1.
The role of point of care thromboelastography (TEG) and thromboelastometry (ROTEM) in management of Primary postpartum haemorrhage: A meta-analysis and systematic review
Khanna P, Sinha C, Singh AK, Kumar A, Sarkar S
Saudi journal of anaesthesia. 2023;17(1):23-32
Abstract
BACKGROUND The utility of instantaneous evaluation of coagulation during primary postpartum haemorrhage (PPH) is paramount in the context of empirical blood product transfusion-related risk of dilutional and consumptive coagulopathy and circulatory overload. METHODS A profound screening of electronic databases till August 15, 2022 was carried out after being enlisted in PROSPERO (CRD42021275514). Randomized control studies, comparative cohort studies, and cross-sectional studies comparing point-of-care viscoelastic test guided blood product transfusion with empirical transfusion in patients with PPH were included. RESULTS We retrieved five studies, with a total of 1914 parturient with PPH. Patients receiving transfusion based upon point of care viscoelastic tests had lesser risk of having emergency hysterectomy (Odds ratio (OR) = 0.55, 95% CI 0.32-0.95, I(2) = 7%), transfusion-associated circulatory overload (TACO) (OR = 0.03, 95% CI 0.00-0.50), reduced transfusion of fresh frozen plasma (OR = 0.07, 95% CI 0.04-0.14, I(2) = 89%), platelets (OR = 0.51, 95% CI 0.28-0.91, I(2) = 89%), packed red blood cell transfusion (OR = 0.70, 95% CI 0.55-0.88, I(2) = 89%), and had better cost-effective treatment [Mean difference (MD) = -357.5, 95% CI - 567.75 to -147.25, I(2) = 93%] than patient received empirical transfusion. However, there was no significant difference in the requirement of ICU admissions (OR = 0.77, 95% CI = 0.46-1.29, I(2) = 82%). No mortality was detected across the studies. CONCLUSIONS Point of care viscoelastic assessment guided transfusion in PPH confederates with reduced morbidity. Nevertheless, more studies on the triggering values for transfusion, long-term survival, and cost-benefit in patients with PPH are warranted to establish its utility.
2.
Obstetric and Maternal Outcomes After B-Lynch Compression Sutures: A Meta-Analysis
Nalini N, Kumar A, Prasad MK, Singh AV, Sharma S, Singh B, Singh TH, Kumar P, Singh HV, Singh S
Cureus. 2022;14(11):e31306
Abstract
This review article aimed to determine the obstetric and maternal outcomes after B-Lynch compression sutures to control atonic postpartum hemorrhage (PPH). This meta-analysis was performed after registering the protocol in the PROSPERO database with the registration number CRD42022355358. Two independent reviewers systematically searched electronic databases and search engines (PubMed, Cochrane Library, and Google Scholar) to retrieve published articles from inception to July 2022. The obstetric and maternal outcomes after the B-Lynch compression suture were computed using the random-effects model in pooled proportion with a 95% confidence interval (CI). Meta-regression analysis and subgroup analysis were performed to explain any source of possible heterogeneity. Quality assessment of the included studies was done using Joanna Briggs Institute (JBI) tools which are critical appraisal tools for systematic reviews and meta-analyses. This meta-analysis included a total of 30 studies involving 1,270 subjects. The pooled proportion of B-Lynch suture alone was 91% (95% CI = 82-97%). The combined proportion of B-Lynch suture plus another compression suture was 1% (95% CI = 0-3%), and the pooled proportion of B-Lynch suture plus vessel ligation was 3% (95% CI = 1-6%). The pooled proportions of PPH controlled and hysterectomies were 94% (95% CI = 91-97%, I(2) = 65.3%) and 7% (95% CI = 4-10%, I(2) = 72.13%), respectively. Therefore, B-Lynch suture (either alone or in combination with other techniques) is a simple and effective measure to control atonic PPH.
3.
