Women's perception towards menopause

To determine knowledge and attitude towards menopause among women aged 40 - 60 year presenting with gynecological complaints. Descriptive cross sectional survey. Obstetrics and Gynaecology Unit III, Civil Hospital Karachi from February 2009 to January 2010. Two-hundred premenopausal and postmenopausal women of 40 - 60 year of age were recruited in the study. They were interviewed after informed consent to obtain information about knowledge and attitude towards menopause. Data entered and analyzed by SPSS version 10. Descriptive statistics like frequencies, percentage proportions were calculated to present all categorical variables. The mean age of the participants was 46.8 year, 54.5% were premenopausal and 45.5% postmenopausal, out of them 10% had surgical menopause. 99% were married and 98.5% multiparous and grand multiparous. Only 22% were educated. 94% had heard about menopause, only 30% knew about symptoms, consequences [22%] and treatment of menopause [11%] especially hormone replacement therapy [HRT - 2%]. Ageing and natural transition were considered the common reasons of menopause. Only 21.5% had negative attitude towards menopause due to reason of somatic problems, loss of fertility and feminity. 58.5% considered treatment for menopause unnecessary. Majority of women knew about menopause but lacked knowledge because of limited source of information, education and cultural taboos

Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

In the past 30 years the rate of caesarean section [C/S] has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. There were 50 patients in each group. In group A, 11 [22%] were booked and 33 [66%] were referred cases. In group B, 48 [96%] were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 [20%] patients in group A, and 39 [78%] patients in group B, placenta previa, chorioamionitis, obstructed labour [6, 12% each]; pregnancy induced hypertension and eclampsia in 5 [10%] cases in group A only. Intra-operative complications in group A were 48 [96%] vs 15 [30%] in group B [p=0.000]. Postoperative morbidity in group A was 50 [100%] and 26 [52%] in group B [p=0.000]. Intra-operative complication was haemorrhage in 46 [92%] cases in group A and 11 [22%] in group B. Anaesthetic complications were 40 [80%]; prolonged intubation 25 [50%], aspiration of gastric contents 8 [16%], and difficult intubation 7 [14%] in group A. Ten [20%] cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 [82%] and 11 [22%] cases respectively. Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.

Trends and determinants of caesarean section

To analyze different indications and frequency of caesarean section [CS] so as to provide recommendations for reduction of caesarean section rate. Descriptive case series. Obstetrics and Gynaecology Unit III, Civil Hospital and Dow University of Health Sciences Karachi, from January 2009 to December 2009. All patients who underwent CS either booked, unbooked or referred were included in the study. The data was collected and analyzed for socio-demographic parameters and indications of CS. Patients with ruptured uterus on laparotomy were excluded. Data was analyzed on SPSS 11; percentages and mean were calculated. During one year study period 778 CS were performed. The rate of CS was 27.94%. Emergency CS was performed on 85.86% and elective caesarean section on 14.14% patients. Among them 71.34% were non-booked and referred cases. The commonest indication was repeat CS [n 367 - 47.17%], followed by labour dystocia [n 78 - 10.01%], breech presentation [n 77 -9.8%], foetal distress [FD n 72 - 9.2%], cephalo-pelvic disproportion [CPD n 71 - 9.1%], hypertensive disorders of pregnancy [PID n 49 - 6.2%] and antepartum haemorrhage [APH n39 - 5.0%]. The rate of caesarean section was high. The majority of the cases were non-booked and referred patients, who mostly underwent emergency CS. The commonest indication was repeat CS

Perinatal mortality contributors in singleton gestation

To determine the feto-maternal factors contributing to perinatal mortality [PNM] in singleton gestation. Descriptive study. Gynae Unit-III, Civil Hospital, Karachi, from January to December 2002. All obstetric patients with singleton pregnancy and gestation age greater than 24 weeks, regardless of age, parity and gravidity attending the gynae unit III in labor room and ward were recruited. Patients with gestational age less than 24 weeks or multiple pregnancy were excluded. Relevant data regarding history, risk factors in mother and baby were recorded on a pre-designed proforma and later analyzed on SPSS 10 for descriptive statistics and comparison of proportions using chi-square statistics. Neonatal death was defined as live born infant who died before 28 days of age. Still birth encompassed any death of a fetus after 20 weeks of gestation or 500 gms, and perinatal mortality was considered as the sum of the still birth and neonatal death. In the 1505 studied mothers, the perinatal loss was 187[12.43%] including 140 still births and 47 neonatal deaths [3.12%]. Perinatal mortality rate [PNMR] was 124/1000 total live births and neonatal death rate [NNDR] was 34/1000 live births. The commonest cause of still birth was antepartum hemorrhage [33.5%] and the commonest cause of NND was birth asphyxia [64%]. PNM in relation to neonatal birth weight was highest in the 2.5 - 3.5 kg range i.e. 70 [50%, p=0.86]. The proportion of primi/multi parity was 60 [45%] and 23 [49%] in still birth and neonatal deaths respectively [p=0.308]. The leading causes of prematurity were antepartum hemorrhage, hypertensive disorders and chorioamnionitis. Perinatal mortality is markedly affected by fetal maturity. Parity and fetal weight have an insignificant effect on perinatal mortality

