SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

Background: To compare the frequency of vaginal cuff dehiscence after total laparoscopic hysterectomy between two different suturing techniques. Place and duration of study: The study was conducted at three centers; postgraduate tertiary care hospital, university affiliated hospital and private multidisciplinary hospital. The studied duration was from January 2019 to June 2020. Method: All patients with indication of total laparoscopic hysterectomy during the study period were included. These were randomly divided in to two groups A and B. Group A was performed upon the conventional interrupted figure of 8 vault suturing and group B with continuous, running, double layered suturing. Keeping the demographics almost same the frequency of a known but rare complication of vaginal cuff dehiscence (VCD) was determined. Results: A total of 195 patients were enrolled. Of these 87 were in group A and 108 in group B. The results were unequivocal as only one patient had the said complication. Conclusion: The morbid complication has no relation with the technique of vault suturing.

Total laparoscopic hysterectomy is safe, acceptable, and doable alternative to conventional standard hysterectomy.

JDUHSstudy to evaluate the rate of induced labor in nulliparous women and to compare delivery outcome between induced and spontaneous labor at term. METHODSThis descriptive study was carried out at Obstetrics and Gynaecology department, Patel Hospital, Karachi from April to October 2019. All women of age between 20-40 years presenting at gestational age between 37-42 weeks assessed on dating scan with singleton pregnancy confirmed on ultrasound, gestational hypertension (BP>140/90 mmHg), gestational diabetes (BSR>140 mgdl), intact membranes on examination, and active phase of labor with cervical dilation at least 4cm were consecutively enrolled. Whereas patients with non-cephalic presentation (on USG), previous scar, anemia (Hb<10g/dl), eclampsia (BP≥140/90mmHg with convulsions), placenta previa, cephalopelvic st disproportion, multiple pregnancy (with 1 noncephalic twin), have previous uterine surgery on history and were confirmed through discharge card, multiple gestation on ultrasound, gestational age less than 28 weeks, caesarean Section done for reasons like ABSTRACT Objective: To assess the delivery outcome in nulliparous women at term and to compare the outcomes among induced versus spontaneous labor. Methods: A descriptive study was conducted at Obstetrics and Gynecology department of Patel Hospital, Karachi from April to October 2019. All women with age between 20-40 years, gestational age between 37-42 weeks, and singleton pregnancy were consecutively included. Mode of delivery and Apgar score at 5 minutes were noted. Results: Of 172 women, the mean age of the women was 29.9±4.64. Vaginal delivery was reported in 102 (59.3%) and cesarean section in 70 (40.7%) women. Cesarean delivery was found to be significantly higher among women with >29 years of age (pvalue 0.006), >38 weeks of gestational age (p-value <0.001), obesity (p-value <0.001), and induction of labor (p-value 0.020). Mean APGAR score at 1 min was 7.45 ±0.69 and APGAR score at 5min was 8.84 ±0.41. Mean APGAR score at 5 minutes was significantly higher in women vaginal delivery than that of women with cesarean delivery (p-value 0.034). Conclusion:The frequency of vaginal delivery was found higher in nulliparous women presenting at term. Moreover, APGAR score at 5 minutes was found to be significantly different in both groups.

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