Frequency of placenta previa in previously scarred and non scarred uterus

To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections [37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus] in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008- December 2011. Most patients [47.36%] were between 26-30 years age group, presented with gestational age between 36-40 weeks [70.17%], were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% [37 cases], and frequency in previously scarred uterus was 67.54% [77 cases]. Major degree Previa was found in 88 cases [77.19%]. There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa [10.67%] from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus

Gestational diabetes; to compare the efficacy of metformin with insulin in diabetes mellitus in terms of fetomaternal outcome

Objectives: To compare the efficacy of Metformin with insulin in gestational diabetes mellitus in terms of fetomaternal outcome

Study Deign: Randomized clinical trial study

Setting: Lady Aitchison Hospital Lahore

Period: January 2014 to March 2015

Methodology: Total 500 pregnant females with GDM were included in the study through nonprobability, consecutive sampling. Patients were divided into 2 equal groups [A: B]. Patients in group A were given tablet metformin 500 mg by oral route and group B was administrated regular injection Insulin by subcutaneous route

Results: The mean age of females was 32.14 +/- 6.13 years. The mean gestational age was 31.07 +/- 3.8 weeks. There were 78 [15.6%] females who had 0 parity, 107 [21.4%] females had parity 1, 175 [35%] females had parity 2, 95 [19%] females had parity 3, 33 [6.6%] females had parity 4 and 12 [2.4%] females had parity 5.There were 54 [10.8%] cases had PTB, out of which 12 [4.8%] had PTB with metformin while 42 [16.8%] had PTB with insulin. There were 115 [23%] neonates required NICU admission, out of which 37 [14.8%] neonates with metforminand78 [31.2%] neonates with insulin. There were 87 [17%] neonates who had neonatal hypoglycemia, out of which 23 [9.2%] neonates with metformin and64 [25.6%] neonates with insulin. The difference was significant between both groups for all fetal outcomes [P<0.05]

Conclusion: The metformin is more effective in preventing adverse fetal and maternal outcome as compared to insulin

Anemic patients; relationship of frequency and severity of iron deficiency anemia with preterm labor and eventual perinatal outcome

Pregnant women are particularly considered to be the most vulnerable group because of the additional demands that are made on maternal stores during pregnancy. The iron deficiency anemia is the most common nutritional deficiency problems in females and is responsible of high maternal death rate in our society

Objectives: to determine the relationship of frequency and severity of iron deficiency anemia to preterm labor and eventual perinatal out come in anemic patients

Study Design: it was a case control study

Study Setting: in Obstetrics and Gynecology Unit-III, Sir Ganga Ram hospital, Lahore from July 2012 to June 2013

Methodology: the study was conducted on 200 patients [100 cases and 100 controls] were studied. Cases were patients admitted in labor room with preterm labor and Controls were females in labor at term at. Convenience sampling was done. On admission relevant history taking examination and investigation were done. The data was collected on a Performa

Results: there were 50 patients with anemia amongst the patients with preterm labor. In the control group, 40 patients were suffering from anemia. In the patients with preterm labor the mean hemoglobin was 9.83 grams/deciliter. In the control group the mean hemoglobin was 10.3gm/dl. [Pregnant women having hemoglobin <10 gm/dl are considered to be anemic]. The odds ratio was calculated to be 3.4 and P value was <0.05

Conclusions: iron deficiency anemia was associated with increased risk for low birth weight, preterm delivery, and perinatal mortality. The frequency of iron-deficiency anemia was seen in both groups of pregnant women

Iatrogenic vesicovaginal fistula

To find the frequency of iatrogenic VVF in patients admitted for repair of VVF in Lady Willingdon Hospital, Lahore. An observational study. Lady Willingdon Hospital, Lahore, from January 2007 to December 2008. All cases of VVF treated at the centre during the study period were included in the study. The patients were admitted and evaluated through detailed history, physical examination, relevant investigations and evaluation under general anaesthesia [EUA]. Iatrogenic VVF was defined as the one following gynaecological procedure. Repair was done through abdominal or vaginal route based on the findings of EUA. Results of repair were noted and analyzed using SPSS version 12. Iatrogenic cases of VVF made more than half of the total cases [54%] while 46% were due to obstructed labour. Women under the age of 40 years, made up 77% of the total cases. The success rate for repair of VVF was 87%. This study shows that iatrogenic injuries in women under 40 years of age form a major share in the etiology of VVF requiring a check on the experience of surgeons doing the gynaecological and obstetrical surgeries in a developing country

