Causes and associated risk factor of retained placenta: a case control study

To determine the causes and to evaluate the significance of various associated risk factors of retained placenta in the study population. A retrospective case control study was carried out between June 1992 and May 1996 on 101 patients with retained placenta. The controls were randomly selected, 202 parturients delivered vaginally and had normal separation and expulsion of placenta. Epidemiological variables, relevant risk factors and selected parameters of index labour and delivery were studied. Retained placenta was more common both in primiparas and in grandmultiparas. Significant association was found between the occurrence of retained placenta and previous history of retained placenta, induced abortion, uterine instrumentation and scarred uterus. Important causative and associated factors identified in index labour and delivery included home delivery by Traditional Birth Attendants, prolonged labour, mismanaged third stage of labour, uterine atonia and morbid adherence of placenta and / or membranes. In the study population underlying causative and associated risk factors were identified as compared to a matchable control group

Indications, Complications and fetal outcomes-a comparison between emergency and elective cesarean sections

A comparison was made between emergency and elective caesarean sections regarding their indications, complications and fetal outcomes. This paper is based on two studies. During these studies 390 [19.70%] elective and 1589 [80.29%] emergency caesareans were done. Common indications for emergency were failure to progress 276 [17.36%], fetal distress 239 [15.04%] and CPD 201 [12.64%], while major indications for elective sections were breech presentation 94 [24.10%] and cases with previous 2 or more caesarean sections 86 [22.05%]. Complications like anaesthetic problems, bleeding and infection occurred more frequently in the emergency cases. There were 7 maternal deaths in emergency group while none in elective cases. There were 96 [6.04%] perinatal deaths in emergency cases as compared to l l [2.82%] in elective ones. Neonatal complications like asphyxia, birth trauma, infections and jaundice were more commonly found in the emergency cases

Cesarean and postpartum hysterectomy: a study from Lahore

A total of 29 women underwent caesarean and postpartum hysterectomy over a period of 5.25 years in one unit of Lady Aitchison Hospital, Lahore. The frequency of obstetric hysterectomy was 2.6/1000 deliveries. In all cases, this procedure was done as an emergency life saving measure. Twenty women had a total and 9 a sub-total hysterectomy. The most common indications included uterine rupture, intractable postpartum haemorrhage and placenta praevia / accreta. Twenty-six [89.66%] patients were either unhooked or referred in labour. Age varied from 19-46 years and parity from 1-12. Seventeen [58.62%] patients developed intraoperative and/or postoperative complications. There were 4 [13.79%] maternal deaths and 12 [41.38%] perinatal deaths. Late presentation of the patients in a poor condition accounted for a high proportion of morbidity and mortality

Ectopic pregnancy: a three year study

A study on ectopic pregnancy was carried out in Unit-I of Department of Obstetrics and Gynaecology at Sir Ganga Ram Hospital, Lahore. Duration of study was from November 1991 to October 1994. During this period there were74 cases of ectopic pregnancy, while 15,617 pregnant patients were admitted. Thus its incidence was 4.73 per 1000 pregnancies. A total of 13,570 women were delivered during the study period giving the incidence of 5.45 per 1000 births. Age of the patients varied from 17-42 years while mean age was 27:22 years. Mean parity was 3.20 while it ranged from 0-10. Most of the cases came with abdominal pain, amenorness. Classical picture of acute actopic pergnancy was found in 23 [31.08%] cases. Important etiological factors were history of induced abortion, pelvic inflammatory disease [PID], and use of intra uterine contraceptive device [IUCD]. Diagnosis was made by clinical features, ultrasonography, culdocentesis and laparoscopy. Laparotomy was done in all the cases. Salpingectomy was carried out in 54 [72.97%] cases. Few patients developed immediate and remote complications. There was one maternal death