Pakistan Journal of Medical Sciences

Published by : PROFESSIONAL MEDICAL PUBLICATIONS

ISSN 1681-715X

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Volume 25

October - December 2009 (Part-I)

Number  5


 

Abstract
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Frequency and indications of cesarean
section in a tertiary care hospital

Gulfareen Haider1, Nishat Zehra2,
Aftab Afroz Munir3, Ambreen Haider4

ABSTRACT

Objective: To determine the frequency of cesarean section and to analyze the indications, so as to introduce measures to control the cesarean section rate.

Methodology: This descriptive study was conducted in obstetric and gynecology department of Isra university hospital Hyderabad Sindh from 1st Jan 2007 to 31st Dce 2007.In this study clinical record of all the patients who underwent cesarean section was analyzed. It included all the pregnant ladies booked in the antenatal clinic and unbooked patients admitted in early labour for whom cesarean section was indicated later. It also included all those cases coming in emergency at any time for which cesarean section was indicated. Clinically diagnosed cases of ruptured uterus proved on laparotomy were not included in the study. Data was analyzed on SPSS version 11 and frequencies as wall as percentages were calculated.

Results: During one year study period, 380 cesarean section were performed. The rate of cesarean section was 64.7%. Emergency cesarean section was performed in 225 (59.2%) patients and elective cesarean section in 155 (40.7%). Among 380 patients, 167 (43.9%) were booked while 213 (56.0%) were unbooked. Repeat cesarean section was the commonest indication seen in 73 (19.2%) patients followed by dystocia in 51 (13.4%) patients, fetal distress in 48 (12.6%) and ante partum hemorrhage in 45 (11.8%) patients. Miscellaneous indications contributed to 16 (4.2%) of the cases.

Conclusion: Majority of patients who underwent cesarean section was unbooked and had an emergency cesarean section. The commonest indication was repeat cesarean section.

KEY WORDS: Cesarean section, Indications, Frequency.

Pak J Med Sci    October - December 2009 (Part-I)    Vol. 25 No. 5    791-796

How to cite this article:

Haider G, Zehra N, Munir AA, Haider A. Frequency and indications of cesarean section in a tertiary care hospital. Pak J Med Sci 2009;25(5):791-796.


1. Dr. Gulfareen Haider, FCPS, M.S
2. Dr. Nishat Zehra , FCPS
3. Dr. Aftab Afroz Munir, FRCOG
4. Dr. Ambreen Haider, MBBS
1-3: Department of Obstetrics & Gynecology
Isra University Hospital,
Hala Road,
Hyderabad - Sindh, Pakistan.
4: Department of Cardiology,
LUMHS,
Hyderabad - Sindh, Pakistan.

Correspondence:

Dr. Gulfareen Haider
Assistant Professor
Department of Obstetrics & Gynaecolgoy,
Isra University Hospital,
Hala Road,
Hyderabad - Sindh,
Pakistan.
Email: gfareen@yahoo.com

* Received for Publication: December 1, 2008

* Revision Received: August 5, 2009

* Revision Accepted: August 24, 2009


INTRODUCTION

The steadily increasing global rates of cesarean section have become one of the most debated topics in maternity care as its prevalence has increased alarmingly in the last few years.1-2 Cesarean section is a major surgical procedure with a corresponding level of risk and should be performed in the presence of specific and clearly defined indications while some of the obstetricians consider it to be quite simple, efficient, safe and psychologically well-tolerated procedure and far superior to secondary interventions such as vacuum delivery or emergency cesarean section.3

Cesarean section is subject of professional controversy.4 Controversy over the rate of cesarean section is going on though there is no clear evidence on the relative benefits of higher or lower rates.5 Today cesarean birth accounts for 15-25% of all deliveries in developed countries with maternal mortality of less than 1:10,000. In South Korea cesarean section rate approached 40% in year 2000.6 WHO recommended that there is no additional health benefits associated with cesarean section rate above 10-15%.7 Leitch and Walker stated that the focus of study should be the indications of cesarean section.8 There is current awareness about the right to self determination, which can be exercised in almost unlimited fashion throughout ones adult life. The women in the developed countries are now requesting elective cesarean section with out any medical or surgical indications as preferred mode of delivery.

Although, the cesarean section rates have increased over the last ten to fifteen years, the four major clinical determinants of the cesarean section rate have not changed. These remain fetal compromise, failure to progress in labour, repeat cesarean section and breech presentation. The fifth most common reason given for performing a cesarean section is now reported to be maternal request.

The trend of increasing cesarean section rates may indicates a trend towards a more costly medical delivery system. Effective implementation of the strategies to reduce cesarean section rates may depend on the social and cultural milieu, associated belief and practices of the society.9 As few studies have been conducted on this topic in Pakistan, this study was conducted to determine the frequency of cesarean section and to analyze the indications in our setup, so as to introduce measures to control the cesarean section rate.

