Acute abdomen at 12 weeks secondary to placenta percreta

With increasing caesarean section rates during the past decades, a rising trend of placenta percreta is observed. Although rare, placenta percreta can present as acute abdomen due to haemoperitoneum during antepartum period. A 24 years old pregnant lady with two previous caesarean sections, presented in emergency at 12 weeks of gestation with syncope, acute abdominal pain and distension. Ultrasonography revealed an ectopic pregnancy in right adnexa with intraperitoneal haemorrhage. On laparotomy, there was moderate hemoperitoneum, both adnexa were normal and placental tissue was protruding through a bleeding previous caesarean scar. Hysterectomy was done. Histopathological report was consistent with the diagnosis of placenta percreta

Profile and repair success of vesico-vaginal fistula in Lahore

To describe the profile of patients with vesico-vaginal fistula [VVF] and success rate of the surgery. Design: Descriptive study. Place and Duration of Study: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. Patients and All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years [range 25-45] with parity varying from 0-9 [median 4]. The position of majority of the fistulas [57.2%] was high [vault, juxta-cervical]. Success rate of the surgery in the study was 85.7%. Majority of the repairs [78.6%] were done through vaginal route. The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention

community based knowledge, attitudes and practice [KAP] study on the non or improper utilization of maternity services by Pakistani mothers

This survey was conducted to figure out the reasons and barriers being responsible for the non or under utilization of the existing facilities by the pregnant women and to propose solutions based on the analysis of the results obtained. For the stated purpose women residing in a slum area of Lahore were interviewed to examine their knowledge, attitudes, belief and practices related to pregnancy and delivery associated complications and towards maternity establishments. Of the 930 married women who were in active phase of reproductive life, 450 were selected randomly for interviewing. Responses of 432 were included for final analysis. About90% respondents were aware of the existence of nearby maternity services but 58% regarded them useless. Of the 432 interviewed, 53% had no knowledge of pregnancy related complications and attributed all mishaps to superstitious beliefs. About 73% women did not know or understand the importance of antenatal care. Home delivery by dais in squatting position in the presence of relatives was considered to be on ideal situation by 79% respondents. Resentment towards institutional births was shown due to lack of privacy, overwhelming hospital atmosphere, fear of operative delivery and lying position during birth. Most of the women were unaware of postpartum complications. Conclusions: From the responses obtained, causes of inadequate and improper utilization of available and accessible services were formulated and solutions proposed accordingly

Dystocia: a continuing problem

A three year retrospective study was carried out at Sir Ganga Ram Hospital, Lahore, on 491 cases of dystocia, which formed 3.58% of 13,723 deliveries during the period. Of these 491 cases, 287 [58.45%] came with late obstructed labour and 204 [41.55%] with various types of prolonged labour. The commonest causes of dystocia were foetal malpositions and malpresentations in 172 [35.03%] patients and cephalopelvic disproportion in 167 [34.01%] cases. Five were in false labour; of the remaining, a large number of cases i.e., 372 [75.76%] came with abnormal length of labour with ruptured membranes. A total of 282 [58.02%] patients required a Caesarean section, while 83 [17.08%] had instrumental delivery and 55 [11.32%] were delivered normally. Infection was the most frequent maternal complication found in 297 [11.2%] patients. There were 6 maternal deaths [maternal mortality rate 17.04/1000 live births]. A total of 139 babies were stillborn, while 21 of the 352 live born expired within the first week; thus the perinatal loss was 160 or 329.21/1000. Important factors contributing to mortality were extreme age groups and parity, lack of proper antenatal and intrapartum care and mismanagement by traditional birth attandents