Vaginal discharge during pregnancy and associated adverse maternal and perinatal outcomes.

OBJECTIVES: To observe the effects of vaginal discharge during pregnancy on maternal and fetal outcomes. METHODS: This observational study was undertaken form June 2018 to 31 May 2019 period in the Department of Obstetrics and Gynaecology at Liaquat University of Medical and Health Sciences hospital Jamshoro Unit IV. Data were collected from a convenience sample of 85 pregnant women. All the pregnant women with vaginal discharge were included in the study, while the women with bleeding and other medical disorders during pregnancy were excluded. Data was analyzed. RESULTS: Women's mean age as 27.4 (±4.7) years and most were 28-35 weeks pregnant (n=29, 34%) and primigravida (n=35, 41%). Seventy six women (89%) presented with vaginal discharge while nine women (11%) reported no vaginal discharge. Of those with vaginal discharge,53 women (69.7%) had vaginal infections: bacterial vaginosis (n=21, 39.6%), vaginal candidiasis (n=17, 32.1%) and vaginal trichomoniasis (n=15, 28.3%). Pathological vaginal discharge (PVD) was associated with vaginal irritation (n=30, p<0.0001), vaginal pain (n=50, p<0.0001), fever (n=12, p=0.015), uterine contractions (n=31, p<0.0001), premature membrane rupture (n=29, p<0.0001), abortion (n=13, p=0.009), pre-term delivery (n=24, p<0.0001) and post-partum endometritis (n=19, p=0.0006). PVD was associated with neonatal outcomes i.e. low birth weight (n=24, p<0.0001), low Apgar score at birth (n=22, p=0.0001), neonatal respiratory distress syndrome (n=21, p=0.0002), neonatal intensive care hospitalisation (n=20, p=0.002) and early neonatal death (n=16, p=0.003). CONCLUSION: Pathological vaginal discharge (PVD) during pregnancy is more frequent and is associated with adverse maternal and perinatal outcomes.

Acute renal morbidities with obstetrical emergencies: An important women health issue.

OBJECTIVE: To observe the impact of acute renal morbidities with obstetrical emergencies on maternal health. METHODS: In this study pregnant women between 28-40 weeks gestational period and delivered women in their puerperal period up to 42 days after delivery having acute renal problems associated with obstetrical emergencies were included. Pregnant and delivered women with obstetrical emergencies and associated other morbidities were excluded. These women were registered on the predesigned proforma after taking written informed consent and taking approval from institutional ethic research committee. The data was collected and analyzed on SPSS version 21. RESULT: Out of these 196 total registered women, majority of these women 81(41.32%) were between 21-30 years of age and multiparous women with parity four and above were 83(42.34%). Commonest presenting symptoms were generalized oedema 123(62.75%) and oligouria 92(46.93%). Frequent obstetrical emergencies observed were pre-eclampsia 53(27.04%), post partum haemorrhage 48(24.48%) and ante partum haemorrhage 36(18.36%) women. The complete recovery was observed in 86(43.87%) women, while mortality was seen in 56(28.57%) women. CONCLUSION: Renal morbidities were more frequently observed in obstetrical emergencies leading to high morbidity and mortality rate.

Labour induction with gestational hypertension: A great obstetric challenge.

OBJECTIVE: To observe the fetomaternal morbidity and mortality with induction of labour in pregnant women with gestational hypertension. METHODS: The subjected study population included was 138 pregnant women with gestational hypertension. These pregnant women were between 34-40 weeks of gestational period in whom labour was induced, while the pregnant women who had labour induction for other reasons were excluded. These women were registered on the predesigned proforma. The data was collected and analyzed on SPSS version 21. RESULT: Out of the 138 cases, mean age of the women was 25.93±5.037, prim gravid women were 78(56.5%), gestational period in majority of these women 71(51.4%) varied between 35-38 weeks. The common presenting symptoms were oedema 119(86.23%), headache 90(65.21%). Labour induction in majority of the cases 81(58.7%) was carried with prosten pessary. The Caesarean section was needed in 39(28.3%) women in emergency due to maternal and fetal reasons or due to failed induction. Maternal complications were uncontrolled hypertension 23(16.7%), intensive care unit admission 21(15.2%), fits 15(10.9%), post partum haemorrhage 13(9.4%). Fetal complications were birth asphyxia 49(35.5%), neonatal intensive care unit admission 17(12.3%), neonatal death 14(10.1%). CONCLUSION: The emergency Caesarean section rate was quite high with induction of labour in pregnant women with gestational diabetes. The maternal morbidity as well as fetal morbidity and mortality rate was also high.

