Comparison of the efficacy and safety of misoprostol for termination of pregnancy in second trimester in scarred versus unscarred uterus

Objectives: To compare the efficacy and safety of Misoprostol for termination of pregnancy in second trimester in scarred versus unscarred uterus

Study Design: Quasi-experimental study

Setting: Obstetrics and Gynaecology unit of Allied / DHQ Hospitals affiliated with Punjab Medical College, Faisalabad

Subjects and Method: During 6 months period from 22nd March, 2007 to 22nd September, 2007. 60 patients [30 with scarred and 30 with unscarred uterus] were admitted for second trimester termination of pregnancy for maternal reason, fetal congenital anomalies and intrauterine fetal demise and induced with vaginal misoprostol. Loading dose of 400 mcg followed by maintenance dose of 200 mcg at 4 hourly interval to a maximum of 4 doses

Main Outcome Measures: Efficacy included induction to delivery interval and safety included maternal complications and side effects like uterine rupture, hysterectomy, severe haemorrhage, pyrexia, nausea and vomiting

Results: Success rate of T.O.P. was 96.7% in group A [scarred uterus] VS 93.3% in group B [unscarred uterus] Maternal complications were nausea and vomiting 3.3% in group A VS 0% in group B, Pyrexia 3.3% in each group, no case of uterine rupture was recorded

Conclusion: Misoprostol is safe and effective drug for Midtrimester T.O.P. in scarred as well as unscarred uterus

Emergency obstetric hysterectomy - one year review at Allied hospital, Faisalabad

To study the cases of obstetric hysterectomy performed over a period of one year [Jan. 2008 to Dec. 2008] in a teaching hospital to determine the incidence, indications, associated risk factor and maternal outcome of patients with a view to suggest ways of improving outcome. One year retrospective study of 38 consecutive cases of obstetric hysterectomies performed during the study period were analyzed. Total number of deliveries during the study period were 8988 and 38 emergency obstetric hysterectomies were undertaken; frequency being 0.42%. Only 26.3% women were booked. The most common indication for procedure were uterine rupture, uterine atony and morbidly adherent placenta. Total hysterectomies were undertaken in 73.6% and sub total in 26.3% women. There were 4 [10.5%] maternal deaths. Patients who died were received in critical condition and with massive haemorrhage. Late arrival and non availability of blood because of incooperative attendants were the main factor in maternal mortality. Emergency obstetric hysterectomy remains an essential life saving procedure. Proper antenatal care and early admission in labour ward, training and retraining of traditional birth, attendants, prompt resuscitation and referral of patient in time will go a long way to reduce the incidence of this procedure

Management of a pregnant patient at term with Von Willebrand disease - III

Von Willebrand disease [VWD] is a common inherited bleeding disorder involving a deficiency or abnormal function of a blood clotting protein called Von Willebrand factor [VWF]. Women with VWD require monitoring during and after pregnancy. This case report describe management of a patient presenting with type III VWD at term and during labour. She had history of severe post-partum haemorrhage [PPH] after cesarean section in previous pregnancy and again had a risk of life-threatening PPH in the current gestation which was managed by appropriate planning and timely decision

Complications and treatment of illegally induced abortion

To detect and treat complication of illicit abortions along with status of abortionist and method used by them. Descriptive study. Department of Gynae and Obstetrics, Allied Hospital, Faisalabad. March 2002 - February, 2003. 50 patients selected either married or unmarried and evaluated for illicit induced abortion performed by untrained personnel and methods used by them. Out of 50 patients, 45 were married and 5 were unmarried. The reasons for termination were illegitimate pregnancy in 7 cases, decreased spacing in between pregnancy in 32 cases and grand multiparity in 11 cases. In 37 patients dilatation and curettage was used as method for termination of pregnancy. In remaining 13 patients methods used were metallic sharp instruments, medicines [herbal/allopathic] and IUCD insertion. 37 patients presented with acute abdomen ended up in emergency laparotomy. 9 patients were treated by curettage only. 2 patients were managed conservatively. 5 patients died due to septicaemia. Illicit induced abortion is a major public health issue. Results highlight the magnitude of the induced abortion and its consequent morbidity. Further more, it also indicate that health care providers, irrespective of legality issues, provide such services on demand. Illicit induced abortion and its complications can be avoided with better and easy provision of contraceptive measures and family planning resources