Dissertation for e

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OBJECTIVES OF THE STUDY

The objective of the study was to:

• compare the efficacy of two conservative methods i.e. uterovaginal

packing and balloon tamponade in the control of Primary

Postpartum Haemorrhage

1



OPERATIONAL DEFINITIONS

Efficacy was measured through:

• Success of control of bleeding

o If bleeding arrested within half an hour after uterovaginal

packing/balloon tamponade then approach adopted was

labeled as success

2



MATERIAL AND METHODS

STUDY DESIGN:

• An experimental (clinical trials) study

STUDY SETTING:

•Department of Obstetrics & Gynaecology, Bahawal Victoria

Hospital, Bahawalpur.

DURATION OF STUDY:

• Six months after approval of synopsis.

SAMPLE SIZE:

• Sample size of 86 cases is calculated with 5% of level of

significance with Power of the test (I-β) 43%, control of bleeding

with uterovaginal packing (P1)=91%, Control of bleeding with

balloon tamponade (P2) 70%, 43 patients with uterovaginal packing

and 43 with balloon tamponade

SAMPLING TECHNIQUE:

• Non probability: purposive sampling

3



SAMPLE SELECT ION:

INCLUSION CRITERIA:

The subjects selected for this study were included:

1. Cases with Primary PPH after vaginal delivery conducted in

hospital

2. Cases with Primary PPH after receiving uterotonics i.e.

Syntocinion Inj. Methergin, Prostaglandins

EXCLUSION CRITERIA:

1. Cases with bleeding disorders

2. Cases with ruptured uterus

3. Cases with retained products of conception or with genital tract

injuries

4. Cases on anticoagulant therapy

DATA COLLECTION PROCEDURE:

All the cases who developed Primary PPH in Obstetrics &

Gynaeology Unit-I after vaginal delivery fulfilling the inclusion criteria were

included in the study (Patient was diagnosed as having PPH by giving

pre-weighed pad, if bleed is more than 500ml).

4



Cases were divided into two groups ‘A’ and ‘B’. After explaining

merits and demerits of study and taking informed consent all eligible

cases were offered two folded slips having letter ‘A’ and ‘B’ and were

asked to pick one of those to allocate the group on random basis. I

inserted sterilized roller gauze into the uterine cavity and vaginal canal for

24 hours under supervision of senior registrar in group ‘A’ and group ‘B’

were treated by insertion of Sengstaken-Blakemore oesophageal catheter

(S.BOC) in the uterine cavity and filled with saline upto 500ml for 24

hours. And study was approved by the ethical committee of BVH.

Data was collected through pre-designed proforma attached as

annexure-1. Proforma had two parts. First part contained socio-

demographic variables (age, parity) and second part contained

information regarding study variables (success of control of bleeding).

Parti-1 was completed when the patient was diagnosed to have

postpartum haemorrhage and second part comprising of study variables

i.e. success of control of bleeding was completed within half an hour.

DATA ANALYSIS PROCEDURE:

The collected data was analyzed accordingly by using SPSS

version 10. Frequency and percentages were computed for success of

5



control of bleeding and compared the proportion of difference in success

of control of bleeding between two groups were measured by Chi-square

test. Mean and standard deviation was computed for quantitative variable

like age. Level of significance was 5%.

6



RESULTS

In this study, a total of 86 patients were recruited after fulfilling the

inclusion/exclusion criteria to compare the efficacy of two conservative

methods i.e. uterovaginal packing and balloon tamponade in the control

of Primary Postpartum Haemorrhage.

In this research, majority of the patients were found between 21-30

years of age in both A & B groups, in Group-A 62.79%(n=27) and in

Group-B 55.81%(n=24), the subjects with 18-20 years of age in Group-A

were 11.63%(n=5) and in Group-B 16.28%(n=7) while 25.58%(n=11) of

Group-A and 27.91%(n=12) in Group-B were found between 31-44 years

of age. Mean and standard deviation was calculated it was found

28.65+5.72 in Group-A and 26.96+4.12 in Group-B. (Table No. 1) Table

No. 2 shows status of parity, majority fothe patients in both groups were

found with Para-3 i.e. 53.49%(n=23) in Group-A and 48.84%(n=21) in

Group-B while 20.93%(n=9) in Group-A and in Group-B 30.23%(n=13)

wee found with para 2 while 25.58%(n=11) in Group-A and 20.93%(n=9)

in Group-B were presented with para-4.

7



The comparison of efficacy of uterovaginal packing and balloon

tamponade in controlling of PPH was compared and presented in Table

No. 3, where in Group-A, we found 88.37%(n=38) were found to be

effective and the bleeding was controlled and only 11.63%(n=5) were

found with bleeding controlled while in Group-B only 46.51%(n=20) were

found with control of bleeding and 53.49%(n=23) were found with

bleeding. P value was found 0.00, which shows significance in efficacy in

patients managed in Group-A.

8



TABLE No. 1:AGE DISTRIBUTION OF THE SUBJECTS

(n=86)

Age in years

Group-A (n=43) Group-B (n=43)

No. of cases Percentag

e

No. of cases Percentage

18-20 05 11.63 07 16.28

21-30 27 62.79 24 55.81

31-44 11 25.58 12 27.91

Total 43 100 43 100

Mean andS.D.

28.65+5.72 26.96+4.12

9



Age Distribution of the Patients

5

117

24

12

27

0

5

10

15

20

25

30

18-20 21-30 31-44

Age in years Group-A Age in years Group-B

10



TABLE No. 2:

PARITY OF THE SUBJECTS(n=86)

Parity

Group-A (n=43) Group-B (n=43)

No. of cases Percentag

e


Para 2 09 20.93 13 30.23

Para 3 23 53.49 21 48.84

Para 4 11 25.58 09 20.93

Total 43 100 43 100

11



9

13

2321

119

0

5

10

15

20

25

Para 2 Para 3 Para 4

Parity of the Subjects

parity Group-A parity Group-B

12



TABLE No. 3:

EFFICACY OF UTEROVAGINAL PACKING ANDBALLOON TAMPONADE IN CONTROL OF PPH

(n=86)

Efficacy

Group-A

(n=43)

Group-B

(n=43)No. of cases Percentag

e


Yes 38 88.37 20 46.51

No 05 11.63 23 53.49

Total 43 100 43 100

P Value= 0.00

13



Efficacy of Uterovaginal Packing and Balloon

Tamponade

38

20

Group-A Group-B

14

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