Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fou...Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.展开更多
Vesico-vaginal fistula is still a major problem in the developing world, in particularNigeria. Vesico-uterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than pr...Vesico-vaginal fistula is still a major problem in the developing world, in particularNigeria. Vesico-uterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than previously thought. We report a case of Mrs U.B. a 28-year-old P2+0 with one living child, who presented with a history of 20 amenorrhea and infertility of 8 years duration. She had caesarean section to relieve an obstructed labor with macerated stillbirth in her last pregnancy. As part of her routine investigation for 20 amenorrhea and infertility, a request for ultrasound scan was made. Ultrasound pictures are presented and discussed. Standard diagnostic investigations for Youssef’s syndrome are by cystoscopy, intravenous urogram and or hysterosalpingography, sonodiagnosis (sonohysterography) is primarily not resorted. We recommend as a standard investigation tool, Ultrasound scan (Sonodiagnosis) for all patients with Vesicovaginal fistula.展开更多
文摘Objectives: Worldwide the use of uterotonic drugs has significantly reduced maternal mortality from postpartum hemorrhage. The objective is to audit the use of uterotonics in the active management of the third and fourth stages of labor. Methods: Personal data, diagnostic clinical information, blood loss and uterotonics administered were extracted from a cohort of 634 consecutive parturient. Trend in Shock Index (Pulse Rate/Systolic Blood Pressure) and 48 hours hematocrit changes were computed and analyzed. Results: There were 422 vagina deliveries and 212 caesarean sections. Primiparous mothers were 141 (34.2%), while grand multiparous mothers were 14 (3.4%). The mean visually estimated postpartum blood loss 165.9 ± 80 ml. There was no significant difference in the mean blood loss between the three parity groups of parturient [P = 0.09]. Fourteen parturient (3.44%) had blood loss ≥500 ml. The value of Shock Index (Pulse Rate/Systolic Blood Pressure) in the study ranged between 0.43 and 1.38. Logistic regression analysis of the variables associated with the switch between the three regimens of uterotonic drugs, showed a significant positive correlation between VEBL and uterotonic drugs administered [Pearson correlation = 0.130, P-value = 0.008]. In addition, there was a significant negative correlation between uterotonic drugs administered and Shock Index at 30 minutes and 2 hours postpartum. The correlation coefficient between VEBL and regimens of uterotonic drugs used was positive and significant (P = 0.019). Conclusion: Visually estimated blood loss, with shock are the main Triggers involved in switching between uterotonic drugs regimens used in active management of PPH. Shock index calculation is vital in management decision. We advocate training of all birth attendants on VEBL.
文摘Vesico-vaginal fistula is still a major problem in the developing world, in particularNigeria. Vesico-uterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than previously thought. We report a case of Mrs U.B. a 28-year-old P2+0 with one living child, who presented with a history of 20 amenorrhea and infertility of 8 years duration. She had caesarean section to relieve an obstructed labor with macerated stillbirth in her last pregnancy. As part of her routine investigation for 20 amenorrhea and infertility, a request for ultrasound scan was made. Ultrasound pictures are presented and discussed. Standard diagnostic investigations for Youssef’s syndrome are by cystoscopy, intravenous urogram and or hysterosalpingography, sonodiagnosis (sonohysterography) is primarily not resorted. We recommend as a standard investigation tool, Ultrasound scan (Sonodiagnosis) for all patients with Vesicovaginal fistula.
