Emergency cesarean section; Comparative analysis of problems encountered between patients of elective Cesarean section and patient for whom elective Cesarean section was planned but ended up in emergency

Comparative analysis of problems encountered between patients of elective caesarean section and patients for whom elective caesarean section was planned but ended up in emergency caesarean section. Descriptive prospective analysis. Gynae Unit-II, Services Hospital, Lahore. One year, 1 st January 2006 to 31st December 2006. A prospective study of 100 patients who presented for antenatal care [ANC] and for whom elective caesarean section [CS] was planned was done. Patients evaluation was done on a designed performa that included demographic, social and obstetrical histories. Problems encountered in the preparatory stage, logistic problems, administrative problems, problems encountered during surgery, maternal, fetal mortality and morbidity were noted. The patients were divided into two categories. Categories I: included patients who had elective CS and category II: included patients who ended up in emergency CS. Numerous problems were encountered for category II patients. In the preparatory phase there was difficulty in arranging medicines for 32 patients. [59.2%], arranging blood for 28 patients [51.8%], obtaining consent for 1 patient [1.85%]. Logistic problems included non-availability of operation theatre for 15 patients [27.75%], nonavailability of anaesthetist for 9 patients [16.65%], and non-availability of paediatrician for 38 babies [17.3%]. None of the emergency CS were done with in the recommended 30 minutes interval. Despite this, there was no significant coloration between the decision delivery interval [DDI] and perinatal outcome. In our study like threatening cases were operative within 60 minutes. Intra operative problems in the category II patients included adhesions in 40 patients [74%] vs 10 patients [21.7%] of category I, partial dehiscence in 16 patients [29.6%] of category II vs 4 patients [8.68%] of category I. Excessive hemorrhage in 8 patients [14.8%] of category II vs 2 patients [4.34%] of category I. Among the post operative complications anemia was present in 20 patients [43.4%] of category I vs 45 patients [83.25%] of category II patients. Blood transfusion was required for 16 patients [29.6%] of category II vs 4 patients [8.68%] of category I and all patients were given iron supplement. Major wound infection were seen in 9 patients [16.65%] of category II vs 2 patients [4.34%] of category I. Resuturing was done after appropriate antibiotic cover and daily. antiseptic dressing. Minor wound infections were seen in 22 patients [40.7%] of category II vs 12 patients [26.04%] of category I. Urinary Tract Infections [UTI] was seen in 6 patients [11.1%] of category II vs 1 patient [2.17%] of category I. Respiratory Tract Infection [RTI] was seen in 5 patients [9.25%] of category II vs 2 patients [4.34%] of category I. All these were treated by appropriate antibiotic cover. Regarding the neonatal outcome 16 babies [29.6%] of category II were kept under observation in neonatal nursery [NNU] as compared to 6 [13.02%] babies of category I. Admission for 2-10 days in NNU were 8 babies [14.96%] of category II vs 2 babies [4.34%] of category I. 2 babies [3.74%] of category II expired later while none of category I. Patients for whom elective CS was planned but who ended up in emergency CS, the DDI was prolonged and there was increase risk of maternal morbidity, fetal morbidity and mortality as compared to those patients who had elective CS

Management prelabour rupture of the membranes at term; Induction of labor compared with expectant

To find out maternal and fetal outcome in induction of labour compared with expectant management for prelabour rupture of membranes at term. Open randomized comparative study. Gynae Unit- II Services Hospital, from 1st April 2007 to 30 September 2007. 100 patients at > 37 weeks with ruptures membranes with no contraindication to vaginal delivery were enrolled in the study. 50 patients were in the expectant group while 50 patients were in the induction group. Both groups had the same general characteristics but the Misoprostol group had a significantly shorter latancy period [10-16 hour Vs 20-24 hours], shorter period of hospitalization, lesser LSCS rate [24% Vs 34%] lesser need of augmentation [40% Vs 62%], choroamnionitis [3% Vs 7.8%], and postpartum fever [1% Vs 1.8%] when compared with expectant group. Rate of infected wound after LSCS were compared in induction and expectant groups [2.2% Vs 2.6%], also there was no difference between them regarding neonatal morbidity and nursery admission. So it was concluded that there was slightly high maternal complications in expectant group but no long-term maternal morbidity. Both groups have no effect on neonatal morbidity and mortality however the duration between PROM and delivery effect the neonatal admission in nursery and antibiotic requirements.