Newborn screening for congenital hypothyroidism in a public sector hospital

Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. To screen newborns for congenital hypothyroidism in two public sector hospitals of Lahore. Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >/= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal [< 20mIU/L] while 27 had high levels [>/= 20mIU/L]. These 27 neonates were further tested using confirmatory tests for serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates. Routine screening of neonates for thyroid disease can pick the disease early and thus prevent later complications

Postnatal depression in middle class Pakistani women

Objective: to assess the presence of Postnatal Depression in middle class Pakistani women

Material and Methods: this observational study was conducted in department of Gynecology and Obstetrics Hameed Latif Hospital, Lahore from 1st November 2009 to 31st October, 2010.Women between the age of 20 to 40 presenting to the obstetrical unit for simple vaginal delivery and caesarian section were included and were observed for 40 post-natal days. Any woman with co-morbid factors such as diabetes mellitus and hypertension were excluded from the study. The Edinburgh post-natal depression scale was used to assess and identify postnatal depression

Results: 250 women belonging to middle or upper social class were studied. 94 [38%] were identified with post-natal depression. 5 needed referral to a psychiatrist; the rest responded to counseling and support. Educational level had a direct bearing on the condition. Most women had never heard of post-natal depression

Conclusion: post-natal depression affects a significant number of Pakistani women but is not recognized; there needs to be better education of women in general and obstetricians in particular to manage this condition

Gestational diabetes mellitus

Gestational diabetes mellitus is common disorder in pregnancy. It is associated with adverse pregnancy out come. There is no consensus regarding the optimal approach to screening of gestational diabetes mellitus. The present study has tried to observe the value of fasting blood glucose in screening of gestational diabetes. To determine the frequency of patients in whom fasting blood glucose and 100gm glucose tolerance show agreement for screening of gestational diabetes mellitus at 24-28 wks. Comparative cross sectional study. The study was conducted at Gynecology and Obstetrics department Shaikh Zayed Federal Post Graduate Institute Lahore. 6 months from 12 Nov 2010 to 11 May 2011. The study included 135 booked patients with positive family history of diabetes mellitus. All patients underwent fasting blood glucose at 24-28 weeks of gestation, regardless of results of fasting blood glucose on next visit they underwent 100g oral glucose tolerance test [OGTT]. The agreement between fasting blood glucose and 100g oral glucose tolerance test was calculated in frequency and percentages. The mean age of women in studied population was 27.15 +/- 3.70. Out of 135 patients 86.7% [117] showed agreement between results of fasting blood glucose and 100g OGTT while 13.31% [18] showed no agreement between both of the tests. Fasting blood glucose is a good screening option for gestational diabetes mellitus along with positive history. It provides a simple, cheap and more practical test for screening of gestational diabetes mellitus. However diagnostic confirmation with 100g OGTT should be done

Paraurethral leiomyoma

Vaginal leiomyoma is a rare solid tumour with a variable presentation that can lead to pre-operative misdiagnosis. Local recurrence and transformation into sarcoma are also rare and surgical excision is recommended. Here, we present the case of a 23-year-old woman with a painless vaginal mass associated with severe dyspareunia since marriage [2 months ago] and dysmenorrhoea. She underwent surgery by vaginal route and histological findings confirmed a leiomyoma. After 2 months, the patient was disease-free and symptoms disappeared

Audit of caesareans section in present practice

Objective: To compare the rate of rise of caesarean section, to know the factors which are responsible for this rise and what measures can be done to decrease its rate

Study Design: [1] A retrospective study [2] Two cycle of audit were conducted

Method: Case records of all women that underwent caesarean section in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore, from 1[st] January 1994 and second from January 2008 to December 2008 was collected on the basis of age, parity, booking status, gestational age, onset of labour and level of urgency of caesarean section

Results: Two cycle audit were conducted. In first from January 1994 to December 1994 total number of deliveries were 1685 and caesarean section rate was 27%, in second from January 2008 to December 2008 total number of deliveries 2167 and caesarean section rate was 42.6%. Analysis shows that caesarean section rate is increased in present practice

Conclusion: The result of our study shows that there is 15% increase in caesarean section rate was compared to 14 years back which is ideally not beneficial for long term interest of patients. So the all possible effort should be made to bring down the caesarean section rate without compromising the well being of mother and fetus

Degenerative uterine fibroid in a pregnant patient

Uterine leiomyomas are the frequently found benign solid tumours of the female genital system, which usually develops 20-50% of all women between the ages of 30 and 50. Here we present the case of a 40 years old lady gravida 8 para 7+0 at 24 weeks of gestation with anterior wall uterine fibroid with complain of spotting and leaking per vagina. She expelled dead fetus 800 gm, the placenta was removed under general anaesthesia in pieces. It seems to be submucous degenerated fibroid. Histological finding confirmed the diagnosis. After few months she was admitted for hysterectomy due to menorrhagia and passage of clots. Ultimate treatment of fibroid is surgery

Safety of repeat caesarean section after one or more C-sections

Objective: to determine the maternal morbidity and mortality associated with multiple repeat caesarean Section

Study Design: retrospective study

Place of study: federal Postgraduate Medical Institute and Shaikh Zayed Hospital, Lahore

Population: total 179 case record, 92 cases of previous one, 61 cases of previous two c-section, and 26 cases of previous three c-section, studied during the period of one year i.e 1/1/2006 to 3 1/12/2006

Main outcome: operative and post operative complications and difficulties

Results: out of 179 cases, 135 were elective and 44 emergency scar. Dehiscence was seen in 23 cases. Duration of operation was high with increasing rates of c-section. Maximum 3 hour, ICU care in only 1 patient. Only one caesarean hysterectomy because of bladder injury needed 6 units of blood i.e. no maternal mortality. One baby was IUD

Conclusion: higher order c-section is not a serious threat to mother and baby provided there is optimal antenatal care, counselling, adequate pre and post operative care, meticulous surgical technique, but patient must be made aware of the risks of operative delivery and frequently repeated pregnancy