Feto-maternal outcome; trial of labour a study at tertiary care hospital

Trial of labour is a clinical test to assess the adequacy of pelvis and ability of fetus and mother to withstand labour. If progressive changes in dilation and station do not occur, a cesarean delivery is performed. Feto-maternal outcome after trial of labour in women with gestational age b/w 37 to 42 weeks. Cross sectional study. Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. One year from 01-02-2009 to 31-01-2010. 100 pregnant women, with gestational age between 37-42 weeks, who underwent trial of labour at labour ward, Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included in the study. Detailed history and examination including abdominal and pelvic examination as well as Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation and CTG. Partogram was maintained to observe the progress of labour. Those who progressed with trial either delivered normally or with the help of instruments and those who did not progress were delivered by C-section. After delivery, mothers were watched for any postpartum complication and condition of neonates was assessed by APGAR score. Out of 100 women included in this study 58% delivered vaginally, 31% delivered by cesarean section and 11% had instrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% had spontaneous labour. 77.0% babies had apgar score > 5[7.1 +/- 0.72], 16% < 5[3.68 +/- 2.18] and 6% were still birth. 81% mothers had no complication during or after delivery, whereas 19 developed complications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterine rupture and one retained placenta. There was no statistically significant difference [P=0.42] when mode of delivery was compared with the trial of labour. However augmentation of labour was associated with increased rate of maternal complications when maternal outcome was compared with the type of labour [P=0.03]. Trial of labour in carefully selected women with high probability to deliver their babies vaginally decreases the rate of LSCS, thereby reducing the maternal morbidity and mortality associated with it. However augmentation of labour is associated with increased rate of maternal complications as compared to spontaneous or induced labour

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

Incidence of placental abruption; morbidity / mortality associated with it

Objective: To determine the Incidence of Placental Abruption and the morbidity / mortality associated with it

Design: Prospective and Observational case Study

Setting and Duration: Department of Obstetrics and Gynecology, Liaquat University of Medical and Health Sciences Hyderabad, for a period of 15 months from January 2007 to March 2008

Patients and Methods: Among all the antenatal patients delivered during the period under review, those suffering from Placental abruption were entered into this study by completing a proforma for each patient. After history, examination and initial management, investigations were carried out. These patients were managed on case to case basis depending on the progression of abruption and delivery. After delivery whether spontaneous or by cesarean section the condition of mother and subsequent complications were recorded and results analyzed on SPSS version 10

Results: During the period 15 months, 2760 patients were admitted to labour room /labour ward and delivered. Among these, 100 patients had abruption making an incidence of 2.89% per year. According to the degree of abruption 33 had mild, 50 had moderate and 17 had severe abruption. 42% had spontaneous vaginal delivery, and 52% underwent cesarean section. 36% of Abruptio patients, developed complications like shock, PPH and DIC. One [1%] patient died in severe abruption

Conclusions: The incidence of Abruptio Placentae in this study is comparable to local studies and studies from developing countries, but is high in comparison to studies from developed countries. The maternal morbidity and mortality rate is not as high as in other studies

Gestational trophoblastic disease

Molar pregnancy represents a significant burden of disease on the spectrum of Gestational Trophoblastic Disease [GTD]. The incidence appears to be quite high in South Asia. The objective of this study was to determine the frequency of GTD, and clinical presentation, management and outcome of patients with molar pregnancy. This retrospective, descriptive study was conducted at Nuclear Institute of Medicine and Radiotherapy [NIMRA], Jamshoro from 1[st] Jan to 31[st] Dec 2009. All patients diagnosed and registered as GTD were included in the study. The clinical records of all molar patients were reviewed regarding presentation, treatment, and follow-up. There were a total of 167 patients presenting with different female genital tract neoplasia at NIMRA during the study period, including 39 [29.35%] cases of GTD. Hydatidiform mole was seen in 33 [84.61%] patients. Complete mole in 31 [79.48%], partial mole in 2 [5.12%] patients, invasive mole in 1 [2.56%] patient, and choriocarcinoma in 5 [12.82%] patients. The mean age of the patients was 27 +/- 9.8 years. The highest incidence was found in nulliparous and para 1. Thirty-two patients had suction evacuation and 1 patient underwent hysterectomy. Patients received chemotherapy, 17 [54.54%] patients followed protocol for 3-6 months. Frequency of molar pregnancy was high, more common in low-parous, poor socioeconomic class women, and usually presented late.

