Adverse outcome of a teenage pregnancy

Introduction: Pregnancy at very young age is a high risk pregnancy. It can lead to the vicious cycle of medical, physical and social problems from which a pregnant girl and her fetus can hardly escape. Approximately 90% of the teenage births occur in developing countries. In teenage pregnancy both mother and her child are at high risk of disease and death. Early pregnancy in teenage is considered as an independent risk factor for adverse pregnancy outcome

Objective: To determine the adverse fetomaternal outcome in teenage pregnancies

Methodology: This retrospective study was conducted in department of obstetrics and Gynecology unit-II , Liaquat University Hospital Hyderabad from 1[st] January 2015 to 31[st] December 2015. Data was collected from hospital records of all nulliparous women aged between13-19 years with a singleton birth of 28 weeks or above. Multigravida women, with multiple pregnancies, alcoholics, smokers, having any medical disorder and those with strong family history of hypertension were excluded from the study. Maternal and Perinatal outcome measures recorded were anemia, pregnancy induced hypertension, pre-eclampsia, preterm labour, operative delivery, stillbirth and low birth weight

Results: The mean age of subjects included in this study was 17.35 years +/- SD1.06 years. Average gestational age at delivery was 36.86 +/-SD 2.15 weeks. Common complications seen in adolescent mothers were Anemia [34.2%], Pregnancy induced hypertension [33.3%] and preterm delivery [23.9%]. Most of the deliveries carried out vaginally however caesarean section was done in 33.33% cases. Regarding fetal outcome, 12.82% deliveries ended in stillbirth and out of live newborns, 21.57% were low birth weight

Conclusion: Teenage Pregnancy are associated with increased risk of unfavorable obstetric outcome, so every effort should be taken to provide optimal care and support to these young mothers

Curriculum-based prescription writing among undergraduate medical and dental students

Background: Prescription writing is highly intricate. It is a reflection of the prescriber's knowledge of clinical pharmacology and well-defined judgment. Weak prescribing skills are mostly exhibited by junior doctors. Contributory factors include improper training, integrated system, and weak skills of the prescriber. Research provides substantial evidence that these flaws can be minimized through structured educational interventions

Objective: To evaluate medical and dental students on rational prescription writing, identification of elements and abbreviations of a prescription

Methods: A cross sectional study was performed on second year medical and dental students of Ziauddin University. In three 3 sessions, the students were taught rationale prescription writing, abbreviations, and elements used in prescription writing consecutively. The elements were based on doctor's and patient's information, followed by the drug component written explicitly. Each session was followed by exercises on case scenarios, to assess their comprehension of the topic. The p value < 0.05 was considered significant

Results: In the study 83% of the students completed components of rational prescription writing for a given case scenario, with 75% and 77% students identifying abbreviations and various elements in five tailor-made prescriptions respectively

Conclusion: Rational prescription writing is a curriculum-based inherent skill acquired by medical and dental students during their training. When rational prescription writing is taught together with elements of a prescription and abbreviations, it equips students with sound knowledge of clinical pharmacology and refines their judgment in formulating prescriptions

Manual vacum aspiration: a safe alternative for surgical management of early pregnancy loss

To assess the efficacy of MVA in the management of first trimester early fetal demise and first and mid-trimester incomplete miscarriages. Prospective observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Teaching Hospital Khairpur from 1[st] January to 31[st] December 2012. A total of 145 cases with early pregnancy loss at < 12 weeks gestation, with a ultrasound diagnosis of an embryonic pregnancy, incomplete, missed and molar pregnancy were included in the study. Primary outcome measures were to assess the efficacy of the procedure and secondary outcome measures included safety of the procedure and rate of complications. A total of 145 women were included in the study. Efficacy of the procedure was 90.3%. Incomplete uterine evacuation was seen in 14 [9.6%] patients while severe hemorrhage was seen in 1 [0.6%] and infection in 6[4.1%] of study population. MVA is an effective alternative to conventional suction curettage, in terms of reduced cost, need for general anesthesia and it is also useful in low resource setting with scarcity of electricity and to avoid prolonged hospital stay

clinic-pathologic correlation of elective abdominal hysterectomy at teaching hospital Khairpur, Pakistan

