European Journal of Molecular & Clinical Medicine

Placenta Previa is the complete or partial covering of the internal os of the cervix with placenta. It is the major risk factor for postpartum haemorrhage and lead to morbidity and mortality of the mother and new born. Uncontrolled postpartum hemorrhage from placenta previa and PAS (placenta accreta spectrum may necessitate need for blood transfusion, hysterectomy, ICU admissions and even death.
Aim: To compare the maternal and fetal outcome between primigravida and multigravida women with placenta previa admitted in Government Vellore Medical College, Tamil Nadu.
Results: The incidence of placenta previa was highest among the following age groups
20-29yrs i.e.67.32%, most common risk factors are caesarean section 45.5%(1 LSCS-30%, 2LSCS-16%), 1 bleeding episode cases-78% followed by 15% of cases has 2 episodes of bleeding,79% of cases in our study participants had cephalic presentation followed by breech 16% followed by transverse lie 5%,Type 2A Placenta previa had 46%, Type 2B placenta previa had 18%,Type 3 Placenta previa 16%,Type 4-11% Lowest incidence.
Type 1 placenta previa 9%, 82% of cases underwent emergency LSCS, 50% of cases underwent prophylactic uterine artery ligation, 32% of cases had PPH managed medically and surgically, 9% of cases underwent elective LSCS, for all 9 cases prophylactic uterine artery ligation done, no postpartum hemorrhage.
Type 2A placenta previa - 46 cases (6 cases elective LSCS, 40 cases emergency LSCS) 15 cases had foley tamponade with uterine artery ligation, 12% cases had foley tamponade, 1 cases underwent subtotal hysterectomy).
Type 2B placenta previa -18 cases (2 cases elective lscs, 16 cases emergency lscs) 9 cases had foley tamponade with uterine artery ligation, 4 cases had uterine artery ligation, 2cases had uterine artery ligation with B lynch).
Type 4 placenta Previa, 11 cases (emergency lscs), 5 cases – Foley with uterine artery ligation, 3 cases total hysterectomy, 1 case subtotal hysterectomy1 bladder repair.
Out of 9 perinatal deaths, Asphyxia and prematurity were major contributions 4.3% and 2.6% respectively followed by RDS1.6%) Neonatal mortality was 8-9% with placenta previa. Perinatal death were higher in gestational age between 30-33 weeks.

Background: Anemia in pregnancy is defined as hemoglobin levels less than 11gm/dL. Severe anaemia is responsible for 20-40% of direct and indirect maternal deaths because of increased susceptibility to cardiac failure, sepsis and association with preeclampsia, antepartum haemorrhage, postpartum haemorrhage and thrombo-embolism. Present study was carried out to fetomaternal outcome in pregnant women with severe anemia at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women with Hb < 7gm/dL, with gestational age > 28 weeks, delivered at our hospital.
Results: Total 72 women with severe anemia were studied, majority were from 19-25 years age group (52.78 %), mean age was 25.4 ± 3.5 years, had completed primary education (70.83 %), from lower Socio-economic status (84.72 %). Though Un-booked (13.89 %) pregnancies were less than booked cases (86.11 %), majority had less than 4 antenatal visits (75 %). Majority of patients were Para 2 (34.72 %), Para > 2 (31.94 %), had spacing between pregnancy was < 2 years (71.93 %). Vaginal (70.83 %) was most common Mode of delivery, followed by LSCS (26.39 %) & Instrument delivery (2.78 %). In present study, maternal complication/ high risk factors noted were premature delivery (52.78 %), postpartum hemorrhage (34.72 %), preeclampsia (20.83 %), prolonged labor (19.44 %), congestive cardiac failure (16.67 %), puerperal pyrexia (15.28 %).  One maternal mortality (1.39 %) was noted. We noted total 7 deaths (3 Intrauterine fetal death/ Stillbirth & 4 Early neonatal deaths), while Low birth weight (<2500 gm) (65.28 %), NICU admission (48.61 %), Apgar score <7 (at 5 minute) (8.33 %).
Conclusion: Anemia in pregnancy is a major health problem in developing countries. Severe anemia during pregnancy is associated with maternal and fetal health outcomes fetomaternal morbidity and mortality.

Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that is characterized by a spectrum neurological and radiological feature from various risk factors.Delay in the diagnosis and treatment may result in death or in irreversible neurological sequelae. Common neurological symptoms includes headache, impairment in level of consciousness, seizures, visual disturbances, and focal neurological deficits. Common triggering factors include blood pressure fluctuations, renal failure, eclampsia, exposure to immunosuppressive or cytotoxic agents and autoimmune disorders.The classic radiographic findings include bilateral subcortical vasogenic edema predominantly affecting the parieto-occipital regions but atypical features include involvement of other regions, cortical involvement, restricted diffusion, hemorrhage, contrast enhancement. It is the first case of PRES without underlying disease. We report a case of postpartum eclampsia presented 8 days after delivery, which is the latest onset ever described. Wesuggest  The presence of prodromal symptoms should be thoroughly investigated, even in the absence of antecedent pre-eclampsia

Background: Postpartum haemorrhage is still the primary cause of maternal
death, particularly in underdeveloped nations. We aimed to see how tranexamic
acid and oxytocin compare in terms of preventing postpartum haemorrhage and
lowering blood loss, hospital stay, morbidity, and death during vaginal
birth.Patients and methods: A prospective, randomised clinical trial study was
conducted on 92 pregnant women who were being prepared for vaginal delivery
and were divided into two groups: Group (A) (TXA group) (46 patients) received 1
gm of tranexamic acid and Group (B) (Non-TXA group) (46 patients) received 10
IU of oxytocin. Hemoglobin and hematocrit readings were tested before and 24
hours after vaginal delivery, and additional basic laboratory tests were
performed.Results: In our study, there was no significant difference in HB at the
pre-test, but the Non-TXA group was considerably lower at the post-test, and the
Non-TXA group had a significant reduction. At the pre-test, there was no
significant difference in HCT, but the Non-TXA group was considerably lower at
the post-test, and the Non-TXA group had a significant reduction. In the TXA
group, the difference in HCT was much smaller. The TXA group had considerably
less blood loss.Conclusion: The use of tranexamic acid during delivery may assist to
minimise blood loss. It is a low-cost and widely available medication. The use of
TXA reduces the requirement for uterotonics, lowering morbidity and mortality.

Background:The misoprostol tablet is very soluble and can be dissolved in 20
minutes when it is put under the tongue a pharmacokinetic study compared the
absorption kinetics of oral, vaginal and sublingual routes of administration of
misoprostol found that sublingual misoprostol has the shortest time to peak
concentration, the highest peak concentration and the greatest bioavailability when
compared to other routes.The aim of the present study was to to improve the
management primary postpartum hemorrhage during and after elective cesarean
section (CS). Patients and methods:This study was carried out on 46 cases admitted
for elective CS at University Hospital. They divided into two groups regarding the
protocol of treatment, was given oxytocin, 10 IU in 250 ml of Normal saline
solution over 10 minutes was administered directly after opening the
uterus.Misoprostol group was given 400 mcg misoprostol plus intra venous
Oxytocin administered directly after opening the uterus. Results: There was
statistical significantly between the two studied groups in hemoglobin and HCT
postoperatively with higher level among intra venous oxytocin plus intra uterine
misoprostol than intra venous oxytocin only group. But regarding preoperative
hemoglobin and HCT, there was no statistically significant difference before and
after treatment. Higher blood loss either intraoperative, postoperative and overall
blood loss on intra venous oxytocin only group than intra venous oxytocin plus
intra uterine misoprostol.There was statistical significantly decrease in both
hemoglobin and HCT postoperatively in the two studied groups but this decrease was
more among intra venous oxytocin only group than intra venous oxytocin plus intra
uterine misoprostol. Conclusion:Intrauterine misoprostol combined with oxytocin
infusion during caesarean section can minimise intraoperative blood loss, avoid
postpartum haemorrhage, and reduce any additional uterotonic medication
requirements.

The aim of our study was to retrospectively examine the history of childbirth and the quality of primary care for bleeding and evaluate the prescribed rehabilitation measures for women who have suffered postpartum hemorrhage and massive bleeding. The materials and methods of the study were 242 birth histories with postpartum hemorrhage for the last 6 years (2013-2018) in the city maternity hospital of Bukhara. The average age of the patients was 26.7 ± 1.2 years. The obstetric pathology leading to bleeding mainly consists of uterus hypotonia - 143 (59.1) and large fetus - 68 (28.1), and preeclampsia and DIOV are equal amounts - 33 (13.64). Only about 20% of women who had postpartum hemorrhage underwent early rehabilitation in the form of prescribing contraceptives.The aim of the research was to study the effectiveness of modern principles of stopping postpartum obstetric bleeding. From 127 cases of bleeding in 101 women (79.5%) the childbirth were with the operational method. With the development of blood loss was renderedstepwise ways to stop bleeding. During hemostasis of the bleeding, ligatures were imposed on the ovarian arteries and the ascending branch of the uterine artery for ischemicization of the uterus, which was effective in 30 (30%) women, and in 114 (89.7%) women managed to achieve organ-sparing tactics.