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

Effect of domestic violence on pregnancy outcome

To determine the causes and type of domestic violence endured by pregnant women and their effect on pregnancy, in terms of maternal and neonatal outcome. Cohort study. The study was conducted in Sir Syed Trust Hospital, Karachi, from March 2007 to February 2008. All the antenatal patients were screened for domestic violence, using a self-made questionnaire and abuse assessment screen. All the pregnant patients, who had language barrier or those who declined to be interviewed were excluded. All the pregnant patients with positive response, according to the abuse assessment screen were included in the group A, while every 4th patient with negative response was taken as control. SPSS 10 was used for statistical analysis. Logistic regression analysis was performed to determine the effect of domestic violence on delivery outcome. Relative risk was also calculated. Statistical significance was taken at p 0.05. Four hundred and ten [n=410] antenatal patients were interviewed. The factors associated with domestic violence included addiction in 32 [39%], allegedly aggressive nature of husband in 21 [25.6%] and unemployment of husband in 6 [7.31%] cases [p=0.001]. Fifty two per cent women had been victims to more than one form of violence. Antenatal complications were not observed in a statistically significant number in either group. Depression was identified in 25.60% of group A and in 3.65% of group B [p=0.001; RR=2.01; 95%CI=1.58-2.56]. Various factors leading to domestic violence were identified among the husbands of women subjected to violence during pregnancy. The differences between the two groups, with regard to neonatal outcome [except depression], did not reach statistical significance. However, depression was significantly higher in the women enduring violence