Perinatal outcome in patients with preeclampsia

To describe perinatal outcome in patients with preeclampsia. Descriptive Hospital based study. Department of Obstetrics and Gynecology, Nishtar Medical College/Hospital Multan from September 2007 to September 2008. Patients admitted through the outpatient department and labour ward with gestation age >20 weeks and diasystolic blood pressure of >/= 90mmHg on more than one occasion 6 hours apart and proteinuria >/= 300mg/24 hours or two mid stream or catheter specimens of urine with >/= ++ proteins on reagent strip testing were included in the study. Besides detailed clinical history, complete blood count, renal function tests, liver function tests, coagulation screen and 24 hours urine protein were done. After the baseline obstetrical ultrasound, two weekly growth scans were done, growth charts were maintained along with umbilical artery Doppler studies, Patients were counseled for planned hospital delivery and time and mode of delivery was decided. Babies were managed by the Pediatricians and if needed shifted to neonatal intensive care unit. The babies were followed for 7 days after birth. 73 patients were managed during the study period. 22 patients had intrauterine growth restriction [IUGR] 23 babies were born preterm, 13 preterm babies had IUGR and 10 out of these were admitted to neonatal intensive care unit. There were 5 deaths [4 still births 1 early neonatal death]. IUGR and preterm births are the most frequent perinatal complications in preeclamptic patients. Health education of masses and regular antenatal care can improve the pregnancy outcome

Twin reversed arterial perfusion sequence / sequence acephalus acardiac fetus

Twin reverse arterial perfusion [TRAP] sequence occurs only in a setting of a monochorionic gestation and complicates approximately 1% of monochorionic twin gestation. In the TRAP sequence the acardiac / acephalic twin receives all of its blood supply from the normal "pump" twin

Uterine torsion in twin pregnancy

A young married women in her 3rd ongoing pregnancy, having no alive issue presented at 37+ weeks with labor pains. Cesarean section was planned because of twin pregnancy and past bad obstetrical history. During operation, the uterus was found to have rotated to 180 degree to the right. A transverse incision was made on posterior wall of uterus to deliver babies. After suturing the incision site, the uterus was repositioned in right place. This paper presents a case of torsion of gravid uterus in which the delivery and repositioning of the uterus was successful

Trial of labour after cesarean delivery: a study of 100 cases

To determine the outcome of trial of labour in patients with previous one lower segment cesarean section. Descriptive study. The study was conducted in the department of obstetrics and gynecology Nishter hospital Multan from July 2002 to December 2003. All patients with previous one cesarean section due to non recurrent cause admitted to the labour ward with spontaneous onset of labour at term were included in this study. Detailed clinical examination including abdominal and pelvic examination and ultrasound for fetal well being and placental localization was done. Progress of labour was monitored through partogram. Fetal monitoring was done by auscultation and cardiotocography [CTG]. Among 100 patients included in this study 69 [69%] had vaginal delivery while 31 [31%] had repeat cesarean section. Out of 69 patients 46 [66.66%] had spontaneous vaginal delivery, 12[17.39%] had Ventouse delivery and in 11[15.9%] patients outlet forceps were applied. Two [2%] had uterine rupture which were successfully repaired. Common indication for repeat cesarean section was failed progress of labour. This hospital based study shows that trial of labour in patients with previous one cesarean section due to non recurrent cause is safe and has success rate of 69% which is encouraging. It is therefore stated that vaginal birth after cesarean section[VBAC]should be offered to properly selected patients in hospitals with twenty four facilities of operation theater and blood transfusion services

Comparison of misoprostol and PGF2alpha for second trimester termination of pregnancy

Aims: To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostaglandin F2alpha [PGF2alpha] injection for termination of pregnancy

Study Design: Interventional study

Setting: This study was conducted in gynae unit III Nishter hospital Multan over period f 15 months

Material and Methods: Patients admitted to labour ward with pregnancy of less than 20 weeks of gestation requiring termination of pregnancy due to fetal and maternal causes were included in this study. A detailed history was taken followed by clinical examination especially the cervical scoring was done. Sixty patients were randomly assigned to receive either tablet misoprostol [cytotec] intravaginally or extra-amniotic injection of prostaglandin F2a Induction-expulsion interval, need for evacuation and the incidence of side effects were analyzed for both groups

