Role of malignancy index in prediction of malignancy in ovarian masses preoperatively

To determine the diagnostic accuracy of risk of malignancy index [RMI] in the preoperative prediction of malignancy in ovarian masses by taking histopathological findings as gold standard. Cross-sectional survey. This study was conducted at Gynae Unit 111, Lady Willingdon Hospital Lahore and duration was one year from 1.1.2013 to 31.12.2013. 140 cases were recruited for the study. Blood drawn for serum Ca-125 level and sent to hospital laboratory and pelvic ultrasound was done. For each risk of malignancy index was calculated value of RMI >/= 200 was taken as positive. Patients were having the mean age 55.8+/-7.6. Comparison of malignancy index vs. histopathology for prediction of malignancy in ovarian masses showed 64 malignant cases on histopathology and 69 on RMI.Sensitivity rate: 89.0%, specificity: 84.2%, diagnostic accuracy: 86.4%, PPV: 82.6% and NPV: 90.1%.The menopausal status, serum CA125 levels and ultrasound reports accumulated together can give us risk of malignancy index which can provide the odds of development of ovarian malignancies

Postpartum haemorrhage; comparison of intra umbilical and intra venous injection of oxytocin on blood loss in third stage of labour

The most common complication 0f the third stage of labour is postpartum haemorrhage, which remains a leading cause of maternal mortality [25.0%], especially in developing countries. In developed countries, 3-5% of deliveries are complicated by postpartum haemorrhage: in developing countries, it is 50 times more common .Third stage of labour which exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage and puerperal infection. The best preventive strategy for these complications is active management of third stage of labour. Active management includes administration of oxytocin within one minute of birth of baby. To compare the mean blood loss after administration of intra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active management of third stage of labour. Randomized controlled trial. Six months from 1-1-2013 to 30-06-2013. Department of Obstetrics and Gynaecology, Unit-III Jinnah Hospital Lahore. 100 patients fulfilling selection criteria were included in the study from labour room. These patients were randomly divided into two groups by using lottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml of normal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocin intravenous stat at anterior shoulder. Total blood loss was noted after complete delivery of placenta. Mean age was 25.0 +/- 3.9 and 24.4 +/- 3.5 in group-A and B, respectively. Mean gestational age was 38.20 +/- 0.96 weeks in group-A and 38.40 +/- 0.94 weeks in group-B. Mean blood loss in intraumbilical oxytocin group was 311.20 +/- 27.23 ml and in intravenous oxytocin group mean blood loss was 373.60 +/- 66.47 ml. There was statistically significant difference between two groups [p<0.001]. In group-A 15 patients [30.0%] and in group-B 20 patients [40.0%] were primigravida while remaining patients were multigravida. The usage of intraumbilical oxytocin in active management of third stage of labour is beneficial in reducing the blood loss in third stage and thus helps in preventing postpartum haemorrhage

Backache in pregnancy; role of physiotherapy in its relief

Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant women worldwide. To find an association between backache and pregnancy with respect to obesity and to evaluate the effect of physiotherapy for relief of pain. This longitudinal observational and randomized control study was conducted on pregnant females for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients [BMI >29.9] and non obese patients [BMI<29.9]. All information was recorded on a Performa that was later entered and analyzed using SPSS-11.5. The mean age of all patients was 33.67 +/- 6.73 years with overall average gestational age of 27.47 +/- 5.19 weeks. Flexed posture was observed in 90[60%] patients and 60[40%] had very bad sitting habit. There were 80 [53.3%] obese and 70 [46.7%] non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine. Most females reported that pain started during the 1[st] trimester [110] but only 40 females reported that they developed pain in the 2[nd] trimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 [33%] patients who had severe backache while 100 [66.7%] had worse possible pain which was regressed to no pain in 140[93.3%] patients at final follow up visit and only 10 [6.7%] had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant. Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. We conclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also, more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapy can be recommended as the first line treatment for pregnant females

study of vesicovaginal fistula repaired by vaginal route at fistula centre Lady Willingdon hospital, Lahore

Vesicovaginal fistula is an abnormal communication between bladder and vagina that allows the passage of urine through vagina leading to continuous dribbling of urine. According to WHO in developing countries, 5 million of women each year suffer severe maternal morbidity in which obstetric fistula is on the top of the list. To determine the outcome of vaginally repaired vesicovaginal fistula [VVF]. Descriptive case series study. This study was conducted at Fistula centre Lady Willington Hospital/King Edward Medical University for a period of one year from Jan 2010 to Dec 2010. This Descriptive case series was carried out for a period of one year in which 60 cases of VVF were included who were repaired by vaginal route and were followed by symptoms assessment like incontinence of urine and signs like soakage of pads were noted. The patients of 20 - 60 years of age who developed vesicovaginal fistula after obstructed labour or after surgeries like caesarean section, total abdominal hysterectomy, vaginal hysterectomy and operative deliveries whose vesicovaginal fistulae were repaired by vaginal route were included in the study, whereas those patients who developed VVF after malignancy and radiotherapy, or repaired by abdominal route and uretric fistulae were excluded from the study. Data was entered and analyzed on SPSS version 18.0. Majority of the patients included in the study 29 [48%] were between 31-40 years and minimum patients were between 20-30 years old with overall mean age of 44.59 +/- 3.12 years and 6 [10%] patients were diabetic. Among 50 cases of first attempt, the success rate at primary repair was achieved in 48 [96%] patients and only 2 [4%] cases were unsuccessful. The success at secondary repair was achieved in 4 patients [66.66%] and failure in 2 patients [33.33%], four patients were operated third time and surgery was successful in only one case. The success of procedure was significant in 1[st] attempt, p-value = 0.0000. Follow-up visit after 3 weeks soakage of urine [after removal of Foleys catheter] was seen in 6 [10%] patients, follow-up after 3 weeks by dye test proved 7 [11.66%] of cases. Incontinence of urine was found in 6 [10%] of patients. Transvaginal route of VVF repair has better outcome and primary repair is more successful, p-value = 0.0000

Iatrogenic vesicovaginal fistula

To find the frequency of iatrogenic VVF in patients admitted for repair of VVF in Lady Willingdon Hospital, Lahore. An observational study. Lady Willingdon Hospital, Lahore, from January 2007 to December 2008. All cases of VVF treated at the centre during the study period were included in the study. The patients were admitted and evaluated through detailed history, physical examination, relevant investigations and evaluation under general anaesthesia [EUA]. Iatrogenic VVF was defined as the one following gynaecological procedure. Repair was done through abdominal or vaginal route based on the findings of EUA. Results of repair were noted and analyzed using SPSS version 12. Iatrogenic cases of VVF made more than half of the total cases [54%] while 46% were due to obstructed labour. Women under the age of 40 years, made up 77% of the total cases. The success rate for repair of VVF was 87%. This study shows that iatrogenic injuries in women under 40 years of age form a major share in the etiology of VVF requiring a check on the experience of surgeons doing the gynaecological and obstetrical surgeries in a developing country