Cervical Tear Research Articles

A comparative analysis of methods of preinduction cervical ripening and induction of labor in Poland and in Germany (Part II): maternal and neonatal outcomes

The benefits and risks of delivery should always be considered before initiating preinduction cervical ripening and labor induction. Understanding the benefits and potential complications is crucial for healthcare professionals to make informed decisions and provide optimal care. The research was conducted retrospectively between January 2019 and July 2022. It involved the analysis of the medical records of 154 pregnant women staying in the Clinic of Obstetrics and Gynecology in the city of Szczecin and 150 pregnant women hospitalized in the Clinic of Obstetrics and Gynecology in the town of Schwedt/Oder in Germany. Inclusion criteria were consent to participate and the implementation of internal written protocols in line with national guidelines for labor induction. The research concerned a group of pregnant women with postdate pregnancy, calculated according to the Naegele’s rule and confirmed by the USG examination conducted in the first trimester of the pregnancy, as well as an unfavorable cervix that received less than 6 points in the Bishop score. Moreover, the pregnant patients with a low biophysical profile and an abnormal record of CTG or comorbidities were also included, as these factors determined the classification of the group above. The study did not include patients who had undergone cesarean section. The average change in evaluation of the cervix marked on the Bishop Score was higher in Germany, and it was 2.7 points, whereas in Poland, it was 1.6 points. The largest percentage of the scores on the Apgar Scale in the first, third and fifth minutes after birth was in the norm and indicated a good health condition of infants. They reached 8 to 10 points in both countries. Significantly more infants in Germany received pH from the umbilical cord within the limits of the norm. And it marks the welfare of neonates (7.20–7.45). The duration of hospitalization in Poland was shorter than in Germany. It was 3.8 days in the case when the median equalled 3. The number of days of preinduction cervical ripening and induction was similar in both countries. The levels of haemoglobin were comparable in both countries. The most common postpartum complications in Poland and Germany were first-degree perineal tears, episiotomies and anemia. Among the postpartum complications, cervical tears, revision of the uterine cavity, and episiotomy were significantly more common in Poland. First- and second-degree perineal tears were more frequent in Germany.

The level of pregnancy and childbirth complications among the residents of front-line city of Kharkiv

Background. The city of Kharkiv has been located in the area of armed conflict or the front-line zone since the beginning of the invasion of Russian troops. A part of the female reproductive-aged population constantly remains in Kharkiv which determines the possible negative impact of wartime stress. The purpose – of the work was to study the level of pregnancy and childbirth complications among women living in Kharkiv. Materials and Methods. A retrospective observational study was conducted based on the materials of the municipal non-commercial enterprise «Municipal Perinatal Center» of the Kharkiv City Council. All the examined contingent was divided into three groups. 2914 women who gave birth in 2021 were included in Group I. There were 956 patients in Group II whose pregnancies were completed in term via childbirth in 2022. Group III included 1288 women who gave birth in 2023. The study was conducted by studying the cards of pregnant women in the computer-automated system of the perinatal center Results. The level of thyroid diseases was likely to increase in 2022 compared to the prior level. In 2023, the upward trend continued. A probable increase in the incidence of diabetes mellitus in pregnant women in 2023 compared to the data of 2021 was detected. Interestingly, the level of anemia and cardiovascular diseases remained stable. However, a significant increase in the urinary system’s infectious processes was established in 2023 compared to previous years. Unfortunately, a substantial increase in the level of maternal trauma during childbirth has been established. This was especially true concern on vaginal and cervical tears. Therefore, sanitation of the urogenital system can be the key to reducing maternal trauma during childbirth. Conclusions. During the military operations, an increase in the level of medical complications among pregnant women in the city of Kharkiv was noted due to a rise in some endocrine diseases and urinary tract infections. The increase in the prevalence of vaginal infections has led to a rise in the rate of vaginal and perineal ruptures. This requires an emphasis on infection monitoring and timely sanitation of the birth canal. The use of preventive measures made it possible to keep the level of major obstetric syndromes such as premature births, and pre-eclampsia, as well as the level of childbirth complications quite stable. The established features should become the basis for further work in the direction of reducing the negative consequences of military aggression on the health of pregnant women in the city of Kharkiv.

