English

Abstract

OBJECTIVES: Evaluation of a new surgical technique to prevent postpartum haemorrhage during cesarean section for major degree placenta previa - A comparative analysis. METHODS: This study was conducted at tertiary care hospital (JNM, NSGH, CN) at Kalyani Nadia, West Bengal, India from the period January 2006 to December 2011. Sixty (60) cases diagnosed to be having major degree placenta previa, undergoing LSCS operation, were selected for this study in two groups for comparative analysis. Group A(N-30) - New surgical technique(Dutta 's) institute in a stepwise manner = delivery of baby > bilateral uterine artery ligation by chromic catgut no-1 suture >injection tranexamic acid (1000mg) IM > injection oxytocin in intravenous infusion (10 units 30 drop /min in 500 ml of 5% dextrose)>delivery of placenta and membranes> checked properly if any tear or laceration in placental site > closure of uterine wound by chromic catgut no 1 in two layers after securing bleeding from placental bed >closure of abdomen in layers . Group B (N-30) (traditional method) = delivery of baby> delivery of placenta and its membrane > injection oxytocin in intravenous infusion (10 units 30 drop /min in 500 ml of 5% dextrose ) > surgical intervention either by bilateral uterine artery or internal iliac artery ligation or cesarean hysterectomy or underlying interrupted suture to control post operative haemorrhage > closure of uterine wound by chromic catgut no 1 suture in two layers > closure of abdomen in layers. RESULTS: It was observed from this comparative analysis that in group B intra operative blood loss > 500cc -18 (60%), cesarean hysterectomy- 6(20%) and bilateral internal iliac artery ligation- 4 (13.3%) were found to be increased as compared to group A. Maternal mortality was found to be high in group B -5(16.6%) as compared to group A- nil. Maternal morbidity was also found to be increase in group B- 13(43.3%) cases as compared to group A- 4(13.3%). Subsequent menstrual cycles were found to be normal in group A - 20(90%) indicating non effect on gonadal function. CONCLUSION: This comparative analysis showed that by advocating this noble approach