Role of intra umblical oxytocin injection in the management of retained placenta

To determine the efficacy of intra umbilical oxytocin injection as a treatment for retained placenta. Quasi experimental study. This was conducted at DHQ Hospital Faisalabad over a period of two year from January 2005 to January 2007. A total 30 haemodynamically stable women having singleton pregnancy and vaginal delivery with retained placenta admitted in labour ward were selected. 20i.u of oxytocin diluted in 20cc normal saline was injected through umbilical vein. Thirty cases of retained placenta were managed during study period. The highest percentages of patients [66.6%] with retained placenta were between the ages of 20-30 years. Majority of patients [46.6%] having parity between 1 to 4. 56.6% of patients having gestation between 38-39 weeks. Intra umbilical oxytocin injection was successful in 70% of patients while 30% of patients required manual removal of placenta. 60% of patients expelled placenta in less than 10 minutes. Amount of blood loss was less than 80ml in 71.4% of patients and 28.5% of patients received blood transfusion. None of patient developed side effects of drug. Injection of oxytocin into the umbilical vein is safe procedure that can cause placental separation and delivery and thus avoiding the anaesthetic risk, genital tract trauma, and infection associated with manual removal of placenta

Presentation and management of ectopic pregnancy in a tertiary care teaching hospital

To identify risk factors, presentation, correlation between clinical signs, symptoms and final diagnosis and treatment of ectopic pregnancy. A cross sectional analytical study. This study was conducted at DHQ Hospital Faisalabad over a period of one year, from January 2004 to January 2005. All the patients, with suspicion of ectopic pregnancy by their presentation, underlying risk factors, were admitted through emergency and gynaecology out patient department. Initial diagnosis of ectopic pregnancy was made in patients presented with amenorrhoea, abdominal pain and irregular bleeding. Ultrasound and urine for pregnancy test were done for confirmation of diagnosis. Any underlying risk factors for ectopic pregnancy were also recorded. A total of 24 cases of ectopic pregnancy were managed during study period. Initial diagnosis was correct in 18 patients [75%], while 6 patients [25%] were assigned a different diagnosis on admission. The highest percentage of patients 66.6% [16 cases with ectopic pregnancy were between the age of 30-35 years. 6[25%] patients were nullipara and 18 [75%], were multiparos. 16[66.6%] of patients had underling risk factors for ectopic pregnancy, while no risk factor was detected in 8[33.3%] patients. The most frequently experienced symptoms of ectopic pregnancy were abdominal pain [66.6%], amenorrhoea [58.3%] and vaginal bleeding [41.6%]. Salpingectomy through laparotomy was done in all cases. No patients qualified for expectant or medical treatments because of late presentation and rupture of the tube beyond the scope of repair. The mortality was nil because of effective resuscitative measures and immediate surgical correction

Indication and maternal outcome of emergency peripartum hysterectomy

To analyze the maternal outcome of peripartum hysterectomy in badly handled cases with ruptured uterus and severe post partum haemorrhage. A retrospective study carried out in Obstetric and Gynaecology Unit-II, Divisional Headquarter Hospital [D. H. Q.] Faisalabad over a period of two years. Thirty patients who underwent emergency peripartum hysterectomy during the study period of two years. Indications, associated maternal morbidity and mortality of peripartum hysterectomy. There were 30 cases of emergency peripartum hysterectomy over a period of two years. The most common indication was uterine rupture [42.9%], followed by uterine atony [26.6%]. All women required blood transfusion, five [17%] developed coogulopathy, four [13.3%] had bladder injuries, two [6%] required salpingoophorectomy for uncontrolled adnexal bleeding and two [6%] patients underwent a repeat laparotomy for internal haemorrhage. Maternal mortality was 6% [n=2]. Peripartum hysterectomy continues to have a high incidence in our community. High parity, illiteracy and ignorance coupled with inadequate maternity services, injudicious use of syntocinon, improper third stage management, abnormal placentation and uterine atony were identified as risk factors for emergency peripartum hysterectomy. An early decision of obstetrician can save blood loss and prevent complications

Incidence and outcome of preterm-premature rupture of membranes

To know the incidence and to evaluate the outcome of cases of preterm premature rupture of membranes [PPROM]. An observational study done over a period of 1 year between 31st January 1999 to 31st January 2000. 136 cases of PPROM admitted in the antenatal ward of Obstetric and Gynecology Unit II, Punjab Medical College, Divisional Head Quarter [DHQ] Hospital, Faisalabad. Main Outcome Measures: Incidence, latency period, perinatal mortality and morbidity and maternal morbidity. Incidence of Pre-term premature rupture of membrane was 5.4%. Most of the patients were below 25 years or above 30 years of age [74%, 66% respectively]. Majority belonged to low socio-economic group. Thirty-two patients had previous history of abortion or preterm delivery, seventy-eight patients delivered within first 48 hours. About 2.6% percent patients developed choriomnionitis. Eighty six percent patients delivered vaginally. Perinatal mortality was 19%. Retained placenta and abruption was seen in 0.7% cases each. PPROM is a major obstetric problem. Expectant management upto 36 weeks is a favourable option in our circumstances where neonatal intensive care units [N.I.C.U.] are not available. Prolongation of pregnancy to achieve fetal maturity can be possible by adopting strict clinical criteria thereby decreasing prematurity

