LSCS audit

16-31st July 2016

Total delivery= 379

SVD= 227
LSCS= 148
EMLSCS=123
ELLSCS=25
Instrumental delivery = 4

Total delivery : 379

Referral =47

Hospital Baling
SVD
20
EMLSCS 12
Discharge

Hospital Yan 11
SVD
5
EMLSCS 5
Instrumental 1

36
4

EMLSCS- 123
Indication

no

Fetal distress

64

Breech in labour

11

Suspected macrosomic baby

7
(4.01kg, 3.7kg, 3.58kg, 3.72kg,
3.83kg, 4.45kg, 4.39kg)

3 previous scar in labour

2 previous scar in labour

Refused VBAC

DCDA twin in labour

Failed IOL

Transverse lie in labour

Poor progress

Cord prolapse

Bleeding PP

Indication

no

Impending eclampsia

PP in labour

APO + Severe PE

Eclampsia

Abruptio placenta

CPD

Secondary arrest

MCDA twin in labour

ELLSCS- 25
indication

no

2 previous scars

11

Breech presentation

Suspected macrosomic baby

4
(3.8kg, 3.84kg, 3.78kg, 3.52kg)

Refused VBAC

PP Type 2

Refused IOL

MCDA twin

CPD

3 prev scar

IOL
indication

no

PROM

PPROM

GDM on d/c

11

postdatism

Reduced fetal movement at term

TRO SGA baby

PIH

PE

GDM on s/c insulin

Oligohydramnious

Late booking

NICU admission=25
indication

No

TRO MAS

TTN

Post PPV

TRO oesophageal fistula

TRO congenital pneumonia

Prematurity

10

Poor APGAR

Down syndrome TRO CHD

Patau Syndrome

Melor 2 admission=53
Indication

no

Presumed sepsis

23

Macrosomic baby for observation

Baby of RVD + mother

Baby of Rh ve mother

Hypoglycemia

Prematurity

Infant of mother with GDM on s/c

insulin

13

GBS +ve mother

Down syndrome

Incomplete moro

Varicella zoster

CTEV

SGA

Macrosomic baby
LSCS 6
Via ELLSCS (3)-5.09kg,4.08kg,4.10kg
Via EMLSCS(3)-4.01kg, 4.45kg,4.39kg
SVD- 2
4.18kg
4.22kg

PPH 2 cases
Case 1
Mdm Z, G6P4+1 at 35 + 2 days ,bleeding PP IV with acreta. Proceeded with
EMLSCS. Intraop, unable to separate placenta at cervical canal, bleeding from
placental site, unable to secure, proceed with hysterectomy. IM duratocin x1
and intrauterine syntometrine x1 given in view of uterine atony prior to
hysterectomy. Upon arrival in ICU, noted pt had per vaginal bleed ++, blood
clot 1L evacuated pervaginally. PSE noted oozing from vaginal. Packed with 2
roller gauze into vagina. Noted pt having persistent bleeding despite vaginal
packing. Went in for relaparatomy and vaginal EUA. Intra op noted bleeding
from escaped vessel at vault, identified and ligated. TBL 4.5L.(3L+1L+0.5L).
Total transfused 8 pint WB and 1 pint PC.
Pre op: 10.6, 342
Post op: 8.4 , plt= 246
Pt was T/O to ICU for close monitoring ,subsequently T/O to HDA and
discharge after 3 days

Case 2
Mdm N, G2P1 @ 38W 5D, ANC : uneventful presented with contraction pain.
CTG at PAC showed persistent type 1 deceleration. VE and ARM done : os
6cm, LMSL. Hence proceed with EMLSCS for fetal distress. Intra op baby was
deeply engaged and pushed from below. Post delivery of baby, noted
extended tear at left side measuring 3cm, repair done. During vaginal
toileting, noted excessive PV bleeding. Called in specialist. EUA done no
cervical tear, noted excessive bleeding coming from os. Proceeded with
relaparatomy. Intra op no bleeding from both uterine angle/no hematoma,
uterine cavity explored and noted bleeding from placenta bed-multiple
hemostatic suture done, Bakri balloon inserted. IM hemabate x 1 given intra
op. TBL 4 L . Intraop, tx 4 pint WB and 1 cycle of DIVC. Pt was admitted to ICU
for observation.
Pre op Hb : 13.8, plt : 217
Post op Hb=7.4, plt : 128 and tx 1pint PC in ICU . Pt then T/O to HDA after 1
day in ICU and then discharge home after 3 days
Before discharge Hb : 9.9, plt 176

Case presentation

Mdm N
24/m/lady, G1P0 at 38w 6d
ANC : uneventful
Came to PAC with contraction pain on 23/7/16
VE done, OS = 3 cm and admitted to ANW for
early labour
TAS done, EFW= 2.98kg
On 24/7/16- pt T/O LR for ARM
Post ARM, noted liquor Light meconium stained

CTG post ARM showed type 1 deceleration

Attendad stat by MO at 0110H
Ve done os 9cm and pt want to bear down
Os full at 0133H
Baby delivered at 0135H on 24/7/16
covered with LMSL, no tone, no cry, no
breathing effort and initial steps
done,oronasal suction LMSL
APGAR score noted 2 in 1min, 2 in 5min, 2
in 10min, 4 in 15min,8 in 20min

 Attended by paeds at 2 mins of life :

no tone, no cry, no breathing effort,
HR>100, SpO2 96% on CPAP, direct
suction x 2 LMSL and intubated
Post intubation in NICU: poor tone,
intermittently opening eyes, sucking
reflex present
Babys weight : 2.74kg
Baby then extubated at 12 H of life

 Baby was discharged from NICU on 27.6.16 with

impression
1) Term AGA
2) MAS
-CXR showed mild MAS
3) Poor APGAR secondary to maternal sedation
-mother took entonox prior to delivery. IV naloxone
given at 1 hour of life. Baby was active post naloxone
Plan upon discharge
-TCA pead on 29/7/16

Thank you