Vaginal birth after cesarean section - a continuing challenge

The purpose of this study was to assess the antenatal and intrapartum factors influencing the success of vaginal delivery in women with one cesarean section. Identification of modifiable risk factors which could help in developing local guidelines to improve the management and success rate of patients undergoing vaginal delivery after one previous cesarean section. Prospective cohort study. This study was carried out at the Department of Obstetrics and Gynecology, Aga Khan University, Hospital, Karachi from 01.01.2008 to 30.06.2008. A sample size of 21 women, undergoing induction of labor [IOL] and 54 women with spontaneous labor were needed. All women with singleton, cephalic, term pregnancies with history of previous one caesarean section were included. Data collected through the Performa and statistical analysis performed using the SPSS computer statistics programme. To compare proportions, the x[2] test and Fisher's exact test were used and student-t test were used to compare means. Both groups were comparable and there was no statistical difference between them, except for the Bishop score which in the induction of labor [IOL] group was 4 +/- 1.54 and in the spontaneous labor group was 5.7 +/- 2.18, which is statistically significant [p value = 0.001]. The results suggest that there is no effect of previous vaginal delivery, epidural analgesia, fetal distress and baby's gender on the outcome of trial of labor [TOL]. The rate of successful vaginal birth after cesarean section [VBAC] is not significantly different in the group of IOL and spontaneous labor. The current clinical evidence suggests that VBAC is advantageous to the mother and has no adverse effects on the fetus but it is no risk free. It is actually the responsibility of the obstetrician to ensure best care and appropriate management plan

Vitamin D levels in patients of acute leukemia before and after remission-induction therapy

To determine the levels of 25-hydroxyvitamin [25[OH]D3] in patients with acute leukemia and the effect of remission-induction chemotherapy. This study was case control, all newly diagnosed patients of acute leukemia between the age of one to sixty years and residents of Pakistan were enrolled and evaluated. Those who were unwilling or unable to provide written informed consent were excluded. All selected patients [n=86] were grouped in to acute myeloid leukemia [AML] and acute lymphoblastic leukemia [ALL]. AML was further categorized as A1 before remission-induction [n=17] and B1 after remission induction [n=13], ALL was further categorized as A2 before remission-induction [n=31] and B2 after remission induction [n=25]. The 25-hydroxyvitamin [25[OH]D3] levels were measured in the sera of all patients [before and after remission-induction] by one step delayed chemiluminescent micro particle immunoassay [CMIA].We compared 25[OH]D3 levels in all patients before and after the remission-induction chemotherapy. A total of 86 patients were analyzed, in which 60 patients were male. Mean age was 24.39 years [range, 1 to 60 years]; the mean levels of 25[OH]D in group A1 [n=17] was 17.70 +/- 3.2 ng/ml, in group B1 [n=13] 14.06 +/- 2.4 ng/ml, 19.07 +/- 7.08 ng/ml in group A2 [n=31], while 10.59 +/- 3.9 ng/ml found in group B2 [n=25]. 25[OH]D3 insufficiency was evident subnormal in majority of patients with acute leukemia and 25[OH]D3 were further reduced after remission-induction as compared to untreated group, difference was statistically significant when compared with each group

insight into the possible anticonvulsant activity of ethanolic extract of pongamia pinnata leaves in mice

Ethanolic extract of Pongamia pinnata leaves was investigated for possible anticonvulsant activity against pentylenetetrazol [PTZ] and Maximum Electroshock [MES] - induced seizures in mice. Effect of the extract on spontaneous locomotor activity was assessed using Actophotometer. Any possible change in brain GABA content was also determined, in a trial, to correlate such change with the anticonvulsant activity. In PTZ-induced seizures, the extract delayed the onset of convulsions dose-dependently. The highest dose elicited complete protection against tonic hind leg extension together with remarkable reduction in mortality. In MES-induced convulsions, the extract produced significant increase in the current required to produce tonic hind leg extension. In Actophotometer the extract produced significant decrease in spontaneous locomotion compared with the control group. Brain GABA content was increased significantly by the extract in a dose-dependent manner. Thus, Investigation of ethanolic extract of P. pinnata leaves showed significant anticonvulsant activity comparable with the reference drug diazepam and such activity was accompanied with reduction in the locomotion and increase in brain GABA concentration

Antioxidant and hepatorprotective activity of cordia macleodii leaves

This Investigation was undertaken to evaluate ethanolic extract of C.macleodii leaves for possible antioxidant and hepatoprotective potential. Antioxidant activity of the extracts was evaluated by four established, in vitro methods viz. 1,1-diphenyl-2picryl hydrazyl [DPPH] radical scavenging method, nitric oxide [NO] radical scavenging method, iron chelation method and reducing power method. The extract demonstrated a significant dose dependent antioxidant activity comparable with ascorbic acid. The extract was also evaluated for hepatoprotective activity by carbon tetrachloride [CCl[4]] induced liver damage model in rats. CCl[4] produced a significant increase in levels of serum glutamate pyruvate transaminase [GPT], serum glutamate oxaloacetate transaminase [GOT], Alkaline Phosphatase [ALP] and total bilirubin. Pretreatment of the rats with ethanolic extract of c. macleodii [100, 200 and 400 mg/kg po] inhibited the increase in levels of GPT, GOT, ALP and Total bilirubin and the inhibition was comparable with Silymarin [100mg/kg po]. The present study revealed that C. macleodii leaves have significant radical scavenging and hepatoprotective activities

