Neonatal outcome in preterm Cesarean section vs preterm Vaginal delivery

To compare neonatal outcome in preterm caesarean section vs. preterm vaginal delivery. Retrospective comparative study from January 2006 to December 2006 at Fatima Memorial Hospital, Lahore All booked and un-booked patients who delivered from January 2006 to December 2006 were included in the study. The decision of spontaneous vaginal delivery or caesarean section made based on obstetric indications. All the data recorded and subsequently analyzed. Out of 6570 total deliveries during one year, 673 [10.2%] patients delivered pre-term, 265 by C-Sections and 408 by Spontaneous vaginal deliveries. Preterm deliveries done, at 34-37, 32-34, 28-32 gestational weeks were 47.1%, 28.9% and 23.9% respectively. The commonest indications of pre-term Caesarean Sections were fetal distress [6.7%], intra-uterine growth restriction [27.1%] and severe pre-eclampsia / eclampsia [26.4]. Neonatal outcome in terms of baby weight and APGAR scores were not significantly different between the two groups. Neonatal survival was 81.1% who delivered by pre-term Caesarean section compared to 77.9% who delivered by pre-term vaginal deliveries. Sepsis was the main cause of neonatal mortality. This study shows that the neonatal outcome of pre-term infants when delivered by Caesarean section shows no significant difference as compared to the preterm infants delivered by vaginal route. Decision of caesarean sections should be based on obstetric indication only

prospective study of postanaesthesia recovery room complications. incidence and treatment

To audit the incidence and nature of post-anesthesia recovery room complications, their treatment and review the role of recovery room in modern anesthetic practice. 3151 patients who received general or regional anaesthesia were admitted to the recovery room during six months period [August 01, 1995 to January 31, 1996]. Information noted on forms by recovery nurse by encircling the pre coded complication. Out of 3151 patients, 2716 patient's data forms could be collected. Therefore results reflect 86% of the patients passing through the recovery. The overall incidence of complications in our population was 36.26%.Complications referable to CNS were 52.29%, the commonest of which was pain[51.26%], agitation [0.18%] and excessive drowsiness [1.01%].The second commonest system was GIT[25.07%] nausea [14.31%] and vomiting [12.18%].The third system was CVS [21.52%],bradycardia [5.48%], tachycardia [7.61%],hypertension [4.26%],hypotension [2.53%],myocardial ischaemia [0.81%] myocardia infarction [0.10%] and new arrhythmias [1.41%].The fourth system was Respiratory system [5.58%], hypoventilation [l.42%], bronchospasm [0.81%], laryngospasm [0.1%] and desaturation [Sp02 < 90%] in [0.1%].0.6% patients had to be reintubated. Two patients had oliguria. Miscellaneous complications were [9.94%]. More than one complication was observed in some patients. The incidence of mortality in our study during this period was 0.10%. Every third patient is susceptible to get some form of complications in the immediate post-anesthesia recovery period. It reflects the importance and need of a specialized designated area called recovery room with qualified staff

Hysteroscopy - 3 Years experience at a Teaching Hospital

To evaluate the indications, effectiveness and safety of hysteroscopy in Gynaecological surgery. Design, A retrospective observational study from January 2003 to December 2005 at Fatima Memorial Hospital, Lahore. 76 patients who presented in the outpatient department of Gynae and Obstetrics at Fatima Memorial Hospital, Lahore with the following complaints including abnormal uterine bleeding, infertility, recurrent abortions and secondary amenorrhea were included in the study. They were pre-operatively investigated and admitted a day prior to the surgery and discharged usually within 24 hours postoperatively. The subsequent follow-up was done in outpatient department. All the data was recorded and then subsequently analyzed. 76 patients were inducted in the study. Out of these 36 [47%] had infertility 20 [26.3%] had abnormal uterine bleeding, 8 patients [10.5%] had recurrent abortions, 8 [10.5%] presented with secondary amenorrhea, 3 patients [3.9%] presented with lost IUCD and one patient [l.3%] had follow-up hysteroscopy after resection of intra- uterine septum. Hysteroscopic findings revealed intra-uterine adhesions in 8 [10.5%], submucous fibroids in 15 [19.7%], endometrial polyp in 10 [13.l%] uterine septa in 8 [10.5%], atrophic endometrium in 9 [11.8%] while there was no abnormal finding in 26 [34.2%] patients. Two patients [0.6%] sustained uterine perforations, which were diagnosed and managed during operation but no other complication occurred. Hysteroscopy is an excellent tool to perform intra-uterine adhesiolysis, polypectomy, submucous myomectomy and endometrial ablation. In addition to being a quicker, less invasive and low risk procedure, it has got the advantage of being cheap with a shorter hospital stay and diminished recovery time. Hysteroscopy, both diagnostic and operative should be an integral part of gynaecological surgery in the teaching units