scholarly journals Timely relaparotomy after caesarean section of a moribund patient can save the life

2015 ◽  
Vol 23 (1) ◽  
pp. 41-47
Author(s):  
Mukti Rani Saha ◽  
Iffat Ara ◽  
Suvash Chandra Roy ◽  
Tapan Kumer Saha ◽  
Nandita Paul ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Rectus Sheath ◽  
Case Fatality ◽  
Near Miss ◽  
College Hospital ◽  
Medical College ◽  
Primary Surgery ◽  
Internal Iliac ◽  
One Year

The aim of this study was to find out the outcome of cases requiring relaparotomy following caesarean delivery during the puerperium. This was a retrospective descriptive study set in a tertiary referral and teaching hospital i.e. Dhaka Medical College Hospital, Dhaka. Over a period of one year from January 1st to 31st December 2010, there were 5027 caesarean deliveries (53%-94%) out of a total of 9320 deliveries. Relaparotomy was done in 48 patients (0.95%) of the caesarean sections. The indications of repeat laparotomy were secondary postpartum haemorrhage (PPH) in 28 cases (58.33%), primary PPH due to uterine atony in 15 cases (31.3%), uterine sepsis with haemorrhage in 2 cases (4.17%), rectus sheath haemotoma in 2 cases (4.13%), internal haemorrhage after caesarean section in 1 case (2.08%). Of these 48 cases, in14 cases, primary caesarean section was done in this institution while 34 had caesarean delivery at other hospitals and clinics at (13 cases) and outside Dhaka (21 cases). Main surgeries performed at relaparotomy were subtotal hysterectomy in 29 cases, total hysterectomy in 9 cases, drainage of haematoma and peritoneal toileting in 4 cases, resuturing of uterine incisions in 5 cases, internal iliac arteries in 1 case. More than one procedure was often performed in one case. There were 6 maternal deaths following relaparotomy caused by shock following PPH, septicaemia and internal haemorrhage. Repeat laparotomy within six weeks of caesarean delivery was required 1 in 200 cases in this institute. Case fatality rate was (12.5%). Near miss fatalities were common. Majority on these were preventable. Identification of risk factors, adequate attention during primary surgery, expert decision, prompt intervention and proper case management during relaparotomy will improve the outcome. Centers carrying out caesarean section should have efficient blood transfusion service in the first place. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22693 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 41-47

scholarly journals Relaparotomy after Cesarean Section : Experience from a Tertiary Referral and Teaching Hospital of Bangladesh

1970 ◽  
Vol 24 (1) ◽  
pp. 3-9
Author(s):  
Salma Rouf ◽  
Sebera Sharmin ◽  
Farhana Dewan ◽  
Salma Akhter
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Teaching Hospital ◽  
Caesarean Delivery ◽  
Rectus Sheath ◽  
Case Fatality ◽  
Wound Dehiscence ◽  
Near Miss ◽  
Tertiary Referral ◽  
College Hospital

