To see the role of metformin in decreasing hyperinsulinemia and body weight and presentation of poly cystic ovarian disease

Objective: The objective of this study is to evaluate the role of metformin in decreasing hyperinsulinemia and body weight in our population and see the pattern of presentation of PCOD

Study Design: Observational / Descriptive study

Place and Duration of Study: This descriptive study was held in the Gynecology Department of Peoples University of Medical and Health Science, Nawabshah Pakistan from 2nd Jan 2013 to Nov 2014

Materials and Methods: Overall 329 cases satisfying the inclusion criteria were incorporated in the study. Criteria for inclusion were founded upon presence on U/S with two or further of the given criteria like hyperandrogenism, hirsutism, and oligomenorrhea and proportion of reversed LH: FSH

After receiving well-informed consent, demographic data and comprehensive history were recorded on self-created questionnaire. A comprehensive analysis was conducted. Relevant analyzes were made and metformin was initialized with a dosage of 250 milligram s.i.d. [I/day] in starting then step by step adjusted to 500-milligram t.i.d. [thrice/day] for six months. Weight loss was promoted through exercise and diet. Cases were evaluated later than 6 months to analyze their serum fasting insulin and change in BMI. Statistical analysis was carried out by SPSS V. 17.0. P value less than 0.05 taken significant after applying the paired t test and Chi-square test

Results: Total 335 women were included in the study, but six patients had lost follow-up. Complete data was available for 329 patients, which is evaluated. Most common presentation of these patients with PCOD was oligomenorrhea which is seen in 253 [76.89%] patients. Mean serum fasting insulin before treatment was 23.47 micro U/ ml. After six months treatment with metformin, it decreases to 20.78 micro U/ ml [P=<0.001]

Mean body weight before treatment was 69.4 kg and after treatment, it was 68.8kg [P= 0.6167]

Conclusion: Metformin was a useful treatment in decreasing the level of insulin. Further large sample size studies are required

Factors affecting physical violence in pregnancy

Objective: To assess the factors affecting physical violence in pregnancy

Study Design: Observational / descriptive / cross sectional study

Place and Duration of Study: This study was carried out in the Obs. and Gynae Department of People University of Medical and Health Science, Nawabshah Sindh from July 2013 to June 2014

Materials and Methods: All women who attended gynae OPD of Peoples university hospital Nawabshah, and had pregnancy ever, were included in the study

Predesigned questionnaire was made and after taking verbal informed consent

Women were interviewed separately

Questions were asked about their relationship with their husbands and family members and physical abuse during pregnancy etc

Results: Total 190 women were enrolled in this study. Out of these, 161[84.7%] women had physical violence during pregnancy while 29 [15.3%] women had no abuse

Factors were significantly related with physical abuse during pregnancy

Women belonging to poor class were more involved in physical violence as compared to upper class [P= 0.000]

Illiterate husbands were more involved in physical abuse than graduates, but results were not significant statistically [P= 0.12]

Conclusion: Poor socioeconomic condition, nuclear family structure and addicted husbands were more involved in physical violence during pregnancy

To determine the frequency of dyslipidemia in primiparous women, with hypertension

Objective: Objective of this study to determine the abnormalities of lipid profile in primiparous women with hypertension

Study Design: Observational study

Place and Duration of Study: This study was conducted at Gynae Department of MMC and of PUMHSNawabshah from March 2012 to February2014

Materials and Methods: Total 100 primiparous women were chosen in this study after the diagnosis of the gestational hypertension. Cases from second trimester of gestational age were incorporated. Women with systolic blood pressure >130 mmHg, and d blood pressure >90 mm of Hg were considered as hypertensive. Every one of the women with known of fetal abnormalities, DM, abnormalities of the thyroid, ischemic coronary illness, renal failure, liver disease and previous history of lipid profile variations and hypertension before the pregnancy were rejected from the study. Blood tests of all the chose women's were taken in fasting and refer to hospital diagnostic laboratory for lipid profile. After the taking the reports information with respect to lipid profile and hypertension were recorded on the proforma