Efficacy of Tranexamic Acid in Reducing Blood Loss in Lower Segment Cesearean Section: A Randomised Controlled Study
Hemapriya L, More G, Kumar A
Journal of obstetrics and gynaecology of India. 2020;70(6):479-484
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Abstract
OBJECTIVES To determine the efficacy of tranexamic acid in decreasing blood loss in elective/emergency LSCS. MATERIALS AND METHODS A prospective randomised case control study was done in 200 pregnant women undergoing elective/emergency LSCS in the Department of Obstetrics and Gynaecology, at a tertiary care teaching hospital in Mysuru, from December 2018 to September 2019. Women in the age group of 18-35 years were included in the study. Those with anaemia (Hb < 10 gm%), hypertension in pregnancy, bleeding diathesis, GDM on insulin, polyhydramnios, oligohydramnios, cardiac and chronic liver disorders were excluded from the study. Two hundred women undergoing emergency/elective LSCS were divided into case (group 1) or control (group 2) groups using a computer-generated random number table. Tranexamic acid (10 mg/Kg) was given in 100 ml Normal Saline 10 mins prior to skin incision to women in the first group, along with routine care (10 Units of Oxytocin IM soon after extraction of the baby). Routine care, as per institutional protocol, was followed in the second group. The primary outcome was to estimate the intraoperative blood loss. Blood loss was measured by weighing pads, mops, drapes before and after surgery and blood in the suction container after surgery. Two separate suction catheters and containers were used, in order to minimise mixing of blood and amniotic fluid. Total blood loss was calculated as the difference in the weight of the pads, mops and drapes before and after surgery and the sum of the amount of blood in suction container. The difference between the pre-operative and post-operative haemoglobin and haematocrit was compared. The pre-operative, intra-operative and post-operative hemodynamics were also compared. RESULTS Statistical analysis was done using MS Excel and R-3.5.1 software. Unpaired and paired t test were used. In our study, there was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative hemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery. CONCLUSION Tranexamic acid can be safely used as a prophylactic agent to reduce bleeding during elective and emergency LSCS.
PICO Summary
Population
Pregnant women undergoing elective or emergency lower segment caesarean section (n= 200).
Intervention
Tranexamic acid (10 mg/Kg) in 100 ml Normal Saline 10 mins prior to skin incision to along with routine care (n= 100).
Comparison
Routine care, as per institutional protocol (n= 100).
Outcome
There was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative haemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery.
4.
Effect of timing of cord clamping on iron stores of infants born to anaemic mothers
Jindal M, Aggarwal KC, Kumar A, Batra A
Indian Journal of Haematology and Blood Transfusion. 2015;31((S1)):S55.. Abstract No. OR 170.
5.
Oral versus high dose parenteral iron supplementation in pregnancy
Kumar A, Jain S, Singh NP, Singh T
International Journal of Gynaecology and Obstetrics. 2005;89((1):):7-13.
Abstract
OBJECTIVE To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron. METHOD A total of 220 pregnant women with a singleton pregnancy and hemoglobin between 8 to 11 g% at 16-24 weeks gestation were identified and randomly divided into two groups. Group A was started on daily oral iron therapy of 100 mg of elemental iron. Group B was given 250 mg of iron sorbitol intramuscularly and repeated at an interval of 4-6 weeks. Blood indices were evaluated at the beginning of study and at 36 weeks to see the effect after iron supplementation in the two groups. The data were analyzed using SPSS software, version 10. 1. RESULTS Definitive and comparable improvement in hemoglobin and all the blood indices (hematocrit, MCH, MCHC, MCV, Serum iron and TIBC) was observed. The absolute change in hemoglobin and hematocrit was 1. 18+/-0. 68 g% and 4. 02+/-2. 59% in oral group, 1. 34+/-0. 77 g% and 4. 93+/-3. 65% in parenteral group, respectively. Serum ferritin showed statistically significant absolute rise (10. 43+/-7. 92 microg/dl) after parenteral iron supplementation as compared to oral iron supplementation (9. 76+/-4. 78 microg/dl). Obstetric outcome was comparable in two groups. CONCLUSION Two treatment regimens are biologically equivalent in terms of hematological response. Two high doses of intramuscular iron can be a good substitute to meet iron requirement in pregnancy.