Genital Tract Injuries Research Articles

A Review on Male Infertility and Herbal Medicine: Complementary and Alternative Therapies in Animal Models

Various factors contributing to male infertility include genetic determinants, hormonal/neurological imbalance, erectile/libido disorders, genital tract injuries, and toxic/ischemic testicular injuries. Herbs increase sperm count and quality parameters, as well as sexual performance in infertile men, through various mechanisms. For this purpose, efforts were made to investigate effective plants in treating infertility, focusing on those studied in animal research. In this review, we explored the latest findings from animal studies on the therapeutic applications of medicinal plants in male infertility. Based on MeSH keywords, 250 animal studies investigating the effects of herbs on male infertility were reviewed, 72 of which were selected after removing duplicated and unrelated articles. The search was conducted in the Scientific Information Database, the World Health Organization database, Web of Science, Science Direct, Iranmedex, Cochran Library, PubMed, and Google Scholar. The mechanisms underlying the therapeutic effects of herbs on male infertility caused by hormonal disorders, oxidative stress, cytokines, inflammatory pathways, as well as erectile and libido disorders were discussed. Aphrodisiac, spermatogenesis-inducing compounds, antioxidants, anti-inflammatory agents, and androgenic compounds, including anthocyanins, proanthocyanidins, ginsenosides, protodioscin, quassinoids, sesquiterpenes, diosgenin, phyto-oestrogens, thymoquinone, and bajijiasu, in these plants increase male fertility by affecting the hypothalamic-pituitary-gonadal axis and improving sperm’s functional parameters and fertility indices in relation with seminiferous tubules.

(214) Urethral and Vaginal Injuries Caused by Insertion of Foreign Objects for Sexual Stimulation: A Literature Review of Sexual Emergencies in Males and Females

Abstract Introduction Foreign body genital tract injuries involve injuries to the male or female reproductive organs, including the vagina and urethra, often requiring urgent care from medical professionals. These injuries are associated with autoerotic stimulation, psychiatric disorders, curiosity, self-harm, or lack of knowledge of safe sexual practices. Early diagnosis and management in the emergency department (ED) are crucial to prevent irreversible damage and potential life-threatening complications. This review aims to comprehensively examine sexual emergencies caused by foreign body genital tract injuries, specifically focusing on vaginal and urethral injuries, while also highlighting common complications and contributing factors. Objective 1. Provide a comprehensive review of foreign body genital tract injuries presenting in ED's at national and international levels. 2. Highlight ED management and common complications associated with these emergencies. 3. Improve medical management, enhance understanding of causative factors, and promote patient education to prevent recurrence. Methods A literature review was conducted using PubMed and Google Scholar databases. Search terms included "foreign body," "sexual," "masturbation," "vagina," and "urethra." Out of 53 articles published between 1985–2023, 16 met the inclusion criteria for analysis, focusing on injuries involving the urethra or vagina and autoeroticism. Results The review included 141 cases of genital injuries caused by foreign body insertion during sexual activities. Males accounted for 128 cases, females for 12, and one was a transgender female. Various foreign bodies, such as silverware, glass, batteries, rings, tubes, and beads, were found to have caused injuries and complications. Surgical management was indicated in 19 cases, non-surgical management in 7, while the approach in 115 cases remained unknown. Conclusions The literature review serves as a crucial reminder of the potential dangers of foreign body insertion during sexual activities. It calls for increased awareness, improved clinical recognition, and better patient education to safeguard individuals from these preventable injuries. By understanding and addressing this issue, healthcare professionals and the broader community can work together to reduce the incidence of genital injuries related to foreign body insertion and enhance overall patient safety and well-being. Disclosure No.

