Comparison of heparin and low dose aspirin with low dose aspirin alone in improving theperinatal outcome in pregnancies with recurrent pregnancy losses

To compare the perinatal outcome of low dose Aspirin [LDA] alone and low dose Aspirin with Heparin in pregnancies with recurrent pregnancy loss [RPL] with or without positive antiphospholipid antibodies [aPL]. Randomized controlled trial. Departments of Obstetrics and Gynaecology Combined Military Hospital [CMH] Quetta, Lahore and Rawalpindi. 30 April 2009 to 30 April 2011. 60 women with recurrent pregnancy losses [RPL] fulfilling clinical criteria of antiphospholipid syndrome [APS] with or without aPL antibodies positive reporting to the antenatal clinic at the three hospitals were included. Convenience sampling was done and subjects were randomly allocated into groups A and B using random numbers table. GroupA received low dose Aspirin[LDA] 75 mg once daily starting from first trimester and GroupB received unfractioned Heparin [UH] 5000IU SC BD or low molecular weight Heparin [LMWH] 40mg subcutaneous along with LDA. In group A 26[86.7%] and in group B 25[83.3%] live births were attained. Significant side-effects were observed in groupB including bruising and injection site pain. Cost of drug for treatment over 28 weeks in groupA was Rs 300 and in groupB was Rs 6300. LDA alone have comparable perinatal outcomes with Heparin in cases of RPL, with an added benefit of no pain and bruising, low cost and more convenience of administration.

Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding

To validate the diagnostic efficacy of saline infusion sonohysterography [SIS] in the evaluation of uterine cavity, in women with postmenopausal bleeding and endometrial thickness >/= 5 mm. Cross-sectional study. Military Hospital, Rawalpindi, from March 2005 to July 2008 and Combined Military Hospital, Multan, from September 2008 to June 2009. Seventy seven eligible participants included women complaining of postmenopausal bleeding were included; out of whom 69 completed the procedure satisfactorily. Pain scores during procedure were assessed to determine patient acceptability. Following saline infusion sonohysterography all patients also underwent an outdoor pipelle endometrial biopsy in a one-stop postmenopausal bleed clinic. Findings of sonohysterography were compared with hysteroscopy/ hysterectomy specimen. Majority of the patients 34 [49.2%] experienced no pain during the procedure, 51 [74%] women had a positive SIS and the findings were negative in 18 [26%] patients. The commonest abnormal finding on SIS was focal thickening in 23 [32%] and endometrial polyp in 12 [17%] cases. Saline infusion hysterosonography picked up 3 cases of false positive polyps [5.8%] and missed a case of submucous fibroid near cervix [1.8%]. Upon comparison of findings of hysteroscopy and hysterectomy in 53 cases, there was complete agreement in a total of 43 [88%] cases. The sensitivity of sonohysterography was 92% and specificity was 78%. All the ladies with abnormal SIS had diagnostic or therapeutic procedures and finally only 24 [35%] were managed on conservative follow-up. Normal SIS led to conservative management in 16 [88%].Sonohysterography in combination with endometrial biopsy is a useful technique useful for the evaluation of postmenopausal bleeding. Patient acceptability and diagnostic capability is high and it reduces demand for hysteroscopy

Prevalance of sexually transmitted diseases among a selected group of Pakistani women

Sexually transmitted diseases or sexually transmissible infections are terms used interchangeably and remains a subject of great interest. Venereal diseases among females are a double-edged sword with an additional risk of transplacental and perinatal spread. The subject remains neglected in Pakistan, while disaster like Hepatitis B and HIV infections are at our doorsteps arleady. Just to take an initiative we attempted to asess prevalence of STD's among a selected group of Pakistani women. A strictly confidential interview including sexual history was followed by examination and laboratory screening. Overall prevalence was not high with one woman having a past history of Syphilis. l patient was culture positive for Chlamydia Trachomatis, 2% were serologically positive for Hepatitis B surface antigen while 22% were positive for Trichomonas Vaginalis. None was found psoitive for HIV. This small study cannot be representative of the whole society, similar studies have to be designed at wider scales for the calcualtion of the exact risk we are exposed. Only then definite prevention and control strategies can be defined to suit our local population