influence of the mode of anesthesia on the neonatal well being after the caesarian delivery

To evaluate the influence of the mode of anesthesia on the neonatal outcome after the caesarian delivery. All the patients who were going to have a caesarian section were enrolled to the trial and their demographic data along with the Apgar Score and need for the NICU [Neonatal intensive care unit] admission, was entered in a specially designed proforma. After the data collection [from 1[st March 2010 to 28[th] February 2011] the data was entered in SPSS version 19 and was analyzed statistically. There were 1308 caesarian deliveries out of which 59.6% [n=779] were delivered electively while 40.4% [n=529] had an emergency delivery. The rate of general anesthesia versus spinal anesthesia was the same i.e. 59.2% [n=199] and 59.7% [n=580] respectively in elective delivery group and 40.8% [n=137] and 40.3% [n=392] respectively in emergency delivery group and this difference was found statistically insignificant. The Apgar Score of the neonates delivered to patients having general anesthesia was significantly poor as compared to the spinal anesthesia group and the rate of NICU admission is also high in general anesthesia group i.e. 10% [n=34] as compared to 5.8% [n=56]; this difference was also statistically significant [p=0.018]. Spinal anesthesia is associated with better neonatal outcome as compared to general anesthesia in both emergency and elective C/Section group.

Appropriate gestational age for elective C-section

Timing of elective caesarean delivery is a relevant public health issue. Neonatal outcome is associated with the duration of gestation at the time of delivery. Rate of C-section is increasing worldwide even in USA it increased from 20.7% in 1996 to 31.1% in 2006. The objective to determine the appropriate age of gestation for elective C-Section in order to have good neonatal outcome and decrease perinatal morbidity. It is a cross sectional study that is retrospective. It will be carried out in the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore from March 2011 to Nov. 2011. One hundred consecutive subjects who had elective C-Sections during the study period were included in the study. Gestation of pregnancy was correlated with the outcome of babies. The newborns were assessed by 5 minutes apgar score and by admission in neonatal unit. In a total of 100 patients 9 had C-Section at 39 completed weeks and 47 had C-sections at 38 completed weeks and 44 had C-Sections at 37 completed weeks of gestation. Most of the babies who had respiratory problems and shifted to nursery were those who were delivered at 37 weeks gestation. Timing of elective Caesarean delivery at term has a relationship and influence on neonatal outcome. The perinatal morbidity can be reduced by decreasing elective caesareans before 39 completed weeks of gestation

comparison of intravaginal misoprostol with prostaglandin E2 [dinoprostone] for induction of Labour at term

To compare the efficacy of Misoprostol and Dinoprostone used as labour inducing agents. The first 100 patients admitted in the labour ward of Shalamar Hospital Lahore for induction of labour between March 2003 and February 2004 and fulfilling the inclusion criteria were randomly allocated to the two drug trial groups and followed till outcome of the delivery. Parameters included induction to delivery interval, need for augmentation of labour, C-section rate, safety of drugs to mother and the neonate and the cost benefit rates. One case got dropped out on her personal choice and left the hospital. The remaining 99 were followed up. Among the vaginally induced Misoprostol group 56% women delivered vaginally within 12 hours, while in vaginally administered Dinoprostone group only 26% delivered within 12 hours. This difference was found statistically significant [p<0.05]. The rate of C-Section in the two groups was not found statistically different [p>0.05]. The most common side effect with Misoprostol was nausea while the patients in the other group experienced vomiting. Vaginally prescribed Misoprostol reduced the induction to delivery interval but did not effect the rate of C-Section. No increase in maternal or neonatal complications was observed. It was highly cost effective

Long term outcome of patients with endometriosis on medical treatment

To evaluate long term outcome of patients with endometriosis on medical treatment [OCP's, progestin, clomiphene citrate according to need of patients], in terms of symptomatic relief, successful conception, recurrence and treatment failure. This quasi experimental study was conducted in Shalamar Hospital Lahore. All patients who had confirmed diagnosis of endometriosis by laparoscopy or by laparotomy were included in the study after informed consent. Type of medical management was decided according to the need of the patients. The patients who did not want to conceive were given medical treatment in the form of combined oral contraceptive pills or progesterone. Patients who wanted to conceive, were given clomiphene citrate. Patients were followed up for 1 to 9 years. Study outcome was expressed in terms of symptomatic relief, pregnancy, recurrence and treatment failure. Data was analyzed using SPSS version 16. Initially, there were 94 patients who had confirmed endometriosis and were included in the study. Out of these,18 patients lost follow up, and were excluded from study. The mean age of these patients was 25 +/- 4.73 years and 50 percent presented with pelvic pain and 36% with infertility. They were followed for 1-9 years. The mean duration of follow up was 4.37 +/- 2.29 years. 61.8% cases became symptom free, 15.8% conceived successfully, whereas 9.2% had persistence of pain. 11.8% had recurrence rate over 12-14 months after discontinuation of medical treatment. Long term follow up of patients with endometriosis showed that medical treatment of endometriosis with COCPs, progestogens, and clomiphene citrate has promising results with less then 20% cases requiring other modes of treatment

