Adverse outcome of a teenage pregnancy

Introduction: Pregnancy at very young age is a high risk pregnancy. It can lead to the vicious cycle of medical, physical and social problems from which a pregnant girl and her fetus can hardly escape. Approximately 90% of the teenage births occur in developing countries. In teenage pregnancy both mother and her child are at high risk of disease and death. Early pregnancy in teenage is considered as an independent risk factor for adverse pregnancy outcome

Objective: To determine the adverse fetomaternal outcome in teenage pregnancies

Methodology: This retrospective study was conducted in department of obstetrics and Gynecology unit-II , Liaquat University Hospital Hyderabad from 1[st] January 2015 to 31[st] December 2015. Data was collected from hospital records of all nulliparous women aged between13-19 years with a singleton birth of 28 weeks or above. Multigravida women, with multiple pregnancies, alcoholics, smokers, having any medical disorder and those with strong family history of hypertension were excluded from the study. Maternal and Perinatal outcome measures recorded were anemia, pregnancy induced hypertension, pre-eclampsia, preterm labour, operative delivery, stillbirth and low birth weight

Results: The mean age of subjects included in this study was 17.35 years +/- SD1.06 years. Average gestational age at delivery was 36.86 +/-SD 2.15 weeks. Common complications seen in adolescent mothers were Anemia [34.2%], Pregnancy induced hypertension [33.3%] and preterm delivery [23.9%]. Most of the deliveries carried out vaginally however caesarean section was done in 33.33% cases. Regarding fetal outcome, 12.82% deliveries ended in stillbirth and out of live newborns, 21.57% were low birth weight

Conclusion: Teenage Pregnancy are associated with increased risk of unfavorable obstetric outcome, so every effort should be taken to provide optimal care and support to these young mothers

Analysis of uterine rupture at university teaching hospital Pakistan

To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan. This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences [LUMHS] for a period of one year from January 1st to December 31st 2012.Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package. The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 [44.26%] with mean age of 30.36 years. and parity group 2-3 [57.37%] with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43[70.49%], injudicious use of oxytocin 33[54.09%], obstructed labour 15 [24.59%] and multiparty 18 [29.50%]. Repair of uterus was performed in 47[77.04%] cases. Maternal case fatality was 5[8.19%], while foetal wastage was 51 [83.60%].This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication

Pattern of presentation of cervical carcinoma at nuclear institute of medicine and radiotherapy, Pakistan

To find the pattern of presentation of cervical carcinoma as seen at Nuclear Institute of Medicine and Radiotherapy, Pakistan. This retrospective descriptive study was conducted at the Nuclear Institute of Medicine and Radiotherapy [NIMRA] for a period of one year from January 1[st] to December 31[st], 2009. The clinical records of all patients diagnosed with carcinoma of the cervix were reviewed with regard to sociodemographic and reproductive parameters. Frequency of cervix and stage of disease at time of presentation were recorded. The data was collected on pre-designed proforma and analysed using SPSS Version 16 statistical package. There were a total of 56 cases [33.53%] of carcinoma of cervix who presented at NIMRA during the study period. The mean age was 51 years. Irregular vaginal bleeding, foul smelling vaginal discharge and post coital bleeding were the most common symptoms. Squamous cell carcinoma corresponds to 52 [92.85%] and adeno carcinoma to 4 [7.14%] cases. Only 8 [14.28%] cases were in Stage I, while 20 [35.71%], 22 [39.28%] were in Stages II and Stage III respectively whilst 6 [10.71%] cases were in advanced stage [1V]. Squamous cell carcinoma accounted for 92.85% of cases with mean age of 51 years, most patients 74.98% presented in stage II, III and IV. Diagnosis at advanced stage needs implementation of large scale educational and screening programme on national level to saves the lives of Pakistani women

Gestational trophoblastic disease

Molar pregnancy represents a significant burden of disease on the spectrum of Gestational Trophoblastic Disease [GTD]. The incidence appears to be quite high in South Asia. The objective of this study was to determine the frequency of GTD, and clinical presentation, management and outcome of patients with molar pregnancy. This retrospective, descriptive study was conducted at Nuclear Institute of Medicine and Radiotherapy [NIMRA], Jamshoro from 1[st] Jan to 31[st] Dec 2009. All patients diagnosed and registered as GTD were included in the study. The clinical records of all molar patients were reviewed regarding presentation, treatment, and follow-up. There were a total of 167 patients presenting with different female genital tract neoplasia at NIMRA during the study period, including 39 [29.35%] cases of GTD. Hydatidiform mole was seen in 33 [84.61%] patients. Complete mole in 31 [79.48%], partial mole in 2 [5.12%] patients, invasive mole in 1 [2.56%] patient, and choriocarcinoma in 5 [12.82%] patients. The mean age of the patients was 27 +/- 9.8 years. The highest incidence was found in nulliparous and para 1. Thirty-two patients had suction evacuation and 1 patient underwent hysterectomy. Patients received chemotherapy, 17 [54.54%] patients followed protocol for 3-6 months. Frequency of molar pregnancy was high, more common in low-parous, poor socioeconomic class women, and usually presented late.

