Emergency obstetric hysterectomy

Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage which fails to be controlled by conservative management. To review 8 years' experience of emergency obstetric hysterectomy in a teaching hospital. A retrospective descriptive study based on hospital data of 156 patients undergoing emergency Obstetric hysterectomy. Obs. and Gynae. Department Unit-I, PMC Allied Hospital Faisalabad. This was a retrospective review carried out from March 2004 to Feb 2012 Main outcome measures were frequency, indications, associated risk factors and maternal morbidity and mortality associated with emergency peripartum/obstetric hysterectomy. During 8 years there were total 156 [0.38%, 3.8 per 1000] emergency obstetric hysterectomies out of which there were 46 caesarian hysterectomies, 65 post partum, 45 for ruptured uterus with total number of delivery 40062. Number of hysterectomies was 48 in the first 4 years of the study [March 2004- Feb 2008] and during the last 4 years [March 2008- Feb 2012] it was 108. Maximum obstetric hysterectomies were in para 3-5 [53.20%] and in 26-30 years age group [35.89%]. The most common indication for hysterectomy was uterine atony [44.23%] followed by uterine rupture [28.85%], Placenta accreta [14.745%] and placenta previa [11.53%]. The maternal mortality was 6.41% [10 patients]. In this series 80% patients were referred from other areas. Frequency of emergency Obstetric hysterectomy is high in our tertiary center and it is continuously increasing due to increased referral of patients. The mortality and morbidity of performing obstetric hysterectomy is higher in patients referred from outside hospital

Pregnancy with adnexal mass: an analysis of thirteen cases

To report presentation and management of adnexal mass during pregnancy. Case Series. Study was conducted from July 2009 to June 2010 in the department of Gynecology and obstetrics unit 1, Allied Hospital Faisalabad. All pregnant patients who delivered in our hospital were screened. Out of these, women with an adnexal pathology were recorded. Their presentation and management was evaluated. A total of 8042 pregnant women were delivered during the mentioned period. Thirteen women were found to have an adnexal pathology. Their age ranged between 20-34 years [mean age: 27yrs]. The clinical presentation: pain abdomen 4 [30.76%]; mass abdomen 2 [15.38%]; mass and pain abdomen 1 [7.69%]; pain with cyst complication 3 [23.07%], and 3 [23.07%] were found during labor. Emergency elective laparotomy along with lower segment caesarean section was done in 7 [53.84%]. Without caesarean sections 2 [15.38%] emergency and 2 [15.38%] elective laparotomies were done. Two [15.38%] were subjected to laparotomy in post partum period. Gynecological procedures included oophorectomy in 8 [61.53%], cystectomy in 3 [23.07%], staging laparotomy 1 [7.69%], oophorectomy with biopsy of contralateral ovary 1 [7.69%]. Maximum 11 [84.61%] adnexal masses were benign cysts, 2 [15.38%] were malignant. Benign adnexal mass such as simple ovarian cysts with complications are not infrequent during pregnancy. Although ovarian malignancy is rare but must be kept in mind in young age group also

Unruptured term pregnancy with an alive fetus in a noncommunicating rudimentary horn with placenta percreta

Pregnancy in rudimentary horn is a rare type of ectopic pregnancy and generally ruptures in second trimester with life threatening hemorrhage. The accuracy of ultrasonography [USG] in diagnosing rudimentary horn pregnancy at an advance gestation is even more difficult. We report a case of unruptured viable 37 weeks pregnancy in rudimentary horn of uterus. It was repeatedly missed on USG and diagnosed at the time of abdominal delivery done for placenta previa and fibroid uterus. The case is reported because of its extreme rarity

