Maternal morbidity associated with repeated cesarean sections

Caesarean section is an essential widely practiced procedure. The rate of Caesarean section averages more than 20% in developed world and make up a similar percentage of hospital deliveries in developing countries. This rate has been increasing and likely to increase in future. Morbidity associated with this operative procedure is therefore of increasing concern. Caesarean morbidity includes antenatal risk of spontaneous abortion, ectopic pregnancy, intra operative adhesions, scar dehiscence, injury to surrounding organs, placenta previa and accrete, caesarean hysterectomy and post operative complications of blood transfusions, infections, pneumonia and DVT. In - spite of good pre and post operative care and relative safety of caesarean section in modern obstetrics maternal morbidity progressively increases with increased number of Caesarean sections. The objective of this study was to determine the maternal morbidity in women undergoing repeated caesarean sections. It is a cross sectional study. This study was conducted for a period of 12 months at the department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Lahore. Majority of patients i.e. 64.67% [n = 97] were recorded between age group of 26 - 30 years while 28% [n = 42] were found between age 31 - 35 years and 7.33% [n = 11] were found between age 21 - 25 years. Mean and Standard Deviation were 29.03 +/- 7.96. 13.67% [n = 46] were recorded with previous 3 caesarean section. Among them 28.67% [n = 43] were with previous one caesarean section, 27.33% [n = 41] were recorded with previous 2 caesarean sections and 13.33% [n = 20] were recorded with previous 4 caesarean sections. Dense adhesions were found in 65% [n = 13], 60.39% [n = 28], 27.91% [n = 12] and 26.83% [n = 11] in the previous IV, III, I and II respectively. Scar Dehiscence 19.51% [n = 8], 15% [n = 3], 13.95% [n = 6] and 8.69% [n = 4] were found in the previous II, IV, I and III respectively. Maternal morbidity increases with increased in the number of caesarean sections

Role of oral misoprostol in first trimester pregnancy failure

To prove the effectiveness and safety of oral Misoprostol in first trimester pregnancy failure. Prospective interventional study. Obstetrics and Gynaecology department, Fatima Memorial Hospital Lahore. A period of 4 months from June 2006 to September 2006. A total of 64 women at 7 to 12 weeks of gestation with confirmed pregnancy failure were enrolled. Every woman included in the study was prescribed tablet Misoprostol 400 ugm by oral route followed by 200 ugm every 4 hourly up to 4 doses and instructed to report back in case of side effect such as nausea, vomiting abdominal pain or vaginal bleeding. Follow up was scheduled on day 2 and day 7. The course of same regimen was repeated if process did not start in 48 hours. Dilatation and curettage was done in case of incomplete expulsion or heavy bleeding. Major outcome measures were complete expulsion rate, need for surgical evacuation and cervical dilatation and side effects. Forty seven [73.43%] women had complete expulsion at one week while 43.75% [28] achieved it within 48 hours. Fifteen [23.43%] women needed surgical intervention out of which 40% needed cervical dilatation prior to evacuation. Forty [62.50%] women had pre-abortion bleeding which was mild to moderate in nature in 82% of cases while 53.12% [34] had abdominal pain. Rest of the side effects were transient and well tolerated. Oral Misoprostol is safe and effective mode of medical management for first trimester pregnancy failure and repeating the second course after 48 hours has significantly increased expulsion rate