Evaluation of 'decision to delivery interval' and causes of delay in emergency caesarean sections in a tertiary care hospital

Objective: to evaluate decision to delivery interval in emergency caesarean sections performed in tertiary care hospital and to evaluate the factors causing delay

Methodology: this cross sectional observational study was conducted in Department of Obstetrics and Gynaecology, B unit, Lady Reading Hospital from 1[st] march 2014 till 31[st] august 2014. All emergency caesarean section category A [requiring delivery within 30 min from decision to delivery] were included and time taken from decision to delivery was noted, in cases where there was delay, the reason was highlighted. Elective caesarean sections and those not requiring urgent caesarean sections were excluded from study. Descriptive statistics were used to analyze the data and results were expressed in percentages

Results: total 102 patients were enrolled in this study, in 35.96% [n=41] there was no delay, in 21.05% [n=24] delay was due to non availability of operating table [it was already occupied], delay in arrangement of medicine led to delay in 13.15% [n=15] patients, non-availability of basic investigation [blood group, HBS/HCV] were responsible for delay in 10.52% [n=12] of cases, cross matched blood arrangement was delaying factor in 7% [n=8] of patients, in 1.75% [n=2] of patients delaying in shifting was found .Regarding indications for caesarian section, the commonest indication was fetal distress [n=25, 24.5%] followed by obstructed labour [n=21, 20.5%]

Conclusion: caesarean section within 30 minutes is possible, ensuring medicine availability and increasing the number of operating tables available for surgery will lead to drastic improvement in achieving our goal

Frequency of postpartum haemorrhage in maternal mortality in a tertiary care hospital

To determine the frequency of postpartum haemorrhage as a cause in maternal mortality during a period of seven years in a tertiary care hospital. This descriptive study was conducted in Gynae A unit of Department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar. Data was collected from maternal mortality records retrospectively from 1[st] January 2003 to 31[st] December 2009. All patients who died in the hospital with a diagnosis of postpartum haemorrhage as the primary cause of death were included in the study. A total of 302 maternal deaths were recorded during the study duration. Out of these 302, 74 were due to Post-partum Haemorrhage which constituted 24.5% of maternal deaths. The mean age of the sample was 29.69 +/- 7.10. Uterine atony was the cause of death in 45.9% [n=34], rupture uterus in 32% [n=24], genital tract tears in 14.86% [n=ll] and retained placenta in 6.75% [n=5] of the cases of Postpartum Haemorrhage. Subtotal abdominal hysterectomy was performed in 51.35% [n=38]; repair of tears and removal of placenta in 6. 75% [n=5] each; Subtotal abdominal hysterectomy with internal iliac If gat ion was performed in 5.4% [n=4] cases while only internal iliac ligation and B Lynch suture was applied in 1.35% [n=l] each. The remaining 20 cases expired before they could be prepared for it. Postpartum Haemorrhage was found to be leading cause of maternal mortality making up to one quarter of total deaths in 7 years. Uterine atony and ruptured uterus were the major causes of Postpartum Haemorrahge. Subtotal abdominal hysterectomy was the major procedure performed

audit of change in rate and indications of caesaren section in a tertiary care hospital of Peshawar

To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively. This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study. During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 [59.81%], followed by grandmultigravida n=93 [21.98%] while n=77 [18.20%] were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680 [47.61%] but it was followed by primigravidas n=480 [33.61%] and least n=268 [18.76%] in grandmultigravidas During 1996, the commonest indications in order of frequency were dystocia n=120 [31.20%], previous caesarean section n=71 [16.78%], placenta praevia n=56 [13.23%] and fetal distress n=48 [11.34%] respectively while during 2006, they were dystocia 310 [21.70%], fetal distress n=197 [13.79%], previous caesarean section = 191 [13.37%] and breech presentation n=180 [12.60%] respectively A significant increase [14.84%] in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006