Umbilical cord blood pH in intrapartum hypoxia

To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. Descriptive analytical study. Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures [healthy, NICU admission or neonatal death], color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. A total of 204 newborns were evaluated. The mean pH level was found to be significantly different [p=0.007] in two groups. The pH value 7.25 had significant association [p < 0.001] with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor [MSL] also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSL had pH > 7.25. Majority [63.6%] cases needed caesarean section as compared to 31.4% controls. There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive

Use of bilateral internal iliac artery ligation for controlling severe obstetric haemorrhage

To study the role of bilateral internal iliac artery ligation [BIAL] in arresting intractable postpartum haemorrhage. This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding [failure rate 16.66%]. While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity

Perineal repair: comparison of suture materials and suturing techniques

To compare the outcome of chromic catgut versus polyglactin 910 suture and of continuous versus interrupted suture technique on perineal repair. Randomized clinical Trial. Darul-Sehat Hospital [a private teaching tertiary care hospital] and the duration of study was 18 months. A total of 200 patients delivering singleton fetus and having episiotomy or second degree perineal tear were included in this study. These 200 patients were randomly allocated with alternating sequence to either of the 4 groups which were, group 1 as continuous repair with chromic catgut no. 0 and 00, group 2 as continuous repair with polyglactin 910 no. 0 and 00, group 3 as interrupted repair with chromic catgut and group 4 as interrupted repair with polyglactin 910. All the repairs were conducted by authors. Primary outcome was the subjective assessment of perineal pain on day 10, while secondary outcomes were dyspareunia at 6 weeks, resumption of sexual activity, wound healing, residual suture removal and number of sutures utilized. Analysis was performed by SPSS-15 and the ANOVA and Chi-square test were used with p-value < 0.05 as the level of significance. Of the 200 patients 50 patients had perineal repair done with chromic catgut and continuous technique, 50 with polyglactin 910 and continuous technique, 50 with chromic catgut and interrupted method and 50 with polyglactin 910 and interrupted method. At day 10 there was no significant difference [p-value > 0.05] in the pain intensity among different groups. Also there was no difference in dyspareunia, resumption of sexual activity and healing, but more cases of suture removal found in polyglactin 910 group as compared to chromic catgut, while significant difference [p-value < 0.05] was found in the number of suture utilization when compared between continuous and interrupted technique. Chromic catgut is still found to be an effective suture material for perineal repair in resource poor countries as the outcome measures are similar to polyglactin 910. Also the continuous suture technique is found to be less costly as less suture material is required without compromising the outcome

Conjoined twins in a triplet pregnancy

Conjoined twin is a rare event. Triplet pregnancy in conjunction with conjoined twin is even rare. In this report we present the outcome of female, monochorionic, diamniotic triplets consisting of two monoamniotic conjoined fetuses and a normal baby in separate amnion. Emergency cesarean section was done due to non progress of labor in a female who was un-booked case. Conjoined twins [thoraco-omphalopagus] died due to birth asphyxia during the section while third baby was normal and remained well

Frequency and pattern of distribution of congenital anomalies in the newborn and associated maternal risk factors

To determine frequency, pattern of distribution of congenital anomalies in newborn and associated maternal risk factors. Cross-sectional observational study. This study was carried out in the Department of Gynecology and Obstetrics, Lyari General Hospital, during the period of January 2000 to October 2005. All the women giving birth to babies with congenital anomalies during this period were included. Demographic details, associated risk factors and the type of congenital anomalies in babies were recorded. Diagnosis of congenital anomalies was based on ultrasonography and clinical evaluation of newborn by experienced neonatologist. During the study period, 5776 patients delivered, of which 76 had congenially malformed babies, making the prevalence of 11.4 per 1000 births. Most of the women [55.26%] belonged to the age group between 21 to 30 years. Congenital anomalies were more commonly [55.26%] seen in the primiparas. The most frequent associated risk factor was history of consanguineous marriage in 44.74%. Neural tube defect [NTD] was found to be the commonest [65.8%] type of anomaly. Among the most frequent NTD was hydrocephalus and anencephaly. The commonest associated risk factor was consanguineous marriage the frequency of which may be reduced by creating awareness regarding the avoidance of consanguineous marriages. NTD were the most prevalent anomaly detected and early prenatal diagnosis is helpful in decreasing the indirect prevalence of perinatal mortality by offering early termination

Dysfunctional uterine bleeding: a clinicohistopathological analysis based

This study was conducted to identify the histopathological changes in patients of dysfunctional uterine bleeding [DUB], their response to different modes of treatment and their effects on maternal well being. Sixty eight cases diagnosed as DUB during a period of one year at Gynae unit II, Abbassi Shaheed Hospital, Karachi were included in the study. DUB was diagnosed in 10.46 percent of women admitted with gynaecological problems. Majority of women were multiparous and belonged to age group between 21 to 40 years. Commonest presenting symptoms were menorrhagia [32.35 percent] and polymenorrhagia [27.94 percent]. Commonest histopathological feature was secretory phase [52.46 percent] and then the proliferative phase. A good response to curettage only was achieved in 14.17 percent of patients, while majority [67.65 percent] needed medical treatment as well. Hysterectomy was performed in 36.76 percent of patients. The negative effect on maternal health was observed as anaemia in 88.23 percent women. Early diagnosis and treatment of DUB can reduce excessive blood loss and its impact on maternal health