Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment

To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section. A randomized double blinded trial. Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010. Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p<0.05 In only 2 [6.6%] of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 [53%] of one layer closure group, and 10 [33%] of the two layer closure group. At 6 weeks, the mean scar thickness in group C [17.08 +1.635 mm] was significantly greater [p<0.001] as compared to group A [13.19 +1.32 mm] and group B [14.58 +1.18 mm]. At long-term follow-up, only 1 [6%] case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 [23%] in group A and 2 [14%] in group B. Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section

Abdominal techniques for surgical management of vaginal vault prolapse

To evaluate and compare the short and long term safety and effectiveness of different abdominal techniques for surgical management of vaginal vault prolapse. Observational Cross sectional study. Department of Obstetrics and Gynaecology Unit II, Bahawal Victoria Hospital, Bahawalpur, from January 2001 to December 2008. A total of 80 cases were divided into four Groups [20 patients in each]. In Group A, patients were managed by sacrocolpolexy with polypropylene [Prolene mesh, Group B had sacrocolpopexy with autologous rectus sheath, Group C underwent high uterosacral ligament suspension and Group D had vault suspension with an autologous fascial sling of rectus shealth.. All cases were analyzed regarding their complaints, clinical examination, investigations and follow up. No recurrence occurred in group A, as compared to 10%, 20% and 15% in Group B, C and D respectively. No patient from Group A reported with incisional hernia as compared to 10%, 5% and 10% in Group B, C and D. Operative time was less in Group A as compared to Group B but longer as compared to Group D and almost same as in Group C. The complaint of low persistent backache remained same in Group A and B [30%] as compared to 35% in Group C and D. Least blood loss was observed in Group A. Sacrocolpopexy is gold standard procedure for treatment of vault prolapse. If it is performed with prolene mesh best results are expected

[PROM], active management at term with oral misoprostol

To assess and compare the number of subjects in both groups [Study and comparison], who went into active labour within 24 hours and to compare the various complications [maternal and fetal] in both groups. Quasi experimental. Convenience sampling. A total of 100 pregnant women presenting with history of leaking amniotic fluid at term [>/= 37 wks] to labour ward of obstetrics and Gynaecology unit, Bahawal Victoria Hospital, Bahawalpur were included in the study. The pregnant women fulfilling the inclusion criteria were enrolled as our study subjects. Rupture of membranes was confirmed by nitrazine test.The patients were randomized into two groups [50 women in study and 50 in comparison group]. In study group, 50 [Ligm of misoprostol was given orally after initial assessment of mother and fetus. The dose was repeated 4 hourly, if there was no uterine activity. The number of patients going into active labour and delivering within 24 hours were noted. Different complications [maternal and fetal] faced during all procedure were also recorded and managed. In comparison group, patients were managed were also recorded and managed. In comparison group, patients were managed conservatively for 24 hours. Like in study group, number of patients gong into active labour and delivering with in 24 hours were noted. Different maternal and fetal complications occurring in this group were also recorded and managed. A total of 100 Pregnant women were included in the study. The sample size [100 patients with PROM at term] was completed in 5 months. During that period over all 1105 deliveries were conducted, so the incidence of PROM at term in the study was 9.4%. It was observed in the study group, that all the patients [100%] went into active labour and 96% were delivered within 24 hours of PROM. While in comparison group 72% patients went into active labour and only 62% were delivered within 24 hours of PROM. The results showed that in study group 36 patients went into active labour with only one dose of oral misoprostol, 9 patients required 2 doses and 5 patients required 3 doses of oral misoprostol for going into active labour. When maternal complications were compared in both groups, 92% patients in study group had no complication while only 8% patients had to face different complications. In comparison group 86% had no complication and in 14% patients different complications occurred. Regarding fetal complications 4% fetus/neonates had to face different complications in each group. In current study there was no significant difference in the mode of delivery between the two groups. It was concluded that active management of pre labour rupture of membrances at term with oral misoprostol is a better option than the expectant management. Oral misoprostol in dose of 50 jugm is an effective agent for cervical ripening and induction of labour in PROM at term as significantly high percentage of patients delivered within 24 hours with no increase in maternal and fetal complications

Postmenopausal bleeding; an experience at Bahawal Victoria Hospital, Bahawalpur

To evaluate the etiology, incidence of malignancy and interval between menopause and onset of abnormal vaginal bleeding in postmenopausal women. Prospective study. Place and duration of study: The study was conducted at Bahawal Victoria Hospital, Bahawalpur for a period of 14 months [February 2002 to March 2003]. Subjects: Thirty five cases of postmenopausal bleeding. A detailed history was taken followed by a detailed general physical, abdominal, pelvic and per-rectal examination. Cervical pap smear was done in all the patients except those with obvious cervical growth. Besides routine laboratory work, abdominal ultrasonography was done in all the cases. All patients were invariably subjected to fractional curretage and cervical biopsy was taken where indicated. Malignancy was found to be the most common cause [51.42%] of postmenopausal bleeding. Carcinoma of the cervix was commonest and found in 34.28%, carcinoma of endometrium in 11.42%, atrophic endometrium in 11.42%, polyps in 8.57%, chronic cervicitis in 8.57%, endometrial hyperplasia in 5.71% carcinoma of ovary in 2.85%, liomyosarcoma in 2.85%, senile vaginitis, trauma, and forgotten IUCD each in 2.85% of cases. Etiology remained undetermined in 5.71% cases. Malignancy was directly related to years of clear span and was 88.88% in cases presenting 10 years or more after the menopause. Carcinoma of cervix was the commonest cause of postmenopausal bleeding in our study. Screening programme for early detection of carcinoma of cervix at a pre-invasive stage is highly recommended