Use of bilateral internal iliac artery ligation for controlling severe obstetric haemorrhage

To study the role of bilateral internal iliac artery ligation [BIAL] in arresting intractable postpartum haemorrhage. This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding [failure rate 16.66%]. While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity

Management of pregnancy with ovarian tumour

To study the maternal and fetal outcome of pregnancies complicated by ovarian tumours.Descriptive study. Gynaecology and Obstetrics Unit I, Dow University of Health Sciences and Civil Hospital Karachi, from January 2003 to December 2004. All patients who attended the antenatal clinic and Emergency Department of Civil Hospital Karachi, Gynaecology and Obstetrics Unit I, from January 2003 to December 2004, were included in the study, if pregnancy was complicated by a coexistent ovarian tumour of > 5cm. Fetal outcome after conservative or surgical management was noted. Thirty Six patients were enrolled in the study. Twenty-seven had surgical interventions and nine were managed conservatively. All patients with conservative management were asymptomatic. Obstetric outcome revealed only one preterm. delivery after conservative management but surgical intervention resulted in five abortions, three pretermand 19 term deliveries. Fetal outcome revealed comparable results in both the groups. There was only one preterm fetus in conservative group while surgically managed group produced three preterm fetuses. No still birth was noted in either group, however intra-uterine growth retardation [IUGR]found in three of the surgically managed group and one of conservative group. Surgical intervention is a reasonable approach to deal with cases of ovarian tumours with pregnancy, but conservative management also has comparable obstetric outcome if safe selection criteriafor mothers is defined

Vaginal birth after caesarean section

To determine the outcome of trial of labor after previous one caesarean section due to non-recurrent cause and evaluate the maternal and perinatal mortality and morbidity after trial of scar. Descriptive study. It was conducted in Obstetrics and Gynaecology Unit - 1, Civil Hospital Karachi from January 2003 to January 2004. The selected subjects in our study were the women with previous one caesarean section due to non-recurrent cause. Singleton pregnancy, adequate pelvis, spontaneous onset of labor were the criteria for trial of labor. The total number of 3612 deliveries were conducted during this study period, whereas, 2624 patients were delivered by caesarean section. Out of these 84 patients formed the cohort, where 34 had elective lower segment caesarean section [LSCS] and 50 were found suitable for trial of scar. Fifty patients underwent trial of labor; of whom 31 had successful vaginal delivery. The success rate was 62% while 19 [38%]patients delivered by repeat caesarean section due to failed trial of scar. The 42.10%of patients had caesarean section due to unsatisfactory progress of labor; 26.31% due to fetal distress, whereas 15.78% patients had caesarean section due to scar tenderness but there was only one partial scar dehiscence that was noticed during operation. 10.5%patients had non-progress and fetaldistress at the same time. Out of 31 patients who were delivered after successful trial, 70% had spontaneous vertexdelivery, 16.2% by forceps vaginal delivery, 9.6% by vacuum extraction and one patient who had breech presentation, delivered by assisted breech vaginal delivery. There was no maternal death or rupture of uterus in our study, nor any perinatal morbidity or mortality recorded. Only one case of scar dehiscence was seen during emergency LSCS, which was not associated with any complication. A trial of labor in selected patients with previous one caesarean section is the reasonable option, if patients are carefully selected and monitored