Dutta’s Scoring Technique for Early Detection and Management of Uterine Atony during Emergency LSCS – A Randomized Trial

Abstract

Background: Uterine atony accounts for 80 % of causes of PPH and is one of the important cause of maternal death. Objective: To analyze the efficacy of Dutta’s score for early detection and management of uterine atony during emergency LSCS to prevent PPH. Study methods: This study was undertaken at JNM, NSGN, CN at Kalyani, Nadia, West Bengal India from 1st January 2007 to 31st December 2011. Three hundred cases undergoing emergency LSCS were selected for randomized trial. Clinical observations were made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization and time of placental expulsion. Score of 0, 1, 2 were given on each observation. Three groups are created depending on scoring-Group A (130) -8 to 10, Group B (N-100) -5 to 7 and Group C (N-70) - 500cc were also found to be reduce in group A- 7.6%, group B-14%. In group C intra operative blood loss >500cc were seen in 47.1 % and post operative -32.9% cases. Hemoglobin level <11gms after 24 hrs of LSCS was found to be minimally reduced (in comparison to preoperative hemoglobin level) in group A (1.5%), group-B (2%) and group C (11.4%). Conclusion: Early diagnosis and management of uterine atony during emergency LSCS after adopting Dutta’s score were found to be not only reduce intra and post operative blood loss but also was found to maintain a satisfactory hemoglobin level and hemodynamic status. Maternal mortality was found to be nil. This randomized trial highlighted the importance of prompt treatment in group C to reduce intra and post operative blood loss and maternal morbidity and mortality.

Keywords

• uterine atony
• dutta’s score
• pph
• mmr