Obstetrical anal sphincter injury - risk factors and outcome of surgical repair by end-to-end re-approximation technique

Objective: To identify the obstetrical risk factors for anal sphincter injury and to review the outcome of our practice of end-to-end reapproximation technique for its repair

Study Design: A prospective observational study

Place and duration: Obstetrics and Gynaecology Unit-A, Khyber Teaching Hospital, Peshawar, from 1[st] January 2011 to 31[st] December 2013

Methodology: All patients with obstetrical anal sphincter injury [OASI] i.e. third and fourth degree perineal tears, after vaginal delivery were included. Data including age, parity, labour characteristics, types of delivery, fetal weight, degree of tear, any previous repair, follow up and outcome were recorded. Primary or secondary repair according to the case was done by end-to-end reapproximation technique. Post operative care was standardized, antibiotics, laxative and pelvic floor exercises were advised. Follow up was done at 6 and then 12 weeks

Results: Thirty two patient had OASI, n = 23 [71.87%] had third degree and n= 9[29.13%] had fourth degree perineal tear. Mean age was 26.07 + 1 S.D [range 19-40 years] including 16[50%] primipara, 12[37.50%] P2-P3 and 4[12.50%] P4 or more. Spontaneous vaginal delivery [SVD] in 21[65.63%], SVD with episiotomy in 5[15.62%] while Breech 1 and instrumental delivery in 5[15.62%]. The risk factors identified were nulliparity, heavier fetal weight [?3.8kg], instrumental delivery, fetal malposition, extension of episiotomy, induction of labour [IOL], oxytocin use and unattended labour. No risk factor could be identified in 6[18.75% patients, more than one factor was identified in 8 women. Seventeen [53.12%] patients with third degree and n= 9[28.13%] with fourth degree tear had primary repair and 9[28.13%] had secondary repair. At 12 weeks follow up over all n=28[87.75%] women were asymptomatic and continent, 1[3.12%] had faecal urgency, 1[3.12%] continence to flatus on physical exersion, in 2[6.25%] repair was unsuccessful with incontinence to stool and flatus. Minor complication were wound infection 2[6.25%] and dyspariuria in 4[12.50%]

Conclusion: Obstetrical risk factors commonly associated with anal sphincter tear were nulliparity, instrumental deliveries, heavier fetal weight, malpositions, prolong labour and delivery by unskilled birth attendants. Our practice of end-to-end approximation technique for repair anal sphincter tears was associated with good outcome in terms of anal continence at 6-12 weeks

Effectiveness of vitamin C in preventing pre-labour rupture of chorio-amniotic membranes in pregnancy in women having history of prom in previous pregnancies

Objective: To determine the effectiveness of vitamin C supplementation in preventing pre-labour rupture of chorio-amniotic membranes [PROM] in pregnancy in women having history of PROM in previous pregnancies

Methodology: this descriptive study was carried out in Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar from August 2013 to January 2014. Cases with history of PROM in previous pregnancies were included in this study. Vitamin C supplementation in preventing PROM was used in these patients. All pregnant patients presented from 22 to 28 weeks gestation received a daily dose of Vitamin C 500mg. PROM at the end of pregnancy was noted

Results: out of 133 patients who received Vitamin C, 98 [74%] didn't experienced PROM and 35 [26%] had PROM, showing the effectiveness of Vitamin C in preventing PROM which is effective in 74%

Conclusion: in our study Vitamin C was proved to be helpful in preventing PROM and it is suggested that patients with previous history of PROM should be given vitamin C supplementation

Breech deliveries comparison between Teaching hospital and private clinic

Breech deliveries over a period of one year [1992] were compared between Gynaecology [A] Unit Khyber Teaching Hospital and Kulsoom maternity home for number, outcome and perinatal mortality. Total number of deliveries in the hospital for the period mentioned was 1502 with 83 breech deliveries, an incidence of 5.52%, While the private hospital number was 2155 total deliveries with 104 breech deliveries, an incidence of 4.7%. The study showed that the perinatal out come was better for the private patients who had regular antenatal check ups than the emergencv admissions in the hospital. Perinatal mortality rate was 2.78/1000 total births for the private and 18.64/1000 total births for the hospital