Lower Genital Tract Injuries during Multiparous Vaginal Delivery in Tertiary Hospital of Western India: An Observational Study

Lower Genital Tract Injuries during Multiparous Vaginal Delivery in Tertiary Hospital of Western India: An Observational Study

Patterns in Second Stage Labor Care Practices Associated With Genital Tract Injury and Postpartum Hemorrhage During Physiologic Birth: A Latent Mixture Model Analysis

INTRODUCTIONGenital tract injury during childbirth contributes to short and long-term problems, including postpartum hemorrhage, incontinence, and pelvic organ prolapse. The purpose of this study was to examine which sets of second stage management techniques employed by midwives attending births in the community setting are associated with genital tract injury and subsequent postpartum hemorrhage.METHODSData from primiparous individuals within the Midwives Alliance of North America (MANA) Stats 2.0 (2004–2009) database were used for this analysis. Latent mixture modeling identified classes (groups) within the sample that are most similar based on 11 different characteristics of second stage management as noted by midwives in their birth notes, including hands-on management techniques during birth, maternal positioning at birth, and water birth.RESULTSThree classes of second stage management techniques best fit this complex dataset. The patterns of techniques used by midwives were only marginally associated with better or worse genital tract outcomes independent of other factors. Two covariables, however, advanced maternal age (OR1.60, 95% CI 1.09–2.34) and births with low fetal heart rate during second stage (OR2.82, 95% CI 1.93–4.10)—were associated with severe genital tract injury. Postpartum hemorrhage was more likely for the two classes where midwives used more hands-on management during second stage, even when considering presence of genital tract injury (OR1.33, 95% CI 1.09–1.63). This study highlights the complex second stage circumstances that interact with management techniques, which together shape or contribute to both genital tissue and hemorrhage outcomes.

Nonobstetric lower genital tract injury patients of a tertiary care center in Eastern Uttar Pradesh, India: A cross-sectional study.

Injuries of lower genital tract are commonly seen in obstetrics patients during labor and delivery. Nonobstetric genital injuries are seen less commonly. Research on injuries to the lower genital tract from nonobstetric trauma is therefore scant. The purpose of this study was to document causes, treatment, and outcomes among patients of lower genital tract injuries visiting to B. R. D. Medical College and Nehru hospital, Gorakhpur, U.P. Admission and operation theater registers of the department of obstetrics and gynecology during 1 year were scrutinized for cases admitted with the diagnosis of genital trauma. Bed-head tickets of patients were scrutinized with the help of a data abstraction form, and information regarding age, cause of injury, site, size and pattern of injuries, treatment, and short-term outcome were recorded. Of a total of 43 cases of traumatic genital tract injuries, 39 women received treatment. Maximum cases were seen in girls aged 6-10 years. Three women were pregnant at the time of injury. Noncoital injuries predominated over coital injuries, i.e., 59% versus 38.4%. Among the noncoital injuries, fall was the most common cause accounting for 75% of the cases. Coital injuries following consensual sex occurred more commonly in women who were sexually active, lactating, or postmenopause. The chief presenting complaint was vaginal bleeding. Vaginal wall laceration/tear was the most common injury reported. Multiple injuries were seen in 40% (17/39) of the cases. Twenty-one cases of laceration/tear (53.8%) were repaired surgically of which seven required examination and repair under anesthesia. Vulvar hematomas were managed by incision and drainage. There was no major morbidity or mortality. The results of this study from eastern Uttar Pradesh, India, support those from other developing nations. Noncoital injuries were found to be the most predominant cause of non-obstetric genital trauma, though, contrary to others, children were seen to be at the greatest risk. It is important to teach children about playing safely and following safety measures while on the road. We must also make them aware so that they do not become victims of rape.

EFFECTIVENESS OF UTEROVAGINAL PACKING IN CONTROL OF PRIMARY POSTPARTUM HEMORRHAGE

Objective: To determine effectiveness of uterovaginal packing in control of primary postpartum hemorrhage. Methodology: It was a prospective interventional study conducted at department of Obstetrics and Gynecology from Nov 2019 to May 2021. Sample size was calculated by WHO sample size calculator with 95% confidence interval and 5% Margin of error of estimation 16. Consecutive non probability sampling technique was utilized and 85 cases with postpartum hemorrhage were enrolled who were admitted through emergency and outpatient department. All women of reproductive age, any gravidity or parity presenting with postpartum hemorrhage due to uterine atony, coagulopathy or placental implantation site bleeding after vaginal or abdominal delivery were includ­ed. Cases with Genital tract injuries requiring repair, retained placental tissue or membranes requiring Evacuation & Curettage, uterine rupture requiring Laparotomy and secondary postpartum hemorrhage were excluded. All information was recorded in a pre-designed proforma and data was analyzed using SPSS version 20. Results: Our study included 85 women with 62.35% normal vaginal deliveries and 37.65% with cesarean section, uterine atony found to be the top most cause of postpartum hemorrhage (47.1%). Success rate of uterovaginal packing remained high i.e 95.3% Conclusion: Our study concludes that Uterovaginal packing was 95.3% effective in the controls of postpartum hemorrhage. It is a quick and effective recovery to control postpartum hemorrhage conservatively.