Iron deficiency anaemia is still a major killer of pregnant women.

OBJECTIVE: To observe the effects of iron deficiency anaemia on the health and life of pregnant women. METHODS: This cross sectional study was conducted at the Department of Obstetrics and Gynaecology Unit IV, Liaquat University of Medical and Health Sciences Jamshoro from 1st June 2015 to 30(th) November 2015, for the period of 6 months. During this study period all the pregnant women from 13-40 weeks of pregnancy with iron deficiency anaemia having haemoglobin level less than 9 gram% were included, while the pregnant women with other medical disorders were excluded from the study. The data was collected and analyzed on SPSS version 21. RESULT: Out of the 305 pregnant registered women with iron deficiency anaemia most women were young 170(55.73%) between 20-30 years, belonged to low socioeconomic group 254(83.27%), they were multiparous 104(34.09%), having very low haemoglobin level between 1-3 gram % in 54(17.70%) women and between 4-6gram% in162 (53.11%) women. These women were prone to high complications such as ante partum haemorrhage 49(16.06%), renal failure 48(15.73%), disseminated intravascular coagulation 54(17.70%) and 16(5.24%) women died. CONCLUSION: Iron deficiency anaemia is common in pregnant women with higher rates of complications.

Acute Hepatitis E Viral Infection in Pregnancy and Maternal Morbidity.

OBJECTIVE: To determine the maternal morbidity in pregnant women with acute hepatitis E viral infection. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Departments of Obstetrics and Gynaecology and Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Red Crescent General Hospital and Saint Elizabeth Hospital, Hyderabad, from January 2011 to December 2013. METHODOLOGY: The study population was pregnant women with acute hepatitis E infection confirmed by ELIZA technique. Pregnant women with other hepatic viral infections were excluded. All medical and obstetric conditions, and mortality were noted on the predesigned proforma. RESULTS: Out of the total 45 admitted pregnant women with hepatitis E viral infection, 22 women (48.9%) had severe morbidity. The most common were hepatic coma in 8 (36.36%) cases and disseminated intravascular coagulation in 14 (63.63%) cases. Highest mortality rate was seen in women with hepatic coma (100%), while in those with disseminated intravascular coagulation, one out of the 14 cases (7.14%) died. CONCLUSION: The acute viral hepatitis E infection in pregnant women is associated with maternal morbidities and high mortality rate.

Synthesis, Biological Evaluation, and Docking of Dihydropyrazole Sulfonamide Containing 2-hydroxyphenyl Moiety: A Series of Novel MMP-2 Inhibitors.

In this study, we synthesized a series of dihydropyrazole sulfonamide derivatives containing 2-hydroxyphenyl moiety as antitumor agents to target the matrix metalloproteinase-2 (MMP-2). All of the synthesized compounds were examined by bioactivity assays, in which compound 4c turned out as a potential antagonist of MMP-2 along with potent anticancer activity against four tumor cell lines. Structure-activity relationship analysis was also performed to examine how structural changes impacted the bioactivity. Suggested to be caused by the induction of apoptosis, the antitumor mechanism of 4c was further confirmed by PI combining with annexin V-FITC staining assay using flow cytometry analysis. These new findings along with molecular docking observations suggested that compound 4c could be developed as a potential anticancer agent.

Hepatitis E -- A preventable health issue -- endangering pregnant women's life and foetal outcomes.

