19. Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up. Taskin L haberal A etal 2006.This study aimed to compare immediate postplacental and early postpartum insertions with interval IUD insertions with respect to efficacy and complications. The study group consisted of 268 women in whom the following TCu 380A IUD insertions were performed: 84 (less than 10 min), 46 (10 min to 72 h) and 138 (more than 6 weeks). The women were followed up 8 weeks, 6 months and 12 months after insertion. Although no statistically significant difference was found between the groups for uterine perforation and infection (p>.001), there was a statistically significant difference between the groups in the incidence of expulsion rates.
This study highlights the safety and efficacy of postpartum insertion of intra uterine device copper T 380A among the parturients by following them for 6 months. Totally 2630 primipara were delivered of which 1828 women were included in the study and IUCDS were inserted based on the medical eligibility criteria after getting written informed consent. Insertion of PPIUCD was done after excluding women who came with draining per vaginum for >18 hours, maternal fever, uterine anomalies, fibroid uterus, postpartum haemorrhage - atonic or traumatic and systemic examination was done as given in the proforma. Acceptance rate is 69.50%.
Results: The study shows that PPIUCD is an effective intervention in both caesarean and vaginal delivery with non- significant differences in safety and efficacy depending on the route of insertion. There was no case of perforation and no significant risk of infection in either caesareans or delivery. Spontaneous expulsion occurred in two cases inserted by vaginal route. Missing string incidence is high in the caesarean group compared to vaginal insertion.
haemorrhage or sepsis during the entire hospital stay. The participants were asked to return for scheduled follow up visits at 1, 3, 6 and 12 months or earlier in case of any adverse event like pelvic pain, foul smelling vaginal discharge or excessive bleeding. At each visit, a detailed history regarding excessive bleeding, symptoms of infection, abdominal cramps or any other complaint was taken, along with general physical and pelvic examination. If vaginal discharge was present, a wet smear was performed; ultrasonography was done at first visit to ascertain the location of IUCD and at subsequent visits if the IUCD thread was not visible. Data was validated, entered into a computer and statistical analysis was carried out using SPSS version 12. Descriptive data were summarized as percentages or means. Parameters studied were continuation rate of intracaesarean Cu T 380A and Cu375 IUCD. The spectrum of adverse events associated with it, including expulsion, removal and failure rates were compared. Chi square test was used for testing the statistical significance of qualitative variables. Student t test was used for quantitative variables to evaluate safety ,efficacy and acceptability. Life table analysis was used to determine expulsion and discontinuation rates for different group of IUCD users. RESULTS
long term reversible method and may be an alternative to tubectomy. Its efficacy, compliance is high does not require daily self-administration and thus women can effectively avoid unintended pregnancies. Post-insertion symptoms are masked by the normal postpartum cramping and lochia. Postpartum insertion is convenient both for the women and the provider. Follow up can be scheduled along with immunization visits. A study on PPIUCD therefore, was done with the aim of future scope of the method, reasons for its acceptability, denial and associated complaints and complications.
This prospective cohort study was done in Obstetrics and Gynecology department of government medical college and hospital, Chandigarh from April 2013 to March 2015. All the patients attending antenatal OPD and unbooked patients referred to labor room in emergency were made aware about the available facility of PPIUCD, motivated for it and their apprehensions were made clear. The women undergoing either elective or emergency caesarean section opted for PPIUCD or sterilization according to their wish for further child bearing. After finding fit for PPIUCD insertion according to medical eligibility criteria by WHO, total 185 patients who opted for intra-caesarean PPIUCD after obtaining informed written consent were recruited for the study.
Chohan .A (2006) have conducted a study to compare the efficacy and safety of different therapeutic measures used for controlling primary postpartum haemorrhage. After identifying the risk factors for primary postpartum hemorrhage thorough history, examination and investigations, these patients were treated medically and surgically to control haemorrhage. If patients reach hospital well in time, effective management of obstetric haemorrhage should be prompt restoration of circulatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapy to arrest the bleeding.
hormone level estimation during this time may be inaccurate and dependant on the method for measuring FT4, therefore a TSH level may offer more insight into maternal thyroid function. 3,4,6 Interpretation of a thyroid function test in pregnancy is further confounded by other hormonal influences like the placental human chorionic gonadotropin (hCG), which increase thyroid hormones and suppress TSH secretion. 7 Anti thyroid peroxidase antibodies (TPOAb) or thyroglobulin antibody (TgAb) develop in a significant proportion of pregnant women with or without evidence of thyroid dysfunction. It has been suggested that these circulating antibodies maybe responsible for postpartum thyroid dysfunction in a section of these women. 8-14
The average value for E level is constant during the last 2 month of gestation. For P is the same, with a slowly decreasing trend. In the last week of gestation the average value of E level increased rapidly, suddenly and heavily and the average value of P level keeps on to decrease, leading to a change of E/P rapport, in favor of E (1:4.07). The differences between levels of ante partum estrogens and progesterone were calculated. There were significant differences (P<0.001) between E values at 8 and 1 week before parturition. Same result was obtained for P values.
