An unrecognized complication of un safe abortion

We report a case of a 30-year old female who presented with uterine perforation with macerated fetus in the abdominal cavity with severe sepsis after an attempted unsafe abortion

Ovarian ectopic pregnancy: a rare condition

Pregnancy of extra-uterine origin can be a serious condition that demands early diagnosis and prompt treatment to save life of the women. Apart from tubal ectopic, ovarian ectopic pregnancy is the second common but rare type of extra-uterine pregnancy. A patient who has been using long term injectable contraception presented with 8 weeks amenorrhea followed by irregular bleeding per vaginum. Spiegelberg criteria were fulfilled. Laparotomy and histopathology confirmed ovarian ectopic pregnancy.

Giant Vaginolith - Case Report

A case of giant vaginal stone secondary to vesicovaginal fistulae is presented. Vagina is a rare site for urinary stone formation. Vaginal stones are thought to be formed due to deposition of urinary salts in the vagina and clinical presentation is variable like difficulty in micturation and dyspareunia. Proper Vaginal examination can be helpful to make the diagnosis . Attention is paid especially in young gynecologists for the importance of1st doing pelvic examination before carrying certain investigations and have a possibility of VVF with vaginal stone

Maternal morbidity and mortality associated with puerperal sepsis

Objective: To identify frequency and risk factors in patients presenting with puerperal sepsis in tertiary care hospital

Study Design: Retrospective study

Place and Duration: Department of Obstetrics and Gynaecology [Unit-II] Liaquat University Hospital, Hyderabad, Sindh from June 2006 to May 2008

Methods: The frequency and predisposing factors were analyzed in patients presenting with puerperal sepsis in tertiary level hospital. Medical record of patients who fulfilled criteria of puerperal sepsis was scrutinized and data was entered in a predesigned proforma

Results: Over the study period 230 patients presented with puerperal sepsis representing 6.28% of 3656 admissions in gynecological unit II. So for risk factors were concerned all patient were anemic, 90.86% patients were unbooked and 64.34% patients arrived in university hospital after being from more than one station. 56.08 %patients had frequent vaginal examination[more than five], 54.78 % patients were delivered at home, 48.26% patients were with prolong rupture of membrane [>6hrs], and 46.52% cases with prolong labour. 16.95% patients were admitted with altered consciousness and mortality rate was 21.68%

Conclusion: The study concluded that puerperal sepsis was preventable in majority of cases. Maternal mortality due to puerperal sepsis was very high with 21.68%

Intraoperative complications encountered in patients with repeat cesarean section

Objective: to find out the type and frequency of intraoperative complications encountered in patients who had repeat cesarean section

Study design: observational Study

Place and duration: the Gynaecology and Obstetrics Unit - III in Liaquat University Hospital Hyderabad. The study period was from July 2005 to July 2006

Method: this study included the women who had repeat cesarean section during the period from July 2005 to July 2006. These women were divided into three groups, group I [GI] included the women with previous 1 cesarean section, group II [GII] included the women with previous 2 cesarean section and group III [GIII] included the women with previous 3 or more cesarean sections. Intraopratieve complications were noted in terms of dense adhesion [with omentum, bowel, uterus and bladder], extremely thinned out lower uterine segment, scar dehiscence, ruptured uterus, placenta praevia, bladder injury, adherent placenta and fetal demise

Results: out of 240 repeat cesarean sections, cases included in GI were 114 [47.5%], in GII were 90 [37.5%] and in GIII were 36 [15%]. Dense adhesions were found in 26 patients of group I [22.8%], in 32 patients of Group II [35.5%] and in 7 patients of group III [19.4%]. Extremely thinned out lower uterine segment was found in 10 patients of group I [8.7%], in 15 patients of group II [16.6%] and in 3 patients of group III [8.3%]. Scar dehiscence was observed in 9 patients of group I [7.8%], in 4 patients of group II [4.4%] and in 2 patients of group III [5.5%]. Ruptured uterus was seen in 3 patients of group I [2.6%] and in 1 patient of group II [1.1%]. Bladder was injured in 1 patient of group I [0.8%] and in 1 patient of group II [1.1%]. Cesarean hysterectomy was performed due to morbidly adherent placenta in 1 case of group I [0.8%] and in 1 case of group III [2.7%]. Fetal demise occurred due to ruptured uterus in 3 cases of group I [2.6%] and in 1 case of group II [1.1%]

