Role of labetalol in control of severe hypertension in pregnancy

To determine the efficacy of Labetalol in the control of severe hypertension in pregnancy. Therapeutic Clinical Trial. Gynae unit 1, Holy Family Hospital, Rawalpindi. 1stApril 2010-31st Dec 2010. All the pregnant women with BP of >/= 160/110 mm of Hg admitted in labour ward were included in the study. Those with bronchial asthma, cardiac failure, heart block, cardiogenic shock, severe bradycardia and hypersensitivity to the drug were excluded from study. Data was collected on a pre-designed proforma. Outcome measures were dose required to achieve the target BP, time taken to achieve the target BP[diastolic BP< 100mmHg], adverse reactions and feto-maternal outcome. Analysis of data was done on SPSS Version 16. Total patients included in the study were 71. Women between 21-30 years were 54 [76%] and 17 [24%] were between 31-40 years. Twenty seven [38%] were Primigravida, 38 [53%] were P1-P4 and 6 [9%] were P5 and above. Out of 71 patients, 10 [14%] presented with PIH, 18 [25%] with Preeclampsia, 39 [55%] with Eclampsia and 4 [06%] with Chronic HTN. Sixty four [90%] of patients presented in 3rd trimester. Range of BP at the time of presentation was from 160/110-250/140 mm of Hg. In 45 [64%] women BP was controlled with labetalol 20-100 mg, while 13 [18%] required >100-200mg and13 [18%] >200-300 mg of labetalol. Time taken to achieve the target BP was 1hour in 43 [60%] women, 2 hrs in 14 [20%], 3 hrs in 14 [20%]. Thirty six [50%] women experienced no side effects and in the remaining 50% nausea and vomiting were the common side effects. None of our patients experienced arrhythmias. After the achievement of target BP, 2/3rd [n=52] were switched over to oral preparation of labetalol. Thirty two patients [45%] delivered vaginally and 39 patients [55%] delivered by caesarean section. Regarding the neonatal outcome 59 [83%] delivered alive and 12 [17%] delivered dead babies. Out of the babies delivered alive, 19 [32%] were shifted to nursery, one baby expired and remaining, 18 were discharged. Majority of women were discharged in healthy state [n= 63] [89%], 08 [11%] were transferred to ICU/ medical unit, out of whom 2 expired later. Labetalol is an effective drug in controlling severe HTN in pregnancy and is associated with mild side effects Foetomaternal outcome was good.

large unilocular mucinous cystadenoma in third trimester of pregnancy

Ovarian malignancy is the second most common gynaecological malignancy diagnosed during pregnancy. A grand multipara, aged 30 years presented with gestational amenorrhea with abdominal discomfort and breathlessness for last 15 days. Sonographic examination demonstrated a huge, unilocular ovarian cyst and an alive fetus of about 30 weeks gestation. Intraoperative findings were huge left ovarian cyst [42x40x20 cm] with straw coloured mucinous fluid. Left salpingo-oophorectomy was performed followed by peritoneal washings and omental biopsy. Histopathology revealed mucinous cystadenomas with inflammatory changes in omentum and no malignant cells in peritoneal washings. She delivered vaginally a female baby of 3.5 kg at 38 weeks with good Apgar score

Evaluation of causes of increasing cesarean section rate in a tertiary care hospital

Background: increasing cesarean section rate is a global phenomenon. There has been public health concern for last three decades about increasing cesarean section rate [CSR]. Objective: the objectives of current study are; to determine cesarean section rate and enlist various factors causing increase in cesarean section rate in a tertiary care hospital

Patients and Methods: this descriptive study was conducted in Gynecology and Obstetrics Department, of Holy family hospital, Rawalpindi, from 1stJanuary to 31st December, 2008. Both booked and non-booked patients for cesarean section were admitted through antenatal clinic and emergency department of this hospital. All the patients who underwent cesarean section were included in this study. Details on age, parity, antenatal care and indications for cesarean section were recorded on a proforma

Results: in our study, maternal age of the patients who had cesarean section ranged from 18 to 45 years. During this study total number of deliveries was 5941, normal vaginal deliveries were 3575 [60.1 %], cesarean sections were 2026 [34%], assisted vaginal breech deliveries were 85 [1.43%] and instrumental deliveries were 255 [4.3%]. Out of total number of deliveries, 3340 [56%] were booked patients and 2601 [44%] were non booked patients. In our study, it was observed that the most frequent indication for cesarean section was fetal distress 645 [32% ], followed by repeat cesarean section 545 [27% ]

Conclusion: the CSR of34% is higher in our study than the rate recommended by World Health Organization. The effective way to decrease the CSR is by proper antenatal evaluation, provision of continuous fetal monitoring to high risk cases, availability of senior obstetrician, and avoidance of unjustified inductions and promotion of vaginal breech delivery