Placental abruption; frequency of its risk factors

To determine the frequency of risk factors associated with Placental Abruption. Prospective and Observational Case Study. Department of Obstetrics and Gynecology, Liaquat University of Medical and Health Sciences Hyderabad, for a period of 15 months from January 2006 to March 2007. All the antenatal patients/ pregnant ladies admitted to labour room /ward and delivered during the above mentioned period were scrutinized and those suffering from Abruptio Placentae were entered into this study by completing a proforma for each patient. The risk factors studied were; Age of Patient, Parity, past history of abruption, rural belonging, history of trauma, association with diabetes, hypertension, smoking and anemia. Results were analyzed on SPSS version 10. A total of 100 patients suffering from placental abruption were studied during 15 months period. The commonest age group was 30 years [47%]. Majority [54%] was multiparous, 66% belonged to rural population and among these, 2/3 were unbooked. Only one patient gave history of trauma. 5 patients had history of previous abruption. History of diabetes was present in only one patient, whereas 38% were hypertensive. Only 4 patients gave positive history of smoking. Anemia was the single most common factor present in 83% ladies. Age around 30 years, multiparity, hypertension, presence of anemia, rural belonging and previous abruption are the risk factors for placental abruption as per this study. No association of abruption has been found with trauma, diabetes or smoking in this study

Clinical presentation and treatment outcome of ovarian tumours at gynaecology ward

Objectives: To document the clinical presentation and treatment outcome of ovarian tumours across all age groups

Study Design: Retrospective data analysis

Place and Duration: This study was conducted at Gynae Unit III, Liaquat University Hospital for two years, from 19[th] July 2003 to 20[th] July 2005

Patients and Method: Patient files of ovarian tumour cases were accessed and a predesigned proforma was used to record the data regarding demographics, history, physical examination, signs, symptoms, investigations, type of surgical treatment, histopathology, chemotherapy, radiotherapy, follow up and mortality. SPSS 10 was used to analyse the data

Result: Out of all gynaecological admissions 1.29% patients presented with ovarian tumours. Out of 55 cases of ovarian tumours 15 [27.27%] were malignant with mean +/- SD age of 45 +/- 13.72 years, and 40 [72.73%] were benign with mean +/- SD age of 30 +/- 10.2 years. The commonest tumour found was of epithelial origin. Most of the patients presented in late stage when survival is poor

Conclusion: Ovarian tumours are most common in multiparous women of 40-45 years of age. Majority of the patients present in advance stage of disease, therefore prognosis is poor and mortality is high

Puerperal sepsis: an outcome of suboptimal obstetric care

Objective: to determine the frequency, causative factors and outcome of delivery by trained or untrained personnel

Study design: descriptive study

Setting: this study was done in the Gynaecology / Obstetric Unit-II, Liaquat University Hospital, Hyderabad Pakistan from 1st January 2006 to 30th December 2006

Patients and mehtods: all the patients who developed puerperal sepsis, delivered outside the university hospital were included in this study, while those who were referred as a case of retained placenta, other obstetric related postpartum morbidities like anaemia, puerperal psychosis, breast abscess, UTI, or who developed postoperative surgical problem delivered at university hospital were excluded from study

Results: out of total 2885 maternal admissions 135 patients had various postpartum problems, 61 patients had puerperal sepsis. Majority [67.2%] was less than 30 years of age and 52.5% of low parity. Among study population 67.2% belonged to low scio-economic group and 96% were illiterate. Majority [67%] of women did not receive any level of care, only 9.8% had level 3 care. Patients who had vaginal delivery were 93.4% while 6.6% had caesarean section. In majority of patients [57.4%] high grade fever was the major symptom followed by distension of abdomen in 26.2% . Evacuation of uterus and laparotomy were done in 39.3% , only evacuation of uterus was carried out in 24.6% and 3.3% had hysterectomy. One third [32.8%] had prolonged hospital stay and other one third [32.8%] died inspite of all possible measures

