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

Induced abortion - a continuing threat to maternal life

In Pakistan, therapeutic induced abortion is a controversial issue and continued to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of 2 years with special emphasis on maternal mortality and morbidity. This prospective study was aimed to determine the frequency of induced abortion, to know the reason for requesting abortion, assess the associated maternal morbidity and mortality in our setup. Descriptive study. This study was conducted at the Department of OBGY, PUMHSW Nawabshah from 1[st] January 2009 to 31[st] December 2010. Hospital record of patients who were admitted with unsafe abortions in 2 years [2009- 2010] were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication and method of abortion, qualification of abortion provider and maternal mortality. Unsafe abortion contributes 4.4% of total patients admitted with abortion over 2 years. Mean age of them was found +/- SD 30.14 + 8.56 and mean parity was 6.07 +/- 3.00. 78.6% patients belong to poor community and > 70% patients were married and used it as a method of contraception. Uterine instrumentation was the commonest method [78%] used to induce abortion. Majority of women were admitted with life threatening complications like haemorrhage [75%], sepsis [53.57%], hypovolumic shock [39.28%] and faecal peritonitis in 21.42%. DIC in 10.71%, uterine perforation in 28.57% and mortality in 4 [14.28%]. 5 [17.85%] were managed conservatively, 13 [46.42%] had re-evacuation, 10 patients had exploratory laparotomy, out of them 2 needed peritoneum toilet, while in 5 patients gut resection and anastomosis and in one permanent colostomy was done. Uterine trauma found in 8 patients [28.57%] in whom 3 [10.70%] ended up in hysterectomy. Unsafe abortion contribute 14.28% of death in study group. The present study conclude that unsafe abortion is a major neglected health issue needs attention and high degree of commitment. Its elimination requires advocacy, policies to support woman right and improving access to family planning services

Female genital tract-reproductive performance with its variable anomalies

To observe the different presentation and reproductive performance of women with congenital anomalies detected by ultrasound, hysterosalpingography and on laparotomy. Prospective observational study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2004 to December 2009. All the women with congenital anomalies of genital tract detected clinically, by ultrasound and hysterosalpingography, attended the outpatient department or presented with a complication and operated; and or those who were incidentally diagnosed during cesarean section or on laparotomy were included in this study. 48 patients with different mullerian duct anomalies were detected during the study period. Their age varied from 15 to 40 years. Mullerian agenesis with absent vagina was found in 6 cases, transverse vaginal septum was found in an other 6 patients. These patients presented with primary amenorrhoea, haematometra and haematocolpos. Imperforated hymen was found in 10 patients. They also present with a primary amenorrhoea, mass in lower abdomen and cyclical pain, few patients presented with acute retention of urine. Longitudinal vaginal septum was found in 3 cases. They presented with dyspareunia and difficult labour. Bicornuate uterus was found in 9 cases. They presented with maipresentations, recurrent abortion and preterm labour. Unicornuate uterus was found in 3 cases. Who were presented with ectopic pregnancy. Uterus dideiphys was found in 3 cases, 5 patients had arcuate uterus, 3 patients presented with congenital second degree uterovaginal prolapse. Uterine abnormalities are not uncommon, although not all the types of uterine anomalies can affect the fertility but most of the time they have bad impact on fertility. Early diagnosis and treatment of these conditions may improve the fertility prospectus and also prevents various obstetrical complications