To study the clinical indication and common pathologies identified on specimen, and complications associated with this procedure. This prospective observational study was carried out at Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur [Shaheed Muhtarama Banazir Bhutto Medical University Larkana Sindh, Pakistan] during one year period from 1[st] May 2010 to 30[th] April 2011. All abdominal hysterectomies performed during this period were studied for the following variables: The primary clinical indication, the histological diagnosis and complications associated with this procedure. Data was collected on pre-designed Performa and analyzed on SPSS version 15. Total number of patients admitted during study period were 5580. Of these, 2280 [40.86%] had the gynecological problems, of these 2280 patients, 820 [35.96%] required surgery. Two hundred ninety women underwent major surgery which included elective abdominal hysterectomy in 150 [51.72%] patient. Peak age incidence was in 35-60 years. In 97% cases indication were for benign conditions. Menstrual disorders were the major clinical indication of hysterectomy while uterus leiomyoma were the common pathology confirmed. There was no mortality associated with the procedure. Menstrual disturbance was leading indication of hysterectomy and leiomyoma was the commonest pathology found on hysterectomy specimen

Eclampsia: still a major cause for adverse maternal and perinatal outcome

To determine the frequency of eclampsia and to investigate the maternal and perinatal outcome of the condition in order to identify whether further improvements can be made to the care of women by early interventions. A descriptive observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Mir's Sindh, during one year period from 1[st] January to 31[st] December 2010. All patients presenting with eclampsia in the labour room were included in the study. The diagnosis was based on case definition and was managed according to the set protocols. Data was recorded on pre-designed Performa. A total of 2796 patients were admitted in labour room during the study period and out of them total cases of eclampsia were 81 patients thus contributing 2.89% of the total admission. Most of the patients were unbooked only 11% patients were booked. 49% of women had first fit in the antenatal period, 37% in intrapartum while 13.5% had first fit in postpartum period. Headache and raised blood pressure was found in 85% of cases. 91% of women received magnesium sulphate, platelet count <150,000/m 3 were found in9.8%, deranged LFT in 14.8% women and abnormal renal function test were found in 34% . Mode of delivery was caesarean section in 57% patients, vaginal delivery in 34.2%. Two patient needed hysterectomies due to severe PPH, 4 maternal deaths were observed in study population. Regarding perinatal outcome 35 fetuses born with LBW, 26 were still born and 9 died in neonatal period. Eclampsia has strongly significant adverse impact on mother and fetus, which could be avoided by provision of integrated, adequate MCH services especially during antenatal period

Role of Foleys catheter for pre-induction ripening of cervix

The unripe cervix may present a problem when delivery is indicated prior to the Spontaneous onset of labour. To assess the role of Foleys, catheter in improving cervical score prior to Induction of labour. Observational type of study. This study was conducted in the Department of Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur, Sindh during six months period from January to June 2012. Foley,s catheter was used for pre-induction cervical Ripening in fifty patients with medical and Obstetrical indication for induction of labour with unfavorable cervix. The study group comprised 35[70%] primigravida and 15[30%] multigravida. The mean maternal age was 20-35 years. Foleys catheter No: 18-22 was inserted in fully aseptic condition extra amniotic up to the level of Internal cervical os and was removed after 24 hours. Pre and post treatment cervical Condition was assessed by Bishop,s score. Foleys was inserted in 50 patients for pre-induction ripening of cervix. Thirty [60%] out of 50 patients delivered spontaneous vaginal delivery, 11[22%]Delivered by caesarean section due to failure to progress, fetal distress and CPD. Mean induction to delivery interval was 12.72hours.There were no cases of infection, Ruptured membranes, hemorrhage or other complications attributed to balloon Catheter used. Pre-induction cervical ripening with extra amniotic Foleys catheter Balloon has the advantages of being effective, simple, economical and free of Systemic serious side effects

Cyclin A2 and P53 expression in various grades of cervical dysplasias and invasive carcinoma of cervix

The aim of the study was to evaluate the status of cyclin A2 in HPV associated cervical cancer. We analyzed the influence of HPV type 16 on the expression of cell cycle regulatory protein Cyclin A2 and p53 in various grades of cervical dysplasias and infiltrating squamous cell carcinoma. The study was conducted in the Department of Pathology, BMSI, JPMC, Karachi. A total of 50 formalin fixed paraffin embedded blocks were used, which included 18 cases of squamous cell carcinoma and 32 cases of various grades of cervical dysplasias. The blocks were analyzed for the presence of HPV type 16, indirectly by Cyclin A2. Polymerase Chain Reaction was performed on 15 Cyclin A2 positive cases for verification of HPV type 16. Cyclin A2 positivity was detected in all 18 cases of squamous cell carcinoma and 21 cases of various grades of cervical dysplasias. 15 cases positive for Cyclin A2 were analyzed for HPV type 16 by PCR. HPV type 16 was identified in 13 cases out of 15. HPV type 16 identification in majority of the cases showing positivity for Cyclin A2, which could be used as potential indicator for early diagnosis of cervical dysplasias and invasive squamous cell carcinoma

