No abstract

Objective:To analyze the Caesarean Section (CS) rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex (NTSV) presentation delivering at a tertiary care hospital of Karachi over four months.Methods:This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS (n=106) were taken as cases and vaginal deliveries (n=106) as controls. This was an unmatched retrospective case-control study.Results:Mean age of patients was 26.6(SD: 4.2) years. Mean gestational-age was 38.6(SD: 1.0) weeks. Likelihood of CS was slightly less in patients who were attended by feto-maternal consultants(OR:0.81 CI:0.38-1.07) and was slightly more in patients managed by non-full-time faculty (OR:1.04 CI:0.59-1.85). Odds of CS was highest amongst consultants having average monthly volumes of 21-30 patients/month (OR:1.069 CI:0.48-2.34). However none of the above findings were statistically significant. A non-significant increase in risk of CS was observed with increase in experience of physicians (p=0.787).Conclusion:The results did not show statistically significant difference in CS rate among different groups of Obstetricians. This might indicate that managing labour according to standard guidelines can eliminate physicians’ bias. This can be further evaluated with larger multicenter prospective studies.

Objective:To compare neonatal outcomes between Category-1 and Non-Category-1 Primary Emergency Cesarean Section.Methods:This was a retrospective analysis, conducted at Aga Khan University Hospital Karachi from January 1st 2016 till December 31st 2016. Non-probability purposive sampling technique was used. A sample size of 375 patients who had primary Emergency Caesarean Section (Em-CS) was identified by keeping CS rate of 41.5% and 5% bond on error. Data was collected from labor ward, operating theatre and neonatal ward records by using structured questionnaire.Results:In the current study, out of 375 participants who underwent primary Em-CS; majority (89.3%) were booked cases. Two-hundred-eighty-two (75.2%) were primiparous women. Two hundred and thirty (61.3%) were at term and 145(38.7%) were preterm. The main indication among Category-1 CS was fetal distress (15.7%). For Non-Category-1 CS, non-progress of labour (45.1%) was the leading cause of abdominal delivery. Except for APGAR score at one minute (p value = 0.048), no other variables were statistically significant when neonatal outcomes were compared among Category-1 and Non-Category-1 CS.Conclusion:In this study, fetal distress and non-progress of labor were the main indications for Category-1 and Non-Category-1 CS respectively. We did not find statistically significant association between indications of Em CS and neonatal outcomes. However further prospective studies are required to confirm this association.

Background Gynecological patients with serious underlying morbidities require admission into intensive care units (ICUs) albeit being few in numbers. Objectives To review gynecological cases with non-pregnancyrelated illness, admitted to ICU with respect to diagnosis, associated risk factors, intervention required, aspects of management, and rate of mortality. Materials and methods Retrospective record view of gynecological patients admitted in the ICU from 2005 to 2014. Setting Aga Khan University Hospital, Karachi. Findings Twenty-six patients were admitted with complications secondary to gynecological indications. The most common reason was pulmonary edema (26.9%); sepsis was documented in 23.1% of all patients. Hemorrhagic shock was found in 11.5% gynecological ICU admissions, cardiogenic shock in 15.4%, and renal failure in 7.7%. Fourteen critically ill women with gynecological cancer were admitted to the ICU (ovarian cancer, n = 8; cervical cancer, n = 1; and endometrial cancer, n = 5). The overall mortality of gynecological patients was 26.92%. The most common interventions were mechanical ventilation (96%) followed by arterial line insertion (88%) and central line insertion (85%). Conclusion Critically ill gynecological patients requiring invasive mechanical ventilation, central hemodynamic monitoring, and invasive arterial pressure monitoring should be admitted to an intensive care unit. How to cite this article Qureshi R, Ahmed SI, Raza A, Amerjee A. Predictors of Mortality of Critically Ill Gynecological Patients. J South Asian Feder Obst Gynae 2016;8(2):96-100.

No abstract