Therapy of heavy menstrual bleeding in Korea: Subanalysis and results from a multinational clinical trial in the Asian region investigating the levonorgestrel-releasing intrauterine system versus conventional therapy

OBJECTIVE: To compare real-life clinical outcomes with the levonorgestrel-releasing intrauterine system (LNG-IUS) and conventional medical therapies (CMTs), including combined oral contraceptives and oral progestins in the treatment of idiopathic heavy menstrual bleeding (HMB) in South Korea. METHODS: This prospective, observational cohort study recruited a total of 647 women aged 18 to 45 years, diagnosed with HMB from 8 countries in Asia, including 209 women from South Korea (LNG-IUS, 169; CMTs, 40), who were followed up to one year. The primary outcome was cumulative continuation rate (still treated with LNG-IUS and CMTs) at 12 months. Secondary outcomes included bleeding pattern, assessment of the treatment efficacy by treating physician and safety profile. RESULTS: The continuation rate at 12 months was significantly higher with the LNG-IUS than CMTs (85.1% vs. 48.5%, respectively; P<0.0001). The 51.5% of CMTs patients discontinued treatment and 18.8% of LNG-IUS patients discontinued treatment. The most common reasons for discontinuation for CMTs were switching to another treatment and personal reasons. When compared to CMTs, the LNG-IUS offered better reduction in subjectively assessed menstrual blood loss and the number of bleeding days, tolerability and with better efficacy in HMB, as assessed by physician's final evaluation. CONCLUSION: This study provides novel information on the real-life treatment patterns of HMB in South Korea. The efficacy of CMTs was inferior compared to the LNG-IUS in the clinical outcomes measured in this study. Due to the better compliance with LNG-IUS, the cumulative continuation rate is higher than CMTs. We conclude that the LNG-IUS should be used as the first-line treatment for HMB in Korean women, in line with international guidelines.

Twin pregnancy one sac with missed miscarriage, second with molar pregnancy

A 32 years old lady G4P2A1, presented with gestational amenorrhoea of 13 weeks and complain of vaginal bleeding one week back. Ultrasound examination revealed an irregular gestational sac with no fetal pole and another well circumscribed mixed echogenecity lesion filling the whole of uterine cavity. Features were consistent with molar pregnancy. Suction curettage was done. Histopathology report revealed complete hydatidiform mole and missed miscarriage

Post menopausal bleeding in patient with infantile uterus

A 58 years old female patient married for 40 years, nulliparous, presented in outpatient department with the complaint of postmenopausal bleeding off and on for six months. Her total abdominal hysterectomy and bilateral salpingoopherectomy was performed. Uterus was small in size [infantile]. Histopathology revealed endometrial hyperplasia with atypia

Risk factors and perinatal outcome in placental abruption

Background: This is bleeding following premature separation of a normally situated placenta. It is a life threatening complication of pregnancy associated with considerable maternal and Perinatal morbidity and mortality. The aim of the study was to determine the risk factors and Perinatal outcome of placental abruption in a tertiary care teaching hospital

Methods: This study was conducted at the Department of Obstetrics and Gynecology Jinnah Hospital, Lahore from May 2000, to May 2001. All cases of placental abruption delivered during the study period were reviewed for risk factors and outcome. The study population was compared with a control group of pregnancies who delivered without any complication

Results: During the study period 84 cases of placental abruption were diagnosed. Risk factors identified for placental abruption were increasing age and parity, pregnancy induced hypertension, preeclampsia, intra uterine growth restriction and multiple pregnancy. As compared to control group the rate of abdominal delivery was higher in study group. There were 25% intrauterine fetal deaths in the study group as compared to 4.76% in the control group

Conclusion: Multiple risk factors are known to cause placental abruption. It is associated with increased mortality and morbidity for mother but the Perinatal outcome is affected mostly. Bad Perinatal outcome is associated with prematurity, low birth weight, intrauterine death and early neonatal death

Profile and repair success of vesico-vaginal fistula in Lahore

To describe the profile of patients with vesico-vaginal fistula [VVF] and success rate of the surgery. Design: Descriptive study. Place and Duration of Study: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. Patients and All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years [range 25-45] with parity varying from 0-9 [median 4]. The position of majority of the fistulas [57.2%] was high [vault, juxta-cervical]. Success rate of the surgery in the study was 85.7%. Majority of the repairs [78.6%] were done through vaginal route. The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention

Comparison of mini laparotomy and laparoscopic ovarian drilling in management of polycystic ovarian disease