Study on Fetal and Maternal Outcome of Postdated Pregnancy

Postdated pregnancy is not so uncommon in obstetric practice. When a pregnancy crosses the expected date of delivery (beyond 280 days) it is called postdated pregnancy. The incidence is about 7% of all pregnancies. This prospective observational study was carried out in 165 postdated pregnancies admitted in the Department of Obstetrics & Gynaecology, during a period of 3 years from January 2021 to December 2023 . Majority of the patients were below 25 years of age (47.88%) and primigravida (41.82%). Most of the patients belonged to rural areas (55.75%) and were middle socio-economic status group (45.45%). The majority of these postdated women were delivered by NVD (52.12%), followed by LSCS (32.72%) and instrumental (15.15%). Postdated pregnancy was associated with perinatal complications like meconium aspiration syndrome, oligohydramnios, fetal birth injuries, septicemia, shoulder dystocia, non-reassuring fetal heart rate status, fetal distress in labour. There was an increased risk of maternal complications like increased caesarean section rate, post-partum hemorrhage (PPH) ,cervical tear, perineal tear. Management of postdated pregnancy is challenging. Careful advice and timely interventions can reduce fetomaternal complications. EWMCJ Vol. 12, No. 1&2, January-July 2024: 94-98

Pituitary Necrosis Revealed by Central Diabetes Insipidus Secondary to Postpartum Hemorrhagic Shock: A Case Report

Postpartum pituitary necrosis results in Sheehan's syndrome, giving a clinical picture of complete or dissociated panhypopitiutarism. It classically involves the anterior pituitary gland and is rarely associated with central diabetes insipidus. We report the case of a 26 year old primiparous woman admitted to intensive care for haemorrhagic shock secondary to post partum haemorrhage due to cervical tear. After resuscitation and haemodynamic stabilisation, she presented with retro-orbital headaches, an absence of milk production and primary hypotonic polyuria with a negative fluid balance. Fluid restriction without improvement and a positive desmopressin test led to the diagnosis of central diabetes insipidus. As part of the aetiological investigation, magnetic resonance imaging (MRI) showed pituitary necrosis. The presence of central diabetes insipidus in the context of post-partum haemorrhage should raise the possibility of pituitary necrosis, although this association is rare. MRI is a key element in the diagnosis, particularly in the acute phase, as the clinical picture of panhypopuitarism occurs much later.

Short cervix: modern perspectives on known problems

The article provides modern literature data on terminology, diagnostics and new approaches to the treatment of short cervix syndrome. The term «short cervix» combines the concept of short cervix and isthmic-cervical insufficiency in most of the guiding documents of the world obstetrics and gynecology societies. However, the issues of diagnosis and correction of these conditions remain relevant and debatable: sonographic criteria, the use of progesterone, cerclage, obstetric pessaries, their various combinations, and the question of their effectiveness.It is necessary to measure the cervix length by transvaginal cervicometry in the 20 weeks of pregnancy in the absence of previous reproductive losses and in the period of 14–16 weeks if there were previous reproductive losses. Therapeutic interventions should be started (vaginal micronized progesterone, cerclage, obstetric pessary) when the cervix is shortened to 25 mm or less at 20 weeks. Urgent cerclage should be performed when the umbilical cord is shortened to 20 mm or less. The effectiveness of cerclage, according to most experts, is comparable to the effectiveness of vaginal progesterone, unlike obstetric pessaries, the effectiveness of which is currently considered unproven.For our country today, in addition to the generally recognized risk factors of this pathology, the factors associated with improper conditions for providing medical care and their consequences are especially relevant. Childbirth in inappropriate places without observing the rules of asepsis and antiseptics, often without qualified medical personnel, can lead to undiagnosed and lack of suturing of cervical tears), their infection, subsequent deformation and functional failure of the cervix.There is also a need to support the micronutrient status of pregnant women in wartime conditions in Ukraine (vitamins of group B, vitamin D, magnesium, polyunsaturated fatty acids) in combination with progestins (micronized progesterone Luteinа) and/or cerclage in case of short cervix.