Maternal mortality in faisalabad and millennium developmental goals

Maternal mortality remains a great challenge to health systems in developing countries. Reliable maternal mortality rate in Pakistan is not exactly known. The estimated range of maternal mortality is 190-1700 deaths per 100,000 live births. Our objective was to find out the maternal mortality rate and its main causes in a tertiary care centre in Faisalabad. This is an observational descriptive study. Maternal death which took place in Gynaecology Unit of Allied Hospital/Punjab Medical College Faisalabad from April 2006 to March 2010 were included in this study. Accidental incidental maternal death, patients with medical and gynecological problems and those beyond 42 days post partum were excluded. Total of maternal deaths during these four years was 168 in 24667 births with MMR of 6.81/1000. The common causes of maternal deaths were obstetrical hemorrhage in 58[34.5%], hypertensive disorders in 31[18.45%], puerperal septicemia in 23[13%] and unsafe abortion in 20[11.9%]. Other direct causes were found in 12 [7.1%] patients. One forty eight [88.09%] patients belonged to uneducated class, 110[65.48%] from rural area whereas 95[56.5%] hadn't received any antenatal care. High MMR [Maternal Mortality Rate] can be prevented with timely and proper antenatal and post natal facilities

Mullerian duct anomalies; unicornuate uterus with or without rudimentary horn pregnancy

Müllerian duct anomalies [MDAs] occur with an incidence estimated to be 4.3%. A unicornuate uterus with or without a rudimentary horn; is a type of mullerian duct abnormality with a frequency of 0.4%. Rudimentary horn pregnancies are rare obstetric complication and may cause difficulty in diagnosis and subsequent management. To alert about Mullerian duct abnormalities especially unicornuate uterus with or without rudimentary horn. Case series. Study was conducted in the department of Gynecology and obstetrics unit1, Allied Hospital Faisalabad. Cases detected during September 2006-0ctober 2011. All admitted cases of MDA whether obstetric or gynecological were included. We calculated cases of unicornuate Uterus with or without rudimentary horn, also included cases of rudimentary horn pregnancy with or without rupture. There were120 cases of MDA out of which 8 [6.6%] were of unicornuate uterus. Out of 8 unicornuate uteri, 7/8 [87.5%] were with rudimentary horn and1/8 [12.5%] without rudimentary horn. Left rudimentary horn in 4/8 patient [50%], right in 3/8 [37.5%] without horn1/8 [12.5%].Out of 7 rudimentary horn 1/7 gynecologic and 6/7 were obstetric, 5/7 [71.42%] ruptured in second trimester, and1/7 [14.28%] term pregnancy. In 1/7 [14.28%] horn not removed because tubal ligation was done. Unilateral renal agenesis was present in 3/8 patient [37.5%]. Ovaries were preserved in 3/7 patients [66%]. There must be high index of suspicion for Mullerian duct abnormalities especially rudimentary horn for achieving good success in diagnosis and management

Abnormal uterine bleeding; histopathological diagnosis by conventional dilatation and curettage

Abnormal uterine bleeding is one of the most frequent conditions in gynecology. Hysteroscope and plastic devices for outdoor endometrial biopsy are gaining popularity but in our setup traditional dilatation and curettage play significant role in diagnosis of abnormal uterine bleeding. To detect different histopathological findings in abnormal uterine bleeding by conventional dilatation and curettage From December 2002 to March 2005. Department of obstetric and gynecology Unit-I Allied Hospital, Faisalabad, under the guidance of Professor Mahnaz Roohi. 161 patients with abnormal uterine bleeding divided into adolescent, reproductive and peri-menopausal age groups. Maximum 59.02% patients with abnormal uterine bleeding were perimenopausal. Menorrhagia 49.06% was commonest bleeding pattern. Histopathological reports revealed 62.11% dysfunctional uterine bleeding, 21.73% organic lesions and 16.16% pregnancy complications. Complications occurred only in 0.62%. Dilatation and curettage is a safe and successful procedure for detecting intrauterine pathologies in abnormal uterine bleeding

