Maternal mortality in a tertiary care hospital

Death of a woman during pregnancy and child birth is an extremely tragic event. It is a waste of a precious life that leaves great feeling of grief and pain for the family and hospital staff and has devastating influence on the community overall. Maternal morbidity and mortality can be prevented by awareness of reproductive health in a community, availability, and utilisation of organised antenatal care, skilled intrapartum management and careful postnatal follow up. Objective was to analyse the pattern of maternal mortality over the period of five years in a tertiary level hospital receiving high risk referred patients from periphery. All patients admitted in Gynae 'A' Unit, Ayub Teaching Hospital from January 2006 to December 2010 were included in the study and number and causes of maternal deaths were noted. During these 5 years there were 78 maternal deaths out of 11,997 obstetrical admissions. There were 7,380 total births and 78 maternal deaths during the study period and Maternal Mortality Rate was 1,057/100,000. The main cause of maternal death was eclampsia and its complications [28.2%]. Eclampsia is the leading cause of maternal mortality in our setup. Proper and timely referral is an important measure to prevent it

Abruptio placentae and its complications at Ayub teaching hospital Abbottabad

Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern. The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation, presenting with ante partum haemorrhage during the study period. Patients underwent a complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer. A total of 53 cases of abruptio placentae were recorded out of 1194 cases [4.4%] admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000 deliveries. Induction of labour was required in 27 [50.9%] cases, while caesarean section was performed in 16 [30.2%] cases. Major complications were intra uterine fetal demise [31/53, 58.5%], fetal distress [8/22 live births, 36.4%] and post partum haemorrhage, which occurred in 10 [18.9%] cases. A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality

Use of Foley's catheter and prostaglandin F-2 alpha in second trimester termination of pregnancy

Termination of pregnancy [TOP] in the second trimester is associated with three to five times higher risk of maternal morbidity and mortality than termination during first trimester. The main concern of obstetrician is to provide the most effective and safest regimen which combines the shortest expulsion interval with least side effects. This study was undertaken to compare the use of Foley's catheter with extra-amniotic instillation of PGF2 alpha for second trimester TOP so that a choice of the safer and cost-effective method could be available. The study was conducted in Department of Obstetrics and Gynecology Unit 'B' at Ayub Teaching Hospital Abbottabad between August 2003 and July 2004. Sixty patients recommended for TOP [missed abortion or anencephalic fetus confirmed on ultrasonography] were randomly allocated into two groups. In group 'A', Foley's catheter alone was used while in group 'B' extra amniotic instillation of Prostaglandin F-2 alpha [PGF2 alpha] was done via a Foley's catheter. After expulsion of catheters in both cases oxytocin infusion containing 30 units were started till the expulsion of fetus, placenta and membranes. The mean induction to expulsion time and the mean induction to delivery time for both groups were noted as well as total cost of treatment. Difference in time interval with regard to induction to expulsion time of catheter and induction to delivery time between the two groups was significant being 3 hours and 5 hours respectively less in group 'B' [p < 0.001]; however only 25% of patients in group 'B' had a significant short induction to delivery time as compared to group 'A'. The difference in costs of treatment between the groups was also significant [p < 0.001]. Use of PGF 2 alpha is preferred, though for poor patients Foley's catheter may be used, but only in a tertiary care setting

Minilaparotomy and ovarian diathermy drilling for clomiphene resistant poly cystic ovarian disease

This study was carried out to determine the effectiveness and safety of minilaparotomy and ovarian drilling for sub fertile women with clomiphene resistant polycystic ovarian syndrome. During a 2 year period [August 2000 to August 2002] 16 patients with polycystic ovarian disease were managed by minilaparotomy and ovarian drilling by diathermy. All the patients underwent full infertility workup and then treated with cyclical clomiphene citrate for 6 months. Six patients [37.5%] presented in age group 15'25 years. Eight patients [50.0%] were in age group 26'35 years. Only 2 [12.5%] patients presented in age group 36'44 years. Eleven [68.75%] patients had primary infertility. Five [31.25%] patients presented with secondary infertility. After treatment and 6 months follow up, ovulation occurred in 14 [87.5%] patients. Eleven [68.75%] women conceived pregnancy. Ovarian drilling is a powerful tool in the treatment of polycystic ovarian disease

Role of dilatation and curettage and interpretation of endometrial biopsy in gynaecological cases

310 Cases of diagnostic D and C were collected randomly from Gynae unit of Lady Reading Hospital Peshawar from January 1990 to January 1991. These were cases of infertility 49.26%, menorrhagia 13.22%, irregular bleeding 29.67%, Postmenopausal bleeding 5.164%, primary and secondary infertility 30.96% and 18.38% respectively. Various aspects like age, parity, marital status, clinical features and histopathological results were analysed 6.45% were below the age of 20 years. 63.22% between 21 to 40 years, 25.16% between 40-50 years and 5.16% were above the age of 50 years. 16.45% patients were nullipara. 15.48% Primipara and 37.09% and 30.96% were multipara and grand multipara respectively. 0.64% patients were un-married, 84.83% were married and 40.51% were widows. Results of endometrial biopsies were as follows. Proliferative phase 47.74%. Secretory phase 35.48%, tuberculous endometritis 1.93%, cystic endometrial hyperplasia 8.38%, Adenomatus hyperplasia 1.29% and adenocarcinoma 0.96%

Early delivery by cesarean section in eclampsia can decrease maternal and foetal mortality and morbidity

This is a retrospective study of 90 cases of eclampsia admitted during a three year period [June 1992 to May 1995] in Unit A of Obstetrics and Gynaecology Department of Women and Children Hospital, Abbottabad. The incidence of eclampsia was 0.93%; 69 [76.67%] patients were primigravidae, 12 [13.33%] were para 1-4 and 9 [10%] were grandmultiparae. All these patients were unbooked and belonged to poor socio-economic class. Thirty [33.33%] were delivered by Caesarean section, indications for which were unfavourable Bishop's score [<5] and live foetuses. Maternal mortality was one [3.33%] among the patients who were delivered by Caesarean section and 12 [20%] among the 60 women who were delivered vaginally