Lower segment cesarean section [LSCS]; indications and complications at teaching hospital, Faisalabad

Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one of the oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in the developed countries. As primary caesarean deliveries contributed most to the overall caesarean section rate [CSR]. So this is clear that primary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery. To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperative complications of LSCS at tertiary care centre. All caesarean sections performed at Obstetrics and Gynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information was obtained from operation theater and labor ward records. During the study period 100 patients undergone caesarean section. Out of 100 patients, 58[58%] had emergency and 42[42%] had elective caesarean section. The leading maternal indications were previous caesarean section 34 [34%], severe pre- eclampsia 6[6%],post date and failed induction of labor6 [6%], placenta previa 6[6%], and failure of progression of labor 5[5%], PROM3[3%], Pre-PROM3[3%]and cephalopelvic disproportion2 [2%].Major fetal indications include fetal distress9 [9%], malpresentation 6[6%], cord prolapse 3[3%],IUGR 5[5%] and pregnancy complicated by multiple fetuses 7 [7%]. Intraoperative surgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8 belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Majority of cesarean section are done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to control CS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection, selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral in time is the key factor in decreasing the cesarean section rate and complications

Abnormal uterine bleeding; histopathological diagnosis by conventional dilatation and curettage

Abnormal uterine bleeding is one of the most frequent conditions in gynecology. Hysteroscope and plastic devices for outdoor endometrial biopsy are gaining popularity but in our setup traditional dilatation and curettage play significant role in diagnosis of abnormal uterine bleeding. To detect different histopathological findings in abnormal uterine bleeding by conventional dilatation and curettage From December 2002 to March 2005. Department of obstetric and gynecology Unit-I Allied Hospital, Faisalabad, under the guidance of Professor Mahnaz Roohi. 161 patients with abnormal uterine bleeding divided into adolescent, reproductive and peri-menopausal age groups. Maximum 59.02% patients with abnormal uterine bleeding were perimenopausal. Menorrhagia 49.06% was commonest bleeding pattern. Histopathological reports revealed 62.11% dysfunctional uterine bleeding, 21.73% organic lesions and 16.16% pregnancy complications. Complications occurred only in 0.62%. Dilatation and curettage is a safe and successful procedure for detecting intrauterine pathologies in abnormal uterine bleeding

Vesicovaginal fistula [VVF]

Vesicovaginal fistula is not an uncommon condition. It gives rise to multiple socio-psychological problems for women usually of younger age. It can be prevented by improving the level of education, health care and poverty. Early diagnosis and appropriate treatment is required to help the patient. Preoperative assessment, treatment of co-morbid factors, proper surgical approach and technique ensures success of surgery. Postoperative care of the patient is equally important to avoid surgical failure

Maternal mortality; one year review at Allied Hospital Faisalabad

To find out maternal mortality ratio [MMR] and to determine major causes of maternal death. A descriptive study. Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. From 01.01.2008 to 31.12.2008. All cases of maternal death during this study periods were included except accidental deaths. There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births. The most common cause of maternal death was hemorrhage [34.5%] followed by hypertensive disorders/eclampsia [31%]. Most of the patients [75.86%] were referred from primary and secondary care level. Maternal mortality is still very high in underdeveloped countries including Pakistan. We must enhance emergency obstetric care [EOC] to achieve the goal of reduction in MMR

Abdominal hysterectomy; performed by postgraduate [PG] trainees

[1] To audit cases of abdominal hysterectomy performed by post graduate tainees. [2] To evaluate mortality and morbidity rate. An observational Study. Department of Obstetrics and gynaecology, Allied Hospital Faisalabad. From 01-01-2005 to 30-06-2006. 120 cases of abdominal hysterectomies done for non obstetric and benign gynaecological conditions were selected for study. The most common indications for hysterectomy was DUB [43.3%]. Overall intra operative complications developed in 5 patients [4.1%]. Post operative complications developed in 9 patients [7.5%]. The mean duration of hospital stay was 5.5 days. No case of death was recorded in the study. This study demonstrates that abdominal hysterectomy can be safely done even during the learning curve of the post graduate trainees with the low complication rate, shorter hospital stay and without significant mortality

Obstructed labour: the preventable factors

Sixty-two cases of obstructed labour were reviewed during 6 months at a district head quarter hospital, Faisalabad to highlight the prevalence of obstructed labour and ascertain how to manage and possibly avoid this complication with special emphasis on preventable factors. There were 1584 deliveries during this period giving an incidence of obstructed labour as one in 25 deliveries. Five patients had rupture of uterus and there was one maternal death