ABSTRACT
To determine the effectiveness and feasibility of transabdominal chorionic villi sample [CVS] procedure for prenatal diagnosis of beta-thalassaemia in a Muslim majority community. Between January 2005 and December 2011, we analysed 798 high-risk mothers with 12-16 weeks of pregnancy for beta-thalassaemia using CVS, performed with a transabdominal route under local anesthesia and ultrasound guidance. The chorionic villi extracted were investigated upon using genomic amplification of beta-globin gene by polymerase chain reaction [PCR]. A total of 798 of which 224[28%] fetus were diagnosed as major, 400[50.1%] as minor, 173[21.6%] as healthy fetus and 1[0.12%] fetus had undetected mutation. Procedure related complications were seen in 20 cases [2.4%] and missed abortion occurred in 6/798. Seven [3%] couples had refused to abort beta-thalassaemia major fetus where as 97% fetus was aborted as per recommendations. Ultrasound guided transabdominal CVS is an effective procedure for prenatal diagnosis of beta- thalassaemia in a Muslim community. We found no cultural hurdles for fetal sampling and prenatal diagnosis
ABSTRACT
To determine the outcome of trial of labor after previous one caesarean section due to non-recurrent cause and evaluate the maternal and perinatal mortality and morbidity after trial of scar. Descriptive study. It was conducted in Obstetrics and Gynaecology Unit - 1, Civil Hospital Karachi from January 2003 to January 2004. The selected subjects in our study were the women with previous one caesarean section due to non-recurrent cause. Singleton pregnancy, adequate pelvis, spontaneous onset of labor were the criteria for trial of labor. The total number of 3612 deliveries were conducted during this study period, whereas, 2624 patients were delivered by caesarean section. Out of these 84 patients formed the cohort, where 34 had elective lower segment caesarean section [LSCS] and 50 were found suitable for trial of scar. Fifty patients underwent trial of labor; of whom 31 had successful vaginal delivery. The success rate was 62% while 19 [38%]patients delivered by repeat caesarean section due to failed trial of scar. The 42.10%of patients had caesarean section due to unsatisfactory progress of labor; 26.31% due to fetal distress, whereas 15.78% patients had caesarean section due to scar tenderness but there was only one partial scar dehiscence that was noticed during operation. 10.5%patients had non-progress and fetaldistress at the same time. Out of 31 patients who were delivered after successful trial, 70% had spontaneous vertexdelivery, 16.2% by forceps vaginal delivery, 9.6% by vacuum extraction and one patient who had breech presentation, delivered by assisted breech vaginal delivery. There was no maternal death or rupture of uterus in our study, nor any perinatal morbidity or mortality recorded. Only one case of scar dehiscence was seen during emergency LSCS, which was not associated with any complication. A trial of labor in selected patients with previous one caesarean section is the reasonable option, if patients are carefully selected and monitored
ABSTRACT
To determine the effectiveness of rectally administered misoprostol for the treatment of post-partum haemorrhage [PPH] and assess its side effects.Therapeutic drug trial carried out from April 2003 to March 2004.Dept. of Gynaecology and Obstetrics [Unit I], Civil Hospital, Karachi.All patients presenting with post-partum haemorrhage.Women of any age or parity, who either delievered at Civil Hospital Karachi or were referred after delivery from elsewhere with primary post-partum haemorrhage were included in this study. Four tablets [800pg] of misoprostol were administered per rectally and the results watched for 30 minutes. The effectiveness of the drug was assessed by the time period taken for the control of the post-partum haemorrhage. The data of the patients was finally analyzed.Out of the 100 patients, 48 had good immediate control by using Misoprostol, while the remaining 52 patients needed further treatment.Rectal misoprostol was only effective in 48% cases qfpost-partum haemorrhage, though it has fewer side effects