1.
Rotational Thromboelastometry for the Transfusion Management of Postpartum Hemorrhage after Cesarean or Vaginal Delivery: A Single-Center Randomized Controlled Trial
Lumbreras-Marquez MI, Singh S, King CH, Nelson CI, Jespersen KN, Fields KG, Wang P, Carusi DA, Farber MK
Journal of gynecology obstetrics and human reproduction. 2022;:102470
2.
Topical vs. intravenous administration of tranexamic acid to minimize blood loss in abdominal hysterectomy perioperatively: A randomized controlled study
Mitra S, Jain K, Singh J, Jindal S, Mehra R, Singh S
Journal of anaesthesiology, clinical pharmacology. 2022;38(2):233-239
Abstract
BACKGROUND AND AIMS Topical application of tranexamic acid (TXA) to bleeding wound surfaces is rapidly gaining recognition and currently a topic of further research in patients undergoing abdominal hysterectomy. The aim of the study was to compare the efficacy of topical vs. intravenous (i.v.) administration of TXA in reducing perioperative blood loss in patients undergoing abdominal hysterectomy. MATERIAL AND METHODS A double-blinded parallel-group randomized controlled study was conducted in a tertiary teaching institute. Group 1 (n = 25) received 10 mg.kg(-1) i.v. bolus of TXA after induction followed by infusion of 1 mg.kg(-1).h(-1) of TXA, in 50 ml of normal saline (NS), till the completion of surgery and just before closure of peritoneum 100 ml of NS was applied topically over the raw surface. Group 2 (n = 25) received 50 ml of NS over 10 min after induction, followed by infusion of 50 ml of NS, till the completion of surgery and just before closure of peritoneum, 1.5 g of TXA mixed in 100 ml of NS was applied topically over the raw surface. The primary outcome was total perioperative blood loss (intraoperative plus 24 h postoperative). The secondary outcomes included change in hemoglobin concentration postoperatively at 12 h, 24 h; need for blood/blood product transfusion; amount of blood/blood product transfused and side effects of TXA. RESULTS Total perioperative blood loss was 312 ± 106.65 ml in group 1 and 325 ± 89.90 ml in group 2 (p = 0.659). It was found that the mean reduction in hemoglobin was 0.7 g.dl(-1) and 0.54 g.dl(-1) in group 1 and 0.67 g.dl(-1) and 0.44 g.dl(-1) in group 2 at 12 h and 24 h respectively, with no significant intergroup difference. CONCLUSION Administration of TXA topically is as efficacious as TXA administered i.v. to minimize perioperative blood loss in patients undergoing abdominal hysterectomy.
3.
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.
4.
A study to compare the efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy
Singh S, Singh S, Singh PK
Journal of Obstetrics & Gynaecology of India. 2013;63((1):):18-21.
Abstract
AIMS AND OBJECTIVES To compare the efficacy, safety, and rate of response of intravenous iron sucrose and intramuscular iron sorbitol therapy for anemia during pregnancy. MATERIAL AND METHODS 100 antenatal cases of gestational age 14-32 weeks were included in this prospective study. Cases were randomly divided into two groups. Group A, having 50 cases received intravenous iron sucrose, and 50 cases in Group B received intramuscular iron sorbitol. Response to therapy in both groups was studied and compared. RESULTS The mean pretherapy hemoglobin in group A was 6.49 gm/dl and in group B was 6.48 gm/dl. The rise in hemoglobin after 4 weeks of starting therapy was 3.52 gm/dl in group A and 2.33 gm/dl in group B. The difference was statistically significant (P < 0.01). The mean time taken to achieve target hemoglobin (>11 gm/dl) was 6.37 weeks in group A and 9.04 weeks in group B. In group A, 8 % (four) cases had grade I adverse effects. In group B, 24 % (12) cases had grade I adverse effects. The difference was statistically significant (P = 0.027). In both the groups, no case discontinued the therapy. CONCLUSION Intravenous iron sucrose is safe, convenient, more effective, and faster acting therapy than intramuscular iron sorbitol therapy for treating moderate to severe anemia during pregnancy.