Association of Caesarean Uterine Scar Health in Women with Previous One Caesarean Section in Relation to Inter- Pregnancy Interval

Background:To find out safe inter pregnancy interval in patients with previous one caesarean section and promote trial of labour after caesarean (TOLAC) . Methods: In this descriptive study one hundred and fifty patients with singleton pregnancy and previous one caesarean section, who were planned for elective caesarean section, between 37-40 weeks, were included. Patients with multiple pregnancies, ruptured uterus, failure of TOLAC, multiple caesarean sections and preterm pregnancies were excluded. Visual uterine scar health was assessed per operatively in relation to different inter pregnancy intervals. Scar health was categorized as healthy or thick, thin, transparent and partial dehiscence. . Result:Patients, with inter- pregnancy interval of 12-18 months, had a high (69.6%) healthy scar. In patients with inter-pregnancy interval of 19-24 months, 76.9% scars were healthy. The group of patients whose inter pregnancy interval was more than 24 months, 71.8% scar were healthy Conclusion: When intra operative visual scar health was assessed in relation with inter pregnancy interval. No significant difference was found in uterine scar health in different inter pregnancy intervals

Rising Caesarean Section Rate – Whether Women Choice, Doctor Preference or Clinical /Non Clinical Indications are Responsible.

Background : To determine the factors responsiblefor the rise in caesarean section rates whetherwomen choice, doctor preference or clinical /nonclinical indications are responsible.Methods: In this observational study antenatalpatients of any age ,with any previous obstetrichistory and parity were asked about their wishesregarding mode of deliveries in the currentpregnancy irrespective of any clinical consideration.Actual indications for caesarean done in the next 3months were noted down and rate of caesarean andfrequencies for each caesarean indication werecalculated. Discussions with doctors regardingreasons for caesarean decisions in their practiceswere done and percentages were calculated for majorindications of caesarean in their practice.Results:Among 558 antenatal women, majority(74.1%) wished for vaginal delivery. Total caesareanrate in 3 months was 42.8%. Previous onecaesareans(24.67%) or previous multiplecaesareans(21.83) were the commonest indications.Clinicians revealed suspected fetalcompromise(intrapartum)(76.6%), previous onecaesareans(66.6%) and previous multiplecaesareans(50%) as the common indications. Nodoctor agreed on economic incentive being the solereason for caesarean in their practice.Conclusion: Majority of women wish to delivervaginally. The main reason for rise in caesarean rateare clinical indications like previous one andmultiple caesareans , suspected fetalcompromise(intrapartum) and failure to progress.Risk minimizing behaviour is prominent among nonclinical reasons for caesarean delivery

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score <7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score<7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac sodium in post-operative pain relief after cesarean delivery in the first 24 hours

Background About 80% of the patients experience enough post-operative pain to require analgesia. Adequate pain relief  is needed after caesarean section to assist ambulation , mother / baby bonding & above all, a  pleasant experience of being a mother. Different analgesics with  various routes of administrations are available for pain relief which include opioids and NSAIDS. Opiods are known for their undesireable side effects . Diclofenac sodium is an NSAID & acts via blocking prostaglandin production. The WHO recommends diclofenac as a first line drug in pain relief. It  is available in various preparations which include injections, tablets and suppositories. We  compared the mean pain experienced by the women after use of diclofenac suppositories and intramuscular diclofenac sodium after elective cesarean section in first 24 hours. Methodology This RCT was done in  the department of Obstetrics and Gynecology, --removed for blind review---from 1st March 2018 till 30th August 2018. Total of 100  antenatal women already planned for elective caesarean section ,who fulfilled inclusion criteria were selected after taking  informed consent & ethical approval by employing non probability consecutive sampling . The age , parity ,gestational age, weight  ,BMI & ASA status of all women was documented. 50 women were randomly assigned to the each group A & B. Group A was given 75 mg intramuscular diclofenac injection  immediately & then 8 hrly for the first 24 hrs after caesarean section while group B was given  100 mg rectal diclofenac suppository immediately & then  after 12 hrs  post caesarean for the first 24 hrs. if needed ,50 mg tramadol I/V was given to the women as rescue analgesia, Visual analogue pain  (VAS) score was used to assess the pain intensity of post operative  women after 24 hrs of caesarean and poltted  in the proforma. The number  of women needing rescue analgesia  in each group was also documented. & compared between the two groups. RESULTS:             Data was analyzed on the SPSS version 23.  In group A; mean age was 26.34 years with STD of 3.69. Mean gestational age was 37.82 weeks with STD of 1.79. In group B; mean age was 25.3 years with STD of 3.47. Mean gestational age was 37.70 weeks with STD of 1.59. In group A; mean weight was 84.62 kgs with STD of 5.76 and mean BMI was 32.18 with STD of 3.16. In group B; mean weight was 84.84 kgs with STD of 7.27 and mean BMI was 31.13 with STD of 3.57. In group A (intramuscular diclofenic injection group) the mean score of pain was 3.72 with STD of 0.57.  In group B (Diclofenic Suppository Group) the mean score of pain was 1.84 with STD of 0.68. P-value was significant. 26 women (52%) in group A (I/M diclofenac group) and 20 women (40%) in group B (rectal diclofenac suppository group) needed rescue analgesia with I/V Tramadol .P value was not significant.     CONCLUSION:             Dicolofenac is an effective post caesarean analgesic . Rectal route of diclofenac  is more effective than the intramuscular route as post caesarean analgesia . Almost less than half number of post caesarean women needed rescue analgesia after using diclofenac suppository

