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Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

To explore the acceptability and feasibility of introducing mifepristone-misoprostol for early medical abortion in home and clinic settings in Albania.This was a prospective study testing a simplified mifepristone-misoprostol regimen in two tertiary-level government health facilities in Tirana, Albania. Women (n = 409) with amenorrhea of 8 weeks or less received 200 mg mifepristone in the clinic and then chose whether to take 400 microg of oral misoprostol 2 days later either at home or in the clinic.Nearly 97% of women successfully terminated their pregnancies using the simplified regimen. Almost all women found the method either satisfactory (49.4%) or highly satisfactory (41.1%). Almost all women who were given the option selected the home use protocol. Women choosing home administration of misoprostol were able to manage the medical abortion process on their own.A reduced dose mifepristone medical abortion regimen with home administration of misoprostol is feasible for introduction into healthcare facilities in Albania.

Background. Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid (TXA) has the potential to reduce bleeding and a large randomized placebo controlled trial of its effect in women with PPH (The WOMAN trial) is underway. TXA might also affect coagulation factors and platelets. Objectives. To examine the effect of TXA on thrombin generation, platelet function, fibrinogen, D-dimer and coagulation factors in women with PPH. Methods. We will conduct a sub-study within the WOMAN trial. Women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion. Blood samples will be collected at baseline and 30 minutes after the first dose of study treatment. Using platelet poor plasma we will measure thrombin generation, fibrinogen, D-dimer, factor V and VIII, and Von Willebrand factor. Platelet function will be evaluated in whole blood using Multiplate® tests.Outcomes. The primary outcome is the effect of TXA on thrombin generation. Secondary outcomes include the effect of TXA on platelet function, fibrinogen, D-dimer and coagulation factors.

To investigate the diagnostic value of MCA/UA pulsatility index ratio for the prediction of adverse perinatal outcome in the fetuses with preeclampsia and gestational hypertension.We included in the study 738 patients recovered in our Hospital with the diagnosis of preeclampsia and gestational hypertension, from January 2006 to December 2009. All the patients underwent accurate color Doppler velocimetry examination. The study population was divided into two groups depending on the normal or abnormal values of MCA/UA pulsatility index ratio.Outcome variables were intrauterine and early neo natal death, admission to the neonatal intensive care unit and the duration of treatment, Apgar score below 7 at 5 minutes,cesarean delivery for fetal distress, gestational age at delivery, neonatal birth weight, IUGR.We divided the study population into two groups depending on normal or abnormal value of MCA/UA pulsatility index ratio. In 314 patients we found abnormal values of MCA/UA pulsatility index ratio. Neonates of mothers with abnormal values of MCA/UA pulsatility index ratio had significantly lower gestational age at delivery (34.8 versus 38.4, P0.0001), lower birth weight (2174.6 g versus 3215.0g, P0.001), significantly greater risk for perinatal death (30.8% versus 0.23%, P0.0001) significantly greater risk of admission to intensive care unit (77.8% versus 47.4%, P0.0001), longer duration of treatment in NICU (10.6 days versus 6.5 days, P0.0001), greater rate of cesarean delivery for fetal distress (76.7% versus 62.5%,P0.0001), a great number of neonates with low Apgar score at 5 minute (61.9% versus 22.4%, P0.0001) greater rate of cesarean delivery for fetal distress (71.9% versus 62.5%,P0.0001), a great number of fetuses IUGR (7.18% versus 1.76%,P0.0001).ACM/UA pulsatility index ratio is a very good predictor of adverse outcome in the fetuses of women with preeclampsia and gestational hypertension.

To describe the prevalence of gestational trophoblastic disease in ectopic pregnancy.Medical records of 105 patients from January 2007 to October 2009. We excluded of the study 5 cases (one case where the answer of the biopsy was not clear; 4 others with diagnosis of adhnexial mass where the pregnancy test had resulted positive but the answer of biopsy have been resulted ruptured ovary cyst and pyosalpingitis). So definitely the size of the sample was 100 patients.79 patients with EP underwent surgery due to a (diagnosis of EP with hem peritoneum and enraptured ectopic pregnancy) and in 18 of them the answer of the biopsy was GTD. 4 of 75 cases admitted in our hospital with diagnosis of EP, (pregnancy test was used instead of estimation of the level of β-hCG because our hospital couldn't offer estimation of the level of β-hCG during 24 hours) have been not confirmed diagnosis of EP by biopsy, but ruptured ovary cyst with hem peritoneum, pyosalpingitis.31 cases with EP (enraptured EP) underwent medical treatment with methotroxate. In 10 cases last management was failed and surgical intervention was institutionalized and histological analysis revealed GTD in 6 of them (partial mole). β-hCG level was detected in 31 cases with enraptured fallopian pregnancy; in all cases where treatment with methotroxate has been failed and GTD was confirmed, the level of β-hCG was10.234 mUI/ml. 21 cases with enraptured fallopian pregnancy were successfully treated, and at this point we never learned the answer of biopsy. We registered one case with cervical pregnancy and one cornual (interstitial portion) pregnancy.we found 18 cases of GTD in EP /11.500 deliveries (1,56 per 1,000 deliveries), prevalence of the GTD in EP was about 18%.