Clinical and ultrasound correlation in first trimester abortion

To compare the diagnostic accuracy of clinical and ultrasound evaluation in first trimester abortions and assess the impact of ultrasound on patient management. Non-interventional comparative study conducted on 100 patients, selected on simple random basis from Gynae Outpatient Department. Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore Materials and All the patients with symptoms of first trimester abortion were evaluated clinically and by ultrasound to formulate a diagnostic and management plan. Both Modalities were compared for diagnostic accuracy, positive and negative correlation in different types of abortions. 34% of the patients were at 10 weeks of gestation, 28% were unsure of dates, 17% were at 11 weeks of gestation, 13% of the patients were at 9 weeks of gestation, 5% were at 6 weeks while 3% were at 7 weeks of gestation. Clinical diagnosis was made in 42% of cases; in 39% definite diagnosis was possible with combined clinical and ultrasound evaluation while in 19% no diagnosis was established with either modality In 89% of the cases the diagnosis was made on single ultrasound scan, while 11% required a repeat scan. Correlation between two modalities was present in 81% of the cases. Positive correlation was obtained in 59% and negative correlation was seen in 22%. The correlation was not possible in 19% of cases. Ultrasonography is an essential tool in diagnosis of early pregnancy failures especially where clinical evaluation is inconclusive

Vaginal birth after caesarean section [VBAC]

Aims and To find out the rate of vaginal delivery after one caesarean section Study Design: Non-interventional, descriptive study Study Setting: Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore. Materials and A trial of vaginal delivery was carried out on 100 patients with previous one caesarean section. Selection criteria were subjects with normal pregnancy, adequate maternal pelvic dimensions vertex presentation and spontaneous onset of labour with previous one uncomplicated LSCS. Patients with classical caesarean section, medical complications, multiple pregnancy, IUGR, placenta previa and extensive myomectomy were excluded from the study. Informed consent was taken from all patients; trail of scar was given with vigilance. Maternal and fetal monitoring was carried out with facility of operation theatre, anaesthesia and paediatrician. Majority of patients was between 20-24 years of age. 58% of the patients were primipara. Successful vaginal delivery was achieved in 72% and rate of repeat section was 28%. Leading indications for repeat section were failure to progress, [50%], fetal distress [28.5%] and scar tenderness [21.43%]. No maternal and fetal mortality occurred. Trial of scar after one LSCS should be encouraged with vigilant monitoring provided no obstetric contraindication exists

Incidence, mode of delivery and apgar score in breech presentation

A study was carried out at services Hospital Lahore affiliated with postgraduate medical institute Lahore, to rind out incidence, mode of delivery and apgar score in breech presentation. There were total 2432 deliveries of all types during the period of study and out of these 130 were full term breech deliveries, accounting for an incidence of 5.3%. Two groups were formed, Group A and Group B. group. Group A comprised of full term primigravidas with breech presentation and total number of patients was 55. Group B comprised of full term multigravidas with breech presentation and total number of patients was 75. In Group A 45 [81%] patients were delivered vaginally and Group B 60 patients [80%] were delivered vaginally. Incidence of non-elective caesarean section in Group A and B was 7.2% and 6% respectively. Total rate of elective caesarean section was 19%. Morbidity in Group A was 2% and Group B was 3.5°/a. There were no fetal complications. A trend of higher 5 minutes apgar score was positively seen in 100% infants. Caesarean section group was fewer lower apgar infants than groups delivered virginally