Reliability of trans-abdominal ultrasonography in determining exact location of placenta in patients of placenta previa major

Objective: To determine the reliability of trans-abdominal ultrasonographical localization of placenta in cases of placenta previa major, by taking peroperative finding as gold standard

Study Design: Validation study

Place and Duration of Study: Maternity ward, Obstetrics and Gynecology department, Military Hospital Rawalpindi from 2007 to 2008

Patients and Methods: A total of 100 patients fulfilling the inclusion and exclusion criteria were recruited for the study. These patients were admitted to the maternity ward, where trans-abdominal ultrasound was performed, site of the placenta and its relation to the internal os was documented. These patients under went elective cesarean section, during which the site and relation of the placenta to the internal os was confirmed

Results: The mean age of patients was 34.23 +/- 6.76 years. Transabdominal ultrasound had a sensitivity of 93.4% in localizing major placenta praevia while the specificity was 83%. Positive predictive value was 94.7%, negative predictive value was 80% and accuracy 91%

Conclusion: Trans-abdominal ultrasound was found highly effective in diagnosing and localizing placenta previa

Cervical screening: do gynecologists themselves practice what they preach? a study based in tertiary care hospitals of Lahore

To determine the frequency of self-compliance to cervical screening guidance among the sexually active female gynecologists in tertiary care hospitals. To identify the possible barriers to effective screening in those who do not undergo cervical screening. Cross sectional study. This study was conducted in the obstetrics and Gynecology department of various tertiary care hospitals of Lahore from 1[st] Jun 2012 to 30[th] Nov 2012. Total 157 female gynecologists, serving in various positions in tertiary care hospitals of Lahore were interviewed by using a structured self reporting performa. The performa was designed to find out the number of gynecologists undergoing pap screening, and in those who fail to undergo screening the single most important barrier presumed to be preventing them from undergoing screening was also evaluated. In this study, only 3.1% of the subject population was found to be undergoing pap-screening, which reflects the national level of screening in urban areas,in sharp constrast to the studies being conducted in developed countries, with screening coverage rates of more than 80%. The prevalence of pap screening in the subject population is disappointingly low and drastic steps are needed to bring about a change in attitude of the subject population which cannot be brought about without changing the current culture of self-negligence and least prioritization for self, in the feminine part of our society

Accuracy of risk of malignancy index in preoperative evaluation of adnexal masses

To evaluate the diagnostic accuracy of risk of malignancy index [RMI] in discriminating between benign and malignant adnexal masses taking histopathology as the gold standard. Validation study. The study was done at the department of Obstetrics and Gynaecology, Government Lady Aitchison Hospital, Lahore from January 2009 to July 2009. Total 60 patients were included in this study. Risk-of-malignancy Index level [RMI] <200 was taken as benign and RMI >200 was taken as malignant. Histopathology report was followed after surgery. Mean age of the patients was found to be 41.03 +/- 8.59 years. The results of RMI were compared with the histopathology with report at histopathology, 91.7% patients had benign masses and 8.3% patients had malignant masses. At RMI, 88.3% patients had benign masses and 11.7% patients had malignant masses. While RMI findings were confirmed with diagnosis made on histopathology the sensitivity, specificity and diagnostic accuracy were found to be 100%, 96.3%, 96.6%, respectively. Positive and negative predictive values of RMI were 71.4%, and 100%, respectively. RMI is an appropriate tool for diagnosing adnexal masses with high risk of malignancy and referring to specialist gynecological centers for suitable surgical operations

Efficacy of dydrogesterone in the management of threatened miscarriage in the first trimester