Complications and management of unsafe abortion

To determine the frequency of unsafe abortion and its morbidity and mortality in patients presenting at Civil Hospital Karachi Descriptive study. Department of Obstetrics and Gynecology, Unit III Civil Hospital Karachi, from 1st January 2001 to 31st December 2005 All patients with history of induced abortion were admitted. The particulars related to each case like age, marital status, parity, reason for requesting abortion, place and expertise of person carrying out the procedure and outcome were recorded. Once patient arrived in our unit detailed examination was done and relevant investigations sent. After primary resuscitation and optimization, the patients were managed according to their complications in collaboration with general surgical department Fifty nine mostly young ladies with age range of 17 to 47 years and mean age of 30.76 years, presented with complications of induced abortion. Fifty four patients were married and 5 were single mothers. Fourteen patients [24%] were nullipara and remaining 45 [76%] were having 5 or more children. Only 7 out of 59 patients were booked cases, who underwent elective therapeutic medical termination of pregnancy [for foetal congenital anomalies in 5 cases and maternal grade III cardiac disease in 2 cases] They had no complication. Fifty two patients presented with induced and unsafe abortion. They were referred cases, and had multiple complications. Two patiens were brought dead and one patient died during pre-operative resuscitation. Out of remaining 49 patients, five [10%] were managed conservatively, 25 [51%] had re-evacuation and 19 [39%] underwent exploratory laparotomy. Ileal perforation was found in 5 cases. These were treated by primary repair and resection and anastomosis [2 cases each] and ileostomy in 1 case. Sigmoid perforation was found in 3 cases and managed by colostomy. Repair of uterine perforation only was done in 4 cases. Hysterectomy was performed in 4 patients. In three patients peritoneal toilet was also done. Overall mortality was 9.6% [n-5] Our data shows high morbidity and mortality associated with induced unsafe abortion in the form of prolonged hospital stay, multiple blood transfusions, laparotomies, hysterectomies that compromises the obstetrical future of young patients

Emergency obstretrical hysterectomy [EOH]: a life saving procedure in obstetrics

To assess the frequency, causes and sequelage of Obstetrical Hysterectomies in a tertiary care unit. Prospective, observational study from 1st Jan. 2001 to 28th Feb. 2006. Departmetn of Gynaecology and Obstetrics, Unit III, Civil Hopsital, Karachi. All Obstetrical Hysterctomies doen during the study period. Out of 11,032 obstetrical patients admitted during the study period, 62 underwent EOH. Their biodata, clinical features, investigations, blood transfusions, operative procedures, morbidity, mortality and follow-up was recorded on a profoma. The data thus obtained was compiled and analyzed. The frequency of EOH was 5.6/1000 obstetric cases. Majority [85.5%] of the cases were referred from elsewhere, while only 9 [14.5%] cases were booked. Multipara and grand multipara [94%] cases were mostly involved and the commonest cause was ruptured uterus [34%]. The maternal mortality was 9.7%. Proper antenatal care, early referral, liberal blood transfusion, timely decision and surgery by an experienced obstetrician are milestones on the road to justify EOH

Subfertility: experience in a tertiary care hospital

To determine the frequency of different causes responsible for subfertility in our setup. Prospective cross-sectional study from March 2005 to March 2006. Oupatients Dept. [OPD] of Gynaecology and Obstetrics [Unit 111], Civil Hospital, Karachi. All patients who were diagnosed as subfertile. Amongst the 156 women included in the study, 85 [54.5%] had primary and 71 [45.6%] secondary subfertility. Majority [59%] of cases were between 21-30 years of age; 78 [50%] complained of subfertility only, while 26 [17%] had history of vaginal discharge, 34 [21%] menstrual disorders and 12 [8%] weight gain. Nineteen [14%] cases had family history of subfertility, 18 [12%] of congenital anomaly and 3[2%] of genetic disorders. Abnormal hormonal profile was seen in 37 [27%] patients, whereas 63 [40.3%] had positive findings on pelvic ultrasound and 43 [27%] patients tubal blockage on hysterosalphinography. Out of 156 women, 27 [17.3%] had Ovarian factor in the form of anovulation, polycystic ovarian syndrome and premature ovarian failure and 51 [32.7%] had Tubo-Ovarian factor in the form of tubal blockage, endometriosis, endometritis and uterine fibroid; in 19 [12.2%] cases both the partners had abnormality, in 40 [25.6%] the male partners had semen abnormality [25.6%], while in 19 [12.2%] no cause could be found. A significant number of patients had secondary subfertility, mostly due to previous surgical interventions, and were suffering from anaemia and vaginal infection. Tubal blockage and male factors were the predominant causes of subfertility

