Frequency of placenta previa in previously scarred and non scarred uterus

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections [37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus] in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients [47.36%] were between 26-30 years age group, presented with gestational age between 36-40 weeks [70.17%], were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% [37 cases], and frequency in previously scarred uterus was 67.54% [77 cases]. Major degree Previa was found in 88 cases [77.19%]. There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa [10.67%] from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus

Emergency obstetrical hysterectomy: frequency indications and maternal outcome

Obstetric hysterectomy still remains a necessary tool for the obstetrician. It is a life saving procedure in cases of severe hemorrhage. The aim of present study was to determine the frequency indication, associated risk factors, maternal morbidity and mortality associated with obstetric hysterectomy in tertiary care center, Lady Willingdon Hospital, Lahore. Retrospective descriptive study. Study carried out in the Department of Obstetrics and Gynecology, Lady Willigdon Hospital, Lahore from August 2005 - July 2010. The frequency of obstetric hysterectomy over a study period was 0.24%. One hundred and eighteen patients were identified. During the same period total 48000 deliveries were conducted. Majority of the women were in the age group 26-40 years, presented between 37-40 weeks of gestation and were mutiparas. Main indications were postpartum hemorrhage, placenta previa and ruptured uterus. Associated risk factors include previous caesarean delivery, placenta previa, multiparity, placental abruption and uterine atony. Complications included postoperative shocks, febrile illness, paralytic ileus, wound infection and urinary tract infection. All women require blood transfusions, total abdominal hysterectomy was commonly performed surgery in our study. Maternal mortality occurred in 13% of patients and due to septicemia, DIG, hypovolemic shock and pulmonary edema. Obstetric hysterectomy is a life saving procedure but decision should be prompt and treatment by an experienced surgeon. It is associated with significant maternal morbidity and mortality which can be prevented by community education about delivery by skilled birth attendants, good maternal care education, active management of labour, early recognition of complications, timely referral and easy availability of transport and third delay at referral facility

Comparison of side effects and complications of intravaginal misoprostol with extra-amniotic prostaglandin F 2 alpha for termination of second trimester pregnancy

The objective of the study is to compare the maternal side effects and complications of Misoprostol and prostaglandin F2alpha for termination of second trimester pregnancy. Non randomized controlled [Experimental] study. This comparative study was carried out in Gynae Unit 1, Lady Willingdon Hospital Lahore from 1[st] Oct 2009 to 31[st] Mar 2010. Sixty patients admitted to gynecology ward for termination of pregnancy through the outpatient department were selected according to inclusion criteria of the study. They were divided into two groups of 30 patients each. Group 1 was given Misoprostol and group 2 PGF2alpha for induction of labour. Induction failure was higher in PGF2alpha group. Side effects were more frequent in the women receiving PGF2a than those receiving Misoprostol [56.67% vs. 43.33%; p=0.96]; diarrhea [26.67% vs. 20%] and fever [16.67% vs. 10%]. Incidence of nausea and vomiting were 6.67% in both the groups. In the same way, the complication of post partum hemorrhage was seen more in PGF2a group than the Misoprostol group [6.67% vs. 3.33%]. The incidence of retained placentas was 6.67% in both the groups. The average cost per treatment was Rs. 619 for PGF2a as compared with Rs. 135 for Misoprostol. Misoprostol is cost effective has fewer complications and side effects as compared to PGF2alpha