accompanying macrocytosis. There was also neutrophilia, eosinophilia as well as lymphopenia as well as hypocalcium and hypomagnesemia. The dystocia was corrected using the Schafer’s technique. This involved the placing of the free end of a wooden plank on the left flank while the other free end, having an assistant standing on it rested on the ground. Rolling the buffalo twice with this arrangement corrected the anomaly.