Abdominal pregnancy; a diagnostic dilema

Abdominal pregnancy is a rare complication with maternal and even higher perinatal mortality. To alert physicians and sonologists about features of abdominal pregnancy. To promote awareness about this potentially lethal condition. Observational case series. 2000 to 2007. Department of Gynecology and Obstetrics, Allied Hospital, Faisalabad. This study was conducted at department of Gynecology and Obstetrics, Allied Hospital, Faisalabad. Eight cases were done during the period 2000 to 2007. There demographic features including age, gestational age, ultrasound findings, operative findings and outcome were noticed. The mean age was 30.125 years [range 23-38]. The recorded mean gestational age was 20.62 [range 10-37 wks]. Out of 8 cases, 6 patients are more than 25 years age. Four patients [50%] were primi gravida. Maximum parity was of 3. Our 50% of patients were having either one or two abortions. The abdominal pregnancy presents in variable fashion with acute abdominal pain [100%], fainting attacks [25%], shock [25%] and rarely with PIH, fetal distress and loss of fetal movements. Abdominal ultrasound was helpful in diagnosis but not conclusive always. The fetal diagnosis was confirmed per operatively. On laparotomy the placenta was attached to different parts of abdomen as following. Abdominal pregnancy is potentially fetal for mother and fetus. The maternal mortality is 12.5% [1/8]. The fetus had 100% Mortality [8/8]. Abdominal pregnancy is a rare occurrence but is challenging diagnostically and therapeutically. Awareness of this condition is very important in reducing the associated morbidity and mortality

Diagnosis and management of congenital anomalies of vagina

Objective: To create awareness by presenting case series of congenital anomalies of the vagina, their diagnosis and management

Design: Interventional case series

Setting: Allied Hospital PMC Faisalabad

Materials and Methods: 18 patients with vaginal anomalies were reviewed between March 2008 and February 2011. Patients were evaluated by symptoms, physical examination and investigations. After management they were followed up to a period of minimum 3 months to a maximum of 2 years

Main Outcome Measures: Improvement in symptoms, creation of vagina with at least a 3-5cm in width leading to perfection of sexual life and fertility

Interventions: were done in 16 [88.88%] cases of transverse and longitudinal vaginal septum, imperforate hymen and absent vagina. Transverse vaginal septum and longitudinal septum was removed, imperforate hymen incised and no postoperative contractures occurred. Mayervon Rokitansky-Küster-Hauser's Syndrome [MRKH] was managed by non surgical method. While absent vagina and cervix with functioning uterus was treated with abdominal hysterectomy followed by vaginoplasty and absent vagina with rudimentary/hypo plastic uterus treated with vaginoplasty

Results: 7[38.88%] cases of vaginal septum, 4[22.22%] cases of imperforate hymen, 1 [5.55%] case of vaginal atresia with absent cervix and functioning uterus, 1[5.55%] hypo plastic uterus with absent lower vagina were operated for creation of vagina. Functioning vagina with a minimum of 4-5cm width in the former area of the septum and atretic vagina was created. 3[16.66%] longitudinal vaginal septum were operated during labor, a satisfactory sexual life was reported by all except in one of the group. We achieved 88.23%[15/17] successful results. While 1[5.55%] cases of absent uterus and vagina in non Inter- vented group did not follow back

Conclusion: Congenital anomalies of the vagina have long term impact on patient sexual and reproductive life. New born girls must be examined for vaginal defects initially so that investigations could be arranged for further abnormalities such as upper mullerian duct and renal tracts

Unicornuate uterus with non-communicating horn diagnosis and management

We present a case of unicornuate uterus with a rudimentary horn of non-communicating variety in a young unmarried girl. The case is described because of rarity and difficulties in the diagnosis and management of such congenital malformation

Placenta percreta with haematuria; a life threatening rarity

Placenta percreta with urinary bladder invasion is a rare but potentially lethal condition with a high mortality rate. A 28 years old woman, gravida three para two with previous 2 cesarean deliveries, at 30 weeks of gestation, was admitted with frank haematuria. The diagnosis of placenta percreta with involvement of urinary bladder was confirmed. An emergency cesarean section and obstetric hysterectomy was performed and urinary bladder was repaired

Scar endometriosis: a rare disease occurrence

Endometriosis is a common gynecological condition. It can pose a diagnostic dilemma when presented as endometriosis in the scar. This is a rare disease entity. We discuss a case of abdominal wall endometriosis following caesarian section. It presented as tender nodule in the left region of previous C-section scar, with cyclical pain and swelling. In view of the possibility of scar endometriosis, the mass was completely excised. Pathologic findings were compatible with scar endometriosis

Secondary abdominal pregnancy

Secondary abdominal pregnancy is a rare form of ectopic pregnancy. A 21 weeks viable secondary abdominal pregnancy after tubal rupture has been found at laparotomy. The case is reported because of its rarity