Results: Total 100 ladies were incorporated, mean age was [mean +SD=28.5 +/- 4.2] years, gestational age was discovered [mean +SD=30.2 +/- 3.1 weeks]. Greater part of the women was found with overweight 68%.Dyslipidemia was found in 59% of the women, while 41% women were noted with ordinary lipid profile. As per the abnormalities of lipid profile, all total cholesterol found up in the 49% of the women, taking after by brought LDL was up in 42.0%, HDL was up in 20%, and TG was noted up in the 53.0% of the women. While in the 45% ladies HDL was noted decreased and 35% women were noted with normalHDL

Conclusion: Variations in the lipid profile are the major reason for hypertension inprimiparous women. Therefore it is very important that serum lipid profiles should be constantly observed all through the entire pregnancy period from ahead of diagnosis of hypertension to reduce the maternal morbidity and mortality in youngwomen

First trimester termination of pregnancy -role of sublingual misoprostol

The objective of this study was to evaluate the efficacy acceptability and dose of misoprostol sublingually in the management first trimester pregnancy failure. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from 01.01.2010 to 31.12.2010. A total 150 patients with the diagnosis of missed and incomplete miscarriage upto 13 weeks gestation. All eligible women who consented were counseled and given detail information protocol. A total of 150 patients with missed miscarriage 119 [79.33%] and incomplete miscarriage 31 [20.66%].The mean age group 28.34 years ,mean parity 4.79 and mean gestational age 8.61 weeks. Efficacy was 92%, 127 [84.66%] had complete miscarriage by the end of 7 days with 2 doses of misoprostol 600ug sublingually 3 hours apart. 23 [15.33%] require 3rd dose of misoprostol and 11 [7.33%] underwent surgical evacuation. Patients satisfaction was 94% [141 patients]. Misoprostol prove with benefit of efficacy, safety and acceptability in first trimester pregnancy failure. In low resources countries achieve infection haemorrhage and uterine damage can for two commonly reported on consequences of post surgical care. Misoprostol treatment can prove to be a rewarding step towards reducing morbidity and mortality

Early pregnancy complications and risk factors

To determine the underlying risk factors in early pregnancy complication and outcome. Case series study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2010 to December 2010. all the women with first trimester pregnancy with different complications were included in this study, while those women with uneventful first trimester were excluded. The included women were registered on pre-designed proforma studied variable including demographic details, gestational period, type of complication, risk factor treatment and outcome. The data was examined in terms of mean and percentage with a confidence interval of 95%. Analysis was done on SPSS version 10. out of 661 total early pregnancy admissions, 309 [46-74%] patients had different early pregnancy of complication. Their mean age was 29.22 +/- 6.22 years. Commonest complications found were abortion in 206 [66.66%] cases. The underlying risk factors found in miscarriage were antiphospholipid syndrome in 8 [3.88%] cases, diabetes mellitus in 35 [16.99%] cases. Hypertension in 50 [24.27%] cases, PCOS in 15 [7.28%] cases and infection in 10 [4.85%] cases. 60 [61.22%] cases were treated by minor surgical procedures and 38 [38.77%] cases treated with conservative medical therapy. Outcome were anaemia in 245 [79.28%] cases, psychological upset in 189 [61.16%], infection in 131 [42.39%] and coagulopathy in 17 [5.50%] cases. Miscarriage was found as the most frequent early pregnancy complication and the most frequent risk factor was hypertension. Outcome included anaemia, psychological upset and infection

