Karthika, R (2022) A Randomised Prospective Comparative study of Efficacy of Vaccum Retraction Cannula and Intrauterine Foley Balloon Tamponade in Atonic Post Partum Hemorrhage. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND AND JUSTIFICATION: Postpartum hemorrhage (PPH) is an obstetrical emergency that takes place following cesarean or vaginal delivery. Prevention can be achieved through timely diagnosis, provision of essential resources and equipment, and correct management of the third stage of labor. PPH can be classified into two categories: primary and secondary PPH. Primary PPH (early PPH) takes place within the first 24 hours following delivery, whereas secondary or delayed PPH transpires after 24 hours to 12 weeks following delivery . PPH can also be described as the loss of ≥500 ml following vaginal delivery or ≥1,000 ml following caesarean delivery . Although theforementioned descriptions of PPH are in line with the WHO guidelines for PPH, it is important to highlight that PPH refers to not only the blood loss, but also related signs 3 and symptoms such as hypovolemia signs (low oxygen saturation, oliguria, tachycardia, and hypotension). PPH has numerous potential causes, but the most common cause is uterine atony, accounting for approximately 80% of all maternal deaths .one in 20 normal vaginal deliveries gets complicated by atonic PPH in our Hospital(Instituite of social obstetrics and gynecology ISO KGH). As highlighted earlier, PPH is one of the most preventable causes of maternal morbidity and mortality. The high prevalence rates, particularly in the developing world, suggest the need for evidence-based practices in management and prevention of PPH.A proper active management of third stage of labour and uterine massage can control the post partum hemorrhage. Medical management includes usage of uterotonics .Inspite of these corrective measures, if the uterus is still found to be atonic, two methods of controlling the torrential bleeding, either byCreating negative pressure inside the uterine cavity with a specially designed uterine cannula, results in shrinking of uterus which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhageor the usage of collapsed balloon(Foleys catheter or condom) which is inserted into the uterus and inflated with saline to fill the uterine cavity to tamponade uterine bleeding.This study performed in our hospital , is to compare the efficacy of vacuum retraction cannula with the balloon tamponade method of controlling postpartum hemorrhage. AIMS AND OBJECTIVES: To compare the efficacy of vacuum retraction cannula and balloon tamponade in arresting bleeding in atonic post partum hemorrhage METHOD OF STUDY: The study includes 100 women who developed atonic post partum hemorrhage in labor room of ISO KGH. Initial management of emptying the bladder with Foleys catheter, uterine massage,injoxytocin 40 units in 500ml NS 60 drops/min, tablet Misoprostol 1000 micrograms kept per rectally.Inspite of these measures, the uterus remaining flabby, and bleeding remains uncontrolled,the usage of either balloon tamponade technique or vacuum retraction technique with SR cannula is employed. The bleeding is controlled using balloon tamponade techniques in 50 women. Introducing 2 Foleys catheter of size 24F inside the uterine cavity (using sponge holding forceps or manually into uterine cavity using ring forceps to hold the cervix) and inflating with 40ml of normal saline in each Foleys catheter. The urobag is connected so that the any further bleeding can be measured by the marking in the urobag. The catheter is deflated after 24hours of post partum hemorrhage. In Other 50 women the bleeding is controlled with the application of SR vaccum retraction cannula, .Under good source of light with wide blade vaginal speculum application, the anterior lip of cervix should be grasped with sponge holding forceps, and the uterine end of the cannula should be inserted in to the uterine cavity up to the level of fundus. The outer end of the cannula should be connected to the suction machine throughtubing. The left palm supporting the fundus per abdomen, right fingers grasp the outer end of the cannula, and push it gentlyup to the fundus. Keeping the cannula in this position (to prevent slipping out), suction machine should be put on, and a negative pressure of 650mmhg should be created, and maintained for 10mnts.Then the suction machine was put off. This makes the cannula to get fixed in this position due to sucking of soft cervical tissues in to the perforations on cervical portion of the cannula. Negative pressure should be applied for 10mts every hour for 3hrs.After this, the negative pressure should be created whenever there is recurrence of bleeding. The cannula should