Assessment of Obstetrics and Gynaecological referred Cases and their Outcomes to Isra Tertiary Care Hospital

Abstract

Objective: To assess, the type of obstetrics and gynaecological cases referred to tertiary care hospitals.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: The study was carried out at the Department of Obstetrics and Gynecology Unit 2 of Isra University Hospital Hyderabad, Pakistan from May 2022 to July 2022.
Materials and Methods: The patients who were referred to the Department of Obstetrics and Gynaecology
Unit 2 at Isra University Hospital during the study duration from various primary, secondary, tertiary, and
private hospitals for any obstetric or gynaecological emergency were the primary source of data. The
confidentiality of each patient was carefully respected. This study evaluated the prevalence of various obstetric
and gynaecological conditions for which patients were usually referred to Isra University Hospital within the
study duration as well as the management options provided to these patients.
Results: The bulk of referrals (71%) were for gynaecological cases, according to the results of our study. Patients under 20 years of age comprised 31% of the total. The majority of patients (20%) were multipara and in their third trimester (18%). Vesicovaginal fistula (VVF) was the most common gynaecological reason for referral
(27%) and the least were ectopic pregnancy and UV prolapse 9% each. Placenta previa (13%), was the most
common obstetric referral in our study and at least 2% were placental abruption, preterm labour, and pre
eclampsia. Furthermore, 24% of VVF patients were successfully managed transvaginal while only 4% were
managed transabdominal. All gynaecological malignancies were treated with total abdominal hysterectomy
with bilateral salpingo-oophorectomy and omentectomy. Laparotomies were done for ectopic pregnancies
and 5 patients of UV Prolapse underwent vaginal hysterectomy whereas only 1 had pessary insertion. Amongst
obstetric cases 7% cases of placenta previa/accreta had Cesarean section, 4% had Cesarean section along with
bladder repair and 2% of cases necessitated myometrial excision. Compression sutures were the most
frequently used form of treatment (5%) for postpartum hemorrhage patients, followed by hysterectomy (4%)
and medical management (2%). Preterm labour was monitored, whereas placental abruption and preeclampsia
required caesarean procedures.
Conclusion: The majority of patients both gynaecological and obstetric referred to Isra Tertiary Care Hospital
throughout a 3 months period had either an urgent need for treatment or a serious condition that necessitated
a specialist's expertise and the availability of the appropriate resources. Therefore, it can be concluded that
there is a critical need to upgrade our health system infrastructure, particularly in the area of maternal and child health care, in order to make it simple to provide timely and appropriate management to a variety of health conditions and lower the likelihood of any mishaps involving the mother or the fetus. Additionally, this will also benefit patients by avoiding unnecessary travel from distant regions and helps reduce the burden on tertiary care health system.