Prevalence and management of anencephaly at divisional headquarter hospital Faisalabad

To determine the prevalence, establish diagnosis and management of anencephaly. Design: A prospective cross sectional study done over a period of one year [01.06.1999 to 31.05.2000]. Setting; Antenatal ward of Obstetric and Gynaecology Unit-II, Punjab Medical College, Divisional Headquarter Hospital [DHQ], Faisalabad. Thirteen pregnant ladies having fetuses with neural tube defect [NTD] admitted in antenatal ward of DHQ Hospital. Main outcome measures: Prevalence of anencephaly diagnosis, establishing any risk factor and possible causative factors. Prevalence of anencephaly was 3.2 per 1000 births and that of spina bifida 2 per 1000 births, 100% anencephalic and 80% infants of spinabifida were diagnosed by ultrasonography. 62% cases underwent termination of pregnancy through vaginal route. Maternal diabetes was found in 12% cases. Female sex was predominant in anencephalic fetuses [61.50%]. Improved maternity services, with facilities for prenatal diagnostic techniques for detection of anencephaly and early termination of affected fetuses can help curtail this congenital anomaly with its associated perinatal mortality. Prevalence can be decreased by giving folic acid supplementation before pregnancy and in first trimester

Management of diabetic pregnancy and its outcome

To find out the effect of optimal management of diabetes during pregnancy on maternal morbidity and perinatal morbidity and mortality. A prospective study of 171 consecutive admissions of diabetic pregnant women to Antenatal Ward of Gynaecology and Obstetrics, Unit II, Punjab Medical College [P.M.C.], Divisional Headquarter Hospital [D.H.Q.] Faisalabad. Setting: Antenatal Ward of Gynaecology and Obstetrics, Unit II, P.M.C., D.H.Q. Hospital, Faisalabad. One hundred and seventy one pregnant women with diabetes admitted in Antenatal Ward. Maternal morbidity, perinatal morbidity and mortality and causes of perinatal mortality. One hundred and seventy one cases of pregnancy with diabetes were booked for antenatal care. One hundred and forty five cases continued follow-up and were managed till delivery, one hundred and sixteen [77%] were booked in third trimester, 26 [17%] in second trimester, 8[5%] in first trimester. Hospital and home blood glucose monitoring was carried out. Two cases ended in first trimester abortion. More than half [59%] patients were delivered by caesarean section. Perinatal mortality was 4.82% with equal incidence of congenital malformations and unexplained still births. Diabetes is an important medical complication of pregnancy. Prenatal counseling for established diabetics, screening for diabetes for all pregnant women, good control of diabetes from conception till delivery, antepartum fetal surveillance and good neonatal care by neonatologists are the keys to successful outcome

Management of eclampsia; 7 year study in Faisalabad

OBJECTIVE: 1. To evaluate various factors responsible for the disease. 2. Effectiveness of mother and child health activities and outcome of the management. DESIGN: Prospective study. PERIOD: [January 1989-Dec 1995. SETTING: Department of Obstetrics and Gynaecology Allied Hospital Faisalabad. PATIENTS AND METHODS: Out of 16952 total births, 249 patients had eclampsia and were managed according to the set protocol. The incidence of eclampsia was 1.4% and matena1 mortality was 13.6%. Eclamptic patients from rural area were 66.5% and that of urban area was 33.7%, 54% patients were primigravida and 46% were multigravidas. The percentage of ante, Intra and postpartum eclampsia were 56, 57, and 12 respectively. 45% patients had abdominal delivery, 30% had forceps delivery, 11% delivered at home, 8% had vaginal delivery in hospital and 6% expired undelivered. Community education programme created awareness about the importance of antenatal check up which led to early detection and treatment of pre-eclampsia thereby preventing development of eclampsia. Special programme of training the traditioinal birth attendants [TBA] to recoginized pre-eclampsia in early stage and to refer the patient to the hospital, and availability of reliable transport to bring the patient from periphery or patient's home to the hospital where prompt treatment be started by the experienced staff would certainly decrease the incidence of eclampsia and its adverse outcome