OBJECTIVE: To observe the clinical spectrum, complications and pregnancy outcome in women with Hepatitis E. METHODS: The descriptive prospective study was conducted at the Liaquat University of Medical and Health Sciences, Jamshoro, Red Crescent General Hospital and Saint Elizabeth Hospital, Hyderabad, from January 1, 2011, to December 31, 2013. All pregnant women with Hepatitis E positive on virology screening were included. The subjects were enrolled from the out-patient department as well as from among those admitted in either Obstetrics or Medical wards. Data was obtained through a predesigned proforma, and analysed using SPSS 20. RESULTS: The overall mean age of the 45 women in the study was 27.78±6.742. There were 21(46.7%) women in 21-30 years age group, 22(48.9) were multiparous, 31(68.9%) were uneducated, and 29(64.4%) were from poor social class. Besides, late second trimester and third trimester of pregnancy was found in 27(60%), unstable condition 10(22.22%), disturbed liver function test 24(53.3%) and raised serum glutamic pyruvic transaminase level >101u/l 27(60%), deranged coagulation profile such as raised prothrombin time 25(55.5%), and activated partial thromboplastin time 18(40%)cases. Overall 36(80%) women were discharged, while 9 (20%) died. Besides, 10(24.4%) babies needed intensive care, 13(42.2%) foetuses died during intrauterine life, 5(11%) were stillborn, while 17(37.8%) were alive and were discharged home. CONCLUSIONS: Pregnant women with Hepatitis E were more vulnerable as their life, health and foetal outcome suffered a lot.

Synthesis of aryl dihydrothiazol acyl shikonin ester derivatives as anticancer agents through microtubule stabilization.

The high incidence of cancer and the side effects of traditional anticancer drugs motivate the search for new and more effective anticancer drugs. In this study, we synthesized 17 kinds of aryl dihydrothiazol acyl shikonin ester derivatives and evaluated their anticancer activity through MTT assay. Among them, C13 showed better antiproliferation activity with IC50=3.14 ± 0.21 µM against HeLa cells than shikonin (IC50=5.75 ± 0.47 µM). We then performed PI staining assay, cell cycle distribution, and cell apoptosis analysis for C13 and found that it can cause cell arrest in G2/M phase, which leads to cell apoptosis. This derivative can also reduce the adhesive ability of HeLa cells. Docking simulation and confocal microscopy assay results further indicated that C13 could bind well to the tubulin at paclitaxel binding site, leading to tubulin polymerization and mitotic disruption.

A potent anticancer agent of shikonin derivative targeting tubulin.

In this study, a shikonin ester derivative, compound , was selected to evaluate its anticancer activities and we found that compound exhibited better antitubulin activities against the human HepG2 cell line with an IC50 value of 1.097 µM. Furthermore, the inhibition of tubulin polymerization results indicated that compound demonstrated the most potent antitubulin activity (IC50 = 13.88), which was compared with shikonin and colchicine as positive controls (IC50 = 25.28 µM and 22.56 µM), respectively. Compound was simulated to have good binding site with tubulin and arrested the cell cycle at G2/M phase, which also induces apoptosis in HepG2 cells, in which P53 and members of Bcl-2 protein family were both involved in the progress of apoptosis revealed by western blot. Confocal microscopy observations revealed compound targeted tubulin and altered its polymerization by interfering with microtubule organization. Based on these results, compound functions as a potent anticancer agent targeting tubulin.

Elective caesarean section for breech presentation in first pregnancy and subsequent mode of labour.

OBJECTIVE: To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. METHODOLOGY: All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned pro forma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. RESULTS: Out of the total, 131 (16.92%) women had previous elective caesarean section due to breech presentation while 643 (83.07%) women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 (70.22%) in women with previous breech presentation (n=131) in comparison with 475 (73.87%) women with previous cephalic presentation n=643 (RR=1.04, p=0.32). The vaginal birth rate after elective caesarean section due to breech presentation was 39 (29.77%) in comparison with 168 (26.12%) cases with previous cephalic presentation (RR=0.98, p=0.83). CONCLUSION: Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section.

Iatrogenic risks and maternal health: Issues and outcomes.

OBJECTIVE: To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. METHODS: This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. RESULTS: During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. CONCLUSION: The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable.

Hepatitis C in haemorrhagic obstetrical emergencies.

