Comparison of single dose versus multiple doses of antibiotic prophylaxis in elective caesarian section

To compare the efficacy of single dose verses multiple doses of antibiotic [cefotaxime] in the prophylaxis of postoperative wound infection in elective caesarian section. This quasi experimental study was conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar from 1[st] January to 31[st] Dec 2007. Hundred patients admitted for elective caesarian section fulfilling selection criteria were included in the study through non probability convenience sampling. These were randomly allocated by card method into 2 groups of 50 each. Patients were operated by specialist registrar and Group A was given single dose of prophylactic antibiotic while group B was given multiple doses. Wound was examined on 2nd and 6[th] day and then after 6 weeks. The efficacy was measured in terms of febrile morbidity; infection and duration of hospital stay. All data were entered in a semi structured proforma. Statistical analysis was carried out by using Chi Square test. Febrile morbidity was equal in both groups [n=10, 20%]. Superficial wound infection was [n=8, 4%] in both groups. Deep wound infection was [n=2, 1%] in group A and [n=4, 2%] in group B and duration of hospital stay was equal in both groups. Nonsurgical site infection occurred in [n=16, 8%] in group A and [n=12, 6%] in group B. There was no significant difference in outcome between the two groups. Single dose antibiotic [cefotaxime] is as effective as multiple doses of antibiotics [cefotaxime] in the prophylaxis of postoperative wound infection in elective caesarian section

misplaced in intrauterine contraceptive device recovered from urinary bladder

The case report describes successful removal of misplaced Intrauterine Contraceptive Device [IUCD] from urinary bladder. X-ray and ultrasound of the pelvis showed IUCD to be lying outside the uterus and on laparotomy IUCD was removed from urinary bladder

Pregnancy after B-Lynch suture and uterine artery ligation in case of placenta increta

This case report describes successful pregnancy outcome following B-Lynch suture and bilateral uterine artery ligation to control bleeding from placental bed in case of placenta increta

Detection of abnormal cervical cytology by Pap smears

Cervical intra-epithelial neoplasia and cervical cancer remain important health problems for women worldwide. Cervical cytology by Papanicolaou stained smears is an effective means of screening for cervical pre-malignant and malignant conditions. This study was designed to determine the prevalence of cervical intra epithelial neoplasia in this region and the role of pap smears for its detection. It was hospital based study on patients who attended the Out Patient Department of Lady Reading Hospital, Peshawar, Pakistan, from January to September 1997. Patients presenting with vaginal discharge, dyspareunia, post-coital bleeding, backache or pain hypogastrium were included. Patients having vaginal bleeding other than post-coital, were excluded from the study. Relevant information was obtained from the patients and recorded. Samples were collected and transferred to glass slides, fixed and stained by Papanicolaou stain. Each slide was carefully examined. Three hundred patients were included in this study. One hundred and twenty three [41%] patients had complaints of vaginal discharge, 39 [13%] post-coital bleeding, 108 [36%] dyspareunia and 30 [10%] backache and /or pain hypogastrium. Regarding contraception, 37 [12.33%] patients were pill users, 31 [10.33%] were on injectable contraceptives, 32 [10.67%] were using barrier method of contraception, 34 [11.33%] patients were having an intrauterine contraceptive device and 160 [55.33%] patients were not using any method of contraception. Pap smears revealed that 8 [2.67%] patients were having cervical intra-epithelial neoplasia. Among these patients, 1 [12%] had intra-uterine contraceptive device, 3 [38%] were on oral contraceptive pill, while 4 [50%] were not using any contraceptive method. One hundred and seventy eight [59.33%] patients were having past history of genital infection where as 128 [42.67%] patients had no such history. Age at first coitus was below 20 years in 268 [89.33%] patients whereas it was above 20 years in only 32 [10.67%] patients. All these patients belonged to poor socio-economic class. Cervical intra epithelial neoplasia is not uncommon in our set up. It can be diagnosed early by Pap smears