Rupture of uterus [fundus]; spontaneous rupture of an unscarred uterus [fundus], at 35 weeks 01 day of gestation of a multigravida

Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at the Civil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polyp one year back. She presented with mild abdominal pains of sudden onset. After conservative management for 10 hours in hospital she suddenly developed severe abdominal pains with P/V bleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy was done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavity with rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar

Primary postpartum hemorrhage; efficacy of oral misoprostol in comparison to intravenous oxytocin

It is to compare efficacy of Oral Misoprostol with intravenous oxytocin in the management of primary post partum hemorrhage. Quasi experimental study. Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 1st December, 2006 to 1st December, 2007. The study was conducted on 90 patients who went into post partum hemorrhage during the study period. Cases were divided into two groups each having 45 patients fulfilling the inclusion criteria. Group 'A' had those who received oral misoprostol 600microg and group 'B' those who received 5 UNITS intravenous oxytocin. The variables analyzed were failure of drug, time taken to control bleeding and side effects of drugs. Students t-test was used for comparison between means and chi-square test for comparison between percentages. Significance was taken at P<0.05. It was noted that failure rate of oral misoprostol was 11.1% and that of oxytocin was 22.2%. Mean time taken to control bleeding by misoprostol was 16.6 minutes and 1.311 minutes by intravenous oxytocin. Side effects was observed in 35.5% cases of misoprostol group and 2.22% cases of oxytocin group. The time taken to control bleeding and side effect profile is more better in intravenous oxytocin as compared to oral misoprostol in the menagemnt of primary postpartum hemorrhage, but number of patients responded to oral misoprostol are more, so it can be used as in combination of oxytocin where oxytocin alone failed to work

Vaginal delivery versus cesarean section; birth outcome in primi gravdae breech

It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Cross-sectional comparative study. Obstetrics and Gynaecology Unit-l, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. The study was carried out on all Primigravida with breech presentation reported through emergency in labour delivered vaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 in cesarean group. Respiratory distress syndrome is more in cesarean [4.4%] than vaginal group [2.2%]. Observed neonatal trauma is more in vaginal group [6.7%] than cesarean section [2.2%]. Neonatal morbidity appears to be more in vaginal breech delivery than I cesarean section for Primigravida with breech presentation at term

Risk factors for primary postpartum hemorrhage

To describe the associated risk factor for primary Postpartum Hemorrhage [PPH] and its severity with increasing parity and duration of labour. It was a descriptive study. Place and duration of study: The Department of Obstetrics and Gynecology [Unit II] of Bahawal Victoria Hospital, Bahawalpur from January 2004 to December 2004. Patient and method: Fifty patients with primary postpartum hemorrhage were included in this study. Data was collected from the patients through a structured proforma. The variable studied were parity, duration of labour and risk factors for primary PPH. The results were statistically analyzed, chi-square test was applied to find out the significance of parity and duration of labour and their relationship with severity of PPH. Simple percentages were used to find associated risk factor for primary PPH. The frequency of primary PPH in primary para was 24% [12 patients] and in multi para was 76%[38 patients]. Severity of PPH increased with increasing parity [P<.05]. After merging the variable of parity severity of PPH increased in patients with prolonged labour in normally delivered patients [P<.05]. As for as risk factors are concerned 60% had uterine atony while 16% got cervical tear and the same number had retained placenta, 8% had preneal tear, Uterine inversion was seen in 6%, 4% presented with polyhydrominos, same with placenta previa type-1. 4% had vaginal laceration, 2% had DIC and 2% had abruptio placenta. The result of the study revealed a number of associated risk factors for primary PPH and proved the relationship of its severity with increasing parity and duration of labour. Duration of labour had a significant relationship with PPH even in Primipara