Adherent placenta Previa; outcome of abnormally

Abnormally adherent placenta is a condition in which all of part of the placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi. In majority of cases chorionic villi are in contact with the myometrium i.e. placenta accretes. To detect the prevalence of morbidity adherent placenta and its outcome in terms of maternal morbidity and mortality. Over one year from October 2006 to October 2007. Gynaecology Unit-ll, Nishtar Hospital, Multan. All women who had pregnancy complicated by morbidity adherent placenta were identified and their case notes retrieved. Information was collected on a prescribed Performa designed for this purpose. There was 2114 deliveries during the study period in labour ward of Nishtar Hospital, Multan. Eight women fulfilled the study criteria. The prevalence was found to be 0.4%. Complications were PPH, acute renal failure, depression, cellulities of wound site and UTI. Due to rising rate of LSCS in present era, the prevalence adherent is also on raise

Rupture of gravid uterus a 3 years review

[1] To evaluate risk factors predisposing to this dreadful event.[2]The modification of treatment offered.[3]The maternal and perinatal outcome. Gynae unit I , Nishtar Hospital Multan. From January 1997 to January 2000. A total of 34 cases of uterine rupture were seen. Out of these 73.5% were complete ruptures, 26.4% were incomplete ruptures. Ruptures were most commonly seen in anterior lower uterine segment. Uterine rupture was most commonly seen in patients with scarred uterus, 32.3% had previous one or two lower uterine segment caesarean section, 5.8% has previous classical caesarean section and another 5.8% had previous dilatation and curettage. Injudicious of oxytocin, unskilled breech extraction and instrumental delivery, undiagnosed cephalopelvic disproportion, neglected transverse lie and hydrocephalic were the other causes seen. Highest number of ruptures were seen in 34-39 years of age group i.e 47.05% . Most of the rupture i.e. 79.4% were diagnosed during labour and 17.6% were diagnosed during postpartum period. Most of the patients with uterine rupture had labour pains for the last 9-16 hours. Regarding clinical features majority of patients had tachycardia, pain and tenderness, fetal heart rate abnormalities, shock, bleeding per vaginum and cessation of uterine contractions. Depending upon the condition, repair and tubal ligation was the surgical treatment most commonly given, others being subtotal hysterectomy [32.4%] total hysterectomy [17.6%] and repair without tubal ligation [18.8%] . Regarding complications, 32.5% had UTI 8.5% had wound infections, 3 patients had cardiac arrest, 2 were resuscitated and one expired. Among long term complications, vesicovaginal fistula was seen in one patient. Maternal mortality rate of 2.9% was seen and perinatal mortality rate of 79.4% seen. stillbirth rate was 70.5% and early neonatal deaths within a week of birth were seen in 8.8% of infants