Emergency obstetrical hysterectomy: frequency indications and maternal outcome

Obstetric hysterectomy still remains a necessary tool for the obstetrician. It is a life saving procedure in cases of severe hemorrhage. The aim of present study was to determine the frequency indication, associated risk factors, maternal morbidity and mortality associated with obstetric hysterectomy in tertiary care center, Lady Willingdon Hospital, Lahore. Retrospective descriptive study. Study carried out in the Department of Obstetrics and Gynecology, Lady Willigdon Hospital, Lahore from August 2005 - July 2010. The frequency of obstetric hysterectomy over a study period was 0.24%. One hundred and eighteen patients were identified. During the same period total 48000 deliveries were conducted. Majority of the women were in the age group 26-40 years, presented between 37-40 weeks of gestation and were mutiparas. Main indications were postpartum hemorrhage, placenta previa and ruptured uterus. Associated risk factors include previous caesarean delivery, placenta previa, multiparity, placental abruption and uterine atony. Complications included postoperative shocks, febrile illness, paralytic ileus, wound infection and urinary tract infection. All women require blood transfusions, total abdominal hysterectomy was commonly performed surgery in our study. Maternal mortality occurred in 13% of patients and due to septicemia, DIG, hypovolemic shock and pulmonary edema. Obstetric hysterectomy is a life saving procedure but decision should be prompt and treatment by an experienced surgeon. It is associated with significant maternal morbidity and mortality which can be prevented by community education about delivery by skilled birth attendants, good maternal care education, active management of labour, early recognition of complications, timely referral and easy availability of transport and third delay at referral facility

Comparison of side effects and complications of intravaginal misoprostol with extra-amniotic prostaglandin F 2 alpha for termination of second trimester pregnancy

The objective of the study is to compare the maternal side effects and complications of Misoprostol and prostaglandin F2alpha for termination of second trimester pregnancy. Non randomized controlled [Experimental] study. This comparative study was carried out in Gynae Unit 1, Lady Willingdon Hospital Lahore from 1[st] Oct 2009 to 31[st] Mar 2010. Sixty patients admitted to gynecology ward for termination of pregnancy through the outpatient department were selected according to inclusion criteria of the study. They were divided into two groups of 30 patients each. Group 1 was given Misoprostol and group 2 PGF2alpha for induction of labour. Induction failure was higher in PGF2alpha group. Side effects were more frequent in the women receiving PGF2a than those receiving Misoprostol [56.67% vs. 43.33%; p=0.96]; diarrhea [26.67% vs. 20%] and fever [16.67% vs. 10%]. Incidence of nausea and vomiting were 6.67% in both the groups. In the same way, the complication of post partum hemorrhage was seen more in PGF2a group than the Misoprostol group [6.67% vs. 3.33%]. The incidence of retained placentas was 6.67% in both the groups. The average cost per treatment was Rs. 619 for PGF2a as compared with Rs. 135 for Misoprostol. Misoprostol is cost effective has fewer complications and side effects as compared to PGF2alpha

Frequency, presentation and management of fibroid uterus

The study was carried-out in Unit - I, Department of Obstetrics and Gynaecology Lady Willingdon Hospital, Lahore from January 2001 to December 2002. A total of 164 women with fibroid uterus were managed during this period. The objective of this study is to find out frequency and presentation of fibroids and to evaluate surgical treatment of women with fibroid uterus. Out of 164 cases, 47 had diagnostic D and C and were managed medically. Out of the rest 117 patients, 23 patients underwent myomectomy after diagnostic D and C. Ninety-three patients had abdominal hysterectomy while only one had vaginal hysterectomy. During operation, haemorrhage was the only complication which occurred in nine cases of myomectomy and intra-operative blood transfusion was done. Patients were followed- up for a period of six weeks to six months. There was no delayed complication or mortality in our study

Uterovaginal prolapse

This cross-sectional study included 160 patients with uterovaginal prolapse managed in Unit - I, Lady Willingdon Hospital, Lahore from January 2001 to December, 2002. Vaginal hysterectomy was done in 103 patients, Manchester repair operation in 18, anterior and posterior repair in 10 patients, posterior repair in 6 patients, ring pessary insertion in 3 patients and sling operation in 2 patients. One nulliparous girl who had Manchester repair and 1 elderly woman who had sling operation for post-hystrectomy vault prolapse had recurrence. These patients became asymptomatic after second operation. There was no mortality