Gestational hypertension; maternal and fetal outcome in women with role of hyperurecemia

Aim of the study was to ascertain prospectively the prognostic value of serum uric acid for fetal and maternal outcomes in women with gestational hypertension. This prospective study was conducted at department of Gynae and Obs, Maternal and Child Health Center, PIMS Islamabad, from January to December 2003. A total of 200 women with a gestational age >20 weeks, and blood pressure >130/90 mmHg were inducted in the study. At presentation serum uric acid, creatinine, hemoglobin, and platelets were measured along with blood pressure. All patients were divided into group A [uric acid <4.5 mg/dl] and group B [>4.5 mg/dl] and were followed for one month after the delivery to record pregnancy and neonatal outcome. A significant difference [p<0.05] in the levels of uric acid, hemoglobin, platelet count, creatinine and blood pressure was noted between patients of group A and B. A significant decrease [p<0.05] in preterm delivery, baby birth weight and increase in fetal mortality was noted in patients of group B as compared to those of group A. Regarding maternal outcome preeclampsia [p=0.005, CI: 0.143-0.689], deranged liver functions [p=0.000, CI: 0.062-0.397], and disseminated intravascular coagulation [p=0.005; CI: 0.049-0.626] was noted in patients of group B as compared to group A. The patients of Group B showed a significant low birth weight, increased fetal mortality rate [p=0.005, CI: 0.030-0.622] and more chances of shifting neonates to NICU [p=0.002, CI: 0.164-0.667] as compared to those of group A. Hyperuricaemia in setting of gestational hypertension was associated with adverse fetal and maternal outcome

Accuracy of risk of malignancy index in preoperative evaluation of adnexal masses

To evaluate the diagnostic accuracy of risk of malignancy index [RMI] in discriminating between benign and malignant adnexal masses taking histopathology as the gold standard. Validation study. The study was done at the department of Obstetrics and Gynaecology, Government Lady Aitchison Hospital, Lahore from January 2009 to July 2009. Total 60 patients were included in this study. Risk-of-malignancy Index level [RMI] <200 was taken as benign and RMI >200 was taken as malignant. Histopathology report was followed after surgery. Mean age of the patients was found to be 41.03 +/- 8.59 years. The results of RMI were compared with the histopathology with report at histopathology, 91.7% patients had benign masses and 8.3% patients had malignant masses. At RMI, 88.3% patients had benign masses and 11.7% patients had malignant masses. While RMI findings were confirmed with diagnosis made on histopathology the sensitivity, specificity and diagnostic accuracy were found to be 100%, 96.3%, 96.6%, respectively. Positive and negative predictive values of RMI were 71.4%, and 100%, respectively. RMI is an appropriate tool for diagnosing adnexal masses with high risk of malignancy and referring to specialist gynecological centers for suitable surgical operations

Impact of leiomyoma in pregnancy

Uterine fibroids or leiomyomas are benign tumours that develop in the uterus, a female reproductive organ. These cause severe complications in females during pregnancy. This study was conducted to see the impact of leiomyoma in pregnant females to make decision for its management in future. During one year of study, total 10,842 patients presented in CMH Lahore for antenatal check-up were included in the study. Out of them, 80 patients had leiomyoma in first trimester. They were followed during antenatal period. Maternal age, parity, size of fibroid, complications during pregnancy, labour and delivery, mode of delivery and indications of caesarean section were noted. The prevalence of fibroids [>/= 5 Cm] in pregnant females was 0.74%. The most common complication observed was PPH [31, 38.75%] cases. Miscarriage occurred in 8 [10%] cases, cord prolepses was observed in 6 [7.5%] cases, placental abruption in 6 [7.5%] cases, placenta previa in 2 [2.5%] cases and retained placenta was observed in 1 [1.25%] case. Breech presentation was found in 10 [12.5%] cases and abdominal hysterectomy was done in 10 [12.5%] cases. Preterm labour occurred in 8 [10%] cases and IUGR was present in 5 [6.25%] cases. No maternal was reported during the study. Among all females, 64 [80%] continue their pregnancy up to term [37-40 weeks of gestation], out of which vaginal delivery occurred in 19 [29.69%] while 45 [70.3%] had LSCS due to failure in progress in 17 [37.8%], cord prolapsed in 6 [13.3%] cases, fibroid in lower segment in 3 [6.7%] cases, breech presentation in 10 [22.2%] cases and low lying placenta in 2 [4.4%] cases. Pregnancy with fibroid is associated with increase in caesarean section rate especially due to dysfunctional labour and malpresentation. There is also increase in incidence of postpartum haemorrhage and associated hysterectomy.