Comparison of Hydralazine and Labetalol tolower severe hypertension in pregnancy

Objective: To compare the intravenous Labetalol versus intravenous hydralazine in patients having severe Pregnancy induced hypertension [PIH] and pre eclampsia [PE] in pregnancy

Methods: Seventy eight women admitted in the Department of Gynecology and Obstetrics, Civil Hospital Karachi, having severe PIH/PE and fulfilling the inclusion criteria were included in the study. Random selection of patients was performed using sealed opaqe envelop for administration of either intravenous noted [IV] Labetalol or Hydrallazine. The mean fall in the MAP in each group was noted. This data was compared by applying SPSS version 13. The study was conducted from November 2012 to April 2013

Results: The mean [+/-SD] age of the labetalol group was 27.46 [+/-5.28] years while that in the hydralazine group was 26.28 [+/-5.17] years. The mean fall in MAP observed in the labetalol group was 29.10 +/- 7.21 mmHg and that in the hydralazine group was 25.05 +/- 10.15 mmHg which was statistically significant with the p value being 0.046

Conclusion: Intra Venous labetalol lowered MAP more than hydralazine, when administered to pregnant females with severe Pregnancy induced hypertension [PIH] and pre eclampsia [PE] in pregnancy

Frequency and risk factors of low birth weight in term pregnancy

Objective: To determine frequency of Low Birth Weight [LBW] at term and to determine frequency of various associated risk factors

Methods: This cross-sectional study was conducted in Department of Obstetrics and Gynaecology Layari General Hospital and Dow University of Health Sciences Karachi between January 2007 to July 2008. Women with singleton pregnancy of 37 and above completed weeks were identified. Those women who gave birth to babies with less than 2500gm were recruited in the study. In all those patients who gave birth to LBW babies risk factors were assessed. The variables including age, parity, booking status, maternal weight and height, socioeconomic condition, smoking, fetal gender and birth weight were noted on a questionare. The data was analyzed on SPSS Version 15. Frequency of LBW and its associated risk factors were determined

Results: During study period 10.6% patients delivered LBW babies. Antenatal care was not received in 67% patients. Parity was less than three in 87%. In 26% of patients maternal weight was less than 50 kg and in 37% patients with LBW, maternal height was less than five feet. Majority of patients were anaemic [72%] including 20% with haemoglobin< 7 grams

Conclusion: LBW is associated with a group of factors which may be regarded as high risk factors. These include low socio economic status, anaemia, primiparity, short maternal height and less than average weight

Frequency of pre-menstrual syndrome and menstrual irregularities in adolescents of different socioeconomic groups

Objective: To assess association between menstrual irregularities and socioeconomic status in adolescent girls

Study Design: Cross sectional study

Place and Duration of study: This study was conducted at different schools and colleges of Karachi from December, 20[th] 2010 to 15[th] January 2011

Materials and Methods: The study included 650 girls from schools and colleges of Karachi district representing different socio economic groups. A questionnaire was constructed comprising of biodata, menstrual cycle pattern and details of dysmenorrhea and premenstrual syndrome [PMS]. Girls between 15-19 years were selected randomly from schools and colleges representing low, middle and high income group. They were requested to fill questionnaire. Information thus obtained was analysed on spss version 11

Results: A total of 611 questionnaires were analyzed. 33.2% of adolescent girls belonged to low income group, 30.3% were from middle and 36.5% from high income group. Mean age of girls was 16.7 years. Menstrual cycle pattern was regular in 75.28% girls. No difference was found in cycle pattern between different socioeconomic groups. 83.79% girls complained of dysmenorrhea and 34.76% of them were from low income group, 29.49% from middle and 35.75% from high income group. Treatment of dysmenorrhea was required in 14.56% girls, including 41.57% from low, 24.71% middle and 33.8% from high income group. PMS was noted 71.68% girls. 36.1% girls reporting PMS were from low and 32.2% and 31.7% from middle and high income group respectively

Conclusion: Menstrual cycles are regular in majority of teen age girls. Dysmenorrhea and PMS are prevalent menstrual disorders in young adolescents. Incidence of PMS is significantly higher in low socio-economic group

Sacrohysteropexy performed as uterus conserving surgery for pelvic organ prolapse: Review of case files

Objective: To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients' satisfaction with the procedure

Methods:This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean +/- SD was calculated for numerical, while frequencies were computed for categorical variables

Results:Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 [95%] patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 [86.7%] did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen [26.7%] patients complained of backache on follow-up visit

Conclusion:This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required

Osteopenia in the younger females

To find out the frequency of osteopenia in young females and compare the bone mineral density [BMD] in females of different age groups. Cross-sectional study. This study was conducted by the Department of Obstetrics and Gynaecology, Unit V, Lyari General Hospital during Dow University of Health Sciences Health Expo at Expo Centre, Karachi, held on October 12, 2009. All females visiting our stall were offered BMD testing, irrespective of age group and parity. Pregnant ladies were excluded. Age, marital status, parity and occupation were noted. BMD was tested using calcaneal quantitative ultrasound [BMD Sahara Hologic G 4262]. WHO criteria were used for defining BMD. Data was entered and analyzed using SPSS version 15. Chi square test was used to compare various groups. Results were considered significant if p value was <0.05. A total of 170 women were included in the study, with mean age of 37.89 +/- 12.6 years. BMD was found decreased in 64% of women of /= 45 years. Osteoporosis was more frequent in women with parity >/= 4. Non-working women were found to have lower BMD as compared to working women and students. Majority of young female population had osteopenia. Steps should be taken to address this problem at an earlier age so as to prevent its complications later in life

Tolerability of hysteroscopy under local anaesthesia

To assess the tolerability of hysteroscopy amongst patients, when performed under local anesthesia. Quasi experimental study from January to December 2006. Dept. of Gynae. and Obstetrics, Sindh Govt. Lyari General Hospital and AI-Hafeez Medical Centre, Karachi. Patients attending the Outpatient Clinics with bleeding per vagina were randomly selected. After the clinical work-up and taking consent, all patients were given injection diclofenac sodium half an hour prior to the procedure. After preparing and positioning the patient, 10cc of injection Bupivacaine was given for para cervical block at 3 and 9 o'clock positions. The uterine cavity was distended with normal saline. Hysteroscopy was performed and the findings noted. Pain scoring was done by visual analogue scale. The condition of the patient was monitored during and after the procedure; they were kept under observation for four hours. Tolerability of the procedure was assessed by pain scoring and the presence of complications, and the results analyzed. During the study period 113 patients underwent hysteroscopy for abnormal uterine bleeding. The procedure was performed successfully in 98.2% patients without any complications, while 1.8% patients experienced transient vasovagal attack. The procedure was painless in 52.2% patients; 40.7% patients had mild pain [score < 3] and were reassured, whereas 7.1% patients had moderate pain [score 3-5]. Only 3.5% cases required analgesia for pain control. All patients remained haemodynamically stable during and after the procedure. Hysteroscopy is very well tolerated under local anaesthesia by our local population