Physiological skin changes during pregnancy

Objective: To find out the frequency and pattern of physiological skin changes in pregnant women

Methods: This descriptive study evaluated 200 consecutive pregnant females presenting to Dermatology Outpatient Department of Nawaz Social Security Hospital, Lahore over a period of one year

Results: Total of twenty-three cutaneous manifestations were studied including striae gravidarum, hyperpigmentation, hair, nail and vascular changes. Majority of pregnant females complained of striae gravidarum [stretch marks] affecting 71.5 percent of study population closely followed by pigmentation i.e. linea nigra [64.5 percent] and melasma [63.5 percent]. The most common vascular change noticed was palmar erythema [43.5 percent] and nail changes included leukonychia [15 percent], while diffuse hair loss [11.5 percent] was the most frequently found hair change

Conclusion: The appreciation of common physiological skin changes during pregnancy will assist in better patient care during antenatal period

Role of malignancy index in prediction of malignancy in ovarian masses preoperatively

To determine the diagnostic accuracy of risk of malignancy index [RMI] in the preoperative prediction of malignancy in ovarian masses by taking histopathological findings as gold standard. Cross-sectional survey. This study was conducted at Gynae Unit 111, Lady Willingdon Hospital Lahore and duration was one year from 1.1.2013 to 31.12.2013. 140 cases were recruited for the study. Blood drawn for serum Ca-125 level and sent to hospital laboratory and pelvic ultrasound was done. For each risk of malignancy index was calculated value of RMI >/= 200 was taken as positive. Patients were having the mean age 55.8+/-7.6. Comparison of malignancy index vs. histopathology for prediction of malignancy in ovarian masses showed 64 malignant cases on histopathology and 69 on RMI.Sensitivity rate: 89.0%, specificity: 84.2%, diagnostic accuracy: 86.4%, PPV: 82.6% and NPV: 90.1%.The menopausal status, serum CA125 levels and ultrasound reports accumulated together can give us risk of malignancy index which can provide the odds of development of ovarian malignancies

Backache in pregnancy; role of physiotherapy in its relief

Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant women worldwide. To find an association between backache and pregnancy with respect to obesity and to evaluate the effect of physiotherapy for relief of pain. This longitudinal observational and randomized control study was conducted on pregnant females for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients [BMI >29.9] and non obese patients [BMI<29.9]. All information was recorded on a Performa that was later entered and analyzed using SPSS-11.5. The mean age of all patients was 33.67 +/- 6.73 years with overall average gestational age of 27.47 +/- 5.19 weeks. Flexed posture was observed in 90[60%] patients and 60[40%] had very bad sitting habit. There were 80 [53.3%] obese and 70 [46.7%] non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine. Most females reported that pain started during the 1[st] trimester [110] but only 40 females reported that they developed pain in the 2[nd] trimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 [33%] patients who had severe backache while 100 [66.7%] had worse possible pain which was regressed to no pain in 140[93.3%] patients at final follow up visit and only 10 [6.7%] had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant. Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. We conclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also, more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapy can be recommended as the first line treatment for pregnant females

study of vesicovaginal fistula repaired by vaginal route at fistula centre Lady Willingdon hospital, Lahore

Vesicovaginal fistula is an abnormal communication between bladder and vagina that allows the passage of urine through vagina leading to continuous dribbling of urine. According to WHO in developing countries, 5 million of women each year suffer severe maternal morbidity in which obstetric fistula is on the top of the list. To determine the outcome of vaginally repaired vesicovaginal fistula [VVF]. Descriptive case series study. This study was conducted at Fistula centre Lady Willington Hospital/King Edward Medical University for a period of one year from Jan 2010 to Dec 2010. This Descriptive case series was carried out for a period of one year in which 60 cases of VVF were included who were repaired by vaginal route and were followed by symptoms assessment like incontinence of urine and signs like soakage of pads were noted. The patients of 20 - 60 years of age who developed vesicovaginal fistula after obstructed labour or after surgeries like caesarean section, total abdominal hysterectomy, vaginal hysterectomy and operative deliveries whose vesicovaginal fistulae were repaired by vaginal route were included in the study, whereas those patients who developed VVF after malignancy and radiotherapy, or repaired by abdominal route and uretric fistulae were excluded from the study. Data was entered and analyzed on SPSS version 18.0. Majority of the patients included in the study 29 [48%] were between 31-40 years and minimum patients were between 20-30 years old with overall mean age of 44.59 +/- 3.12 years and 6 [10%] patients were diabetic. Among 50 cases of first attempt, the success rate at primary repair was achieved in 48 [96%] patients and only 2 [4%] cases were unsuccessful. The success at secondary repair was achieved in 4 patients [66.66%] and failure in 2 patients [33.33%], four patients were operated third time and surgery was successful in only one case. The success of procedure was significant in 1[st] attempt, p-value = 0.0000. Follow-up visit after 3 weeks soakage of urine [after removal of Foleys catheter] was seen in 6 [10%] patients, follow-up after 3 weeks by dye test proved 7 [11.66%] of cases. Incontinence of urine was found in 6 [10%] of patients. Transvaginal route of VVF repair has better outcome and primary repair is more successful, p-value = 0.0000