Conclusion: women with repeat cesarean section are at risk of having multiple intraoperative surgical complications, which may increase the rate of maternal and fetal morbidity and fetal mortality

Uterine rupture at LUMHS: a review of 85 cases

Objective: to evaluate risk factors, management and pregnancy outcome of patients with buterine rupture at teaching hospital

Design: prospective observational study

Setting: obstetrical and Gynecology Unit II, Liaquat University Hospital Hyderabad-Pakistan; from 1st January 2004 to 31st December 2007

Patients and methods: all patients diagnosed as case of intrapartum uterine rupture were approached. A pre-designed proforma was used to collect the demographic features, predisposing risk factors, management and feto-maternal outcome. Data fed to SPSS program version 10 to analyze the results

Results: total maternity admissions were 12678 with 11961 deliveries. A total number of 85 cases of uterine rupture were identified, giving a ratio of 0.7% or 1:141 deliveries. There were 46 cases in scarred and 39 cases with unscarred uteri. Highest incidence was found in age group 25-30 years [57.6%] and in parity group 1-3 [62.3%]. Misuse of oxytocic's [85.8%], scarred uterus [54.1%], obstructed labour [42.3%] and grand multiparty [21%] were found as main predisposing factors. Uterine repair was done in 61% of cases while hysterectomy was performed in 39% cases. Bladder repair was additionally required in 9.5% of cases. There were 6 [7%] maternal and 64 [75%] perinatal deaths due to uterine rupture

Conclusion: uterine rupture is yet a common obstetrical emergency in our area. The significant morbidity and mortality deserves our special attention by a collaborative approach. Regular antenatal checks, careful selection of patients for vaginal delivery, vigilantly monitored labour with smooth switch-over to operative delivery can reduce this drastic obstetrical complication

Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term

To compare the safety and efficacy of Misoprostol through oral and vaginal routes for induction of labour at term. Quasi-experimental study. Department of Gynaecology and Obstetrics [Unit-IV], Liaquat University Hospital, Jamshoro, Pakistan, from January to December 2004. Eighty term patients who met the inclusion criteria were selected for induction of labour with [50 micro g] Misoprostol, either by oral or vaginal route. The patients were allocated in two groups-A and B, using non-probability convenient sampling technique. The dose was repeated at an interval of 6 hours upto maximum dose of 150 micro g. Improvement in Bishop's score, analgesic requirements, route of delivery, maternal complications, neonatal outcomes were noted. The commonest indication in group-A was premature rupture of membranes in 16 patients [40%] and in 8 [20%] patients of group-B. Mean improvement in Bishop's score after 6 hours was greater in group-A [3.6 +/- 3.09] than group-B [3.3 +/- 3.45, p=0.70]. Induction to delivery interval was less in group-A [6.7 +/- 4.4 hours] than group-B [7.5 +/- 4.3 hours, p=0.41]. Oxytocin augmentation was required more in group-B as compared to group-A. Normal vaginal deliveries were achieved in 95% of group-A and in 80% of group-B. The dose of 50 micro g was effective in 31[77.5%] patients of group-A as compared to 24 [60.0%] patients of group-B, while 100 micro g was needed in 6 [15.0%] patients of group-A as compared to 13 [32.5%] patients in group-B. There was no significant difference between both the groups with regard to analgesic requirement, instrumental delivery, maternal complications and neonatal outcome. Safety and efficacy was comparable between low-dose vaginal and oral Misoprostol uses for induction of labour. However, oral route was better with respect to treatment interval, number of doses required and route of delivery. Both routes of administration can alternatively be used for induction of labour in developing countries where cost of drug does matter

Key to successful vesico-vaginal fistula repair-an experience of urogenital fistula surgeries and outcome at gynaecological surgical CAMP-2005

Vesico-vaginal fistula is not life threatening medical problem, but the woman face demoralization, social boycott and even divorce and separation. The aetiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynaecological surgeries or radiotherapy. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynaecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. This prospective study was carried out to analyze the success rate in patients attending the referral hospital and sent from free gynaecological surgery camps held at interior of Sindh, and included pre-operative evaluation for route of surgery, operative techniques and postoperative care. Total 70 patients were admitted from the patients attending the camp. Out of these, 29 patients had uro-genital fistula. Surgical repair of the fistula was done through vaginal route on 27 patients while 2 required abdominal approach. Out of 29 surgical repairs performed, 27 proved successful. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit along with appropriate care and expertise accounts for the desired results