Prevalence, Associated Risk Factors and Maternal Outcomes of Lower Genital Tract Injuries in the Bamenda Regional Hospital

BACKGROUND: Tears of the genital tract are lesions resulting from the breakage of the continuity of the lower genital tract during childbirth. These injuries are associated with high maternal morbidity or mortality if severe, poorly managed or delayed in repair. It is a frequent complication of vaginal delivery. This study was aimed at determining the prevalence, demographic characteristics, risk factors, patterns and the t-term maternal outcomes of lower genital tract injuries in the labour room and the post-natal ward of the Bamenda Regional Hospital. METHODS: This was a hospital-based cross-sectional study of women managed for genital tract injuries following vaginal birth in the Bamenda Regional Hospital (BRH) from March 2019 to July 2019. A non-probabilistic, consecutive and exhaustive sampling technique was used to select participants (sample size estimated at 237). Among those selected were women who had a vaginal birth. However, the researchers’ interest was particularly centered on the women who had genital tract injuries. Data was collected using a pretested questionnaire and analyzed using the SPSS version 22 software. RESULTS: In total, 310 participants were included in this study. The mean age of the participants was 26.1 years (SD = 5.2), while the median age was 25 years (interquartile range = 22 - 29). Of the 310 participants included in the study, 128 developed a birth tract injury giving a prevalence of 41.3% (95% CI, 35.8 - 47.0). The most common type of injury was spontaneous tears (33.9%), the majority of which were perineal (30.6%) compared to episiotomies (7.4%). Most perineal tears were first degree tears (23.2%) followed by second-degree tears (6.8%). Third-degree perineal tears were rare (0.6%). We did not have any cases of fourth-degree perineal tears. We also encountered a few cases of cervical tears (0.6%). The factors associated with birth tract injury were assessed using bivariate and multiple logistic regression analysis. On bivariate analysis, being an adolescent parturient (OR = 2.8, 95% CI: 1.4 - 5.7, p = 0.005), single (OR = 1.78, 95% CI, 1.04 - 3.03, p = 0.034), having a history of birth tract injury (OR = 1.69, 95% CI, 1.01 - 2.95, p = 0.042), a duration of active phase of labour (OR = 2.1, 95% CI, 1.3 - 3.3, p = 0.002), being a primipara (OR = 2.8, 95% CI, 1.0 - 8.4, p = 0.045), inducing labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), augmenting labour (OR = 2.4, 95% CI, 1.1 - 5.4, p = 0.033), birthweight of 4000 g or more (OR = 3.0, 95% CI, 1.3 - 7.4, p cm (OR = 3.3, 95% CI, 1.5 - 7.9, p = 0.005) were statistically significantly associated with birth tract injuries. The majority of the blood loss post-partum was between 200 and 500 cc. Only one participant had a blood loss of 500 cc and above. Also, the severity of genital pain lasting beyond 24 hours postpartum was mostly less than 5/10 (50.6%) followed by genital pains > 7/10 (41.7%). The prevalence of infection of the injury was (1.6%) and no maternal death from injury was recorded. CONCLUSION: The prevalence of lower genital tract injuries in the Bamenda Regional hospital is high. First-degree tears were the most common followed by episiotomies. The perineal outcome in the BRH is poor and should be improved upon.

Primary postpartum haemorrhage at the Libreville University Hospital Centre: Epidemiological profile of women.