Results: Successful termination was achieved in 98% patients with misoprostol and 94% with PGF2a Induction expulsion interval was < 12 hrs in 80% patients in misoprostol group and 60% in PGF2a group [P value < 0.000]. Evacuation rate was 23.3% with PGF2a and 10% with misoprostol group. The incidence of prostaglandin-associated pyrexia, vomiting and diarrhea were significantly increased in the PGF2alpha group [p<0.05]

Conclusion: In this study, vaginal misoprostol has been found to be more effective and associated with a shorter induction to expulsion interval, fewer ERPOC for incomplete evacuation and less side effects when compared with extra-amniotic PGF2alpha. In view of its effectiveness, as shown in this study, vaginally administered misoprostol has the potential to provide a better option for medical abortion in many parts of the world

Intrarectal prostaglandin in the management of postpartum hemorrhage

To investigate the effectiveness of intrarectal prostaglandin in the management of atonic postpartum hemorrhage in patient who do not respond to conventional oxytocic agents. This study included patients, who had single term pregnancies with cephalic presentation and had normal vaginal deliveries in Gynae Unit-1 from 1st February 1999 to 30th November 1999. All patients had active management of third stage of labour and if uterine response was not adequate, then first uterine massage was done and oxytocic infusion was given. If patient continued to bleed PGE2 vaginal tablet was placed in the rectum. A total of 1200 normal vaginal deliveries occurred during the study period and 51 cases of atonic PPH were reported. Intrarectal PGE2 was used in 19 patients and was effective in 13 patients. In the rest six patients surgical intervention was done. Gynae Unit-1, Department of Obstetrics and Gynaecology Sandeman Provincial Hospital, Quetta. Results: During the study period 51 cases [4.25%] of atonic PPH were reported out of a total of 1200 normal vaginal deliveries. Twenty one [41.17%] patients were between 35 years and 45 years of age. Twenty two [43.1 3%] patients had a parity between P-5 and P-1 0. In 1 9 [37.25%] patients intrarectal PGE2 was used. It was effective in 13 [68.42%] patients and failed in six [31.57%] patients. Out of six patients, bilateral uterine artery ligation was done in four [66.66%] patients and hysterectomy done in two [33.33%] patients

Uterine rupture: an analysis of 25 cases

To review the incidence of uterine rupture at Sondeman [P] Hospital Quetta and to highlight the main causes and management approach. A retrospective analysis of the referred cases received with suspected diagnosis of uterine rupture over a period of fourteen months [1[st] March, 1999 to 30[th] April 2000]. Setting: Gynae Unit-1, Department of Obstetrics and Gynaecology Sandeman Provincial Hospital, Quetta During this period of fourteen months 61 87 deliveries took place in the hospital including 25 cases of uterine rupture, an incidence of 4 per 1 000 deliveries. Repair of uterus with bilateral tubal ligation was done in 14 [56%] patients while subtotal abdominal hysterectomy had to be done in 8 [32%] patients. Major postoperative complication was wound sepsis seen in four [16%] patients. Three [12%] maternal deaths occurred, two [66.66%] patients died due to hemorrhage and one [33.33%] patient due to sepsis. Fetal mortality was 1 00%

clinicohistopathological analysis of 110 ovarian tumors

To evaluate clinical presentations and histological type of ovarian tumours. Design: Retrospective analysis. Settings: Gynaecology and histopathology departments of CMH Kharian. Subjects: All the cases whose ovarian tumours were removed and were subjected to histopathology, during the study period. Ninety seven benign and 13 malignant tumours were seen. The age range was 8-80 years but majority of the patients [60%] were between 25-44 years. Most of the patients [89%] were multipara and bleeding P/V was the predominant symptom [79%], followed by pain abdomen [77%], pelvic mass [73%] and vague gastrointestinal symptoms [35%]. The majority of the tumours were unilateral [99] and maximum size was 30 cm in diameter. Purely cystic tumours were most common [78%], whereas 17% were semisolid and 5% solid. On histology majority of the benign tumours were dysfunctional cysts type and malignant were serous cystadenocarcinoma. Benign cysts were mostly dysfunctional cysts so promotion of conservative treatment is recommended. Nulliparity is not associated factor in our cases and late reporting in advanced stages of disease is common