Effects of amniotomy versus spontaneous rupture of membrane on progress of labour and foetal outcome in primigravidae

Objectives: To compare the efficacy of amniotomy with spontaneous rupture of membranes in terms of progress of labour, mode of delivery and foetal outcome in primigravidae

Design: Comparative study

Place and Duration: The study was conducted at Gynae Unit-1 Jinnah Postgraduate Medical Center, Karachi over a period of year from 10[th] July 2002 to 9[th] July 2003

Patients and Methods: Two-hundred primigravidae in active labour [at least 4 cm cervical dilatation] were randomly assigned for amniotomy. Subjects were equally divided into two groups. In subjects of Group A amniotomy was carried out and subjects of Group B were left for spontaneous rupture of membranes. Results of both groups were compared for duration of labour, mode of delivery and foetal outcome in terms of Apgar score at 5 minutes and admission to nursery

Results: The mean duration of labour was 6.66 +/- 1.4 hrs in Group-A and 7.66 +/- 1.75 hrs in Group B showing a significant decrease of 1 hour in duration of labour. There was no significant difference in terms of mode of delivery; foetal Apgar at 5 minutes and neonatal admission to nursery in first 24 hrs following delivery also showed non-significant difference between the two groups

Conclusions: Our study showed that artificially rupturing the membranes during active labour in primigravidae significantly decrease the duration of labour while there was no significant difference in terms of mode of delivery and foetal outcome between the two groups

Maternal morta1ity 2007-2008; [confidential inquiries of Ghulam Mohammad Mahar medical college hospital, Sukkur]

To analyse the maternal mortality with its causes and possible contributing risk factors at Ghulam Mohammad Mahar Medical College Hospital, Sukkur. This study was carried out at Gynae / Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from Jan-2007 to Dec-2008. Descriptive case series study. This study was conducted by analysing the death records of all maternal deaths who died over a period of two [02] years from Jan 2007 to Dec 2008. The demographic record included age, parity, booking status and education. The cause of death and possible contributing factors were evaluated. 48 mothers died during this period making Maternal Mortality Ratio [MMR] of 1578/100,000 live births. Direct causes contributed to 79% [38] of maternal deaths while 21% [10] were due to indirect causes. The major causes of deaths were eclampsia 27% [13], haemorrhage 33% [11], Sepsis 21% [10], Obstructed labour 8% [4]. Among indirect causes, hepatic encethalopathy, anemia and renal failure were observed. Eclampsia, haemorrhage and Sepsis are still the major killers. Factors which need urgent improvement include education, antenatal booking, early diagnosis and referrals to tertiary care centers

Puerperal sepsis: presentation, management and outcome: a hospital based study

Puerperal sepsis is a major cause of morbidity and mortality in Pakistan, but due to scarce data its magnitude is underestimated. To describe the presentation, management, and outcome in patients admitted with puerperal sepsis. Descriptive prospective study, carried out at Gynae/Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from 1[st] July 2007 to 31[st] December 2009. All the patients who met with the criteria of puerperal sepsis i.e. high grade temperature more than 38 °C, foul smelling vaginal discharge, open perineal wound / abdominal stitches were included in the study. The patients presenting with other postpartum obstetric reasons like post-partum haemorrhage, urinary tract infection, Mastitis, retained placenta were excluded. A total of 245 patients were admitted for postpartum problems, of whom 144[59%] were diagnosed as puerperal sepsis. Majority 122[85%] of the cases were between 21-40 years age, and multiparas were at a higher risk. Mode of delivery was vaginal in 133[92.4%] patients, while delivery was conducted at home by untrained birth attendants in 113[78%] patients. Anemia and prolonged neglected labour were commonly reported problems while, common presenting symptoms included high grade fever in 137[95%], foul smelling vaginal discharge in 46[32%], and abdominal distension in 32[22%] cases. More serious presentations like septicemia, multiple organ failure were seen in 26[18%] cases. Besides, antibiotics, 24[16.6%] needed dilatation and evacuation while, laparotomy was performed in 15[10.4%]. Mortality was seen in 18[12.5%] cases while, 28[19.4%] had prolonged hospital stay > 8 days. Puerperal sepsis is a leading cause of maternal morbidity and mortality in our setup which can be controlled by proper antenatal care, delivery by trained birth attendants, early referral and good antibiotic cover. Trained birth attendants and health care providers should be trained to detect early signs and symptoms of puerperal sepsis and its prompt treatment in order to reduce maternal morbidity and mortality