Osteoporosis in women

Objective: To find out the frequency of osteopenia and osteoporosis and to evaluate their etiological factors in women

Study design: Cross sectional study

Place and Duration of Study: Department of Obstetrics and Gynecology Fatima Hospital Baqai Medical University, in October 2014

Methodology: Females visiting the outpatient department were randomly selected. These were offered bone mineral density [BMD] test and calcaneal ultrasound. Variables assessed were marital status, parity, lactation status, dietary habits, covering body / using hijab [veil], profession etc. Data was entered and analyzed using SPSS version 15. Chi square test and Fisher Exact test were applied. Results were considered significant if p value was < 0.05

Results: One hundred and thirty two women were evaluated in the study. Mean age of woman was 34.27 + 9.04 year. Osteopenia was detected in 71 [53.8%] women while 20 [15.2%] were in the category of osteoporosis. Significant association was found between anemia and bone density while no significant association was found between working status of women and bone density. Lactation and veil also played important role in BMD scores

Conclusions: Osteopenia was common in pre-menopausal period. The frequency of osteoporosis was found to be less than osteopenia

Abnormal cardiotocography; perinatal outcome

To observe the effect of abnormal Cardiotocography to delivery interval on perinatal outcome in terms of Apgar score. Descriptive case series study. Baqai Medical University department of obstetrics and gynecology Fatima Hospital Karachi from Jan 2011 to July 2011. One hundred patients were registered who had pathological Cardiotocography. Bishop's score was noted and decision to deliver the patient was made according to the abnormality, and bishop's score. If bishop's score was good and vaginal delivery was imminent, then her second stage was shortened by operative vaginal delivery. Fetal distress was managed by left lateral position, O2 inhalation and hydration. If delivery was not imminent then decision of urgent LSCS was made, meanwhile fetal distress was managed. Decision - delivery interval was recorded, and fetal outcome was noted in terms of Apgar score and resuscitation needed. During this period one hundred pregnant women at term had pathological CTG for which they were delivered urgently. Among them 12% of parturients were delivered within 30 min, 68% delivered within 30-60 min, 12% delivered in 60-90 min and only 8% were delivered in 90-120 min. Seventy four [74%] of parturients were delivered by emergency lower segment caesarean section and 26% of parturients were delivered by instrumental vaginal delivery. Fetal outcome in terms of 1 min Apgar score, 38% of neonates had Apgar score of <7, 46% had >7 and 16% had Apgar score of <5. This group of neonates required resuscitation and 5 min Apgar was good. No neonate was admitted in Neonatal unit. In this study it is concluded that with fetal heart rate abnormality, if fetus is delivered within 60 min, it is not associated with poor fetal and neonatal outcome, provided fetal distress is managed while preparing for emergency lower segment caesarean section

Gynaecological hysterectomy; an audit in tertiary care hospital

Objective: To audit indications and outcome of hysterectomies in Fatima Hospital Baqai Medical University Karachi so as to improve the quality of care provided to patients. Study Design: Descriptive observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Fatima hospital, Baqai Medical University Karachi from November 2009 to November 2011

Patients and Methods: All patients undergoing hysterectomy for gynaecological conditions from 2009 to 2011were included in the study

Results: Hysterectomies for gynaecological conditions accounted for184 cases during the study period. Mean age of patient was 49 [range 30-60 years]. Mean parity was 6 [range 0-11]. The most common indication for hysterectomy was fibroid uterus 56[30.4%] cases, dysfunctional uterine bleeding 38 [20.6%] cases, and uterovaginal prolapse 10 [5.4%] cases. Abdominal hysterectomy accounted for 174[96.6%] and vaginal hysterectomy accounted for 10 [5.4%] cases. Twenty six [14%] patients were found to be suffering from hypertension, 6[3.3%] patients were suffering from diabetes mellitus. Wound infection occurred in 11 [6%] cases. No mortality was associated with hysterectomy during the study period. The duration of hospital stay was less in vaginal route as compared to abdominal