We present a case of recurrent coronary artery dissections, which were treated conservatively. The case is notable in three respects. Firstly, recurrent post-partum coronary artery dissection is extremely unusual. Secondly, the patient presented 9 weeks and 3 days post-partum, which is relatively late compared to previously described cases . Thirdly, the recurrence was complicated by failure to place a coronary artery stent, which presented unique pro- blems for management of this dissection. The specific pre- disposing factors of the peripartum period in the pathogenesis of spontaneous coronary artery dissection are still unclear. Most coronary artery dissections occur within two weeks post-partum . This indicates that physiological factors related to parturition are associated with a propensity for coronary artery dissection. Our patient presented over two months post-partum, which is relatively late. Shah and colleagues described a 23-year-old patient who also presented with coronary artery dissection that occurred two months after elective abortion at 14 weeks . This patient would later also develop recurrent dissection. The reason why patients are susceptible to recurrent dissection of multiple coronary arteries such a long time after parturition is not clear and could be a genetic predisposition.
their duly signed informed consents. Information related to their socio-demographic characteristics, detailed account of their menstrual and obstetric history, including bad obstetric history, past and present medical illnesses, family details and psychosocial stressor were recorded in a specially pre-designed proforma. Detailed psycho- education about post-partum depression, its prevalence and presentation explained to them and doubts if any were clarified. They were made to undergo Supportive Psychotherapy throughout their antenatal period in the form of 30-minute therapy sessions conducted fortnightly. Each patient had to undergo a minimum of 5 such sessions. Following their delivery on the 5 th day
Interviews conducted in English were transcribed verba- tim and those conducted in Twi, Ga and Ewe were tran- scribed in English based on the meaning derived. These non-English transcripts were discussed with experts in these languages to ensure that participants’ comments were accurately represented. The transcripts were checked for accuracy and completeness by listening to the tapes and comparing them to the transcripts. Concurrent data analysis was undertaken in this study such that emerging findings were followed in subsequent interviews. The principles of content analysis were applied where tran- scripts were read several times and coded. Similar codes were grouped and re-grouped as the study progressed. Groups and sub-groups were named as themes and sub- themes according to the key findings . Consistent with the tenets of phenomenology, the study held that know- ledge is derived from the lived experiences of participants  and post-partum women have knowledge on their re- ligious beliefs and practices. An inductive content analysis was therefore appropriate for data analysis. The research team discussed the themes and sub-themes to ensure that the women’s worlds were fully captured. The NVivo soft- ware version 10 was used to manage the data. The first au- thor did the initial data analysis and the other co-authors coded independently and the themes and sub-themes were compared. Discrepancies in coding and theme devel- opment were discussed and a consensus was reached that best suited the data generated.
This Policy sets out the requirements for the safe insertion and postinsertion care of CVADs in NSW Health facilities. Except where specified all instances of CVAD insertion must comply with this Policy regardless of the clinical setting. The Policy also sets out to minimise complications from the insertion, management and access of CVADs.
elevate pretese nei confronti delle proprie prestazioni re- lativamente a vecchi e nuovi compiti aprono la strada al fallimento, che rappresenta la via regia per la colpa, cioè il tema caratterizzante la depressione postpartum. Dunque nella maternità per le donne TM si cela un tragi- co paradosso. Da un lato, la maternità porterebbe a com- pimento il progetto esistenziale in cui al massimo grado potrebbe incarnarsi l’ordo melancolico: la famiglia, cioè la pietra che, nella visione coscienziosa e tendenzial- mente tradizionalista del TM, rappresenta l’architrave dell’ordine sociale. Dall’altro, nella laboriosa costruzio- ne di quest’ordo, e nella sua fragile costituzione, si cela un’insidia terribile: l’incapacità di far funzionare la fa- miglia sulla base dei propri valori e delle proprie rigide aspettative. La crisi della propria idea di famiglia, dei ruo- li sociali che in essa si vorrebbe venissero rispecchiati, della continuità rispetto alle tradizioni ereditate dal nu- cleo di provenienza; tutto questo prelude allo scompenso melancolico. Tutte queste “cose” da dover tenere in ordi- ne innescano un conflitto nella donna TM tra la tendenza alla precisione e all’esattezza e l’incapacità ad operare. La donna può difficilmente rinunciare all’una come alle altre e rimane sempre più invischiata in una situazione di “disperazione”, una situazione caratterizzata dal dubbio, nella quale non è possibile raggiungere una decisione definitiva. Questa stagnazione rappresenta l’anticamera dell’inibizione melanconica e della colpa relativa alla propria inadeguatezza.
