ABSTRACT
Background: All pregnant women are at risk of obstetrical complications and most of these occur during labour. In our community local dai, trained birth attendants, lady health visitors and nurses contribute a major part in home deliveries which may be associated with increased risk of fetomaternal complications
Objective: To determine the fetomaternal complication in cases referred to tertiary care hospital after trial of labor outside the facility
Patients and Methods: Study design: Descriptive case series
Setting: Department of Gynaecology and Obstetrics, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of study: One year from 1st January, 2012 to 31st December, 2012. A total of 240 patients who had a trial of labour outside the tertiary care Hospital, were selected for the study. The data was collected on a redesigned questionnaire, having demographic data fetal and maternal outcome. The outcomes assessed were fetomaternal complications i.e prolonged labour, obstructed labour, prolonged rupture of membranes, uterine rupture, abnormal presentation and primary postpartum haemorrhage. Foetal outcome in terms of Apgar score at birth and still births were studied. The data was entered and analyzed in SPSS version 15
Results: 240 patients admitted through emergency after trial of labour by Traditional birth attendants [TEA], Lady health Visitor [LHV] or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of 240 patients in study, 118 [49%] were primigravida while 40 [16%] were grandmultipara. About 90% of patients never had any antenatal checkup. Majority of the patients [94%] were under care of TEA and LHV. The maternal morbidities were prolonged labour 128 [53.3%], obstructed labour 76 [31.6%], prolonged rupture of membranes 60 [25%], abnormal presentation 50 [20.83%], and primary postpartum hemorrhage 30 [12.5%]. Two thirds of the mothers were in need of emergency obstetric care: 70 patients [29.16%] required forceps or vacum extractions and 118 patients [49.16%] required caesarean section. Laparotomy was carried out in 10 patients due to ruptured uterus, out of which four had hysterectomy. There were two maternal deaths due to ruptured uterus. Regarding perinatal outcome there were 64 stillbirths, while 102 had Apgar score below 5 at five minutes. 24 babies died in first 12 hours
Conclusion: This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution
ABSTRACT
Background:-incidence of major trauma is high in this part of the country with an equally high mortality. Trauma care has improved globally after introduction of trauma audit in various centers of the world. Trauma-Injury Severity Score [TRISS] is used for determining survival probability and evaluation of trauma care based on Injury Severity Score, Revised Trauma Score and focused on trauma outcome [deaths and survivors]
Objective: present study was designed to improve and document the care of trauma patients by adopting TRISS methodology for charting and audit
Patients and Methods: this prospective study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, from 1st December 2009 to 31st May 2010. All trauma patients received in the accident and emergency department were included in this study, according to criteria of Major Trauma Outcome Study [MTOS]
Results: a total of 528 patients were included in this study, with mean age of 28.43+/- 9.2 years. Male to female ratio was 4.5:1. It was noted that 278 patients had multiple injuries involving more than one body region. Mortality rate in our series was 11.17% [which is high] and all these patients had major trauma score [>16]. Among total deaths [59], 26 patients died unexpectedly, in spite of their survival probability was greater than 0.5
Conclusion: trauma chart is a reliable tool to judge the effectiveness of medical care in a hospital and to reduce the number of missed injuries. We identified almost 44 % unexpected deaths in our series