Systemic reactions with total dose infusion of iron dextran complex in obstetric patients

Iron dextran complex (Imferon) total dose infusion (TDI) was used to treat iron deficiency anemia in 310 obstetric patients. Systemic reactions were reported for 13.5% of the group. Most (90.5%) of the severe reactions occurred during the test dose, while 66.6% recorded during or after TDI were mild. Antihistamine premedication included administration of promethazine hydrochloride to 104 patients and intramuscular and intravenous drip chlorpheniramine hydrogen maleate to 206 patients. Total systemic reactions were statistically greater with intramuscular promethazine hydrochloride than with intramuscular and intravenous chlorpheniramine maleate (p less than 0.001). On the other hand, the rates of severe reactions and reactions during the test dose were similar for both antihistamine schedules (p greater than 0.05). The incidence of all systemic reactions was the same for pregnant and postnatal women (p greater than 0.05), but severe reactions were more frequent among pregnant than postnatal patients (p less than 0.001). There were no fatalities.

A closed submucous cervical suture for the incompetent cervix

Twenty-five consecutive cases of cervical incompetence were treated by a closed submucous cervical suture that I developed. Twenty patients proceeded to term and delivered live babies. This was statistically significant when compared to their own reproductive performance before operation (P less than 0.001). The suture described is simple, easy, quick, bloodless, anchored to three points in the cervical musculature and is passed deep to the cervical blood vessels.

Acute inversion of the uterus

Eight successive cases of acute puerperal inversion of the uterus are presented. The incidence was one in 26,364 deliveries. Fundal insertion of the placenta, adherent placenta and low parity were significant factors in our cases. Two patients were given halothane anesthesia to relax uterine retraction and cervical ring. Vaginal repositioning was successful in seven cases. One patient required abdominal repositioning. Apart from iron deficiency anemia, the postoperative period was uneventful.

Uterine rupture and vacuum extraction

Eleven uterine ruptures occurred among 11415 vacuum extractions, and these cases are analysed. Cervical tears extending into the lower uterine segment or into the broad ligament occurred in 4 cases, lower segment tears in 6 and a fundal tear in 1. One patient died of respiratory failure. The possible cause of uterine rupture with vacuum extraction appear to be a combination of an unengaged fetal head, an incompletely dilated cervix and an undetected mild cephalopelvic disproportion especially in grandmultiparae, dehiscent or weak uterine scars, prolonged traction without progress, manipulations in shoulder dystocia and obstruction and excessive non controlled traction. Uterine rupture can be minimized by careful selection of cases, proper technique and early recognition of failure.