Morphological evaluation of nasal cavity growths in different age groups

To study the various morphological patterns of nasal cavity growths in different age groups of the samples received in the pathology department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical centre. It was a retrospective study, carried out at the Deptt of Pathology, Basic Medical Sciences Institute, Jinnah postgraduate Medical Centre, Karachi. All the nasal lesions received during the period of 5 years i.e from January 2004 to 31st December 2008 were reviewed. All specimens were formalin fixed, routinely processed for paraffin embedding, sectioned and finally stained with hematoxylin and eosin using standard procedures. Immunohistochemistry with markers was performed in few cases. Total number of 143 cases of Nasal growths were received and evaluated. These cases were further classified into subtypes based on the histological features. Out of 143 cases, 116[86.6%] were non- neoplastic and 18[13.4%] were neoplastic lesions. The major bulk of the non-neoplastic lesions was formed by inflammatory polyp 83 cases [61.9%], followed by Allergic polyp 22 cases [16.4%], 4 cases [3%] each of Fungal polyp and Granuloma pyogenicum and 3 cases [2.2%] of Antrochoanal polyp. Neoplastic lesions came out to be 18 [13.4%] in number, among which 9 cases [6.7%] were of angiofibroma, 4 cases[3%] of Inverted squamous papilloma and 1 case [0.7%] of Pleomorphic adenoma.4 out of 18 cases [22.2%] were malignant lesions, of which 2 cases [50%] were Adenocarcinoma and lease [25%] each of adenoid cystic carcinoma and epithelioid hemangioendothelioma. In non-neoplastic growths, inflammatory nasal polyps were most common, however angiofibroma being the most frequently occurring neoplastic lesions. We also encountered low/high grade adenocarcinoma and hemangioendothelioma

Assessment of efficacy and safety of manual vacuum aspiration [MVA]

Objective: To assess the efficacy of manual vacuum aspiration [MVA] in term of complete uterine evacuation of product of conception. Secondary end point was to assess safety of procedure

Study Design: Retrospective descriptive study

Place and Duration: Department of Obstetrics and Gynecology, Unit-II Liaquat University Hospital Hyderabad Sindh from 15[th] October 2008 to 14[th] September 2009. PATIENT and METHOD: A retrospective review medical records of patients who underwent MVA was carried out. Primary out come measures were efficacy and secondary out come measures were to assess prevalence of complications

Results: During study period 146 patients underwent surgical management for early pregnancy demise, incomplete miscarriage, retained product of conception after full term pregnancy. Out of 146, 112 patients were scheduled to undergo MVA. Efficacy of procedure was 88.18% [97/110]. Incomplete uterine evacuation was seen in 11 patients [9.82%], while 2 patients started to bleed heavily and shifted in Operation Theater in emergency

Conclusion: MVA was introduced in Liaquat University of Medical and Health Science [LUMHS] for last 1 year. It is effective, cheap and should be considered to avoid prolonged hospital stay and cost

Uterine rupture at LUMHS: a review of 85 cases

Objective: to evaluate risk factors, management and pregnancy outcome of patients with buterine rupture at teaching hospital

Design: prospective observational study

Setting: obstetrical and Gynecology Unit II, Liaquat University Hospital Hyderabad-Pakistan; from 1st January 2004 to 31st December 2007

Patients and methods: all patients diagnosed as case of intrapartum uterine rupture were approached. A pre-designed proforma was used to collect the demographic features, predisposing risk factors, management and feto-maternal outcome. Data fed to SPSS program version 10 to analyze the results

Results: total maternity admissions were 12678 with 11961 deliveries. A total number of 85 cases of uterine rupture were identified, giving a ratio of 0.7% or 1:141 deliveries. There were 46 cases in scarred and 39 cases with unscarred uteri. Highest incidence was found in age group 25-30 years [57.6%] and in parity group 1-3 [62.3%]. Misuse of oxytocic's [85.8%], scarred uterus [54.1%], obstructed labour [42.3%] and grand multiparty [21%] were found as main predisposing factors. Uterine repair was done in 61% of cases while hysterectomy was performed in 39% cases. Bladder repair was additionally required in 9.5% of cases. There were 6 [7%] maternal and 64 [75%] perinatal deaths due to uterine rupture

Conclusion: uterine rupture is yet a common obstetrical emergency in our area. The significant morbidity and mortality deserves our special attention by a collaborative approach. Regular antenatal checks, careful selection of patients for vaginal delivery, vigilantly monitored labour with smooth switch-over to operative delivery can reduce this drastic obstetrical complication

Risk factors, clinical presentation and management of 62 cases of ectopic pregnancy at tertiary care center

Objective: to observe the risk factors, clinical pattern and management of ectopic pregnancy

Design: descriptive observational study

Place and duration: gynecological Unit II, Liaquat University of Medical and Health Sciences, Hyderabad from January 1st 2006 to April 1st 2008

