Bacterial vaginosis; comparison of vaginal metronidazole with vaginal clindamycin in the treatment of bacterial vaginosis

Bacterial vaginosis is the most common vulvovaginal infection and represents the 35% of all the infections occurring in women in the reproductive age. Serious forms of can induce several complications such as spontaneous preterm labour and preterm birth, late miscarriage and postpartum endometritis, PID, infertility, vaginal cuff infection and postabortal sepsis. To compare the efficacy of vaginal metronidazole and vaginal clindamycin in the treatment of bacterial vaginosis. Interventional: Quasi experimental study. Obstetrics outpatient department, Ghurki Trust Teaching Hospital, Lahore. Six months i.e. from 01-01-2009 to 30-06-2009. Mean age of patients was found to be 24.33 years. In the 100 patients enrolled, no statistically significant difference was found between Clindamycin 2% vaginal creams compared with metronidazole 0.75% vaginal gel using Amsell's criteria. Metronidazole has a failure rate of 13% while failure rate was 6% in the clindamycin group. A 3 day regimen of clindamycin 2% vaginal cream was as effective as 5 day regimen of metronidazole 0.75% vaginal gel in the treatment of bacterial vaginosis

Septicemia; As a sequel of induced miscarriage

lnduced Miscarriage is defined as the elective termination of pregnancy before 24 weeks of gestation. To determine the frequency of sepsis associated with induced Miscarriage. Cross-sectional survey. Department of Obstetrics and Gynaecoiogy, Unit-II, Ghurki Trust Teaching Hospital, Lahore. Six months from 25-12-08 to 24-06-09. Total 110 cases were taken. Complete history including parity and mode of admission was taken. All information was recorded on specially designed proforma. A large number of patients turned out to be para 3-4 i.e. 87 [79%], 15 cases [13.7%] had the parity between 5-7 and only 8 cases [7.3%] were para 1-2 [Table-l]. 0n analyzing the mode of admission it was found that 50 [45.4%] patients were admitted through out-patient department. 60 cases [54.6%]were admitted through emergency [Table-ll]. Finally the frequency of sepsis amongst women presenting with Miscarriage was calculated and it was found to be 25 [22.7%]. 85 [77.3%] cases did not show any evidence of sepsis [Table-lll]. Illegal Miscarriages are a major contribution to septic morbidity leading to a large number of maternal deaths which is a dilemma in under developed countries like ours. Better public awareness and access to contraceptive measures has a definite role to play in improving the outcome.

Emergency contraception; knowledge and attitude of family physician of a teaching hospital, Lahore

To assess the knowledge of family medicine health care providers and their attitude towards emergency contraception [EC] in Lahore Medical and Dental College and out-patient centers of Ghurki Teaching Hospital Lahore. Medline Data Base. Cross sectional descriptive study. 3 months period, from March to June 2011. Faculty physicians from different specialties, residents, and medical officers were included in the study. Data was collected on a structured pre-coded 21 -item questionnaire containing demographic profile of the respondents and questions concerning their knowledge, attitudes and beliefs towards emergency contraception. In total 85 interviews were conducted with the response rate of 100%. There were 43 faculty members [50%], 14 residents [16%] and 28 medical officers [32%], 51 male [60%], 34 female [40%] physicians, the majority 58 [68%] were married. Although 79 of the respondents [92.9%] reported considerable familiarity with EC, objective assessment revealed deficiency in their knowledge. Only 41 [48%] correctly chose menstrual irregularity not being most common side effect of Per oral emergency contraception [POEC] while only 28 [32.9%] of respondents answered that EC is not an abortifacient. Only 30 respondents [35%] had an opportunity to learn about EC through workshops. Among the barriers identified 27 respondents believe that as use of POEC would promote sexual promiscuity [31%] and 59 were concerned about birth defects/ side effects [69%].Religious and ethical barriers were also a concern in 57 [67%] and 62 [69%]] of the respondents respectively. Overall attitudes regarding emergency contraception were positive, however 45 [52.9%] were unsatisfied with their current knowledge and 77 [90%] were interested in learning more about EC. Physicians need more detailed information about EC, which would increase the application rate of the users and decrease their own prejudices

Effectiveness of transdermal glyceryl trinitrate patch

To determine the effectiveness of transdermal patch of glyceryl trinitrate as tocolytic agent. Interventional- Quasi experimental study. Department of Obstetrics and Gynecology Unit- 1, Services hospital, Lahore. One year [February 10, 2006 - February 10, 2007]. Fifty pregnant women with preterm labour were included in the study. 54% of pregnant women were between G2 - G4. Majority [48%] of the women presented between 31 - 34 weeks of gestation. 46% of pregnant women had bishop score of 4 or more. 64% of patients found to have no risk factor for preterm labour. Majority [86%] responded after application of second patch [10 mg glyceryl trinitrate patch]. 84% had no side effects. Local skin reaction [10%] and headache [4%] observed in few patients. 58% of pregnant women delivered after 48 hours and 78% of them delivered vaginally which was statically significant and majority of babies delivered weight more than 1.5 kg and with good Apgar score. It is concluded from the study that glyceryl trinitrate is a safer tocolytic, which has simple method of application; rapid onset of action with low cost, low risk from side effects and it does not require intensive monitoring

