Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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This study describes cases of fibroids with venous thromboembolism (VTE) managed at UHWI between the years 1999-2004. We examined records to find patients with fibroids and VTE diagnosed before or after surgery. We found 438 women with VTE and 72 of these (16.4%) with fibroids. ⋯ Most cases 67/72 (93%) had VTE without surgery. Of the five cases with VTE after surgery for fibroids, none had prophylactic heparin. Of the cases, 15 died--23% of women with VTE at PM and 0.8% of those with fibroids.
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Randomized Controlled Trial Comparative Study
The effect of sublingual misoprostol versus intravenous oxytocin in reducing bleeding after caesarean section.
In this study, 100 singleton pregnant women underwent a caesarean delivery under general anaesthesia and were studied in terms of postpartum bleeding using oxytocin or misoprostol. Patients were randomly divided into two equal groups. One group received two tabs of misoprostol 200 microg sublingually and the second group took intravenous infusion of 20 units of oxytocin at the rate of 10 cc/min immediately after delivery until full contraction of the uterine. ⋯ The need to give additional oxytocin therapy in oxytocin group (36%) was significantly higher than misoprostol group (14%) (p = 0.032). It seems that the efficacy of sublingual misoprostol is equivalent to that of low dose intravenous oxytocin in reducing postpartum haemorrhage at caesarean section. Misoprostol has some other advantages like long shelf -life, stability at room temperature and oral use.
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Primary atony of the lower uterine segment appears to be a distinct cause of postpartum haemorrhage. We report a case series of women with postpartum haemorrhage where ultrasound and clinical findings revealed a well contracted fundus and upper uterine segment and a ballooned out lower uterine segment, a condition we have called primary atony of the lower uterine segment. We hope that this case series will lead to increased recognition of this condition, stimulate others to report their experience and lead to additional studies to better characterise this entity, and develop more effective therapies.
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Consultant obstetricians and gynaecologists are often recalled from home back into hospital to attend emergencies. We audited their driving practices and compliance to motor traffic regulations on recall to these emergencies with the aid of a questionnaire survey. A total of 218 of the 300 UK consultants surveyed responded. ⋯ A total of 37 consultants had been stopped for traffic violations, nine with a GWL and 28 without. Five consultants had been involved in accidents returning to hospital to attend an emergency. Obstetricians and gynaecologists are disregarding motor traffic regulations in order to attend emergencies.
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Relationship between visually estimated blood loss at delivery and postpartum change in haematocrit.
This study was to assess blood loss using visual estimation and change in postpartum haematocrit value following vaginal delivery, and to study any relationship that may exist. A total of 152 parturients who had had vaginal delivery were studied. Blood loss at delivery was visually estimated. ⋯ It was concluded that postpartum haematocrit has a significant negative non-linear correlation with VEBL. In the absence of primary postpartum haemorrhage, majority of women have either the same or an increased haematocrit following vaginal delivery. Consequently, routine haematocrit estimation in parturients with visual estimated blood loss of <500 ml barely confers any cost benefit.