Frequency and clinicopathological presentation of gynaecological malignancies

To describe the frequency and clinicopathological presentation of malignancies of the female genital tract presenting to a tertiary care hospital. This descriptive study was carried out at Department of Obstetrics and Gynaecology, Unit A of Khyber Teaching Hospital, Peshawar from January 2008 to December 2012. A total of 4657 patients were admitted during the study period and all the patients having genital tract malignancies were included. Detailed history was taken and relevant examinations and investigations were carried out. Surgical procedures were performed where needed and specimens were sent for histopathology. Clinical and surgical staging was also carried out. All the details were noted down on a semi-structured proforma. There were 43 cases of gynaecological malignancies with mean age of 43.74 +/- 15.51 years. Ovarian cancer was the most common [n=22, 51.22%] followed by uterine cancer [n=10, 23.33%]. The majority of patients diagnosed with ovarian cancers [n=9/22, 40.94%] were nulliparous, whereas the majority of uterine and cervical cancers were multiparous [n=7/10, 70.0%] and grand multiparous [n=7/9, 77.78%], respectively. Ovarian cancers mostly presented with an abdominal mass [n=16/22, 72.7%] while uterine and cervical cancer presented with irregular cycles [n=7/10, 70.0%] and post coital bleeding [n=4/10, 40%]. Advanced stage cancer cases were 19/43 [44.22%]. Serouscystadeno carcinoma was the most common ovarian malignancy [n=16/22, 72.73%] while endometrioid adenocarcinoma [n=9/10, 90%] was the most common uterine carcinoma and squamous cell carcinoma was the most common cervical carcinoma [n=7/9, 77.88%].Conclusions: Ovarian cancer was the most commonly encountered malignancyal though all gynaecological malignancies are rare

Maternal and foetal outcome in successful vaginal birth after caesarean section versus repeat caesarean section

To compare successful vaginal birth after caesarean section [VBAC] and repeat caesarean section [c/section], with respect to maternal and fetal outcome.This comparative study was conducted at Women and Children Teaching Hospital, Bannu from January to December 2010. Patients with previous one caesarean section who went into spontaneous labour were included in the study. A detailed history and examination of each patient was recorded on a semi structured proforma. For the analysis, they were divided into two groups [VBAC and repeat c/section].The comparison in both the groups was made with respect to mode of delivery, maternal and fetal outcomes. Out of 62 patients included in the study, 21 [33.3%] deliveries were vaginal, either assisted or spontaneous, while remaining 41[66.1%] had an emergency repeat c/section. In the successful VBAC group, one patient each had Partial Scar Dehiscence, PPH, blood transfusion and puerperal pyrexia. In emergency C/section group 24 patients had blood transfusion, 8 had puerperal pyrexia and 7 had PPH. In the successful VBAC group, two neonates each had a low Apgar score and needed ICU admission while in emergency C/section group 6 neonates needed ICU admission and 5 had a low Apgar score. Maternal and fetal outcome is better in successful VBAC as compared to repeat emergencyc/section

Clinical presetations and complications associated with tubal rupture in patients with tubal ectopic pregnancy

The objectives of study was to describe the clinical presentation, frequency of tubal ruptur and short term maternal morbidity and mortality in cases of tubal ectopic pregnancy presenting to a tertiary care teaching hospital. This was a descriptive study of 50 cases of tubal ectopic pregnancy; both ruptured and unruptured, presented at Khyber Teaching Hospital Peshawar from September 2002 to December 2003. Detailed history regarding age, parity, presenting features, past medical and surgical history and history regarding risk factors was taken. Operative findings regarding surgical procedures were noted. Data collected was analysed on SPSSv.10 and chi square test was used as a test of significance. The mean age of the sample was 29.50+10.50. Among the etiologic factors, PID was [14%], previous ectopic [4%], ovulation induction [4%] and IUCD insertion [2%]. Common clinical features were abdominal pain [90%], amenorrhea [84%], vaginal bleeding [70%], shock [32%]. Clinical signs raising suspicion of tubal rupture were shock [36.3%], anemia [86.3%] and irregular mass in pouch of douglas [88.6%]. Diagnosis was made clinically [92% cases] and abdominal USG with positive findings [92.5°/ cases]. Laparotomy showed ruptured tube in 88% cases, of which 88% had rupture of ampullary region. Surgical procedures done were salpingectomy for 97% and salpingoophrectomy for 7% of ruptured tubal ectopics. Short term morbidities were shock [32%], peritonitis [32%] and severe anemia [10%]. No maternal mortality was recorded. The most common risk factor was PID and the most common presenting complaint was abdominal pain and amenorrhea

Prostaglandin F2 alpha: an effective alternate to surgical control of postpartum hemorrhage in uterine atony

To find out the use of Prostaglandin F2 alpha to avoid the surgical control of primary postpartum hemorrhage due to uterine atony and the adverse effects associated with prostaglandin F2 alpha. This was a Quasi-Experimental study carried out in obstetrics and gynecology unit 3 of Khyber Teaching Hospital Peshawar from 1st July 2003 - 30th June 2004. 50 patients having primary post partum hemorrhage due to uterine atony not responding to conventional oxytocics were given systemic and local prostaglandin F2 alpha. Vital signs, estimated blood loss and effect on uterine muscular tone were noted before and after prostaglandin F2 alpha. Surgical interventions were used in patients with continuous profuse vaginal bleeding despite maximum dose of prostaglandin F2 alpha and/ or hernodynamic instability of the patients. A semi-structured proforma was used to collect the data. A total of 44 [88%] patients responded well to the drug. Estimated blood loss before prostaglandin F2 alpha was 1000 - 4000ml with mean of 2250.00 + 686.98ml as compared to 416.00 + 294.41ml after prostaglandin F2 alpha was used. Side effects of the drug were mostly self limiting and required symptomatic treatment. No maternal death was recorded. Prostaglandin F2 alpha is an effective drug to control Primary post partum hemorrhage due to uterine atony and avoids surgical interventions in most of the patients. Side effects are minimum, most of which are self limiting