IntroductionNeonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes. MethodsA prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma. ResultsOur sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries. ConclusionBased on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.
The routine prophylactic administration of an uterotonic agent is an integralpart of active management of the third stage of labor, helping to prevent postpartum haemorrhage (PPH). The two mostwidely used uterotonic agents are: ergometrine-oxytocin (Syntometrine ®) (a combination of oxytocin, 5 internationalunits (iu) and ergometrine, 0.5 mg) and oxytocin, (Syntocinon ®) 10 international units (iu). Objective: To compare theefficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the management of third stage of labor.Study design: Experimental study. Setting: Department of obstetrics and gynaecology Combined Military HospitalPeshawar. Period: Over one year period from March 2005 to March 2006. Methods: A total 200 women havingsingleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simplerandom sampling using random number tables, 100 patients received 2 ml Syntometrine, (a combination of oxytocin,5iu and ergometrine meleate 0.5mg) intramuscularly and 100 patients received 10iu of intravenous syntocinon at thedelivery of anterior shoulder of the fetus. Results: The use of intravenous oxytocin,, was associated with a reductionin postpartum blood loss (P<0.001) but there was no difference in the risk of post partum hemorrhage, in the need forrepeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for bloodtransfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The useof syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% Cl 1.00-5.70) other side effects weremild in nature with no differences between the two groups. Conclusions: There are no important clinical differencesin the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum bloodloss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low
Objective: The purpose of this study is to determine the prevalence of placenta previa and adverse outcomes in patients with repeated C-sections. Study Design: Descriptive/Observational study Place and Duration: Gynaecology and Obstetrics Department, Combined Military Hospital, Peshawar for the period from February 2021 to January 2022. Methods: There were 60 pregnant women had age 20-50 years were presented. Pregnant women with the history of c-section were included in this study. After getting informed written consent demographics of included patients i.e age, body mass index, gestational age, parity and gravidity were recorded. After delivery, association of placenta previa was recorded. Maternal and fetus outcomes were also assessed in this study. SPSS 21.0 was used to analyze all data. Results: Majority of the cases 28 (46.7%) were aged between 20-30 years, 20 (33.3%) had age 31-40 years and 12 (20%) patients were aged between 41-50 years. 34 (56.7%) cases had BMI >25kg/m2 and 26 (43.3%) patients had BMI <25kg/m2. Mean parity of the patients was 4.7±3.21 and mean gestational age was 36.13±14.61 weeks. Frequency of placenta previa was found in 15 (25%) cases in which majority 9 (60%) were males and 6 (40%) were females. Among 15 cases of placenta previa, low apgar score, low birth weight and ICU admission were the adverse outcomes among new borns. In mothers, frequent bleeding, pre-eclampsia and gestational diabetes were the adverse events. Conclusion: The results of this research led us to the conclusion that the prevalence of placenta previa rises with an increasing number of prior caesarean sections and the associated negative fetomaternal outcome. Keywords: C-section, Placenta Previa, Adverse Events, Parity
Objective: This research aims to determine how well balloon temponade works as a treatment for postpartum bleeding. Study Design: Retrospective Study Place and Duration: Gynaecology and Obstetrics Department, Combined Military Hospital, Peshawar for the duration from February 2021 to January 2022. Methods: Total 118 women had age 18-40 years were presented in this study. Patients who were diagnosed with, or who were admitted to the hospital for treatment of primary postpartum haemorrhage caused by uterine atony were included. Gestational age and parity among all females were recorded. Folly catheter intrauterine ballon tamponade was used and its effectiveness among all cases was assessed. SPSS 23.0 was used to analyze all data. Results: Among 118 cases, 40 (33.9%) cases had age 18-25 years, 55 (46.6%) females had age 26-30 years and 23 (19.8%) cases had age >30years. 75 (63.6%) had BMI <25kg/m2 and 43 (36.4%) had BMI >25kg/m2. Mean gestational age of the females was 36.55±6.72 and mean parity was 3.11±6.9. Mean blood loss was 1208.5±227.9 ml. Mean pulse rate was 106.8±4.97 bpm. Mean systolic and diastolic blood pressure was 88.41±12.7 mmHg and 56.14±8.4 mmHg. Efficacy of balloon tamponade was found in 108 (91.5%) cases. Complications were found in 3 (3.5%) cases. Conclusion: We conclude that follys intrauterine catheter balloon tamponade controls postpartum bleeding. There should be a low threshold for using balloon tamponade as it is effective, easy to use, easily available, has a low complication rate, and is an economical modality to control non-traumatic postpartum haemorrhage, especially in resource-limited settings, and sustain reproductive potential. Keywords: Balloon Temponade, PostPartum Haemorrhage, Efficacy, Complications
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