Postpartum choriocarcinoma

Choriocarcinoma, following term pregnancy, is a rare form of gestational trophoblastic disease. The usual presentation is with persistent primary or secondary postpartum hemorrhage, the diagnosis is often delayed because of failure to recognize this mode of presentation of the disease. Early diagnosis is important because this rare condition is potentially curable with appropriate chemotherapy. A case of postpartum choriocarcinoma, following a term pregnancy is reported that was successfully treated with methotrexate therapy and surgery

Granulosa cell ovarian tumor as cause of primary amenorrhoea

An 18-year old single girl presented in gynecological outpatients department in April 2004 as a case of primary amenorrhoea and abdominal mass. Laparotomy was performed and tumor removed. Diagnosis of granulosa cell tumor was confirmed on histopathology. Granulosa cell ovarian tumor usually presents with menstrual problem in the form of precocious puberty, irregular bleeding or postmenopausal bleeding. Our patient presented with primary amenorrhoea that is extremely rare presentation

Concurrent fibroadenoma of breast and fibromatosis of vulva and thigh

Fibromatosis is a rare locally aggressive fibroproliferative neoplasm. Vulvar fibromatosis is extremely rare tumor. A case of a young woman is reported who presented with large vulvar, thigh and breast masses and was surgically treated. The pathological examination showed fibromatosis of vulvar and thigh masses and fibroadenoma of breast lump

Role of magnesium sulphate in hypertensive disorders of pregnancy

Objective: To see the efficacy of Magnesium sulphate in preventing and controlling fits in hypertensive disorders of pregnancy. Design: Descriptive Study. Setting: Department of Gynaecology and Obstetrics, Liaquat University Hospital Hyderabad from January to December 2002

Patients and Methods: Thirty one patients having severe hypertension [Systolic BP>/=160 and Diastolic>/=110mmHg] with or without proteinuria and fits were studied. Diagnosis was made through history, clinical findings and relevant investigations. Immediate management consisted of maintenance of intravenous line, clearance of airway and anti hypertensive medications for prevention and control of fits after excluding contraindications for magnesium sulphate therapy. All patients received Magnesium sulphate according to protocol. Occurrence and recurrence of fits, control of BP, side effects of magnesium sulphate, mode of delivery, maternal and fetal outcome were noted

Results: Total 91 patients were diagnosed with blood pressure 140/100mmHg or above having severe pregnancy induced hypertension [PIH], pre-eclampsia and eclampsia during study duration. Out of these, 31 patients met criteria for magnesium sulphate therapy. Age range of patients was 16-35 years. Only 7 cases were booked and all eclamptic patients were referred cases. Majority of women was nullipara. Gestational age at admission was more than 35 weeks in 20 patients [64.51%]. Twenty six women [83.87%] had blood pressure at admission > 160/110 mmHg. Fits were effectively controlled in eclamptic patients and none of the patients with preeclampsia and PIH developed fits who received magnesium sulphate. Fetal outcome was good in those who came at term with alive fetus and delivered by caesarean section. Nineteen [61.29%] fetus were alive, 8 were delivered still birth and 4 died during neonatal period. Only one patient had respiratory depression. There was no maternal death

Conclusion: Magnesium sulphate can be safely and effectively used for the prevention and control of fits in hypertensive disorders of pregnancy

Ovarian Tumours along with pregnancy

Pregnancy complicated by ovarian tumours is rare. 18 women having ovarian tumours associated with pregnancy were admitted at Liaquat Medical College Hospital, Hyderabad from January 1991 to October 1994. All cases of ovarian tumours were more than 6 cms in diameter and were confirmed at Laparotomy. 65 percent of the ovarian tumours were diagnosed during 1st and 2nd trimester, therefore, the role of the clinical examination and ultrasound in early pregnancy is emphasized as a diagnostic aid. 25 percent were diagnosed during Caesarean section and puerperium. This underlines the importance of examining the ovaries at the time of Caesarean sections and careful abdominal examination during puerperium