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Objective: To evaluate the association of increased uric acid in pregnancy-induced hypertension with adverse perinatal outcomes. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Anesthesia, Gynecology & Obstetrics, Combined Military Hospital, Okara Pakistan, from Mar to Sep 2018. Methodology: After approval of the Hospital Ethical Committee, 106 patients with pregnancy-induced hypertension were included in our study (n=53 in each group). Group-A had patient with raised uric acid, whereas Group-B had normal uric acid. Perinatal outcomes were monitored prospectively. Results: There was no difference in demographic profile of the two study groups. Raised uric acid was shown to be associated with a higher cesarean mode of delivery (p=0.014); preterm delivery (0.001); intrauterine growth retardation (0.038); and low APGAR at 5mintues (0.008). Raised uric had a sensitivity greater than 65% and specificity greater than 50% for perinatal outcomes. Conclusion: Raised uric acid is associated with adverse perinatal outcomes in neonates. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of umbilical cord milking as an alternative to delayed cord clamping during caserean section by comparing neonatal outcomes. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital, Okara, from Mar to Oct 2018. Methodology: A total of 384 cases (n=192 in each group) were included in our study. In group A, the half-length of umbilical cord was milked thrice by the operating surgeon before clamping and cutting it. In group B the umbilical cord was cut 90 second after delivery of the baby. The outcomes were: APGAR score at one and five minutes after delivery, haemglobin and haematocrit 4 hours after delivery of baby. Requirement of oxygen and ventilatory support during the 24 hours after birth were also noted. Results: Our two study groups didn’t vary in their demographic profile. The difference between the APGAR score at one and five minutes was not statistically significant, (p>0.05). The diffrence in haemoglobin and haematocrit levels of the neonates 4 hours after delivery were insignificant (p-value 0.27 and 0.14 respectively). Conclusion: Milking of the umbilical cord can be used as an alternative to the recommended technique of delayed umbilical cord clamping, especially when immediate resuscitation of the newborn is needed. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the frequency and risk factors for post-operative surgical site infection (SSI) in cesarean section. Study Design: Cross-sectional study. Setting: Departments of Gynecology & Obstetrics and Anesthesiology, Secondary Care Hospital. Period: January to December 2017. Material & Methods: After the approval of hospital ethical committee, 337 parturient who underwent cesarean section were included in our study. Outcomes were: frequency and risk factors for post-cesarean wound infection. Data was analyzed by SPSS version 20. Qualitative data presented as frequency and percentage. Chi- square (Fishers test) used to analyze significance. P-value ≤ 0.05 taken as significant. Results: A total of 337 patients were included in our final analysis. The frequency of wound infection was 15 (4.4%). The mean age was 27.5 years ± 5.8 in our study population. There was no difference in age (p=0.781), parity (p=0.898), antenatal visits (p=0.319), referral from doctor (p=0.205), anemia (p=0.731), nature of surgery (elective or emergency LSCS) p=0.548, severity of anemia (p=0.962), blood grouping Rh-factor (p=0.531), chorioamnionitis (p=0.707), labor (p=0.955), premature rupture of membrane (p=0.427) and antepartum hemorrhage (p=0.769). 11 (3.3%) of the patients with SSI were treated conservatively while 4 (1.2%) required debridement and secondary suturing. None of our patients required referral to tertiary care hospital for treatment of SSI. Conclusion: The incidence of SSI after cesarean section was less in our study and we didn’t find maternal age, gestational age, previous cesareans delivery, antenatal visits, PROM, labor before LSCS, anemia to be associated with risk of SSI. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of preoperative leukocytosis and its association with wound infection. Study Design: Prospective-cross sectional, analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Thall, from Jan to Dec 2017. Methodology: After the approval of hospital ethics committee, 340 pregnant ladies undergoing both elective and emergency cesarean section were included in our study. The outcome of our study was the frequency of preoperative leukocytosis and its association with postoperative wound infection. SPSS version 20 was used to analyze data. The qualitative data was presented as frequency and percentage. Chi-square was used to analyze significance. A p-value ≤0.05 was taken as significant. Results: Frequency of preoperative leukocytosis was 121 (36.6%). A total of 111 (64.1%) pregnant ladies had pre-operative leukocytosis without post-operative wound infection versus 10 (66.6%) in patients with wound infection, p≤0.05, odd ratio 3.77. The sensitivity of pre-op total leukocyte count (TLC) for prediction of post-op wound infection was 66.6% (95% CI 38.3 to 88.8%) and specificity of 