Maternal and neonatal adverse outcome at repeat cesarean delivery versus repeat vaginal delivery

To determine selected maternal and neonatal adverse outcomes at repeat cesarean delivery compared with repeat vaginal delivery. Cross-sectional study. Lyari General Hospital, Karachi, from January 2005 to December 2008. Healthy pregnant women at 28-42 weeks of second singleton pregnancy were selected for study. Those with previous cesarean birth was labelled the exposed group and those with previous vaginal birth were considered the control group. Maternal and neonatal morbidity's attributable to the previous cesarean section was estimated. Potential confounders like persistent medical disorders, previous adverse outcome and trial of scar cases was excluded. Results were presented in frequency and percentage. Effects of outcomes were calculated as odds ratio with 95% confidence interval. SPSS-16 was used for statistical data analysis. A total of 195 mothers at repeat cesarean delivery were compared with 1486 mothers at repeat vaginal delivery. Mothers with previous cesarean birth were at high risk of peripartum hysterectomy and placenta accrete followed by placenta praevia [OR 7.6 [95% CI = 0.48-122.8], 7.6 [0.48-122.8] and 2.5 [0.68-9.6] respectively]. Very preterm birth [OR = 3.86, 95% CI 1.15-12.97]] was the most significant neonatal adverse outcome. Cesarean section in first pregnancy conferred an additional risk in the second pregnancy even after exclusion of known complications of trial of scar. These should be part of overall clinical assessment at the time of first cesarean section

clinicopathological review of elective abdominal hysterectomy

To review correlation between indications and histopathology of elective abdominal hysterectomy. Descriptive study. Lyari General Hospital, Dow University of Health Sciences Karachi from June 2005-to May 2007. Data including age, parity, presenting symptoms and indications for hysterectomy was extracted from files and histopathology of all hysterectomy specimens was collected for detailed study. During 2 years a total of 54 elective abdominal hysterectomies were performed. Abdominal hysterectomy rate was 4.4 /1000 during study period. In 97% indications were for benign conditions. Peak age incidence was 41-50 years and peak parity was 4-6. In 27.7% indication for hysterectomy was menstrual problem followed by lieomyoma in 22.2%. On histopathology of uterus in 59.2% leiomyoma and in 24% adenomyosis were confirmed. There was no mortality associated with the procedure. Menstrual disturbance is leading indication of hysterectomy and leiomyoma is the commonest pathology. Adenomyosis is main cause of menstrual problem

Cesarean delivery rates and indications at a teaching hospital

A descriptive study was conducted to assess the cesarean delivery rates. Indications and fetomaternal outcome at the Department of Gynecology and Obstetrics, Unit 1V, Sindh Govt. Lyari General Hospital, Karachi, from June 2005 to May 2008. Demographic and obstetrical data of the subjects under going cesarean section was collected. During the study period, 506 cesarean sections were performed at the rate of 22.92%, 22.78% and 22.83% in respective years. Unbooked cases were 47.43%. Primiparous women were 33.5%. Majority [80.83%] were between 21-30 years of age. Elective cesarean sections were 16.2% and emergency section were 83.79%. Main indications of cesarean sections in primiparous women were dystocia [35%], malpresentation [17.6%] and fetal distress [16.4%]. In multiparous women, main indications were previous cesarean section [53%], malpresentation [12.7%] and dystocia [12.5%]. Projected maternal mortality ratio was 197.6/100,000 live births and perinatal mortality rate was 69/1000 live births

