Adverse fetomaternal outcome among pregnant overweight women

To compare the adverse fetometernal out come in overweight and normal weight pregnant women. This comparative cohort study was conducted from 1[st] October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI [25 - 29.9 Kg/m[2]] were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. The age range was between 30 to 45 years with mean age of 30 +/- 4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia [27% versus 9% in controls], PIH [24% versus 8% in controls], gestational diabetes mellitus [22% versus 5% in controls], prolonged labour [4% versus 6% in controls], Caesarean section [44% versus 16% in controls], Wound infection [3% versus 2% in controls] and Postpartum Hemorrhage [5% versus 2% in controls]. P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth [13% versus 2%], Early neonatal death [11% versus 1%], shoulder dystocia [5% versus 1%] and NICU admission [47% versus 10%]. Results were statistically significant except shoulder dystocia. We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome

Maternal morbidity and perinatal outcome in preterm premature rupture of membranes before 37 weeks gestation

To assess the maternal morbidity and perinatal outcome in pre-term pre mature rupture of membranes between 24 to 37 weeks gestation. This observational study was carried out in Gynaecology and Obstetrics Unit -1, at University Hospital Hyderabad, from October 2010 to October 2011. It included one hundred patients admitted through the outpatient department, as well as from casualty department of University Hospital Hyderabad. Detailed Clinical examination of the patient was done. Systemic review was also done to see any co-morbidity. All patients had laboratory investigations. Inclusion criteria were all patients gestational age between 24 to 37 weeks with preterm premature rupture of membrane [PPROM] confirmed by ultrasound and clinical examination regardless of their age. Exclusion criteria were patients with congenital anomalies, multiple pregnancy, pre-eclampsia and eclampsia, diabetes mellitus, polyhydramniosl intrauterine growth restriction and placenta abruption. Data was collected using a proforma. Detailed workup including history, general physical examination, abdomen and pelvic examination and relevant specific investigations were noted. Out of 100 patients included in this study Primigravida were 17% and multigravida 83%. There was wide variation of age ranging from a minimum of 20to > 40 years. The mean age was 30+ 3.1 years. Mostly patients belonged to the poor class in 72% cases followed by middle class in 21% and upper class 7%, Analysis shows that out of 100 mothers 26% had PROM of < 24 hrs duration and 74% had > 24 hrs of duration. Maternal outcome in 16 cases of Preterm Premature Rupture of Membrane findings revealed septicemia in 12% cases and Chorioamnionitis in 12% cases. Fetal outcome in 27 cases of preterm premature rupture of membrane revealed prematurity in 5% cases, fetal distress in 4% cases, cord compression in 5% cases, necrotizing enterocolitis in 2% cases, hypoxia in 9% cases and pulmonary hypoplasia in 2% cases. Low socioeconomic status is associated with increased neonatal morbidity due to fetal distress, cord compression, necrotizing enterocolitis, hypoxia and pulmonary hypoplasia at the time of delivery. An appropriate and accurate diagnosis of PROM is critical to optimize pregnancy outcome. It is suggested that the timely diagnosis and management of preterm PROM will allow obstetric care providers to optimize perinatal outcome and minimize neonatal morbidity

Abdominal pregnancy

Abdominal pregnancy is a rare form of ectopic pregnancy associated with high maternal [0.20%] and perinatal [40-95%] mortality; surprisingly we had three consecutive cases of this condition. Case 1: Was referred from Taulka hospital where the patient presented as, four months gestational amenorrhea with acute diarrhea vomiting and severe anemia. She was treated symptomatically, transfused two units of blood and referred to Liaquat University Hospital with Ultrasound report showing suspicion of abdominal pregnancy. Case 2: Was newly married primipara who presented with four months gestational amenorrhea and severe lower abdominal pain. Ultrasound report showed a complex mass of 8.0cm just below the anterior abdominal wall [over the uterus] with alive fetus. The uterus was empty, so the diagnosis of abdominal pregnancy was made. Case 3: Was a young 19 years old lady, initially admitted in surgical unit as case of acute abdomen with history of five months pregnancy followed by D and C two weeks back by LHV [Lady Health Visitor], they collaborated with gynae unit due to this history. Examination showed septic, tender on palpation, on P/V examination some dry shrunken cord like structure with foul smelling discharge hanging out from vagina, identified a gut loop with uterine perforation. In this case abdominal pregnancy was diagnosed on surgery as ultrasound report could not give the clear picture. All cases were managed with surgical intervention. In first two cases fetuses were delivered alive but non viable, in third case fetus was dead macerated found within abdominal cavity in right side. In first case placenta was removed completely and in second case, it was adherent with adjacent structures not actively bleeding so left in situ and post operatively three doses of injection methotrexate were given. First two cases recovered completely while in third case patient required ICU care after surgery. All three cases who had different clinical presentations were diagnosed and managed successfully

Hyperhomocysteinemia in Pakistani women suffering from uexplained subfertility

Hyperhomocysteinemia [hhcy] has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently is association with infertility has been underscored in IVF failure; however limited information is available about the relationship of hhcy and subfertility. To find out the association between unexplained subfertility and hhcy in Pakistani women. This observational study was conducted in Department of Obstetrics and Gynaecolocy, Liaquat University Hospital Hyderabad from 1[st] April 2008 to 31[st] March 2009. Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hysterosalpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 [80%] were suffering from primary subfertility while 10 [20%] were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls [12.8 +/- 5.1 versus 9.7 +/- 1.7, p-value=0.04]. Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association

Twisted right fimbrial [paraovarian] cyst

A 30-year old woman presented with lower abdominal pain and a feeling of fullness in the same region. Ultrasound pelvis was suggestive of an ovarian cyst. At laparotomy a twisted right fimbrial [paraovarian] cyst was found and cystectomy performed

Infant feeding practices in the rural and urban areas in district Abbottabad

This article summarises the findings of a field study of infant feeding patterns in Urban and Rural areas of District Abbottabad. The main purpose of this study was to find out the reasons of declining trend of breast feeding. Over 70% rural mothers had no education and about 93% did not go to school. Average duration of breast feeding was observed to be 5.8 months and 19.2 months in the urban and rural areas respectively. The degree of suckling in urban and rural women was 9.7% and 24.7% respectively. It was observed that in urban areas 96% infants received breast milk for first 4 months of their life and by 2 years this level was dropped to 31%. In rural areas mothers breast fed their babies for 2 years on the average. 57% rural mothers believed that breast feeding is natural thing to do. The most obvious reason for stopping breast feeding was the next pregnancy. Urban mothers preferred brand name cereals as compared to home made, which are most commonly used by rural mothers