study of caesarean birth in a teaching hospital

A study was conducted to analyze the factors responsible for apparently high caesarean section rate in a teaching hospital, Nishtar Hospital, Multan and to assess maternal morbidity and mortality as well fetal outcome after caesarean section. Total 770 pregnant women were registered, 396 [51.43%] underwent caesarean section and 374 women [48.57%] had vaginal delivery. Each patient was assessed regarding her age, parity, obstetric background, booking status, elective or emergency caesarean section, maternal morbidity and mortality and fetal outcome. Most of the women who underwent caesarean section were in 20-30 years age group and of low parity i.e. 0-4 [80%]. Out of 396 patients, 325 [82.07%] had emergency caesarean section versus 71 [17.96%] elective caesarean section and 293 [74%] were non-booked cases that came to hospital for the first time as an emergency. Repeated caesarean section [26%], APH [17.92%], CPD and mal-presentation [14.14%], PET and eclampsia [13.38%], failed progress of labour and fetal distress [12.85%] and obstructed labour [12.12%] were the common indications for abdominal delivery. Wound sepsis was seen in 41 [10,35%] patients, PPH in 11 [2.77%] patients and one patient [0.25%] developed VVF who was operated for obstructed labour. The maternal deaths [0.75%] occurred following emergency caesarean section, all due to septicemia. 314 babies [79.29%] were born alive, 46 [11.60%] babies were already dead and 36 [9.09%] were early neonatal death [ENND]. Although caesarean section rate i.e. 51.43% was quite high in our unit, this was not true caesarean section rate for a specific population. Majority of the patients who underwent caesarean section in a teaching hospital, tertiary referral center, were high risk, non-booked cases and already had a trial of labour. So abdominal delivery was the only choice to manage these cases. Maternal morbidity and mortality was high in emergency non-booked cases versus elective caesarean section. Provision of adequate antenatal health services, timely identification of high risk cases, public awareness, interlinked close relationship between primary health services and tertiary hospital, early referral with back-up system, improvement in existing health facility in a teaching hospital with involvement of senior, skilled and experienced personnel in the management of obstetrics emergencies are the measures to be adopted to reduce the caesarean section rate, maternal morbidity and mortality and to improve fetal outcome

Unexpected pathology at vaginal hysterectomy for genital prolapse

Uterovaginal prolapse was a common disabling condition in multiparous women of advancing age in post-menopausal women. Among the various types of prolapse, second degree of uterovaginal prolapse was the most common finding and these all had normal coloured healthy looking cervix having normal cervical cytology and endometrial biopsy. Every vaginal hysterectomy specimen was subjected to detailed histopathological examination and out of all hysterectomy specimens; occult squamous carcinoma of cervix was detected in spite of normal previous cytology showing the false negativity of these screening tests. So it is necessary that every vaginal hysterectomy specimen, even if it grossly looks to be normal, should be subjected for detailed histopathological examination, so that the lady who was operated can have better follow up after recognition of unexpected finding