Laparoscopic Instruments

Product Details:

Introduction:


As per the WHO estimate 303,000 maternal deaths were reported globally in the year 2015. Low resource countries like Sub-Saharan Africa and Southern Asia contributed 99% of maternal deaths.In developing countries, postpartum hemorrhage (PPH) remains the leading cause for maternal deaths, amounting to 1, 27,000 (60%) deaths every year. Fifty percent of these women die due to atonic PPH. Majority of these deaths occur in peripheral centers with sub-optimal facilities.Even though some risk factors like obstructed prolonged labor, accidental hemorrhage, and big babies are known to cause atonic PPH, it is not very clear why some women develop atonic PPH and why some women do not. For the same reason this problem cannot be predictable. The only management strategy even today is ‘watchful expectancy’ and act immediately when the problem develops. Simpler techniques like uterine massage, uterotonics drugs, and uterine packing and balloon tamponadecan be practiced in low resource settings. Techniques like B-Lynch suturing, stepwise devascularization, internal iliac ligation and uterine artery embolization are available at higher medical centers. These higher techniques are not within the reach of every parturient woman when simpler techniques fail.




In low resource settings unpredictable sudden massive bleeding makes it difficult to organize competent manpower, compatible blood and transport to higher medical center. Many times mothers die on roads while being transported to higher medical centers due to hypovolemic shock. In some women the speed with which the hemorrhage kills the mother is so rapid, that thewomen succumb to death just within 1-1.5 hours after the onset of bleeding . The rapidity with which some women slip in to coagulation failure and multi organ dysfunction syndrome from hemorrhagic shock is alarming. Because of these complex reasons the maternal mortality is not coming down in low resource settings9. There is every need for a simpler and sure technique which can stop bleeding, or at least stop bleeding temporarily to buy some time to tide over the crisis. Concept: Creating negative pressure inside the uterine cavity with a specially designed uterine cannula, results in shrinking of uterus which can assist the natural physiological process of contraction and retraction to stop atonic postpartum hemorrhage. Methods: Sixteen singleton pregnant women who had normal vaginal delivers and 4 women who underwent caesarean sections,who developed atonic postpartum hemorrhage, and who didnot respond well for medical managementwere included in this study. All the women received 10units of oxytocin IM at the appearance of anterior shoulder, 5units of intra venous oxytocin after the delivery of placenta, and then uterine massage. Inj. Carboprost 125micgmsIM was also given when the bleeding did not stop. SR cannula was applied in all these women when all medical methods failed.

 


1.SR suction cannulas for PPH after vaginal delivery:Two sizes of vaginal cannulas are made measuring 25cm long, and have auterine angle. Uterine portion measures 14mm long, and with 24mm and 18mm in diameter. Vaginal portion measures 10cm long with 12mm in diameter. The outer portion is the nipple of the cannula to be connected to suction machine with tubing. Perforations on fundal portion are large and longitudinal, and on cervical portion they are round and small. Vaginal portion do not have any perforations (Fig.1 A and B).


2.SR suction cannulas for atonic PPH at caesarean delivery: These are two shorter cannulas measuring 14cm long. Cannula with 12mm diameter is meant for undilated cervix, and the cannula with 18mm diameter is meant for dilated cervix.