Complications and outcome with epidurals for labour: Analysis of seven years experience

To audit the incidence of obstetric epidural complications and its outcome at Fatima Memorial Hospital, Lahore. All parturients who received epidurals for painless deliveries in the labour room of Fatima Memorial Hospital from 1999 to 2005 were included in this audit. All parturients received bolus of 500-1000m1 of Ringers lactate or 0.9% Normal saline prior to insertion of epidural catheter. Information regarding parturient's name, age, gravida [primi or multi], effectiveness of epidural or any complication was noted by anaesthetist on register kept in the anaesthesia office. Out of 25916 deliveries during seven years, 2610 [10.07%] parturients received epidural for painless delivery. Those who received epidurals, 437 developed one or more complications. The overall incidence of complications was 19.57%.Consultants gave epidural to 2004 parturients [76.90%] and residents gave to 602 parturients [23.10%]. The most common complication or complaint was shivering, 166 parturient [6.36%]. Next common was hypotension, 162 parturients [6.20%]. Inadequate analgesia and missed segment noted in 99 [3.79%] parturients. Post delivery urinary retention was problem in 25 [0.95%]. Dural puncture occurred in 15 [0.57%] and three [0.11%] received blood patch for control of persistent post dural puncture headache. In three parturients procedure was abandoned. Other complication like Intravascular injection noted in two [0.07%], Catheter blockade in three [0.11%], Reinsertion of catheter required in five [0.19%] and High spinal noted in three [0.11%] parturients. One parturient had total spinal and intubated, Eight [0.30%] parturients complained backaches. Out of 2610, parturients who received epidurals 237 [9.09%] underwent Caesarian sections, 185 [7.09%] deliveries were assisted by Vacuum and 150 [5.57%] by outlet forceps. Every sixth parturient [16.747%] is susceptible to get some form of complications when epidural analgesia is offered for pain relief but these complications can be detected early and managed if monitoring facilities available

Neonatal outcome in preterm Cesarean section vs preterm Vaginal delivery

To compare neonatal outcome in preterm caesarean section vs. preterm vaginal delivery. Retrospective comparative study from January 2006 to December 2006 at Fatima Memorial Hospital, Lahore All booked and un-booked patients who delivered from January 2006 to December 2006 were included in the study. The decision of spontaneous vaginal delivery or caesarean section made based on obstetric indications. All the data recorded and subsequently analyzed. Out of 6570 total deliveries during one year, 673 [10.2%] patients delivered pre-term, 265 by C-Sections and 408 by Spontaneous vaginal deliveries. Preterm deliveries done, at 34-37, 32-34, 28-32 gestational weeks were 47.1%, 28.9% and 23.9% respectively. The commonest indications of pre-term Caesarean Sections were fetal distress [6.7%], intra-uterine growth restriction [27.1%] and severe pre-eclampsia / eclampsia [26.4]. Neonatal outcome in terms of baby weight and APGAR scores were not significantly different between the two groups. Neonatal survival was 81.1% who delivered by pre-term Caesarean section compared to 77.9% who delivered by pre-term vaginal deliveries. Sepsis was the main cause of neonatal mortality. This study shows that the neonatal outcome of pre-term infants when delivered by Caesarean section shows no significant difference as compared to the preterm infants delivered by vaginal route. Decision of caesarean sections should be based on obstetric indication only

Hysteroscopy - 3 Years experience at a Teaching Hospital

To evaluate the indications, effectiveness and safety of hysteroscopy in Gynaecological surgery. Design, A retrospective observational study from January 2003 to December 2005 at Fatima Memorial Hospital, Lahore. 76 patients who presented in the outpatient department of Gynae and Obstetrics at Fatima Memorial Hospital, Lahore with the following complaints including abnormal uterine bleeding, infertility, recurrent abortions and secondary amenorrhea were included in the study. They were pre-operatively investigated and admitted a day prior to the surgery and discharged usually within 24 hours postoperatively. The subsequent follow-up was done in outpatient department. All the data was recorded and then subsequently analyzed. 76 patients were inducted in the study. Out of these 36 [47%] had infertility 20 [26.3%] had abnormal uterine bleeding, 8 patients [10.5%] had recurrent abortions, 8 [10.5%] presented with secondary amenorrhea, 3 patients [3.9%] presented with lost IUCD and one patient [l.3%] had follow-up hysteroscopy after resection of intra- uterine septum. Hysteroscopic findings revealed intra-uterine adhesions in 8 [10.5%], submucous fibroids in 15 [19.7%], endometrial polyp in 10 [13.l%] uterine septa in 8 [10.5%], atrophic endometrium in 9 [11.8%] while there was no abnormal finding in 26 [34.2%] patients. Two patients [0.6%] sustained uterine perforations, which were diagnosed and managed during operation but no other complication occurred. Hysteroscopy is an excellent tool to perform intra-uterine adhesiolysis, polypectomy, submucous myomectomy and endometrial ablation. In addition to being a quicker, less invasive and low risk procedure, it has got the advantage of being cheap with a shorter hospital stay and diminished recovery time. Hysteroscopy, both diagnostic and operative should be an integral part of gynaecological surgery in the teaching units

Spinal anaesthesia versus general anaesthesia for elective caesarean section: effect on Apgar score and acid base status of newborn

Purpose of this study was to compare effect of halogenated volatile agents and spinal anesthesia on the APGAR score and on the umbilical acid-hase status of the infant. Total seventy five [75] patients were included in the study that underwent elective cesarean section; 15 had spinal anesthesia and thirty patients had general anesthesia with Halothane group and thirty with Isoflurane. The neonatal outcome was grouped into asphyxiated [APGAR score 1-3], depressed [APGAR score 4-6] acidotic but vigorous [APGAR score 7-10]. In all three groups none of the baby was asphyxiated. 26 babies in each general anesthesia group and 14 in spinal anesthesia group had APGAR score between 8-10 at one minute and I 011 0 at 5 minutes. In conclusion the results favor regional block as the procedure of choice for the well being of the infant delivered through cesarean section