OBJECTIVE: To determine the maternal health and fetal outcome in hepatitis C with obstetrical haemorrhagic emergencies. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology Unit-I, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, Sindh, from January 2009 to December 2010. METHODOLOGY: All the women admitted during the study period with different obstetrical haemorrhagic emergencies were included. On virology screening, hepatitis C screening was done on all. The women with non-haemorrhagic obstetrical emergencies were excluded. Studied variables included demographic characteristics, the nature of obstetrical emergency, haemorrhagic conditions and maternal and fetal morbidity and mortality. The data was analyzed on SPSS version 20. RESULTS: More frequent obstetrical haemorrhagic emergencies were observed with hepatitis C positive in comparison with hepatitis C negative cases including post-partum haemorrhage in 292 (80.88%) and ante-partum haemorrhage in 69 (19.11%) cases. Associated morbidities seen were disseminated intravascular coagulation in 43 (11.91%) and shock in 29 (8.03%) cases with hepatitis C positive. Fetal still birth rate was 37 (10.24%) in hepatitis C positive cases. CONCLUSION: Frequency of maternal morbidity and mortality and perinatal mortality was high in obstetrical haemorrhagic emergencies with hepatitis C positive cases.

Risk factors and complications of puerperal sepsis at a tertiary healthcare centre.

OBJECTIVE: To determine the risk factors and complications of puerperal sepsis. METHODS: This was an observational prospective Cohort study conducted from January 2011 to December 2011 at the Obstetrics and Gynaecology Department Liaquat University of Medical & Health Sciences Jamshoro/Hyderabad, Sindh Pakistan. During this study period, all the women who delivered in this hospital or referred to this hospital within 42 days after delivery with puerperal pyrexia/sepsis diagnosed on clinical examination as well as with relevant investigations were included in the study. Women with other ailments like malaria, typhoid fever and postpartum eclampsia during the puerperal period were excluded. The subjects were registered on predesigned proforma after giving informed written consent. The data was collected and analyzed using SPSS version 17. RESULTS: During this period there were 3316 obstetrical admission and out of these 129(3.89%) women had puerperal sepsis. Most of these women 84(65.11%) were aged 31 years and above, multiparous 101 (78.29%), and unbooked 98 (75.96%) cases. Common risk factors found were absent membranes in 108(83.72%) of the women, delivered or undelivered and mismanaged, referred cases 95(73.64%), are being delivered in this hospital 34(26.35%). Morbidities seen were septicemia in 35 (27.13%) cases, and disseminated intra vascular coagulation in 23(17.82%) cases, while 11 (8.52%) of the women died. CONCLUSION: Common risk factors were anaemia; suboptimal personal hygiene as well as improper sterilization which resulted in severe health hazards such as septicemia, disseminated intravascular coagulation as well as death.

Infertility and weight reduction: influence and outcome.

OBJECTIVE: To assess the effect of weight reduction in obese infertile women on conception rate spontaneously as well as with ovulation induction and pregnancy outcome. STUDY DESIGN: Observational experimental study. PLACE AND DURATION OF STUDY: Different private clinics at Mirpurkhas, Thana Bola Khan and Hyderabad, Sindh, Pakistan, from March 2008 to February 2011. METHODOLOGY: Infertile women who were obese with the body mass index (BMI) > 30 kg/ m2 and failed to conceive within 2 - 5 years after taking treatment of infertility for many cycles were inducted. These women underwent life style change program related to exercise and diet for 6 months and in the next 6 months they were observed for spontaneous conception. Those women who failed to conceive were prescribed ovulation induction (clomifene citrate) for the next 6 months and were observed for conception. After conception, they visited regularly during antenatal period till delivery. The data was collected and analyzed on SPSS version 17. RESULTS: The mean decrease in the body index observed was 9.6 ± 1.23 kg/m2, spontaneous conception rate was (n = 35, 41.17%) and miscarriage rate was (n = 9, 16.66%). CONCLUSION: Weight reduction leads to high spontaneous conception rate as well as with ovulation induction therapy and improves the pregnancy outcome.

Design and synthesis of fluoroacylshikonin as an anticancer agent.

