Analysis of uterine rupture at university teaching hospital Pakistan

To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan. This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences [LUMHS] for a period of one year from January 1st to December 31st 2012.Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package. The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 [44.26%] with mean age of 30.36 years. and parity group 2-3 [57.37%] with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43[70.49%], injudicious use of oxytocin 33[54.09%], obstructed labour 15 [24.59%] and multiparty 18 [29.50%]. Repair of uterus was performed in 47[77.04%] cases. Maternal case fatality was 5[8.19%], while foetal wastage was 51 [83.60%].This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication

Pattern of presentation of cervical carcinoma at nuclear institute of medicine and radiotherapy, Pakistan

To find the pattern of presentation of cervical carcinoma as seen at Nuclear Institute of Medicine and Radiotherapy, Pakistan. This retrospective descriptive study was conducted at the Nuclear Institute of Medicine and Radiotherapy [NIMRA] for a period of one year from January 1[st] to December 31[st], 2009. The clinical records of all patients diagnosed with carcinoma of the cervix were reviewed with regard to sociodemographic and reproductive parameters. Frequency of cervix and stage of disease at time of presentation were recorded. The data was collected on pre-designed proforma and analysed using SPSS Version 16 statistical package. There were a total of 56 cases [33.53%] of carcinoma of cervix who presented at NIMRA during the study period. The mean age was 51 years. Irregular vaginal bleeding, foul smelling vaginal discharge and post coital bleeding were the most common symptoms. Squamous cell carcinoma corresponds to 52 [92.85%] and adeno carcinoma to 4 [7.14%] cases. Only 8 [14.28%] cases were in Stage I, while 20 [35.71%], 22 [39.28%] were in Stages II and Stage III respectively whilst 6 [10.71%] cases were in advanced stage [1V]. Squamous cell carcinoma accounted for 92.85% of cases with mean age of 51 years, most patients 74.98% presented in stage II, III and IV. Diagnosis at advanced stage needs implementation of large scale educational and screening programme on national level to saves the lives of Pakistani women

Gestational trophoblastic disease

Molar pregnancy represents a significant burden of disease on the spectrum of Gestational Trophoblastic Disease [GTD]. The incidence appears to be quite high in South Asia. The objective of this study was to determine the frequency of GTD, and clinical presentation, management and outcome of patients with molar pregnancy. This retrospective, descriptive study was conducted at Nuclear Institute of Medicine and Radiotherapy [NIMRA], Jamshoro from 1[st] Jan to 31[st] Dec 2009. All patients diagnosed and registered as GTD were included in the study. The clinical records of all molar patients were reviewed regarding presentation, treatment, and follow-up. There were a total of 167 patients presenting with different female genital tract neoplasia at NIMRA during the study period, including 39 [29.35%] cases of GTD. Hydatidiform mole was seen in 33 [84.61%] patients. Complete mole in 31 [79.48%], partial mole in 2 [5.12%] patients, invasive mole in 1 [2.56%] patient, and choriocarcinoma in 5 [12.82%] patients. The mean age of the patients was 27 +/- 9.8 years. The highest incidence was found in nulliparous and para 1. Thirty-two patients had suction evacuation and 1 patient underwent hysterectomy. Patients received chemotherapy, 17 [54.54%] patients followed protocol for 3-6 months. Frequency of molar pregnancy was high, more common in low-parous, poor socioeconomic class women, and usually presented late.

Laparoscopic evaluation of female factors in infertility

To find out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A case series. Department of Obstetric and Gynaecology, Liaquat University Hospital [LUH], Hyderabad, from January 2006 to December 2007. All infertile women underwent diagnostic laparoscopy for primary and secondary infertility during the study period were included. Couples who had not lived together for at least 12 months, and those with male factor infertility were excluded. Data were collected on a proforma, and analysed on SPSS package for windows version 10. Frequencies were calculated for laparoscopic findings regarding primary and secondary infertility. Fifty infertile women underwent laparoscopy during the study period, 32 [64%] had primary infertility while 18 [36%] secondary infertility. Eight [25.0%] patients with primary and 2 [11.1%] patients with secondary infertility had no visible abnormality. The common finding was tubal blockage in 7 [21.9%] and 6 [33.3%] cases of primary and secondary infertility respectively. Five [15.6%] cases of primary infertility were detected as polycystic ovaries [PCO] which was not found in cases of secondary infertility. Endometriosis was found in 4 [12.5%] cases with primary infertility and 2 [11.1%] cases with secondary infertility. Pelvic inflammatory disease [PID] was found in 1 [3.1%] and 2 [16.7%] cases of primary and secondary infertility respectively. Peritubal and periovarian adhesions were detected in 2 [6.3%] cases with primary infertility and 4 [22.2%] cases with secondary infertility. Fibriod was found in 2 [6.3%] and 1 [5.6%] cases of primary and secondary infertility respectively. Ovarian cyst detected in 2 [6.3%] cases with primary infertility while none was found in cases of secondary infertility. Most common causes responsible for infertility were tubal occlusion, endometriosis, peritubal and periovarian adhesions. Ovarian causes were seen in primary infertility only