Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

In the past 30 years the rate of caesarean section [C/S] has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. There were 50 patients in each group. In group A, 11 [22%] were booked and 33 [66%] were referred cases. In group B, 48 [96%] were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 [20%] patients in group A, and 39 [78%] patients in group B, placenta previa, chorioamionitis, obstructed labour [6, 12% each]; pregnancy induced hypertension and eclampsia in 5 [10%] cases in group A only. Intra-operative complications in group A were 48 [96%] vs 15 [30%] in group B [p=0.000]. Postoperative morbidity in group A was 50 [100%] and 26 [52%] in group B [p=0.000]. Intra-operative complication was haemorrhage in 46 [92%] cases in group A and 11 [22%] in group B. Anaesthetic complications were 40 [80%]; prolonged intubation 25 [50%], aspiration of gastric contents 8 [16%], and difficult intubation 7 [14%] in group A. Ten [20%] cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 [82%] and 11 [22%] cases respectively. Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.

Trends and determinants of caesarean section

To analyze different indications and frequency of caesarean section [CS] so as to provide recommendations for reduction of caesarean section rate. Descriptive case series. Obstetrics and Gynaecology Unit III, Civil Hospital and Dow University of Health Sciences Karachi, from January 2009 to December 2009. All patients who underwent CS either booked, unbooked or referred were included in the study. The data was collected and analyzed for socio-demographic parameters and indications of CS. Patients with ruptured uterus on laparotomy were excluded. Data was analyzed on SPSS 11; percentages and mean were calculated. During one year study period 778 CS were performed. The rate of CS was 27.94%. Emergency CS was performed on 85.86% and elective caesarean section on 14.14% patients. Among them 71.34% were non-booked and referred cases. The commonest indication was repeat CS [n 367 - 47.17%], followed by labour dystocia [n 78 - 10.01%], breech presentation [n 77 -9.8%], foetal distress [FD n 72 - 9.2%], cephalo-pelvic disproportion [CPD n 71 - 9.1%], hypertensive disorders of pregnancy [PID n 49 - 6.2%] and antepartum haemorrhage [APH n39 - 5.0%]. The rate of caesarean section was high. The majority of the cases were non-booked and referred patients, who mostly underwent emergency CS. The commonest indication was repeat CS

Emergency obstretrical hysterectomy [EOH]: a life saving procedure in obstetrics

To assess the frequency, causes and sequelage of Obstetrical Hysterectomies in a tertiary care unit. Prospective, observational study from 1st Jan. 2001 to 28th Feb. 2006. Departmetn of Gynaecology and Obstetrics, Unit III, Civil Hopsital, Karachi. All Obstetrical Hysterctomies doen during the study period. Out of 11,032 obstetrical patients admitted during the study period, 62 underwent EOH. Their biodata, clinical features, investigations, blood transfusions, operative procedures, morbidity, mortality and follow-up was recorded on a profoma. The data thus obtained was compiled and analyzed. The frequency of EOH was 5.6/1000 obstetric cases. Majority [85.5%] of the cases were referred from elsewhere, while only 9 [14.5%] cases were booked. Multipara and grand multipara [94%] cases were mostly involved and the commonest cause was ruptured uterus [34%]. The maternal mortality was 9.7%. Proper antenatal care, early referral, liberal blood transfusion, timely decision and surgery by an experienced obstetrician are milestones on the road to justify EOH

Subfertility: experience in a tertiary care hospital

To determine the frequency of different causes responsible for subfertility in our setup. Prospective cross-sectional study from March 2005 to March 2006. Oupatients Dept. [OPD] of Gynaecology and Obstetrics [Unit 111], Civil Hospital, Karachi. All patients who were diagnosed as subfertile. Amongst the 156 women included in the study, 85 [54.5%] had primary and 71 [45.6%] secondary subfertility. Majority [59%] of cases were between 21-30 years of age; 78 [50%] complained of subfertility only, while 26 [17%] had history of vaginal discharge, 34 [21%] menstrual disorders and 12 [8%] weight gain. Nineteen [14%] cases had family history of subfertility, 18 [12%] of congenital anomaly and 3[2%] of genetic disorders. Abnormal hormonal profile was seen in 37 [27%] patients, whereas 63 [40.3%] had positive findings on pelvic ultrasound and 43 [27%] patients tubal blockage on hysterosalphinography. Out of 156 women, 27 [17.3%] had Ovarian factor in the form of anovulation, polycystic ovarian syndrome and premature ovarian failure and 51 [32.7%] had Tubo-Ovarian factor in the form of tubal blockage, endometriosis, endometritis and uterine fibroid; in 19 [12.2%] cases both the partners had abnormality, in 40 [25.6%] the male partners had semen abnormality [25.6%], while in 19 [12.2%] no cause could be found. A significant number of patients had secondary subfertility, mostly due to previous surgical interventions, and were suffering from anaemia and vaginal infection. Tubal blockage and male factors were the predominant causes of subfertility