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

Association of Caesarean Uterine Scar Health in Women with Previous One Caesarean Section in Relation to Inter- Pregnancy Interval

Background:To find out safe inter pregnancy interval in patients with previous one caesarean section and promote trial of labour after caesarean (TOLAC) . Methods: In this descriptive study one hundred and fifty patients with singleton pregnancy and previous one caesarean section, who were planned for elective caesarean section, between 37-40 weeks, were included. Patients with multiple pregnancies, ruptured uterus, failure of TOLAC, multiple caesarean sections and preterm pregnancies were excluded. Visual uterine scar health was assessed per operatively in relation to different inter pregnancy intervals. Scar health was categorized as healthy or thick, thin, transparent and partial dehiscence. . Result:Patients, with inter- pregnancy interval of 12-18 months, had a high (69.6%) healthy scar. In patients with inter-pregnancy interval of 19-24 months, 76.9% scars were healthy. The group of patients whose inter pregnancy interval was more than 24 months, 71.8% scar were healthy Conclusion: When intra operative visual scar health was assessed in relation with inter pregnancy interval. No significant difference was found in uterine scar health in different inter pregnancy intervals

Comparison of efficacy and safety of zinc gluconate versus placebo for treatment of Primary Dysmenorrhea

Background & Objectives: Dysmenorrhea is a common gynecological complaint in women of reproductive age. Primary dysmenorrhea is defined as painful menstruation in the absence of any pelvic pathology and occurs in response to increased prostaglandin release from the ischemic endometrium. Conventional treatments include NSAIDs and oral contraceptive pills.  Zinc is an essential micronutrient with anti-inflammatory properties. We conducted this study to evaluate the efficacy and safety of zinc supplementation in treatment of primary dysmenorrhea in our target population as it presents as very common gynaecological issue in young adolescents females.   Methods: 100 participants with primary dysmenorrhea were enrolled in study from outpatient department via non-probability consecutive sampling. They were randomized into two groups. The intervention group (Group A) received zinc gluconate 50mg once daily and the control group (Group B) received placebo drug once daily, for 5 days before and 2 days after onset of menstruation. After three and six months of treatment severity of primary dysmenorrhea was assessed and compared in both groups using visual analogue scale for pain, along with side effect profile. Results: The treatment with Zinc gluconate reduced the mean pain score in females with primary dysmenorrhea after 3months with a further reduction after 6 months of treatment (P<0.001) as compared to placebo. Very few (4% after 3 months & 6% after 6 months) participants experienced the side effects of Zinc supplementation. Conclusion: zinc gluconate 50mg daily for 5 days before and 2 days after onset of menstruation can effectively treat the primary dysmenorrhea. The drug has very few side effects at this dose and duration of use. Key words: Primary dysmenorrhea, zinc gluconate, pain severity, visual analogue scale. &nbsp

Feto-maternal Outcome of Reverse Breech Extraction versus Dis-impaction of Fetal Head in Caesarean Section for Obstructed Labour

Objectives: Obstructed labour is an obstetrical emergency with adverse feto-maternal consequences and caesarean delivery in such cases requires skillful handling of impacted fetal head. Objective of our study was to guide clinician about caesarean technique that facilitates the delivery with least complications for mother and baby. Methods: It was a randomized clinical trial with non-probability consecutive sampling conducted at –removed for blind review---from 1st july 2018 – 30th june 2020. Patients who underwent emergency cesarean section were randomized to undergo either push technique for delivery of impacted fetal head (Group A) or reverse breech extraction method (Group B) via lottery method. The data of 60 patients who fulfilled the inclusion criteria was analyzed using SPSS version 19. Maternal outcome measured were extension of uterine incision, blood transfusion, postpartum pyrexia, wound infection, postpartum hemorrhage and length of hospital stay. Fetal outcome measured were 5 minutes Apgar score, birth weight and NICU admission. Results: The results of our study showed statistically significant difference between extension of uterine incision(p-value=0.015), blood transfusion during surgery (p-value=0.021) and postpartum hemorrhage (p-value=0.020) in two groups with pull technique associated with less traumatic extension of uterine incision, less intraoperative transfusion and less PPH than push technique of fetal delivery. Length of hospital stay was also significantly less in reverse breech extraction group(p-value=0.001).More patients had postpartum pyrexia, wound infection, low 5-min Apgar score and NICU admissions in cephalic delivery group but results were not statistically significant. Conclusion: The results of our study recommend reverse breech extraction technique to be a safe alternative to conventional vaginal pushing of fetal head especially regarding maternal outcomes during caesarean section of patients with obstructed labour for fetal delivery. Key words: Obstructed labour, impacted fetal head, reverse breech extraction, caesarean sectio