A series of shikonin derivatives, selectively acylated by various fluorinated carboxylic acids at the side chain of shikonin, were synthesized and their anticancer activity evaluated, in which eight compounds are reported for the first time. Among all the compounds tested, compound showed the most potent anticancer activity against B16-F10 (malignant melanoma cells), MG63 (human osteosarcoma cells), and A549 (lung cancer cells) with IC50 0.39 ± 0.01, 0.72 ± 0.04 and 0.58 ± 0.02 µmol/L. Docking simulation of compound was carried out to position into a tubulin active site to determine the probable binding conformation. All the results suggested that compound may be a potential anticancer agent.

Diagnostic laparoscopic findings in chronic pelvic pain.

OBJECTIVE: To assess the cause of pain on diagnostic laparoscopy in women with chronic pelvic pain and equivocal clinical and ultrasound examination. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Red Crescent General Hospital, Hyderabad, Sindh, from January 2007 to December 2009. METHODOLOGY: All the women presenting with chronic pelvic pain for more than 6 months duration, without any obvious pathological findings on clinical as well as on ultrasound examination were recruited. Women with chronic pelvic pain and having pelvic pathological lesions detected on clinical and/or ultrasound examination were excluded. Clinical, ultrasound, and laparoscopic data was collected and analyzed on SPSS version 14. The results were described as frequency, proportion, compared by chi-square test with significance at p < 0.05. RESULTS: Highest frequency of chronic pelvic pain was observed in women aged between 26 - 35 years (62.4%), 53 out of 85 women. Most of these women were married (90.6%) and nulliparous (47.1%). Pain was reported as dull and sharp by 35 women (41.2%), infertility (n = 46, 54.1%) and dyspareunia (n = 45, 52.9%) were the commonest co-existent complaints. On laparoscopic examination, pathological lesions were detected in 65, tuberculosis in 17 (20%) endometriosis in 11 women (12.9%), pelvic inflammatory diseases and pelvic adhesion in 8 (9.4%) women each and ovarian cyst in 6 women (7.1%). CONCLUSION: Positive laparoscopic yield was high in women with pelvic pain. Pelvic tuberculosis was the most common pathology detected followed by endometriosis, pelvic inflammatory disease and adhesions.

Obstetrical trauma to the genital tract following vaginal delivery.

OBJECTIVE: To determine the frequency, types and complications of genital tract trauma during child birth. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Unit I, Liaquat University of Medical and Health Sciences, Jamshoro, from June 2006 to May 2010. METHODOLOGY: All women who sustained genital tract trauma during delivery at the study centre and those referred from periphery with the same condition within 40 days of delivery were enrolled in the study. Exclusion criteria were women who sustained genital tract injury with caesarean section and genital tract trauma due to accident. Studied variables included age of women, parity, place of labour, type of trauma received and its immediate complications. The data was expressed in terms of descriptive statistics. RESULTS: Out of a total 9216 cases admitted in maternity ward during the study period, 467 cases (5.06%) had sustained genital tract trauma. The most frequent obstetrical trauma seen in primiparous referral cases were vaginal tears in 16 cases (25.39%) and perineal tears in 12 cases (19.04%). Multiparous women were 196 (41.97%) and cervical tears were the most frequent obstetrical trauma in them (n=52, 26.53%). Grand multiparous women were 208 having cervical tears (44.4%) and uterine rupture in 77 cases (37.01%) each. Most frequent early morbidities were postpartum haemorrhage (n= 352, 75.37%), hypovolemic shock (n= 220, 47.10%) and infection (n=158, 33.83%). The mortality rate was 16.05%. CONCLUSION: Genital tract trauma is a common complication of vaginal birth mostly seen in grand multipara, leading to haemorrhage, shock and infection.

Risk factors in early pregnancy complications.