Conclusion: the study conclude that in majority of women sepsis as well as maternal death was preventable. It can be reduced by proper counseling of women about importance of antepartum, intrapartum and postpartum care and training of Dais and refreshing courses of trained birth attendants [TBAs]

Role of serum leptin level as a marker of severity of pre eclampsia

To explore the possibility of serum leptin being a marker of severity of pre-eclampsia, so that risk of imminent eclampsia and eclampsia can be reduced. This observational study was conducted at a private hospital of Hyderabad from 31st July to 1st December 2007. Forty primipara with same age, body mass indices and gestational age were included in this study. Twenty women had raised blood pressure in third trimester of pregnancy and 20 women with a normal blood pressure in third trimester of pregnancy. The exclusion criteria included history of diabetes, twin pregnancy, chronic hypertension, liver or renal disease. After counselling and affordability of laboratory testing their blood sample was taken for serum leptin, uric acid, serum creatinine and urine for albumin. The serum leptin level was measured by radio-immunoassay [RIA] kits. All data was filled in a pre-designed proforma after taking detailed history and examination. Statistical analysis was performed on SPSS. Student's t-test was applied where applicable. Mean systolic and diastolic blood pressure between pre-eclamptic and control group showed a marked difference [p<0.001] ranging from 149.50 +/- 3.44 and 104.40 +/- 3.03 as compared to control 107 +/- 1.56 and 74.50 +/- 1.49 respectively, similarly proteinuria was present in 20 [100%] cases of pre-eclampsia and 07 [35%] of normotensive women. Mean serum leptin level was significantly high in preeclampstic [79.380 +/- 3.287], when compared with a control group [27.825 +/- 1.050]. Mean serum uric acid in pre-eclamptic [5.040 +/- 0.147] showed significant changes than control [3.600 +/- 0.141], while serum creatinine level was insignificant in both groups. It has been observed that Mean +/- SEM value of serum leptin level was much higher in severe pre-eclamptics [76.418 +/- 5.056] than in women with mild pre-eclampsia [40.856 +/- 2.807]. All the parameters correlated positively and significantly with increased blood pressure. Elevated plasma leptin concentration appears to be a marker of pre-eclampsia independently or along with other parameters of pre-eclampsia could be used to reduce the severity of pre-eclampsia thus avoiding risk effects of pre-eclampsia to mother and foetus. This study still needs more research work to prove our results

Feto maternal outcome among abruptio placentae cases at a university hospital of Sindh

Objective: To determine fetomaternal outcome in women presenting with abruptio placentae at our setup. Design: A descriptive study. Setting: Department of Obstetrics and Gynecology Unit-II, Liaquat University Hospital Hyderabad, Sindh - Pakistan. Study was carried out from January to December 2007

Methods: All patients presenting with antepartum hemorrhage due to abruptio placentae at any gestational age after 28 weeks to term were included in the study. Women having bleeding due to causes other than abruption like placenta previa, vasa previa, carcinoma cervix and other local lesions were excluded. All the data collected through history, examination and investigations were recorded on a predesigned proforma. Data were analyzed using SPSS version 10.0

Results: Total number of cases admitted in labour ward was 2563. Forty-eight [1.87%] women had abruptio placentae. Maternal complications were postpartum hemorrhage [16.6%], disseminated intravascular coagulation [4.16%] and renal failure [6.25%]. Maternal death occurred in 4 women [8.33%]. Adverse fetal outcome was noted in severe cases of abruption. Still birth occurred in 41.6% cases

Conclusion: In our setup, frequency of abruptio placenta is comparable with local and international literature. Incidence of abruptio placenta is high in our women as most of the women belong to poor socio-economic class. Antenatal care plays an important role in decreasing the incidence of abruptio placenta

Comparison of salbutamol and nifedipine as a tocolytic agent in the treatment of preterm Labour

Objectives: To compare the efficacy and safety of beta agonist salbutamol and calcium channel blocker nifedipine in inhibiting uterine contractions for prolongation of pregnancy and to evaluate the maternal side effects and neonatal outcome of the two drugs. Design: Quasi experimental study from November 2007 to March 2008. Setting: Maajee private hospital of Hyderabad and Department of Obstetrics and Gynecology [Unit -II], Liaquat University Hospital Hyderabad, Sindh - Pakistan. Total deliveries conducted in both settings were 6,360 per year

