ABSTRACT
Objective: To analyze the Caesarean Section [CS] rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex [NTSV] presentation delivering at a tertiary care hospital of Karachi over four months
Methods: This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS [n=106] were taken as cases and vaginal deliveries [n=106] as controls. This was an unmatched retrospective case-control study
Results: Mean age of patients was 26.6[SD: 4.2] years. Mean gestational-age was 38.6[SD: 1.0] weeks. Likelihood of CS was slightly less in patients who were attended by feto-maternal consultants[OR:0.81 CI:0.38-1.07] and was slightly more in patients managed by non-full-time faculty [OR:1.04 CI:0.59-1.85]. Odds of CS was highest amongst consultants having average monthly volumes of 21-30 patients/month [OR:1.069 CI:0.48-2.34]. However none of the above findings were statistically significant. A non-significant increase in risk of CS was observed with increase in experience of physicians [p=0.787]
Conclusion: The results did not show statistically significant difference in CS rate among different groups of Obstetricians. This might indicate that managing labour according to standard guidelines can eliminate physicians' bias. This can be further evaluated with larger multicenter prospective studies
ABSTRACT
Objective: To gain insight into learning-environment of Maternal Neonatal and Child Health community clerkship, using Dundee Ready Educational Environment Measure questionnaire and focus group discussion to improve students' quality of learning. Study Design: Sequential Mixed Method Study. Place and Duration of Study: Primary Centers [Aga Khan Health Services, Pakistan] and Secondary Center [Aga Khan University], from Nov 2014 to Oct 2015
Material and Methods: All consenting third-year MBBS students after completing maternal neonatal and child health [MNCH] rotation anonymously filled the Dundee Ready Educational Environment Measure [DREEM] questionnaire. Data was entered in MS Excel 2013 and SPSS version 21. Descriptive statistics were calculated such as frequencies, mean and standard deviation of the total/subscale scores. Independent samples t test was used to identify gender-related differences among DREEM scores with p-value of < 0.05 as statistically significant. Focus Group Discussion [FGD] was conducted with all consenting facilitators [Faculty/Lady Health Visitors]. Thematic analysis of qualitative data was done using constant iterative approach
Results: From a total of 99 students, 78 [78.8%] consented, of which 36 [46.2%] were males and 42 [53.8%] females. Mean total DREEM score was 126.26/200 [63.13%] indicating a more positive learning environment. Total means with percentages and interpretation of subscale scores showed 'Students Perception of Learning [SPOL]', 28.92/ 48 [60.25%] indicating more positive approach; 'Students Perception of Teachers [SPOT]', 28.58/ 44 [64.95%] indicating teachers are moving in right direction; 'Students Academic Self-Perception [SASP]', 20.64/32 [64.5%] indicating students felt positive academically; 'Students' Perception of Atmosphere [SPOA]' 31.17/48 [64.93%] indicating positive learning-atmosphere and Students' Social Self-Perception [SSSP], 16.93/28 [60.46%] showing not-too-bad social-environment. Thus, DREEM results showed, students perceived their learning environment to be overall positive. As a composite score in the five domains of educational environment no statistically significant difference was found between males and females. [SPOL: p value 0.655; SPOT: p value 0.760; SASP: p value 0.685; SPOA: p value 0.245; SSSP: p value 0.280]. Common issues identified through DREEM and student-facilitators through FGD were grouped into three themes; 'Challenges faced', 'Student-learning facilitation' and 'Way-forward'. Triangulation of data from DREEM questionnaire and FGD indicated validation of outcomes
Conclusion: MNCH clerkship is a rotation, in a low/middle income country, in early years of inception. Students are satisfied but there is scope for improvement. This evaluation helped = identify problem areas to enable improvement of program and inspire other institutions to arrange community clerkships
ABSTRACT
Objective: To compare neonatal outcomes between Category-1 and Non-Category-1 Primary Emergency Cesarean Section
Methods: This was a retrospective analysis, conducted at Aga Khan University Hospital Karachi from January 1st 2016 till December 31st 2016. Non-probability purposive sampling technique was used. A sample size of 375 patients who had primary Emergency Caesarean Section [Em-CS] was identified by keeping CS rate of 41.5% and 5% bond on error. Data was collected from labor ward, operating theatre and neonatal ward records by using structured questionnaire
Results: In the current study, out of 375 participants who underwent primary Em-CS; majority [89.3%] were booked cases. Two-hundred-eighty-two [75.2%] were primiparous women. Two hundred and thirty [61.3%] were at term and 145[38.7%] were preterm. The main indication among Category-1 CS was fetal distress [15.7%]. For Non-Category-1 CS, non-progress of labour [45.1%] was the leading cause of abdominal delivery. Except for APGAR score at one minute [p value = 0.048], no other variables were statistically significant when neonatal outcomes were compared among Category 1 and Non-Category-1 CS
Conclusion: In this study, fetal distress and non-progress of labor were the main indications for Category-1 and Non-Category-1 CS respectively. We did not find statistically significant association between indications of Em CS and neonatal outcomes. However further prospective studies are required to confirm this association