ABSTRACT
Objective: To determine the prevalence, etiology and complications of emergency obstetric hysterectomy [EOH] at a tertiary care hospital in Karachi
Methods: This was a retrospective cohort study which was carried out in the Department of Obstetrics and Gynecology Unit II, Civil Hospital Karachi from March 2015 to March 2017. All patients undergoing EOH were included in the study. Data was collected from medical files and labor room registers in accordance with ethical guidelines. Information included demographic characteristics, reasons for EOH, procedure associated morbidity and mortality. Data was recorded on a predesigned pro forma and analyzed using IBM SPSS Statistics for Macintosh, Version 18.0
Results: Out of 7,968 deliveries in two years, 32 patients under went EOH, [prevalence 4.01 per 1,000 deliveries]. The mean age was 30.0 +/- 5.2 years. Most women [75%] were multipara. The main mode of delivery was caesarean section [80%], mostly done as an emergency procedure [81%]. In 10[30%] patients EOH was performed for uncontrollable hemorrhage due to uterine atony, followed by a morbidly adherent placenta [28%]. Morbidity included disseminated intravascular coagulation [DIC] in four patients[19%] and three patients underwent repeat laparotomy for uncontrollable hemorrhage. There were three maternal deaths, giving a case.fatality index of 9.3%
Conclusion: Uterine atony and morbidly adherent placenta were the main reasons for emergency obstetric hysterectomy [EOH] in our set up
ABSTRACT
Objective: To assess the effect of metformin in controlling Gestational Diabetes Mellitus [GDM] in women with Polycystic Ovarian Syndrome [PCOS]. Study Design: Comparative cohort study. Place and Duration of Study: Gynecology Clinics of Mamji Hospital, Karachi, from 2008 to 2010. Methodology: Patients who had been diagnosed Polycystic Ovarian Syndrome [PCOS] with hyperinsulinemiaandconceived and continued pregnancy, were divided in two groups; 50 patients received metformin throughout pregnancy and 32 did not. Development of GDM was ascertained in both groups. The patients were followed throughout pregnancy and in puerperium with OGTT as per WHO criteria. Primary outcome measure was development of gestational diabetes mellitus. Comparison of continuous variables was done using student 't' test. For categorical variables, frequency and percentages are reported while, odds ratio is also estimated for GDM during pregnancy. Results: A total of 82 women with PCOS were included in this study, out of whom, 50 patients received metformin treatment while 32 patients did not. Pregnant women with PCOS in both groups were comparable in age, weight, parity and BMI. Mean fasting insulin levels at beginning of study entry were 17.22 +/- 2.3 mIU/L and 16.93 +/- 2.28 mIU/L in metformin and no metformin group respectively [p=0.589]. Mean fasting blood sugar levels were 94.54 mg/dl in metformin and 99.59 mg/dl in no metformin group p < 0.001. A total of 5 [10%] patients in metformin group developed GDM while 11 [34.37% OR 4.71, p = 0.01] developed GDM in no metformin group. Patients not receiving metformin were 4.7 times likely to have GDM [OR: 4.71] compared to those who received it. Conclusion: The frequency of gestational diabetes, was significantly higher in patients with PCOS who had not received metformin compared to those who did. Key Words: Metformin. Polycystic Ovarian Syndrome [PCOS]. Gestational diabetes. Pregnancy
ABSTRACT
To estimate the effects of low maternal education, malnutrition, anemia, pre-eclampsia, gestational diabetes, depression, domestic violence on pregnancy outcome. Hospital based cross sectional study done in obstetrics and gynecology department of a tertiary care teaching hospital from November 2010 to April 2011. Five hundred married women between 15-45 years of age attending the obstetric clinic for any problem or were admitted in the obstetrics ward were interviewed and data entered in a questionnaire. Apart from basic demographic information, their educational level, nutritional status, anemia, history of eclampsia, diabetes, depression and domestic violence were recorded. Socioeconomic groupings was done on the basis of monthly income i.e. monthly income less than Rs. 6000 [lower], 6000-12000 [middle] and more than Rs. 12000 [upper]. For the ease of analysis, the study population was divided into three socioeconomic groups. Majority [62.4%] were in the lower socioeconomic bracket while 34.6% were in the middle and only 3% were in the upper strata. In the lower socioeconomic group 62% women were uneducated, only 25.3% women had regular antenatal care, and only 80% could afford balanced diet once in two weeks. Almost 50% were anemic, 13.1% were under weight, 12.1% had low birth weight babies and 3.2% had still births. Violence was reported by 17%. In the high socioeconomic group only 13% women were uneducated and all parameters were 50% better than those in the lower socioeconomic group with 53.3% women having regular antenatal care, 40% taking balanced diet once in two weeks, 6.7% being under weight and 6.7% having low birth weight babies. The frequency of anemia was slightly less [40%] when compare d with the lower socioeconomic group. Violence was reported by 7%. Mode of delivery was a cesarean section in 26.4% with 13.4% ending up in wound infection. Poverty is a key hindrance to women's wellbeing especially during pregnancy resulting in malnutrition, anemia, low birth babies or fetal loss