audit of caesarean section

The study was carried out to determine the caesarean section rate, to analyse the indications so that measures can be taken to reduce the caesarean section rate and its associated complications. A retrospective study was carried out over a period of five years from January 2000 to December 2004 at Gynae unit-I Bolan Medical Complex Hospital Quetta affiliated with Bolan Medical College Quetta. The source of information was the record of labour room, Operation Theater, antenatal and postnatal wards. This record provided the detailed information. The frequency of caesarean section during the study period was about 21%. Indications included, Dystocia [19.8%]. Fetal distress [19.6%]. Placenta praevia [18.3%]. Repeat caesarean [15.5%]. Previous one LSCS [for recurrent cause] [8.8%] Previous two or more LSCS [6.7%] Breech presentation [14.5%] and Cephalo pelvic disproportion [12.01%]. Nineteen percent of the total maternal deaths occurred during this period were because of the complications of caesarean section and Anesthesia. High prevalence of illiteracy and poverty in our female population of reproductive age, early marriages, high parity and increased maternal ages along with flaws in the health care system e.g, lack of facilities at the primary and secondary health care system, poor referral chain and departmental polices regarding dealing with commonest indications of caesarean section have been identified as major causes of ever increasing CSR

Vaginitis and sexually transmitted infections in a hospital based study

To determine the frequency of Sexually transmitted infections [STIs] in immigrant population versus the local population, comparing the symptomatic patients against the asymptomatic women as controls. A cross-sectional comparative study was conducted in Gynaecology Clinic of Unit 1, Bolan Medical Complex Hospital, Quetta. The study duration was six months from 1st April, 2004 to 31st October, 2004, examining 500 women. World Health Organization [WHO] recommended questionnaire was answered and High Vaginal Swab [HVS] was taken from posterior fornix of patient's vagina. Gram staining was done by the Pathology Department of the same hospital and description was based on Nugent's score and modified Spiegel's criteria. Blood was analyzed for human immunodeficiency virus [HIV] and hepatitis-B surface antigen [HBsAg] by immunochromatography. Analysis of results was done by Chi square test, screening test validity and incidence testing. Women with vaginal discharge had higher incidence of STI [84%] than without it [38%]. Refugees and women with grand multiparity made the high risk groups of targeted testing [P <0.001]. The commonest notifiable infections, in this study were vaginitis [33.48%], bacterial vaginosis [30.7%], candidiasis [10%], trichomoniasis [7.2%], gonorrhea [1.35%] and 1 case each of lymphogranuloma venereum and chancroid, and 3 carrier states of HbsAg were detected. No case of syphilis or HIV/AIDS, or genital herpes was found. This study will serve as a marker for the tip of an iceberg of STI in Balochistan, needing targeted testing in high risk groups

Perinatal mortality rate in relation to gender

To calculate the gross and gender adjusted perinatal mortality rate [PMR] and determine the association between gender and susceptibility towards perinatal death. Design: A cross-sectional hospital-based study conducted at Gynae Unit-I of Bolan Medical Complex Hospital, Quetta from 1st January to 31st December, 2002. Patients and The study included the total births and perinatal deaths over one year period. The cause of death was ascertained through specifically-designed questionnaires and external autopsy. PMR was defined as the number of fetal deaths from 28 weeks of gestations to early neonatal deaths within 7 days after birth. Birth weight of >1000 grams or 35 cms crown-heel length was considered in lieu of unknown gestational age. Multiple pregnancies and stillbirths occurring at home were excluded. Extended Wiggles Worth classification was used to study the etiology of perinatal death separately. The PMR was calculated to be 113 per 1000 births. Stillbirth rate was 103 per 1000 total births; out of these, 56.5% were intrapartum and 43.3% antepartum. Male stillbirths were 89.24% in intrapartum and 62.5% in antepartum [df=1,X2=16, p<0.001]. Out of 16 early neonatal deaths, 11 were male infants. Aberdeen classification revealed obstetric causes of PMR as antepartum haemorrhage [34 cases;76% males], malpresentations [28 cases; 57% males], and congenital anomalies [26 cases; 80% males], after adjusting for maternal age and parity. This study shows fetal gender as statistically significant risk factor and it will pave the way for future community-based studies to confirm such an association, after adjusting for other co-variables

Uterine rupture: an analysis of 25 cases

To review the incidence of uterine rupture at Sondeman [P] Hospital Quetta and to highlight the main causes and management approach. A retrospective analysis of the referred cases received with suspected diagnosis of uterine rupture over a period of fourteen months [1[st] March, 1999 to 30[th] April 2000]. Setting: Gynae Unit-1, Department of Obstetrics and Gynaecology Sandeman Provincial Hospital, Quetta During this period of fourteen months 61 87 deliveries took place in the hospital including 25 cases of uterine rupture, an incidence of 4 per 1 000 deliveries. Repair of uterus with bilateral tubal ligation was done in 14 [56%] patients while subtotal abdominal hysterectomy had to be done in 8 [32%] patients. Major postoperative complication was wound sepsis seen in four [16%] patients. Three [12%] maternal deaths occurred, two [66.66%] patients died due to hemorrhage and one [33.33%] patient due to sepsis. Fetal mortality was 1 00%