Comparison of efficacy of intramyometrial versus intramuscular prostaglandin F2α (PGF2α) in the management of primary postpartum hemorrhage due to uterine atony.

Objective: To determine the better route of prostaglandin F2α either intramyometrial or intramuscular for the management of uterine atony and to prevent surgical intervention. Study Design: Randomized Controlled Trial. Settings: Bahawal Victoria Hospital. Period: Feb 2018 to July 2018. Material & Method: A total of 266 patients with primary PPH due to uterine atony of 20 to 39 years of age were enrolled in the study. Patients of primary PPH due to bleeding disorders, ruptured uterus, on anticoagulant therapy and hypersensitivity to prostaglandin were excluded. Patients were divided randomly into two groups i.e. Group A (for intramyometrial injection) & Group B (for intramuscular injection). Outcome variables like arrest of bleeding within 30 minutes after start of treatment (efficacy) were noted for successful or unsuccessful outcome. Results: The mean age of women in group A was 26.94 ± 4.43 and in group B was 26.21 ± 4.09 years (p=0.005). The mean parity in group A was 2.92 ± 0.87 and in group B was 2.93 ± 0.98 (p=0.8579). Efficacy was 82.71% in group A (Intramyometrial group) and 91.73% in group B (Intramuscular group) with p-value of 0.0276. Conclusion: This study concluded that intramuscular prostaglandin F2α has better efficacy i.e. 91.73% in a patient of uterine atony for management of primary PPH as compared to intramyometrial rout of administration for prostaglandin F2α.

Maternal death due to ruptured uterus consequent to abruptio placentae: 2 case reports

Background Abruptio placentae is a complication of pregnancy that can lead to uterine rupture, increasing maternal and fetal mortality, especially when there is a lack of medical outreach in remote areas. Case presentation We present two maternal deaths due to uterine rupture in a term pregnancy consequent to abruptio placentae. In one case, the uterus ruptured at the previous lower segment Caesarean section (LSCS) scar site and in another over the lateral wall of Couvelaire uterus. In both cases, the fetus was partially lying outside the uterus in the peritoneal cavity, and there was a massive retro-placental clot. Conclusions Early identification of high-risk factors, followed by institutional delivery, may reduce maternal and fetal mortality due to abruption followed by uterine rupture.

The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

Incidence and Risk factors of Uterine Scar Dehiscence after Previous Caesarean Section

Objectives: To assess the incidence and risk factors of scar dehiscence. Methodology: This was a prospective observational study where a total of 210 patients were involved over a period of six months (May 2020 to November 2020) who came to Sandeman Provincial Hospital, BUMHS gynaecology unit 1. The parturient were above the age of 18 and had previous uncomplicated lower segment caesarean sections. Patients with previous classical caesarean section and ruptured uterus diagnosed pre or intra-operatively were excluded from the study. Sampling technique: Non-probability convenience sampling technique will be used. Results: In this study, the mean age of the patients was 31.57 ± 4.26 years, the mean gestational age was 34.43± 4.45 weeks. The incidence of scar dehiscence was observed in 47 patients. Conclusion: Uterine Scar Dehiscence is one of the factors that increases fetal and maternal morbidity and mortality rate. Its incidence is found to be related with C-sections, inadequately short intra-pregnancy time interval, preterm delivery, VBAC and trial labour. In this study, the incidence of scar dehiscence was 22.38%. Keywords: Previous one caesarean section, scar dehiscence, scar tenderness

Peripartum hysterectomy at a tertiary center

Aims: To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center. Methods: This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section. Results: Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury. Conclusion: Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy.

A rare case of placenta percreta causing uterine rupture and massive haemoperitoneum in 2nd trimester: an obvious near miss

Placenta accreta spectrum is very rarely encountered with ruptured uterus and is commonly seen in third trimester of pregnancy. Hereby, a case of placenta percreta with uterine rupture in second trimester of pregnancy is presented. 40 year old women with previous 2 LSCS presented in emergency department with ninteen weeks pregnancy and massive haemoperitoneum. Emergency laprotomy revealed uterine rupture alnong with placenta percreta for which obstetric hysterectomy was done. Although, a rare occurrence, obstetricians should consider patients placenta accreta spectrum in patients with previous surgeries presenting with haemoperitoneum and signs of hypovolemic shock in second trimester of pregnancy, considering the possibility of rupture at the site of placenta adherance.

Maternal and perinatal outcomes of uterine rupture in Lubumbashi, Democratic Republic of Congo

Introduction: Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of mortality among women with uterine rupture in referral hospitals of Lubumbashi, in the south east part of the Democratic Republic of Congo. Methods: Institution based cross sectional study was conducted from December 1st, 2012 to 31st, 2016 on uterine rupture. During the study selected 158 women were included by using exhaustive sampling method. Data were checked, coded and analyzed into STATA version 12. Chi-square test was used to identify the predictors of maternal and perinatal mortalities in women with uterine rupture and 95% Confidence Interval of odds ratio at p - value less than 0.05 was taken as a significance level. Results: The overall prevalence of uterine rupture was 0.49%. The average age of the patients was 29.5 ± 6.2 years and 71.52% of them were between 20 and 34 years old; more than 60% had a parity ≥4 (average parity: 4.7 ± 2.5). 81.17% of the cases had a fully ruptured uterus and 51.17% of the uterine ruptures were located in the lower segment. Repair of the pregnant ruptured uterus was performed in 93.04% of the cases and hysterectomy in 5.06%. Maternal and perinatal mortalities were 8.86% and 72.04% respectively. Regarding maternal mortality, no parameter showed a significant association with maternal death. As for perinatal mortality, parity ≥4, complete rupture and segmento-corporeal lesion were significantly associated with perinatal death (p < 0.05). Conclusion: Uterine rupture remains one of the causes of maternal and perinatal mortality in Lubumbashi. The place occupied by uterine ruptures in obstetric activity requires joint and urgent action by all stakeholders in the health system in order to combat this scourge, witness to poor quality obstetric care.

A case of ruptured uterus during pregnancy

(Reported in the Society of Odessa Doctors on January 14, 1895).On the evening of September 6, 1894, a pregnant woman was admitted to the gynecological department of Dr. Yuzefovich at the Odessa Jewish Hospital, which I temporarily supervised, with symptoms of septic peritonit on the 5th day after the onset of the disease. In the hospital, after the diagnosis of rupture of the pregnant uterus was made, laporatomia and amputation of the ruptured uterus were performed. The patient died on the 8th day after the operation. The gap in this case, as we will see further from the given history of the disease, occurred without any mechanical stroke, such as: fall, shock, etc. In view of the fact that the ruptures of the pregnant uterus occur extremely rarely and ethiology without ruptures occurring from outside dark, I think it is not uninteresting to report the incident I have observed. This case is also of interest in the therapeutic relationship, the patient received proper help only on the 8th day from the onset of the disease. It can be said with more or less certainty that if this gap had been identified during the onset of the developing disease, then, with proper assistance, it would have been possible to prevent the onset of a lethal outcome.

A case of recovery from a ruptured uterus

D. reports the following extremely interesting case of recovery from a ruptured uterus.