Objectives: The objective of the study was to find out the incidence, indications, risk factors and outcomes of cases requiring relaparotomy following caesarean delivery during the puerperium. Material and Methods: This was a retrospective descriptive study set in a tertiary referral and teaching hospital ( Dhaka Medical College Hospital) in Dhaka, capital of Bangladesh. Results: Over a period of one year from January 1st to 31st December 2007, there were 3830 caesarean deliveries (48.43%) out of a total of 7909 deliveries. Relaparotomy was done in 24 patients (0.63%) of the caesarean sections. The indications of repeat laparotomy were secondary postpartum haemorrhage (PPH) in 11 cases(45.8%), primary PPH due to uterine atony in 8 cases (33%), uterine sepsis with haemorrhage in 1 case (4.17%), rectus sheath haematoma in 2 cases (8.3%), internal haemorrhage after caesarean section in 1 case (4.17%) and abdominal wound dehiscence in 1 case (4.17%). Of these 24 cases, in 4 cases, primary caesarean section was done in this institution while 20 had caesarean delivery at other hospitals and clinics at (5 cases) and outside Dhaka (15 cases). Main surgeries performed at relaparotomy were subtotal hysterectomy in 12 cases, total hysterectomy in 5 cases, drainage of haematoma and peritoneal toileting in 2 cases, resuturing of uterine incisions in 1 case, ligation of uterine vessels in 2 cases and internal iliac arteries in 1 case and others. More than one procedure was often performed in one case. There were 6 maternal deaths following relaparotomy caused by shock following PPH, septicaemia and internal haemorrhage. Conclusion: Repeat laparotomy within six weeks of caesarean delivery was required 1 in 200 cases in this institute. Case fatality rate was high (25%). Near miss fatalities were also common. Majority of these were preventable. Identification of risk factors, adequate attention during primary surgery, expert decision, prompt intervention and proper case management during relaparotomy will improve the outcome. Key words: Caesarean delivery; relaparotomy. DOI: 10.3329/bjog.v24i1.6319 Bangladesh J Obstet Gynaecol, 2009; Vol. 24(1) : 3-9

scholarly journals Trial of scar in post caesarean pregnancies

2018 ◽  
Vol 7 (3) ◽  
pp. 1173
Author(s):  
G. Kuppulakshmi ◽  
S. Saranya
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Uterine Wall ◽  
Perinatal Morbidity ◽  
Surgical Incision ◽  
Medical College ◽  
Caesarean Birth ◽  
Obstetric Management ◽  
One Year ◽  
Present Pregnancy

Background: The term caesarean delivery used to describe the delivery of a fetus through a surgical incision of the intact anterior uterine wall. The objective of this study was to analyse the maternal and perinatal morbidity between successful VBAC and failed vaginal delivery in cases selected for trial of labour.Methods: Prospective study conducted in Government RSRM Lying In Hospital, Government Stanley Medical College, Chennai over a period of one year from January 2017 to December 2017.Results: Trial of labour in previous caesarean section was more successful when the interval between previous caesarean and present pregnancy was between two to four years 86.40%. Conclusions: Most patients with a prior caesarean birth are candidates for VBAC. In properly selected women, a trial of labour after one previous low transverse caesarean section constitutes the best and safest form of obstetric management.

scholarly journals Caesarean Delivery: Increases Subsequent Risk of Placenta Praevia

1970 ◽  
pp. 13-17
Author(s):  
Nasreen Banu ◽  
Nasima Begum
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Mode Of Delivery ◽  
Subsequent Pregnancy ◽  
Placenta Praevia ◽  
Chi Square ◽  
College Hospital ◽  
Medical College ◽  
Chi Square Test ◽  
Control Study

This case control study was conducted in the Department of Obstetrics and Gynecology, Chittagong Medical College Hospital, in the period from April 07 to March 08. A total of 232 multiparous pregnant women were included in this study; among them 51 were cases (with placenta praevia) and 181 were similar matched control. Past mode of delivery were explored in both the groups and analyzed statistically.Out of 232 subjects, prior caesarean delivery had 25.5% (n=13) in cases and 44.2% (n=80) in controls. After statistical analysis, caesarean section was considered as a risk factor for placenta praevia in subsequent pregnancy. The odds ratio = 0.43 (CI 0.22 – 0.86) and chi square test = 5.80 (df =1; p= 0.016). Key words: Placenta praevia; caesarean section. DOI: 10.3329/bjpp.v25i1.5740Bangladesh J Physiol Pharmacol 2009; 25(1&2) : 13-17

scholarly journals Indication and outcome of relaparotomy after caesarean section

2013 ◽  
Vol 45 (1-2) ◽  
pp. 19-23
Author(s):  
Sankar Prosad Biswas ◽  
Surovi Halder ◽  
Feroja Banu Shirin
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Postpartum Haemorrhage ◽  
Anterior Abdominal Wall ◽  
Rectus Sheath ◽  
Near Miss ◽  
Maternal Deaths ◽  
Uterine Arteries ◽  
Life Saving

