Maternal and perinatal outcome of preeclampsia and eclampsia treated with magnesium sulphate

Objective: to determine the maternal and perinatal outcome of pre-eclampsia and eclampsia treated with magnesium sulphate

Study design: interventional study

Place and Duration of study: department of Obstetrics and Gynecology Unit-I, Jinnah Postgraduate Medical Centre Karachi, from May 2012 to April 2014

Methodology: all patients admitted with pre-eclampsia and eclampsia were included. After taking detailed history and clinical examination they were treated with magnesium sulphate [MgSO[4]]. Patients were monitored for recurrent fits, side effects of MgSO[4], and causes of discontinuation of treatment. Maternal outcome in terms of mode of delivery, number of maternal deaths and perinatal outcome in terms of perinatal death and APGAR scores were recorded

Results: the study was conducted on 50 pre-eclamptic patients [Group-I] and 100 eclamptic patients [Group II]. Mean age of patient in group-I was 26.94 +/- 5.5 year and in Group-II 24.32 +/- 5.8 year. High frequency of eclampsia [n=61, 61%] was found in antepartum cases. Majority of patients [n=79, 52.6%] were primigravidae in both the groups. In group-II five patients had recurrence of fits. There were seven maternal deaths due to eclampsia but none of the deaths was attributed to magnesium sulphate therapy. Overall perinatal mortality was 30.7% [n=46]

Conclusions: recurrence of seizure was seen in only 5% eclamptic women and none in those with severe pre-eclampsia. Magnesium sulphate was found effective in treatment as well prophylaxis of eclampsia

Feto-maternal outcomes in women with congenital heart disease

To determine Pregnancy Outcomes in Women with Congenital Heart Disease. Cross sectional study. This study was conducated at Obstetrics and Gynaecology ward 9 Jinah Postgraduate Medical Centre Karachi and National Institute of Cardiovascular Diseases [NICVD], from May 2008 and January 2011. All Pregnant women with congenital heart disease presenting at OPD of National Institute of Cardiovascular Diseases delivering at Obstetrics and Gynaecology ward 9 Jinah Postgraduate Medical Centre Karachi were included. Cardiac complications were subdivided into primary and secondary Cardiac events. A primary cardiac event consisted of cardiac death, cardiac arrest, stroke, symptomatic sustained bradyarrhythmia or tachyarrhythmia requiring therapy, or pulmonary edema documented by physical examination or radiography. Decline in >/= 2 NYHA functional classes, need for urgent invasive cardiac interventions during pregnancy or within 6 weeks postpartum, and symptomatic nonsustained bradyarrhythmia or tachyarrhythmia requiring therapy were considered secondary cardiac events. Obstetric events consisted of preeclampsia, postpartum hemorrhage, and noncardiac death. Neonatal events were defined as preterm delivery [<37 weeks of gestation], birth weight small for gestational age respiratory distress syndrome, cerebral intraventricular hemorrhage, fetal death or neonatal death. Spontaneous abortion was defined as fetal loss before 20 weeks of gestation. 36 women with congenital heart disease. Spontaneous abortions occurred in 6 pregnancies at 10.8 +/- 3.7 weeks, and 2 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.6% and sustained arrhythmias in 8.3%. Adverse neonatal outcomes occurred in 27.7% of ongoing pregnancies and included preterm delivery [19.4%], small for gestational age [8.33%], respiratory distress syndrome [833%], intrauterine fetal demise [2.77%], and neonatal death [2.77%]. Feto-maternal outcome in women with congenital heart disease can be improved further with proper management and counseling

