ABSTRACT
Objective: To compare the effectiveness of learning procedural skills on patients versus mannequins and models
Methods: Seventy four interns from two consecutive batches at the Department of Obstetrics and Gynaecolgy Unit-I at Jinnah Postgraduate Medical Center Karachi participated in the study between April and September 2014. Five basic skills; taking a cervical [Pap] smear, intrauterine contraceptive device insertion, manual vacuum aspiration, making/ suturing an episiotomy and active management of the third stage of labour were identified. Interns were randomly allocated to two training groups [Group-1 and 2 of thirty eight and thirty six trainees respectively], with Group-I received training on the five procedural skills on models and mannequins for four weeks while Group-II trained on patients initially. After an evaluation at four weeks the groups crossed over with a final evaluation at eight weeks. The evaluation was through identical objective structured assessment of technical skills on models and mannequins for both groups with standard checklists
Results: There was no significant difference in skills between the two groups at the four weeks assessment. However at the end of training, Group-1 trainees performed significantly better than Group 2 with higher overall tests scores [86.7 +/- 2.7 versus 80.4 +/- 4.8, p <0.001]. This difference was more marked in skills of intrauterine contraceptive device insertion, making and suturing an episiotomy and active management of third stage of labour
Conclusion: Our findings suggest that simulations using models and mannequins for developing procedural skills can be readily incorporated in training programs with potential benefits for teaching infrequently performed or more difficult procedures. Our data suggest potential benefits of initiation of trainings on simulations and mannequins followed by human subject exposure
ABSTRACT
Objective: To determine the frequency, risk factors and, maternal and perinatal outcome in women presenting with abruptio placentae at a tertiary care hospital
Methodology: This observational, descriptive study was conducted in the Department of Obstetrics and Gynecology Unit I, Jinnah Postgraduate Medical Centre [JPMC], Karachi from January 2011 to December 2013. All pregnant women with gestational age 28 weeks or greater, having retro-placental clots on ultrasound and/or painful vaginal bleeding were included by using nonprobability purposive sampling technique
Results:There were 24,591 obstetric admissions during the study period, and 21,669 of them delivered. Of these 489 were diagnosed as abruptio placentae, making it a condition with a frequency of 1.98% of obstetric admissions and 2.25% of deliveries. 394 of the 489 cases [80.6%] were un-booked. Majority of them [252, 51.5%] were grand multipara with mean parity of 4.8 +/- 3.3. 330 [61.4%] were older than 30 years [36.1+/- 12.6 years]. 392 [80.2%] delivered vaginally and the rest 97 [19.8%] were delivered by Caesarean section. Hypertension and pre-eclampsia were collectively seen in 124 [25.2%], anaemia in 77 [15.7%], smoking in 39 [7.9%] and trauma in 8 [1.6%] patients. Noteworthy maternal complications were postpartum haemorrhage [PPH] in 70 [14.3%], postpartum anemia in 55 [11.2%], disseminated intravascular coagulation in 13 [2.65%] and renal failure in 2 [0.4%] patients. Maternal death occurred in 17 [3.5%] women. Still birth occurred in 194 [39.7%] patients. Perinatal Mortality was 68.7%
Conclusion: Abruptio placenta has a significantly increased risk of maternal and perinatal mortality. Risk factors include multiparity, hypertension, pre-eclampsia, anaemia and smoking
ABSTRACT
Objective: To evaluate the frequency of emergency obstetric hysterectomy, and to find out its indications and accompanying maternal and perinatal morbidity and mortality
Methodology: This cross sectional study was undertaken at Obstetrics and Gynaecology department of Unit-I, Jinnah Postgraduate Medical Centre, Karachi from 1st January 2015 to 31st December 2016. Those patients who had emergency obstetric hysterectomy at JPMC during this period were included in the study. Their parity, booking status, age, indication and, the type of surgery undertaken was recorded. Maternal and fetal morbidity and mortality were also determined. Data was analyzed using SPSS 20
Results: A total of 14,157 deliveries were carried out during the study period. Out of them, 32 hysterectomies were undertaken due to obstetric indications [0.22%]. The most common indication was ruptured uterus in 20 [62.5%]. The most common complication was infection [40.6%]. Five patients could not survive after the surgery [15.6%] and perinatal deaths were 19 [59.3%]
Conclusion: Obstetric hysterectomy needs to be done in emergency cases where life of the patient can not be saved otherwise. However, clear judgement, highly professional surgical technique and optimal time for the surgery can decrease mortality and morbidity in such cases
ABSTRACT
Objective:-To determine the frequency of Hepatitis C virus infection and maternal and fetal outcome in pregnant women with Hepatitis C virus infection
Materials and Methods:This descriptive case series study was conducted in the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Center, Karachi for a period of six months from 17-02-2015 to 18-08-2015. A total of 202 pregnant women of any parity and gestational age after 24 weeks were selected in this study. After taking history and examination, 5ml of blood was drawn from the peripheral vein from each patient and serum was tested for the presence of Anti-HCV antibodies in all patients using a third generation ELIZA test in diagnostic laboratory. All data was collected in pre-approved proforma
Results: The frequency of hepatitis C virus infection in pregnant women was observed in 15.35% [31/202] cases. The average age of the patients was 27.35±4.66 years. The most common obstetrical complication in women with hepatitis C virus infection was jaundice 77.4% [24/31] followed by preterm delivery 35.5% [11/31], LBW 32.3% [10/31], placenta previa 25.8% [8/31], premature birth 19.4% [6/31], intra uterine death 19.4% [6/31], hepatic encephlopathy 9.7% [3/31] and maternal death 9.7% [3/31]. Rate of jaundice, preterm birth, premature birth, intra uterine death and low birth weight was also significantly high in those pregnant women who were HCV positive.