The objective was to determine the indicatons, management and the outcome among the patient who underwent relaparotomy after caesarean section and to suggest the way to improve the quality of care. This was a retrospective descriptive study done in a tertiary level referral and teaching hospital, Khulna, Bangladesh, out of 55 cases requiring relaparotomy after caesarean section. Over a period of 15 months from 1st January 2011 to 31st march 2012, 1180 caesarean deliveries were done, out of total 3270 deliveries. During this period, relaparotomy was done in 55 cases. Among these, 10 cases followed caesarean delivery at this institute itself, while 45 cases have had caesarean delivery at peripheral hospitals. Postpartum haemorrhage in 31 cases (56.36%) and rectus sheath haematoma in 8 cases (14.55%) were the leading cause of relaparotomy. Among the 55 cases, 39 had emergency caesarean delivery while 16 had elective operation. Procedures undertaken at laparotomy were hysterectomy in 21 cases (38.18%), resuturing of uterine wound with uterine brace suture in 13 cases(23.63%), bilateral uterine arteries and ovarian vessels ligation in 7 cases (12.73%), drainage of haematoma in 8 cases (14.55%), and repair of anterior abdominal wall & peritoneal toileting in 5 cases (9.09%). A third laparotomy was done in 3 cases of which 2 cases were due to secondary PPH, a negative relaparotomy was done in one case. There were 7 maternal deaths following relaparotomy caused by hemorrhagic shock, septicaemia & renal failure and was 12.73%. Caesarean section is a life saving operation. However maternal mortality and near miss fatality after relaparotomy following caesarean section are common. So, relaparotomy should be considered as a procedure after a near miss fatality of mother. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13625 Bang Med J (Khulna) 2012; 45 : 19-23

scholarly journals Primary Causes of Caesarean Section among the Primigravida in Rajshahi Medical College Hospital

2019 ◽  
Vol 31 (2) ◽  
pp. 54-58
Author(s):  
Mosammat Nargis Shamima ◽  
Mst Rawson Ara Khatun ◽  
Rubayet Zereen ◽  
Nurjahan Akter ◽  
Nargis Zahan ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Skilled Birth Attendance ◽  
Middle Income Country ◽  
Medical College Hospital ◽  
College Hospital ◽  
Middle Income ◽  
Medical College ◽  
Birth Attendance ◽  
One Year

Background: Bangladesh recently became a middle income country and despite of its relatively low skilled birth attendance (26.5%) nevertheless experience a rise in caesarean section (CS) rate. But now the rate of CS increased almost seven fold from 3.5% in 2004 to 23% in 2016. Objective: To find out the cause and incidence of caesarean section among the primigravid mother in Rajshahi medical college hospital performed in between January 2017 to December 2017. Methods: This prospective type of observational study was performed in Rajshahi Medical College Hospital (RMCH) over a period of one year from January 2017 to December 2017. All primigravida who underwent caesarean section in RMCH were included. Result: During the study period there were 11018 deliveries. Overall CS rate was 40.98%. The rate in primi was 30.70% and last year it was 25.58%. Conclusion: The vast majority of CS was not medically indicated. A number of policies and program had been launched to counteract this increasing rate of CS but virtually there was no impact. TAJ 2018; 31(2): 54-58

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

scholarly journals Disease Profile and Death Pattern among the Children Admitted in Rajshahi Medical College Hospital

2021 ◽  
Vol 34 (1) ◽  
pp. 55-62
Author(s):  
Be Nazir Ahmmad ◽  
Fazlur Rahman ◽  
Naznin Parvin ◽  
Md Shamsul Alam ◽  
Shitangshu Banerjee ◽  
...  
Keyword(s):  
Health Care ◽  
Case Fatality Rate ◽  
Age Groups ◽  
Case Fatality ◽  
Medical College Hospital ◽  
Watery Diarrhea ◽  
Fatality Rate ◽  
College Hospital ◽  
Under Five ◽  
Medical College

