Maternal morbidity in emergency versus elective caesarean section at a tertiary care hospital.

BACKGROUND: In the past 30 years the rate of caesarean section (C/S) has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. METHOD: It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. RESULTS: There were 50 patients in each group. In group A, 11 (22%) were booked and 33 (66%) were referred cases. In group B, 48 (96%) were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 (20%) patients in group A, and 39 (78%) patients in group B, placenta previa, chorioamionitis, obstructed labour (6, 12% each); pregnancy induced hypertension and eclampsia in 5 (10%) cases in group A only. Intra-operative complications in group A were 48 (96%) vs 15 (30%) in group B (p = 0.000). Postoperative morbidity in group A was 50 (100%) and 26 (52%) in group B (p = 0.000). Intra-operative complication was haemorrhage in 46 (92%) cases in group A and 11 (22%) in group B. Anaesthetic complications were 40 (80%); prolonged intubation 25 (50%), aspiration of gastric contents 8 (16%), and difficult intubation 7 (14%) in group A. Ten (20%) cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 (82%) and 11 (22%) cases respectively. CONCLUSION: Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.

Prevalence of syphilis among antenatal clinic attendees in Karachi: imperative to begin universal screening in Pakistan.

OBJECTIVES: To assess the prevalence and associated risk factors of syphilis among antenatal clinic attendees by a multi-center cross-sectional study in Karachi, Pakistan. METHODS: We administered a structured questionnaire and obtained a blood sample for syphilis serology (rapid plasma reagin test with Treponema pallidum hemagglutination assay confirmation) from all women giving informed consent over six weeks in 2007. Prevalence was calculated at 95% confidence intervals. Multivariate analysis was adapted to assess risk factors. RESULTS: There were seven (0.9%) confirmed cases of syphilis (95% CI: 0.4, 1.8) in a sample size of 800 women recruited from three urban sites (-1% refusal rate). Women who lived in an area where male drug use is prevalent had 1.5% higher prevalence rates than women from the other two sites 0.5%. CONCLUSIONS: We documented higher-than-expected syphilis seroprevalence rates in a low risk population of antenatal clinic attendees in Pakistan. Bridge populations for syphilis may include drug users, who are usually married, and Hijras or their clients. In accordance with our results, the national policy for syphilis control in Pakistan should be modified to include universal syphilis screening in antenatal clinics with subsequent partner notification.

Perinatal mortality contributors in singleton gestation.

OBJECTIVE: To determine the feto-maternal factors contributing to perinatal mortality (PNM) in singleton gestation. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Gynae Unit-III, Civil Hospital, Karachi, from January to December 2002. METHODOLOGY: All obstetric patients with singleton pregnancy and gestation age greater than 24 weeks, regardless of age, parity and gravidity attending the gynae unit III in labor room and ward were recruited. Patients with gestational age less than 24 weeks or multiple pregnancy were excluded. Relevant data regarding history, risk factors in mother and baby were recorded on a pre-designed pro forma and later analyzed on SPSS 10 for descriptive statistics and comparison of proportions using chi-square statistics. Neonatal death was defined as live born infant who died before 28 days of age. Still birth encompassed any death of a fetus after 20 weeks of gestation or 500 gms, and perinatal mortality was considered as the sum of the still birth and neonatal death. RESULTS: In the 1505 studied mothers, the perinatal loss was 187(12.43%) including 140 still births and 47 neonatal deaths (3.12%). Perinatal mortality rate (PNMR) was 124/1000 total live births and neonatal death rate (NNDR) was 34/1000 live births. The commonest cause of still birth was antepartum hemorrhage (33.5%) and the commonest cause of NND was birth asphyxia (64%). PNM in relation to neonatal birth weight was highest in the 2.5 - 3.5 kg range i.e. 70 (50%, p=0.86). The proportion of primi/multi parity was 60 (45%) and 23 (49%) in still birth and neonatal deaths respectively (p=0.308). The leading causes of prematurity were antepartum hemorrhage, hypertensive disorders and chorioamnionitis. CONCLUSION: Perinatal mortality is markedly affected by fetal maturity. Parity and fetal weight have an insignificant effect on perinatal mortality.