In Gabon, the proportion of maternal deaths directly related to Primary PostPartum Haemorrhage (PPPH) is 15 to 25%, despite the different means that the World Health Organization has made available to the providers of Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of Primary PostPartum Haemorrhage to improve its management and reduce the rate of maternal deaths. An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. Sociodemographic variables were expressed using percentage. The relationship between the etiologies of PPPH and certain characteristics of the women was established using the ORs with their 95% confidence intervals. The difference was significant if p < 0.05. The prevalence of PPPH was 1.6%. Delivery haemorrhages accounted for 65.5% of PPPH. The main factors associated with delivery haemorrhages were pauci parity and multiparity (p = 0.003 and 0.051), post-term (p = 0.042), and birth weight >4,000 g (p = 0.006). Those associated with genital tract injuries were young maternal age (p = 0.008) and multiparity (p = 0.028). The most common etiology was haemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the primary postpartum period as well as capacity building of health providers on EmONC.

Primary spontaneous complete colporrhexis following vaginal delivery — A rare case

Spontaneous trauma to the genital tract during vaginal delivery without instrumentation is very rare. Colporrhexis- rupture of vaginal vault is a very rare type of genital tract injury. A 31 year’s woman P2L2 with a previous one left ectopic pregnancy was referred to our institute within one hour of vaginal delivery as a case of suspected rupture uterus. On Per speculum examination under anaesthesia revealed protrusion of the omentum and intestine into the vagina, colporrhexis of the posterior vaginal wall was suspected which could not be repaired vaginally hence proceeded with laparotomy Opening the abdomen revealed injury of the small intestine also. Total abdominal hysterectomy with the repair of colporrhexis with small bowel resection and anastomosis with temporary ileostomy done. Colporrhexis - a dreadful complication, known to occur both in non-pregnant and pregnant state. It is subdivided into primary or secondary, spontaneous or traumatic, complete or incomplete. We encountered a case of vaginal delivery which had resulted in primary spontaneous complete posterior colporrhexis with small bowel injury

Transcatheter Arterial Embolization in the Management of Postpartum Hemorrhage due to Genital Tract Injury after Vaginal Delivery

PurposeTo evaluate efficacy and safety of transcatheter arterial embolization (TAE) in managing postpartum hemorrhage (PPH) due to genital tract injury after vaginal delivery and to investigate factors associated with outcome of TAE. Materials and MethodsA retrospective review of 43 women (mean age, 32.6 years) who underwent TAE to manage PPH secondary to genital tract injury after vaginal delivery was performed at a single institution between January 2007 and December 2018. Clinical data and outcomes were obtained. Patients were classified into clinical success (n = 39) and failure (n = 4) groups, and comparisons between the groups were performed. ResultsThe clinical success rate of TAE for PPH due to genital tract injury was 90.7%. In the clinical failure group, transfusion volumes were higher (failure vs success: packed red blood cells, 14 pt ± 3.37 vs 6.26 pt ± 4.52, P = .003; platelets, 10.33 pt ± 4.04 vs 2.92 pt ± 6.15, P = .036); hemoglobin levels before the procedure were lower (failure vs success: 7.3 g/dL vs 10.7, P = .016). Periprocedural complications included pulmonary edema (25.6%), fever (23.3%), and pain (9.3%). Twenty-four patients were either followed for > 6 months or answered a telephone survey; 23 (95.8%) recovered regular menstruation, and pregnancy was confirmed in 11 (45.8%). Regarding fertility desires, 7 women attempted to conceive, 6 of whom (85.7%) became pregnant. ConclusionsTAE is an effective and safe method for managing PPH due to genital tract injury after vaginal delivery. Lower hemoglobin levels before the procedure and higher transfusion volumes were associated with clinical failure of TAE.

Efficacy of balloon tamponade in control of primary postpartum haemorrhage (PPH).

