Perinatal outcome of nuchal cord

To find out the perinatal outcome in cases of vaginal delivery with nuchal cord versus babies delivered by elective caesarian section with nuchal cord. A retrospective, cross-sectional, comparative study done between January to December 2011at Kalsoom Maternity Hospital where 1776 patients were analyzed for presence of nuchal cord prior to and at the time of delivery and perinatal outcome. The cases with nuchal cord undergoing vaginal delivery were 205 [study group] versus 85 elective caesarian section with nuchal cord served as control group. Outcome variables between the two groups were compared. Incidence of nuchal cord was 16.3%. Incidence of single nuchal cord was highest in normal delivery [73.9%]. No significant difference was found between the mean of both 1- and 5-minute Apgar scores [8 and 10, respectively] between the two groups, but infants born with nuchal cords vaginally, tended to have lower scores at 1 minute [p=0.008]. This trend was not evident in the 5-minute Apgar test. Two neonatal admission were done [in vaginal delivery group] for 24 hour and then discharged for babies with apgar score 3/10, 5/10 and 4/10, 6/10 respectively. Elective caesarian section cause an additional morbidity and does not justify in case of nuchal cord as outcome is almost same in both condition. Nuchal cord is not associated with adverse perinatal outcome therefore do not influence clinical management. Doing elective section is not justified as there is no difference in perinatal outcome

Is amnioinfusion effective enough to reduce perinatal mortality?

To assess the effects of amnioinfusion for meconium stained liquor on reducing perinatal death. This case control study was conducted in Kalsoom Maternity hospital, Peshawar on singleton pregnancies with cephalic presentation, >37 weeks gestation and meconium stained liquor at admission or during labor, randomized in two groups. Group 1 [study group] received amnioinfusion [normal saline 500mls at room temperature] over a period of 30 minutes at a rate of 10-20 mls/min. Group 2 [control group] did not receive such treatment. Fetal heart monitoring at every 10-15 minutes along with progress of labour plotted on a partogram was recorded. Out of 82 cases, 1 breech and 2 premature were excluded so 79 were left for the study. All were with cephalic presentation and gestation >37 weeks in 73.41% cases and postdates in 26.5% cases. In Group 1 [n=52], 36 [69.2%] had normal vaginal delivery [NVD], 4[7.7%] had outlet forceps delivery, 12[23.1%] had vacuum vaginal delivery and cesarean section rate was 0%. Two [3.8%] newborns were referred to nursery with 1 [1.9%] early neonatal death. In Group 2 [n=27], 6 [22.2%] had NVD, 11[40.7%] delivered with outlet forceps, 10[37.1%] had vacuum vaginal delivery and no cesarean section. Twelve [44.4%] babies were referred to nursery with 2 [7.4%] early neonatal deaths. Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for fetal surveillance are limited. The technique appears to be safe, simple and economical

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