ABSTRACT
Objective: To analyse the factors associated with Caesarean Section [CS] of Nulliparous, Term and Singleton pregnancies with Vertex presentation [NTSV] at a tertiary care hospital
Methods: In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries [SVD] were taken as cases and controls
Results: The mean maternal age of cases [CS] was 26.64 [SD:3.9] and of controls [SVD] was 26.7[SD:3.9] years, whereas mean gestational age was 38.66 +/- 1.12 and 38.57 +/- 0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed 3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant [p value 0.077]. Labour was induced in 38% patients. The Odds of Induction of Labour [IOL] were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times [81%] if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery [MOD] in this study
Conclusion: Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section
ABSTRACT
Objective: To compare risk factors and progression free survival of Type-1 and II endometrial cancers
Methods: A retrospective analysis of 149 patients with early stage endometrial carcinoma treated between 1997 and 2012 in Aga Khan University Hospital, Karachi was performed
Results: A total of 149 patients were analyzed. Type-l tumors accounted for 92% of cases in the study while 8% wereType-ll tumors. The mean age, BMI, parity, co-morbidities [hypertension and Diabetes], family history and history of polycystic disease were comparable in both groups. Overall better survival [113 Vs 24 months] was observed for Type-l endometrial cancer
Conclusion: Both types of endometrial cancer may share common etiologic factors. Despite the limitation of small numbers in one group this study confirms better survival in Type-l endometrial cancer
ABSTRACT
To compare the peri-operative morbidity and survival rates between ovarian cancer patients treated with two different approaches. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data related to patients with advanced stage ovarian carcinoma treated between 1999 and 2008. Medical records were reviewed and relevant demographic, clinical, surgical, pathologic and follow-up information was acquired. Progression-free survival and overall survival rates were compared between patients who underwent primary debulking surgery and those who had received neo-adjuvant chemotherapy before surgery. SPSS 19 was used for statistical analysis. Of the total 118 patients, 78[66%] had undergone primary debulking surgery and 40[34%] had received neo-adjuvant chemotherapy. The mean age and pre-operative carcinoma antigen-125 level were similar. The debulking group had 74[94.8%] patients with stage 3, and 4[5.1%] patients with stage 4 disease, while the other group had 32[80%] and 8[20%] with stage 3and 4 respectively. The frequency of optimal debulking was 42[56.8%] in the former group against 27[79.4%] in the latter [p=0.01]. Duration of surgery, estimated blood loss >1500ml and stay at the intensive care unit were not statistically different [p>0.05]. Rate of Urinary tract, bowel injury and bowel resections were also similar. There was no difference in the progression-free survival in both groups [p>0.05]. Neo-adjuvant chemotherapy followed by interval debulking produced comparable survival rates and peri-operative complications
Subject(s)
Humans , Female , Neoadjuvant Therapy , Chemotherapy, Adjuvant , Cytoreduction Surgical Procedures , Neoplasm Staging , Perioperative Period , Morbidity , Survival Analysis , Retrospective StudiesABSTRACT
To compare perioperative morbidity and survival data between patients with early-stage endometrial cancer who did or did not undergo selective lymphadenectomy. Retrospective analysis of 180 patients with early-stage endometrial carcinoma treated between 1999 and 2008 was performed in Aga Khan University Hospital, Karachi, Pakistan. Data from 180 patients were analysed. The selective lymphadenectomy group contained 108 women [60%] and the no lymphadenectomy group contained 72 women [40%]. The median number of lymph nodes removed was 9. The mean age and extent of disease, as assessed by staging, tumour size, myometrial invasion, and lymphovascular invasion were comparable between groups. Upstaging of the disease to stage 3 and 4 occurred in 11% of patients in the lymphadenectomy group. There were no significant differences in the medical or surgical complications between groups. At a median follow-up of 26 months, both groups had comparable survival [lymphadenectomy versus no lymphadenectomy: 34 versus 32 months]. Similar survival was noted for patients who underwent the removal of more or less than 5 pelvic lymph nodes. Selective lymphadenectomy offers the advantage of improved surgical staging but no therapeutic benefit in terms of overall survival