Causes of infertility in females: evaluated by diagnostic laparoscopy at a tertiary care centre

To determine the frequency of various causes of infertility through diagnostic laparoscopy. Cross sectional comparative study. The study was conducted in gynaecology/obstetrics department unit I of Military Hospital Rawalpindi from May 2011 - May 2012. A total of 50 patients were recruited in the study through outpatient clinic, 32 out of 50 had primary infertility and 18 had secondary infertility. Diagnostic laparoscopy was performed under general anesthesia and findings were recorded. The mean age of patients was 26.4 years. Out of 50 patients 20 [40%] had polycystic ovaries, 15 [30%] had tubal blockage, 7 [14%] had endometriosis and 2 [4%] had fibroids while 6[12%] were found to have normal pelvis and no pathology was detected. Polycystic ovaries was found to be the major cause of infertility in this study group, followed by tubal factor infertility either secondary to pelvic inflammatory disease or otherwise, both these causes are treatable to a variable extent and fertility can be resumed if managed properly

effect of metformin on endometrial hyperplasia in patients with polycystic ovarian syndrome [PCOS]

To study the effect of metformin therapy in patients with poly cystic ovarian syndrome having irregular heavy menstrual cycle and thickened endometrium [hyperplasia] on transvaginal ultrasound. Quasi - experimental study. The study was conducted in Military Hospital Rawalpindi, department of gynae / obs unit-1 from January 2009 - June 2010. A total of 100 patients in the age group of 40-47 years who reported to gynae OPD with irregular heavy menstrual cycles with or without clinical features of hyperandrogenism were selected and informed consent was taken. Transvaginal ultrasound [TVS] was performed on them by the same operator and those who had polycystic ovaries [enlarged ovaries with > 8-9 follicles peripherally enlarged] and endometrial thickness > 12 mm in the follicular phase of the cycle were selected. Total 100 patients were included in the study, but 10 patients were dropped out. Metformin was started after explaining the purpose of the study initially in low dose [500-1000 mg/day] and was adjusted to 1500 mg/day over next 4-6 weeks. Patients with abnormal liver or renal functions and those already taking hormonal therapy or on tamoxifen were excluded from the study. The endometrial thickness was assessed on monthly follow up visits and final findings were recorded and presented at the end of one year. Of 90 patients, mean age of patients was 43.25 years [SD = 1.91], mean pretreatment endometrial thickness was 20.25 mm [SD= 4.85] mean and post treatment endometrial thickness was 16,38mm [5D = 4.72], There was a significant reduction in endometrial thickness after treatment with metformin. Metformin therapy [1500 mg/day] significantly reduces endometrial thickness [hyperplasia] in patients with PCOS

Frequency of polycystic ovarian syndrome [PCOS] Among obese diabetic and non diabetic females with clinical features of: hyperandrogenism

To determine the frequency of Polycystic Ovarian Syndrome in obese diabetic and non-diabetic females with clinical features of hyperandrogenism and to find if type 2 diabetes is a risk factor for developing polycystic ovarian syndrome. A cross-sectional comparative study. The study was done in Gynaecology and obstetric unit of Military Hospital Rawalpindi from June 2004 to April 2005. Eighty four obese females were enrolled and counseled about the procedure Body Mass Index [BMI] age and clinical features of hyperandrogenism, were recorded. Informed consent was taken, their relevant information was documented on the data collection sheets. These females were divided in two groups, 46 patients who had type 2 diabetes mellitus were enrolled in group 1 [n=46], 38 patients with normal fasting plasma glucose were enrolled in group 2 [n=38] as controls. Transvaginal scan was done on females of both groups to record the findings of Polycystic Ovarian Syndrome [PCOS]. Eighty four women were included for the study, all had BMI > 28, out of 46 patients who were enrolled in group-1; 32 [69%] [95% C1:59.2-78.8] had polycystic ovaries on transvaginal scan [table], while in control group, 38 women who were enrolled 23; [61%] [95% CI: 50.7 - 71.3] had polycystic ovaries. The frequency of PCOS was slightly higher in diabetics compared to the non diabetics 70% vs 61% respectively. The statistical analysis by chi-square test revealed a statistically insignificant relationship [p>0.05]. There was no statistically significant difference between the frequency of PCOS among diabetics and non-diabetics and this does not support the view that type 2 diabetes could be a risk factor for PCOS

Post partum haemorrhage prophylaxis; Comparison of the efficacy of misoprostol and ergometrine in cesarean delivery

Post partum hemorrhage [PPH] is defined as the loss of greater than 500ml of blood from the genital tract in the first 24 hours following delivery. PPH occurs in 2-11% of all deliveries. To compare the efficacy of misoprostol and ergometrine for the prophylaxis of Post Partum Haemorrhage. Prospective study. Gynaecology and Obstetrics Department Military Hospital Rawalpindi. From 01 July 2006 to 31 Dec 2006. A total of 200 patients were recruited in the study, they were divided in two groups, group - I [n- 100] included those patients who were administered ergometrine intravenously at the time of delivery of head for the prophylaxis of post partum haemorrhage, Group - 2 [n-100] included those patients who were administered Misoprostol 800 microgram per rectally just before the start of cesarean section for the same purpose. Blood loss was calculated objectively by squeezing the soaked pads and quantifying the amount of clots in a kidney tray of standard size to be equal to 500ml. In group I [n-100] 15 patients had mild PPH blood loss > 500ml, out of them 03 had severe PPH requiring bimanual message and 02 patients required blood transfusion, in group II[n-100]. 08 patients had PPH, blood loss > 500 ml, out of them 01 patient required uterine message and none required blood transfusion. Chi-square test was applied to compare the efficacy of the two groups, P > 0.05 showed no significant difference in the efficacy of the two groups but the side effects were obviously less in the Misoprostol group. No patient in group II had GI symptoms while 36 patient in group I had retching and, vomiting and 03 patients had raised B.P after the administration of ergometrine. Misoprostol administered per rectally has equal efficacy to ergometrine given intravenously for the prophylaxis of post partum haemorrhage but the side effect profile and patient tolerability is better with Misoprostol