Laproscopic evaluation of primary infertility causes and post procedure complications among infertile females from a tertiary care hospital of Karachi

Background: Infertility is a common problem globally affecting a large proportion of world population. Laparoscopy provides meaningful information regarding different factors that may cause infertility

Objective: To determine the frequency of causes of primary infertility in women by diagnostic laparoscopy

Study Design: Cross sectional study design

Setting: Study was performed at the Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi

Duration: September 2011 to February 2012

Subjects and Methods: 86 patients with primary infertility were included in the study and underwent laparoscopy for determining causes of infertility. Data was analyzed on SPSS, frequencies and percentages were determined for qualitative variables while mean and standard deviation was determined for quantitative variable

Results: Eighty six females were included in the study with mean age of 28.6 + 5.2 years and mean duration of infertility was 4.9 + 1.9 years. Findings on laparoscopy were analyzed and 51.2% of females were found with tubal blockage, while other findings were; hydrosalpinx in 25.6%, PCOs in 22.1%, Ovarian abnormalities in 38.4%, Pelvic adhesions in 38.4% and uterine congenital anomalies in 3.5%

Conclusion: Tubal diseases found to be one of the major factor causing primary infertility and diagnostic laparoscopy will play a valuable role in early and prompt diagnosis and management of causes leading primary infertility

Perinatal outcome in pregnant patients with moderately severe mitral stenosis

To determine the frequencies of prematurity, low birth weight babies and perinatal deaths in pregnant women presenting with moderately severe mitral stenosis. Descriptive case series. Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre Karachi, from October 2008 till April 2009. Pregnant women with moderately severe mitral stenosis [mitral valve area <2cm2] fulfilling inclusion criteria, selected through antenatal clinic were included in the study. Perinatal outcome in terms of prematurity, low birth weight, and perinatal mortality were assessed. There werea total of 54 pregnant women with moderately severe mitral stenosis managed during the study period. Preterm babies numbered 22[40.7%], low birth weight babies [<2.5kgs] were found in 17 [31.5%] cases and perinatal mortality seen in 7[13%] cases. Encouraging perinatal outcome was observed in this study which was targeting very high risk cardiac patients

Primary PPH; Role of uterine packing in control of haemorrhage

To determine the effectiveness and safety of uterine packing in selected cases of primary postpartum haemorrhage. Cross-sectional study. The study was conducted at Jinnah Postgraduate Medical Centre, Karachi, From September 2003 to April 2008. Women developing primary PPH due to uterine atony, placenta previa and coagulation failure were selected for uterine packing. Firm packing was done with enormous length of sterile ribbon gauze, using 'layering technique' under prophylactic antibiotic cover. Vagina was also packed to give additional pressure. Pack was removed after 12 - 36 hours or early in case of failure to control haemorrhage. Pulse, blood pressure, soakage of pads, height of uterine fundus and temperature were monitored to assess effectiveness and safety. 39 women were included in the study. Cause of PPH was uterine atony in 30 [76.9%], coagulation failure in 5 [12.8%] and placenta previa in 4 [10.3%] cases. Packing was successful in arresting haemorrhage in 32 [82.1%] and failed in 7 [17.9%] cases; 95% Confidence Interval 67-91. There was no case of concealed haemorrhage, four patients developed emdometritis and none had delayed haemorrhage. 13 laparotomies were prevented. The difference between the causes of haemorrhage in successful and failed cases did not show a definite trend. If employed early, uterine packing is a quick, effective and safe method for controlling primary PPH in carefully selected cases