Women's empowerment and health: the role of institutions of power in Pakistan

Women's right to health has been reiterated many times. However, there are social and cultural barriers in developing countries that hinder their empowerment. Women's low status, deprivation of education and lack of control over their own lives and bodies have a negative impact on their health status and that of their families. This paper discusses women's empowerment and health within the framework of the 4 institutions of power in a society-family, community, health care systems and the state-with special reference to the situation in Pakistan. It concludes that to improve women's health status, concerted efforts are needed by all these institutions of power to work towards gender equality and the greater empowerment of women

Does malaria during pregnancy affect the newborn?

To investigate the effect of malarial infection during pregnancy on the newborn. A retrospective cohort study was conducted at The Aga Khan University Hospital [AKUH], Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight [LBW] and intrauterine growth retardation [IUGR] in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period. Pregnant women with malaria had a 3.1 times greater risk of preterm labor [p=0.14]. They were more likely to be anaemic compared to women without malaria [RR=2.9, 95% CI=1.6-5.4] and had a significantly lower mean haemoglobin level [p=0.0001]. Maternal malaria was significantly associated with LBW babies [p=0.001]. The mean birth weight of infants born to pregnant women with malaria was 461 g less [p=0.0005]. No significant association was, however, found between malarial infection during pregnancy and IUGR [p=0.33]. Malarial infection during pregnancy is associated with poor maternal and fetal outcome. It is significantly associated with maternal anaemia and LBW infants. Appropriate measures must, therefore, be taken to prevent malaria during pregnancy, especially in endemic areas

Correlation of fracture index with BMD T-score in postmenopausal females

To find the correlation between Fracture Index and BMD T-score so that fracture index can be used as a predictive tool for fracture risk estimation in post menopausal females. Design: A cross-sectional study was conducted on a sample of 396 women age 50 years and above. BMD T-score measurements using ultrasound and Fracture Index calculations based on the risk factor assessment were performed. Setting: North Medical Ward, Unit 4 Et Out Patient Clinics, Mayo Hospital and Akram Medical complex, Lahore. Main outcome: Use of Fracture Index as a predictive tool for the estimation of fracture risk in post menopausal females. The study results showed that when Fracture Index increases BMD T-score decreases to osteoporotic range and correlation coefficient is -0.162. When Fracture Index increases, BMD T-score decreases therefore we can use Fracture Index as an assessment tool for predicting fracture risk in postmenopausal females

Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan

Maternal anaemia is a common problem in pregnancy, particularly in developing countries. We investigated the relationship between maternal anaemia and perinatal outcome in a cohort of 629 pregnant women from October 2001 to 2002. Of these, 313 were anaemic [haemoglobin < 11 g/L]. Perinatal outcomes included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low Apgar scores and intrauterine fetal death. Univariate and multivariate analyses were performed. The risk of preterm delivery and low birth weight among the anaemic women was 4 and 1.9 times more respectively than the non-anaemic women. The neonates of anaemic women also had 1.8 times increased risk having low Apgar scores at 1 minute and there was a 3.7 greater risk of intrauterine fetal death among the anaemic women than the non-anaemic women

Maternal deaths in a developing country: a study from the Aga Khan University Hospital, Karachi, Pakistan 1988-1999

OBJECTIVE: The maternal deaths occurring over a twelve-year period [1988-1999] in a tertiary referral center were reviewed. The purpose of the study was to assess the causes of these maternal deaths. SETTING: The Aga Khan University Hospital [AKUH] Karachi, Pakistan. METHODS: The medical records of maternal deaths were reviewed. These were women who had either registered for delivery at the hospital; or were referred from another hospital or from home, when an emergency developed. They were either admitted to the Medicine, Surgery and the Obstetrics and Gynaecology Departments at the hospital. A total of 81 maternal deaths were identified, of which five were the registered patients. Causes of deaths were eclampsia, puerperal sepsis and pulmonary embolism. The maternal mortality ratio in the registered patients was 20 per 100,000 live births. Ninety% of the women were between the age group of 15-35 years. Of these forty two% were primigravidas, forty four% of the women died due to direct causes, of which sepsis was the most common cause and accounted for twenty five% of the total deaths. Indirect causes were responsible for 55.6% of the deaths, including hepatic failure in 21%, other infectious disease in 17% and malignancy in 5% of the cases. In developing countries other than obstetrical causes, infectious diseases contribute to the death of women during childbearing years. Comprehensive medical services and adequate obstetrical emergency services can lower maternal mortality rates at all levels

Bacteriuria and pregnancy outcome: a prospective hospital-based study in Pakistan women

The prevalence of bacteriuria in Pakistani women and its association with complications of pregnancy was studied. Out of 1579 women,77 had bacteriuria [4.8%]. There was no association of age, gravidity, parity, haemoglobin, pre-eclampsia, mode of delivery, gestational age at delivery, preterm delivery and low birth-weight with presence of bacteriuria. With detection and treatment the pregnancy outcome of women with bacteriuria in pregnancy was the same as that of those without