Objective: To evaluate the intra-operative and post operative morbidity associated with minilap and laparoscopic ovarian drilling in patients with polycystic ovarian disease

Setting and Duration: Gynae Unit I of Jinnah Hospital Lahore and Ghurki Trust Teaching Hospital, Lahore and Surgimed Hospital Lahore from January 1999 to June 2004

Patients and Methods: A total of 76 patients were included in this study. All patients required ovarian drilling. Patients were randomized into 2 groups - one undergoing laparoscopic drilling [36 patients] and the other group had drilling via minilap [40 patients]. The intra operative complications and post operative morbidity were analyzed

Results: 36 patients had ovarian drilling via laparoscopy. Bleeding was seen in 6 [16.6%] patients, in 2 [5.5%] patients laparotomy had to be done to control bleeding; visceral perforation was seen in 2 [5.5%] patients. Of 40 patients undergoing laparotomy, bleeding was seen in 1 [2.5%] patients only. No visceral perforation was seen in this group. Easy approachability was seen in the minilap group. The duration of hospital stay in both groups was 1.5 days

Conclusion: Mini laparotomy as a route for ovarian drilling is a safer option; with no increase in duration of hospital stay and is associated with lower morbidity

Management of ovarian cyst during pregnancy

Objective: To determine the optimum management of ovarian cyst in association with pregnancy

Setting and duration: From January 1999 to December 2003 in Gynae Unit I, Jinnah Hospital Lahore and Ghurki Trust Teaching Hospital, Lahore

Patients and methods: 21 patients were included in this study. All patients presented in early 2nd trimester of pregnancy [14-26 weeks]. Simple ovarian cysts were seen in 20 patients. One patient had a multiseptate cyst and had cystic and solid areas

Results: 2 [9.52%] patients had laparotomy for cyst removal in the puerperium; 4 [19.04%] had cystectomy at the time of LSCS while 71.4% [15 patients] had laparotomy for ovarian cystectomy during pregnancy due to torsion. The histopathology report was follicular cysts in 20 patients [95.23%] while 1 [4.76%] had a germ cell tumour. This patient was given PEB [cisplatin, epirubicin and bleomycin] chemotherapy after 20 weeks of gestation

Conclusion: Ovarian cyst in combination with pregnancy is seen in 0.01% of pregnancies. Management depends upon the presentation and symptoms. Laparotomy done in the 2,d trimester usually does not cause fetal loss. The cysts are usually benign with malignancy seen very rarely

analysis of fetal and maternal morbidity and mortality in retained second twin

To evaluate the maternal morbidity, fetal morbidity and mortality related to retained second twin. Design: A prospective study. Place and Duration of Study: Jinnah Hospital, Lahore from July 1996 to March 1998. Materials and Patients presenting to the labor ward after having delivered the first twin at home and with retention of the second twin in utero were included in the study. A total number of 7 patients were included in this study. Result: Malpresentation was seen in 3 patients [42.83%] and uterine inertia in 2 [28.57%] were found to be the commonest reasons for causing retention of second twin, while uterine inertia and malpresentation together was seen in 1 patient [14.28%] and cephalopelvic disproportion in 1 patient [14.28%]. The perinatal mortality rate was 71.42%. Maternal morbidity like fever was seen in 4 patients [57.14%], while postpartum hemorrhage was seen in two patients [28.75%]. Blood transfusion was required in 5 patients [71.42%]. Complications like scar dehiscence was also seen. In postpartum period breast engorgement requiring treatment with bromocriptine was seen in 3 patients [42.83%]. Retained second twin is associated with a high perinatal mortality rate and also causes increased morbidity in mother. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high risk pregnancy and its associated problems at birth; and the problem of retained second twin should not be allowed to develop in a teaching hospital

Endometriosis; efficacy and safety of decapeptyl [triptorelin] in its treatment

A prospective study was carried out during 1st September 1995 to 31 st August in private patients of Sir Ganga Ram Hospital, Lahore. The purpose was to study the safety and efficacy of decapeptyl in the treatment of endometriosis. Six women with proven endometriosis were treated with a delayed release preparation of the super active agonist D. Trp-6-LH-RH in biodegradable microcapsules, administered intra-muscularly at intervals of 30 days for a period of 6 months. All patients showed clinical improvement and reduction in stage and score of endometriosis. Hot flushes and dyspareunia were the main side effects. Resumption of menses occurred in all patients after the last injection. Results demonstrate that a long lasting, reversible hypogonadism can be induced in cyclic women by intramuscular injections of D. Trp-6-LH-RH microcapsules at monthly intervals. This simple and conventient treatment should be useful in treating endomentriosis