Main Subjects : Obstetrics and Gynecology

The effectiveness of uterine packing combined with topical tranexamic acid for the management of primary postpartum hemorrhage

Maysara Mohammed Abdulrhidha; Jubran Khaleel Hassan; Dhamya S. Alharoon

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 104-108
DOI: 10.33762/mjbu.2020.127000.1010

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary PPH compared to uterine packing alone.
Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional local pathway of management of PPH had failed to control bleeding. In 15 women(the case group), uterine pack impregnated with 20 ml of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without tranexamic acid was used, outcome studied include the need for further surgical intervention and need for blood product.
Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference in effectiveness of both methods is statistically insignificant. The requirement for blood product transfusion was less in TXA group.
Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive surgical intervention as hysterectomy.

Cervical Cancer in a 25-Year Old Woman: Case Report.

Maysoon Sharief

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 131-136
DOI: 10.33762/mjbu.2020.128960.1051

A case of female 25 years old, married for 5 years, illiterate and she has 3 children from Basrah, Southern Iraq, she had history of recurrent vaginal bleeding during the second and 3rd trimesters in the last pregnancy unfortunately she was missed diagnosed during pregnancy as pregnancy cause of vaginal bleeding and was delivered by caesarian section due to cervical mass and bleeding with no history of follow up after delivery and continuous irregular vaginal bleeding 2 months after delivery till the last consultation when she developed severe pallor and severe vaginal bleeding . The patient was admitted to the Maternal and Child Hospital, Basrah, Iraq. On speculum examination, the cervix was fusiform, enlarged, barrel in shape, friable and bled on touch. Hemoglobin level was 6 gm/dl.
Ultrasound and Magnetic Resonance Imaging (MRI) confirmed the presence of a large 7X5X6 Cm. cervical malignant solid mass lesion seen invading the upper third of vagina and lower endometrial cavity. No invasion to the rectum and urinary bladder.

Total abdominal hysterectomy, bilateral salpingoophorectomy along with the removal of upper third of the vagina were done after blood correction. The patients agreed that future fertility cannot be preserved. Postoperatively, This finding was proved by the histopathological diagnosis which was invasive non-keratinized, moderately differentiated squamous cell carcinoma of the cervix (FIGO stage IB2).. patient was referred to oncologist for further management.