ABSTRACT
Abdominal pregnancy is a rare form of ectopic pregnancy associated with high maternal [0.20%] and perinatal [40-95%] mortality; surprisingly we had three consecutive cases of this condition. Case 1: Was referred from Taulka hospital where the patient presented as, four months gestational amenorrhea with acute diarrhea vomiting and severe anemia. She was treated symptomatically, transfused two units of blood and referred to Liaquat University Hospital with Ultrasound report showing suspicion of abdominal pregnancy. Case 2: Was newly married primipara who presented with four months gestational amenorrhea and severe lower abdominal pain. Ultrasound report showed a complex mass of 8.0cm just below the anterior abdominal wall [over the uterus] with alive fetus. The uterus was empty, so the diagnosis of abdominal pregnancy was made. Case 3: Was a young 19 years old lady, initially admitted in surgical unit as case of acute abdomen with history of five months pregnancy followed by D and C two weeks back by LHV [Lady Health Visitor], they collaborated with gynae unit due to this history. Examination showed septic, tender on palpation, on P/V examination some dry shrunken cord like structure with foul smelling discharge hanging out from vagina, identified a gut loop with uterine perforation. In this case abdominal pregnancy was diagnosed on surgery as ultrasound report could not give the clear picture. All cases were managed with surgical intervention. In first two cases fetuses were delivered alive but non viable, in third case fetus was dead macerated found within abdominal cavity in right side. In first case placenta was removed completely and in second case, it was adherent with adjacent structures not actively bleeding so left in situ and post operatively three doses of injection methotrexate were given. First two cases recovered completely while in third case patient required ICU care after surgery. All three cases who had different clinical presentations were diagnosed and managed successfully
ABSTRACT
Objective: to determine the frequency, risk factors, complications and outcome of obstructed labour in our setup
Study design: a retrospective study
Setting: obstetrics and Gynaecology Unit IV, Liaquat University Hospital, Jamshoro - Pakistan from January 2004 to December 2006 [three years]
Methods: patients' records, labour room registers, operation theatre books and perinatal records were reviewed retrospectively to gather information about patients admitted with obstructed labour
Results: out of 2126 hospital deliveries during the study period, 44 [2.1%] were admitted with obstructed labour as an emergency. Only 13 [29.5%] had received antenatal care at some stage of pregnancy. Thirty-two [72.2%] patients belonged to rural areas. Mean duration of labour was 15.9+/-11.6 hours. Cephalo-pelvic disproportion in 22 [49.3%] cases was the most common risk factor of obstruction, followed by malposition/malpresentation in 19 [43.3%] cases. Caesarean section was the most common mode of delivery [81.1%]. Three [6.8%] patients had ruptured uterus. Still birth rate was very high i.e. 14 [31%] and neonatal deaths were 4 [9%], while 26 [49%] babies survived with minor problems
Conclusion: obstructed labour still poses a great maternal and foetal problem in our setup. Malpractice by untrained persons is a major factor. Most of these cases are preventable by proper antenatal care provided by properly trained persons