Methods: One hundred pregnant women having single fetus, with preterm labour [<37 weeks] were studied. A proforma was filled from each patient that included information regarding history, findings of clinical examination and investigations. These patients were divided into two groups. Group A received salbutamol [beta-agonist] treatment and group B nifedipine [calcium channel blocker]. Salbutamol was given 4mg intravenously in 500cc of 5% dextrose solution, started at 10 drops per minute and increased at interval of 15-20 minutes until the contractions were stopped, then maintained with 4mg oral dose while nifedipine was given as 20mg oral tablets. Results were analyzed by SPSS version 10.0

Results: Total 100 patients were divided into two groups of 50 each. Mean age in group A was 27.64 + 6.006 [20-33 years] and in group B, 27.84+6.60 [22-36 years]. Mean parity in group A was 2.34+ 1.97 [1-3] and group-B was 2.58 + 1.99 [1-3]. Mean gestational age in group A was 31.14+2.43 [28-36 weeks] and in group B, 32.34 + 2.68 [28.36 weeks]. In group A 35 [70%] of patients had stopped contraction in 1st hour as compared to group B where only 10 [20%] were tocolysed for the treatment, 40% of patients had no contraction in 3[rd] hour of treatment in this group. Two [4%] women suffered from hypotension and headache with nifedipine as compared to salbutamol group where 9 [18%] women had nausea, vomiting, palpitation and tachycardia. Neonatal outcome and pregnancy prolongation till 36 weeks were similar in both groups

Conclusion: This study shows that tocolytic effect of prolongation of the pregnancy and the neonatal outcome of the two drugs are the same. However, calcium channel blockers are associated with less frequent side effects

Perinatal mortality and related obstetric risk factors at a tertiary care hospital of Hyderabad

Objective: To determine perinatal mortality rate and its related obstetric risk factors in our setup. Design: Observational study. Setting: Department of Obstetrics and Gynaecology [Unit-I], Liaquat University Hospital Hyderabad, from January to December 2006

Patients and Methods: All perinatal deaths including stillbirths [SBs] and early neonatal deaths [ENNDs] within 0-7 days of birth after 24 weeks of gestation were studied during the study period, while Pregnancies <24 weeks of gestation were excluded from the study. The relevant information was collected through a pre-designed proforma which contained variables including maternal demographics, obstetric risk factors and other details

Results: A total number of 2224 deliveries were analysed for perinatal mortality. Out of these, there were 224 perinatal deaths giving a PNMR of 100.7/1000 births. There were 196 SBs and 28 ENNDs. Among these, 88% women were unbooked. Commonest risk factors was antepartum haemorrhage [27.67%], followed by hypertensive disorders of pregnancy [23.21%] and mechanical factors affecting labour [14.28%]. Congenital abnormalities were found in 9.8% of PNDs while maternal medical disorders were seen in 6.25% cases. In 3.5% cases, chorioamnionitis/ neonatal septicaemia was the underlying cause and multiple pregnancies were seen in only 02 [0.89%] cases. However, in 32 [14.28%] cases, no cause was found

Conclusion: The high perinatal mortality rate in present study is comparable to the figures from other institutions. Main reason being lack of antenatal and pre-pregnancy care where from almost all obstetric risk factors can be picked up and treated / prevented

therapeutic efficacy of pharmacological versus non-pharmacological measures in the management of post burn itch

To standardize the management protocol of post burn itch by comparing therapeutic efficacy of pharmacological with non-pharmacological measures. A prospective, clinical investigative and quasi-experimental study. This study was conducted at Burn emergency Unit, Liaquat University of Medical and Health Sciences Jamshoro for the period of 18 months from January 2006 to June 2007. A total of 80 patients were included in the study, and equally divided into 2 groups. Group A received an oral antihistamine with topical Ibuprofen while Group B received olive oil massage followed by wearing of compressive garments. The demographic data and initial assessment of the severity of itch on linear descriptive scale was made by the research team; while subsequent data for the entire study period was obtained by the attending burn clinician who was blind to the allocated regimen. Results were analyzed using computer statistical software SPSS Group A included 40 patients with 23 males and 17 females having mean age of 28.13 [SD +/- 13.03] and mean body surface area affected 15.387% [SD +/- 5.408] and mean itch scale of 5.500 [SD +/- 2.219]. Group B comprised of 40 patients with 21 males and 19 females with a mean age of 29.38 [SD +/- 14.35] with mean affected body surface area of 16.150% [SD +/- 5.555] and mean itch scale of 5.350 [SD +/- 1.762]. The main outcome measure was the improvement in burn itch. The results after 12 weeks of treatment for both groups showed a remarkable improvement in Group B when compared to Group A [p-value 0.000 and 0.365 respectively]. The non-pharmacological measures are superior to the pharmacologic measure with respect to their clinical efficacy and their improvement is highly significant after 4 weeks of treatment