OBJECTIVE: To determine the underlying risk factors in early pregnancy complications and outcome. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Obstetrics and Gynaecology Unit-IV, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2007 to June 2008. METHODOLOGY: All the women with first trimester pregnancy with different complications were included in this study while those women with uneventful first trimester were excluded. The inducted women were registered on pre-designed proforma. Studied variables including demographic details, gestational period, type of complications, risk factors, treatment and outcome. The data was expressed in terms of mean and percentages with a confidence interval of 95%. Analysis was done on SPSS version 14. RESULTS: Out of a 204 total admissions, 115 (56.37%) patients had different early pregnancy complications. Their mean age was 29.4+6.8 years. Commonest complications found were abortion in 88 (76.52%) cases. The underlying risk factors found in abortion were antiphospholipid syndrome in 5 (5.68%) cases, Diabetes mellitus in 8 (9.09%) cases, hypertension in 16 (18.18%) cases, and polycystic ovarian syndrome and infection in 11 (12.5%) cases each. Most of the cases 69 (60%) were treated by minor surgical procedures, and 22 (19.13%) cases responded with conservative medical therapy. Outcome were anaemia in 92 (79.3%) cases, psychological upset in 72 (62.1%), infection in 55 (44%) cases and coagulopathy in 9 (7.8%) cases. CONCLUSION: Abortion was found as the most frequent early pregnancy complication and the most frequent underlying risk factor was hypertension. Outcome included anaemia, psychological upset and infection.

Subjective pain perceptions during labour and its management.

OBJECTIVE: To investigate women's own labour pain perception, experiences and satisfaction with health care providers at a referral hospital of Sindh. METHODS: A descriptive study conducted on 400 labouring women at Obstetrics and Gynaecology Department Unit-II and IV Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to July 2006. Four hundred full term labouring women in first stage of labour were included in the study. All the women with associated medical problems were excluded. Two questionnaires were completed containing demographic details, antenatal record, mode of onset of labour, labour duration, ambulation, use of various pharmacological agents and women's personal experiences regarding pain perception and future family planning. Data was collected and analyzed on simple percentage basis. RESULTS: This study shows an acceptable birth experience in 136 (34%) cases, while 264 (66%) patients found it an exhausting painful experience. Common factors which favour good experience included lower socioeconomic class 67 (57.98%), rural population (54.68%), multiparous women (68.08%), prior knowledge of labour pains (69.31%), spontaneous labour (86.89%), use of pharmacological agents (76.04%) and co-operative staff attitude (89.27%). Those who found labour pains an acceptable process, 87.5% had a positive attitude for future child bearing. CONCLUSION: Childbirth can be a good experience with effective antenatal counseling. A highly professional attitude and tender loving care is the key to a pain free labour.

Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section.

BACKGROUND: To determine the frequency of second stage intervention and the risk of maternal and foetal morbidity and mortality associated with instrumental vaginal deliveries versus caesarean section in our tertiary care set up. METHODS: This descriptive study was conducted in the Department of Obstetrics and Gynaecology (Unit-II) Liaquat University Hospital Hyderabad Sindh, Pakistan from January 2005 to December 2006. All the women who underwent instrumental vaginal delivery and caesarean section due to prolonged second stage of labour were included in this study. Data were collected on a pre-designed proforma, which included demographic details, maternal and perinatal morbidity as well as any complications etc. Finally, data were analysed through software program SPSS 10.0. RESULTS: Frequency of second stage intervention was 22.2%. Among, 400 women who undergone second stage intervention, 240 (60%) were delivered by caesarean section and 160 (40%) were delivered with the help of instruments. Majority of women, i.e., 49.25% were between 21-30 years of age, 73% were un-booked cases while 45% cases were primigravida. Complications with abdominal delivery were paralytic ileus in 35 (14.58%) cases, post partum haemorrhage in 30 (12.5%) cases and tear extension in 13 cases. Complications with instrumental delivery were vaginal tear in 28 (17.5%) cases, cervical tear in 12 (7.5%) and third degree perineal tear in 4 (2.5%) cases. The perinatal outcome with abdominal delivery (86.66%) was better as compared to instrumental delivery (72.5%). CONCLUSION: The frequency of second stage intervention seems high in our set up and is associated with significant maternal and perinatal morbidity. Maternal morbidity was more frequent abdominal delivery while neonatal morbidity and mortality was more frequent with instrumental delivery.