Diabetes mellitus during pregnancy: a study of fifty cases

To review and critically evaluate the incidence, epidemiology, clinical pattern, diagnosis, management, complications and outcome of diabetes mellitus during pregnancy in hospital based study. Setting: A study of 50 cases of diabetes mellitus during pregnancy studied during the period 1ST June 2001 to 1st June 2003 at Department of Obstetrics and Gynecology Unit-II, Jinnah Hospital, Lahore. Main outcome measures: Maternal and fetal outcome. Total number of women delivered were 11271. Fifty cases of diabetes mellitus during pregnancy were studied. Mostly the patients were more then 30 years of age, multiparous ladies with gestational diabetes in 80% of cases, Type-II diabetes in 16% and only in 4% Type-I diabetes was reported. Insulin was required in 40% of patients. Eight women out of 50 had spontaneous miscarriage, 5 underwent preterm delivery while 36 reached term with one intrauterine death. Total number of babies delivered alive were 41. There was one stillbirth and 3 neonatal deaths. Management of diabetes mellitus in pregnancy involves teamwork of Obstetricians,Physicians and Neonatologists

study on gestational trophoblastic disease [GTD]

To review and critically evaluate, the incidence, epidemiology, clinical pattern, diagnosis, management, complications and surveillance of GTD in our set up. Design: A study of 20 cases of GTD managed in two years 1993-1994. Setting: Department of Obstetrics and Gynecology Postgraduate Medical Institute/Service Hospital, Lahore. 20 Patients of GTD admitted in the ward. Main outcome measures: Incidence, clinical features, diagnosis, management, complications and follow-up. During this period four thousand three hundred and forty two patients delivered giving an incidence of GTD as 1:217 births. Nineteen cases were of Hydatidiform mole and 1 of Choriocarcinoma. One of the patients later on developed invasive mole. Eighteen patients were managed by suction curettage, one by hysterectomy. In a 42 years patient with persistent high serum beta HCG, invasive mole was suspected which proved on hysterectomy and histopathology Choriocarcinoma was diagnosed on histopathology of curettings in a 45 years patient. Chemotherapy 'MAC' [methotrexate, actinomycin, chlorambucil] regimen was given but hysterectomy was performed for heavy vaginal bleeding. Strict follow up was advised, but patients compliance remained unsatisfactory. One patient delivered a healthy baby girl at term. The diagnosis was made from clinical features, ultrasonography, serum beta HCG. Suction curettage is the management of choice for hydatidiform mole. Regular follow up of cases is essential

Heart disease during pregnancy a study of 54 cases

To review and critically evaluate the prevalence, epidemiology, clinical pattern, diagnosis, management, complications and outcome in our set-up. Design: A study of 54 cases of cardiac disease during the two year period of 1994 and 1995. Setting: Department of Obstetrics and Gynaecology Postgraduate Medical Institute, Services Hospital Lahore. Patients: Fifty four obstetrical cases with cardiac disease admitted in the ward. Main outcome measures: Prevalence, clinical features, diagnosis, management and complications. During this period five thousand six hundred and ninety nine [5699] patients delivered giving the prevalence of cardiac disease 0.95%. Mostly the cases were 26-30 years primigravidae, in class I and II of rheumatic heart disease and only in few cases the class aggravated. Prophylactic antibiotics were given to all cases, half were digitalized, three quarters required diuretics and heparin, one had infective endocarditis and none underwent cardiac surgery. No other complication occurred. Three quarters reached term and delivered vaginally and only few had caesarean sections, preterm delivery and spontaneous or therapeutic abortion. Only 7.4% had post partum complications. Contraception by barrier method or sterilisation was advised. Mostly healthy babies were delivered, three still births and two neonatal deaths occurred, Co-operation of the Obstetrician, Cardiologist, Anaesthetist and Neonatologist can achieve good results regarding fetal outcome in the management of heart disease during pregnancy

Emergency obstetric hysterectomy

In all 12.401 patients were delivered and 21 emergency obstetric hysterectomies were performed over a period of 6 years [1990-95] giving a frequency of 1.69/1000 deliveries. This drastic surgery was carried out to save valuable maternal lives in conditions of uncontrollable haemorrhage due to uterine rupture, atony, placenta praevia/accreta or disseminated intravascular coagulation [DIC]. Most of the patients were from the suburbs, unbooked, poor and lower middle class, 35-40 years of age, 52% with high parity, and 66.6% handled by traditional birth attendants [TBA], brought in moribund condition. They were resuscitated and given blood transfusions. Conservative methods were tried where possible; 15 underwent total and 6 subtotal hysterectomy. There were 5 maternal and 9 perinatal deaths. Ignorance, illiteracy, poverty, high parity, inadequate maternity and family planning services, lack of proper training of TBAs and transportation facilities predisposed to catastrophic conditions, adverse complications, grave morbidity, poor prognosis and maternal loss