The Mostafa Maged hemostatic flipping-over technique to control and prevent the post-partum bleeding from the lower uterine segment in placenta previa cases

Post-partum hemorrhage is still a headache to all obstetricians around the whole world. Every obstetrician exerts his own full effort to control bleeding which can occur post-partum by applying all maneuvers to preserve the fertility and the uterus for the patient. We demonstrate a new technique (Mostafa Maged) technique to control and prevent post-partum hemorrhage. It is so simple maneuver and easy to be applied within short period of time. Satisfactory hemostasis can be assessed after application. The aim of this technique is to see the Success in Controlling and prevention of the bleeding from placenta previa cases from lower uterine segment. The average duration of this new technique is (5-7) minutes. The results have shown that the hysterectomy done to one patient with new technique (1/13) (7.6%) cases because of the uncontrollable bleeding, blood was creeping down from the flipped sutured lower uterine segment. All of patients are introduced to the operating room as first-time cesarean section. One patient (7.6%) out of thirteen patients were tachycardiac post-operatively due to the more loss of blood as the new (Mostafa Maged) technique took a long time in these two patients (8 minutes). The tests of success were expected if hemostasis is done by the bimanual compression at first place.

Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient’s dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms related to impaired coagulation. Regional anesthesia may not have safe outcome due to dengue infection. doi: https://doi.org/10.12669/pjms.38.1.4519 How to cite this:Ahmed U, Aman A. Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4519 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Uterine Artery Laceration after Vacuum Delivery

Post-partum hemorrhage is one of the leading causes of maternal mortality and it’s etiology needs to be identified in order for adequate treatment to be provided. We report a case of a post-partum hemorrhage in a multiparous woman treated with selective coil packing embolization after identification of laceration of the right uterine artery’s ascending branch. The patient was admitted to an intensive care unit in hemorrhagic hypovolemic shock and disseminated intravascular coagulation and underwent total hysterectomy due to infectious complications.

Risk factors for post-partum hemorrhage in patients who underwent operative vaginal delivery in a tertiary care center

Background: Operative vaginal delivery is a timely intervention to cut short second stage labor when imminent delivery is in the interests of mother, fetus, or both. It reduces second stage cesarean section morbidity and uterine scar and its influence on future obstetric career. The possible structural neonatal adverse outcomes due to operative vaginal delivery are well quantified. However, its effects on maternal outcome need to be understood better. In this paper, we study the effect of operative vaginal delivery on maternal post-partum hemorrhage (PPH) and the associated risk factors.Methods: It was a retrospective study carried out for the period July 2016 to July 2020 at Ramaiah Medical College, Bengaluru. Total number of vaginal deliveries in this period were 6318. Out of these, 1020 patients underwent assisted vaginal delivery using vacuum/ forceps/ sequential use of instrument. Blood loss greater than 500 ml is considered PPH for the purpose of this study. 15% of the study population was noted to have PPH. We employ a multivariate logistic regression to identify statistically significant risk factors for PPH in women undergoing operative vaginal delivery.Results: The logistic regression model identifies multiparity, maternal age, neonatal birth weight more than 3.5 kg, application of forceps in women with hypertensive disorders, III-degree tear, cervical tear to significantly increase the risk of PPH in our study population.Conclusions: Certain factors seem to increase the risk of PPH in operative vaginal delivery. The risks and benefits must be weighed properly before use of instruments.

Cost-effectiveness of uterine balloon tamponade devices in managing atonic post-partum hemorrhage at public health facilities in India

Objective Post-partum hemorrhage (PPH) is the leading direct cause of maternal mortality in India. Uterine balloon tamponade (UBT) is recommended for atonic PPH cases not responding to uterotonics. This study assessed cost-effectiveness of three UBT devices used in Indian public health settings. Methods A decision tree model was built to assess cost-effectiveness of Bakri-UBT and low-cost ESM-UBT alternatives as compared to the recommended standard of care i.e. condom-UBT intervention. A hypothetical annual cohort of women eligible for UBT intervention after experiencing atonic PPH in Indian public health facilities were evaluated for associated costs and outcomes over life-time horizon using a disaggregated societal perspective. Costs by undertaking primary costing and clinical parameters from published literature were used. Incremental cost per Disability Adjusted Life Years (DALY) averted, number of surgeries and maternal deaths with the interventions were estimated. An India specific willingness to pay threshold of INR 24,211 (USD 375) was used to evaluate cost-effectiveness. Detailed sensitivity analysis and expected value of information analysis was undertaken. Results ESM-UBT at base-case Incremental Cost-Effectiveness Ratio (ICER) of INR -2,412 (USD 37) per DALY averted is a cost-saving intervention i.e. is less expensive and more effective as compared to condom-UBT. Probabilistic sensitivity analysis however shows an error probability of 0.36, indicating a degree of uncertainty around model results. Bakri-UBT at an ICER value of INR -126,219 (USD -1,957) per DALY averted incurs higher incremental societal costs and is less effective as compared to condom-UBT. Hence, Bakri-UBT is not cost-effective. Conclusion For atonic PPH management in India, condom-UBT offers better value as compared to Bakri-UBT. Given the limited clinical effectiveness evidence and uncertainty in sensitivity analysis, cost-saving result for ESM-UBT must be considered with caution. Future research may focus on generating high quality comparative clinical evidence for UBT devices to facilitate policy decision making.