Background: Rajshahi medical college hospital is a tertiary care teaching and referral center in the North-West part of Bangladesh. To assess the epidemiological trend in hospital admission, including morbidity and mortality pattern of illness in the pediatric population, it needs to develop effective health care planning, appropriate resource allocation, and integration of existing health care service facilities. Objective: To evaluate the diseases and deaths of children admitted in the department of pediatrics, Rajshahi medical college hospital, Rajshahi. Materials and methods: This is a retrospective study. The collected case records of all patients admitted in the department of pediatrics from 1st January 2017 to 31st December 2019 (3 years) were analyzed.  Result: A total of 62000 children were admitted during the mentioned study period. All the patients were distributed into three age groups infant, under five, and more than five, contributing 22%, 27.5%, and 19%, respectively. Acute watery diarrhea (21%), hereditary hemolytic anemia (18%), bronchopneumonia (10.4%), acute gastritis (9.4%), and acute bronchiolitis and wheezy child (7.17%) were the top five diseases in each of the three years of admission. Among the total admitted patients, 1003 (1.61%) patients died. Infant, under five, and more than five age groups constitute 61.3%, 28.1%, and 15.1%, respectively. Encephalitis and fulminant hepatic failure found the top two diseases causing death with a case fatality rate was 61% and 43%, respectively. The next highest case fatality rate was found in acute leukemia (15%). Other common causes of death include meningitis, cerebral palsy with complications (7.5%), bronchopneumonia with complications (3.8%). Conclusion: An admission-related comprehensive evaluation of this study will help to understand the diseases and death patterns of a hospital, leading to the development of more effective planning and case management strategies. TAJ 2021; 34: No-1: 55-62

scholarly journals Rising Trend of Caesarean Section in a Tertiary Hospital Over a Decade

1970 ◽  
Vol 29 (3) ◽  
pp. 126-132 ◽  
Author(s):  
R Nazneen ◽  
RA Begum ◽  
K Sultana
Keyword(s):  
Caesarean Section ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
Background Information ◽  
P Value ◽  
Demographic And Health Surveys ◽  
College Hospital ◽  
Medical College ◽  
Foetal Movement

Background information: Since the early 1990s, emergency obstetric care (EmOC) in Bangladesh has played important role to reduce the maternal mortality rate. Along with other indicators of improved maternal care, there is a trend of rising caesarean section rates over the last decade affecting the economy of the country. According to demographic and Health Surveys conducted between 1993 and 2004, rate of caesarean section has risen from 2% to 6% which is more pronounced in urban area. Objective: To assess the indications and the trends of caesarean sections done over a 10-year period from 1995- 2004. Study Design: A retrospective observational study of the cases of caesarean sections over a decade. Study setting: Holy Family Red Crescent Medical College Hospital. Results: 23748 women were admitted in department of Obstetrics and Gynacology. Total deliveries were 21149(89.05% of total admission). The caesarean birth rate increased from 45.85% to 70.55%. The indications varied a little in cases of malpresentation and eclampsia. APH and IUGR has risen a little (from 2.56 to 2.6 to 1.83 to 2.34%) respectively. But proportion of repeat caesarean section and that of presumed foetal distress (or less foetal movement) increased (from 25.99 to 31.45% and from 8 to 15%), recently the indication, as maternal choice is also coming up (from .43 to .8%). The proportion has fallen in prolonged labour for cervical dystocia (from 17 to 2.6%) and obstructed labour (from 4.6% to .36%). The data were compared and analyzed by Z Test and corresponding P value was calculated which was not significant. Conclusion: Though caesarean section is a very safe intervention in obstetrics at present, crucial evaluation of the indications is advocated to reduce the rates of caesarean secion. Keywords: Caesarean section rates; Indications DOI: http://dx.doi.org/10.3329/jbcps.v29i3.9432 JBCPS 2011; 29(3): 126-132

scholarly journals Rising rates of second stage caesarean section and its impact on maternal outcome

