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O84 Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago Hospital
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
of pregnancy in the first trimester. 53.7% used the technique in which they were trained, 39.1% based their technique on experience and only 6.3% replied they adapted their technique on recommendations according to the National guidelines. 61.7% said they would change their operative routine according to changes in the recommendations in the National Guidelines. Almost 40% replied they would not change their routine (3.6%) or only if they found the recommendations relevant (34.7%) according to the National guidelines. Conclusions: Therefore we conclude that common procedures like surgical termination of first trimester pregnancies ought to get more attention. Gynecologists should seek to evolve the surgical procedure and the authors of National Guidelines might think about how to market new trends and recommendations. O84 Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago Hospital M. Balikuddembe. Makerere University/Mulago National Referral and Teaching Hospital Background: The MMR at Mulago National Hospital is 600 deaths/100,000 live births and pregnancy outcomes are related to the decision-operation interval (DOI). The DOI and its determinants were not well described in Mulago. Objective: To determine DOI, maternal and foetal outcomes relative to the DOI and explore factors that determine the DOI among mothers who get emergency caesarean section at Mulago. Method: A prospective cohort study of women who had EmCS in October 2008 was done. Consecutive sampling was used to enrol participants who were followed from the time of the decision of operation to the 3rd postpartum day. Results: Results of 351 mothers were analysed. 1.1%, 39.2% and 4.8% mothers had DOI within 30 minutes, 4 h and over 24 h respectively. The mean DOI was 465 minutes with a median of 320 minutes. Bad outcomes occurred in 41.3% mothers but moreso (51.8%) in the under-20 year olds. These included obstructed labour (5.7%), low 5-minute Apgar score (12.5%), special care unit admission (12.0%) and perinatal death (10.9%). Survival analysis showed bad outcomes to increase with DOI over 21 /2 h. Determinants of DOI were lack of theatre space and personnel factors like shift change-over delays and absenteeism/late coming mostly. Conclusion: The DOI for EmCS is 71 /2 h with bad outcomes increasing after 21 /2 h. Delays were mostly due to lack of theatre space and personnel factors. Recommendation: Personnel sensitisation on time management and theatre space allocation need to be ensured. O85 The effect of trauma during embryo transfer on pregnancy rates in IVF-ICSI cycles K. Banerjee Objective: The aim of the study was to find out whether any extent of trauma during embryo transfer, for example, the use of stylet or evidence of bleeding in the transfer catheter, has an effect on the pregnancy rates in IVF-ICSI cycles. Design: Retrospective. Tertiary Private Health Set up. New Delhi, India. Materials and Methods: Forty three consecutive patients who were undergoing IVF-ICSI cycles at our Centre from September to December, 2008 were retrospectivel recruited into the study. Stylet was not used during embryo transfer in twenty seven patients and was used in sixteen patients. Bleeding in the inner catheter was noticed in seven of these forty three patients. All cases were matched according to age and number of eggs collected. IVFICSI was performed and the positive pregnacy rate and clinical
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pregnancy rate were compared in each of these groups. Chi square test and Mann Whitney U test were applied for statistical analysis. Results: The mean age of the patients was 32±5 years. The total number of eggs collected was 10+/-6. This was not statistically significant in any of these groups. The positive pregnacy rate in patients where stylet was used was 62% (10/16), and 66% (18/27) where stylet was not used. The positive pregnacy rate in patients where bleeding was found was 71% (5/7), and 58% (21/36) where bleeding was not found. There was no statistically significant difference in the positive pregnancy rates between the various groups. Conclusions: Trauma during embryo transfer has always been a concern to the IVF clinicians. This study indicates that the use of stylet or the presence of bleeding in the inner catheter does not affect pregnancy rates. O86 Biochemical changes in eclampsia patients in a tertiary level hospital of Bangladesh L. Banu. Instutute of Child and Mother Health Objective: Globally eclampsia is a killer disease of the pregnant women which involves multiple organs of the body. The aim of the study was to throw light on the biochemical changes, risk factors, outcome of mothers and perinates in