65.1% (59.5% to 70.34%). Most patients, 13 (86.6%), with wound infection required only debridement and intravenous antibiotics: IV linezolid and metronidazole; rest 2(13.4%) required secondary suturing for patient recovery. Conclusion: Preoperative leukocytosis was common in parturient undergoing cesarean section incidence of wound infection was low in this study. The post-operative wound infection risk is shown to correlate with the preoperative leukocytosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the recovery of bowel function by chewing gum in comparison with standard care. Study Design: Randomized control trial (RCT). Place and Duration of Study: Department of Gynecology and Obstetrics, Combined Military Hospital, Okara Cantt for the duration of 6 months from Apr to Sep 2018. Methodology: After the approval of hospital ethics committee, 100 patients undergoing elective cesarean section were divided into two groups (n=50 in each group). Group A were told to chew gum for 1 hour, four hours postoperatively in addition to standard care. Group B were the control group, with no addition of chew gum. The data were analyzed by SPSS version 20. Qualitative data presented as frequency and percentage; chi-square used to calculate significance. Descriptive data were presented as mean ± SD; T-test used to calculate significance. A p-value less than 0.05 was taken as significant. Results: The two groups did not vary in their demographic profile. The mean time for auscultation of bowel sound was 6.5 hours ± 1.03 in group A versus 9.3 hours ± 1.56 in group B; p-value <0.05. The mean time to passage of flatus was 14.28 hours ± 3.05 in group A versus 18.3 hours ± 3.42 in group B; p-value <0.05. Conclusion: Chewing gum postoperatively results in early return of bowel function, as evidenced by earlier return of bowel sounds and passage of flatus. It can be an inexpensive and convenient method for improved patient comfort and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence and risk factor for scar dehiscence in parturient with previous LSCS. Study Design: Prospective, observational study. Place and Duration of Study: Department of Gynecology and Obstetrics; department of Anesthesiology, Combined Military Hospital, Okara, from Jul to Dec 2018. Methodology: After the approval of hospital ethical committee, 300 parturient undergoing cesarean section were included in our study. The outcomes were incidence and risk factors for scar dehiscence. SPSS version 20 was used to analyze data. Descriptive data was presented as frequency and percentage. Chi square was used to calculate significance and p-value less than 0.05 taken as significant. Results: A total of 300 patients with previous cesarean delivery were included in our study. Our study has shown that no use of antepartum nutritional supplement (30.3% vs 66.7%), early term pregnancy, emergency LSCS (40.9% vs 8.1%), laboring patient (30.3% vs 4.7%) with duration of labor more than 24 hours (3% vs 0.9%) and inter-delivery gap (2.01years ± 1.05 vs 2.3 years ± 0.96) are independent risk factors for scar dehiscence in patient with history of previous cesarean sections, p-value <0.05. However parturient age, anemia, presence of comorbidity, previous gravidity or parity, previous number of LSCS did not show significant difference between patient with or without scar dehiscence. Conclusion: Scar dehiscence in setting of previous cesarean section fairly common in our population and high index of suspicion is required for timely diagnosis and management to improve maternal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the intraoperative blood loss and adhesions, peri-operative blood and intravenous iron supplementation between hepatitis seropositive and seronegative pregnant women undergoing elective cesarean delivery. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesiology and Gynecology and Obstetrics, Combine Military Hospital, Okara Cantt Pakistan, from Oct 2018 to Mar 2019. Methodology: After approval of the hospital ethical committee, 134 (n=67 in each Group) pregnant women were included in our study by convenient sampling. Patients were divided into two groups. Group-A included seronegative pregnant women, whereas Group-B were seropositive pregnant women. Results: There was no difference in the age (p=0.357), gravidity (p=0.159), parity (p=0.226) and the number of cesarean sections (p=0.475) between the two groups. There was no difference in the two groups regarding peri-operative haemoglobin change, with an insignificant reduction of 0.60±1.21 g/dL in Group-A versus a reduction of 0.50±1.08 g/dL in Group-B. A mild level of adhesion was observed intraoperatively in 26(35.6%) in Group-A versus 27(37.5%) in Group-B; p=0.170. Mild difficulty securing hemostasis was reported in 25(34.2%) vs 29(40.2%) patients; p=0.329. 61(83.5%) did not require a peri-operative blood transfusion in Group-A versus 59(81.9%) in Group-B; p=0.528. Conclusion: Our study has shown that the peri-operative haemoglobin level, blood product and intravenous iron supplementation, intra-operative adhesions encountered, and difficulty in hemostasis were comparable between sero-positive and sero-negative viral hepatitis pregnant women. [ABSTRACT FROM AUTHOR]