Prevalence of postpartum complications and associated factors among postpartum women in Uganda, a cross-sectional study

BackgroundPostnatal care exhibits the lowest coverage levels in the obstetric continuum of care. The highest rates of maternal and newborn morbidity and mortality occur within 24 h of birth. Assessment of women in this time period could improve the detection of postpartum complications and maternal outcomes. This study determined the patterns of maternal assessment and the factors associated with postpartum complications.MethodsThis was a cross-sectional study involving observations of immediate postpartum care provided to women following uncomplicated vaginal births at three health facilities in Mpigi and Butambala districts (Uganda) from November 2020 to January 2021. Data were collected using an observation checklist and a data abstraction form for maternal and newborn social demographic data. The collected data were analyzed using Stata version 14.0. Maternal assessment patterns were summarized as frequencies, and the prevalence of postpartum complications was calculated. Logistic regression analysis was performed at both bivariate and multivariate levels to identify factors associated with developing postpartum complications among these women.ResultsWe observed 263 women receiving care at three health facilities in the immediate postpartum period. The level of maternal assessments was very low at 9/263 (3.4%), 29/263(11%) and 10(3.8%) within the first two hours, at three hours and at the fourth hour, respectively. The prevalence of postpartum complications was 37/263 (14.1%), with 67.6% experiencing postpartum hemorrhage (PPH), 13.5% having perineal tears, and 10.8% having cervical tears. Mothers who did not undergo a postpartum check in the first three hours (p = 0.001), those who were discharged after 24 h (p = 0.038), and those who were transferred to the postpartum ward after two hours (p = 0.001) were more likely to have developed postpartum complications.ConclusionThe maternal assessment patterns observed in the population were suboptimal. Women who were not assessed at the third hour and those transferred after two hours to the postnatal ward were more likely to have developed postpartum complications.

Pregnant women's perceptions of daily iron supplementation in rural Ghana

Background/Aims In Ghana, compliance with daily iron supplementation during pregnancy is low, particularly in the Tain district. This may be related to pregnant women's perceptions of iron supplements. The aim of this study was to explore pregnant women's perceptions of daily iron supplements in the Tain district. Methods This descriptive qualitative study used an interpretative approach. Data were gathered from a purposive sample of 20 pregnant mothers, through semi-structured interviews and face-to-face in-depth discussions. Data were analysed thematically. Results Women were unwilling to take iron supplements because of their belief that daily iron supplements make a baby too big for vaginal birth, leading to cervical tears, episiotomy or caesarean section. They were also concerned that supplements could cause nausea and vomiting during pregnancy, and excessive bleeding during labour and birth. Conclusions It is important to educate pregnant women on the benefits of iron supplementation during pregnancy and encourage them to acquire information from verified sources.

Study of Macrosomic Deliveries in the Gynaecology and Obstetrics Department of the "Major Moussa Diakite" Reference Health Center in Kati, Koulikoro, Republic of Mali

The delivery of a macrosomic baby remains a concern for obstetricians and neonatologists, especially when the delivery is vaginal, because of the risk of maternal and perinatal complications. The aim of this article is to study macrosomic deliveries in the gynaecology and obstetrics department of the Kati reference health center. Method: This was a prospective, cross-sectional study which ran from 1 November 2020 to 31 October 2022, a period of 24 months. It concerned all deliveries in which the birth weight of the newborn was greater than or equal to 4000 grams, excluding cases of foetal malformations. Results: Out of a total of 4676 deliveries, we recorded 127 cases of macrosomia, a frequency of 2.7%. The average age of the women was 28.5 years, ranging from 16 to 47 years. The main risk factors identified were high multiparity (29.1%), maternal obesity (28.4%), overdue delivery (19.7%), previous delivery with the presentation was cephalic in 93.7% of cases, and delivery was by vaginal route in 63.8% of cases, compared with caesarean section in 36.2%. Maternal complications were dominated by perineal tears in thirteen cases (10.2%), cervical tears in two cases (1.6%), endometritis in two cases (1.6%), vaginal tears in one case (0.8) and haemorrhage during delivery in one case (0.8%). However, no complications were found in 108 out of 127 deliveries (85%). The Apgar score was less than eight at 1 minute in 12.6% of newborns. We observed serosanguineous hump (8.7%), brachial plexus paralysis (4.7%), clavicle fracture (1.6%) and early neonatal death (2.4%) due to neonatal distress. Conclusion: Macrosomic delivery carries very real risks, and the indications for vaginal delivery must be restricted in order to improve maternal and foetal prognosis.

Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study

Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study

Term delivery through Partial Annular Cervical Tear in a Multigravida with history of Genital Prolapse: A Case Report

Injury to the cervix is one of the common complications of pregnancy and delivery, but partial annular tear of the cervix is a rare entity, let alone vaginal delivery through it. A 32-year-old second gravida presented to a tertiary care hospital in Haryana, India in early labour. Her intrapartum course was uneventful. Following delivery of the baby and after-births, a third degree prolapse of the cervix was noted along with partial annular cervical tear of about 10cm involving the posterior cervical lip and 2cm away from the external os. There was mild bleeding from the edges of the tear and it was repaired with intermittent simple suture using 2-0 chromic catgut. On further probing, the patient denied any cervical trauma or surgery in the past but she gave history of something coming down per vaginum on straining for the last two years. She had not taken any treatment for the management of prolapse. She was given prophylactic oral antibiotics for 5 days and was advised Kegel’s exercise during the postpartum period. On discharge, she was stable, the cervical repair appeared healthy and was asked to follow-up after 6 weeks. This case highlights the possibility of cervical tear in patients having genital prolapse during delivery, first such being reported.

Morbidity and mortality during delivery on a scarred uterus in the obstetric gynecology department EHS Batna, Algeria

Introduction. The existence of a scar uterus is a risk factor for obstetric morbidity in subsequent pregnancies. The objective of this work was to evaluate the morbidity and mortality during delivery in a scar uterus in our department, in order to reduce it and improve the maternal and fetal prognosis. Methods. We conducted a descriptive, retrospective, single-center epidemiological study at the EHS mother-child Batna from January 1, 2018 to December 31, 2019, which involved women with a scar uterus of obstetric origin with a pregnancy age greater than 22 Weeks of amenorrhea. Results. During this period; 28407 women delivered in our department; of which 3002 were carriers of a scar uterus (10.56%). The overall complication rate was 6.10% regardless of the mode of delivery: Uterine rupture with 19 cases of dehiscence of the scar (0.63%) and 9 cases of complete uterine rupture (0.30%). 2.60% of women had delivery hemorrhage and 1.13% required transfusion. Hemostasis hysterectomy was necessary for 9 women (0.30%). We observed 7 cases of placenta accreta, a rate of 0.23%, the wounds of the surrounding organs were caused in 3 cases (0.17%), the iterative laparotomy was performed in 2 cases (0.11%). Cervical tears complicated 5 vaginal deliveries (0.36%). Infectious complications (endometritis, surgical site infection, deep abscesses, episiotomy suture infection) were encountered in 1.77% of cases (n=53). A delay in admission duration of more than 7 days was necessary for 1.17% of women (n=35). No maternal deaths were reported. On the fetal side, we counted 3000 live births of which 94.77% had an Apgar score at 5 minutes greater than or equal to 7. The neonatal mortality rate was 1.87%. Conclusion. Women with a scar uterus are more and more numerous; the prognosis of delivery on a scar uterus is burdened with numerous complications, the most important of which is uterine rupture. However, the maternal-fetal prognosis can be improved by good monitoring of pregnancy, a careful selection of candidates for vaginal delivery and a close monitoring of the uterine test.

Cervical lacerations: A case series

Cervical laceration (CL) after vaginal delivery is one of the uncommon side effects with significant morbidity if undetected and unattended to promptly. This is however one of the common causes for postpartum haemorrhage. There are several documented risk factors for CL such as previous interventions on the cervix, induction of labour, use of Prostaglandins for induction, precipitate labour, operative vaginal deliveries and birth weight of more than 3500gm.In this article we have described a series of eleven women who were detected to have CL following vaginal delivery. One of whom had delivery of the baby through a bucket handle cervical tear with a non-dilated cervical os. Almost all of them needed multiple blood and product transfusions in view of postpartum haemorrhage with one of them developing acute kidney injury subsequently. This necessitates the need for prompt identification of CL and its needed intervention.