Profile of women who experienced vesicovaginal fistula due to obstetric trauma: results from survey at gynecological surgery camp 2005

To assess the demographic, sociocultural and environmental factors responsible for the causation of Vesicovaginal fistula [VVF] due to obstetric injury. This was a descriptive survey carried out among patients with Vesicovaginal fistula, recruited from free fistula repair camps arranged at the interior of Sindh Province Pakistan from 6[th] January 2005 to 18[th] January 2005. Twenty seven patients were interviewed. The information regarding demography, sociocultural and environmental factors was gathered and analyzed by SPSS V 16. The mean age of patients was 25.37 +/- 6.5 years. The mean age at first delivery was 18.55 +/- 2.4 years. Majority of patients 22[81.5%] were illiterate and 21[77.8%] belonged to poor socioeconomic class. Nineteen [70.4%] patients had availability of transport 24 hours a day. Twenty four [88.9%] patients traveled for 1-5 hours to reach health facility. Early age at the time of marriage and pregnancy, illiteracy, poor socioeconomic condition and unavailability of emergency obstetric care by skilled person are the causative factors for Vesicovaginal fistula

Perinatal mortality and related obstetric risk factors at a tertiary care hospital of Hyderabad

Objective: To determine perinatal mortality rate and its related obstetric risk factors in our setup. Design: Observational study. Setting: Department of Obstetrics and Gynaecology [Unit-I], Liaquat University Hospital Hyderabad, from January to December 2006

Patients and Methods: All perinatal deaths including stillbirths [SBs] and early neonatal deaths [ENNDs] within 0-7 days of birth after 24 weeks of gestation were studied during the study period, while Pregnancies <24 weeks of gestation were excluded from the study. The relevant information was collected through a pre-designed proforma which contained variables including maternal demographics, obstetric risk factors and other details

Results: A total number of 2224 deliveries were analysed for perinatal mortality. Out of these, there were 224 perinatal deaths giving a PNMR of 100.7/1000 births. There were 196 SBs and 28 ENNDs. Among these, 88% women were unbooked. Commonest risk factors was antepartum haemorrhage [27.67%], followed by hypertensive disorders of pregnancy [23.21%] and mechanical factors affecting labour [14.28%]. Congenital abnormalities were found in 9.8% of PNDs while maternal medical disorders were seen in 6.25% cases. In 3.5% cases, chorioamnionitis/ neonatal septicaemia was the underlying cause and multiple pregnancies were seen in only 02 [0.89%] cases. However, in 32 [14.28%] cases, no cause was found

Conclusion: The high perinatal mortality rate in present study is comparable to the figures from other institutions. Main reason being lack of antenatal and pre-pregnancy care where from almost all obstetric risk factors can be picked up and treated / prevented

Role of serum leptin level as a marker of severity of pre eclampsia

To explore the possibility of serum leptin being a marker of severity of pre-eclampsia, so that risk of imminent eclampsia and eclampsia can be reduced. This observational study was conducted at a private hospital of Hyderabad from 31st July to 1st December 2007. Forty primipara with same age, body mass indices and gestational age were included in this study. Twenty women had raised blood pressure in third trimester of pregnancy and 20 women with a normal blood pressure in third trimester of pregnancy. The exclusion criteria included history of diabetes, twin pregnancy, chronic hypertension, liver or renal disease. After counselling and affordability of laboratory testing their blood sample was taken for serum leptin, uric acid, serum creatinine and urine for albumin. The serum leptin level was measured by radio-immunoassay [RIA] kits. All data was filled in a pre-designed proforma after taking detailed history and examination. Statistical analysis was performed on SPSS. Student's t-test was applied where applicable. Mean systolic and diastolic blood pressure between pre-eclamptic and control group showed a marked difference [p<0.001] ranging from 149.50 +/- 3.44 and 104.40 +/- 3.03 as compared to control 107 +/- 1.56 and 74.50 +/- 1.49 respectively, similarly proteinuria was present in 20 [100%] cases of pre-eclampsia and 07 [35%] of normotensive women. Mean serum leptin level was significantly high in preeclampstic [79.380 +/- 3.287], when compared with a control group [27.825 +/- 1.050]. Mean serum uric acid in pre-eclamptic [5.040 +/- 0.147] showed significant changes than control [3.600 +/- 0.141], while serum creatinine level was insignificant in both groups. It has been observed that Mean +/- SEM value of serum leptin level was much higher in severe pre-eclamptics [76.418 +/- 5.056] than in women with mild pre-eclampsia [40.856 +/- 2.807]. All the parameters correlated positively and significantly with increased blood pressure. Elevated plasma leptin concentration appears to be a marker of pre-eclampsia independently or along with other parameters of pre-eclampsia could be used to reduce the severity of pre-eclampsia thus avoiding risk effects of pre-eclampsia to mother and foetus. This study still needs more research work to prove our results

Antenatal screening for hepatitis B and C virus carrier state at a University Hospital

To determine hepatitis B virus [HBV] and hepatitis C virus [HCV] carrier state among pregnant women at gynaecology and obstetrics department of Liaquat University Hospital, Hyderabad -Sindh. A descriptive study. Maternity units of Liaquat University Hospital, Hyderabad - Sindh from January 2003 to December 2003. One hundred and three pregnant women with 35 to 40 weeks of pregnancy admitted in maternity units due to obstetrical reasons were screened for hepatitis B and C seropositivity after they gave informed consent. Immuno- chromatography and ELISA technique were used for blood testing. Pregnant women with symptomatic liver disease were excluded from the study. Convenient sampling approach was adopted for the data collection. Among screened population, 29.1% of pregnant women were found positive for HBV or HCV. Out of these, 16.5% women were positive for HCV where as 12.6% for HBV. All women had history of injections and ear and nose prick where as 20% had positive history of blood transfusions, followed by history of jaundice among them or with their partner. In our set up, frequency of 29.1% sero-positivity for HBV and HCV among pregnant women is alarming. These sero-positive mothers are not only at risk of having cirrhosis and liver cancer later on, but also are a continuous threat to their offsprings and care providers. Hence, there is a dire need to conduct more epidemiological studies on this problem and take measures for prevention and control of the disease