Intra-operative complications increase with successive number of cesarean sections: Myth or fact?

OBJECTIVE: To determine whether complications related to surgery increase with increasing number of cesarean sections (CSs) in upper segment placenta. To compare the complications in urgent and elective high order (4-6) repeat CSs. METHODS: A retrospective analysis of 519 women who underwent repeat CS was performed from January to December 2012. Women were divided into 3 groups: group 1 with previous 3 CS (n=325), group 2 with previous 4 CS (n=139), and group 3 with previous > or =5 CS (n=55). RESULTS: Statistically significant differences (P < 0.001) were observed among 3 groups, regarding mean gravidity, type of CS, midline incision and bilateral tubal ligation performed. The risks of severe intra-peritoneal adhesions, thin out lower uterine segment and bladder injury were significantly increased (P < 0.001) with increasing number of CS deliveries. Only one cesarean hysterectomy was done in group 1 due to post partum hemorrhage. No significant differences were found in blood loss, duration of surgery, post operative hospital stay as well as birth weight and Apgar scores of newborns. The elective and emergency CS groups of high order repeat CS had no remarkable differences in operative, post operative complications and fetal outcome. CONCLUSION: Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.

Cerebro-oculo-facio-skeletal syndrome

Cerebro-oculo-facio-skeletal syndrome [COFSS] is a recessively inherited neurodegenerative disorder. We describe an 8 months old Saudi girl, a product of consanguineous parents with unremarkable pre-natal and postnatal history and birth weight 2 kg. She was having microcephaly, micrognathia, micro-ophthalmia, large low set ears, upper lip overhanging the lower lip and congenital contractures. Growth and development were severely retarded. MRI and MRS [magnetic resonance spectrometry] of brain displayed severe brain atrophy and hypo/demyelination of white matter. The relationship between COFSS and differential diagnoses, Cockayne syndrome [CS], Pena-Shokier phenotype [PSP] and Neu-Lexova syndrome [NLS] are discussed. Pre-natal diagnosis followed by appropriate management in time may be helpful to reduce its incidence in the community

profile of mortality and morbidity outcomes of illegal abortions in Lahore

To evaluate the morbidity, mortality and sociodemographic characteristics of illegally induced, unsafe abortion and their relationship with different modes of management. This descriptive study was conducted in Department of Gynae/Obs; Social Security Hospital, Lahore from June 2009 - November2010. A total of 105 cases admitted in the hospital with complications of unsafe abortion that fulfilled the inclusion criteria. The patients/their female attendants were interviewed by doctors. The patients were examined in detail, investigated and managed accordingly. A structured proforma was used to collect data. The data were analyzed. Out of 105 cases, 68[64.8%] were below 30 years. Eighty six [81.9%] were married and rest 19[18.1%] were unmarried females. Forty seven [44.8%] women were illiterate. About 2/3[rd] women were from lower socioeconomic [SE] class and 1/3[rd] from lower middle SE class. Only 63 patients [60.5%] were having some knowledge of contraceptives. Thirty eight [36.2%] abortions were conducted by Doctors [outside the public hospital], 34[32.4%] by untrained birth attendants and 33[31.4%] by Nurses/ lady health visitors [LHVs]. Forty [38.1%] women were managed conservatively, 38[36.2%] by D and C and 27[25.7%] by laparotomy. Significantly higher number of patients [41%] underwent laparotomy whose abortion was conducted by untrained providers. Ninety five [90.5%] patients recovered while 10[9.5%] expired due to serious complications. Illegal abortions are more common among lower socioeconomic class and are associated with significant mortality and morbidity especially provided by unskilled providers. Further studies to assess social, cultural, legal and health system correlates are indicated

Abetalipoproteinemia in a Saudi infant

Abetalipoproteinemia is a rare genetic disorder. A 5-month-old Saudi boy presented with chronic diarrhoea and failure to thrive since 3 months of age. He was cachectic. His peripheral blood picture showed many acanthocytes and he had very low lipid profile. He improved on medium chain triglyceride [MCT] formula and administration of fat soluble vitamins