2018 ◽  
Vol 7 (7) ◽  
pp. 2681
Author(s):  
Shanmugapriya Kumaresan ◽  
Malarvizhi Loganathan
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Adverse Outcomes ◽  
Cesarean Sections ◽  
Maternal Complications ◽  
College Hospital ◽  
Second Stage Of Labor ◽  
Medical College ◽  
Second Stage ◽  
Second Stage Of Labour

Background: There is an alarming rise in caesarean section leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery. With this increasing caesarean section rate, there is a concerning increase in the rate of second stage caesarean section. This study highlights includes the rate of caesarean deliveries in the second stage of labour, the indications for delivery and the associated maternal morbidity in this cohort of women.  Methods: This was a prospective cohort review of all women with a singleton, cephalic fetus at term delivered by caesarean section in the second stage of labor between July, 2016 and December 31, 2017 at government medical college hospital Dharmapuri. The main outcome measures were second stage caesarean section, indications and its maternal morbidity.Results: 250 women underwent caesarean delivery in the advanced labor. Among the 250 patient’s majority of them were in the age group of 21-30 yrs. about 76% of the patients were primigravidae and only the remaining 24% were multigravida. The commonest indications for doing caesarean section in the second stage of labor was cephalo pelvic disproportion and non-reassuring fetal heart rate patterns. The difficult task was delivery of the deeply engaged head, the increased likelihood of intraoperative and post-operative complications.Conclusions: Cesarean sections done in second stage of labor are associated with several intra-operative maternal complications and morbidity.

scholarly journals Disease Profile and Death Pattern Among Children Admitted in a Medical College Hospital

2012 ◽  
Vol 36 (2) ◽  
pp. 66-70
Author(s):  
M Shameem Hasan ◽  
Sanat Kumar Barua ◽  
M Nasiruddin Mahmud ◽  
AHM Kamal ◽  
M Enayetullah ◽  
...  
Keyword(s):  
Child Health ◽  
Case Fatality Rate ◽  
Causes Of Death ◽  
Case Fatality ◽  
Medical College Hospital ◽  
Watery Diarrhea ◽  
Fatality Rate ◽  
College Hospital ◽  
Medical College ◽  
Acute Watery Diarrhea

Background: An understanding of epidemiological trend in hospital admissions, including diseases and death pattern, is critical for health care planning, appropriate resource allocation & improving existing services facilities. Objectives: To evaluate the disease and death pattern of children admitted in the department of Child Health, Chittagong Medical College Hospital (CMCH), Chittagong. Materials and Methods: This was a retrospective study. The case records of all patients admitted in the department from Jan 1, 2008 to Dec 31, 2010 were analyzed. Result: Total 38,692 children were admitted during this study period; among them total 1897(4.9%) patient died. Infant and under five age groups constitute 45.2% and 75.9% respectively, total admission whereas deaths from the same groups were 43.7% & 79.3% respectively. Bronchopneumonia (22%), acute watery diarrhea (15%), hereditary hemolytic anemia (12%), and bronchiolitis (10%), topped the first four positions in each of the three years of admission. Septicemia and encephalitis, with a case fatality rate of 24% and 35% respectively, were found as top two causes of death. Highest case fatality rate was found in hepatic encephalopathy (54%). Other common causes of death include meningitis (19%), severe malaria (21%), leukemia (22%), severe malnutrition with complications (11%), and congenital heart diseases (12%) Conclusion: Comprehensive evaluation of admission and death related findings of this study will help to determine possible gaps in patient care and planning for more effective case-management strategies. DOI: http://dx.doi.org/10.3329/bjch.v36i2.13081 Bangladesh J Child Health 2012; VOL 36 (2) : 66-70

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