EFFICACY OF INTRAMYOMETRIAL PROSTAGLANDIN IN THE MANAGEMENT OF PRIMARY POSTPARTUM HEMORRHAGE DUE TO UTERINE ATONY IN THE MULTIPARA AFTER FAILURE ON CONVENTIAL THERAPY
Objective: To determine the success rate of postgardin (PG) F2α in a primary post partum Hemorrhage (PPH) due to uterine along in multipara.
Design: Quasi-experimental study.
Place and Duration of Study: Department of Obstetrics & Gynecology in PNS Shifa Karachi Pakistan, from 1st June 2004 to 30th May 2005.
Patients and Method: During this one year 126 cases of multipara had primary post partum hemorrhage. Inclusion criteria was multipara who developed PPH due to uterine atony and who did not respond to any other non surgical treatment modalities. Medical diseases were not considered in exclusion criteria. Primary gravida and those with secondary PPH were excluded. Out of these 26 patients had not responded by conventional methods. 250μg of PG F2α was administered intra-myonemetrially. Syntocinon drip was stopped before and ergometrine was not given along this. The patients without uterine atony were managed according to the cause.
Results: In this study 26(100%) received PGF2α out of which 22 (84.6 %) patients responded successfully. Two patients required second dose. It was repeated at 15-90 minute interval maximum three doses were tried. The four patients (15.38 %) who failed to response, two patients had chorioamionitis, one patient had placenta praevia. One patient had no uterine response possibly due to delayed use of drug and excessive blood loss.
Conclusion: PGF2α is a safe drug which can reduce the rate of surgical procedures in cases of uterine atony.