Clinical presentations of congenital uterine anomalies

Objective: to observe clinical presentations of uterine anomalies

Material and Methods: uterine anomalies were detected during prenatal ultrasonography, detected during LSCS done for various obstetric indications. Discovered during EUA, and detected during laparoscopy or laparotomy. The clinical data of these patients was reviewed regarding age, parity, marital status and presenting symptoms. All data was entered in pre designed proforma and analyzed using SPSS version 14

Results: total 43 cases of uterine anomalies were detected. Most common type of anomaly detected was bicornuate uterus followed by uterus didelphys, arcuate uterus, unicornuate uterus with non-communicating horn and septate uterus. These anomalies clinically presented with fetal malpresentations, dysmenorrhoea, retained placenta ·and primary infertility. Diagnosis was confirmed puring prenatal USG, examination under anesthesia, during LSCS, during laparoscopy and laparotomy

Conclusion: women with uterine anomalies complain of symptoms such as dysmenorrhea, pelvic pain, but most are asymptomatic and diagnosed incidentally. They are frequently complicated by obstetrical challenges such as preterm labor, mal presentation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly

Fetal outcome of pregnancy with hypertension

Objective: to assess relationship of neonatal morbidity and mortality with severity of hypertension. The effect of severity of hypertension on time of delivery and neonatal outcome including birth weight, APGAR score, neonatal nursery admission, intrauterine death and neonatal deaths was studied

Methods: all pregnant patients with diastolic blood pressure of at least 90 mmHg or systolic blood pressure of 140 mmHg taken at two occasions at least 6 hours apart, with singleton pregnancy at any gestational age were included in the study. They were categorized in two groups according to diastolic blood pressure at the time of presentation. Mild to moderate hypertensive patients were those with diastolic blood pressure up till 109 mmHg. Patients with diastolic blood pressure 110 mmHg or more were labeled as severely hypertensive patients. AU patients were followed throughout antenatal period till delivery. Time of delivery was decided by senior consultants according to obstetrical parameters. All babies delivered were attended by pediatricians and admission in neonatal nursery was decided by pediatricians. Babies admitted in nursery were followed till discharge or expiry

Results: out of 1661 screened patients, 119 hypertensive pregnant patients were detected [an incidence of 7 .16%]. Out of these 78.2% were mild to moderate hypertensive and 21.8% were severely hypertensive patients. The effect of severity of hypertension was significant on time of delivery. There were 74% preterm deliveries in severely hypertensive patients as compared to 13% in mild to moderate group [p; 0.0001]. The effect of severity of hypertension was significant on birth weight, APGAR score, intrauterine and neonatal deaths

Conclusion: fetal morbidity and mortality is directly related to severity of hypertension in terms of birth weight, pre-term deliveries, APGAR score and perinatal mortality rate

Diagnostic yield of hysteroscopy in patients with irregular uterine bleeding

Objective: to find out the role of diagnostic hysteroscopy in accurate diagnosis of patients presenting with irregular uterine bleeding in our setup

Material and Methods: all the patients who underwent hysteroscopy for irregular uterine bleeding during study period were included. Age, parity, marital status and LMP were noted. Hysteroscopic findings were determined and subsequent endometrial samples taken. A comparison was made between hysteroscopic impression and histological examination

Results: total 148 patients had hysteroscopy for irregular uterine bleeding. The age range of our patients was 20-70 years with the mean age of 38.3 years. 97.2% patients were married and 88.5% pre-menopausal. Hysteroscopically findings noted in 113 patients [76.3%] and confirmed on histopathology in 89 cases [60.1 %]. Four patients [2. 7%] had a suspicion of carcinoma endometrium and histopathology confirmed this in 3 cases [2.02%]. We failed to perform hysteroscopy in 3 cases [2%] due to cervical stenosis

Conclusion: hysteroscopy with a biopsy has a high diagnostic yield

Do we really need to arrange blood for all patients undergoing C-section?

Objective: To find out whether it is really necessary to arrange blood for all patients undergoing C-Section in our setup

Patients and Methods: This cross sectional study was conducted at Shalamar Hospital Lahore from October 2008 to August 2009. All patients undergoing C-section both emergency and elective under care of the authors were included in the study. Age and parity was noted and indication of C-Section was determined. Their hemoglobin was determined by cyanoheamoglobin method. The need for blood transfusion and its possible indication was assessed in all patients. The intraoperative and postoperative complications were also noted. The average cost of cross matching and arrangement of one unit of blood in different hospitals of Lahore was also noted

Results: Out of 351 patients who underwent C-Section, 27 patients required blood transfusion. Common indication was massive hemorrhage due to placenta previa, abruption, previous surgeries, twin pregnancy and uterine atony. Other indication for transfusion was Hb less than 8 gm% at term. The calculated cost of cross matching and arrangement of one unit of blood was 1500 to 2400 Pak rupees

Conclusion: It is not cost effective to arrange blood for all patients undergoing C-Section as a routine. It should be limited to the high risk patients like those with placenta previa, previous surgeries and significant anemia