Background: Emergency obstetric hysterectomy is the life-saving surgical intervention when all other available measures are unable to control obstetric hemorrhage. In addition to the known indications and risk factors for globally increasing this near miss event, home deliveries by untrained birth attendants is irrefutable cause of obstetric morbidity and mortality Aim: To identify the risk factors and indications for EOH like Pakistan. Study design: Retrospective descriptive study. Settings: OB/GYN department of Lahore General Hospital, PGMI. Duration: Two years, from start of 2020 to the end of 2021. Methodology: All patients having emergency obstetric hysterectomy in Gynae Unit 3, were included in this study. Risk factors and indications for the procedure were recorded. Outcome in the form of morbidity and mortality was reviewed. Results: Out of total 6809 deliveries, 48 patients had EOH and majority were multiparous with age ranging from 20 to 35 years. Complicated home deliveries ending in EOH were 8.32% of the cases. Two third of the patients had one or more previous caesarean sections and 70.8% underwent Caesarean section in the index pregnancy. Most of the women, 81.25%, were un-booked cases. Most common indication for EOH (50%) in our study was uterine atony and 45.81% of the cases had morbidly adherent placenta. Conclusion: Rising trend of caesarian sections leading to placental issues, lack of proper antenatal care and deliveries at inappropriate places are the contributing factors in morbidity and mortality associated with EOH. Keywords: Uterine atony, morbidly adherent placenta, emergency obstetric hysterectomy.
Objective: To examine the indications of induction of labour at Services Hospital Lahore, a tertiary) care hospital and to study the maternal and fetal outcomes of this obstetrical intervention. Study design:: This study involved a retrospective analysis of 100 patients with Bishop score Of ≤ 6, admitted for induction of labour, done with Prostaglandin E2 , pessary (Dinoprostone 3mg), followed by amniotomy and / or oxytocin infusion. A comparison of indications and outcomes was made among nullipara and multipara. Data was analyzed by X2’ and Student’s / test. Results: The induction rate was 8% and the commonest indication was hypertensive disorders of pregnancy 42%, followed by prolonged pregnancy 22% and pre- labour rupture of membranes 21% . The mean induction to delivery interval was 21.2 hours for nullipara and 15. 1 hours for parous women, p = 0.00 was statistically significant. The caesarean delivery rate was higher with induced labours in nullipara 52% than in multipara 22%, the difference was statistically significant. 21% babies born with induced labours had Apgar score ≤ 4 and 8% required admission in neonatal intensive care unit. 17% patients had postnatal or post-operative complications. There were perinatal or maternal losses. Conclusion: It was concluded from the study that labour induction results in increased risk of operative delivery and longer hospital stay. Therefore, all obstetrical units should monitor the frequency of labour induction, scrutinize the indications and assess the impact of induction to determine the effect on caesarean delivery rate and perinatal outcome.
Objective: The aim of this study was to evaluate the obstetrical outcomes in patients with triplet pregnancy, with and without antenatal care. Study Design: Case Series. Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynaecology, Services Hospital Lahore, from 1st January 1998 to 31st December 2003. Patients and Methods: Twelve women, including 6 booked and 6 unbooked patients, with triplet pregnancies of ?24 weeks of gestation, who presented at the Department of Obstetrics and Gynaecology, during the study period, were selected. Obstetrical history, examination and antenatal records were assessed. Obstetrical outcomes including length of fetal gestational ages at delivery, birth weights, apgar scores and neonatal assessment, admission in neonatal intensive care and stillbirths / neonatal deaths were recorded. Data was tabulated and comparison of obstetrical outcomes between booked and unbooked patients was done. Results:. In analyses that were limited to triplet pregnancies presenting of >=24 weeks of gestation thus excluding those which could have ended in miscarriage. There were 6 unbooked patients who came to Labour ward with preterm labour, premature rupture of membranes or preeclampsia and were delivered in the Department. 6 patients with triplet pregnancy were booked in the first trimester and received antenatal care. The data was retrospectively collected over 6 years period. There were 6 nullipara and 6 multipara women in our study. The average maternal age was 30.3 years (range 24-36 years) and average maternal weight was 63.25 Kg (range 53 - 75 kg). 10 patients had conceived by ovulation induction and 2 patients had conceived spontaneously. The average gestational age at delivery in unbooked patients was 32 weeks (range 29-35 weeks) and was 34.8 weeks (range 33 - 37 weeks) in booked patients. Caesarean section was the preferred mode of delivery. However, two unbooked patients presented in active labour at 29 and 30 weeks delivered vaginally. Among the booked patients 15 babies were live-born with apgar score `, two babies required admission in neonatal nursery and were discharged on recovery, however one baby died of sepsis in nursery after 4 days and there were no intrauterine deaths. Among the unbooked patients only 3 babies were live-born with apgar score >=7, five babies were admitted in neonatal nursery and recovered within a week. 7 babies died in the first week of life, mostly due to complications of prematurity. There were three intrauterine fetal deaths among the unbooked patients. Conclusion: It was concluded from the study that with antenatal management the obstetrical outcomes of triplet pregnancy improves.
Background: Emergency obstetric hysterectomy is removal of the uterus to stop life threatening obstetric hemorrhage when all other measures fail. The life threatening hemorrhage and unavoidable emergency removal of the uterus is associated with considerable morbidity and mortality. Objectives: To review the complications associated with the potentially avoidable procedure of EOH. Material and methods: All the women, regardless of booking status, presenting in emergency labor room and outpatient department of Gynae Unit 3 from January 2020 to December 2021, who underwent EOH were included in the study. Preventive measures and complications associated with the EOH were reviewed. Results: Total number of births recorded in two years, between January 2020 and December 2021 were 6809. Out of these, vaginal deliveries were 3669 (53.8%) and remaining were the Caesarean sections, 3140 (46.1%). Out of 48 EOH performed, majority of the complications (61.5%) encountered were hypovolemic shock, coagulopathy, re-exploration, and visceral injuries, each being 15.38% of the complications. Conclusion: EOH being the life-saving surgical procedure is associated with significant complications. Improving the antenatal care and health education of women can reduce the maternal morbidity and mortality especially in the developing countries. Key words: Obstetric hemorrhage, EOH, complications.
Objective: To explore the perception of Obstetrics and Gynaecology (OB/GYN) postgraduates about the use of simulation in improving their clinical skills. Study Design: Explanatory sequential mixed method design. Place and Duration of Study: Obstetrics and Gynaecology department of Sharif Medical and Dental City (SMDC) Lahore Pakistan, from Jun to Oct 2019. Methodology: By using a homogenous purposive sampling technique eight postgraduate residents from Obstetrics and Gynaecology department were recruited. The study had two phases: In the first phase, quantitative data was collected and analyzed while in the second phase qualitative data were collected by following the quantitative phase and then analyzed. This framework was tracked through the procedure of instrumental delivery with vacuum application in a real-life situation. A survey was conducted before and after the simulation training by using a researcher-developed Likert scale questionnaire. After that in-depth qualitative interviews were conducted. The improvement in clinical performance was evaluated by pairedsample t-test and thematic analysis. Results: Significant performance improvement (p<0.001) after simulation training was reported. The thematic analysis revealed a lack of proficiency in clinical experience before simulation at behavioural and technical levels while enhancement in clinical experience after simulation at both levels. The perceived benefits of simulation with the major trends of simulation as time-friendly, as a source of deliberate practice, and as safe practice in the unthreatened environment were explored. The theme of suggestions was also explored. Conclusion: The participants showed improvement in their clinical skills by describing the optimized benefits of simulation. Few of them are.......
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