Objective: The increasing rate of cesarean sections (CS) is a significant concern for healthcare providers worldwide. The World Health Organization (WHO) recommends that CS rates should not exceed 10-15% at the population level. The Robson classification system is a widely used tool for assessing and comparing CS rates based on the indications and patient population across different hospitals and obstetric populations. This audit report will help identify areas for improvement in obstetric care practices and facilitate the development of strategies to optimize obstetric care and reduce CS rates, thereby improving maternal and neonatal outcomes. Methods: This retrospective study utilizing hospital records was conducted from January 1st, 2022, to December 31st, 2022, at the Department of Obstetrics and Gynecology in Holy Family Hospital, Karachi, Pakistan. During the study period of one year, a total of 449 cesarean sections were conducted, which were classified into the ten groups of The Robson Classification. Group CS rate, Group size, Relative contribution of group to overall CS rate, and Absolute group contribution to overall CS rate was calculated for each group. Overall indications of CS in all groups was analyzed and based on the results interventions were suggested to be implemented to optimize CS. Results: 1464 women were delivered during this one year period. A total of 507 CS were our population of interest. Of the cesarean sections performed, 48.8% (247) were elective and 51.2% (260) were emergency. The Robson classification group 5 (51.9%), group 2 (18.5%), and group 10 (14.4%) respectively were the major contributor to the overall CS rate. The main indications for CS were previous history of caesarean section (32.3%), non-progress of labor (21.15%), and cephalopelvic disproportion (16.92%). Conclusion: It is crucial to develop strategies to decrease the unnecessary CS rate while ensuring safe and appropriate obstetric care. Furthermore, there is a need for further research to identify the underlying factors contributing to the high CS rates and to develop effective interventions to address this issue. Implementation of these strategies may lead to improved maternal and fetal outcomes, reduced healthcare costs, and increased patient satisfaction.
Idiopathic pulmonary haemosiderosis is a rare disorder, with recurrent life-threatening alveolar haemorrhages and chronic lung parenchymal changes. It is associated with a triad of haemoptysis, iron deficiency anaemia, and diffuse pulmonary infiltrates. Although most cases are idiopathic, secondary haemosiderosis linked to known diseases has also been observed. Most of the cases remain undiagnosed because the disease is very low on the list of differentials.
There is no specified age for the disease. The present study reports on an adolescent female patient who presented with microcytic anaemia and bilateral lung infiltrates to the National Institute of Child Health (NICH), Karachi, a tertiary care hospital. She was diagnosed with Idiopathic pulmonary haemosiderosis after ruling out other possibilities.
Keywords: Pulmonary haemosiderosis, Alveolar haemorrhages, Lung disease, Alveolar hypoventilation syndrome.
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The unchecked use of steroids by untrained practitioners, known as quacks, in rural areas of Pakistan has resulted in a surge of Cushing's Syndrome cases in children. This public health crisis requires urgent attention as it can cause growth retardation, delayed puberty, and cognitive impairment in children. The situation is further complicated by the lack of awareness among the local population about the dangers of steroid misuse, and the scarcity of medical facilities and qualified doctors in rural areas. To address this issue, a multi-pronged approach is required that involves raising awareness, strengthening regulatory mechanisms, and improving access to qualified medical professionals. This collaborative effort from all stakeholders can prevent further harm to children and promote their health and well-being.
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