Iron deficiency anaemia is still a major killer of pregnant women

Objective: To observe the effects of iron deficiency anaemia on the health and life of pregnant women

Methods: This cross sectional study was conducted at the Department of Obstetrics and Gynaecology Unit IV, Liaquat University of Medical and Health Sciences Jamshoro from 1st June 2015 to 30th November 2015, for the period of 6 months. During this study period all the pregnant women from 13-40 weeks of pregnancy with iron deficiency anaemia having haemoglobin level less than 9 gram% were included, while the pregnant women with other medical disorders were excluded from the study. The data was collected and analyzed on SPSS version 21

Result: Out of the 305 pregnant registered women with iron deficiency anaemia most women were young 170[55.73%] between 20-30 years, belonged to low socioeconomic group 254[83.27%], they were multiparous 104[34.09%], having very low haemoglobin level between 1-3 gram % in 54[17.70%] women and between 4-6gram% in162 [53.11%] women. These women were prone to high complications such as ante partum haemorrhage 49[16.06%], renal failure 48[15.73%], disseminated intravascular coagulation 54[17.70%] and 16[5.24%] women died

Conclusion: Iron deficiency anaemia is common in pregnant women with higher rates of complications

Obstetrical trauma to the genital tract following vaginal delivery

To determine the frequency, types and complications of genital tract trauma during child birth. Case series. Department of Obstetrics and Gynaecology, Unit I, Liaquat University of Medical and Health Sciences, Jamshoro, from June 2006 to May 2010. All women who sustained genital tract trauma during delivery at the study centre and those referred from periphery with the same condition within 40 days of delivery were enrolled in the study. Exclusion criteria were women who sustained genital tract injury with caesarean section and genital tract trauma due to accident. Studied variables included age of women, parity, place of labour, type of trauma received and its immediate complications. The data was expressed in terms of descriptive statistics. Out of a total 9216 cases admitted in maternity ward during the study period, 467 cases [5.06%] had sustained genital tract trauma. The most frequent obstetrical trauma seen in primiparous referral cases were vaginal tears in 16 cases [25.39%] and perineal tears in 12 cases [19.04%]. Multiparous women were 196 [41.97%] and cervical tears were the most frequent obstetrical trauma in them [n=52, 26.53%]. Grand multiparous women were 208 having cervical tears [44.4%] and uterine rupture in 77 cases [37.01%] each. Most frequent early morbidities were postpartum haemorrhage [n=352, 75.37%], hypovolemic shock [n=220, 47.10%] and infection [n=158, 33.83%]. The mortality rate was 16.05%. Genital tract trauma is a common complication of vaginal birth mostly seen in grand multipara, leading to haemorrhage, shock and infection

Frequency of second stage intervention and its outcome in relation with instrumental vaginal delivery versus caesarean section

To determine the frequency of second stage intervention and the risk of maternal and foetal morbidity and mortality associated with instrumental vaginal deliveries versus caesarean section in our tertiary care set up. This descriptive study was conducted in the Department of Obstetrics and Gynaecology [Unit-II] Liaquat University Hospital Hyderabad Sindh, Pakistan from January 2005 to December 2006. All the women who underwent instrumental vaginal delivery and caesarean section due to prolonged second stage of labour were included in this study. Data were collected on a pre-designed proforma, which included demographic details, maternal and perinatal morbidity as well as any complications etc. Finally, data were analysed through software program SPSS 10.0. Frequency of second stage intervention was 22.2%. Among, 400 women who undergone second stage intervention, 240 [60%] were delivered by caesarean section and 160 [40%] were delivered with the help of instruments. Majority of women, i.e., 49.25% were between 21-30 years of age, 73% were un-booked cases while 45% cases were primigravida. Complications with abdominal delivery were paralytic ileus in 35 [14.58%] cases, post partum haemorrhage in 30 [12.5%] cases and tear extension in 13 cases. Complications with instrumental delivery were vaginal tear in 28 [17.5%] cases, cervical tear in 12 [7.5%] and third degree perineal tear in 4 [2.5%] cases. The perinatal outcome with abdominal delivery [86.66%] was better as compared to instrumental delivery [72.5%]. The frequency of second stage intervention seems high in our set up and is associated with significant maternal and perinatal morbidity. Maternal morbidity was more frequent abdominal delivery while neonatal morbidity and mortality was more frequent with instrumental delivery

Clinical spectrum and management of ovarian tumours in young girls upto 20 years of age

Ovarian tumours are one of the common malignancies all over the world affecting all age groups. This study analyses different clinical presentation and management of ovarian tumours in young girls up to 20 years. Patients up to 20 years of age admitted with the diagnosis of ovarian tumour were included. Data collected on a proforma. Variables studied included age, presenting symptoms, investigations, surgical findings, type of surgery, histopathology reports and follow-up. The patients with malignant ovarian tumour were followed by oncologist as well as gynaecologist. Data analysis was done on SPSS. The mean age was 17.27 +/- 2.46 SD years. The common symptoms included abdominal mass, abdominal pain, urinary problems, menstrual irregularities and generalized malaise. All patients were operated after preliminary investigations. Patients were advised to have follow-up post-operatively after 1 month. The follow up was done by oncologist and gynaecologist. Six patients [12.5%] died and 22 [45.83%] were lost to follow up. Ovarian tumours are quite common in young girls. Majority of patients seek medical advice once the disease becomes symptomatic, complicated or advanced disease in the case of malignancy. Histopathology of the tumours revealed that epithelial cell tumour is the commonest tumour in contrast to germ cell tumour as reported by world literature

Pattern of fetal deaths at a university hospital of Sindh

Perinatal mortality is a significant public health problem throughout the world. Its prevalence is quite high in the developing countries on account of number of factors. Most of the causes are treatable and fetal outcome can be improved by provision of good health care facilities during antepartum and intrapartum periods and through public education regarding reproductive health and better utilization of health services. To determine the pattern of intrauterine fetal deaths before or in the process of labor in our tertiary care set up. This descriptive case series was conducted at Department of Obstetrics and Gynaecology [unit-IV] at Liaquat University Hospital, Jamshoro, Sindh, from April 2002 to October 2003. In total, 50 intrauterine fetal deaths from 24 weeks of gestation to full term pregnancy were analyzed. The case records of all the women were evaluated and data collected regarding their age, period of gestation, clinical features, antenatal records, previous obstetrical history, labor, mode of delivery as well as complications during or after the labor. Out of 697 deliveries, 50 [7.17%] babies were still born. Of these 84% were fresh still born. The commonest factors were antepartum hemorrhage [30%], mismanaged labor [26%], premature rupture of membranes [26%] and congenital anomalies [16%]. Majority of fetal deaths in our set up are due to avoidable factors. Hence, there is strong need to improve the quality of care by proper antenatal care, identification of high risk cases and referral to tertiary care hospitals for proper management to prevent morbidity and mortality in this regard

Meigs' syndrome

Meigs syndrome is a rare clinical condition commonly considered to be associated with malignant ovarian tumour. A case of unmarried female is presented who came with a slowly increasing abdominal mass. Clinical and ultrasonic investigations revealed a mobile, solid right adenexal tumour in the lower abdomen, along with ascites and pleural effusion of the right lung. The level of CA 125 was also raised. Diagnosis of Meigs syndrome was confirmed after surgical intervention. The tumour was successfully removed and pleural effusion disappeared 15 days after the intervention. Cytomorphologic study of both the tumour and ascitic fluid was negative for malignancy