Vitamin D is acquired through synthesis in the epidermis after sun exposure and through the diet. Season of the year and latitude affect the amount of ultraviolet B radi- ation. Sun exposure is restricted during winter in northern Sweden since sun hours are few. Due to fear of skin cancer and premature ageing unprotected exposure to the sun has declined during the last decades. Dietary vitamin D is mostly derived from fortified milk products, egg, fatty fish and fish containing food. A recent Swedish study among young adults living in northern Sweden showed that low levels of vitamin D were common during winter even if the dietary vitamin D intake met the current national recommendations .
When men are placed in conventionally feminine roles, they may look for ways to compensate for the loss of their masculinity. This has been the case among male temporary workers (Henson and Rogers 2001), male school teachers, social workers, librarians, and nurses (Williams 1995). Doing conventionally feminine emotion work could have compromised the masculinity of the men I studied. But these men did not have such a problem because they had middle-class signifiers of masculinity (e.g., professional success). In addition, the men responded to their wives’ distress in ways that fed their masculinity. They defined themselves as rational and strong relative to their wives, and affirmed their identities as good, middle-class husbands and fathers (i.e., as good men). Offering breaks meant that the man was an engaged father (in spite of how little time he may have spent with the child). Taking charge and changing the woman’s perspective reinforced his sense of control and established his perspective as the rational one. Conflict avoidance allowed the men to prioritize their needs while giving the appearance of being engaged in the
The study indicates that majority of the users were living with their spouses according to Figure 4. This is an indication that living with a marital partner in- fluenced high uptake of PPIUCD. It disregards Rachel et al.  in Nyanza western Kenya in a study on overcoming barriers to family planning through integration who found that living with marital partners was significant related to low use of FP methods. This was because married women had to consult their husbands before making a decision on family planning. But in this study women made their own choice of contraceptive use to prevent or space pregnancy. The findings are similar to a study by Katheit and Agarwal  who found out that living together with the spouse influenced PPIUCD uptake unlike those who were separated. This was a study on evaluation of post placental intra uterine device in terms of awareness, acceptance and expulsion in a tertiary care centre. It contradicts to a study on factors influencing uptake of IUCDamongpost par- tum adolescents by Melisa et al.  found that living with marital partners had no influence on the women’s choice of contraceptive use. A few of the mothers lived with their own mothers or their mothers in law. According to Atem et al. , in a study on determinants of unmet need for family planning among women in Urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, the major reason for non-use of contraception among women with un- met need for family planning was due to disapproval by mothers in laws. This contradicts to a study on family planning use and associated factors among pas- toralist community of a far region, eastern Ethiopia by Mussie et al. . The study found that three-quarters of the non-users had the influence of their par- ents. The other 10% of the respondents lived with their significant others for example their children or other relatives. A study by Wulifan et al.  who found that optimal contraceptive use among women of reproductive age was in- fluenced by their own choice and preference of contraceptives use. This was a
In general, TOA responds well to the empirical anti- biotic regimen recommended by the Centers for Disease Control and Prevention . However, approximately 25% of TOA cases need surgical intervention or drainage . Four principal indications for laparotomy/laparoscopy among these patients are suspicion of a surgical emer- gency (rupture of the abscess or organs), unsuccessful drainage of the abscess, poor response to treatment with drainage and antibiotics, and uncertainty about the diag- nosis . Kuo et al.  found that, among multiparous patients, hysterectomies were more commonly performed.
We conducted quality control (QC) analyses as per the manufacturer’s recommendations. Before starting the study, TEM staff trained the Nigerian study team to use the ROTEM machine. We stored the ROTEM data on the machine with a backup after each analysis. We collected, cleaned and analysed the study data at the Clinical Trials Unit of the London School of Hygiene & Tropical Medi- cine. Fibrinolysis was assessed as the amount of clot lysis on EXTEM (https://www.rotem.de/en/methodology/inter- pretation/). We defined hyper-fibrinolysis as ML > 15% on ROTEM EXTEM. This definition of hyper-fibrinolysis is provided by the manufacturer and is widely used in research studies . Coagulopathy was defined as an EXTEM A5 < 40 mm or a prothrombin ratio > 1.5. This A5 definition of coagulopathy was based on studies of the use of ROTEM to diagnose acute traumatic coagulopathy in which a A5 < 40 mm predicted the receipt of massive blood transfusion in 73% of patients [10, 11]. Normal ROTEM values for peri-partum Nigerian women have not been studied, so instead we have indicated the normal values from a study of 161 healthy peri-partum Dutch women .
were 224, who were divided into two groups. Group- A, PPIUCD group (112 patients), IUCD were implanted with ten minutes of delivery (both normal delivery and caesarean section) by the trained obstetrician using a Kelly’s placental forceps, and those who received IUCD within 48 hours of delivery (immediate PPIUCD) were also included in this group. In Group- B, interval IUCD group (112 patients), the IUCD was inserted anytime of a woman’s menstrual cycle that were medically fit and not pregnant, within six months of delivery. Data was recorded on predesigned performa. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Effect modifiers were controlled through stratification of age, parity to see the effect of these on outcome variable. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.