Conclusions: An audit should be carried out every year to improve the level of care of patients and also the expertise of surgeon should be checked. The study has shown that hysterectomy is a safe procedure but the high morbidity associated with this procedure is bothersome. The other options like endometrial ablation, intrauterine hormonal device like mirenaetc should also be considered. More efforts should be made on vaginal hysterectomies as it is economical and morbidity is less with it

Frequency and determinants of hepatitis C virus infection among females admitted for gynaecological surgeries

To find out the frequency of hepatitis C virus [HCV] infection and determination of their risk factors in pre-operative gynaecological patients. Case control study. Department of Obstetrics and Gynaecology at Fatima Hospital of Baqai University, from July 2009 to June 2011. All patients admitted either for surgery were routinely screened for hepatitis B and C. The data of sero-positive patients for hepatitis C were taken as test group A and sero-negative patients were taken as control group B. The data were collected through a designed performa and analyzed through SSPS version 16.0. The p value of =0.05 was taken as significant for any individual risk factors responsible for the transmission of hepatitis C infection. All patients admitted either for surgery were routinely screened for hepatitis B and C. The data of sero-positive patients for hepatitis C were taken as test group A and sero-negative patients were taken as control group B. The data were collected through a designed performa and analyzed through SSPS version 16.0. The p value of =0.05 was taken as significant for any individual risk factors responsible for the transmission of hepatitis C infection. Risk factors, which are usually considered to be responsible for the transmission of hepatitis C viral infection, were found to be significant in our studied population

Paraurehthrial abcess

Paraurehthral abcess in female is a rare lesion. The patient was a 25 years old female who had history of something coming out of vagina with perineal heaviness. She had history of off and on foul smelling copious vaginal discharge

On vaginal examination a 6 x 6cm mass around the anterior lip of cervix was seen with excessive foul smelling vaginal discharge. Ultrasound showed a hypoechoic cyctic mass near cervical region. Incision and drainage of abcess was done and about 300ml of pus drained followed by marsupilization. Histopathology revealed section of vaginal wall with subepithelial infilration of neutrophils and lymphocytes. No. evidence of malignancy was seen

Frequency of impaired oral glucose tolerance test in high risk pregnancies for gestational diabetes mellitus

To determine the frequency of impaired oral glucose tolerance test in high risk pregnancies for Gestational Diabetes Mellitus [GDM]. Cross-sectional study. The study was conducted in Obstetric Ward and outpatient department, at Baqai Hospital, Nazimabad and Fatima Hospital, Baqai Medical University, Karachi, from May to October 2005. A total of 50 high risk pregnancies for gestational diabetes mellitus were selected through outpatient department of obstetrics. Data was collected according to certain obstetric and non-obstetric risk factors for GDM as inclusion criteria through a designed proforma i.e. family history of diabetes, macrosomia [i.e, wt > 3.5 kg], abortions, grand multiparity, a sudden increase in weight [>1 kg/wk] during pregnancy, age > 35 years, early neonatal deaths/sudden IUDS, polyhydramnios, urogenital infections [vulvo-vaginal candidiasis and UTI], previous history of GDM, congenital abnormalities [with or without polyhydramnios] and multiple pregnancy. Oral glucose tolerance test was performed and analyzed according to American Diabetic Association criteria, 2004. The most frequent risk factors were family history of diabetes mellitus in 1st degree relative and large for dates babies in 18 patients. Similarly, high risk factors such as history of abortions and grand multiparity were present in 16 and 14 pregnant women respectively. Least common factors, which contributed for GDM, were polyhydramnios in 4 cases and perinatal mortality [due to congenital anomalies of foetus, intrauterine deaths or neonatal deaths] seen only in 5 cases. Overall impaired oral glucose tolerance test was found in 24%. Most patients had one [17%] or two risk factors commonly [23%]. Only 2% had shown five or more risk factors. Oral glucose tolerance test is a useful diagnostic tool to detect GDM in high risk pregnancies, depending upon the high frequency of number of risk factors in each individual