Maternal factors associated with low birth weight babies

To determine the maternal factors associated with low birth weight babies in women age of 15-35 years. Case control study. This study was carried out in the department of gynecology and obstetrics, Isra University Hospital [IUH] Hyderabad, Sindh from 02-05-2009 to 02-11-2009. Total 200 women were included in the study.100 as cases and 100 as control. Mothers aged 15-35 years, who deliver live or dead singleton baby through vaginal delivery or cesarean section after 37 week of gestation were included in the study while others who have delivered newborn with congenital abnormalities, had multiple pregnancy or known chronic illness [hypertension, tuberculosis, diabetes mellitus] were excluded from the study. The mean +/- SD of maternal age [years] in cases was26.40 +/- 4.77 and controls was 26.23 +/- 4.36 with P-value 0.739. The mean +/- SD of maternal weight [Kg] in cases was 53.13 +/- 8.93 and in controls was 64.97 +/- 13.72 with P-value < 0.001. Maternal history of smoking and anemia had significant association with low birth weight with P-Value of 0.005 and <0.001 respectively. It was concluded from our study that malnutrition, anemia, short stature like under weight and height are important risk factors for low birth weight

Frequency of low birth weight in primigravida reported PUMHS hospital Nawabshah

To determine the frequency of low birth weight in primigravida reported at PMC Hospital Nawabshah. Descriptive case series study. Departments of Gynaecology and Obstetrics and paeds medicine, at Peoples University of Medical and Health Sciences Nawabshah, from Jan 2011 to the Dec 2011. this study consisted of 319 pregnant women at 16 weeks of gestational age with singleton pregnancy reporting to the Antenatal Clinic, Obstetrics and Gynaecology Department were selected. Weight was measured by using weight machine throughout antenatal checkups. Weight and height was measured by same person rechecked. Their pregnancies were followed to assess the low birth weight. The neonatologist evaluated the babies. All primigravida women in the reproductive age group between >18 to <35 years with singleton pregnancy, normal fetal lie, and Height 5 feet or more were included. Exclusion criteria were patients associated with uterine anomalies [like uterine polyp, uterine septae, submucosal fibroid], smoking, short stature, other medical disorder like diabetes, hypertension, thyroid disorders, epilepsy and asthma. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. 319 patients included in this study. There was a wide variation in age was noted. The youngest patient was 18 years old and the oldest patient was 35 years old. The mean age was 21.21 + 4.22 years and peak age group for presentation of primigravida in our study is 26 to 30 years. clinical asses the fetal weight and observed 42 [13.16%] cases were <3.5kg weight while remaining 277[86.83%] cases were 2.5 to 4 kg weight. In conclusion, we observed in our study that low body weight of primigravida mother is associated with low birth weight babies

Incidence of benign ovarian tumors in rural areas: a 10 years study in a tertiary care hospital Nawabsha

To determine the frequency of benign ovarian tumors attending the tertiary care hospital Nawabshah. Descriptive cross-sectional study. This study consisted of 419 patients of benign ovarian tumors admitted through the outpatient department, as well as from casualty department of Peoples University Hospital Nawabshah. Detailed history of duration of complain and clinical examination of the patient was done. All patients underwent for base line and specific investigations especially ultrasonography and biopsy sampling for assessment of histopathological examination. All patients in the reproductive age group between 15 to 60 years with any one or more presenting complains of ovarian tumors like abdominal mass, bloating, discomfort, pain or pelvic swelling were included. Exclusion criteria were patients more than 60 years of age, previous history of ovarian tumor and non-consenting women. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software No. 16. 419 patients included in this study. There was wide variation of age ranging from a minimum of 10 years to 60 years. The mean age was 31.68 +/- 5.45 years. In this study incidence of ovarian neoplasm slowly increase per year. Clinical examination of patients revealed that pain in abdomen was the commonest presenting symptom 396 [94.5%] followed by mass per abdomen seen in 297 [70.88%], bloating in 146 [34.88%] and abdominal swelling in 167[39.85%]. Histopathology findings revealed was serous cystadenocarcinoma in 182 [43.4%] cases, mucinous cystadenoma 116 [27.7%] cases, mature teratoma 98 [23.4%] cases, thecoma 16 [3.8%] cases, fibroma in 05 [1.2%] cases and Brenner tumor 02 [0.5%] cases. In conclusion our study revealed that histopathologically most common type is serous cystadenoma followed by mucinous cystadenoma. The peak incidence of benign tumors was seen in the 3[rd] and 4[th] decades of the life