Postdate Pregnancy Maternal and Fetal Outcomes among Sudanese Women

Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses. Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018. An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded. Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%). Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and > 7 in 86.9%. Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week. Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection.

Comparison of Efficacy of Vaginal Misoprostol versus a Synthetic Osmotic Dilator (Dilapan-S) for Cervical Preparation before Operative Hysteroscopy: A Randomized Controlled Study.

To compare the need for mechanical cervical dilatation following vaginal misoprostol or synthetic osmotic dilator (Dilapan-S) usage for cervical preparation before operative hysteroscopy. Fifty-five premenopausal women scheduled for operative hysteroscopic procedures with a 26 Fr resectoscope were included in this randomized, controlled clinical trial. After randomization, either 400 μg of vaginal misoprostol or intracervical synthetic osmotic dilator (Dilapan-S) was inserted 12 h before operative hysteroscopy. The need for additional mechanical cervical dilatation before insertion of the resectoscope was compared between the two groups. Initial cervical diameter before mechanical dilatation, intraoperative complications (cervical tears, creation of a false passage), and ease of dilatation were also compared between the two groups. In the misoprostol group, 92% of women required additional mechanical cervical dilatation, whereas only 36% of women in the Dilapan-S group required additional dilatation (P < 0.05). The median initial cervical diameter achieved with Dilapan was 9 mm (Q1: 7 mm; Q3: 10 mm), and with misoprostol, it was 6 mm (Q1: 4.5 mm; Q3: 8 mm) (P < 0.05). There was no significant difference in other outcome parameters between the two groups. Synthetic osmotic dilator (Dilapan-S) is more efficacious than vaginal misoprostol at ripening the cervix before operative hysteroscopy.

Pre-induction cervical ripening and hygroscopic cervical dilators in pre-labor induction

Introduction Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool to prepare the cervix when the BISHOP-score is low. About one-third of IOL cases require cervical ripening, which is the physical softening, thinning, and dilation of the cervix in preparation for labor and birth. We report a single center experience regarding the use of hygroscopic dilators in the pre-labor phase to obtain cervical ripening before labor induction. Materials & Methods We conducted a retrospective observational study comparing patient records from the Gynecology and Obstetrics Unit in “Santo Stefano” Hospital in Prato, Tuscany. The inclusion criteria for participants were women who had undergone pre-labor induction because of a BISHOP-score < 3. The gestational age of all the pregnant women was at term (> 37 weeks). Results From January 2022 to April 2022, a total of 581 women delivered at term of gestational age at the Gynecology and Obstetrics Unit in “Santo Stefano” Hospital. Cervical ripening was necessary for 82 women with a Bishop score < 3 and hygroscopic cervical dilators were used in 35/82 (42.7%) patients. All patients showed a change in Bishop-score upon removal of the dilators. All 35 patients (100%) reported an increase in terms of consistency and dilation of the cervix but not in terms of length. None of the patients reported discomfort during the 24 h that they kept the hygroscopic dilators in place. No patients reported uterine tachysystole on cardiotocographic tracing, vaginal bleeding, rupture of membranes or cervical tears. Conclusions Our results are in line with those in the literature, demonstrating the validity of hygroscopic dilators in cervical maturation of pregnancies at term and their efficacy was again highlighted in terms of both maternal and fetal safety and patient satisfaction.

Étude prospective sur 46 patientes de la pratique de l’IVG chirurgicale entre 14 et 16 SA : parcours de soins et complications

Étude prospective sur 46 patientes de la pratique de l’IVG chirurgicale entre 14 et 16 SA : parcours de soins et complications

ASSESSMENT OF IMMEDIATE PERINEAL COMPLICATIONS OF NORMAL VAGINAL DELIVERY VERSUS VAGINAL DELIVERY WITH EPISIOTOMY IN TERM PREGNANCY IN A TERTIARY CARE HOSPITAL

