Different pattern of presentation of ectopic pregnancy and its management

To determine the clinical presentations and the management options for ectopic pregnancy. Descriptive study. Department of Obstetrics and Gynecology Liaquat National Hospital Karachi, from 13[th] August 2011 to 12[th] August 2012. A total of 40 cases diagnosed with ectopic gestation were included in this study. Information was retrieved from the case notes and labor ward registers. The data was analyzed with simple descriptive statistics. During the study period the total number of gynecological admissions were 1126 and 1618 deliveries conducted. Forty patients had ectopic gestations accounting for 2.4% of all deliveries and 3.5% of all gynecological admissions. The peak age group was 20-30 year [62.5%]; 95% [n=38] were married. Cases of ectopic pregnancy found more in primigravida 45% [n=18] patients. Abdominal pain was the most common presenting symptom in 92.5% [n=37] of patients whereas history of amenorrhea present in 75% and vaginal bleeding was found in 45% of patients. Commonest clinical sign was cervical excitation present in 82%. Identifiable risk factors were present in 52.5% of cases, the most frequent being previous miscarriages in 22.5%. Surgical management was done in 95% patients while 5% managed medically. Ruptured ectopic pregnancy was seen in 85%. Tubal ectopic pregnancy was present in 92.5% [n=37], ovarian 2.5%, and heterotopic pregnancy in 2.5%. Salpingectomy was performed in 89% while salpingotomy done in 7.8% cases. Hysterectomy was done in one patient. Blood was transfused in 75% [n=30] patients. There was no maternal death related to ectopic pregnancy. Ectopic pregnancy was found more in primigravida. Abdominal pain was the single most consistent feature of ectopic pregnancy. Most cases presented late making tubal conservation treatment inapplicable.

Fetomaternal outcome with hepatitis E in pregnancy

To assess the maternal morbidity and mortality and fetal outcome with hepatitis E [HEV] in pregnancy. Cross-sectional study. Liaquat National Hospital, Karachi, from May 2008 to April 2010. Thirty patients admitted at Gynae Ward with serologically proven HEV in pregnancy were included in the study. All these patients were followed during their hospital stay with liver function tests and coagulation profile. Maternal morbidity and mortality and fetal outcome were recorded. Maximum maternal morbidities were noted in patients who presented in 3rd trimester, both clinically and derangement of haematological and biochemical tests. out of 30 patients, 08 patients expired with maternal mortality rate of 29.3% and rest were discharged safely. Perinatal mortality rate was 30.3 per 1000 live births. Hepatitis E runs a fulminant course during pregnancy with very high mortality rate especially during third trimester and postpartum period

Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome [PRES] is a clinico-neuro-radiological entity may develop in patients with pre-eclampsia, eclampsia or delayed postpartum eclampsia, immunological conditions and with certain anti-neoplastic agents. This case report describes about a patient with pregnancy induced hypertension who developed PRES postnatally. Early recognition and treatment prevented serious morbidity

Awareness and practice of contraception among child bearing age women

To assess the awareness and practice of contraception among child bearing women attending tertiary care hospital. Cross-sectional. This study was conducted at the outpatient department of Gynecology and Obstetrics Liaquat National Medical College and Hospital Karachi, from May 2008 to July 2008. Two hundred women of child bearing age were interviewed regarding their awareness, attitude and practices of contraception. The inquiries were recorded by pre designed questionnaire. Questions regarding methods of contraception known and source of knowledge and their practices were recorded. Convenient sampling was used to distribute questionnaire. Mean age of the patients was 29.88 years [SD 6.38 years]. 73% of the women were educated, and majority of them were Muslims. Awareness was seen regarding contraception in 81% of the women interviewed but only 49% practiced any method. Barrier method of contraception was the most popular method known and practiced. Media seemed to be the major source of information [64.5%]. In response to the reason for non use, majority feared side effects [56.8%]. Major reason for use of contraception was spacing [47.9%]. Majority [77.5%] of women had assertive attitude towards contraception. There is a gap between awareness and practice of contraception. Despite having knowledge the compliance is low. One of the major factors among reasons of non use of contraception is fear of side effects

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

Congenital adrenal hyperplasia causing clitoromegaly

Congenital Adrenal Hyperplasia [CAH] is caused by congenital insufficiency of the enzyme 21 - hydroxylase [21-OHD] in the cortisol synthesis pathway. Because of the virilizing effects of androgens over-production, affected girls develop clitoral hypertrophy. Three patients with CAH are discussed below along with their surgical management and follow-up

