Objective: Comparative analysis of problems encountered betweenpatients of elective caesarean section and patients for whom elective caesarean section was planned but ended upin emergency caesarean section. Design: Descriptive prospective analysis. Setting: Gynae Unit-II, Services Hospital,Lahore. Duration: One year, 1 January 2006 to 31 December 2006. Patients & Methods: A prospective study of st st100 patients who presented for antenatal care (ANC) and for whom elective caesarean section (CS) was planned wasdone. Patients evaluation was done on a designed performa that included demographic, social and obstetrical histories.Problems encountered in the preparatory stage, logistic problems, administrative problems, problems encounteredduring surgery, maternal, fetal mortality and morbidity were noted. Results: The patients were divided into twocategories. Categories I: included patients who had elective CS and category II: included patients who ended up inemergency CS. Numerous problems were encountered for category II patients. In the preparatory phase there wasdifficulty in arranging medicines for 32 patients. (59.2%), arranging blood for 28 patients (51.8%), obtaining consentfor 1 patient (1.85%). Logistic problems included non-availability of operation theatre for 15 patients (27.75%), nonavailability of anaesthetist for 9 patients (16.65%), and non-availability of paediatrician for 38 babies (17.3%). Noneof the emergency CS were done with in the recommended 30 minutes interval. Despite this, there was no significantcoloration between the decision delivery interval (DDI) and perinatal outcome. In our study like threatening cases wereoperative within 60 minutes. Intra operative problems in the category II patients included adhesions in 40 patients (74%)vs 10 patients (21.7%) of category I, partial dehiscence in 16 patients (29.6%) of category II vs 4 patients (8.68%) ofcategory I. Excessive hemorrhage in 8 patients (14.8%) of category II vs 2 patients (4.34%) of category I. Among thepost operative complications anemia was present in 20 patients (43.4%) of category I vs 45 patients (83.25%) ofcategory II patients. Blood transfusion was required for 16 patients (29.6%) of category II vs 4 patients (8.68%) ofcategory I and all patients were given iron supplement. Major wound infection were seen in 9 patients (16.65%) ofcategory II vs 2 patients (4.34%) of category I. Resuturing was done after appropriate antibiotic cover and dailyantiseptic dressing. Minor wound infections were seen in 22 patients (40.7%) of category II vs 12 patients (26.04%)of category I. Urinary Tract Infections (UTI) was seen in 6 patients (11.1%) of category II vs 1 patient (2.17%) ofcategory I. Respiratory Tract Infection (RTI) was seen in 5 patients (9.25%) of category II vs 2 patients (4.34%) ofcategory I. All these were treated by appropriate antibiotic cover. Regarding the neonatal outcome 16 babies (29.6%)of category II were kept under observation in neonatal nursery (NNU) as compared to 6 (13.02%) babies of categoryI. Admission for 2-10 days in NNU were 8 babies (14.96%) of category II vs 2 babies (4.34%) of category I. 2 babies(3.74%) of category II expired later while none of category I. Conclusion: Patients for whom elective CS was plannedbut who ended up in emergency CS, the DDI was prolonged and there was increase risk of maternal morbidity, fetalmorbidity and mortality as compared to those patients who had elective CS.
Term pregnancy with large anterior wall intramural fibroid: an intra-operative challenge
