Fetomaternal outcome of pregnancy with Mitral stenosis

Objective: To evaluate the frequency of fetomaternal outcome of pregnancy with Mitral stenosis admitted in Civil Hospital Karachi. Methods: It was a two years descriptive study done in the Department of Obstetrics and Gynaecology Civil Hospital Karachi. All pregnant women with a known or newly diagnosed Mitral stenosis on echocardiography were included in the study. History was taken regarding age, parity, gestational age [calculated by ultrasound] and complaints. Mode of delivery and Maternal mortality noted. Foetal outcome was analyzed by birth weight and Apgar score. Results: A total of 101 patients meeting the inclusion criteria were enrolled in the study. The ages of the women ranged between 20-29 years [69%] and 81% were multigravidas. Vaginal delivery occurred in 67 [66.3%] women and 78.3% were term pregnancies. Preterm deliveries were 21.8% and 27.7% newborns were low birth weight. APGAR score <7 was found in 14.9% of neonates and 9 babies had intrauterine death. Low ejection fraction<55% was diagnosed in 20[13.9%] women and Maternal mortality was found in two cases. Conclusion: Heart disease in pregnancy is associated with significant morbidity, it should be carefully managed in a tertiary care hospital to obtain optimum maternal and foetal outcome

Pregnancies with meconium stained liquor

To assess the frequency of meconium stained liquor and related factors. Descriptive case series. This study was conducted in the Department of Obstetrics and Gynaecology Unit IV, Lyari General Hospital Karachi, from April 2010 to March 2011. All women with gestational age of at least 37 weeks, with cephalic presentation and presence of meconium on vaginal examination were included. Patients with multiple gestation, mal presentation, previous scar, fever and fetal malformation were excluded from the study. Personal data, history, examination, investigations and labor findings were recorded. During the study period the total numbers of deliveries conducted were 908. Out of these 7.7% women had meconium stained amniotic fluid. Grade I meconium was present in 15 [21%] cases, grade II in 19 [27%] and grade III in 36 [51%] cases. Obese multigravidas accounted for majority of cases as compared to primigravidas. Gestational age and postdate pregnancies had no significant impact on meconium stained amniotic fluid [MSAF]. Most of the women [64%] had spontaneous vaginal delivery. Meconium stained amniotic fluid was found in 7.7% cases and more than 50% were of grade III type. Most of the women were multigravida and 67% were moderately anemic

Chemoprophylaxis in caesarean section

To determine the usefulness of two different regimens of antibiotics on post caesarean infectious morbidities. A comparative study drug trial. Department of Obstetrics and Gynaecology Lyari General Hospital and private hospitals of Karachi, from January 2009 to June 2009. Patients who underwent caesarean section were recruited. The patient were divided into two groups of 74 each. Group A received triple antibiotic therapy including injection cephradine, aminoglycoside and metronidazole for first 48 hours. Followed by oral therapy for 5 days. Group B received injection ceftriaxone and metronidazole for first 48 hours followed by oral therapy for 5 days. In both groups therapy was started before skin incision. Those who had established infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the antibiotics used, were excluded. Patients were assessed post operatively for infectious complications including febrile illness, dysuria, offensive lochia and abdominal wound infection. No significant difference was found between the two groups. Complications found were febrile morbidity [23.0% Vs 18.7%], urinary tract infection [13.3% Vs 16.0%] wound infection [14.7% Vs 10.7%] and lochia [6.7% Vs 8.0%] respectively in Group A and Group B. There was a significant difference in terms of cost effectiveness of 3[rd] generation cephalosporin that was more. Both first and third generation cephalosporins are equally effective in caesarean section as prophylaxis

Emergency contraception: knowledge and attitude among females

To assess women's knowledge of emergency contraception. Descriptive study. Gynaecology Unit IV, Lyari General Hospital Karachi, In January 2009. Women aged between 18 to 45 years visiting Gynaecology OPD at Lyari General Hospital Karachi were interviewed and responses entered in a specially designed questionnaire of knowledge and attitude about emergency contraception. Of the 300 respondents, 129[43%] had practiced contraception while 9[3%] admitted to having an induced abortion. Only 144[48%] had heard of emergency contraception [EC]. 123[41%] knew only about hormonal method of EC. Only 6[2%] knew the correct timing of EC. Six requested for EC previously. Many women were uninformed about the action and timing of EC. Health facilitator should educate masses about EC, emphasizing available methods and correct timing of use

Caesarean section rate: current trends

To determine the rate and analyze indications of caesarean section. Observational study. The study was conducted in Obstetrics and Gynaecology Unit four, Sindh Govt Lyari General Hospital attached to Dow University of Health Sciences from April 2005 till March 2006. All pregnant women booked in antenatal clinic and unbooked patients admitted in early labour on whom caesarean section [CS] was performed, were included in the study. The medical records of all patients were examined to study the socio-demographic variables, nature of procedure and the indication of abdominal delivery. The total number of births during study period were 930 of which 186 patients underwent caesarean section which makes 20% caesarean section rate [CSR] in our unit. Out of 186 CS done, 144 were performed in emergency and 42 as elective cases. The mean age was 30 years and the mean parity was 1.9. Primigravidas were 71[39%], multigravidas 75[40%] and grandmultiparas 40[21%]. Commonest indication for caesarean section was repeat caesarean section. Failed progress of labour was the 2nd commonest indication among the 15% of cases. Obstructed labour and fetal distress were indications in 9.6% of cases. Other indications include breech presentation, ante partum hemorrhage, hypertensive disorders, twin pregnancies and transverse lie. The most effective mean to control increasing CSR is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous C-section, selective vaginal breech delivery and regular audit of C-section in the department

Conjoined twins in a triplet pregnancy

Conjoined twin is a rare event. Triplet pregnancy in conjunction with conjoined twin is even rare. In this report we present the outcome of female, monochorionic, diamniotic triplets consisting of two monoamniotic conjoined fetuses and a normal baby in separate amnion. Emergency cesarean section was done due to non progress of labor in a female who was un-booked case. Conjoined twins [thoraco-omphalopagus] died due to birth asphyxia during the section while third baby was normal and remained well