ABSTRACT
To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section. A randomized double blinded trial. Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010. Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p<0.05 In only 2 [6.6%] of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 [53%] of one layer closure group, and 10 [33%] of the two layer closure group. At 6 weeks, the mean scar thickness in group C [17.08 +1.635 mm] was significantly greater [p<0.001] as compared to group A [13.19 +1.32 mm] and group B [14.58 +1.18 mm]. At long-term follow-up, only 1 [6%] case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 [23%] in group A and 2 [14%] in group B. Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section
ABSTRACT
To compare the efficacy and maternal side effects of hydralazine with sublingual nifedipine in controlling blood pressure in severe pre-eclampsia [PE] and eclampsia. Quasi interventional The study was conducted in the Department of Obstetrics and Gynecology unit II, Bahawal Victoria Hospital [BVH] Bahawalpur, from January 2007 to January 2008. A total of sixty patients were divided in two groups of 30 each [group A-hydralazine and group B-nifedipine]. All were admitted through emergency. Allocation to each group was random. All patients matched for variables like age, parity, previous history of PE so as to minimize the confounding effects. There were 20 [66.67%] patients with complications in group A and 25 [83.33%] patients in group B [p 0.136]. Headache in group A was noted in 7 [35%] patients and in 10 [40%] patients of group B, palpitations reported in 6 [30%] cases of group A and 8 [32%] in group B. Maternal hypotension was found in 6 [30%] patients of group A and 7 [28%] in group B and fetal distress noted in one [5%] patient of group A only. P value in all above complications was>0.005. Hospital stay of up to 9 days was observed in 17 [56.67%] patients of group A, and four [13.33%] patients in group B. Patients who stayed 9-12 days were 12 [40%] in group A and 18 [60%] in group B, while the longest stay at hospital [12-15 days] was found in one [3.33%] patient of group A and 8 [26.67%] patients in group B. There was no patient who was admitted for more than 15 days in both the groups. When time taken to control BP was compared, one hour was observed in 15 [50%] patients in group A and 5 hours in 5 [16.67%] patients in group B after initial dose of both hydralazine and sublingual nifedipine respectively. Ten [33.33%] patients took 2-3 hours in group A and 16 [53.33%] patients in group B after 2nd dose. Total 4-5 hours time interval was observed in 5 [16.6%] patients in group A and in 9 [30%] patients of group B after receiving 4th dose. Hydralazine was significantly more effective in controlling blood pressure [BP] after administration of its initial dose, thus reducing the total dose of drug given and had better outcome of mother and fetus, with reduced hospital stay as compared to sublingual nifedipine
ABSTRACT
To compare the fetal and maternal morbidity in terms of fetal distress, chorioamnionitis and mode of delivery in conservative and active management of preterm prelabor rupture of membranes [PPROM] at 34-37 weeks of pregnancy. Quasi experimental study. Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur from January 2007 to December 2007. A total of 100 cases were included in the study and divided into two groups of 50 each, Group "A" patients were managed conservatively and group "B" underwent active management with immediate induction of labor. Eighteen [18%] patients developed chorioamnionitis. Out of these 13 [26%] were in conservatively managed group and 5 [10%] in actively managed group. Twelve [12%] patients developed fetal distress. 7 [14%] in conservatively managed group and 5 [10%] in actively managed group. A total of 20 [20%] patients underwent cesarean section. Out of these 11 [22%] were from conservatively managed group and 9 [18%] from actively managed group. Induction of labor at presentation is a better option than conservative management in terms of chorioamnionitis but the results are not significantly different for the fetal distress and mode of delivery