Obstetric outcomes; subsequent to stillbirth in the first pregnancy

To compare obstetric outcomes in the pregnancy subsequent to still birth with that following live birth in first pregnancy. Medline data base. Prospective cohort study. Ghurki Trust Teaching Hospital Lahore. The study included women who delivered a stillbirth between 2005 - 2007[exposed cohort]. A group of women with live birth [unexposed cohort] was matched for delivery within the same year, maternal age [ +/- 3 years], parity [ +/- 1]. In 2009, the charts of these women were examined for subsequent pregnancies. Main outcome measures Maternal and neonatal outcomes in the second pregnancy, pre eclampsia, placental abruption, labour induction, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth. The exposed cohort group B [n =50] was at increased risk of preeclampsia [44% versus 28%, p value = 0.001<0.05] and placental abruption [20% versus 2%] and malpresentation [18% versus 4%]. labour induction [20% versus 8%] instrumental delivery [16%versus 8%] and emergency caesarean [40%versus 16%]; and prematurity [62%versus 26%, p value = 0.001<0.05], low birthweight [86% versus 54%, p value = 0.000<0.05] and stillbirths [6% versus 2%, p value = 0.489>0.05] of the infant as compared with the unexposed cohort group A[n =50]. Majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a highrisk group with an increased incidence of adverse maternal and neonatal outcomes

Adenexal cysts;survey of ultrasonography, preoperative findings, histopathology

[1] To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. [2] To determine the relationship of age with type of ovarian tumour. [3] To categorize the management of these cases according to the intra-operative findings. [4] To analyze the occurrence of various histopathological types of tumour. Medline Study Single centered prospective descriptive study of 150 cases. Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to, 31st December 2006. 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain [53%] followed by menstrual disturbances [30%], abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management

Internal as to placental edge distance and mode of delivery in minor degree placenta previa

To determine the frequency of vaginal delivery cases of minor placenta praevia. This study was carried out at the Department of Obstetrics and Gynaecology and labour room of Ghurki Trust Teaching hospital for six months from 1-07-2007 to 3 1-12-2007. Total forty patients were included. A suspected diagnosis of placenta praevia on abdominal ultrasound was further assessed by TVS. Mean age of the patients was 22.80 +/- 3.77, Mean gestational age at last ultrasound was found to be 37.02 +/- 0.76 weeks. During labour, all patients were monitored for vaginal bleeding. APH occurred in 22.5%, However, in all cases, it was mild bleeding and no patient required emergency caesarean section because of haemorrhage. 80.0% patients delivered vaginally and 20.0% had emergency LSCS. In no case of caesarean section had to perform for APH. 200% patients had LSCS either because of fetal distress or failed progress of labour. The data of this study support the trial of vaginal delivery in cases with a placental edge to internal os distance more than 2cm, Because these patients have high likelihood of normal vaginal delivery and decrease chances of significant anteparturn haemorrhage

Ovarian response to ovulation induction

Objective: to analyze the response of ovaries to ovulation inducing agents

Patients and Methods: study period was _ June 2006 to December 2008. Study design was observational study. 833 patients were enrolled in this study. Different ovulation inducing agents were used to stimulate the ovaries. The median age was 26 years with a range of 21-39 years. Follicular development was assessed in both ovaries by TVS and endometrial thickness was noted on day 11 of the cycle. Data was analyzed by SPSS Version 11.0

Results: 37.82% patients showed f9tliculatdeyelqpment in both ovaries; 34.9% patients showed dominant follicle in right ovary while18.97% showed follicular development in· left ovary alone. Endometrial thickness was better in association with right sided follicular development

Conclusion: it was seen-that-right-ovary showed a better response to ovulation inducing agents as compared to the left ovary. Endometrial thickness was evaluable on day 11 showing growth. The significance of this finding is unclear and more studies need t9be done to confirm this finding

Twin pregnancy one sac with missed miscarriage, second with molar pregnancy

A 32 years old lady G4P2A1, presented with gestational amenorrhoea of 13 weeks and complain of vaginal bleeding one week back. Ultrasound examination revealed an irregular gestational sac with no fetal pole and another well circumscribed mixed echogenecity lesion filling the whole of uterine cavity. Features were consistent with molar pregnancy. Suction curettage was done. Histopathology report revealed complete hydatidiform mole and missed miscarriage

Post menopausal bleeding in patient with infantile uterus

A 58 years old female patient married for 40 years, nulliparous, presented in outpatient department with the complaint of postmenopausal bleeding off and on for six months. Her total abdominal hysterectomy and bilateral salpingoopherectomy was performed. Uterus was small in size [infantile]. Histopathology revealed endometrial hyperplasia with atypia