Eclampsia: still a dreadful situation

To study the prevalence of eclampsia, its related maternal morbidity, mortality and perinatal outcome. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Nawabshah from 1st January 2009 to 31st December 2009. All the patients admitted with eclampsia were included in this study and they were analyzed according to their age, parity, duration of gestation, timing of convulsions, mode of delivery, complications and feto-maternal outcome. 107 patients of eclampsia presented during the study period, giving a frequency of 2.43%. Mean age group involved was 15-24 years [47.7%] and 25 - 34 years [44.9%] while 7.5% were > 35 years. Majority of the patients belong to 15-24 years age group and found to be statistically significant [p-0.000]. Primi gravida [65%] were highly effected population. 57% [62] patients had fits in antenatal period while 9.3% [10] patients had intrapartum and 32% [35] patients had postpartum fits. Vaginal was the commonest mode of delivery 49 [45.5%]. Assisted vaginal delivery in 21 [19.6%], while cesarean section was performed in 37 [34.6%] patients. 39 [36.44%] maternal deaths occurred during study period, while 7 materanl deaths were attributed to eclampsia. Regarding the neonatal outcome, 64.5% [69] were born alive, 20.6% [22] were IUD and 15% [16] were dead during neonatal period mostly due to prematurity [75.7%].Eclampsia is a big challenge in obstetrics, it can lead to very high maternal and perinatal mortality and morbidity. It is a 3rd commonest cause of maternal death in developing countries. Community health education coupled with availability of emergency obstetric and neonatal care service at doorstep would reduce the incidence of eclampsia and its associated morbidity and mortality in Pakistan

Maternal morta1ity 2007-2008; [confidential inquiries of Ghulam Mohammad Mahar medical college hospital, Sukkur]

To analyse the maternal mortality with its causes and possible contributing risk factors at Ghulam Mohammad Mahar Medical College Hospital, Sukkur. This study was carried out at Gynae / Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from Jan-2007 to Dec-2008. Descriptive case series study. This study was conducted by analysing the death records of all maternal deaths who died over a period of two [02] years from Jan 2007 to Dec 2008. The demographic record included age, parity, booking status and education. The cause of death and possible contributing factors were evaluated. 48 mothers died during this period making Maternal Mortality Ratio [MMR] of 1578/100,000 live births. Direct causes contributed to 79% [38] of maternal deaths while 21% [10] were due to indirect causes. The major causes of deaths were eclampsia 27% [13], haemorrhage 33% [11], Sepsis 21% [10], Obstructed labour 8% [4]. Among indirect causes, hepatic encethalopathy, anemia and renal failure were observed. Eclampsia, haemorrhage and Sepsis are still the major killers. Factors which need urgent improvement include education, antenatal booking, early diagnosis and referrals to tertiary care centers

audit of primary postpartum hemorrhage

The purpose of this study is to determine the causes of PPH, its risk factors, and treatment measures adopted. This prospective study was carried out in. the Department of obstetrics and gynaecology, Peoples Medical Collage Hospital Nawabshah from January 2009 to December 2009. Treatment measures including medical, surgical and blood transfusion were evaluated. A total of 165 cases of primary PPH were managed in one year. Uterine atony was identified major cause 128 [77.5%], traumatic causes of genital tract were 37 [22.4%], socioeconomic status was poor in 110 [66%] and lower middle class in 41 [24%]. Most of the patients 86 [52.1%] were delivered by traditional birth attendant, lady health visitors 36 [21.8%] and qualified medical doctors 29 [17.5%]. Blood pressure was unrecordable in 43 [26.0%], systolic B.P was below 80 mm in 55 [33.3%], systolic B.P above 100 mm in 67 [40.6%], hemoglobin [Hb%] level were b/w 8-10 gm% in 89 [53.93%], and less than 8 gm% in 76 [46.06%]. Blood transfusion was done in all cases. Uterine massage was done in 45 [27.27%]. Minor surgical procedures were performed in 57 [34.5], manual removal of placenta in 8 [4.8%], compression suture were applied in 2 [1.2%], hysterectomy in 20 [12.12%], and repair of uterus in 5 [3%]. Out of 62 cases who developed complications, 35 [21.21%] developed anemia, acute renal failure in 10 [6.06%], and disseminated intravascular coagulation in 3 [1.81%], maternal deaths due to irreversible shock and renal failure were in 10 [6.06%]. Maternal mortality during year 2009 due to PPH was 10 [29.41%]. PPH is a preventable problem. Maternal mortality and morbidity resulting from it can be reduced by identifying the risk factors, early referral, proper assessment and treatment of the cause. Conservative procedures should be considered prior to undertaken hysterectomy, and hysterectomy should be performed as the last option