To study the efficacy of dydrogesterone in pregnant women with threatened miscarriage in the first trimester. Randomized control trial. Department of Obstetrics and Gynaecology, Military Hospital Rawalpindi from Jan 2008 to Dec 2008. One hundred and fifty two pregnant women presenting to the Gynae and Obs department [MH Rwp] before 12[th] gestational week were selected on the basis of slight pain or vaginal bleeding, no cervical dilatation and a viable pregnancy on ultrasound. They were divided randomly into two groups each containing 76 patients with the help of simple random number table, after obtaining their consent and explaining all the risks and benefits to them. Bias was controlled by double blinding. Patients in group A received oral dydrogesterone [10mg twice daily] and patients in group B received placebo. Treatment was continued till the 12[th] gestational week and patients were followed up 4 weekly after the completion of treatment till the 20[th] gestational week. Improvement was judged by continuation of pregnancy and remittance of symptoms. Patients in group A had a greater improvement in the symptoms of pain and vaginal bleeding but the difference between the two groups was not statistically significant. However the number of patients who had a normal growth and whose pregnancies continued was significantly higher in group A. It was concluded that the continuing pregnancy success rate was significantly higher in women treated with dydrogesterone compared with women who received placebo treatment

Efficacy of cervical cerclage in sonographically shortened cervix in women at moderate risk of preterm delivery

To compare the efficacy and safety of cervical cerclage following objective shortening of cervix by endovaginal ultrasound with elective cerclage in women at high risk of midtrimester miscarriage or preterm delivery. Quasi experimental. Place and Duration of study: Military Hospital Rawalpind., January 2005 to July 2008. Material and Cases of elective cerclage were matched for maternal age, previous history of single mid trimester loss or preterm delivery or preterm rupture of membranes before 34 weeks with women who had selective cerclage if cervical length became < 25mm. All patients were followed up till delivery and outcomes in the two groups were assessed in terms of duration of gestation and neonatal survival. 23 cases of elective cerclage were matched to 24 cases of selective cerclage. Transvaginal ultrasound indicated cerclage was performed in 50% of the control group due to decrease in cervical length. There was no significant difference in the number delivering before 25 weeks 2[8.6%] versus 3[12.4%], those delivering at gestation>35 weeks 17 [73%] versus 16[66.6%][p=0.94]. Neonatal survival was also similar 18[78%] versus 19[79%] p=0.96. Cervical length as measured by TVS is the best available technique for predicting preterm labour. In women deemed moderately high risk on the basis of history, sonographic cervical length indicated cerclage appears to reduce cerclage rates without comprising pregnancy outcome

Female reproductive life - myths and realities

To determine the knowledge and practice of myths associated with female reproductive life prevailing in our society. The study was taken in Gynaecology Department of Military Hospital Rawalpindi from 01st May 2008 to 30th May 2008. about 250 female patients attending the Gynae / Obst department of the Military Hospital as out patient were involved. Each patient was asked to fill up a Performa designed to assess knowledge and practice of myths associated with female reproductive life prevailing in our society. The participants ranged from various socio-economic and educational background; however majority of the patients reporting at the Gynae/ Obst department of Military Hospital Rawalpindi belong to lower socio-economic and poor educational background. Age was not selected as a criteria however only adult, married women were interviewed since these constitute the bulk of patients attending to the Gynae / Obst department of the Military Hospital Rawalpindi. A majority believed in myths related to menstruation, pregnancy, epidural analgesia, infertility and menopause. However the knowledge about family planning and C-section was quite up to date and majority did not believe in the myths related to these aspects of female reproductive life. The study shows that although the myths related to family planning and C-section are not affecting the life styles of majority of our population, but still there are areas in the female reproductive life like menstruation, pregnancy, epidermal analgesia infertility and menopause where concepts are not very clear in the general population and there is a need for proper health education of the masses regarding these aspects

Primary non-hodgkin's lymphoma of vagina associated with pregnancy

We report a case of non-Hodgkin's lymphoma [NHL] in 23 years old, 36 weeks pregnant female, who presented with a swelling in the vagina. Biopsy of the lesion led to profuse haemorrhage and emergency caesarean-section along with bilateral ligation of internal iliac arteries were required. Recovery was smooth and she was discharged from the hospital on the 5th postoperative day. Histopathology revealed non-Hodgkin's lymphoma, diffuse large B cell type [DLBCL]. Further treatment by medical oncologist led to complete resolution of the tumour at three months