Objectives: To assess immediate intra and postpartum perineal complications following normal vaginal delivery versus vaginal delivery with episiotomy in term pregnancy. Material and methods: This Cross-sectional study, was conducted in Peshawar, Lady Reading Hospital, Gynae ward from 1st November 2019 to 31st January 2020 after approval from Institutional Research Board. A total of 250 patients (125 in each group), 120 in group A with normal vaginal delivery, 115 in group B (vaginal delivery with an episiotomy), and 15 patients were excluded due to different modes of delivery (instrumental delivery/cesarean section). All patients with full-term pregnancies were included. Patients who refused to give consent or had bleeding disorders and indications for instrumental delivery or cesarean section were excluded. Non-probable convenience sampling technique, P-value &lt;0.05, 95% confidence interval, and Chi-square test used for statistical analysis Results: In the group, A mean age of 22 years, primigravida (PG) 84 (70%) multigravida (MG) 36 (30%) mean period of gestation (POG) 38 weeks, 96(80%) spontaneous, 24 (20%) induced labor. In group B the mean age was 21.8 years, PG 77 (66%), MG 38(33%), mean POG 41 weeks, 97 (84%) spontaneous, and 18 (15%) induced labor. Group A vaginal tears 6 (5%), cervical tears 4 (3%), mixed tears 9 (7.5%), para-urethral tears 2 (1.6%), and perineal tears 9(7.5%). Group B vaginal tears 3 (2.6%), cervical tears 3 (2.6%), mixed tears 2 (1.7%). No significant post-natal pain difference was observed in the groups. CONCLUSION: Routine practice of episiotomy should be discouraged as no significant difference was observed in both groups. KEYWORDS: Episiotomy, Term pregnancy, Vaginal delivery.

Fetomaternal Outcomes of Postdated Pregnancy: A Prospective Observational Study

Background: With increasing gestational age, the risk to the mother and the foetus increases. Our research aims to examine maternal and foetal outcomes in pregnancies that go over the scheduled delivery date in order to establish safe induction times and the most suitable delivery method. Method: This was a 6-month prospective observational study conducted in the Department of obstetrics and gynaecology, LD Hospital GMC Srinagar from July 2017 to December 2017. The patient provided written, fully informed consent. The non-random sampling strategy resulted in the inclusion of 100 patients in total. Results: We observed that with an average gestational age of (40.8±2.76) weeks, majority of our patients (77.8%) had gestational age of 40-41 weeks. Majority of our patients (65.6%) had NVD mode of delivery. Meconium stain liquor with fetal distress was indication for cesarean section for 29% of patients, followed by failure of induction as the cesarean indication for 25.8% patients. Respiratory distress syndrome was evident in 8.9%, meconium aspiration syndrome was found in 6.7% patients, 3.3% and there were two neonatal deaths. Conclusion: Fetal discomfort, meconium aspiration syndrome, and foetal hypoxia were all connected with postdated pregnancy among other perinatal issues. Postpartum haemorrhage (PPH), perineal tears, cervical tears, and shoulder dystocia were among the consequences of childbirth that were more likely to occur. Obstetricians find managing postdated pregnancies challenging, but with good advice and monitoring, they can reduce maternal anxiety and unfavourable outcomes. Keywords: Last menstrual period, Maternal complication, Postdated, Pregnancy outcome

Incidence, risk factors and outcome of Postpartum Hemorrhage in a Jigme Dorji Wangchuck National Referral Hospital: a retrospective case-control study.

Introduction: Primary postpartum hemorrhage is one of the leading causes of maternal death in Bhutan but data on the incidence and risk factors for primary postpartum hemorrhage are scarce. The purpose of this research is to look into the incidence, its associated risk factors and maternal outcome of primary postpartum hemorrhage among women who gave birth at the national referral hospital. Methods: The incidence of primary postpartum hemorrhage was estimated total number of primary postpartum hemorrhage cases of total deliveries during the study period. A case-control study was conducted to identify risk factors for primary postpartum hemorrhage. Cases of primary postpartum hemorrhage was defined by blood loss of greater or equal to 500ml in vaginal delivery or greater or equal to 1000ml for abdominal delivery within 24 hours of delivery. A multivariable logistic regression was used to identify associated risk factors of primary postpartum hemorrhage. Results: Among 9,221 deliveries, primary postpartum hemorrhage occurred in 180 cases (1.95%; 95% CI=1.68%-2.26%) during two year period. The significant risk factors for primary postpartum hemorrhage were, labor induction (adjusted OR=2.27; 95% CI= 1.11-31.47, p=0.005), current pregnancy complications (aOR=2.50; 95% CI: 1.32-4.74, p=0.005), and gestational age at term delivery (aOR=6.49; 95% CI:1.12-37.48, p=0.037). The significant causes of primary postpartum hemorrhage were uterine atony (aOR=72.57; 95% CI:5.95-885.76, p=0.001), retained placenta (aOR=18.08; 95% CI:2.66-122.81, p=0.003) and perineal and cervical tear (aOR=27.80; 95% CI: 15.13-51.07, p less than 0.001). Conclusions: The incidence of primary postpartum hemorrhage was 1.95% which is lower compared to other South East Asian countries. The causes and risk factors identified in this study may help predict primary postpartum hemorrhage and aid healthcare providers in better management of primary postpartum hemorrhage in all women giving birth.