Antenatal screening for hepatitis B and C virus carrier state at a University Hospital

To determine hepatitis B virus [HBV] and hepatitis C virus [HCV] carrier state among pregnant women at gynaecology and obstetrics department of Liaquat University Hospital, Hyderabad -Sindh. A descriptive study. Maternity units of Liaquat University Hospital, Hyderabad - Sindh from January 2003 to December 2003. One hundred and three pregnant women with 35 to 40 weeks of pregnancy admitted in maternity units due to obstetrical reasons were screened for hepatitis B and C seropositivity after they gave informed consent. Immuno- chromatography and ELISA technique were used for blood testing. Pregnant women with symptomatic liver disease were excluded from the study. Convenient sampling approach was adopted for the data collection. Among screened population, 29.1% of pregnant women were found positive for HBV or HCV. Out of these, 16.5% women were positive for HCV where as 12.6% for HBV. All women had history of injections and ear and nose prick where as 20% had positive history of blood transfusions, followed by history of jaundice among them or with their partner. In our set up, frequency of 29.1% sero-positivity for HBV and HCV among pregnant women is alarming. These sero-positive mothers are not only at risk of having cirrhosis and liver cancer later on, but also are a continuous threat to their offsprings and care providers. Hence, there is a dire need to conduct more epidemiological studies on this problem and take measures for prevention and control of the disease

Hematocrit, hemoglobin concentration, R.B.C. count in acute mental stress

To study the haematologial effects of acute mental stress, blood samples were obtained from 91 healthy, normotensive, non-smoking first year male medical students aged 20-28 years before and during mental stress period. There was found significant change [p<0.001] in erthrocyte counts [mean +/- SEM 4.98 +/- 0.5 vs 4.81 +/- 0.03 [10x12L] [p<0.001] and haematocrit was observed [mean +/- SEM 45.3 +/- 0.5 vs 42.3 +/- 0.1% [p<0.001]. It is concluded that studied haematological variable might be of value as a measure of physiological stress. Haematocrit elevation resulting from mental stress my be clinically relevant and should he taken into consideration stress marker, at least, in hypertensive patients who are at risk of occlusive vascular diseases, since this study does not enroll any hypertensive subjects, however, future studies are needed to see any association, if there is any

Maternal Mortality in induced abortion

Maternal mortality resulting from induced abortion was studied over a period from 1st November 1996 to 30th October, 1997. A total of 400 patients were admitted with abortion, comprising 20% of total admissions, of these, 11 [2.7%] cases were of induced abortion. In nine [81.81%] there was history of instrumentation and 2 [18.18%] had used herbal medicine. Three [27,7%] women died. The most common cause of death was septicaemia

Emergency hysterectomy for gestational trophlastic tumours

A total of 2,200 pregnant women's were admitted in Gynae unit Ill in Liaquat Medical College Hyderabad [LMCH] between 31st January to 30th August 1998 and during the same period 1376 women's delivered and 400 patients were admitted with abortion. At this rate of patients turn over, a total of 32 [2.32 percent] cases of gestational trophoblastic disease were admitted, of whom 2 were of choriocarcinoma. Thus the incidence of gestational trophoblastic disease was 4.3/1000 and choriocarcinoma. 0.68/1000 term deliveries. Both patients of choriocarcinoma were unfortunately subjected to emergency hysterectomy because of life threatening haemorrhage following initial curettage. In these young patients hysterectomy can be avoided if the condition is diagnosed early, treated with chemotherapy, as majority of patients can retain child bearing capacity and often have normal pregnancy after therapy