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 analyse the factors associated with Caesarean Section [CS] of Nulliparous, Term and Singleton pregnancies with Vertex presentation [NTSV] at a tertiary care hospital
Methods: In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries [SVD] were taken as cases and controls
Results: The mean maternal age of cases [CS] was 26.64 [SD:3.9] and of controls [SVD] was 26.7[SD:3.9] years, whereas mean gestational age was 38.66 +/- 1.12 and 38.57 +/- 0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed 3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant [p value 0.077]. Labour was induced in 38% patients. The Odds of Induction of Labour [IOL] were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times [81%] if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery [MOD] in this study
Conclusion: Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section
ABSTRACT
To compare perioperative morbidity and survival data between patients with early-stage endometrial cancer who did or did not undergo selective lymphadenectomy. Retrospective analysis of 180 patients with early-stage endometrial carcinoma treated between 1999 and 2008 was performed in Aga Khan University Hospital, Karachi, Pakistan. Data from 180 patients were analysed. The selective lymphadenectomy group contained 108 women [60%] and the no lymphadenectomy group contained 72 women [40%]. The median number of lymph nodes removed was 9. The mean age and extent of disease, as assessed by staging, tumour size, myometrial invasion, and lymphovascular invasion were comparable between groups. Upstaging of the disease to stage 3 and 4 occurred in 11% of patients in the lymphadenectomy group. There were no significant differences in the medical or surgical complications between groups. At a median follow-up of 26 months, both groups had comparable survival [lymphadenectomy versus no lymphadenectomy: 34 versus 32 months]. Similar survival was noted for patients who underwent the removal of more or less than 5 pelvic lymph nodes. Selective lymphadenectomy offers the advantage of improved surgical staging but no therapeutic benefit in terms of overall survival