Objective: The aim of the study was to assess the magnitude and causes of three delays and their possible implications for safe motherhood. Methods:The cross-sectional prospective study was carried out over a period of 1 year from January to December 2010. All patients who fulfill the WHO criteria for maternal near miss and all cases of maternal death during this period were included in the study. The various factors responsible for the delays in accessing obstetrics care facilities at all the three levels were analyzed. Results:During 1 year period there were 10,553 emergency admissions in labor room and there were 4538 deliveries, out of these 123 patients who fulfilled the WHO criteria for near miss were included in the study. 83% of patients (102) reported first delay in seeking care and the most common reason for delay was inability to judge the graveness of situation. After initial care there was a delay in reaching a facility with comprehensive obstetric care in 62% of cases (76 patients) and this delay was of around 6 to 8 hours. Once the patients reached Jinnah Hospital there was a delay in about 15 (12%) patients. There were 13 maternal deaths during this period of 1 year and there was a delay both at seeking initial care and referral by the initial care providers. Conclusion:Delay in deciding to seek care (1st delay) was the major factors responsible for high maternal mortality and morbidity. So the role of community actors such as mothers in law, husbands, local healers and pharmacies and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

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Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17⋅7 per cent) had SBO due to hernia. Surgery was performed in 312 (75⋅2 per cent) of the 415 patients; small bowel resection was required in 198 (63⋅5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32⋅1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9⋅4 per cent (39 of 415), and was highest in patients with a groin hernia (11⋅1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16⋅3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1⋅05, 95 per cent c.i. 1⋅01 to 1⋅10; P = 0⋅009) and complications (odds ratio 1⋅05, 95 per cent c.i. 1⋅02 to 1⋅09; P = 0⋅001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group. *Members of the National Audit of Small Bowel Obstruction (NASBO) Steering Group and NASBO Collaborators are co-authors of this study and are listed in Appendix S1 (supporting information) Funding information