https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/133 Sun, 06 Nov 2016 13:50:52 +0000 Ibrahim Med. Coll. J. 2009; 3(1): 21-23 Keywords: Pregnancy, normal delivery, Caesarean delivery, delivery practices, tertiary hospital. Introduction Of 146 million people living in Bangladesh, 20 per cent are women of reproductive age and maternal mortality is a serious problem in this country. Recognizing the comprehensive nature of package services required for maternal and child care for the development of the reproductive health and safe motherhood, Government is committed to the reduction of maternal mortality in Bangladesh. Efforts are being directed to antenatal care, TT vaccination, identification of high risk pregnancies, TBA training, promotion of safe birth practices and family planning which influences maternal and neonatal mortality. There were several studies that address obstetric problems in Bangladesh, particularly those related to abortions, septic or habitual, and toxemia of pregnancy.1-8 Some reported on forceps delivery. 9,10 Although there are a number of studies on Caesarian deliveries done elsewhere,11-16 there is a dearth of data regarding Caesarian deliveries in Bangladesh. This study looks into the prevalence and practices of deliveries with a focus on Caesarian sections, in a large referral hospital in the capital of the country. Methods and Materials This observational study interviewed and investigated the records of 2714 subjects attending the Postnatal Ward of a referral hospital of Dhaka from August 1994 to March 1995. Data were collected from their registries and clinical history sheets. These history sheets usually maintained detailed clinical information starting from her admission till she got discharged.  Hospital records were utilized for collection of data using a checklist. Patients delivered normally or by Caesarian section were interviewed to gather in-depth data on key variables using a pre-tested semi-structured interview schedule. SPSS/PC+ was used to prepare frequencies and cross-tabulations. Results Table 1 shows the different types of deliveries conducted in different sites with different outcomes of deliveries. Of these participants (n = 2714), 1509 (55.6%) had a history of normal delivery and 1150 (42.4%) underwent Caesarean sections. Very few (1.7%) had other means of delivery and only 0.7% reported to have forceps delivery. The Caesarian delivery for the first baby was 14.1%, which gradually decreased in subsequent deliveries. Table-1: Obstetric histories regarding types, sites and outcomes of deliveries (n=2714)                                     Delivery order Sites of delivery Normal Home Alive First 27 (14.1) 69 (35.9) 14 (7.3) 100 (86.2) 88 (75.9) 103 (88.8) Third 5 (8.6) 11 (19.0) 3 (5.2) 28 (90.3) 22 (71.0) 26 (83.9)     Most of the deliveries, whether normal or Caesarean, were conducted by the trainee doctors (43.6%) and Medical Officers (25.7%) (table 2). Professors and Assistant Professors performed less than 1%. The normal or Caesarean deliveries were assisted mostly by trainee doctors (54.4%), interns (19.0%) and nurses (15.8%); and very few by Medical Officers (8.3%) and Assistant Registrars (2.1%). The neonatal death was very high ranging from 7.3% at first delivery to 16.1% at the fourth one (table not shown). Table-2: Normal or Caesarean deliveries performed by different categories of doctors or nurses n Deliveries assisted by % 1 Registrar 0.4 3 Assistant Registrar 2.1 14 Medical Officer 8.3 93 Trainee doctor (PG) 54.4 129 Intern doctor 19.0 219 Nurse 15.8 41     2     502 Total 100.0       This study was conducted through a research grant from the World Bank through the Bangladesh Medical Research Council (BMRC). References 2.   Begum SF. Surgical treatment of recurrent second trimester abortion: report on 32 cases. Dhaka Med Coll J 1974; 87-90. 4.   Burhanuddin AFM. Interruption of pregnancy by indigenious method. Bang Med J 1973; 2(2): 53-6. 6.   Azim AKMA. Septic abortion in relation to maternal mortality. Bang J Obstet Gynecol 1989; 4(1): 19-25. 8.   Ali SE and Zakaria GM. Management of a case of severe toxaemia of pregnancy. Syl Med Coll J 1979; 19-22. 10.Begum A and Tahera D. Forceps delivery – a critical analysis of indications and complications. Bang J Obstet Gynecol 1990; 5(1): 1-7. 12.Guillemette J and Fraser MD. Differences between obstetricians in caesarian section rates and the management of labour. Br J Obstet Gynecol 1992; 99(2): 105-8. 14.Pridjian G et al. Caesarian: changing the trend. Obstet Gynecol 1991; 77(2): 195-200. 16.Muyder XD and Thiery M. The caesarian delivery rate can be safely reduced in a developing country. Obstet Gynecol 1990 Mar; 75(3) Pt 1: 360-4. 18.Safe Motherhood. Millions of women lack maternity care. Safe Motherhood Newsletter 1994; 14: 1. 2026 Ibrahim Medical College. All rights reserved.