effect of anaesthesia modus on amount of blood loss in cesarean sections

A cesarean section is the delivery of a baby through a incision in the mother's abdomen and the uterus. It is the most common major surgery that women undergo. In the UK about 1:4 pregnant women give birth by c/section every year. To compare the effect of spinal and general anaesthesia on the amount of blood loss during cesarean section. It is a cross - sectional study to be carried out at Shalamar Hospital. It was conducted in one year's time i.e. from 1st March 2010 to 28th February 2011. All the patients with low risk of bleeding were enrolled to the trial. The choice of anaesthesia was the patient's choice after counselling by the anaesthesiologist. The total number of patients enrolled to the trial were 1308 out of which 972 patients received spinal anaesthesia and 336 patients were given general anaesthesia. The Demographic data along with preoperative haemoglobin and haematocrite was recorded on the proforma designed for the purpose. The demographic data including age and gravidity was not statistically different in both the groups similarly the preoperative haemoglobin and haematocrite was also insignificantly different in both the groups. The mean amount of blood loss is 357 ml in the spinal group and 501 ml in the patients who received general anaesthesia, this difference is statistically significant. The postoperative haemoglobin and haematocrite is also significantly reduced in the patients who received general anaesthesia. The rate of transfusion is 14.6% [n = 49] in general anaesthesia group and 3.2% [n = 31] in the spinal anaesthesia group and this difference is also statistically significant. The study proves that spinal anaesthesia is a better choice of anesthesia as it reduces the amount of blood loss and requirement of the post-operative blood transfusion

Prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities

Polycystic ovaries are considered to be the most frequent cause of hirsutism with its prevalence of 10% of woman of reproductive age group. Polycystic ovarian syndrome [PCOS] reflects multiple potential etiologies and variable clinical presentations. To investigate the prevalence of polycystic ovaries among patients with hirsutism and menstrual abnormalities [oligo- or oligohypomenorrhea] and to correlate presence of hirsutism with BMI, polycystic ovaries, ovarian volume and biochemical markers. All patients who presented with oligo- or oligohypomenorrhea or hirsutism either in outpatient clinic of Obstetrics and Gynecology, Shalamar Hospital or a private laser clinic were enrolled in study. Patients who had hirsutism with normal menstrual cycle were excluded from study. Enrolled patients were categorized into two groups on basis of hirsutism, group 1: oligomenorrhea/oligohypomenorrhea with hirsutism and group 2: oligomenorrhea/oligohypomenorrhea without hirsutism. A detailed clinical history, clinical examination, hormonal profile and abdominopelvic ultrasound were done in all patients. SPSS- version 16 was used for statistical analysis. Out of 90 patients who enrolled in the study, 10 did not report back, so were excluded from study. Out of 80 patients with menstrual problem, 55 [68.7%] had hirsutism [group 1] and 25 [31.3%] had no hirsutism [group 2]. Prevalence of polycystic ovaries was 815% among patients with hirsutism and oligo/oligohypomenorrhea [group 1] as compared to 44% in patients with oligo/oligohypomenorrhea without hirsutism [group 2]. Ovarian volume >10ml and BMI were not statistically significant among both groups. Regarding hormonal profile, serum LH/FSH ratio and testosterone levels were significant among patients with hirsutism as compared to without hirsutism. Prevalence of polycystic ovaries by morphology, FSH/LH ratio and serum testosterone are significantly present among patients with oligo/oligohypomenorrhea and hirsutism as compared to those with oligo/oligohypomennorhea without hirsutism. However Ovarian volume and BMI are not statistically significant among both groups

Congenital adrenal hyperplasia with polycystic ovarian disease: a rare cause of hirsutism

Hirsutism may be defined as presence of terminal hairs in women with a male-like pattern of distribution. Hirsutism is related to serum androgen and cutaneous sensitivity to other hormones. The most prevalent causes of hirsutism are polycystic ovary syndrome and isolated hirsutism. Nonclassical congenital adrenal hyperplasia [21-hydroxylase deficiency] and drug induced type are less frequent rather rare causes. Diagnostic evaluations should address identifying etiology and its associated co-morbidities to properly manage the patients. We present a case of 22-year-old unmarried female who presented with hirsutism and on detailed evaluation she was diagnosed as a case of nonclassical adrenal hyperplasia and polycystic ovaries. Along with laser hair removal,proper treatment of underlying etiology led to reversal of her symptoms

Rupture of membranes in second trimester of pregnancy

The management of rupture of membranes at a nearly viability stage is still controversial. A case of a primigravida, who had rupture of membranes at 23 weeks of gestation, is reported. On conservative management, her pregnancy continued to 30 weeks and she delivered a normal fetus, who showed no abnormality till one year of follow-up