Background and Objective: Maternal death measurement is essential to a country’s wellbeing and development status. In emerging countries like Pakistan, it remains an intimidating and failed public health challenge. Objectives of our audit were to estimate trends and causes of maternal demise in Lady Reading Hospital, Peshawar, Pakistan. Methods: Between January 2013 to December 2017, a retrospective study was carried out at Medical Teaching Institute, Lady Reading Hospital, Peshawar. A structured proforma was used to collect data from the medical records. To detect trends in mother demise maternal mortality ratio was calculated for each year and for all five years, Spss version 23 was used for data analysis. Results: In the five-year periods 134 deaths were recorded. The maternal mortality during the study period was 431/100,000 live births. An unstable trend in mortality with two crowning periods in 2013 and 2017 was observed. Hemorrhage persisted as the foremost cause of maternal death over the five years period, accounting for 47.76% deaths followed by hypertension, accounting for 25.37% deaths. An increased risk of 35.08% was observed among women aged 25-29 years, followed by 26.11% in 20-24 years and 23.88% in >30 years. Conclusion: There is a decreasing trend of maternal death from 2013 to 2016 but a slight increase was noted in 2017. Hemorrhage was the top cause responsible for the maternal death. doi: https://doi.org/10.12669/pjms.35.4.1091 How to cite this:Rafiq S, Syed W, Ghaffar SF. Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1091 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: To determine relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome Methods: This descriptive cross-sectional study was conducted in the department of Gynaecology, Lady Reading Hospital Peshawar, Pakistan, from January 2019 to July 2019. This study included 27 full-term pregnant women who had abnormal CTG during the active or latent phase of labour. Data were analyzed by IBM SPSS Statistics for Windows, Version 23.0. Results: Out of 27, most patients 13 (48.14%) were in the age group 20-25 years,11 (40.74%) to 26-30 years and 3 (11.11%) belonged to 31-35 years of age group. CTG abnormalities were severe bradycardia, late deccelerations and persistent variable deccelerations with loss of baseline variability. Of all delivered babies, 21 (77%) babies had birth weight<3.5 kg and 6 (22%) had >3.5 kg birth weight. 20 (74.07%) had acidosis (pH <7.2) at the time of birth, of which one had severe hypoxemia and acidosis with pH 6.85. APGAR score at 0 minutes showed a strong positive correlation (r=0.818, p= <0.001) with cord pH, while APGAR at five minutes was also strongly correlated (r= 773, p=<0.001). Of all babies 18(66.66%) with PH less than 7.2 were admitted in NICU while only 2 babies with PH more than 7.2 were admitted. (p value= 0.005). Conclusion: Low umbilical cord pH values of babies born by cesarean section (for fetal distress) are strongly correlated with low APGAR score at birth and higher rates of NICU admission. doi: https://doi.org/10.12669/pjms.36.7.2536 How to cite this:Syed W, Liaqat N, Qazi Q, Yasmeen S. Relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2536 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background & Objective: Placenta previa and its accompanying fetomaternal complications are increasing day by day because of globally increasing rates of cesarean deliveries, trends of assisted reproductive techniques, and delaying pregnancies to later ages. Placenta previa is an important contributor to iatrogenic and mostly emergent preterm deliveries, which add to increased neonatal morbidity and mortality. The predictors of preterm deliveries can help clinician make necessary preparations for optimal fetomaternal outcome. The aim of the current study was to determine relationship of placental edge thickness and cervical length with gestation at delivery in patients having placenta previa. Methods: It was a descriptive case series study conducted in the department of obstetrics and gynecology, Medical Teaching Institute Lady Reading Hospital Peshawar from January 2020 till January 2021. Seventy five patients fulfilled the inclusion criteria and were included in the study. Already diagnosed cases of placenta previa, with singleton alive pregnancies and gestation of 28 weeks or more were enrolled. Trans vaginal ultrasound was done to determine placental edge thickness and cervical length. Patients data on gestation at delivery were collected from hospital records. Results: A significant negative correlation between the placental edge thickness and gestational age at delivery was seen (r= -0.566, P= 0.001). The correlation between length of cervical canal and gestation at delivery was positive (r= 0.362, P=0.001). Also thick placental edge of > 2cm had significant association with birth before 37 weeks (P=0.023). A short cervix of less than 2.5 cm had also statistically significant association with birth before 37 weeks (P=0.022). Conclusion: There is linear inverse relationship of placental edge thickness with gestation at delivery. The relationship of cervical length with gestation is positive linear. Patients with thick placental edge are more likely to deliver preterm than those having thin placental edge. doi: https://doi.org/10.12669/pjms.38.5.5097 How to cite this:Syed W, Liaqat N, Naseeb G, Khattak SM. Relationship of placental edge thickness and cervical length to gestational age at delivery in patients with placenta previa. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.5097 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background and Objective: Obesity with its growing prevalence is a major public health problem influencing gestational age at delivery. Raised Body Mass Index (BMI) has been shown to be associated with significantly increased risk of prolonged pregnancy; which is an important contributor to perinatal morbidity and mortality. Obesity needs modified antenatal, intrapartum and postpartum care by obstetrician. Limited data is found regarding association of obesity with prolonged pregnancy and the same fact led us to search for this association. Methods: This cohort study was carried out in Gynecology and Obstetrics department, MTI Lady Reading Hospital Peshawar from March 2020 to April 2021. Patients were enrolled in third trimester at 37 weeks of gestation with primary exposures of interest being either self-reported pre-pregnancy weight or obtained from first trimester antenatal record. Patients were divided into two classes based on BMI i.e., one with BMI <25 and other with BMI ≥ 25. Patients in both classes were followed till their delivery to determine outcome of gestational age at delivery. Results: Statistically significant difference between the two groups was seen at lower age range of 18-21 years(p-0.04) and higher age range of 39-42 years (p-0.0001). Statistically significant association was found between high pre pregnancy BMI and postdates pregnancy (OR:4.93 ;95%CI:1.98-12.26, p-0.001). Association of induction of labor with high pre pregnancy BMI was not significant. (OR 0.56, 95%CI:0.21-1.48, P < 0.001). Higher rates of Instrumental deliveries(p-0.0005) and cesarean sections (p-0.0001) were seen in higher BMI group. Conclusion: Higher pre-pregnancy BMI is associated with increased risk of postdates pregnancy. doi: https://doi.org/10.12669/pjms.38.5.4815 How to cite this:Qazi Q, Liaqat N, Hussain SS, Syed W. Association of high Body Mass Index and postdates pregnancy. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.4815 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
OBJECTIVES: The objective of the study was to evaluate the efficacy of tranexamic acid in decreasing blood loss at the caesarian section (CS). METHODOLOGY: A descriptive case series study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, Pakistan. Data were collected from September 24, 2018, to March 24, 2019. A total of 114 term women (18-35 years age) with singleton term breech cases were analyzed for a period of six months RESULTS: In this study the mean age was 30 years with SD±2.341 and the mean period of gestation was 38 weeks with SD±4.76. Moreover, tranexamic acid was effective in 91% of patients and was not effective in 9% of patients. CONCLUSION: Our study concludes that the efficacy of tranexamic acid was 91% in reducing the blood loss during CS in primigravida patients with breech presentation.
Objective: To compare adverse feto-maternal outcome between women with early and late onset preeclampsia.Methodology: This cross sectional study was conducted in Gynecology and Obstetrics and Gynecology Department, Lady Reading Hospital, Peshawar from March 2016 to September 2016. A total of 254 patients having singleton pregnancy of more than 20 weeks were included. Week 34 was used as a cutoff to classify patients into Early Onset Preeclampsia (EOPE) and Late Onset Preeclampsia (LOPE). All the subjects were followed up till one week after delivery to compare adverse fetomaternal outcome. SPSS version 25 was used for data analysis.Results: Out of 254 patients, 172 (67.7%) patients had LOPE while 82 (32.3%) presented with EOPE. The mean Body Mass Index (BMI) for EOPE and LOPE was 25.25±1.70kg/m 2 and 25.97±2.03kg/m 2 , respectively. Most of the patients were multigravida in both groups, 43 (52.4%) in EOPE and 122 (70.93%) in LOPE. Preterm birth was more common in the EOPE (n=49, 59.75%) as compared to LOPE (n=60, 34.88%) with a p-value of ≤0.05. LOPE group had more cesarean sections (n=62, 36.02%) than EOPE (n=16, 19.53%) with a p-value of ≤0.05. Neonatal Intensive Care Unit (NICU) admissions were more common in EOPE group (60.92%) as compared to LOPE (41.82%) having a p-value of ≤0.05. Neonatal deaths and small for gestational age was found to be insignificant in the two groups. Conclusion:Preterm birth and NICU admissions were more common in EOPE while cesarean section was more commonly done in LOPE.
Background: Caesarean section is a time honoured approach that evolved to save maternal lives in the times of difficult deliveries. The rise in the rates of caesarean section is a matter of concern as being a major surgery, it is associated with risks that can extend for years and affect the health and future pregnancies of women.Objective: This study is carried out to analyses changing trends in the rates and indications of caesarean sections in the last six years in a Tertiary Care Hospital of Peshawar.Materials and Methods: This retrospective study is carried out by collecting record of all deliveries including indications of caesarean sections of the years 2014,2016 and 2018 of the unit. Results: The caesarean rate was 174/1000 total births for year 2014.It was 143 and 176 per 1000 total births for the year 2016 and 2018. The commonest indication for primary caesarean section was fetal malpresentations with rates as 31.5,30.2 and 29.9 per 1000 total births for 2014,2016 and 2018 respectively. Fetal distress was observed as the second commonest indication. Previous 2 or more caesareans was the commonest indication for repeat caesarean sections in all three years , with rise in rates from 21.4 to 28.70 per 1000 total births from 2014 to 2018.Conclusion: The rates of caesarean sections of the last five years on average are close to the WHO rates. Fetal Malpresentations, Distress and Previous two or more caesarean section are the leading indications of caesarean sections.
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