Ovarian dermoid causing pilimiction

Ovarian dermoid cyst is one of the common problems seen in gynaecology, they make upto 10 - 25% of all ovarian neoplasms and are usually seen in younger age group. Mature cystic teratomas are usually an incidental finding during a clinical examinations, radiographic studies or during abdominal operations performed for other indications. Other presentations include abdominal symptoms from complications of the cyst such as torsion, rupture, infection and malignant transformation. Dermoid cyst in urinary bladder is a very rare condition. Here we are presenting a case report of a female who presented with lower abdominal pain and passage of hair in urine [pilimiction]. Upon investigations it was found that patient had right sided dermoid which had penetrated the wall of bladder and expelled its contents in the bladder. This was a very rare presentation and no such case has been reported in Pakistani literature

Single dose prophylactic antibiotic versus routine 5 days prophylactic antibiotic in prevention of postoperative infection in elective, clean abdominal gynecologic surgeries

To compare the efficacy of single dose versus routine five days prophylactic antibiotic in prevention of postoperative infection in elective gynecologic and obstetric surgeries. Randomized control trial. Department of Obstetrics and Gynaecology Liaquat National Hospital and Medical College Karachi, from August 2010 to August 2011. A total of 303 patients undergoing elective gynecologic and obstetric surgeries were included. Patients were randomly divided into two groups with 153 patients each. One group received single dose of antibiotic at the time of induction of anaesthesia and other received 1[st] dose at induction of anesthesia, 2nd after 12 hours and then two doses daily 12 hourly for 5 days. Rate of postoperative infections in terms of wound infection, urinary tract infection and febrile morbidity, were recorded. The commonest surgical procedure performed were cesarean section in both the groups followed by total abdominal hysterectomy. There was no statistically significant difference in the rates of postoperative wound infection on 2[nd] [0% vs 2.6%, p = 0.123] and 21st [0.7% vs 0.7%, p = 0.99] postoperative day in both the groups. Similarly febrile morbidity on 2[nd] postoperative day was [3.3% vs 4.6%, p=0.56] and no fever observed on 21[st] day of surgery in both the groups. As regards the urinary tract infection there was no statistically significant difference between the groups on 2[nd] day [22.9% vs 14.4%, ??? p=] and 21[st] day [5.2% vs 2.6%, p = 0.24]. Both the regimens were equally effective against postoperative infectious morbidity. Single dose of prophylactic antibiotic prevented unnecessary long course of antibiotic and potential antibiotic resistance

Peripartum hysterectomy

To find out causes and outcome of peripartum hysterectomy. Case series. Department of Obstetrics and Gynaecology, Liaquat National Hospital Karachi, from January 2011 to December 2011. Retrospective analysis of series of cases of peripartum hysterectomy identified from hospital records was done. The cases were reviewed for the indications, type of operation [total or sub total hysterectomy], maternal characteristics, booking status, labour and mode of delivery, postoperative morbidity, fetal and maternal outcomes. Total deliveries in 12 month period were 1493, with 9 peripartum hysterectomies. The frequency was 6.0/1000 deliveries. Uterine atony leading to haemorrhage was noted in 3[33.3%] cases and placenta previa type 4 in 5[55.5%]. There were 2[22%] cases of morbidly adherent placenta, and one each with severe puerperial sepsis leading to infective endometritis and broad ligament haematoma. There were 2 patients who expired while in ICU and 7 were discharged home. Two babies were stillborn. In spite of performing peripartum hysterectomies, there occur considerable number of maternal deaths. This could be prevented by good antenatal care, active management of labour, early recognition of complications and early referrals