Comparison of mini laparotomy and laparoscopic ovarian drilling in management of polycystic ovarian disease

Objective: To evaluate the intra-operative and post operative morbidity associated with minilap and laparoscopic ovarian drilling in patients with polycystic ovarian disease

Setting and Duration: Gynae Unit I of Jinnah Hospital Lahore and Ghurki Trust Teaching Hospital, Lahore and Surgimed Hospital Lahore from January 1999 to June 2004

Patients and Methods: A total of 76 patients were included in this study. All patients required ovarian drilling. Patients were randomized into 2 groups - one undergoing laparoscopic drilling [36 patients] and the other group had drilling via minilap [40 patients]. The intra operative complications and post operative morbidity were analyzed

Results: 36 patients had ovarian drilling via laparoscopy. Bleeding was seen in 6 [16.6%] patients, in 2 [5.5%] patients laparotomy had to be done to control bleeding; visceral perforation was seen in 2 [5.5%] patients. Of 40 patients undergoing laparotomy, bleeding was seen in 1 [2.5%] patients only. No visceral perforation was seen in this group. Easy approachability was seen in the minilap group. The duration of hospital stay in both groups was 1.5 days

Conclusion: Mini laparotomy as a route for ovarian drilling is a safer option; with no increase in duration of hospital stay and is associated with lower morbidity

Management of ovarian cyst during pregnancy

Objective: To determine the optimum management of ovarian cyst in association with pregnancy

Setting and duration: From January 1999 to December 2003 in Gynae Unit I, Jinnah Hospital Lahore and Ghurki Trust Teaching Hospital, Lahore

Patients and methods: 21 patients were included in this study. All patients presented in early 2nd trimester of pregnancy [14-26 weeks]. Simple ovarian cysts were seen in 20 patients. One patient had a multiseptate cyst and had cystic and solid areas

Results: 2 [9.52%] patients had laparotomy for cyst removal in the puerperium; 4 [19.04%] had cystectomy at the time of LSCS while 71.4% [15 patients] had laparotomy for ovarian cystectomy during pregnancy due to torsion. The histopathology report was follicular cysts in 20 patients [95.23%] while 1 [4.76%] had a germ cell tumour. This patient was given PEB [cisplatin, epirubicin and bleomycin] chemotherapy after 20 weeks of gestation

Conclusion: Ovarian cyst in combination with pregnancy is seen in 0.01% of pregnancies. Management depends upon the presentation and symptoms. Laparotomy done in the 2,d trimester usually does not cause fetal loss. The cysts are usually benign with malignancy seen very rarely

analysis of fetal and maternal morbidity and mortality in retained second twin

To evaluate the maternal morbidity, fetal morbidity and mortality related to retained second twin. Design: A prospective study. Place and Duration of Study: Jinnah Hospital, Lahore from July 1996 to March 1998. Materials and Patients presenting to the labor ward after having delivered the first twin at home and with retention of the second twin in utero were included in the study. A total number of 7 patients were included in this study. Result: Malpresentation was seen in 3 patients [42.83%] and uterine inertia in 2 [28.57%] were found to be the commonest reasons for causing retention of second twin, while uterine inertia and malpresentation together was seen in 1 patient [14.28%] and cephalopelvic disproportion in 1 patient [14.28%]. The perinatal mortality rate was 71.42%. Maternal morbidity like fever was seen in 4 patients [57.14%], while postpartum hemorrhage was seen in two patients [28.75%]. Blood transfusion was required in 5 patients [71.42%]. Complications like scar dehiscence was also seen. In postpartum period breast engorgement requiring treatment with bromocriptine was seen in 3 patients [42.83%]. Retained second twin is associated with a high perinatal mortality rate and also causes increased morbidity in mother. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high risk pregnancy and its associated problems at birth; and the problem of retained second twin should not be allowed to develop in a teaching hospital

Feasibility of secondary cytoreductive surgery for recurrent epithelial ovarian cancer

To determine the feasibility of secondary cytoreductive surgery in patients who present with recurrent epithelial ovarian tumors. Design: Retrospective and prospective. Place and Duration of Study: Gynaecology Unit II of Jinnah Hospital Lahore. Study period extended from July, 1996 to March, 1998. Materials and A total number of 21 patients, who had undergone initial optimal cytoreductive surgery and combination chemotherapy but had relapsed after a disease-free interval of 6 months or greater, were included. All patients were subjected to secondary cytoreductive surgery. Optimal secondary cytoreduction was possible in 8 [38.09%] patients. 11[52.38%] patients had suboptimal cytoreduction, while 2 [9.52%] were inoperable. The intraoperative morbidity showed injury to the intestine occurred in 3[14.28%] of the patients, severe hemorrhage in 4[19.05%] and visceral perforation in 2[9.52%] patients. There was no operative mortality. Secondary cytoreductive surgery for recurrent epithelial ovarian cancers is a feasible approach but is associated with significant morbidity. Further studies with larger number of patients are needed to clearly define the role of secondary cytoreduction in recurrent epithelial cancer