METHODOLOGY

This is a descriptive study conducted from 1st Jan 2007 to 31st Dce 2007 based on sample of convenience. It included all the pregnant ladies booked in the antenatal clinic and unbooked patients admitted in early labour in which cesarean section was indicated later. It also included all those cases coming in emergency at any time for which cesarean section was indicated. Clinically diagnosed cases of ruptured uterus and proved on laparotomy were not included in the study. A proforma for each patient was completed, regarding the relevant information of the cesarean delivery including maternal age, parity, obstetric background, whether booked or un booked cases, elective or emergency cesarean section, operative procedure including abdominal and uterine incision, type of anesthesia, fetal outcome as well as maternal morbidity .

All study subjects were divided in low, middle and upper social class, if family income was up to rupees five thousand per month, up to Rupees fifteen thousand per month or more than Rupees fifteen thousand per month respectively. Data was analyzed on SPSS version 11 for frequency and percentage.

RESULTS

In the study period we delivered 587 patients of whom 380 underwent cesarean section and 207 patients had vaginal delivery. Hence the cesarean section rate was 64.7%. Sociodemographic details are given in Table-I.

Out of 380 patients, 218(57.3%) patients belonged to rural area while 162(42.6%) patients came from urban area. Out of 380 patients who underwent cesarean section, 213 (56.0%) patients were unbooked while 167(43.9%) were booked cases who received antenatal care. Two hundred twenty five (59.2%) patients underwent emergency cesarean section while in 155(40.7%) patients cesarean section was done electively.

Table-II shows indications for cesarean section. The most common indication of cesarean section was repeat cesarean section seen in 73(19.2%) patients. Out of these 73 patients, repeat cesarean section was done due to previous two cesarean section in 41 patients, due to previous three cesarean section in 22 patients and because of previous four cesarean section in 10 patients.

Another common indication of cesarean section was dystocia; prolong labour which was present in 51(13.4%) patients and fetal distress in 48(12.6%) patients. Other indications of cesarean section were ante partum hemorrhage (APH) which was present in 45(11.8%) patients. Out of these 45 patients, 34 patients had placenta abruption while 11 patients have placenta previa. All cesarean section were performed in general anesthesia by pfannenstiel incision.

DISCUSSION

Isra University hospital caters majority of the patients from nearby villages. People living in villages have lack of awareness about health measures and health facilities. The people are extremely poor. Family size is large. They donít believe in antenatal care and consider birth a natural process. They bring their ladies to the hospital only when they are seriously ill and insist on vaginal delivery.10

Medicolegal aspect of burn victims: A ten years study

  Pakistan Journal of Medical Sciences

Published by : PROFESSIONAL MEDICAL PUBLICATIONS

ISSN 1681-715X

HOME   |   SEARCH   |   CURRENT ISSUE   |   PAST ISSUES

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ORIGINAL ARTICLE

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Volume 25

October - December 2009 (Part-I)

Number  5


 

Abstract
PDF of this Article

Medicolegal aspect of burn victims:
A ten years study

Ishtiaq Ahmed1, Umar Farooq2,
Wiqas Afzal3, Muhammad Salman4

ABSTRACT

Objectives: To see the prevalence and nature of medico-legal burns among patients.

Methodology: It is a retrospective observational study conducted at Fauji Foundation Hospital, Rawalpindi from April 1999 to April 2008. All patients of more then ten years of age, irrespective of sex with burn injuries were included in the study.

Results: One hundred seventy eight patients were studied and among them one hundred forty six (82.02%) were accidental burns with more prevalence among females (81.50%). Twenty three (12.92%) patients were having homicidal burns and all were females while nine (5.06%) patients sustained suicidal burns and among them six (66.66%) were females. Majority of patients i.e. one hundred six were from 2nd and 3rd decade of life. Among homicidal injuries twenty one (65.62%) were from flame and two (6.26%) from acid. All suicidal patients sustained flame burns. Females are more commonly involved (66.66%) as compared to males (33.34%).

Conclusion: Homicidal and suicidal burns are not uncommon especially among young women (i.e. 15 to 30 years of age) and every case should not be taken as accident until proved otherwise. A clinical forensic expert or concerned authorities should evaluate all these cases to minimise the likelihood of inaccurate diagnosis.

KEY WORDS: Burn, Medico-legal, Homicide, Suicide.

Pak J Med Sci    October - December 2009 (Part-I)    Vol. 25 No. 5    797-800

How to cite this article:

Ahmed I, Farooq U, Afzal W, Salman M. edicolegal aspect of burn victims: A ten years study. Pak J Med Sci 2009;25(5):797-800.


