Vaginal birth after cesarean section - a continuing challenge

The purpose of this study was to assess the antenatal and intrapartum factors influencing the success of vaginal delivery in women with one cesarean section. Identification of modifiable risk factors which could help in developing local guidelines to improve the management and success rate of patients undergoing vaginal delivery after one previous cesarean section. Prospective cohort study. This study was carried out at the Department of Obstetrics and Gynecology, Aga Khan University, Hospital, Karachi from 01.01.2008 to 30.06.2008. A sample size of 21 women, undergoing induction of labor [IOL] and 54 women with spontaneous labor were needed. All women with singleton, cephalic, term pregnancies with history of previous one caesarean section were included. Data collected through the Performa and statistical analysis performed using the SPSS computer statistics programme. To compare proportions, the x[2] test and Fisher's exact test were used and student-t test were used to compare means. Both groups were comparable and there was no statistical difference between them, except for the Bishop score which in the induction of labor [IOL] group was 4 +/- 1.54 and in the spontaneous labor group was 5.7 +/- 2.18, which is statistically significant [p value = 0.001]. The results suggest that there is no effect of previous vaginal delivery, epidural analgesia, fetal distress and baby's gender on the outcome of trial of labor [TOL]. The rate of successful vaginal birth after cesarean section [VBAC] is not significantly different in the group of IOL and spontaneous labor. The current clinical evidence suggests that VBAC is advantageous to the mother and has no adverse effects on the fetus but it is no risk free. It is actually the responsibility of the obstetrician to ensure best care and appropriate management plan

Does malaria during pregnancy affect the newborn?

To investigate the effect of malarial infection during pregnancy on the newborn. A retrospective cohort study was conducted at The Aga Khan University Hospital [AKUH], Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight [LBW] and intrauterine growth retardation [IUGR] in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period. Pregnant women with malaria had a 3.1 times greater risk of preterm labor [p=0.14]. They were more likely to be anaemic compared to women without malaria [RR=2.9, 95% CI=1.6-5.4] and had a significantly lower mean haemoglobin level [p=0.0001]. Maternal malaria was significantly associated with LBW babies [p=0.001]. The mean birth weight of infants born to pregnant women with malaria was 461 g less [p=0.0005]. No significant association was, however, found between malarial infection during pregnancy and IUGR [p=0.33]. Malarial infection during pregnancy is associated with poor maternal and fetal outcome. It is significantly associated with maternal anaemia and LBW infants. Appropriate measures must, therefore, be taken to prevent malaria during pregnancy, especially in endemic areas

Bacteriuria and pregnancy outcome: a prospective hospital-based study in Pakistan women

The prevalence of bacteriuria in Pakistani women and its association with complications of pregnancy was studied. Out of 1579 women,77 had bacteriuria [4.8%]. There was no association of age, gravidity, parity, haemoglobin, pre-eclampsia, mode of delivery, gestational age at delivery, preterm delivery and low birth-weight with presence of bacteriuria. With detection and treatment the pregnancy outcome of women with bacteriuria in pregnancy was the same as that of those without