Pregnancy; management and outcome before and after 41 weeks

To evaluate whether serial monitoring of fetuses beyond 40 weeks with biophysical profile and non-stress test improves the fetal outcome in terms of morbidity and mortality determined by APGAR score at 5 minutes, presence of meconium in liquor, weight of baby and admission of neonate in nursery and to compare the maternal morbidity associated with prolonged pregnancy, labour induction and mode of delivery in the study and control group. It is a prospective controlled study conducted in the department of obstetrics and gynaecology Ghurki Trust Teaching Hospital, Lahore from 1st September 2007 to 31st August 2009. 200 patients at 40 weeks of pregnancy matching the inclusion criteria were enrolled for the study. They were divided into a study and a control group consisting of 100 patients each. Patients in the study group were subjected to fetal monitoring in the form of cardiotocography [CTG] and biophysical profile [BPP] while those in the control group were evaluated clinically and by kick count chart [KCC]. The outcome of the two groups beyond 40 weeks was compared with each other. The percentage of patients reaching 42 weeks was 4 in each group. The rest went into spontaneous labour, were induced or had emergency caesarean sections due to various reasons. The difference between the rest of the parameters like maternal morbidity, mode of delivery, fetal APGAR score and admission in neonatal intensive care unit [NICU] between the two groups were not statistically different. After 40 weeks of gestation fetal monitoring should be started with proper counseling of the patient, clinical assessment and fetal kick chart. NST and biophysical profile should be used selectively in patients with sluggish fetal movement or suspected reduced liquor clinically. All patients who reach 42 weeks must be induced

Adenexal cysts;survey of ultrasonography, preoperative findings, histopathology

[1] To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. [2] To determine the relationship of age with type of ovarian tumour. [3] To categorize the management of these cases according to the intra-operative findings. [4] To analyze the occurrence of various histopathological types of tumour. Medline Study Single centered prospective descriptive study of 150 cases. Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to, 31st December 2006. 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain [53%] followed by menstrual disturbances [30%], abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management

Functioning uterus with absent cervix, short vagina and transverse septum

A 25-year-old married lady with primary amenorrhea, infertility, lower abdominal pain and dyspareunia underwent vaginoplasty, total abdominal hysterectomy with right adnexal clearance for congenital absent cervix, vaginal septum with functioning uterus and right sided endometrioma. Mould was kept in vagina for 2 weeks followed by intermittent vaginal dilatation for one week. Couple was advised normal coital function and intermittent vaginal dilatation at home. Patient was followed regularly in OPD for 4 months and there was no complaint regarding sexual life

Infertile female; laparoscopic evaluation

To highlight the role of laparoscopy in the diagnosis and management of problems related to infertility. Retrospective, descriptive study. Department of Obstetrics and Gynaecology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore between 15t January 2003 to December 2003. Forty three women were selected for laparoscopy, 25 having primary infertility and 18 having secondary infertility. Laparoscopy diagnosed significant number of previously undiagnosed [unexplained] cases. In laparoscopy multiple procedures like laparoscopic ovarian diathermy, adhesiolysis, cauterization of endometriotic spots, and removal of endometriomas, salpingostomy and cauterization of fibroids can be performed in women with primary as well as secondary infertility while having minimal complications, short hospital stay and no mortality. Laparoscopy is a valuable diagnostic tool for female infertility. Laparoscopy is less invasive and more convenient