Efficacy of lng-ius in menorrhagia

To determine the therapeutic efficacy of levonorgestrel releasing intra uterine system in achieving a reduction in heavy menstrual bleeding in patients of idiopathic menorrhagia. Quasi experimental study. At out patient department of Gynecology and Obstetrics, Military Hospital Rawalpindi, from October 2005 to June 2008. Fifty patients who fit in the inclusion criteria were recruited by purposive non probability convenience technique. Insertion of LNG-IUS was done on the fifth day of the menstrual cycle. Menstrual blood loss and Hb level was assessed before the insertion and at three monthly intervals after the insertion for one year for the evaluation of the efficacy of the treatment and recorded on a Performa. Amount of menstrual blood loss was estimated subjectively as mild, moderate and severe. Hb level was measured at intervals. Menstrual blood loss and change in Hb levels before and after insertion were analyzed by the 'Chi-square test' using SPSS version 10.0. The results of this study showed a significant improvement in the amount of menstrual blood loss and a subsequent rise in the Hb levels after insertion of LNG-IUS in the patients of idiopathic menorrhagia. The LNG-IUS reduced bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. It has the potential to replace hysterectomy as treatment of choice in selected patients

Health consequences of induced abortion

Perforation of the uterus presents one of the gravest complications of emptying the pregnant uterus. induced abortion has emerged as one of the major share-holders of maternal mortality in third world countries. Of particulars importance is the fact that most of the illegal abortions, performed in the underdeveloped and developing countries, are attempted in older, multiparous women, increasing the risks many- fold. In the present article, a typical case of induced abortion, resulting in severe bowel injury, is presented followed by a discussion of the extent of the problem and its moral, social, and financial implications. Attention is drawn to the important role obstetrician / gynecologist can play, by providing better maternal / child health services, in an effort to reduce the incidence of induced abortion

Ante partum haemorrhage due to placenta-previa: an alarm to mother and foetus

Placenta previa is the major cause of antepartum haemorrhage. It is one of the known cause of foeto maternal mortality especially in the unbooked cases.Pregnant patients of 15-45 years age admitted through OPD/COD during three years from April 1996-1999 were included in the study.Diagnosis was made on the clinical grounds and confirmed by the ultrasonography. Risk factors and the out come was compared in booked and unbooked cases. Results concluded good prognosis in booked cases where problem was detected earlier and monitored vigilantly. In unbooked cases haemorrhage, infection, coexisting pathology and surgical complications caused maternal mortality while prematurity, hypoxia and malpresentation were associated with foetal mortality. In conclusion early diagnosis management and preventing the avoidable causes were suggested i.e., limiting the family to 3 by the age of 30 years and later use of contraceptive methods, admission of the pregnant patient with placenta previa at the gestational age of 34 weeks completed or earlier if any complication arises and this followed by the cesarean section at 37 completed weeks, especially in the cases of central placenta previa, previous cesarean section or coexisting pathology. Education about the antenatal care, health facility for foeto maternal health at hospitals is important, easy and rich availability of the blood for transfusion if required. Surgical facilities in cases with haemorrhage, Bed rest, avoiding trauma and long travelling in high risk cases especially in cases of placenta previa type 3 or 4

Changing pattern of eclampsia over a 20-year period

This study was conducted to compare eclamptic cases presenting at Lady Willingdon Hospital in 1978 and then in 1998. Out of 7673 patients delivered, 132 cases of eclampsia treated in 1978 were reviewed retrospectively. 9,650 women were delivered in 1998 and 97 cases of eclampsia treated were collected prospectively. It was noted that incidence of eclampsia fell almost 50% from 17/1,000 deliveries in 1978 to 10/ 1,000 deliveries in 1998. There was also a changing trend observed. In 1970's most eclamptic patients were unbooked while recently a lot of patients presenting with eclamptic fits were booked cases under care of general practitioners getting treatment for hypertension. Maternal death from eclampsia occurred in 12.1% of cases in 1978 but fell to 6.1% in 1998. Perinatal mortality rate - did not improve much. It was 432.6 / 1,000 cases of eclampsia in 1978 and 330 / 1,000 in 1998

day-care unit. [a patient and personnel oriented and cost effective patient management]

A retrospective study of hospital records was conducted to evaluate the usefulness of day-care Unit established in Lady Willingdon Hospital. During the year 1997 570 patients were diagnosed and treated in this day care unit. Office procedures carried out included 411 hysteroscopies, 90 laparoscopies, 15 cystoscopies, 30 colposcopies/cervical biopsies and 24 vulval growth removal/bartholin abscess drainage procedures. A out of 570 patients [0.7%] had to be admitted because of complications. The incidence of undesirable side effects was 4.2%

Comparison of different tratment regimens in infertile women with hyperprolactinaemia

A total of 70 patients with hyperprolactinaemic infertility were studied over a period of one year. Our goal was to compare two treatment regimens: bromocriptine plus placebo and bromocriptine plus clomiphene citrate in management of these patients. A double-blinded randomised, placebo-controlled trial was carried out. Ovulation/conception was achieved in a shorter time with greater safety and success rate in patients receiving combined therapy as compared to patients on bromocriptine alone