pregnancy complicated by eclampsia Methods A prospective cross sectional study was done in the department of obstetrics & gynaecology of the Institute of Child and Mother Health, Dhaka, Bangladesh from 12.9.2004 to 23.1.2006. Around 3838 deliveries took place during this period and 168 (4.31%) were eclampsia cases. Data were collected by using a structured questionnaire. The variables include maternal age, parity, gestational age, mode of delivery, antenatal care, severity of proteinuria, number of convulsions, type of eclampsia, frequency of maternal and perinatal complications, maternal death, birth weight, number of still birth, neonatal death, intrauterine death (IUD) asphyxia, and prematurity. The biochemical markers estimated were SGPT, serum bilirubin, uric acid, urea, creatinine, and 24 hours urinary total protein Results were correlated with clinical condition. Results: Age of the patients ranged between 16–40 years (mean 22.4 years), parity ranged between 1–7 (mean 1.57 years), gestational age at the time of convulsion between 24–42 weeks (mean34.94 weeks), maximum systolic blood pressure (BP) between 110–210 mm Hg (mean 155.4 mm Hg), diastolic BP between 70–160 mmHg (mean 109.6 mmHg). Twenty six percent patients had antenatal checkup (ANC). Number of convulsions ranged between 1–12 (mean 4.76), antipartum eclampsia cases were 64.7% intrapartum eclampsia10.5% and postpartum eclampsia were 23%. Normal vaginal delivery 52% and lower segment ceaserian section were 46.5%. Among the total deliveries 68.9%were alive babies, 13.48% still birth, 4.2%IUD, 4.2% neonatal death and 4% were born asphyxiated. Birth weight ranged from 1 kg to 3.7 kg (mean 2.26 kg). There were 5.8% maternal deaths. Around 19.4% were below 19 years and 5.7% was above 30 years. More cases were found among overweight (52.1%) and mildly anaemic (78.9%) patients. Proteinuria was present among 80.80% cases and 21.9% cases had proteinuria of 1000 mg – 4550 mg per 24 hours urine. Biochemical derangements were found among 56.9% cases. Neonatal outcome includes18.6%were stillborn, 7.1% neonatal death, 5.7% premature and 1.4% were IUD. Two patients had HELLP Syndrome and one had acute renal failure Maternal death rate was 5.7%. Conclusion: Malnutrition and debility was not found to be the risk factors for eclampsia in this study. Worst perinatal and maternal outcome were found among those with abnormal biochemical changes. Early detection of biochemical derangements may help to prevent or reduce fatal outcome.
of pregnancy in the first trimester. 53.7% used the technique in which they were trained, 39.1% based their technique on experience and only 6.3% replied they adapted their technique on recommendations according to the National guidelines. 61.7% said they would change their operative routine according to changes in the recommendations in the National Guidelines. Almost 40% replied they would not change their routine (3.6%) or only if they found the recommendations relevant (34.7%) according to the National guidelines. Conclusions: Therefore we conclude that common procedures like surgical termination of first trimester pregnancies ought to get more attention. Gynecologists should seek to evolve the surgical procedure and the authors of National Guidelines might think about how to market new trends and recommendations. O84 Impact of decision–operation interval on pregnancy outcomes among mothers who undergo emergency caesarean section at Mulago Hospital M. Balikuddembe. Makerere University/Mulago National Referral and Teaching Hospital Background: The MMR at Mulago National Hospital is 600 deaths/100,000 live births and pregnancy outcomes are related to the decision-operation interval (DOI). The DOI and its determinants were not well described in Mulago. Objective: To determine DOI, maternal and foetal outcomes relative to the DOI and explore factors that determine the DOI among mothers who get emergency caesarean section at Mulago. Method: A prospective cohort study of women who had EmCS in October 2008 was done. Consecutive sampling was used to enrol participants who were followed from the time of the decision of operation to the 3rd postpartum day. Results: Results of 351 mothers were analysed. 