Conclusion: HCV positivity may be a surrogate marker for increased risk of poor pregnancy outcomes and the HCV-positive pregnant population may require greater clinical vigilance in this regard
ABSTRACT
Objective: To determine the frequency of preterm deliveries in women presenting with threatened abortion at tertiary care hospital
Study design: Cross sectional study
Place and duration of study: Department of Obstetrics and Gynaecology Unit I, Jinnah Postgraduate Medical Center [JPMC] Karachi, from October 2014 to March 2015
Methodology: Women between 18 year to 45 year of age diagnosed as cases of threatened abortion, were consecutively selected. Patients with non-obstetric causes of bleeding such as cervicitis, vaginitis, cystitis, trauma, significant cervical dilation, ectopic pregnancy, multiple gestations etc were excluded from the study. The variables assessed were maternal age, gestational age and parity. Preterm delivery and obstetrical factors were expressed as frequency and percentages. Stratification of age, gestational age, parity and obstetrical factors was done. Chi square test was applied to the data and p <0.05 was taken as significant
Results: During the study period 105 women were diagnosed as cases with threatened abortion. The mean maternal age was 26.53 +/- 6.36 year. Mean gestational age was 29.92 +/- 3 weeks while mean parity was 2.30 +/- 1.18 [range: 1 to 5 children]. Frequency of preterm delivery among patients of threatened abortion was 17.14% [n =18]. Age was high significant [p = 0.001] effect modifier which decreased more than half from 20.83% in 18-25 year of age to 9.09% in 36-45 year of age. There was no significant difference with variation of gestational age and parity. With any obstetrical condition [pre-eclampsia, eclampsia, HELLP syndrome and placental abruption] much higher frequency of preterm delivery was noted as compared to having none [p = 0.000]
Conclusion: The frequency of preterm delivery in patients of threatened abortion was more common in younger age and primigravida
ABSTRACT
Objective: To determine the frequency of successful ovulation induction with letrozole in infertile women with polycystic ovarian [PCO] syndrome who were resistant to clomiphene citrate
Study design: Descriptive case series
Place and duration of study: Department of Gynaecology and Obstetrics ward-8, Jinnah Postgraduate Medical Center Karachi, from September 2009 to March, 2010
Methodology: Women between 20-40 year of age with history of PCO and primary infertility of at least one year duration who failed induction on clomiphene citrate for at least 2 months, were included in the study. After taking informed consent and counseling letrozole was given in a dose of 2.5 mg daily from day 3-7 of menstrual period. Patients were monitored by transvaginal ultrasound scan [TVS]. The mean follicular diameter was noted on day 10, 12, 14, and 16. This was followed by HCG injection 10000 IU and serial monitoring of the follicles till 18mm size reached
Results: Sixty seven patients were selected. Mean age was 27.6 +/- 3.3 year and mean duration of infertility was 4.3 +/- 1.6 year. Fifteen [22.4%] of patients had infertility for 4 years, 13 [19.4%] had for 5 years and 12 [17.9%] for 6 years. Ovulation was successfully induced in 33 [49.3%] women
Conclusion: Letrozole can be used as a second line agent when there is resistance to clomiphene citrate, a first-line treatment, for induction of ovulation in women with polycystic ovarian syndrome
ABSTRACT
A case of heterotopic pregnancy is reported that presented with 7 weeks of amenorrhea, lower abdominal pain and spotting per vaginum. Ultrasound showed an intra-uterine gestational sac as well as right-sided ruptured tubal pregnancy. Emergency laparotomy and right salpingectomy was performed. Subsequent ongoing alive intra-uterine pregnancy was delivered by vaginal route at term
Subject(s)
Humans , Female , Pregnancy, Ectopic , Pregnancy Outcome , Disease Management , Amenorrhea , Fallopian TubesABSTRACT
A case of wandering [pelvic] spleen associated with third degree uterovaginal prolapse and ascaris in the biliary and intestinal tract is being presented here. On laparotomy; congested splenomegaly was found in the pelvis. Splenectomy, total abdominal hysterectomy and bilateral salpingo-ophrectomy was performed
Subject(s)
Humans , Female , Uterine Prolapse , Ascaris , Ascariasis , Urinary Bladder Diseases , Rectocele , Biliary Tract , Intestines , PelvisABSTRACT
To find out number of cases with endometriosis. its relationship with age, parity and socioeconomic condition and to document its different stages. Design: An observational study. Place and Duration: Study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre Karachi, over four years period from 1st January 2000 to 31st December 2003. Subject And Methods Three hundred diagnostic laparoscopies were performed in patients with various clinical presentations such as chronic pelvic pain, dysmenorrhea, dyspareunia, infertility and menstrual irregularities 'to find out those due to endometriosis. Forty cases of endometriosis were diagnosed at laparoscopy. Majority [75%] of the patients with endometriosis were between 20-30 years of age. Endometriosis was more common in infertile as compared to fertile ladies. As JPMC is a tertiary care public sector hospital providing services to relatively poor class of patients, all the cases of endometriosis were found in lower socio economic class. Ten cases [25%] of endometriosis were in stage-I, fifteen cases [37.5%] in stage-II while there were 5 and 10 cases in stage III and IV respectively. Endometriosis is not an uncommon gynecological problem and is commonly found in young and reproductive age group, of patients. Laparoscopy being a minimally invasive procedure requiring minimum time of hospitalization and minor post-operative discomfort is invaluable in diagnosis of endometriosis