Patients and methods: all patients with confirmed diagnosis of ectopic pregnancy were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation, management and findings at surgery. Data fed to SPSS program version 11 to analyses the results in terms of frequency and percentages

Results: total maternity admissions were 8016 with 62 cases of ectopic pregnancy giving an incidence of 0.8% or 1:129. Mean age was 24 years. Majority of the patients were of low parity [n=34, 54.8%]. Pelvic inflammatory disease [n=22, 35.4%], previous abdominal pelvic surgery [n=16, 26%], previous ectopic [n=4, 6.4%] and infertility [n=22, 35.4%] were seen as the major risk factors. Regarding the clinical pattern; abdominal pain, amenorrhea and collapse appeared as the common clinical presentations. All patients required surgery. Open laparotomy was performed in 56 [90.3%] cases while 6 [9.7%] patients managed laparoscopically. None of the patients found suitable for conservative or medical management. There was no maternal death related to ectopic pregnancy and the postoperative recovery was uneventful

Conclusion: the classic clinical pattern of amenorrhea and abdominal pain was lacking in most of the cases with ectopic pregnancy and there were initial diagnostic difficulties. Pelvic inflammatory disease and history of infertility were the main risk factors. Due to the delay in making diagnosis at early stage, open surgery was required in all cases. This emphasizes the importance of a thorough clinical evaluation and appropriate investigations for patients with high suspicious to benefit our poor patients by the use of recent therapeutic modalities

Key to successful vesico-vaginal fistula repair-an experience of urogenital fistula surgeries and outcome at gynaecological surgical CAMP-2005

Vesico-vaginal fistula is not life threatening medical problem, but the woman face demoralization, social boycott and even divorce and separation. The aetiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynaecological surgeries or radiotherapy. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynaecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. This prospective study was carried out to analyze the success rate in patients attending the referral hospital and sent from free gynaecological surgery camps held at interior of Sindh, and included pre-operative evaluation for route of surgery, operative techniques and postoperative care. Total 70 patients were admitted from the patients attending the camp. Out of these, 29 patients had uro-genital fistula. Surgical repair of the fistula was done through vaginal route on 27 patients while 2 required abdominal approach. Out of 29 surgical repairs performed, 27 proved successful. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit along with appropriate care and expertise accounts for the desired results

Road traffic injuries in the third trimester of pregnancy

Road traffic accident third trimester of pregnancy present with dual problem the one is the injury to mother and others to the foetus. There were 9 women in the third trimester of pregnancy who were severely injured in road traffic accidents. Three cases were in accelerated labours and half the babies died. Immediate obstetric interference was often impractical and did not improve fetal survival. Note war thy injuries of the central nervous .system were associated with very high fetal mortality. Fractures of the pelvic were not disastrous. The first consideration in management should he the well being of the severely inured mother. Since the injuries that would kill the, fetus are not likely to be amenable to surgery. The only, justification for intervention for the sake of the fetus that survives the moment of impact is to salvage it from its dying mother's body

Pre-eclampsia: Prevention strategies

The objective of the study was to assess the use of pharmacological prophylasix by health care providers in women with risk factors of pregnruy induced hypertension. One hundred hypertensive women who were referred to Gynecology Unit - I of Liaquat University Hospital during one year period from 1st January, 2000 to 31st December, 2000 were evaluated thoroughly by history, examination and management out come. The inclusion criteria were women with pregnancy of > 20 weeks, with diastolic B.P > 100 mm of Hg on two occasions 4 hours apart. Eight-three women had at least one of the risk factors and 40 of them visited some kind of healthcare facility. None was prescribed prophylactic medication. A total of 50 women had eclampsia. Perinatal mortality was 20 and maternal mortality was 7. We conclude that the lack of awareness about prophylaxis among care givers may be responsible for high maternal and perinatal mortality

Perineal pain after vaginal delivery

The objective of this study was to assess pain morbidity after vaginal delivery and effect of episiotomy on it. Fifty women delivering vaginally at Liaquat University Hospital and Aga Khan Maternal and Child Care Center Hyderabad were followed through a pre-developed questionnaire at 24-48 hours after delivery, 10th post partum day and 10th post partum week for assessment of pain All women with episiotomy [n-25] required oral analgesia following delivery, 2 required parenteral analgesia for 24 hours compared to no analgesia for perineal pain in control group. At day 10, 4 [16%] among episiotomy group had inflamed and gaping wound requiring local treatment and removal of stitches. Two [8%] required admission for restitching Dyspareunia was more common among episiotomy group, Two required medical / surgical intervention for it. Episiotomy adversely affect the pain morbidity after vaginal delivery