Objectives: Primary postpartum haemorrhage (PPH) refers to excessive blood loss (&gt;500ml) during 3rd stage of labour in the 1st 24 hours after delivery, thereafter, significant bleeding is referred to as secondary PPH. Its incidence is about 5% of deliveries. This study was conducted to note the efficacy of balloon tamponade in the control of PPH. Study Design: Experimental study. Setting: Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur. Period: 1st January 2018 to 30th June 2018. Material &amp; Methods: A total of 80 cases with Primary PPH after vaginal delivery were considered for this study. Cases with Bleeding disorders, ruptured uterus, retained products of conception, genital tract injuries or on anticoagulant therapy were excluded. All patients received balloon tamponade. Failure of control of bleeding was observed amongst all the patients. Results: Mean age, gestational age and parity were 24.54 years, 37.88 weeks and 3.17 respectively. Mean estimated blood loss was found to be 1125+320 ml, SBP 90.10+20.6 mmHg, DBP 57+7.2 mmHg and pulse 106+9.2 bpm. As far efficacy of balloon tamponade is concerned, it was noted in 71 (88.8%) women. When women were analyzed for maternal age, gestational age and parity status, no significant difference was found (P value &gt; 0.05). Conclusion: Balloon tamponade has good efficacy (88.8%) in controlling PPH. Its ease of use in cases at increased risk of PPH makes it a suitable option.

Epidemiology, prevention and management of early postpartum hemorrhage - a systematic review.

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of at least 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includes literature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available prevention and treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies. The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelated and sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxis should be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atony which contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genital tract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect. However, carbetocin seems to be the most effective in certain situations. Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment should include uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterine tamponade should be considered due to its high effectiveness. Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment. It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood loss evaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future.

Trends in misoprostol use and abortion complications: A cross-sectional study from nine referral hospitals in Nigeria.

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years’ data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers’ exact and chi-square for trend tests (p<0.05).ResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P <0.001). Patients who used misoprostol were significantly less likely to have infectious morbidity, genital tract injuries or medical complications. There was no difference in incomplete abortion in the groups. Patients were more likely to have in-patient care with surgical abortions (p<0.001), to need prolonged antibiotic regimens (p = 0.003), need further surgeries or additional specialist care (p = 0.009).ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Postpartum haemorrhage due to genital tract injury after vaginal delivery: safety and efficacy of transcatheter arterial embolisation.

To evaluate the safety and efficacy of transcatheter arterial embolisation (TAE) managing postpartum haemorrhage associated with genital tract injury (PPH-GTI) and to determine the factors associated with clinical outcomes. From 2002 to 2017, a retrospective analysis was performed in 60 patients (mean 31.5 years) undergoing TAE for PPH-GTI. Information regarding clinical data, angiography and embolisation details, and clinical outcomes was obtained. Univariate analyses were performed to determine the factors related to clinical outcomes. Technical and clinical success was achieved in 98% and 88%, respectively. Bleeding foci were observed on angiography in 56 patients (93%). The major bleeding artery was the vaginal artery (32%, 24/74), followed by the uterine artery (cervicovaginal branch) (n = 18), internal pudendal artery (n = 13), cervical artery (n = 9), inferior mesenteric artery (n = 4) and external pudendal artery (n = 3). Embolic agents were gelatin sponge particles (n = 23), gelatin sponge with permanent embolic agents (microcoils, n-butyl cyanoacrylate) (n = 34) and permanent embolic agents only (n = 3). In seven patients, bleeding control failed and was managed by repeat TAE (n = 5) or surgery (n = 2) and with eventual bleeding control in all of these patients. Univariate analysis showed that paravaginal haematoma, massive transfusion and long hospital stay were related to clinical failure. During the mean follow-up period of 33.1 months, regular menstruation resumed in 95.2% (40/42) and 14 of them became pregnant. TAE is safe and effective for treating PPH-GTI. Massive transfusion, paravaginal haematoma and long hospital stay were related to the failure of bleeding control. • PPH-GTI had a high detection rate of active bleeding foci on angiography. • Besides vaginal artery, inferior mesenteric and external pudendal arteries were notable bleeding foci. • Permanent embolic agents were used more than only gelatin sponge particles. • Paravaginal haematoma and massive transfusion were related to clinical failure. • TAE for PPH-GTI was safe and effective with preservation of menstrual cycles.

