Clomiphene citrate for ovulation inducation in patients with polycystic ovarian sndrome

To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Observational study. Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Clomiphene citrate [50-150mg] was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Forty-six patients [54.76%] ovulated in six cycles while twenty-seven [32.14%] remained anovulatory. Sixteen women [34.79%] conceived during the study period. Out of which ten women [62.5%] miscarried. Endometerial thickness did not differ [P>.50] between the conceived and non-conceived group but echogenic grade A pattern [75%] was observed during the conceived cycles [P<. 001]. Clomiphene citrate [CC] is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome

Primary post partum haemorrhage after vaginal birth: an analysis of risk factors

To analyze the risk factors for primary post partum Haemorrhage. Gynae/Obstetrics-Unit I Lady Willingdon Hospital Lahore. Observational Analytical study. One year Ist January 2005 to 31 December 2005. It was an observational analytical study in which the data about patients was collected with the help of proformas. Uterine atony due to various underlying risk factors is the major cause of post partum Haemorrhage. If these factors are identified and treated accordingly then a lot of mothers can be saved

Primary post partum haemorrhage: outcome of different treatment measures

This study was carried out to compare the efficacy and safety of different therapeutic measures used for controlling primary postpartum haemorrhage [PPH]. The venue of this work was the Department of Obstetrics and Gynaecology Lady Willingdon Hospital Lahore over a period of six months from July 1, 2005 - December 31, 2005. Fifty patients of primary PPH were recruited in this study. After identifying the risk factors for primary PPH thorough history, examination and investigations, these patients were treated medically and surgically to control haemorrhage. Control of bleeding by different measures was secured for the survival of patients. Medical intervention included use of oxytocins, and prostaglandins. Different surgical procedures like manual removal of placenta, suturing of genital tract tears, bimanual uterine compression and packing, stepwise devascularization and caesarean hysterectomy were done. Results of different procedures were analysed by using research proforma. The results show that out o f fifty, fifteen [30%] were booked patients. The major predisposing factor was grand multiparity in twenty-five [50%] patients. The predominant cause was uterine atony in thirty [60%] cases. Twenty [66%] patients were completely cured by different oxytocins. Eight [16%] had manual removal of placenta and two [4%] required evacuation of retained products of conception. Nine [18%] were treated by suturing the tears and lacerations. The commonest morbidity [66%] was anaemia. Mortality rate was 6%. In conclusion there is a need to reduce the alarmingly high maternal mortality and morbidity caused by primary PPH. Its main predisposing factors should be controlled. High parity, illiteracy and ignorance coupled with inadequate maternity services contribute towards this tragedy. If patients reach hospital well in time, effective management of obstetric haemorrhage should be prompt restoration of circulatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapy to arrest the bleeding

Amnion graft in vaginoplasty: an Experience at 3 teaching hospitals of Lahore

This study was carried out to determine the outcome of vaginoplasty using amnion graft. It was conducted in 3 different hospitals of Lahore including Lady Willingdon hospital. Sir Ganga Ram hospital, and General hospital from March 2001 to March 2005. Ten patients with Mayer-Rokitansky -Kauster-Hauser syndrome [MRKH] included in the study, underwent vaginoplasty using amnion graft. All patients were followed upto 6 months and beyond to determine the outcome of vaginoplasty and coital function. The patients' age ranged between 18-30 years. Eight patients [80%] were married and two were unmarried. The procedure was uncomplicated in nine while one had rectal injury, which was repaired successfully before application of graft. Follow up ranged upto 6months and beyond. Eight patients had excellent vaginal depth upto 8cm after 6months. One patient had cicatrisation. One patient lost follow-up. Five had satisfactory coital function. Ammon graft vaginoplasty is an ideal, simpler method and provides good results n ot only in terms of improvement in vaginal length but also couple's satisfaction at coitus

Uterine rupture: an audit to analyze management options, maternal and fetal outcome

Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics and Gynae Department of Lahore General Hospital, Lahore. The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 [2.9%/1000] deliveries. Among these incomplete rupture were 3 [21.4%] and complete rupture were 11 [78.4%]. Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 [78.4%]. Lower uterine segment posterior surface = 2 [14.2%] and upper uterine segment rupture was = 1 [7.14%]. The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. [35.7%] and previous uterine surgery in 5 cases [35.7%]. 2 cases [14.21] were due to cephalopelvic disproportion due to hydrocephalus and 2 [14.2%] cases were of malpresentation [transverse lie] mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases [50%]. Repair of uterus was done in 5 cases [35.7%], in 2-cases [14.2%]. Bladder repair alongwith uterine repair was done. In two cases [14.2%] of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10[71.4%] and alive babies were 4 [28.5%] high perinatal mortality of 71% were found. Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA's and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section

Frequency of placenta praevia with previous caesarean section

Two hundred Cases of Previous Caesarean Sections were Studied. 130 were associated with Placenta previa. The aim of Study was to evaluate the frequency of Placenta previa with Previous Caesarean Section. Out of 130 Patients 73% were Symptomatic and 27% were asymptomatic. The most Common ante-natal Complications were anemia 40% and repeated Warning haemorrhages 64%. Out of 130 Patients 35 Patients had Previous one Caesarean Section 27%, 80 Patient had Previous two Caesarean Section 61.5% and 15 Patients had Previous three Caesarean Section 11.5%

Comparison of intravenous hydralazine - bolus dose versus continuous infusion drip in eclampsia

The leading cause of maternal death from eclampsia is cerebral hemorrhage, which is presumably the consequence of severe hypertension, so the acute elevations in blood pressure above 160/100 mm Hg should be brought under control. A study of forty diagnosed cases of eclampsia was carried out in Lady Willingdon Hospital, Lahore to determine the time and quantity of drug required to control high blood pressure levels by intravenous hydralazine bolus dose versus continuous infusion drip. Patients were divided into control and case group. In control group continuous infusion was given and in cases bolus dose was given. Mean time taken to control blood pressure by continuous infusion was 124.75 minutes and drug quantity was 23.50 mg while it was 52 minutes and 12.25 mg in case of bolus method. The study showed that 60-70% less time was required and 37.5-50% less drug quantity was used in bolus method versus continuous infusion of intravenous hydralazine. Regarding efficacy of intravenous hydralazine, it was fou nd to be statistically superior in this study [P<0.05] so that management strategy should be changed in favour of bolus dose as compared to continuous infusion of intravenous hydralazine

Endometriosis-current management

This article extensively reviews different aspects of the current management of endometriosis. Various drug therapies are discussed in detail with reference to their use alone and/or in combination with surgery. The effectiveness in terms of symptomatic relief is 75-100% with pseudopregnancy, 66-100% with danazol and 85-95% with GnRH analogues. The pregnancy rates are 28 - 76% with danazol and 10-58% with pseudo-pregnancy. The pattern of side effects favours the use of GnRH analogues but their cost prevents them being used as a drug of first choice in our community