ABSTRACT
Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally.
ABSTRACT
Background: Foetal growth restriction refers to a condition in which the foetus is unable to achieve its genetically determined growth potential. Doppler velocimetry in FGR not only decides the optimum time of delivery but also the optimum mode of delivery and so authors evaluated the Doppler patterns in growth restricted fetuses.Methods: Nested case-control study conducted among normal and abnormal Doppler groups at a tertiary care teaching hospital in the year 2017.Results: Among 82 growth restricted foetuses, 54 of them had normal Doppler patterns (65.85%) and 28 had abnormal Doppler patterns (34.15%).13(46.5%) had umbilical S/D elevation,2 (7.14%) had AEDV,1(3.57%) with REDV and 12 (42.8%) with CPR<1. Mean maternal age was slightly higher in the abnormal Doppler group. FGR babies with abnormal velocity waveforms had shorter diagnosis to delivery interval than those with normal Doppler and decision for delivery was taken at a lower gestational age. (p value-0.001). Mothers of FGR babies with abnormal Doppler studies underwent emergency caesarean section for non-reassuring foetal heart patterns. (p value-0.001) The mean birth weight was higher (2201.80gm) in Doppler normal FGR and it was 1929.46grams in abnormal umbilical Doppler group and 1363.33gm in AREDV (pvalue-0.001). Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Growth restricted foetuses with normal umbilical velocimetry are at a lower risk than those with abnormal velocimetry in terms of prolonged diagnosis-delivery interval and shorter NICU days. The need for neonatal resuscitation at birth was more in babies with abnormal Doppler velocimetry and absent diastole /reversed diastolic flow of umbilical artery velocimetry.
ABSTRACT
Background: Inter-hospital Emergency obstetric transfers should be carried out effectively and efficiently to avoid maternal and fetal morbidity and mortality. Authors would like to analyse the determinants ,patterns and reasons for referrals to tertiary hospital for women with obstetric high-risk, complications and obstetric emergencies from both public and private sectors and look into course in hospital and their feto-matermal morbidities.Methods: Descriptive study done at a tertiary care teaching hospital where 124 obstetrical referrals from nearby private and public health sectors were recruited.Results: Infertility treated obstetric referrals were at significant risk of referral (p value-0.002). Public sector referrals had past history of early pregnancy loss which was significant (p value-0.002). Public sector had statistically significant in -labour referrals (p value-0.04). All the obstetric referrals from public health sector reached within half an hour while one third of private sector referrals travelled more than an hour for emergency obstetric care (p value 0.001). Bronchial Asthma caused significant morbidity among public sector referrals (p value-0.001). Public sector referrals <31 weeks were nil while 55 % obstetric referrals were referred <31 weeks from various private hospitals seeked neonatal care with significant p value (0.016). NICU admissions were statistically significant in private sector referrals (p-value 0.001). Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Specific guidelines for whom to refer, how to refer, when to refer and where to refer would be helpful in making timely referral. More stringent documentation in the referral slips and more co-ordination between the referral unit and the higher centers are required to build a strong health system.