Validation of a Predictive Model of Vaginal Birth after Caesarean Section in Pakistani Women.

OBJECTIVE: To determine the frequency of successful trials of vaginal birth after Caesarean section (VBAC) using the Flamm and Geiger model. STUDY DESIGN: Observational study. Place and Duration of the Study: Obstetrics and Gynaecology Unit II of Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. METHODOLOGY: Women with singleton pregnancy having cephalic presentation, previous one lower segment caesarean section (LSCS), and without any contraindication for vaginal delivery were included. Women bearing foetus having estimated weight >3.5kg, morbid obesity, multiple pregnancies, non-cephalic presentation, placenta praevia, abruptio placentae, uncontrolled maternal comorbidities, or had previous two or more Caesarean sections were excluded. Flamm and Geiger score was applied to record observations of successful and unsuccessful trials. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the score were calculated by ROC curve, along with its area under the curve (AUC) and Youden's index curve, with 95% confidence interval. RESULTS: This study included 258 participants. Successful vaginal delivery was possible in 125 (48.4%) participants, whereas 133 (51.6%) underwent emergency Caesarean section. Cervical dilatation and effacement were the main factors assessing the success. The Flamm and Geiger score of >5 had an area under the curve of 0.813 (0.762-0.864). The score's sensitivity was 75% (67-82%), specificity 76% (68-82%), and PPV of 75% with an accuracy of 76%. CONCLUSION: The Flamm and Geiger score of >5 demonstrated high sensitivity, specificity, PPV, and accuracy in predicting later successful vaginal birth. It is recommended as a promising and valuable tool for assessing VBAC's success in low-resource countries. KEY WORDS: Vaginal birth after caesarean, Flamm and Geiger Model, Indication of caesarean, trial of labour after caesarean, VBAC risk scoring criteria.

Awareness among general population attending Civil Hospital Karachi about risk factors associated with infertility.

OBJECTIVE: To evaluate awareness amongst general population attending Civil Hospital Karachi regarding risk factors associated with infertility. METHODS: A descriptive study was conducted on subjects who were attendants to the patients admitted in Civil Hospital Karachi or had appointment in outpatient department. They were interviewed one-on-one after their verbal consent, through separate questionnaires for each gender, from September 2012 to January 2013. Minimal age of the respondents included was 18 years. Data was entered and analyzed in SPSS (version 20.0). RESULTS: A total of 289 attendants were interviewed, 150 were females, with mean age 38.1 +/- 11.3 years, remaining 139 were males having a mean age of 32.5 +/- 9.9 years. Correct knowledge about the risk factors causing infertility was found to be limited among people. Only 159 (66.9%) and 142 (49%) of the total respondents recognized obesity and diabetes as a threat. Just 54 (36%) and 72 (48%) of females were able to appreciate hirsutism and menorrhagia respectively as cause. Sixty (43%) and 67 (48%) of males considered mumps and smoking respectively as culprits. In contrast to previous researches, men received greater votes for being a probable victim of infertility (55%; 159 of the total respondents). CONCLUSION: Inadequacy of knowledge about infertility was clearly demonstrated through this study. This lack of knowledge explains why such a strong stigma is attached to infertility in the society.