Rates of caesarean section and trials and success of vaginal birth after caesarean sections in secondary care hospital

We planned to investigate the rates of Caesarean Section [CS], potential Vaginal Births After previous Caesarean Section [VBAC], and successful VBAC in a secondary care hospital. We conducted an analytical retrospective study at Aga Khan Hospital for Women, Karimabad, Karachi, from October 2011 to September 2012. Data related to total deliveries, Lower Segment CS [LSCS], attempted VBAC and successful VBAC was retrieved from medical records. Total number of deliveries were 3266. Of these, 1021[31.26%] deliveries were conducted by CS. A total of 365[11.1%] had a previous history of one CS and VBAC trial was given to 33[9%] of these pregnancies. The success rate of VBAC was 21[63.6%]. Our results highlight that despite having limited resources, our rates of CS, VBAC trials and successful VBACs were within reasonable limits when compared with international rates

How to decrease the complication rate in the initial phase of introduction of laparoscopic cholecystectomy in a new setup

Laparoscopic Cholecystectomy [LC] is yet to be fully established in developing countries due to lack of economic resources and training facilities. These limitations dictate that an approach be used whereby laparoscopic technique can be established without the need of attending costly training sessions. This study was aimed to describe the strategy that we used to introduce LC in our hospital and to present the outcome of the initial 250 cases. Prospective Study, Place and Duration of Study: Sindh Government Qatar Hospital [SGQH], Karachi, Pakistan from January 2009 to July 2011. The strategy used involved initial detailed literature review regarding LC, practice with instruments using a costless endotrainer, initial careful case selection and hands-on supervision of the first 25 cases by an experienced laparoscopic surgeon. Initially selected patients included those with duration of symptoms less than 6 months, thin patients and patients with gallbladder wall thickness of up to 4 cm on ultrasound. Outcome in terms of conversion rate, postoperative recovery, complications including CBD injury and mortality is described. The mean operative time for the first 25 cases was 89 minutes and overall was 46 minutes. Four [1.6%] patients were converted to open procedure. 153 [61.2%] were discharged by the 3rd postoperative day. 35 postoperative complications were detected in 22 [8.8%] patients with rate of CBD injury being 1.2%. Major complications occurred in 8 [3.2%] patients. The mortality rate was 1 .2%. Our results indicate that the strategy we used to introduce LC in our setup was successful in establishing the procedure with an initial slightly higher but comparable complication rate