Laproscopic evaluation of primary infertility causes and post procedure complications among infertile females from a tertiary care hospital of Karachi

Background: Infertility is a common problem globally affecting a large proportion of world population. Laparoscopy provides meaningful information regarding different factors that may cause infertility

Objective: To determine the frequency of causes of primary infertility in women by diagnostic laparoscopy

Study Design: Cross sectional study design

Setting: Study was performed at the Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi

Duration: September 2011 to February 2012

Subjects and Methods: 86 patients with primary infertility were included in the study and underwent laparoscopy for determining causes of infertility. Data was analyzed on SPSS, frequencies and percentages were determined for qualitative variables while mean and standard deviation was determined for quantitative variable

Results: Eighty six females were included in the study with mean age of 28.6 + 5.2 years and mean duration of infertility was 4.9 + 1.9 years. Findings on laparoscopy were analyzed and 51.2% of females were found with tubal blockage, while other findings were; hydrosalpinx in 25.6%, PCOs in 22.1%, Ovarian abnormalities in 38.4%, Pelvic adhesions in 38.4% and uterine congenital anomalies in 3.5%

Conclusion: Tubal diseases found to be one of the major factor causing primary infertility and diagnostic laparoscopy will play a valuable role in early and prompt diagnosis and management of causes leading primary infertility

Primary PPH; Role of uterine packing in control of haemorrhage

To determine the effectiveness and safety of uterine packing in selected cases of primary postpartum haemorrhage. Cross-sectional study. The study was conducted at Jinnah Postgraduate Medical Centre, Karachi, From September 2003 to April 2008. Women developing primary PPH due to uterine atony, placenta previa and coagulation failure were selected for uterine packing. Firm packing was done with enormous length of sterile ribbon gauze, using 'layering technique' under prophylactic antibiotic cover. Vagina was also packed to give additional pressure. Pack was removed after 12 - 36 hours or early in case of failure to control haemorrhage. Pulse, blood pressure, soakage of pads, height of uterine fundus and temperature were monitored to assess effectiveness and safety. 39 women were included in the study. Cause of PPH was uterine atony in 30 [76.9%], coagulation failure in 5 [12.8%] and placenta previa in 4 [10.3%] cases. Packing was successful in arresting haemorrhage in 32 [82.1%] and failed in 7 [17.9%] cases; 95% Confidence Interval 67-91. There was no case of concealed haemorrhage, four patients developed emdometritis and none had delayed haemorrhage. 13 laparotomies were prevented. The difference between the causes of haemorrhage in successful and failed cases did not show a definite trend. If employed early, uterine packing is a quick, effective and safe method for controlling primary PPH in carefully selected cases

Therapeutic termination of second trimester pregnancies with low dose misoprostol

To determine the effectiveness of 50micro g misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester [14-26 weeks] of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder [hypertension or diabetes] or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 [range 4-48 hours]. Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4 +/- 15.9 hours in alive fetuses [t -value:1.9, p: 0.05]. Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect

Placenta percreta: a rare catastrophe

To document the clinical presentation, risk factors, management and management of placenta percreta. Case series. A 5 year study from January 2001 to December 2005 in Gynaecology and Obstetrics department, Unit II, Jinnah Postgraduate Medical Centre, Karachi. This study included patients of placenta percreta who were either diagnosed on ultrasound during antenatal period or accidentally found at exploratory laparotomy or caesarean section. A total of 11 cases of placenta percreta were managed during the study period. The frequency of the lesion was 1: 2058 deliveries. In 7 patients placenta had invaded and perforated the uterine wall, in 3 patients it had invaded the urinary bladder as well and in one patient there was broad ligament invasion. Most common risk factors were previous caesarean section [CS] in 91 percent cases and placenta previa [91 percent] followed by curettage [9 percent]. Hysterectomy was performed in all patients. Partial cystectomy and bladder repair was done in those cases where urinary bladder was invaded. Urinary bladder injury occurred in two [27.27 percent] patients. Two patients died, one due to irreversible shock and other due to acute renal failure. Placenta percreta is a rare catastrophe associated with high maternal morbidity and mortality. Early diagnosis and surgery following adequate resuscitation should be accomplished with multidisciplinary team