SURVEY OF UNSAFE ABORTION IN SELECTED HEALTH FACILITIES IN

AbstractIn order to fill the gap in evidence based information, and help in programming for the reduction ofmaternal deaths due to unsafe abortion, a nationwide hospital based survey in 9 of the 11administrative regions of Ethiopia was conducted from June to December 2000.A total of 1075 women presenting with abortion to the 15 hospitals during the study period wereconsecutively enrolled . About 58 percent of the cases were in the age range of 20-29 years, 26.5percent were illiterate, and 27.5 percent were with secondary education. Three-fourth of patientshad spontaneous abortion and one fourth (25.6 percent) of them had induced abortion. Themajority of women (87 percent) were aware of contraceptive methods, but only about half of themever used a family planning method. Of those pregnancies that ended in abortion 60 percent wereunplanned and 50 percent were unwanted. Method non-use was responsible for 78 percent ofpregnancies that occurred. Among those with induced abortion, the most common reason fortermination of pregnancy was contraceptive need. Rape accounted only for 3 percent of allpregnancies that ended in abortion (i.e. 2.5 percent of all reasons for termination of pregnancies).Fifty eight percent of women who induced abortion terminated the current pregnancy either byseeking the help of untrained personnel or by themselves with no assistance. The most frequentreason for hospital visit was vaginal bleeding and abdominal pain. Evacuation and curettage (E &amp;C) was the commonest method (83.6 percent) of evacuating the contents of the uterus. The majorcategories of complications identified were infection (28 percent), genital tract injuries (12percent), foreign bodies in the genital tract (1.6 percent) and organ failure (13.1 percent). Therewere 13 deaths, which made an overall procedure related deaths of 1,209 per 100,000 abortions.Using a modified Delphi technique, and taking the six months study period, it was found out that thetotal cost to treat incomplete abortion by health facilities under this survey was Birr 332,259.9. Inconclusion, there is a need for a strong family planning program for the country, to preventunwanted and unplanned pregnancies. There is a also an urgent need for improvement of providersknowledge and skills, provision of safe abortion services, and liberalization of the abortion law.(Ethiop. J. Reproductive Health May 2007, 1(1), 28-43)

Lower Genital Tract Trauma in a Tertiary Care Centre in Mid-Western Nepal

The study of lower genital tract trauma has become important in gynaecological practice. There is paucity of reports on this clinical entity from our settings. The main aim of this study is to document injuries in female lower genital tract in Mid-Western Nepal. Sixty female patients admitted to the hospital with genital tract injuries caused by coitus or accidents were included in the study. Details of the causes of trauma clinical presentations and management were recorded. These injuries were grouped according to etiological factors. This study included 33 (55%) coital injuries and 27 (45%) non- coital injuries. Out of coital injury, 12 cases were criminal assault (rape) in age group of 4 to 18 years. Four unmarried girls had consensual sex. Non-coital injuries were due to fall from height, cattle horn injuries, straddle type of trauma, vulvar haematoma and anorectal injuries. Appropriate surgical intervention can avert morbidity and mortality.

Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery.&#x0D; &#x0D; Methods: A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed.&#x0D; &#x0D; Results: One hundred and four successful vacuum deliveries (2.9%) were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome.&#x0D; &#x0D; Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

Comparision of Maternal and Neonatal Outcomes in Outlet Forceps and Vacuum Extraction Deliveries

Aims: To compare the maternal and neonatal out come between forceps and vacuum extractions deliveries. Methods and materials: A total of 100 patients were retrospectively analysed to compare the outcome between forceps (N=50) and vacuum application(N=50) between January 2015 to December 2015 in a tertiary care hospital. The indications for instrumental delivery were fetal distress, failure of descent of head, to cut short second stage of labor, poor maternal efforts. Maternal outcomes were analysed in terms of genital tract injuries (vaginal tears, cervical tears) perineal hematoma, paraurethral tears, postpartum hemorrhage. Neonatal outcomes were analysed in terms of APGAR scores), neonatal trauma (bruise marks, clavicular fractures), Cephalhematoma, Respiratory Distress Syndrome, NICU admissions. and neonatal mortality. The 2 groups were compared using paired T test with p<0.05 is statistically significant. The data were analysed using SPSS soft ware version 16. Results: The most common age group in both the groups were between 21-29 years. Primigravida women with gestational age between 37-40 weeks more commonly required instrumental delivery in both the groups. Fetal Distress was the most common indication(42%) for vaccum application and poor maternal efforts (36%) is the most common indication for forceps. The maternal morbidity was higher in forceps compared to vacuum (58% Vs .40%). Amongst maternal morbidities seen, genital tract injuries (perineal laceration, episiotomy extension and cervical tears) were most common both arms but more in forceps arm which is statistically significant. Amongst the fetal morbidity noted, Neonatal Trauma (Bruises, abrasion, clavicular fracture) was more common in forceps application comparative to vacuum (16% Vs 2%). Cephalhematoma was noted only with vacuum applications (12% Vs 0 %). NICU admission was significantly more in forceps application compare to vacuum (32 % Vs 24%). Conclusion: Vaccum application has a better maternal and neonatal outcome compared to forceps delivery, except cephalhematoma in the neonate which is increasing seen with vaccum application.

Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India.

Background & objectives:In developed countries, efforts have been made to restrict episiotomy practice. However, in developing countries the episiotomy rates continue to be high. This study was conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India.Methods:Prospective data of all women undergoing vaginal delivery including instrumental delivery were collected daily from the labour room registers of the 18 tertiary care hospitals on a structured proforma. Weekly data from all sites were sent to a central unit for compilation and analysis. Odds ratio was used to compare the proportion of genital trauma among women with and without episiotomy both in nulliparous and multiparous women.Results:Among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent (n=76,305) cases. Nulliparaous women were 8.8 times more likely to undergo episiotomy than multiparous women. The various genital tract injuries reported were first degree perineal tear (n=4805, 3.9%), second degree perineal tear (n=1082, 0.9%), third and fourth degree perineal tear (n=186, 0.2%), anterior vaginal trauma requiring suturing (n=490, 0.4%), extension of episiotomy/vaginal laceration/excessive bleeding from episiotomy or tear (n=177, 0.15%), vulval/vaginal haematoma (n=70, 0.06%) and cervical tear (n=108, 0.08%). The combined rate of third and fourth degree perineal tears was observed to be significantly lower (P<0.001) among nullipara who received episiotomy (0.13%) compared to those who delivered without episiotomy (0.62%).Interpretations & conclusions:Significantly lower rates of third or fourth degree perineal tear were seen among nulliparous women undergoing episiotomy. The risk and benefit of episiotomy and its complications need to be evaluated through randomized clinical trials in the Indian context.

Effectiveness of the combat pelvic protection system in the prevention of genital and urinary tract injuries: An observational study.

Historically, the incidence of genital and urinary tract (GU) injuries in major conflicts has been approximately 5%. To mitigate the risk of blast injury to the external genitalia, the United States and United Kingdom issued protective overgarments and undergarments to troops deployed in support of Operation Enduring Freedom. These two systems combined constitute the pelvic protection system (PPS). Our hypothesis was that PPS use is associated with a reduction of GU injuries in subjects exposed to dismounted improvised explosive device blast injuries. We identified two groups for comparison: those who were confirmed to have worn the PPS at time of injury (n = 58) and a historical control group who were confirmed as not wearing the PPS (non-PPS) (n = 61). Patients with any level of lower extremity amputation from dismounted improvised explosive device blast mechanism were included. The primary outcome measure was presence of a GU injury on admission. A univariate analysis assessing the strength of association with odds ratios and 95% confidence intervals was performed between the PPS and non-PPS groups. Mean Injury Severity Score (ISS) was higher in the PPS versus the non-PPS group (26.1 vs. 19.3, p = 0.0012). Overall, 31% of the patients in the PPS group sustained at least one GU injury versus 62.3% in the non-PPS group. The odds ratio of sustaining a GU injury in the PPS group as compared with the PPS group is 0.28 (31% vs. 62.3%; 95 % confidence interval, 0.62-0.12; p < 0.001). The most frequent injures were open scrotal/testes wounds, followed by open penis, and open bladder/urethra injuries. The use of the PPS is associated with a decreased odds ratio of GU injury. Despite a 31% absolute reduction, future work should focus on improved efficiency. Prognostic/epidemiologic study, level IV; therapeutic study, level V.