Foeto-maternal outcome of abruptio placentae at a tertiary care hospital

Objective: To determine the frequency, risk factors and, maternal and perinatal outcome in women presenting with abruptio placentae at a tertiary care hospital

Methodology: This observational, descriptive study was conducted in the Department of Obstetrics and Gynecology Unit I, Jinnah Postgraduate Medical Centre [JPMC], Karachi from January 2011 to December 2013. All pregnant women with gestational age 28 weeks or greater, having retro-placental clots on ultrasound and/or painful vaginal bleeding were included by using nonprobability purposive sampling technique

Results:There were 24,591 obstetric admissions during the study period, and 21,669 of them delivered. Of these 489 were diagnosed as abruptio placentae, making it a condition with a frequency of 1.98% of obstetric admissions and 2.25% of deliveries. 394 of the 489 cases [80.6%] were un-booked. Majority of them [252, 51.5%] were grand multipara with mean parity of 4.8 +/- 3.3. 330 [61.4%] were older than 30 years [36.1+/- 12.6 years]. 392 [80.2%] delivered vaginally and the rest 97 [19.8%] were delivered by Caesarean section. Hypertension and pre-eclampsia were collectively seen in 124 [25.2%], anaemia in 77 [15.7%], smoking in 39 [7.9%] and trauma in 8 [1.6%] patients. Noteworthy maternal complications were postpartum haemorrhage [PPH] in 70 [14.3%], postpartum anemia in 55 [11.2%], disseminated intravascular coagulation in 13 [2.65%] and renal failure in 2 [0.4%] patients. Maternal death occurred in 17 [3.5%] women. Still birth occurred in 194 [39.7%] patients. Perinatal Mortality was 68.7%

Conclusion: Abruptio placenta has a significantly increased risk of maternal and perinatal mortality. Risk factors include multiparity, hypertension, pre-eclampsia, anaemia and smoking

Emergency obstetric hysterectomy

Objective: To evaluate the frequency of emergency obstetric hysterectomy, and to find out its indications and accompanying maternal and perinatal morbidity and mortality

Methodology: This cross sectional study was undertaken at Obstetrics and Gynaecology department of Unit-I, Jinnah Postgraduate Medical Centre, Karachi from 1st January 2015 to 31st December 2016. Those patients who had emergency obstetric hysterectomy at JPMC during this period were included in the study. Their parity, booking status, age, indication and, the type of surgery undertaken was recorded. Maternal and fetal morbidity and mortality were also determined. Data was analyzed using SPSS 20

Results: A total of 14,157 deliveries were carried out during the study period. Out of them, 32 hysterectomies were undertaken due to obstetric indications [0.22%]. The most common indication was ruptured uterus in 20 [62.5%]. The most common complication was infection [40.6%]. Five patients could not survive after the surgery [15.6%] and perinatal deaths were 19 [59.3%]

Conclusion: Obstetric hysterectomy needs to be done in emergency cases where life of the patient can not be saved otherwise. However, clear judgement, highly professional surgical technique and optimal time for the surgery can decrease mortality and morbidity in such cases

Frequency and outcome of hepatitis C virus infection in pregnant women at tertiary care hospital

Objective:-To determine the frequency of Hepatitis C virus infection and maternal and fetal outcome in pregnant women with Hepatitis C virus infection

Materials and Methods:This descriptive case series study was conducted in the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Center, Karachi for a period of six months from 17-02-2015 to 18-08-2015. A total of 202 pregnant women of any parity and gestational age after 24 weeks were selected in this study. After taking history and examination, 5ml of blood was drawn from the peripheral vein from each patient and serum was tested for the presence of Anti-HCV antibodies in all patients using a third generation ELIZA test in diagnostic laboratory. All data was collected in pre-approved proforma

Results: The frequency of hepatitis C virus infection in pregnant women was observed in 15.35% [31/202] cases. The average age of the patients was 27.35±4.66 years. The most common obstetrical complication in women with hepatitis C virus infection was jaundice 77.4% [24/31] followed by preterm delivery 35.5% [11/31], LBW 32.3% [10/31], placenta previa 25.8% [8/31], premature birth 19.4% [6/31], intra uterine death 19.4% [6/31], hepatic encephlopathy 9.7% [3/31] and maternal death 9.7% [3/31]. Rate of jaundice, preterm birth, premature birth, intra uterine death and low birth weight was also significantly high in those pregnant women who were HCV positive.

Conclusion: HCV positivity may be a surrogate marker for increased risk of poor pregnancy outcomes and the HCV-positive pregnant population may require greater clinical vigilance in this regard

Comparison of ease of I-gel insertion with standard and rotational techniques in adults

Objective: To compare number of attempts, mean time of Insertion, mean airway leak pressure, insertion success and blood staining at removal of l-gel insertion through standard and rotational techniques, in adult anesthetized patients

Study design Randomized clinical trial

Place and Duration of study: Department of Anaesthesiology and SICU, Jinnah Postgraduate Medical Centre Karachi, from January 2016 to April 2016

Methodology: Patients scheduled for elective surgical procedures under general anaesthesia with controlled ventilation, were included in this study. A total of 150 patients were randomly assigned by random number into Group S [standard insertion technique - n=75] and Group R [rotational technique - n=75]. Comparison was done in terms of mean time taken for I-gel insertion, mean air leak pressure, number of attempts taken for insertion and presence of blood staining on removal

Results: Mean time of insertion in Group S was 14.6 +/- 3.7 second and in Group R 13.2 +/- 2.7 seconds. Mean airway leak pressure was 23.1 +/- 4.6 cm of H2O in Group S and 24.4 +/- 2.9 cm of H2O in Group R. The median number of attempts taken for insertion in each group was 1. Success of insertion was 93.3% [n=70] in Group S and 98.7% [n=74] in Group R. Blood staining of I-gel at removal was noted in 22 [29.3%] and 14 [18%] patients in group S and R respectively

Conclusion: The rotational technique for I-gel insertion was better than the standard technique

Frequency of oronasal fistulae in complete cleft palate repair

To determine the frequency of oro-nasal fistula in patients undergoing complete cleft palate repair by two flappalatoplasty. Case series. Department of Plastic Surgery, Services Hospital, Lahore, from January to December 2013. Patients admitted to the study place for repair of cleft palate after informed consent obtained were included. Cleft palate was repaired by two-flap palatoplasty, using Bardach technique. Patients were discharged on the second postoperative day and followed-up at third week postoperatively. During follow-up visits, fistulae formation and their sites were recorded on pre-designed proforma. Among the total 90 patients, 40 patients [44.4%] were male and 50 patients [55.6%] were female. The mean age was 6.4 +/- 5.7 years ranging from 9 months to 20 years. At third week follow-up, 5 patients [5.6%] had fistulae formation. Four patients [80%] had anterior fistulae and one patient [20%] had posterior fistula. With two-flap palatoplasty Bardach procedure for repair of cleft palate, the complication of fistula formation was uncommon at 5.6%, provided the repair was tension free and multi-layered