Vaginal breech delivery: still a safe option.

BACKGROUND: Elective caesarean section has replaced vaginal delivery for term breech foetuses due to fear of complications of vaginal breech delivery. This increasing rate of caesarean section worldwide is alarming. It has not only led to increase in adverse consequences in subsequent pregnancies and future fertility but also loss of skills for vaginal breech delivery. This study was conducted to determine the safety of vaginal breech birth in terms of maternal and neonatal complications. METHODS: This cross sectional study was conducted at department of Obstetrics/Gynaecology, Ayub Medical College, Abbottabad from January 2004 to December 2011. One seventy-eight women having successful vaginal breech delivery of singleton term foetuses from 2004-2008 were selected. They were studied for neonatal complications like low Apgar score (AS) < 7 at 5 min, birth trauma, admission to neonatal intensive care units and perinatal mortality. Maternal complications including any genital tract trauma and post-partum haemorrhage (PPH) were also noted. RESULTS: There were 11243 deliveries during this period, including 674 breech presentations at term (incidence of breech 6%). Out of 178 successful vaginal breech deliveries, 8 (4.49%) neonates had AS < 7 at 5 min, and 6 (3.37%) neonates needed NICU admission. There were no cases of birth trauma or perinatal morbidity. Maternal complications occurred in only 5 (2.8%) patients, 2 (1.1%) having perineal tears, 2 (1.12%) retained placenta and one (0.56%) case of post partum haemorrhage. CONCLUSION: Vaginal breech delivery can be safely undertaken without compromising maternal and neonatal outcome if strict criteria are met before and during labour.

Vesicovaginal and rectovaginal fistulas: 12-year results of surgical treatment.

BACKGROUND: Although the magnitude of obstetric fistulae (OF) is reported to have decreased in industrialised countries, it is still a major problem in developing countries especially the fistulae resulting from obstructed labour. Vesico-vaginal fistulae (VVF) are the most common and the most frequent type of urogenital fistulas. In most cases, surgery is required for treatment. The aim of this study was to analyse the results of surgical treatment of VVF and Rectovaginal Fistulae (RVF) in a tertiary level institution over 12 years period. METHODS: This retrospective study was conducted at Ayub Teaching Hospital, and Women and Children Hospital, Abbottabad. It included records of a total of 74 patients who were surgically treated from 2001 to 2012. RESULTS: Cause of VVF was obstructed labour in 81.08% of cases, and it was iatrogenic in 18.92% cases. In the surgical treatment of primary VVF transvaginal approach was used in 91.9%, while transabdomenal approach was used in 2.7% cases. In 54.1% of cases the VVF healed after a single surgical intervention, while in 45.9% cases more-than-one operations were required. CONCLUSION: Birth trauma is still a major cause of VVF/RVF in our region. Prevention is possible with provision of sufficient health care and public awareness. Successful repair is possible with 1st surgery.

Association of maternal hypertension with placental abruption.

BACKGROUND: Placental abruption is one of the leading causes of maternal mortality and morbidity. Many causes predispose an expecting mother to placental abruption, such as trauma, previous history, smoking, ethnicity and hypertension. The present study concentrated on maternal hypertension as a cause of abruption. METHODS: All subjects of this comparative study underwent a complete obstetrical clinical workup comprising history, general physical examination, abdominal and pelvic examination, and relevant investigations. The maternal condition was assessed and managed according to established labour ward protocols, which included both pharmacological and surgical intervention. Patients were allotted various subgroups for detailed data analysis and comparative analysis. RESULTS: A total of 50 cases and 50 controls for placental abruption were studied during the study period. Both groups were compared based on parity, gestational age, proteinurea, haemoglobin, and hypertension. Mean systolic blood pressure (SBP) of cases in this study was 155 +/- 7.8 mmHg versus mean SBP for controls was 120 +/-14 mmHg. Mean diastolic blood pressure (DBP) of the cases was 104 +/- 6.6 mmHg compared to controls where mean DBP was 71 +/-11 mmHg. Among the controls, 45 (90%) had blood pressures in the normal range. There was statistically significant differences between cases and controls with respect to hypertension (p < 0.01). CONCLUSION: Placental abruption is strongly associated with maternal hypertension.

Neonatal outcome in pre-eclamptic patients.

BACKGROUND: Pre-eclampsia (PE) is defined as hypertension (blood pressure of 140/90 mm Hg on two occasion 4-6 hour apart or single reading of diastolic blood pressure of >110 mm Hg) and proteinuria developing after 20 weeks of pregnancy up to 6 weeks post partum in previously normotensive, non-proteinuric women. The aim of this study was to determine the neonatal outcome in babies born ofpre-eclamptic patients. METHODS: It is a cross-sectional comparative study and was carried out in department of Obstetrics and Gynaecology unit C of Ayub Teaching Hospital, Abbottabad from 1st January 2007 to 30th June 2007. The study population included all cases presenting with pre-eclampsia after 20 weeks gestation to emergency and OPD and controls (Normal subject without pre-eclampsia). RESULTS: A total of 73 cases of pre-eclampsia were recorded in study period and were matched for age, gestational age and parity with controls. Neonatal outcome data showed a perinatal mortality of 328 neonates per 1000 total births, major cause being still births and intrauterine death (IUD). Decreased APGAR score was present in 31 cases and 3 controls. CONCLUSION: Pre-eclampsia has great implication on adverse neonatal outcome. The various complications seen are low APGAR score, IUD, low birth weight, intrauterine growth restriction and increased need for admission to Neonatal Intensive Care Unit (NICU).