ABSTRACT
Several risk factors for placenta praevia exist, including previous cesarean section [C/S]. This association has been investigated long time ago, however in this hospital there is no documented evidence. This study was done to assess the risk of placenta praevia based on number of previous cesarean sections. A hospital-based study, at Omdurman maternity hospital- OMH during; January 2010- December 2012. Deliveries in OMH were reviewed by trained registrars. Patients diagnosed prenatally or during delivery as placenta praevia were included. All women operated were followed till discharge from hospital. Total number of deliveries during the study period is 94758.Of them 68415 [72.2%] delivered vaginally and 26343 [27.8%] by C/S.Of the latter 10643 [40.4%] underwent elective and 15700 [59.6%] emergency CS.448 [0.5%] were diagnosed as placenta praevia. Placenta praevia was more common in patients with scarred uterus being found a 250 out of 9853 CS [2.5%]. Its frequency increased with the number of uterine scars: one scar; [1.7%], [RR = 1.45, CI= 1.12- 1.88], 2-4 scars [2.8%], [RR = 2.32, CI= 1.87-2.87] and five or more scars; [12.7%], [RR = 10.54, CI= 7.34-15.13]. Nineteen patients [7.6%] had adherent placenta, [RR = 42.41, CI =5.69-315.83], 68[15.2%] had history of dilatation and curettage [D and C] or evacuation,[RR = 1.5, CI = 1.18- 1.94], 37 [8.3%] had previous history of placenta praevia, [RR= 8.30, CI = 6.17- 11.19]. Three maternal deaths were encountered [0.7%]. The frequency of placenta praevia in this study increased with increasing number of previous C/S, and was associated with adverse feto-maternal outcome. This study provides a reason to reduce primary C/S and encouraging vaginal birth after C/S [VBAC]
Subject(s)
Humans , Female , Pregnancy , Cesarean Section, Repeat , Hospitals, MaternityABSTRACT
To find out the impact of female genital mutilation [FGM] on the second stage of labour at Omdurman Maternity Hospital [OMH]. A descriptive cross-sectional study, for primigravidae delivered vaginally in 2010. After an informed consent circumcised women, were included as study group and uncircumcised ladies as control group. Data was collected by trained registrars using a structured questionnaire to collect frequency of postpartum haemorrhage [PPH], perineal tear, birth asphyxia, neonatal death and hospital stay. A total of 1961 primigravidae, delivered in 2010 at OMH, 629[32.1%] were circumcised and 1332[67.9%] were uncircumcised. There was no significant difference in the mode of delivery and episiotomy. FGM places women at a greater risk during childbirth, endangering their health and their babies compared to uncircumcised.
Subject(s)
Humans , Female , Labor Stage, Second , Maternal Welfare , Cross-Sectional Studies , Surveys and Questionnaires , Pregnancy Outcome , Obstetric Labor Complications/etiologyABSTRACT
The cesarean section is indicated when vaginal delivery is not safe for the mother or the baby. A descriptive study done in Omdurman maternity hospital-OMH to assess the impact of spinal anesthesia [SA] on cesarean section[C/S], including, intra and post operative maternal complications, neonatal outcome and patients' satisfaction in 2011. Women delivered by C/S under SA were included in the study after an informed consent. All women in the study were operated on by trained registrars or obstetricians, under SA given, either by anesthetist or assistant anesthetist under supervision with similar conditions and were followed till discharge from hospital. Total number of deliveries at OMH in 2011 were 30397, 21677 [71.3%] delivered vaginally, 8720 [28.7%] delivered by C/S, only 24 women [0.3%] delivered under general anaethesia- GA. Women included in the study were 1029, 517 [50.2%] were elective and 512 [49.8%] were emergency C/S. Intra- operatively, 79 women [7.7%] developed hypotension, their BP dropped by more than 30 mmHg, four women developed severe shivering for which they received intravenous 25 mg pethedine, and 44 neonates received oxygen by mask and only one needed endotranchial intubation. Post operatively, only two women had disabling headache, 24 women [2.4%] had episodes of vomiting and 199 [19.3%] had pain in their lower limbs, buttock and thigh, it disappeared completely before discharge. In this study, 880 women [85.5%] were satisfied with SA, while 149 [14.5%] were not satisfied due to pain at the time of puncture, headache, or transient lower limb pain after operation. Spinal anesthesia is increasingly used for C/S in this hospital, with excellent patients' satisfaction, without increase in maternal and neonatal mortality or morbidity
