Perinatal outcome in low ammniotic fluid index

In high risk pregnancies, there is a dire need to assess amniotic fluid volume. If values of amniotic fluid volume fall within normal limits, it reassures us regarding well being of fetus. The chronically stressed fetus is likely to have low amniotic fluid. Amniotic fluid index is a reliable fetal surveillance test and in some obstetrical units highly reliable parameter. Decreased amniotic fluid index has been considered as an indicator of poor neonatal outcome. AFI may be used to predict the occurrence of thick meconium stained liquor and need for intervention for fetal distress in post date pregnancies. Descriptive Study. Obstetrics and Gynaecology department of Fatima Memorial Hospital, Lahore affiliated with Fatima College of Medicine and dentistry Lahore. 6 month from 7/2/2007 to 7/8/2007. All pregnant women, meeting the inclusion criteria admitted in labour room either through emergency or OPD were selected. The AFI was calculated ultrasonically and these patients were followed till the time of delivery and the APGAR scores of newborn were compared with AFI. During the study period AFI was measured in 60 patients. Among these patients, 32 patients had AFI between 3-4 cm and babies were meconium stained, 23 patients had AFI of 5-6 cm and babies had normal APGAR at the time of delivery. AFI was < 2 cm in 5 patients and babies required resuscitation and admitted in nursery. The AFI is a reliable predictor of neonatal outcome

Gynaecological hysterectomy; indications, morbidity and mortality at a tertiary care hospital

The aims of study are [1]To make an audit of hysterectomies by either route in a teaching hospital.[2]To determine the morbidity and mortality associated with this procedure. Descriptive study. Gynae and Obstetrics units, Independent University Hospital Faisalabad. From 1-1-2006 to 31-12-2008. Retrospective collection of data by convenience sample technique. 27% cases were due to fibroids, 22% were due to uterovaginal prolapse, 19% [DUB], 13% [chronic PID]. The complications were 28% [UTI] by abdominal route and 13.3% were by vaginal route, 26.6% wound infection and 2.6% in vaginal hysterectomy, rest of complications were comparable by both routes. Vaginal hysterectomy has more promising results but is reserved for specific indications

Lower segment cesarean section [LSCS]; indications and complications at teaching hospital, Faisalabad

Caesarean section is one of the commonly performed surgical procedures in obstetric and is certainly one of the oldest operations in surgery. Recently there has been a dramatic rise in the caesarean section rate world wide especially in the developed countries. As primary caesarean deliveries contributed most to the overall caesarean section rate [CSR]. So this is clear that primary caesarean section is an important target for reduction because it leads to an increased risk for repeat caesarean delivery. To have an overview of fetomaternal indications for LSCS at a teaching hospital And to review intra-operative and postoperative complications of LSCS at tertiary care centre. All caesarean sections performed at Obstetrics and Gynecology Unit Independent University Hospital Faisalabad from January 2009 to December 2010 were reviewed. Information was obtained from operation theater and labor ward records. During the study period 100 patients undergone caesarean section. Out of 100 patients, 58[58%] had emergency and 42[42%] had elective caesarean section. The leading maternal indications were previous caesarean section 34 [34%], severe pre- eclampsia 6[6%],post date and failed induction of labor6 [6%], placenta previa 6[6%], and failure of progression of labor 5[5%], PROM3[3%], Pre-PROM3[3%]and cephalopelvic disproportion2 [2%].Major fetal indications include fetal distress9 [9%], malpresentation 6[6%], cord prolapse 3[3%],IUGR 5[5%] and pregnancy complicated by multiple fetuses 7 [7%]. Intraoperative surgical and anesthetic complications were observed in very few patients. Nine babies had perinatal deaths in this study, 8 belonged to emergency and only one baby died in elective group due to aspiration pneumonia. Majority of cesarean section are done in emergency situations and previous CS is the most frequent indication of cesarean section. The most effective mean to control CS is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous Csection, selective vaginal breech delivery and regular audit of C-section as well as early detection of at risk cases and proper referral in time is the key factor in decreasing the cesarean section rate and complications

Laparoscopy; its role in diagnosis of various gynecological conditions

Diagnostic Laparoscopy is considered to be the gold standard for the evaluation of the pelvis and is considered a safe procedure. Diagnostic Laparoscopy is a technique in the routine investigation and treatment of infertility as well as other gynecological problems. To determine, Laparoscopic findings in different gynecological conditions, different causes of infertility and complications of laparoscopy Retrospective, descriptive study. We reviewed case records of all patients who underwent laparoscopy for their different Gynecological problems. Data were collected from patient case records in a data entry sheet In our study a total of Thirty patients under went laparoscopy for investigation of different gynecological problems. There were 17 patients who have primary infertility and 6 have secondary infertility while 7 presented with Lower abdominal pain. In our study the leading cause of primary infertility was Polycystic Ovarian Disease[29%].Other causes were bilateral tubal blockade [23.53%] ,17% has PID and fibroid uteri, While one patients shown Endometriosis as well as one patient had no obvious pathology.[5.88%].On laparoscopic examination of secondary infertility 50% shown Tubal blocked while 16.67 shown Fibroid uterus and PID.One patient had normal pelvic findings[16.67]. Regarding patients presented with pain lower abdomen 57.15% has ovarian cyst, 28.58% has Ectopic pregnancy while one case[14.29%] had hetrotropic pregnancy. In 24 patients had no complication and recovery was smooth. laparoscopy had to be converted into Laparotomy due to significant hemorrhage in two patient and wound infection was observed in two patients. One patient presented with post operative fever and one presented with abdominal pain. Laparoscopy is a valuable diagnostic tool for females in different gynecological problems. The benefit of the laparoscopy to open surgery include less pain, less scarring, less disability and quicker recovery

Infertility: still an enigma; an overview of infertile couples in outpatients of gynae

[1] To find out the major causative factors in primary versus secondary infertility in study group. [2] To suggest an easy plan of investigation for an infertile couple. Descriptive study. Gynecology and Obstetric Unit in Independent University Hospital, Faisalabad. Two years from Jan 2008 to Dec 2009. Convenience sample technique was used to collect the patients. Anovulation had contributed 20% in primary infertility and 16% in secondary infertility. Tubal factor was more common in secondary infertility. Male factor was 40% in primary infertility and 16% secondary infertility. Counseling, reassurance and efficient, timely and appropriate management plan is essential to minimize the distress of infertile couples

Maternal mortality; a neglected tragedy

More than half a million maternal deaths occurred worldwide each year and 98% of these are in developing world. The objectives of the study were to calculate maternal mortality rate and determine the major causes of maternal mortality. A prospective study. Department of Obstetric and Gynaecology Unit-I, Allied Hospital, Faisalabad from 01.01.2002 to 31.12.2002. All maternal deaths during this period were included after taking detailed history and examination. There were total 25 maternal deaths and Maternal Mortality Rate [MMR] was 557/100,000 live births. The main causes were hemorrhage, septicemia and eclampsia. To achieve the objective of reduction in MMR, we must enhance emergency obstetric care with the adoption of the fast referral system particularly in the far-flung rural areas of Pakistan