ABSTRACT
A patient with tuberculosis of the vulva is reported. A 50 years old unmarried female had complaint of persistent vaginal discharge for 10 years. On examination her vulva was hypertrophied and there were papillary growths on clitoral and rectal region. Biopsy showed chronic caseating granulomatous inflammation suggestive of Tuberculosis. The lesions healed completely after giving antituberculous chemotherapy for 6 months
ABSTRACT
Objectives: To evaluate the effects of clomiphene citrate alone versus combined metformin and clomiphene citrate in patients of polycystic ovarian syndrome with anovulatory infertility in increasing ovulation and pregnancy rate
Study design: A Randomized controlled study
Place and duration: The study was done at the infertility clinic of Gynaecology and Obstetrics dept of KRL hospital Islamabad for one year from 16th November, 2009 till 15th November, 2010
Methodology: 74 diagnosed patients of PCOS with anovulatory infertility were included in the study. Simple random sampling was done and 37 patients of group A were given clomiphene citrate from 50-150 mg on 2nd - 6th day of menstrual cycle, for 6 cycles. The patients of group B were given Metformin 1.5 gms daily for 6 months alongwith clomiphene citrate 50-150 mg on 2nd -6th day of menstrual period, maximum 6 cycles. Ovulation was monitored by transvaginal sonography and serum progesterone level measurement which was done on 21st day of the cycle. Pregnancy was confirmed by serum B-hCG
Results: The analysis showed that the ovulation was significantly higher [78%, 29/37] in group B as compared to group A [40.54%, 15/37], [P-value 0.001] in group B as compared to group A. Similarly the pregnancy rate was also significantly higher in group B i.e 62.16% [23/37] vs. 24.32% [9/37], P-value 0.001] as compared to group A
Conclusion: The results proved that metformin along with clomiphene citrate significantly improves ovulation and pregnancy rate in patients of PCOS with anovulatory infertility and the combination of both drugs produced far better results than clomiphene citrate alone
ABSTRACT
The women residing in a developing country have 200 times greater risk of suffering from pregnancy and childbirth related mortality compared with the women of a developed country. To investigate relevant causes and the determinants of maternal mortality through conducting scientific clinical studies. We conducted a prospective study of maternal deaths in the obstetrics and gynaecology unit of RGH for one year. January 2007 to December 2007. We investigated the socio-demographic variables-- including age, parity, socio-economic status and literacy-- along with the social behavior towards the antenatal. We designed standardized data collecting forms to collect data from the confidential hospital notes of the patients. The collected medical data of the patients proved useful in analyzing the underlying causes and the risk factors behind direct and indirect maternal mortalities. In our unit, we have recorded 28 maternal deaths during the study period. 24 [86%] deaths are due to the direct causes and 4 [14%] are due to the indirect causes. The leading direct causes are hemorrhage 9 [37.5%], eclampsia 7 [29%], septicemia 5 [21%] and anaesthesia complications 2 [8%]. Similarly, the distribution of indirect causes is: blood transfusion reactions 2 [50%], hepatic failure 2 [50%], Consequently, crude maternal mortality rate can be extrapolated at 645 per 100,000 maternities and maternal mortality ratio at 659 per 100,000 live births. The socio demographics of the dead mothers are: 16 [57%] patients in the age group of 25-35 years, 13 [52%] are multiparas [G2-G4] and 10 [36%] are grandmulti para i.e. G5 and above. Moreover, 13 [46%] of them expired at term. The majority of them is illiterate and belongs to lower socio-economic group. 14 [42%] mothers have not received antenatal care and just 4 [15%] of them have received antenatal care from RGH or other hospital. 23 [92%] patients have been suffering from anemia and we received 15 [54%] of them in a critical state with the hospital stay of less than 1 2 hours. In our study hemorrhage and hypertensive disorders of pregnancy are the leading causes of maternal deaths. We argue that most of these maternal deaths could have been possibly avoided by periodic interventions during the pregnancy, child birth and the postpartum period