Obstetrics Outcome of Cases Referred to Tertiary Care Hospital after Trial of Labour

Abstract

Introduction:  Labour is the physiological process with its inherent risk of complications so it requires supervision by skilled birth attendants. Delivery con-ducted by untrained birth attendants has a 4.67 times higher mortality rate as compared to the one conducted by SBAs. This study was conducted to determine feto-maternal outcome of cases referred to Fatima Memo-rial Hospital, after a trial of labour by TBA’s.

Objectives:  To determine feto-maternal outcome and to identify factors associated with adverse obstetric outcome.

Study Design:  Case series descriptive study.

Setting:  Department of Obstetrics and Gynecology Fatima Memorial Hospital, Lahore.

Duration with Dates:  Six months from 1^st April 2011 to 30^th September 2011.

Subjects and Methods:  One hundred patients who were admitted through emergency after a trial of labo-ur by traditional birth attendants (TBAs), lady health visitors (LHVs) or doctors at home or private clinics were managed and followed in the department of gy-necology and obstetrics Unit II. Patients were clini-cally evaluated and relevant investigations were car-ried out in all patients. Final diagnosis was made on the basis of history, clinical examination and investi-gations. Data collection too was structured proforma specifically designed for the purpose.

Results:  Mean age of the patients was 27.28 ± 5.13 years. Fever was the most common complication fou-nd in 69 (69%) patients. Antepartum hemorrhage occ-urred in 22 (22%) cases. Postpartum hemorrhage com-plicated 46 (46%) pregnancies leading to shock in 51 (51%) patients. Oligohydramnios was observed in 35 (35%) patients and uterine rupture in 5 (5%) cases. There were 3 (3%) maternal deaths.

      Low Apgar score was observed in 36 (36%) ba-bies. Meconium staining was present in 34 (34%) cases and 34 (34%) babies needed hospitalization. (Fe-tal growth restriction was found in 23 (23%) patients. There were 23 (23%) fetal neonate deaths.

Conclusion:  Postpartum hemorrhage led to maternal and fetal complications in majority of the patients whi-ch was not handled appropriately and immediately.

Key Words:  Postpartum hemorrhage (PPH), Oligo-hydramnios, shock.