Early pregnancy complications and risk factors

To determine the underlying risk factors in early pregnancy complication and outcome. Case series study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2010 to December 2010. all the women with first trimester pregnancy with different complications were included in this study, while those women with uneventful first trimester were excluded. The included women were registered on pre-designed proforma studied variable including demographic details, gestational period, type of complication, risk factor treatment and outcome. The data was examined in terms of mean and percentage with a confidence interval of 95%. Analysis was done on SPSS version 10. out of 661 total early pregnancy admissions, 309 [46-74%] patients had different early pregnancy of complication. Their mean age was 29.22 +/- 6.22 years. Commonest complications found were abortion in 206 [66.66%] cases. The underlying risk factors found in miscarriage were antiphospholipid syndrome in 8 [3.88%] cases, diabetes mellitus in 35 [16.99%] cases. Hypertension in 50 [24.27%] cases, PCOS in 15 [7.28%] cases and infection in 10 [4.85%] cases. 60 [61.22%] cases were treated by minor surgical procedures and 38 [38.77%] cases treated with conservative medical therapy. Outcome were anaemia in 245 [79.28%] cases, psychological upset in 189 [61.16%], infection in 131 [42.39%] and coagulopathy in 17 [5.50%] cases. Miscarriage was found as the most frequent early pregnancy complication and the most frequent risk factor was hypertension. Outcome included anaemia, psychological upset and infection

Unruptured ectopic pregnancy is still uncommon in our setup

To analyze the frequency of ectopic pregnancy, treatment modalities, maternal outcome and why the unruptured ectopic pregnancy is presented less frequently in our set up. Cross sectional descriptive study. This study was conducted at the Department of OBGYN PUMHS Nawabshah from January 2008 to December 2010. All the patients who have a clinical suspicion for ectopic pregnancy or diagnosed by ultrasonography included in the study. Verbal interviews were taken in the post operative period for assessment of educational and socio economic status of patient along with the behavior of the referring authority. Patients' records were reviewed for clinico surgical finding and maternal outcome. Eighty eight [88] women were presented with ectopic pregnancy out of 13286 deliveries at PUMHS Hospital Nawabshah during 03 years study period making a frequency of 0.66%. No risk factor identified in 58[65.9%] of cases. 56[63.63%] patients presented in acute way. Regarding treatment modalities 86[97.72%] patients underwent laparotomy amongst them salpingectomy was performed in 50[56.81%], salpingo-oophorectomy in 28[31.81%], milking of tube were carried out in 03[3.40%] patients and complete tubal abortion was found in 05[5.86%] patients. 02 patients with unruptured ectopic pregnancy were selected for medical treatment, 01 was successful and other failed and treated by salpingectomy. Maternal outcome was satisfactory; no maternal death was found in the study group. Blood transfusion was required in 100% of patients [1-4 pints]. Regarding the aspect of why we are not receiving the patients with unruptured ectopic pregnancy, we found that > 90% of our patients belong to poor socioeconomic group and uneducated. Remaining patients belong to middle social class and were able to write their name. We found it an important factor in starting late antenatal care. We also assessed the behavior of referring authority as well as in our out- patient department; urine for the P.T was the preferable method of diagnosing first trimester pregnancy. Ultrasound was only advocated once patients presented with acute symptoms of ectopic pregnancy. The detection of unruptured ectopic pregnancy is almost nil in our setup due to late reporting to hospital by women when pregnant and inability of the health care providers to suspect it when faced with early pregnancy problems of lower abdominal pain and irregular vaginal bleeding. A change in the health professional behavior, provision of beta HCG estimation and transvaginal ultrasound in public sector hospitals are the modalities to improve the detection of unruptured ectopic pregnancy