Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM] and maternal death at tertiary health care centre

Pakistan stands second in the world s rating of highest stillbirth rate. This gives an emergency call to authorities involved in maternity health care of Pakistan to take serious and quick steps to address the problem. Retrospective observational study at tertiary health care centre to see frequency and risk factors for stillbirth in cases of severe acute maternal morbidity [SAMM] and maternal death over period from January 2008 till Jan 2010. High stillbirth rate 438 /1000 was found in the study group as compared to still birth rate of 74 /1000 in rest of the deliveries during the same period. Data analysis by using multivariate regression for variables after adjusting for co variable showed significant association [p value < .05] with still births of following factors grand multipara [adjusted OR 1.887 Cl 1.156-3.081] primigravida [adjusted OR 1.623 Cl -1.023-2.573] low education [adjusted OR 19.378 Cl- 2.586-145.208] lack of standard antenatal [care Non booked [adjusted OR 10.101 Cl 3.847-26.518] referred cases [OR 5.879 Cl 2.166-15.954]] preterm deliveries [adjusted OR 2.994 Cl 1.512-5.931] and vaginal deliveries 1.986 [Cl 1.351-2.920] whereas uterine rupture [adjusted OR 4.003 Cl 1.647-9.729] prepartum haemorrhage [adjusted OR 3.617 Cl 1.756-7.451] and hypertension [adjusted OR 3.298 Cl 2.040- 5.330]were significant obstetric risk factors. Audit of SAMM and maternal death with emphasis on risk factors of still birth would help to find strategies to reduce preventable causes of stillbirth .This would be important relatively quick contribution to efforts of achieving MDG 4

Ruptured ectopic pregnancy: clinical presentation and management

To determine the clinical presentations and the management modalities of ruptured ectopic pregnancy [EP]. This is a cross-sectional analytical study. The study was conducted in Obstetrics and Gynaecology Department of Sindh Government Lyari General Hospital, Karachi, from 1st June 2002 to 31st May 2005. All women diagnosed with ruptured ectopic pregnancy were included in this study. Data were collected on a structured proforma. The variables studied included age, parity, presenting symptoms and signs, haemoglobin level, urinary HCG, beta HCG level, ultrasonographic findings, type of treatment provided and associated morbidity and mortality. Mean +/- SD of continuous variables like age, parity and haemoglobin level were calculated while categorical variables like amenorrhea, abdominal pain, vaginal bleeding, anaemia, shock, abdominal tenderness, adnexal mass, cervical excitation and the other findings were given in numbers and percentages. A total of 34 women were diagnosed as having EP. Frequency of ectopic pregnancy found was 1.22% of total 2790 deliveries. Out of these 33 patients [97.6%] had ruptured EP. The mean age was 26.18 years and the mean parity was 1.9. Common presenting symptoms were amenorrhea and abdominal pain, both found in 27[81.8%] patients and vaginal bleeding was present in 9[27.3%] cases. Common physical signs detected were abdominal tenderness and cervical excitation in 24[72.7%] and 21[63.6%] respectively. Anaemia was found in 21 subjects [63.6%] and mass in adnexa in 12 cases. Laparotomy was done in 32[96.9%] out of 33 patients. Salpingectomy was carried out in 22[66.7%] cases and salpingostomy in 6[18.2%]. One patient underwent hysterectomy having cornual ectopic pregnancy. There was no maternal death in this study. Blood Transfusion was required in 27[81.8%] patients. Medical treatment was offered in only one patient who presented with a mass in adnexa and was haemodynamically stable but she left against medical advice. Abdominal pain, amenorrhea, anaemia and cervical excitation were the most consistent features of ruptured ectopic pregnancy. Therefore EP must be kept in mind in women having these features as conservative management is an option for early diagnosed cases. Shock and shoulder tip pain are late findings to appear therefore found in less number of patients. Surgical treatment was done in most of the cases because of late referrals. Early diagnosis and intervention would also reduce the maternal morbidity and mortality

Caesarean section rate: current trends

To determine the rate and analyze indications of caesarean section. Observational study. The study was conducted in Obstetrics and Gynaecology Unit four, Sindh Govt Lyari General Hospital attached to Dow University of Health Sciences from April 2005 till March 2006. All pregnant women booked in antenatal clinic and unbooked patients admitted in early labour on whom caesarean section [CS] was performed, were included in the study. The medical records of all patients were examined to study the socio-demographic variables, nature of procedure and the indication of abdominal delivery. The total number of births during study period were 930 of which 186 patients underwent caesarean section which makes 20% caesarean section rate [CSR] in our unit. Out of 186 CS done, 144 were performed in emergency and 42 as elective cases. The mean age was 30 years and the mean parity was 1.9. Primigravidas were 71[39%], multigravidas 75[40%] and grandmultiparas 40[21%]. Commonest indication for caesarean section was repeat caesarean section. Failed progress of labour was the 2nd commonest indication among the 15% of cases. Obstructed labour and fetal distress were indications in 9.6% of cases. Other indications include breech presentation, ante partum hemorrhage, hypertensive disorders, twin pregnancies and transverse lie. The most effective mean to control increasing CSR is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous C-section, selective vaginal breech delivery and regular audit of C-section in the department

Tuberculoma of vulva: a clinical rarity

Tuberculoma of the vulva is a clinical rarity and only few cases have been reported in the literature. It may cause diagnostic confusion with other tumorous growths of the vulva and also with lymphogranuloma venerium. A case report of a 33 year old woman with extensive tuberculosis of the external and internal genitalia along with the involvement of lower abdominal wall is presented. Diagnosis management and response of the lesion to antitubercular therapy is discussed