Postpartum haemorrhage management: A randomized controlled trial comparing transvaginal uterine artery clamp, vacuum-assisted uterine contraction and condom tamponade.

OBJECTIVE: While there have been numerous innovations recently for the management of postpartum haemorrhage (PPH), a limited body of research supports their application during this critical complication, which contributes significantly to maternal mortality worldwide. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of three interventions - transvaginal uterine artery clamp (TVUAC), vacuum-assisted uterine contraction using a suction cannula (SC), and condom tamponade (CT) - in the management of atonic PPH. METHODS: An open-label RCT was conducted among women who delivered vaginally and developed atonic PPH at a tertiary care obstetric facility. Block randomization with sealed envelopes was used to allocate eligible participants into three interventional arms with a 1:1:1 ratio. The exclusion criteria were twin deliveries, haemodynamically unstable patients, and individuals who did not provide informed consent. The primary outcome variables assessed were blood loss post-application, total blood loss, time taken for application, and time required to achieve haemostasis within each trial arm. The secondary outcomes were the need for a second instrument or surgical intervention to control bleeding, and requirement for blood transfusion. Effectiveness outcomes were analysed as intention-to-treat, whilst safety outcomes were analysed as as-treated. RESULTS: Sixteen participants were randomized to each intervention group (n = 48). TVUAC and SC demonstrated comparable outcomes, while CT lagged in all examined parameters. Following device application, blood loss was similar in both the TVUAC (235 ± 187 ml) and SC (246.5 ± 189 ml) groups. However, following the use of CT, there was blood loss of 431 ± 427 ml, although this difference was not significant (p = 0.113). When considering total blood loss, the TVUAC group (903 ± 234 ml) showed slightly higher values than the SC group (887 ± 184 ml). However, the CT group exhibited notably higher total blood loss (1068 ± 455 ml) than the TVUAC and SC groups. In terms of application time, both TVUAC (1.8 ± 1.1 min) and SC (1.6 ± 0.9 min) significantly outperformed CT (3 ± 1.3 min) (p = 0.002). Furthermore, the time interval from the diagnosis of PPH to achieving haemostasis (defined as the time taken for active haemostasis) was significantly shorter in the TVUAC group (6 ± 4 min) and the SC group (5.7 ± 1.6 min) compared with the CT group (9.7 ± 3.8 min) (p = 0.002). CONCLUSIONS: TVUAC and SC are more effective for the management of PPH than CT. However, both TVUAC and SC have advantages and disadvantages. While these results suggest a potential preference for TVUAC and SC over CT for the management of PPH, further research is necessary to validate these findings.

Maternal and neonatal outcomes in pregnancy induced hypertension: an observational study.

Hypertension during pregnancy has been extensively studied due to significant maternal morbidity, mortality, and perinatal mortality that may result. The outcome in hypertensive disorders in pregnancy vary significantly across populations and between institutions serving the same populace. OBJECTIVE: In the present study, the authors sought to determine the outcome for mother and fetus with pregnancy induced hypertension (PIH) in a rural community at a tertiary care center at Thrissur Medical College, Kerala, India. MATERIALS AND METHODS: The authors included all singleton pregnancies with hypertensive disease that had deliveries in our institution in a six-month period excluding the ones with pre-existing hypertension and other comorbidities. RESULTS: 46.5% ofthe patients required a cesarean section, 37.2% had pre-term labor, 52.4% had low birth weight, and 9.4% unfortunately were stillborn. DISCUSSION: These results emphasize the need for screening and close follow-up of hypertension in pregnancy for safeguarding fetal and maternal wellbeing. Even after practicing the current standard of care, the higher rate of complications associated with PIH is unacceptable. The authors feel that unique management protocols should be implemented for different patient populations, based on ethnicity, lifestyle, and availability of medical resources.

Confidential Review of Maternal Deaths in Kerala: a country case study.

The Confidential Review of Maternal Deaths (CRMD) in Kerala was started in 2004, with support from the World Health Organization and modelled on the United Kingdom Confidential Enquiries into Maternal Deaths. It is carried out by the Kerala Federation of Obstetrics and Gynaecology with support from the government of Kerala. The leading causes of maternal deaths identified during the period 2004-09 were haemorrhage, hypertension, amniotic fluid embolism, heart disease and sepsis. Follow-up actions in the form of advocating for emergency preparedness, proper transport and standard protocols for management were initiated. Recently the international arm of the United Kingdom National Institute for Health and Clinical Excellence has helped to establish standards to improve obstetric care in Kerala based on the findings of the CRMD Kerala.

Growth and characterization of pure and doped KHP NLO single crystals.

Single crystals of Potassium Hydrogen Phthalate doped with amino acid l-lysine were grown successfully by slow evaporation method. The concentration of dopant in the mother solution was 0.5mol%, 1mol% and 2mol%. There is a drastic change in the morphology due to variation in doping rates which is also reflected in the X-ray diffraction data. The Fourier Transform infrared spectroscopy study confirms the incorporation of l-lysine into Potassium Hydrogen Phthalate crystal. The thermal study indicates the dissociating nature of the crystal. The nonlinear optical property of the grown crystal has been confirmed by Kurtz-powder second harmonic generation test. The dopant of 0.5mol% and 1mol% shows higher second harmonic generation result than pure Potassium Hydrogen Phthalate. Results are discussed.

A study on Fourier transform infrared spectroscopy, thermal, mechanical, NLO and laser damage properties on unidirectional Glycinium Picrate Mono Glycine crystal.

By directional solidification, single crystal of Glycinium Picrate Mono Glycine (GPMG) was successfully grown by Sankaranarayanan-Ramasamy (SR) method. An optically transparent crystal of GPMG has been grown along 〈011〉 plane by a mixed solvent of acetone and double distilled water. The evaporation rate was controlled and a single crystal of 12mm diameter and 35mm length was obtained. Single crystal X-ray diffraction, Fourier Transform Infrared Spectroscopy (FTIR), thermal, mechanical, SHG and laser damage studies were carried out. The results are discussed in detail.