1. Dr. Ishtiaq Ahmed, FCPS
2. Dr. Umar Farooq, FCPS
3. Dr. Wiqas Afzal, MBBS
4. Dr. Muhammad Salman, MBBS
1-4: Department of Surgery
Social Security Hospital,
Islamabad - Pakistan.

Correspondence

Dr. Umar Farooq
House # 576, Street 40,
Phase II, Bahria Town,
Rawalpindi - Pakistan.
E-mail: dhorri@hotmail.com

* Received for Publication: May 22, 2009

* Revision Receive: August 8, 2009

* Revision Accepted: August 10, 2009


INTRODUCTION

The incidence of suicide and homicide is on the increase worldwide, including Pakistan. One million people die annually due to suicides and homicides alone1. Poisoning, hanging and drowning are the major methods of suicide in contrast to blunt trauma, sharp trauma and strangulation are more common in homicide. However deaths due to burns are seen more frequently in both homicide and suicide especially in subcontinent. Combined methods are more common in homicide as compared to suicide. Predominance of male is found in all methods of suicide and homicide, except burning.1,2 Quarrel and revenge were the common precipitating cause/motive for homicide in comparison to chronic illness and mental illness for suicide.1

Burns are one of the most common modes used in suicide or homicide in Indo-Pak especially among young victims.3-5Acid, Alkali, Hot liquids are rarely used for suicidal or homicidal purposes in our country. Homicidal burning of young unmarried and married women in Indo-Pak is a major concern for law enforcing authorities, the judiciary, police and medico-legal experts.4 Every burn especially in young unmarried or married females is not an accident because they may be homicidal or suicidal. Usually these cases were simulated as accidents by their relatives. In these incidences, the most common reasons given in history are being caught fire while cooking, explosion due to gas leakage, after an explosion in kerosene stove or when chimney fell on victim while lighting lamp etc.3,6,7 These are all usual explanations given in the history, narrated by relatives or in postmortem reports of these victims. Majority of these explanations are found not true when inquired in detail by forensic experts.

METHODOLOGY

This retrospective observational study was conducted at Burn Unit Fauji Foundation Hospital, Rawalpindi from April 1999 to April 2008. All patients of more then ten years of age, irrespective of sex with burns injuries were included in the study. Patients reporting to causally department or admitted in burn units were evaluated carefully regarding cause, place and circumstances of injury, extent of involvement of area burnt and mortality of burn victims. Patients less then ten years of age were excluded from the study because medico-legal aspect is least likely in these patients.

Patients and their relatives/attendants were carefully interviewed by medical officer and in charge nurse repeatedly regarding the circumstances and nature of accident, complete profile of the patient and their family etc was recorded carefully. All these informationís were gathered in complete secrecy and by repeated informal interviews and discussions. All findings were recorded on separate Performaís containing all demographic details of patient and their family, and evaluated statistically at the end of study.

RESULTS

A total of 178 patients were studied during study period. Among them one hundred forty six (82.02%) were accidental with more prevalence in females one hundred nineteen (81.50%). Twenty three (12.92%) patients were having homicidal burns and all were females. No homicidal burn was reported among males. Nine (5.06%) patients sustained suicidal burns and among them six (66.66%) were females. Majority of patients, one hundred six are from 2nd and 3rd decade of life (Table-I) i.e. sixty eight (38.20%) and thirty eight (21.385) respectively.

Table-II shows that among homicidal injuries twenty one (65.62%) were from flame and two (6.26%) from acid. Homicidal injuries due to burn are not reported in males. Among suicidal patients all nine patients (28.12%) sustained flame burns. Females are more commonly involved (66.66%) as compared to males (33.34%).

DISCUSSION

Incidence of burns whether accidental, homicidal or suicidal are not uncommon in Indo-Pak society. Incidence, etiology and nature of burn vary from one community to another and depend mainly upon age, sex, customs, economic status, environmental and social circumstances1,2. Accidental burns are common in females as compared to males in Pakistan because working in kitchen is the prime responsibility of females. So they are more prone to burn accidents at home. In our study majority of females (81.50%) sustained accidental burns at home as compared to males (18.50 %).

Homicide by burning amongst women is a major concern in Indo-Pak as it has been common throughout all social strata and geographic areas6, 8. In our study, 12.92% patients were having homicidal burns and all were females. Incidence of homicidal burn is quite high in India as compared to our country. Ambade from Nagpur from India9 in their study observed that homicidal deaths due to burning accounted for 21.6% of the total medico legal deaths. Kumar and his colleagues showed in their study incidence of homicide burn was 31%.10