Effectiveness of admission test

To find out the effectiveness of Admission Test [AT] in detecting fetal hypoxia already present at admission to predict hypoxia in labor and to correlate the results of the AT with the perinatal outcome. Descriptive study. A total of 100 women in labor both high and low risk groups were selected in the study. All of them were subjected to an admission test [AT] which is a 15-20 minutes recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission in labor. The results of AT were not revealed to the concerned obstetrician in labor room and the test were evaluated after delivery so as not to influence the clinical management. The results of the AT were 'reactive' in 75 [75%], 'equivocal' in 22 [22%] and 'ominous' in 3 [3%] women. Women with the reactive AT had low risk of intrapartum fetal distress, 1.3% as compared to 4.5% in the equivocal and 66.6% in the ominous group. Operative delivery for fetal distress was required in only 1 [1.3%] woman of the reactive group, in 1 [4.5%] woman of the equivocal group and in 2 [66.6%] women of the ominous AT group. Resuscitation was required in 2 [2.6%] babies of the reactive group, in 4 [18.1%] babies of the equivocal group and in 1 [33.3%] baby of the ominous AT group. Nine babies required neonatal unit and NICU admission for neonatal sepsis 5 [6.6%] were from the reactive, 2 [4.5%] were from the equivocal and 2 [66.6%] were from the ominous AT group. The test was useful to detect fetal distress already present at admission and had the ability to propose fetal well being for the next few hours of labor. It is simple, convenient, non invasive and economical for screening purpose

Association between peritoneal closure at primary cesarean section and significant adhesions at second cesarean section

To evaluate impact of peritonization at primary cesarean section in terms of abdominopelvic adhesions at second cesarean section. A randomized trial. Women undergoing first cesarean delivery were randomized to either closure of both the visceral and parietal peritoneum [Group A, n =150] or non closure [Group B, n=150]. At second cesarean, the variety and frequency of adhesions were examined. The incidence of adhesions in the closure group was significantly higher than in the non closure group [p<0.05]. The mean total operating time and the mean interval from skin incision to delivery in the closure group was significantly longer than in the non closure group [P <0.05, P<0.05 respectively] at second cesarean section. Peritoneal closure in cesarean delivery is associated with significant adhesion formation. The practice of non-closure of peritoneum is therefore recommended

Pelvic organ prolapse in peri urban area of Karachi

To study prevalence, presentation and management of utero vaginal prolapse in Lyari [a periurban area of Karachi] A cross sectional study The study was conducted in Gyn/Obs department of Lyari General Hospital from 1st July 2005 to 30th June 2006. During this period 40 gynae admissions were cases of utero vaginal prolapse. After detailed history, examination and initial work up planned surgery was performed. All patients were followed in OPD after 6 weeks of operation During 1 year study period out of 376 gynae admissions 40 were cases of uterovaginal prolapse. So prevalence of utero vaginal prolapse in Lyari is 9.4. All were OPD admissions except 1 with incarcerated prolapse admitted through emergency. Around 50% were >50 years of age and 75% were grandmultipara. Main presenting complaint [100%] was vaginal protrusion. vaginal hysterectomy with anterior and posterior repair was done in 62.6%. Median length of stay was 5-7 days. Very few cases had intraoperative and postoperative complications. None had mortality

Benign tumours of the vulva

To present clinicopathological analysis of benign tumours of the vulva. Design: A case series. Place and Duration of Study: The study was carried out in two phases at JPMC, Karachi from October 1995 to April 1997 and at Usman Memorial Hospital from 1st February 2003 to 30th July 2003. Patients and Thirty cases of benign tumours of vulva were studied during 2 years research period. Detailed history along with complete local and general physical examination followed by all necessary pre-operative investigations were carried out. Excision surgery was the treatment of choice in majority of cases while marsupialization was done for Bartholin's cyst. Histopathology of tumours specimen was also collected. A total of 30 cases were studied. Twenty-two were cystic and 8 were solid tumours. Aggressive angiomyxoma was 10% of solid tumours and Bartholin's cyst was 46.6% of cystic tumours. Most of the patients were multipara and between 21-30 years of age. The main site of tumour was labium majus. Excision surgery for all cases and marsupialization for Bartholin's cyst was treatment of choice. Aggressive angiomyxoma is the commonest solid benign vulval tumour. It should be considered in the differential diagnosis of vulval mass in women of reproductive age