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

study of abruption placentae

To determine the frequency of abruptio placentae and to find out associated risk factors and out come. Cross-sectional study. The Department of Gynaecology and Obstetrics Unit II, Jinnah Postgraduate MedicalCentre [JPMC], Karachi over one year period from July 2004 to June 2005. This study includes those patients who were brought to JPMC, Karachi with abruptio placentae after 28 weeks of pregnancy. Local causes of bleeding per vagina, placentae previa and ruptured uterus were excluded from the study both clinically and with the help of ultrasound. Total number of deliveries during one year from July 2004 to June 2005 was 4497. Total number of patients with placental abruptio were 102, making an incidence of 1:44 deliveries [2.26%]. Eight cases were booked while rest of the patients were nonbooked. Hypertension, preeclampsia [37.2%], anaemia 34.3% and grand multiparty were most common associated risk factors. Maternal age had no significant relation to occurrence of abruptio placentae. Most of the patients presented with bleeding per vaginum [93%] followed by onset of labour pains [80%]. Maternal morbidity was high. Most common complication was anaemia 34.4% followed by post partum infection [> 14%] Perinatal mortality was significantly high [62.5%]. There was only one maternal death due to irreversible shock. Incidence of abruption placenta is high [2.26%]. Resultant maternal morbidity and perinatal mortality is significant. This calls for early detection, regular visits, and special surveillance. There should be timely referral to tertiary care centre

Placenta percreta: a rare catastrophe

To document the clinical presentation, risk factors, management and management of placenta percreta. Case series. A 5 year study from January 2001 to December 2005 in Gynaecology and Obstetrics department, Unit II, Jinnah Postgraduate Medical Centre, Karachi. This study included patients of placenta percreta who were either diagnosed on ultrasound during antenatal period or accidentally found at exploratory laparotomy or caesarean section. A total of 11 cases of placenta percreta were managed during the study period. The frequency of the lesion was 1: 2058 deliveries. In 7 patients placenta had invaded and perforated the uterine wall, in 3 patients it had invaded the urinary bladder as well and in one patient there was broad ligament invasion. Most common risk factors were previous caesarean section [CS] in 91 percent cases and placenta previa [91 percent] followed by curettage [9 percent]. Hysterectomy was performed in all patients. Partial cystectomy and bladder repair was done in those cases where urinary bladder was invaded. Urinary bladder injury occurred in two [27.27 percent] patients. Two patients died, one due to irreversible shock and other due to acute renal failure. Placenta percreta is a rare catastrophe associated with high maternal morbidity and mortality. Early diagnosis and surgery following adequate resuscitation should be accomplished with multidisciplinary team

Acute inversion of uterus

Twelve patients with acute inversion of uterus were admitted in the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Centre, Karachi over a period of 2 years from January 1997 to December 1998. The total number of deliveries during this period was 12866 making an incidence of acute inversion of uterus 0.093 percent [1:1072]. None of the patients were booked in Jinnah Postgraduate Medical Centre. All patients were admitted in emergency. Most common presenting features were shock in 75 percent [95 percent Cl, 45.8-93.21] of the admission and postpartum haemorrhage 66.6 percent, [95 percent CI, 37.7-88.4]. Three out of 12 patients were dead on arrival. The maternal mortality was found to be 25 percent

Rupture of uterus at term

Analysis of 195 cases of ruptured uterus admitted in the department of Gynaecology and Obstetrics JInnah Postgraduate Medical Centre, Karachi was made over a period of live years from 1st January 1989 to 31 st December 1993. The total number of deliveries during this period was 35468 making the incidence of ruptured uterus 0.55% [1:182]. Out of these 195 cases 27 were booked while the rest were admitted in emergency. The most common cause was rupture of the previous caesarean section scar other causes being obstructed labour injudicious use of oxytocics and trauma. The maternal mortality in this series was 8.72% and foetal mortality 72.82%

study of twenty-two cases of tropical splenomegaly and chloroquine therapy

Twenty-two adults [14 male and 8 female] who presented with tropical splenomegaly syndrome [TSS] were studied. The majority [77.2%] had complaints related to a grossly enlarged spleen while 91% had anaemia [Hb <10g%] which was microytic hypochromic in 13 [59%] and normocytic normochromic in 9 [41%]. IgM values were raised in 86.6% of patients; it had no relation to the size of spleen. Ultrasound examination of the abdomen showed normal echotexture of the liver in 18 [81.8%] patients and diffuse liver abnormality in 4 [18.2%] with a mean portal vein size of 11 mm. Histopathological examination of the liver revealed normal liver architecture, sinusoidal and periportal lymphocytic infiltration and Kupffer cell hyperplasia in all patients. A good clinical response was observed in all patients by laboratory parameters after long term chloroquine therapy