Contraceptive knowledge, attitude and practice among rural women

To assess the knowledge, attitude regarding family planning and the practice of contraceptives among rural women. A cross-sectional observational study. The gynaecological outpatient clinic of Fatima Hospital, Baqai Medical University, Karachi, from July to December 2005. One-hundred women between the ages 15-45, living with their husbands and coming from rural area [villages] were interviewed. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity and educational status. Descriptive analysis was conducted to obtain percentages. Out of 100 interviewed women with mean age of 29.7 years, 81[81%] had some knowledge about family planning methods. The media provided information of contraceptives in 52 out of 81 [64%] women. Regarding the usage of contraceptive methods, only 53 [53%] of the respondents were using some sort of contraception. Barrier method [condoms] was in practice by 18 [33.9%] and 12 [22.6%] of women had already undergone tubal ligation. The women using injectables and intrauterine contraceptive devices were 10 [18.8%] and 7 [13.2%] respectively. Six were using oral contraceptive pills [11.3%]. Positive attitude towards contraception was shown by 76 [76%] of them, while 41[41%] stated their husbands' positive attitude towards contraception. In the present study, there was a low contraceptive use among women of rural origin despite good knowledge. Motivation of couples through media and health personnel can help to achieve positive attitude of husbands for effective use of contraceptives

Drug induced hirsutism

Hirsutism is a symptom or sign, which may have more serious associations than cosmetic and psychological concern alone, such as adrenal hyperplasia and ovarian tumor, particularly if it develops well after puberty. Some medicines having androgenic activity may also cause this problem. Here, we present a case of a young unmarried girl who was given anabolic steroid for the treatment of dysmenorrhoea which resulted in hirsutism

Complete androgen insensitivity syndrome in AN X Y female

An 18 years old, unmarried girl, attending the Gynaecological outpatient department, with history of primary amenorrhea, presented an ultrasonography report which revealed absence of uterine contours in that patient. There was no history of cyclical pain. Patient had two step sisters, aged 13 and 10 [born of different father], out of whom the elder had started menstruating. On clinical examination, the height of the patient was 167.5 cm and she weighed 52 kg. She had welldeveloped breasts. Her pubic and axillary hairs were scanty. Patient was admitted for further investigations, which showed elevated serum gonadotrophins [FSH=21.9 miu/ml LH= 9:46 miu/ml] and testosterone levels [5.08 ng/ml]. The pelvic ultrasonography was repeated which showed absent uterus but gonads were present bilaterally. Barr bodies were absent on buccal smear examination and karyotyping revealed 46 XY chromosomes. Examination of the patient under anaesthesia was carried out which showed normal labia majora, minora and uretheral opening and a short vagina. Gonadectomy was performed and subjected to histopathological examination, histopathology report showed that the gonads were testicular tissue. Patient's postoperative period was uneventful. She was advised to use vaginal dilators to increase the length of vagina. Hormone replacement therapy was prescribed to prevent early osteoporosis. She attended OPD for regular follow-up, no complaint were reported by the patient during this period

Dysfunctional uterine bleeding: a clinicohistopathological analysis based

This study was conducted to identify the histopathological changes in patients of dysfunctional uterine bleeding [DUB], their response to different modes of treatment and their effects on maternal well being. Sixty eight cases diagnosed as DUB during a period of one year at Gynae unit II, Abbassi Shaheed Hospital, Karachi were included in the study. DUB was diagnosed in 10.46 percent of women admitted with gynaecological problems. Majority of women were multiparous and belonged to age group between 21 to 40 years. Commonest presenting symptoms were menorrhagia [32.35 percent] and polymenorrhagia [27.94 percent]. Commonest histopathological feature was secretory phase [52.46 percent] and then the proliferative phase. A good response to curettage only was achieved in 14.17 percent of patients, while majority [67.65 percent] needed medical treatment as well. Hysterectomy was performed in 36.76 percent of patients. The negative effect on maternal health was observed as anaemia in 88.23 percent women. Early diagnosis and treatment of DUB can reduce excessive blood loss and its impact on maternal health

Evaluation of single-dose oral therapy with fluconazole in vaginal candidiasis

The efficacy and safety of single-dose oral treatment with fluconazole 150mg was evaluated in 40 patients with mean age of 26 years [range 18-42 years]. At the short-term follow up of 5-9 days after treatment, 85% of patients were clinically cured of showed improvement, while 70% of patients were mycologically and cured. At the long-term follow up of 4-6 weeks post-treatment. 77.5% of patients were clinically cured or improved where as 63% of patients were determined candida-free on microscpic/culture examination. No side effects were observed by the investigator or reported by the patients in this open, non-comparative study