analysis of caesarean birth in a private teaching hospital

The objective of this study was to analysis the Caesarean Birth in Private Teaching Hospital. Retrospective study. This study was carried out at the Department of Gynae /Obst Alkhidmat Teaching Mansoorah Hospital, Lahore affiliated with University College of Medicine and Dentistry, Lahore over a period of 1 year from April 2012 to March 2013. The study was carried out to analysis the indications and to assess the maternal mortality and mortality as well as fetal outcome after C/S. The frequency of caesarean section during the study period was about 46%. Indications included, repeat caesarean [38.21%], failed inductions [19.9%], fetal distress [15.6%], Ceaphaloplevic disproportions [7.6%] breech presentation [6.36%], APH and PIH [4.7%], Twins and mal presentations [3.82%] and other [3.66%]. Out of 628 patients [79.62%] were booked patients while [51.6%] patients had elective cesarean section. Anaemia, UTI, PPH and wound sepsis were common maternal complications. Two patients 0.31% died due to complications of surgery or anaesthesia. [97.29%] babies were born alive, [1.43%] were IUD either fresh or macerated while only [1.27%] babies died in the early neonatal period. Although caesarean section rate i.e.46.38% is quite high in our hospital but this is not a true caesarean section rate for a specific population. Majority of the patients who underwent C/s were booked, belonging to educated middle class families having awareness of the complications that may occur during trial of labour. Provision of adequate antenatal health services timely identification of high risk cases use of electronic fetal monitoring; involvement of senior, skilled and experienced personnel in the management of obstetrical emergencies are responsible for the apparently higher rate of caesarean section. In order to reduce C/S rate frequency of trial of labor must be increased with the goal of vaginal delivery but without compromising maternal and fetal health

Frequency, causes and outcome of placenta praevia

The objective of the study was to identify and target preventive interventions among women at increased risk of placenta praevia. This is a Descriptive study. All the case records of women with the diagnosis of pregnancy with placenta praevia were reviewed. The frequency of placenta praevia was 1.45% or 1:69 deliveries complicating a singleton pregnancy. Diagnosis of placenta praevia was confirmed by complete history, examination and finally the ultra sound examination, the course of events during antenatal period, their mode of delivery and fetal outcome of all such patients were assessed. Special attention was paid to the past history of dilatation and curettage, previous LSCS and or other forms of uterine surgical procedures. There were 7082 deliveries during the study period. Out of which 103 patients had placenta praevia. The frequency of placenta praevia was found to be 1.45% or 1:69 deliveries. The maximum No. of patients 38 [36.89%] had placenta praevia type III. Highest percentage of the patients with placenta praevia were between 30-35 years. 40 [38.83%] gave history of one or more Gynecological/Obstetrical procedures before the present pregnancy. Incidence of placenta praevia was significantly higher in patients with previous Caesarean Section i.e 15 [15.15%] had previous one or more LSCS. While 18 [17.4%] had history of previous curettage/induced abortion. The poor socioeconomic status illiteracy early marriages, multiparity, long distances from the referral centers, lack of proper health care facilities at the primary and secondary health care centers predisposed the patients in our area to increased incidence and complications of placenta praevia

audit of caesarean section

The study was carried out to determine the caesarean section rate, to analyse the indications so that measures can be taken to reduce the caesarean section rate and its associated complications. A retrospective study was carried out over a period of five years from January 2000 to December 2004 at Gynae unit-I Bolan Medical Complex Hospital Quetta affiliated with Bolan Medical College Quetta. The source of information was the record of labour room, Operation Theater, antenatal and postnatal wards. This record provided the detailed information. The frequency of caesarean section during the study period was about 21%. Indications included, Dystocia [19.8%]. Fetal distress [19.6%]. Placenta praevia [18.3%]. Repeat caesarean [15.5%]. Previous one LSCS [for recurrent cause] [8.8%] Previous two or more LSCS [6.7%] Breech presentation [14.5%] and Cephalo pelvic disproportion [12.01%]. Nineteen percent of the total maternal deaths occurred during this period were because of the complications of caesarean section and Anesthesia. High prevalence of illiteracy and poverty in our female population of reproductive age, early marriages, high parity and increased maternal ages along with flaws in the health care system e.g, lack of facilities at the primary and secondary health care system, poor referral chain and departmental polices regarding dealing with commonest indications of caesarean section have been identified as major causes of ever increasing CSR