ABSTRACT
To assess patient satisfaction and morbidity associated with 24 hours hospital stay after elective caesarean section. A descriptive study done in Omdurman maternity hospital [OMH] in 2010. All women admitted for elective C/S were counselled for discharge after 24 hours from C/S. Those with medical or obstetrical problems necessitating admission for longer time were excluded. Women who refused to be discharged were included as control after an informed consent. All women were operated on by trained registrars or consultants under similar conditions and were followed till discharge from hospital. The total number of deliveries in OMH during 2010 was 28975. Out of them 21022[72.6%] had spontaneous vaginal delivery and 7953 [27.4%] delivered by caesarean section. Elective C/S comprised 3204[11.1%] while emergency C/S 4749[16.4%]. The study included 1439.716[49.8%] as study group and 723[50.2%] as control. Readmission was needed for 41[2.8%], 15[1.1%] from study group and 26[1.8%] from control group. The reason in 24[1,7%] was wound infection, 5[0.3%] DVT, two with endometritis and eight [0.6%] due to non- pregnancy related infection. Although, there is slight increase in rate of readmission due to wound infection and DVT in control group, there is no significant statistical difference between the two groups. However there is significant statistical difference in the rate of satisfaction between the two groups. In the study group, 613[85.6%] ladies were satisfied with the short hospital stay compared to 269[37.2%] in the control group who were satisfied with longer hospital stay after elective C/S [P = 0.0001]. Short hospital stay after elective C/S was associated with more patients' satisfaction, without increase in maternal mortality or morbidity, compared to control
ABSTRACT
Androgen insensitivity Syndrome [AIS] [testicular feminization syndrome] is a rare X-linked recessive condition. These patients characteristically have a 46 XY Karyotype and present with a spectrum of phenotypic abnormalities. AIS may be complete [CAIS], that is phenotypically normal women with adequate breast development normal external genitalia, vagina of variable depth, absent uterus, and coarse or absent pubic hair and axillary hair. They are male karyotype with negative sex chromatin. Partial Androgen Insensitivity Syndrome [PAIS], phenotype range from mildly virilized female with external genitalia [clitorimegaly] to mildly undervirilized male external genitalia [hyopspadius or diminished penile size]. The gonad [undescended] testes may be intraabdominal, inguinal or labial. Malignant transformation of the testis is rare. Here we present a case of a young lady with seminoma arising in CAIS
Subject(s)
Humans , Female , Androgen-Insensitivity Syndrome , Amenorrhea , Testicular Neoplasms , TestisABSTRACT
Transurethral meatotomy with knife electrode or Collings ' knife was done in 18 patients who either had a stone impacted in the intramural ureter and not suitable for ureteroscopic manipulations due to its large size [13] or when the dormia basket became impacted during attempts to extract the stone [5]. The stone was recurrent following open surgery in 10 of the 18 patients. This method resulted in successful endoscopic removal of the stones in all patients. Vesicoureteric reflux was detected in 10 patients at 1 month and in only 3 patients at 3 months. Follow up of these patients revealed no symptomatic upper tract infection or renal damage caused by this reflux. It was concluded that endoscopic ureteral meatotomy is recommended for the removal of impacted intramural ureteric stones not suitable for ureteroscopic manipulations or stones impacted in the dormia basket at the ureteric orifice, especially in recurrent cases