Primary amenorrhea with bilateral endometriotic cysts

Primary amenorrhea is a common problem. Diagnosis is usually by going through systematic approach of history, examination and investigations. This case had bilateral large endometriotic cysts in the adnexal region. Uterus was normal sized with well-formed endometrium. She underwent laparotomy followed by drainage of endometriotic cysts, stripping and reconstruction of ovaries was performed. Patient was given a trial of combined oral contraceptive pills for two consecutive cycles to observe withdrawal bleeding, but it failed. Till now we are unable to find out such case in literature. Exact case of primary amenorrhea could not be found

Prevalence of domestic violence among women seeking abortion

To determine the prevalence of domestic violence in women seeking abortion. This cross-sectional study was conducted in outpatient department of Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar, family planning Centre, Marie Stoop's society Peshawar and a private clinic from April 2012 to March 2013. Approval was taken from the ethical committee of the hospital before starting the study. A Proforma made and women seeking induced abortion that volunteered to answer the questions were included in the study. Confidentiality was maintained to avoid potential retaliation from disclosure. Domestic violence was reported by 40 [38.9%] women out of 105 women seeking induced abortion, who were interviewed consecutively. Majority of them were in stable relationship being married for more than a year [n=38, 95%]. Physical and sexual violence both were reported by 10 [25%] women each while all three types of violence i.e., verbal; physical; and sexual, were reported by 16 [40%] women. Domestic violence was reported more in spouses with lower educational status [n=22, 55%]. Violence by intimate partner was reported in 23 [57.5%] and by other family members in 7 [17.5%] cases. More than one third of the women of the sample were faced with the problem of domestic violence. Level of education was inversely related to domestic violence as it was reported more in spouses with lower educational status

Maternal morbidity associated with emergency versus elective caesarean section

To compare maternal morbidity in elective versus emergency caesarean section in a tertiary care teaching hospital. This comparative study was conducted at Department of Gynecology and Obstetrics, Lady Reading Hospital Peshawar, Pakistan, from July 2006 to June 2007. A total of 100 patients, 50 in emergency and 50 in elective caesarean section group through convenient sampling were included in the study. The sample size was calculated as 100 by keeping 8% prevalence of caesarean section in Pakistan and using WHO software for sample size estimation. The complications were compared in both groups using a semi structured proforma. The comparison was done by using Chi-square test and p-value

Active versus conservative management of prelabour rupture of membranes at term

To compare maternal and foetal outcome of active versus conservative management of premature rupture of membranes after 37 completed weeks of pregnancy. This quasi-experimental study was carried out at Gynae unit, Lady Reading Hospital, Peshawar from September 2004 to September 2005 and included 100 patients out of which 50 were managed conservatively and 50 actively. After confirming the leakage of amniotic fluid, patients were randomized by lottery method to conservative or induced group. The patients in the group that was managed conservatively were shifted to obstetrical ward to await the onset of regular uterine activity for at least 48 hrs. After Bishops scoring, patients were induced with vaginal prostaglandin E2 tablet. Both groups received intravenous antibiotics. Total number of patients with PROM at term was 3.84%. Total cost of stay in hospital and management was greater in induced group [P. value <0.05%]. Latent time was short in induced group whereas hospital stay was prolonged in induced group. About 80% of patients in conservative group delivered by NVD as compared to 60% in induced group. Among complications mild fever and PPH were significantly [P. value <0.05] more common in conservative group. There was neither neonatal death nor stillbirth in both groups. No statistically significant difference [P. value >0.05] was observed in respect of perinatal outcome and infectious morbidity in babies. Conservative management of PROM at term should be viewed more positively for at least 48 hrs under appropriate antibiotic cover and with active management of 3[rd] stage of Labour

Decreased amniotic fluid index and adverse pregnancy outcome at term

To find out the effect of decreased amniotic fluid index [AFI] on adverse pregnancy outcome at term. This experimental study was conducted at Gynae [B] unit Lady Reading Hospital Peshawar from September 2004 to August 2005. A total of 100 pregnant women admitted in labour ward were included in the study. Fifty cases with an amniotic fluid index of <5cm comprised the patient group. Fifty controls having AFI>5cm were matched with the cases regarding age [ +/- 3years], parity and antenatal complication [hypertension, diabetes]. Apart from demographic details, maternal outcome measures such as induction of labour; mode of delivery; meconium stained liquor; and fetal outcome measures such as Apgar score and admission to neonatal intensive care unit were recorded on a semi structured proforma for both the groups and analyzed by Chi square test using SPSS v.ll. Labour induction was significantly higher in patients having AFI<5cm as compared to the control group [p-value=0.009]. Meconium stained liquor [p-value=0.023] and cesarean section rate for fetal distress [p-value=0.000] were higher in patients having AFI<5cm. Neonatal complications were found to be more frequent in the patients having AFI<5cm and these include, low Apgar score <7 [p<0.00l] and neonatal intensive care unit admission [p=0.078]. There was no perinatal mortality in both the groups. Amniotic fluid index of <5cm was associated with adverse pregnancy outcomes in the form of meconium stained liquor, induction of labour, cesarean section for fetal distress, low Apgar score and neonatal intensive care unit admission