ABSTRACT
Obstructed labour with ruptured uterus is a serious obstetrical complication with a high incidence of maternal and foetal morbidity and mortality. This study was conducted to find out the incidence of uterine rupture particularly in the patients of obstructed labour [OL], foeto-maternal outcome of such patients, and its management. This two year descriptive study was conducted in the Department of Obstetrics and Gynaecology Unit-I, at Muhammad Medical College Hospital from 1[st] January 2007 to 31[st] December 2008, on 40 diagnosed cases of OL. Patients were admitted through Casualty or were admitted in ward. Patients with previous caesarean section and myomectomy were excluded. Ruptured uterus was found in 8 out of 40 patients of obstructed labour, they were relatively elder and grand-multiparous. Mean age of the patients was 36.5 years, while parity ranged between 5 and 12. Only one [12.5%] patient was primigravida with mean gestational age of 39.15 weeks. Seven [87.5%] patients had abdominal pain and tenderness, 5 [62.5%] vaginal bleeding, and 2 [25%] had shock. All cases were immediately managed with fluid replacement, blood transfusion and surgery. Six [75%] cases were diagnosed as ruptured uterus on clinical features while 2 [25%] with incomplete rupture were diagnosed on caesarean section for obstructed labour. Foetal mortality rate was high [7, 87.5%]; 5 [62.5%] were fresh stillbirth and 2 [12.5%] died in nursery. Only 1 [12.5%] baby survived. There was 1 maternal death due to puerperal sepsis. The incidence of rupture uterus in obstructed labour was 20%. Immediate intervention is important factor for successful management of uterine rupture
ABSTRACT
To find the frequency of iatrogenic VVF in patients admitted for repair of VVF in Lady Willingdon Hospital, Lahore. An observational study. Lady Willingdon Hospital, Lahore, from January 2007 to December 2008. All cases of VVF treated at the centre during the study period were included in the study. The patients were admitted and evaluated through detailed history, physical examination, relevant investigations and evaluation under general anaesthesia [EUA]. Iatrogenic VVF was defined as the one following gynaecological procedure. Repair was done through abdominal or vaginal route based on the findings of EUA. Results of repair were noted and analyzed using SPSS version 12. Iatrogenic cases of VVF made more than half of the total cases [54%] while 46% were due to obstructed labour. Women under the age of 40 years, made up 77% of the total cases. The success rate for repair of VVF was 87%. This study shows that iatrogenic injuries in women under 40 years of age form a major share in the etiology of VVF requiring a check on the experience of surgeons doing the gynaecological and obstetrical surgeries in a developing country