Oral versus vaginal misoprostol for induction of labour at term

To compare the safety and efficacy of misoprostol through oral and vaginal routes for induction of labor at term. Cross-sectional comparative study. Department of Gynecology and Obstetrics, Ward-9, Jinnah Postgraduate Medical Centre Karachi, from October 2004 to March 2005. Two hundred term patients meeting inclusion criteria for induction of labour were selected using non-probability convenient sampling technique. They were allocated to two groups to receive misoprostol 50 micrograms [micro g] either by vaginal or oral routes. The dose was repeated at an interval of 4 hours till Bishop score improved or need arose for intervention. Results were analyzed through software SPSS version 10.0. Mean induction-delivery [I-D] interval were similar in both groups; vaginal [9.09 +/- 3.4 hours] and oral [9.81 +/- 4.43 hours p=0.33]. Oxytocin augmentation and analgesia requirement were also not statistically significant [p=0.5]. Only one patient had uterine hyper stimulation in the vaginal group. There was no significant difference between the groups with regard to caesarean section rate, maternal complications like post partum haemorrhage [PPH] and neonatal outcome. Oral misoprostol has the potential to induce labour as safely and effectively as its vaginal analogue

Alternative to surgical evacuation of uterus: misoprostol for post-abortion care

To compares the effectiveness of single 600 micrograms [micro g] dose of sublingual misoprostol with manual vacuum aspiration [MVA] for treatment of incomplete and missed abortions. Quasi- Experimental study. Post-abortion care room, Jinnah Postgraduate medical centre [JPMC] Karachi, from September 2008 to December 2008. Hundred consenting women with incomplete and missed abortions were randomized to either a single dose of 600 micrograms of sublingual misoprostol or MVA for treatment of their condition. Main outcome measure was complete abortion following initial treatment. Secondary outcome measures were satisfaction rate and acceptability of the method. Regardless of treatment assigned, nearly all participants had a complete uterine evacuation [Misoprostol =92% MVA= 100% p=0.12]. A slightly more satisfaction rate was observed in the misoprostol group [p=0.001] as 86% participants expressed desire to choose misoprostol again while the number was 76% in MVA group. Sublingual misoprostol is as safe and as effective as manual vacuum aspiration for post-abortion care

Spontaneous rupture of primigravid uterus due to morbidly adherent placenta

Morbidly adherent placenta in a nulliparous woman is a rare phenomenon. An unusual case of a 20 years old primigravida presented in emergency with unstable haemodynamics and abdominal pain at 17 weeks of gestation is reported. She was found to have complete placental invasion and heamoperitoneum on laparotomy. Although there is an increased risk of placental invasion [increta and percreta] causing uterine rupture in previous caesareans but morbid adhesion resulting in placenta percreta without previous uterine surgery is a rarity. Exact pathogenesis is still unknown. Prenatal diagnosis with the help of Doppler ultrasound and MRI is important to reduce both fetal and maternal morbidity and mortality

Comparing effects of spinal versus general anesthesia in patients undergoing emergency cesarean sections: an obstetrician's view

Objective: to compare the maternal and neonatal effects of spinal versus general anesthesia in terms of quality of analgesia, muscle relaxation, blood loss during surgery, postoperative analgesia requirement and apgar score

Study design: comparative study

Place and duration: department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, from July 2004 till June 2005

Patients and methods: total 250 patients were included in the study. Informed consent was obtained. Spinal anesthesia [SA] was given to 100 patients and General anesthesia [GA] to 150 patients. Maternal effects were observed in terms of quality of analgesia, muscle relaxation, blood loss and postoperative analgesia requirement. Neonates were assessed by Apgar score. Results were analyzed through SPSS version 10.0

Results: in the Spinal group, quality of analgesia and muscle relaxation was excellent [CI=95%]. Blood loss and amount of blood transfusion was significantly less [p=0.001] in the spinal group. Apgar score at 1 minute was better in the spinal group but the difference at 5 minutes was insignificant. Postoperative analgesia requirement was also significantly less [p-value <0.001]. There was one mortality due to Total Spinal block

Conclusion: there remains no doubt that spinal anesthesia, whenever medically feasible, is superior to general anesthesia in emergency cesarean sections

Therapeutic termination of second trimester pregnancies with low dose misoprostol

To determine the effectiveness of 50micro g misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester [14-26 weeks] of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder [hypertension or diabetes] or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50micro g misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 [range 4-48 hours]. Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4 +/- 15.9 hours in alive fetuses [t -value:1.9, p: 0.05]. Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 micro g misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect