Mid trimester termination; PGF2 alpha versus misoprostol

The objective of study was to compare the efficacy of extra amniotic prostaglandin F2 alpha and vaginal misoprostol for termination of 2nd trimester pregnancy. It was quasi experimental study. The study was conducted at Gynae Unit II, DHQ Hospital affiliated with Punjab Medical College, Faisalabad for a period of one year from July 2012 to June 2013. This study included 100 patients who presented with congenitally anomalous foetus or IUD during 2nd trimester for termination of pregnancy. Outcome was evaluated by percentage of successful cases for TOP and induction to delivery interval. As regards the efficacy of misoprostol, success rate for termination of pregnancy was 86% and mean induction to delivery interval was 13.16+/-1.987 hours. Regarding PGF2 alpha success rate for TOP was 88% and mean induction to delivery interval was 16.07+/-3.202 hours. Misoprostol is comparable in its efficacy to PGF2 alpha for mid trimester termination and can be used as a cheaper alternative

giant skin tag [acrochordon] on the labium majus

Skin tag or an acrochordon is a benign, soft tissue lesion found predominantly in obese and diabetic people; showing a female propensity. It may be sessile or pedunculated and size may vary from 1mm-10mm when it may go unnoticed by the patient. However very rarely it may grow enormously resulting in a giant acrochordon as reported here

Maternal mortality: an ice berg one year review at DHQ Hospital, Faisalabad

Objectives: To find out the major causes of maternal death and determine the maternal mortality ratio

Study Design: A Descriptive study

Setting: This study was carried out at Gynae and Obst. Unit-II DHQ Hospital Faisalabad from Jan-2011 to Dec-2011 [I year study]

Material and methods: All maternal death during pregnancy, labour and perpeurium were included. The data regarding age, parity, booking status, gestational age, risk factors, cause of death and distance from hospital was recorded on a proforma. The data was analyzed and was presented as frequencies and percentages

Results: The maternal mortality ratio was 412/100,000 live births during the period of one year. The most common cause of maternal death was hemorrhage 51.6% [16] followed by hypertensive disorders [22.5%]. The othercauses were septicemia 3.2% [1] thromboembolic disease 3.2% [1], cardiac disease 6.5% [2], anaemia 6.5% [2] and anaesthetic complications were seen in 9.7% [3] patients

Conclusion: Health care by skilled professionals before during and after child birth can save the lives of women and their babies. Antenatal care by skilled health worker, educating the community, appropriate referral system, provision of fast and reliable transport facilities, availability of emergency obstetric care [EMOC], regular emergency drills and reduction in rate of caesarean section to decrease the risk of placenta accreta and uterine rupture, and finally establishing comprehensive nationwide system to collect and analyze data of maternal death are the key steps towards decreasing maternal mortality

Morbidity with placenta previa

Introduction: Placenta previa is a rare obstetric catastrophe associated with high maternal morbidity and mortality. This condition is multifactorial and can lead to life threatening conditions like postpartum hemorrhage, obstetrical hysterectomy and placenta accreta. A concerted effort should be made towards careful evaluation, timely delivery and provision of skillful management to reduce the associated morbidity. In low socio-economic background and poor settings, these complications may even lead to maternal death

Objective: To determine the frequency of maternal morbidity in placenta previa in terms of placenta accreta, obstretical hysterectomy and postpartum hemorrhage in patients with placenta previa

Study Design: It is a descriptive case series study

Setting: Department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad

Duration of Study with dates: The study was carried out over a period of six months from 01-04-2011 to 01-10-2011

Subjects and Methods: A total 215 cases were included in the study. The patients with diagnosed placenta previa or those with painless vaginal bleeding subsequently diagnosed on ultrasonography to have placenta previa were included in the study. Majority of patients were delivered by caesarean section. Active management of third stage was done to prevent primary postpartum haemorrhage [PPH]. In cases of PPH, conservative management was done first in the form of intramuscular syntometrine [Oxytocin 5 IU/ergometrine 0.5mg] and intravenous infusion of syntocinon [40 IU in 500ml 0.9% saline over 4-6 hours]. In cases of failed medical management of PPH and morbidly adherent placenta [placenta accreta] obstretical hysterectomy was carried out

Results: Mean age of the patients was 28.14 +/- 5.57 years. Distribution of cases by gestational age shows that the majority of patients 147 [68.36%] were between 32-37 weeks of gestation and 25[11.62%] patients were <32 weeks while 43 [20%] were >37 weeks. Mean gestational age was 34.60 +/- 2.95 weeks. Parity distribution was as follows: 31 [14.40%] patients had parity 0-3, 89 [41.39%] patients had parity 4-6 and 95 [44.18%] had parity > 6 with mean parity of 5.46 +/- 1.82. Postpartum hemorrhage developed in 61[28.4%] of patients. Placenta accreta was present in 18 [8.37%] patients. Obstetrical hysterectomy was done in 13 [6.04%] of patients and none of the patients expired

Conclusion: Placenta previa usually leads to life threatening complications. Close attention should be paid to massive hemorrhage. Adequate blood transfusions and prompt intervention to deliver by cesarean section and anticipating the risk of placenta accreta and necessity of obstetrical hysterectomy can reduce the maternal morbidity

Adjuvant gemcitabine in case of carcinoma of pancreas. A case report

This report describes a case of a 53 year old man who presented with a diagnosis of carcinoma head of pancreas, and initially underwent surgery. Since carcinoma of pancreas has a high recurrence rate even after surgery, the patient was offered Gemcitabine [1000mg/m2, weekly for 7 weeks, then 1 week of rest followed by once weekly for 3 weeks, then rest week every 4 weeks]. He received 16 doses of gemcitabine. There was absolutely no grade 3 or 4 toxicity nor any delays, reductions or omission of doses. Post treatment CT scans showed no evidence of recurrence and patient is in good health 15 months post chemotherapy