Comparison the Effectiveness of Oxytocin and Misoprostol in Prevention of Primary Post-Partum Haemorrhage

Introduction: Postpartum haemorrhage is one of the leading causes of maternal mortality. Maternal Mortality globally is estimated as 599.00 deaths per year, a ratio of 400 maternal deaths per 10,000 live births. The aim of this study was to compare the effectiveness of oxytocin and misoprostol in prevention of primary post-partum haemorrhage Material and Method: It was Randomized Controlled Trial, which was conducted in the department of Obstetrics and Gynaecology, Hospital, Peshawar, between 14th March 2020 to 22 April 2022). The sample size was 100(50 in each group) Using 4% of PPH in misoprostol group, 24% of PPH in oxytocin group, 95% confidence level and 90% power of test under WHO software for sample size determination. Results: A total of 100 patients of primary post-partum haemorrhage were observed, which were divided in two equal groups A &amp; B. Patients in Group A were managed with misoprostol while patients in group B will be subjected to oxytocin. Gravida wise distribution shows that out of 50 patients 22(44%) were gravid less than or equal to one,18(36) patient have 2-5 and 10(20%) were more than 5 while group B contains 25(50%) less than or equal to one, 17(34%) patients 2-5 and 8(16%) have gravid more than 5. Gravida distribution among the groups was insignificant with p-value=0.802. Average age was 27.82 years+4.56SD with range of 20-36 years. Group A contained 13(26%) patients in less than or equal to 25 years, 30(60%) patients 26-35 years and 7(14%) patients having ages of more than 35 years. While group B contained 18(36%) patients in less than or equal to 25 years, 28(56%) in 26-35 years and 4(8%) patients with age more than 35 years. The age distribution among the group was also insignificant with p-value 0.429. Efficacy wise distribution was significant with p-value = 0.021. Group A showed 47(94%) efficacy while non-effective in 3(6%) patients. Similarly, Group B showed 39 (78%) efficacy while non effective in 11(22%) patients. The misoprostol has greater efficacy than oxytocin. Age wise distribution of drug-efficacy shows that efficacy was almost same in all age groups. The patients having less than or equal to 25 years of age have shown efficacy in 12(92.3%) patients while 1(7.7%) patients being non-effective. Patients with 26-35 years of age have shown efficacy in 28(93.3%) of patients and 2(6.7%) have shown no efficacy. Similarly, 7(100%) patients have shown efficacy and no patients have no efficacy, with age more than 36 years of age. The same pattern was followed in group B, although age wise efficacy was insignificant in both the groups with p-value=0.765 and 0.987 respectively. The prevention of PPH, particularly in resource poor settings, where PPH is the leading cause of maternal mortality The enormity of postpartum haemorrhage and the limitations in the use of oxytocin for the adequate preventive therapy were the basic rationales behind this study. Secondarily, our cultural setups of home deliveries have a marked role in grave morbidity as well as lack a consensus protocol for the choice of adequate preventive treatment of haemorrhage. Keeping in view the above mentioned factors, this study was conducted to compare the effectiveness of the per rectal misoprostol medication to the intramuscular oxytocin to control the blood loss as adequate preventive therapy. Conclusion: Misoprostol is more effective as compared to oxytocin in prevention of primary postpartum hemorrhage. Keywords: Primary Postpartum haemorrhage, Cervical tears, Vaginal tears, oxytocin, Misoprostol, efficacy