Clinical presentations of congenital uterine anomalies

Objective: to observe clinical presentations of uterine anomalies

Material and Methods: uterine anomalies were detected during prenatal ultrasonography, detected during LSCS done for various obstetric indications. Discovered during EUA, and detected during laparoscopy or laparotomy. The clinical data of these patients was reviewed regarding age, parity, marital status and presenting symptoms. All data was entered in pre designed proforma and analyzed using SPSS version 14

Results: total 43 cases of uterine anomalies were detected. Most common type of anomaly detected was bicornuate uterus followed by uterus didelphys, arcuate uterus, unicornuate uterus with non-communicating horn and septate uterus. These anomalies clinically presented with fetal malpresentations, dysmenorrhoea, retained placenta ·and primary infertility. Diagnosis was confirmed puring prenatal USG, examination under anesthesia, during LSCS, during laparoscopy and laparotomy

Conclusion: women with uterine anomalies complain of symptoms such as dysmenorrhea, pelvic pain, but most are asymptomatic and diagnosed incidentally. They are frequently complicated by obstetrical challenges such as preterm labor, mal presentation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly

Appropriate gestational age for elective C-section

Timing of elective caesarean delivery is a relevant public health issue. Neonatal outcome is associated with the duration of gestation at the time of delivery. Rate of C-section is increasing worldwide even in USA it increased from 20.7% in 1996 to 31.1% in 2006. The objective to determine the appropriate age of gestation for elective C-Section in order to have good neonatal outcome and decrease perinatal morbidity. It is a cross sectional study that is retrospective. It will be carried out in the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore from March 2011 to Nov. 2011. One hundred consecutive subjects who had elective C-Sections during the study period were included in the study. Gestation of pregnancy was correlated with the outcome of babies. The newborns were assessed by 5 minutes apgar score and by admission in neonatal unit. In a total of 100 patients 9 had C-Section at 39 completed weeks and 47 had C-sections at 38 completed weeks and 44 had C-Sections at 37 completed weeks of gestation. Most of the babies who had respiratory problems and shifted to nursery were those who were delivered at 37 weeks gestation. Timing of elective Caesarean delivery at term has a relationship and influence on neonatal outcome. The perinatal morbidity can be reduced by decreasing elective caesareans before 39 completed weeks of gestation

Diagnostic yield of hysteroscopy in patients with irregular uterine bleeding

Objective: to find out the role of diagnostic hysteroscopy in accurate diagnosis of patients presenting with irregular uterine bleeding in our setup

Material and Methods: all the patients who underwent hysteroscopy for irregular uterine bleeding during study period were included. Age, parity, marital status and LMP were noted. Hysteroscopic findings were determined and subsequent endometrial samples taken. A comparison was made between hysteroscopic impression and histological examination

Results: total 148 patients had hysteroscopy for irregular uterine bleeding. The age range of our patients was 20-70 years with the mean age of 38.3 years. 97.2% patients were married and 88.5% pre-menopausal. Hysteroscopically findings noted in 113 patients [76.3%] and confirmed on histopathology in 89 cases [60.1 %]. Four patients [2. 7%] had a suspicion of carcinoma endometrium and histopathology confirmed this in 3 cases [2.02%]. We failed to perform hysteroscopy in 3 cases [2%] due to cervical stenosis

Conclusion: hysteroscopy with a biopsy has a high diagnostic yield

Do we really need to arrange blood for all patients undergoing C-section?

Objective: To find out whether it is really necessary to arrange blood for all patients undergoing C-Section in our setup

Patients and Methods: This cross sectional study was conducted at Shalamar Hospital Lahore from October 2008 to August 2009. All patients undergoing C-section both emergency and elective under care of the authors were included in the study. Age and parity was noted and indication of C-Section was determined. Their hemoglobin was determined by cyanoheamoglobin method. The need for blood transfusion and its possible indication was assessed in all patients. The intraoperative and postoperative complications were also noted. The average cost of cross matching and arrangement of one unit of blood in different hospitals of Lahore was also noted

Results: Out of 351 patients who underwent C-Section, 27 patients required blood transfusion. Common indication was massive hemorrhage due to placenta previa, abruption, previous surgeries, twin pregnancy and uterine atony. Other indication for transfusion was Hb less than 8 gm% at term. The calculated cost of cross matching and arrangement of one unit of blood was 1500 to 2400 Pak rupees

Conclusion: It is not cost effective to arrange blood for all patients undergoing C-Section as a routine. It should be limited to the high risk patients like those with placenta previa, previous surgeries and significant anemia