bekept in position as long as the threat for recurrence of bleeding expected,or even up to 24hrs. The efficacy of both methods are analysed in terms of time to arrest the bleeding, amount of blood loss, the need for blood transfusion, the incidence of secondary PPH, the need for other operative procedures. RESULTS: In our study each group i.e the Cannula group and the Foley’s method was used to compare the effectiveness on the postpartum hemorrhage. Each group consist of 50 participants. A total of 100 participants. • Majority of the study participants belongs to 21-25 years of age (Cannula-21(41%), Foley's-19 (32%) followed by the 26 to 30 years. • The mean age of the study participants in the Cannula group is 25.18±4.59 and that of the Foley’s tamponade is 26.30±4.59. • There is no difference between the mean age of the study participants in both the groups and it is found to be not significant. • In both the groups majority of the study participants have 36-40 weeks of gestation 33(66%). • Nearly more than half of the study participants has gestation weeks 36-40 weeks. • There is difference between the gestational weeks in both the groups and it is found to be statistically. • Majority of the study participant have the parity more than 2 followed by para 1. • There is no difference in the parity status of the study participants and it is found to be not statistically significant. • Risk factors was present in majority of the study participants (Cannula -40 (80%) and foleys-28 (56%). • The most common risk factor is the Prolonged labour (Cannula -20 (40%) and foleys-9 (18%). • The second most common risk factor is multiple pregnancy (Cannula-7 (14%) and Foleys tamponade-6 (12%). • Majority of the study participants have 7-10 grams of Antenatal hemoglobin Cannula-34 (68%) and Foleys tamponade-32 (64%). • There is a difference exist between the antenatal hemoglobin and the difference is found to be statistically significant. • Most of the study participants stated that the delivery was conducted by the Labour naturalis in both the groups It is observed Cannula-38 (76%) and Foleys tamponade-.72 (64%) followed by the outlet forceps. • The duration of the third stage of labour in Cannula group and Foleys tamponade group were similar in < 5 mins of age (Cannula-33 and Foleys-32%. • There is no difference exist on duration of the third stage of labour and it is not found to be clinically stable. • The mean duration to stop bleeding in Cannula is 3.4±2.40 and the Foley’s tamponade is 12.7±6.29. • There is a difference in the mean duration to stop bleeding between the two groups and it is found to be statistically significant. • The blood loss observed after applying negative pressure was found to be 20% in the Cannula group and 28% in the Foley’s tamponade group. • There is a difference in the blood loss between the groups but it is not found to be statistically significant. • In postnatal hemoglobin status majority of the study participants have 7-10 grams in cannula group 37 (74%) and in the Foley’s tamponade it is 36 (72%). • There is a difference in the postnatal hemoglobin status between the group and it is not found to be significant. CONCLUSION: One of the preventable cause of maternal morbidity and mortality is Postpartum Hemorrhage. • Simple methods can be used to reduce the disaster. • For assisting the normal physiological process of contraction and retraction Vaccum retraction is used. • Vaccum extraction is simple and it is cost effective technique used to decrease the blood loss. • Vaccum extraction method can be used in low resource setting and can also be considered to keep the instruments together with the delivery tray. • Even the labour room staff should be trained in how to apply this technique and when to apply it. LIMITATIONS: • Our sample size is small so more explorations couldn’t be made. • We didn’t follow up the patients after the techniques to find any side effects or disturbances like long term ishchemia on the cervix and the uterus parts due to the effect of vaccum. RECOMMENDATIONS: • Vaccum method is considered to be the best method for the low resource setting due to its inexpensiveness. • Train the staff about how to manage PPH with this vaccum technique. • With large number of sample size Randomised control study have to be done to explore further findings.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221916868 |
| Uncontrolled Keywords: | Efficacy, Vaccum Retraction Cannula, Intrauterine Foley Balloon Tamponade, Atonic Post Partum Hemorrhage. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Apr 2022 08:36 |
| Last Modified: | 27 Nov 2023 16:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19327 |
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