Retrospective analysis of acute hepatitis e infection in hospitalized pregnant cases

Hepatitis E virus [HEV] is endemic in Pakistan with 16-19% seropositivity of HEV IgG antibodies. The HEV is considered fatal during pregnancy as compared to general population. The objective of the study was to determine the maternal and fetal morbidity and mortality in HEV IgM positive pregnant cases. The study was conducted in four hospitals i.e. Pakistan Institute of Medical Sciences, Islamabad, Isra University Hospital Jamshoro, Sindh, Lady reading Hospital and Hayatabad Medical Complex, Peshawar, Khyber Pakhtoonkhwa. The medical record of pregnant cases from 2008 to 2011 was retrieved who were positive for HEV IgM. Information about age, gestational age, viral markers [HEV IgM, HBsAg, anti HCV], complications during pregnancy and outcome were recorded on pre design questionnaire. Data was analyzed using SPSS version 15. Medical record of 70 HEV positive pregnant cases was retrieved and out of these, 34 were found complete and analyzed further. The median age was 26 years. Twenty six pregnancies [76%] were in 3[rd] trimesters, 05 in 2[nd] trimester and 01 in 1[st] trimester. Pruiritis was the commonest symptom [28 cases], followed by jaundice [27], nausea/ vomiting [25] and encephalopathy [18]. Of 34 cases, 12 were artificially induced, 08 had premature labor, 04 delivered spontaneously [full term], 04 died undelivered and 04 continued till term. One got delivered at home and another had an abortion at home before coming to hospital. A total of 12 mothers along with their undelivered babies died, of these 08 were in 3[rd] trimester and 04 in 2[nd] trimester. Four out of 07 babies who were delivered prematurely also died. Maternal mortality was directly associated with delivery as 24 out of 34 mothers survived who were delivered either naturally or were induced while 12 out of 34 who continued their pregnancy died [p<=0 .004]. Third trimester had the highest maternal death. Acute hepatitis E during pregnancy led to 35% maternal and 47% fetal mortality. Acute hepatitis in pregnancy should always be screened for HEV and if found positive should be vigilantly followed to save mother and child

Challenging behaviour: assessing risk factors in people with learning disability

Challenging behaviour is common amongst people with learning disability and represents one of the greatest challenges to clinicians and service providers. This behaviour can be costly to manage and frequently leads to a significant burden of care, social exclusion, high health and social care costs. The main aim of this article is to highlight the important risk factors that need to be considered by clinicians whilst assessing people with challenging behaviour, to help formulate holistic and robust care plans tailored towards identified needs of an individual. Literature at Psych info, Medline and Cinahl [1980-2010] is reviewed for risk factors associated with challenging behaviour in people with learning disability. Various risk factors associated with challenging behaviour include male gender, adulthood, living at residential services, severe learning disability, underlying mental health disorders, and physical health problems etc. This article also aims to guide recommendations based on highlighted risk factors, for future planning of services and support by commissioners and service providers for this client group.

Management of gestational trophoblastic tumours: a five-year clinical experience

An analysis of a 5-year clinical experience in the management of gestational trophoblastic tumours in a tertiary care hospital. Design: A prospective cohort follow-up study. Place and Duration of Study: The study was conducted at Hayatabad Medical Complex, Peshawar from 1998 to 2003. Patients and A total of 30 cases were managed and a detailed analysis of these patients was done. Of these 13 followed Hydatidiform Mole, 10 after abortion and 7 after a term pregnancy. Out of 30 cases of gestational trophoblastic tumour, 63.3% were between 21 and 38 years of age. Ninety% of the patients presented with vaginal bleeding, while life-threatening hemorrhage occurred in 23.3%of the cases.43.3% of the patients had hydatidiform mole as an antecedent pregnancy and 36.7% of the patients presented within four months of the antecedent pregnancy. Blood groups O and B were most frequently encountered i.e. in 40% and 33.3% of the cases. Metastatic disease was present in 46.6% of the cases, of which 8 were high risk and one was of medium risk group. Major sites of metastasis were lungs [33.3%] and vagina [30%]. Serum BHCG of 40,000 miu / ml and above was present in 53.3% of the cases [P=0.016] and number of metastasis >8 were found in 16.7% cases [P=0.001]. Prior chemotherapy was given in only 2 patients and both of them died due to resistance. Chemotherapy was given to 100% of patients; survival was 100% in low-risk group and 50% in high-risk group [P=0.004]. Overall mortality was 20% i.e. 6 patients died of the disease. Major side effects of chemotherapy were stomatitis [66.6%], alopecia [56.6%], low hemoglobin [60%], weight loss and recurrent infection. Late diagnosis, previously failed chemotherapy and high WHO prognostic scores are major risk factors affecting outcome in these patients. Hence every female in reproductive age group with unexplained bleeding per vaginum should be investigated with serum BHCG [Beta human chorionic gonadotrophin]

Maternal and perinatal outcome in term singleton breech persentation

This study was carried out to determine the maternal and perinatal outcome in singleton term breech presentations in the pretext of mode of delivery so that appropriate management protocol can be devised without compromising fetomaternal well being. Material and This observational prospective study was carried out in obstetrics and gynaecology unit of Hayatabad Medical Complex Peshawar, from 1st January 2000 to 31st December 2000. All singleton term breech presentations were enrolled. Exclusion criteria included multiple pregnancies and preterm pregnancies. Data collected included age, present and past obstetric history, type of breech presentation, mode of delivery, indication for caesarean section either elective or emergency, fetal outcome and maternal complications. During this study a total of 265 cases of singleton term breech presentation were delivered [4.7%]. Vaginal breech delivery was carried out in 148 cases [55.8%]and caesarean sections in 117 cases [44%]. Elective caesarean sections were done in 78 cases [29.4%], and majority of these were primigravida [68.75%]. Emergency caesarean sections were done in 39 cases [14.7%]. Of the emergency caesarean sections major indication was fetal distress in 14 cases [35.8%] and failure to progress and obstructed labour in 12 cases [30.7%]. Route of delivery did not affect the perinatal outcome per say except for congenital abnormalities. Total number of congenital abnormalities associated with breech presentation were 7 and total number of intra uterine deaths associated with fetal and maternal problems were 13. All vaginal breech deliveries went into spontaneous labour and induction was performed in four cases, all were intra uterine deaths. Maternal and fetal complications were seen more frequently in the group requiring emergency caesarean section. Proper selection of cases for vaginal delivery, vigorous intrapartum monitering and proper technique of breech delivery have been established as the most important determinant for successful outcome in vaginal breech delivery without compromising fetomaternal well being and curtailing the caesarean section rate done for this mal presentation