Preterm labor-still a challenge

To identify the frequency of different aetiological factors of preterm labour, and to suggest preventive measures to reduce its incidence. Prospective, descriptice study from June 2005 to Dec. 2005. Setting: Department of Gynaecology and Obstetrics [Unit III], Civil Hospital, Karachi. One hundred pregnant women having one foetus, with preterm labour [<37 weeks]. Information regarding past history, present symptoms, menstrual and obstetrical history, findings of clinical examination and investigations like haemoglobin%, total leucocyte count, platelet count, random blood sugar, urine D/R [microscopy, culture, and sensitivity], high vaginal swab [gram staining, culture and sensitivity] and ultrasound pelvis [for gestational age, amount of liquor, placental localization, placental abruption, fetal and uterine abnormalities] were recorded on a proforma and the results analyzed. Out of the 100 women with preterm labour, 50% were<25 years of age, 80% belonged to the lower socio-economic group, 70% were not booked cases, 40% were primigravida and 18% had a past history of preterm labour. Urinary tract infection was found in 32% of the cases, bacterial vaginosis in 13%, abruptio placenta in 18%, unexplai-ed antepartum haemorrhage [APH] in 2%, polyhydramnios in 5%, pregnancy induced hypertension in 4%, cervical incompetence in 2%, fetal anomalies in 2% and pulmonary Kock?s in 1% cases; in 21% cases no risk factors could be identified. Preterm labour and delivery are a major cause of perinatal morbidity and mortality, specially in the developing countries. The costs of neonatal intensive care in short term and the resources needed to support children with long-term morbidity as a result of preterm birth are considerable. Preventable and treatable causes of preterm labour should be identified and dealt with for the better maternal and foetal outcome

Frequency Of Endometrial Carcinoma in patients with Postmenopausal Bleeding

To find out the incidence of Endometrial Carcinoma in women with postmenopausal bleeding. Design and Observational, cross section study over a period of 18 months.Dept. of Gynaecology and Obstetrics [Unit Ill], Civil Hospital, Karachi.45 patients with postmenopausal bleeding.All these patients were evaluated under anaesthesia, and diagnostic dilatation and curettage was done for histo-pathological assessment of the endometrial lining.Benign lesions accounted for majority [65%] of the causes of postmenopausal bleeding, followed by adenomatous hyperplasia [11.1%], carcinoma endometrium [11.1%] and carcinoma cervix [8.8%].As postmenopausal bleeding still remains to be the commonest symptom of carcinoma endometrium, hence patients presenting with it should be worked up on a priority basis to detect and manage carcinoma at an early stage

Frequency and causes of primary amenorrhoea at Civil Hospital Karachi

This prospective study was conducted in Gynaecology Unit III of Civil Hospital, Karachi from September 2001 to August 2003, to evaluate the frequency and causes of primary amenorrhoea. A total of 19900 cases attended the Outpatient Clinic during the study period. Amongst these there were 13 [0.065%] cases of primary amenorrhoea, including six [46.15%] due to anatomical defects, four [30.78%] due to Turner's Syndrome, two [15.38%] due to tuberculosis and one [7.69%] due to Androgen Insensitivity Syndrome

Efficacy of systemic Itraconazole in the treatment of vaginal candidiasis

This prospective, interventional study was conducted in the Department of Gynaecology and Obstetrics [Unit III] of Civil Hospital, Karachi from June 2001 to December 2001 on 20 patients with presumptive diagnosis of vaginal candidiasis based on the signs and symptoms. Subjective as well as objective analysis of the symptoms was done, and a high vaginal swab taken prior to starting the therapy. Itraconazole [Sporanox] 100mg was given orally twice daily for one day and followed weekly for three consecutive weeks. The results of the outcome revealed the drug to be effective, safe and well tollerated in the treatment of vaginal candidiasis

Myasthenia gravis with pregnancy: report of two cases

Two cases of Myasthenia Gravis with pregnancy are being reported. They were booked early at antenatal out patient department and their progress closely followed up in the ante natal, natal and postnatal period. Pregnancy in myasthenia gravis is a high risk situation; therefore both patients were seen more frequently for early detection and treatment of complications such as PIH, polyhydramnios, arthrogryposis, etc. and their management was done in collaboration with a physician. Narcotics, tranquilizers, barbiturates, and antibiotics like gentamicin, kanamycin, lincomycin were avoided. Fatigue in the 1st stage of labour was avoided by good analgesia, elective forceps were used to shorten the 2nd stage of labour and fatigue was prevented in 3rd stage too. The post partum period was also monitored closely as it is the danger time with highest morbidity and mortality to both the parturant mother and the neonate