1.1%, 39.2% and 4.8% mothers had DOI within 30 minutes, 4 h and over 24 h respectively. The mean DOI was 465 minutes with a median of 320 minutes. Bad outcomes occurred in 41.3% mothers but moreso (51.8%) in the under-20 year olds. These included obstructed labour (5.7%), low 5-minute Apgar score (12.5%), special care unit admission (12.0%) and perinatal death (10.9%). Survival analysis showed bad outcomes to increase with DOI over 21 /2 h. Determinants of DOI were lack of theatre space and personnel factors like shift change-over delays and absenteeism/late coming mostly. Conclusion: The DOI for EmCS is 71 /2 h with bad outcomes increasing after 21 /2 h. Delays were mostly due to lack of theatre space and personnel factors. Recommendation: Personnel sensitisation on time management and theatre space allocation need to be ensured. O85 The effect of trauma during embryo transfer on pregnancy rates in IVF-ICSI cycles K. Banerjee Objective: The aim of the study was to find out whether any extent of trauma during embryo transfer, for example, the use of stylet or evidence of bleeding in the transfer catheter, has an effect on the pregnancy rates in IVF-ICSI cycles. Design: Retrospective. Tertiary Private Health Set up. New Delhi, India. Materials and Methods: Forty three consecutive patients who were undergoing IVF-ICSI cycles at our Centre from September to December, 2008 were retrospectivel recruited into the study. Stylet was not used during embryo transfer in twenty seven patients and was used in sixteen patients. Bleeding in the inner catheter was noticed in seven of these forty three patients. All cases were matched according to age and number of eggs collected. IVFICSI was performed and the positive pregnacy rate and clinical
S117
pregnancy rate were compared in each of these groups. Chi square test and Mann Whitney U test were applied for statistical analysis. Results: The mean age of the patients was 32±5 years. The total number of eggs collected was 10+/-6. This was not statistically significant in any of these groups. The positive pregnacy rate in patients where stylet was used was 62% (10/16), and 66% (18/27) where stylet was not used. The positive pregnacy rate in patients where bleeding was found was 71% (5/7), and 58% (21/36) where bleeding was not found. There was no statistically significant difference in the positive pregnancy rates between the various groups. Conclusions: Trauma during embryo transfer has always been a concern to the IVF clinicians. This study indicates that the use of stylet or the presence of bleeding in the inner catheter does not affect pregnancy rates. O86 Biochemical changes in eclampsia patients in a tertiary level hospital of Bangladesh L. Banu. Instutute of Child and Mother Health Objective: Globally eclampsia is a killer disease of the pregnant women which involves multiple organs of the body. The aim of the study was to throw light on the biochemical changes, risk factors, outcome of mothers and perinates in pregnancy complicated by eclampsia Methods A prospective cross sectional study was done in the department of obstetrics & gynaecology of the Institute of Child and Mother Health, Dhaka, Bangladesh from 12.9.2004 to 23.1.2006. Around 3838 deliveries took place during this period and 168 (4.31%) were eclampsia cases. Data were collected by using a structured questionnaire. The variables include maternal age, parity, gestational age, mode of delivery, antenatal care, severity of proteinuria, number of convulsions, type of eclampsia, frequency of maternal and perinatal complications, maternal death, birth weight, number of still birth, neonatal death, intrauterine death (IUD) asphyxia, and prematurity. The biochemical markers estimated were SGPT, serum bilirubin, uric acid, urea, creatinine, and 24 hours urinary total protein Results were correlated with clinical condition. Results: Age of the patients ranged between 16–40 years (mean 22.4 years), parity ranged between 1–7 (mean 1.57 years), gestational age at the time of convulsion between 24–42 weeks (mean34.94 weeks), maximum systolic blood pressure (BP) between 110–210 mm Hg (mean 155.4 mm Hg), diastolic BP between 70–160 mmHg (mean 109.6 mmHg). Twenty six percent patients had antenatal checkup (ANC). Number of convulsions ranged between 1–12 (mean 4.76), antipartum eclampsia cases were 64.7% intrapartum eclampsia10.5% and postpartum eclampsia were 23%. Normal vaginal delivery 52% and lower segment ceaserian section were 46.5%. Among the total deliveries 68.9%were alive babies, 13.48% still birth, 4.2%IUD, 4.2% neonatal death and 4% were born asphyxiated. Birth weight ranged from 1 kg to 3.7 kg (mean 2.26 kg). There were 5.8% maternal deaths. Around 19.4% were below 19 years and 5.7% was above 30 years. More cases were found among overweight (52.1%) and mildly anaemic (78.9%) patients. Proteinuria was present among 80.80% cases and 21.9% cases had proteinuria of 1000 mg – 4550 mg per 24 hours urine. Biochemical derangements were found among 56.9% cases. Neonatal outcome includes18.6%were stillborn, 7.1% neonatal death, 5.7% premature and 1.4% were IUD. Two patients had HELLP Syndrome and one had acute renal failure Maternal death rate was 5.7%. Conclusion: Malnutrition and debility was not found to be the risk factors for eclampsia in this study. Worst perinatal and maternal outcome were found among those with abnormal biochemical changes. Early detection of biochemical derangements may help to prevent or reduce fatal outcome.