Perinatal outcome among fasting and non fasting mothers during the month of Ramadan

Objective: To compare the perinatal outcome among fasting and non fasting pregnant mothers

Methods: A total of 180 women, who came for delivery in the labor suite were included, after verbal informed consent. These women were divided in two groups fasting [n=100], and non-fasting [n=80]

Results: The mean age of the mothers was 27.16 +/- 4.27 years in the fasting group and 27.36 +/- 4.92 years in nonfasting group. The average BMI of mothers was 25.31 +/- 3.26 kg/m[2]in fasting group while 25.64 +/- 3.58 kg/m[2] in non-fasting group. Perinatal outcomes, the birth weight, head circumference and mid arm circumference were almost similar between the two groups. Weight of placenta was 537.80 +/- 80.01g in fasting group while 540.50 +/- 84.29 g in non-fasting group and height of baby was 45.79 +/- 3.07 cm in fasting group while 46.61 +/- 2.92 cm in non-fasting group. In fasting group, placenta weight was 531.5 +/- 92.80 g in boys while 544.8 +/- 62.79 g in girls and ratio of placental to birth weight was 18.8 +/- 2.28 in boys while 19.4 +/- 2.70 in girls

Conclusion: Maternal fasting affects placental weight and length of baby, with effect more pronounced in male babies

Physicians' migration: perceptions of Pakistani medical students

Objective: to study the perceptions of medical students about factors responsible for physicians' migration

Study Design: cross-sectional survey

Place and Duration of Study: Dow Medical College and Civil Hospital, Karachi, from April to May 2015

Methodology: a self-administered structured questionnaire was used including demographic details, attitudes about push and pull factors of migration, and reasons for migrating or not migrating abroad. Final year students and interns were included. Likert scale from 1 to 4 [1=strongly disagree to 4=strongly agree] was used to assess attitudes. Data was analyzed by SPSS version 16

Results: a total of 240 medical students, mostly females [n=181, 75%] [60% final year and 40% interns], participated in the study. Majority wished to go abroad [n=127; 54%] with United States being the favorite destination [n=80; 66.1%] and internal medicine fields being the preferred choice for specialization [n=126; 54%]. The major pull factors were better quality of postgraduate education abroad [n=110; 48.2%] and economic prospects [80; 35.2%]; while the push factors were a weak healthcare system [n=219; 94.3%], inadequate salary structure [n=205; 88.3%], insecurity [n=219; 93.9%] and increasing religious intolerance in Pakistan [n=183; 78.5%]

Conclusion: this survey highlights the continuing trend of physician migration from Pakistan owing to interplay of various push and pull factors. Majority of our medical students wish to migrate, mainly due to low salaries, poor job structure, and insecurity. Urgent interventions are required to reverse this trend of medical brain-drain

Clinical spectrum of posterior reversible encephalopathy syndrome [PRES] in patients with eclampsia

To identify the prevalence, demographic details and clinical features of PRES in women suffering from eclampsia. Women admitted in the labor room suite with diagnosis of eclampsia were studied. The study period was from October 15. 2011 to March 15. 2012, in the department of obstetrics and gynecology unit 3, Civil hospital Karachi.Of all patients with diagnosis of eclampsia, 22 underwent neuro imaging by computerized tomography. Demographic details, clinical findings and maternal and perinatal outcome were entered on a predesigned Performa. Thirty four women were identified, with eclampsia. Neuro imaging was done in 22 women. Posterior reversible encephalopathy syndrome was recognized in 9 [22] patients. The mean systolic blood pressure was 161 [ +/- 11] mm Hg, and mean diastolic blood pressure was 111 [ +/- 10] mm Hg. Mean number of fits were three, and the mean gestational age of patients were 35 weeks. Gestational age was found significantly associated with PRES [p <0.3] Mean leukocyte count in patients with eclampsi

Maternal and perinatal outcome of hypertensive disorders of pregnancy at a tertiary care hospital

To study the frequency of various hypertensive disorders of pregnancy and to determine their maternal and perinatal outcome. Retrospective descriptive study. Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi, from January 2002 to December 2007. A total of 626 cases were reviewed for age, parity, gestational age, diagnosis, antenatal and intra partum complications, mode of delivery and neonatal outcome. Data was analyzed using SPSS software [version 16]. Total number of deliveries during the study period was 11,718 and there were 626 cases of hypertensive disorders of pregnancy giving a frequency of 5.34%. Pre-eclampsia was seen in 308 [49%], severe pre-eclampsia in 85 [13%], eclampsia in 121 [19.2%], chronic hypertension in 41[6%] and postpartum eclampsia in 21 [3.3%] patients. There were 39 maternal deaths [case fatality rate: 6.23%]. The mean ages for pre-eclampsia, severe pre-eclampsia, eclampsia and chronic hypertension were 28, 27, 24 and 29 [27 years] years respectively. The commonest maternal complication of hypertensive disorders was postpartum hemorrhage in 24 women [4.2%]. This was followed by placental abruption in 9 women [1.6%] and pulmonary edema in 8 women [1.4]. The prevalence of prematurity in pre-eclampsia, severe pre-eclampsia and eclampsia in study population was 14%, 5% and 8.6% respectively. Cesarean section was required for pre-eclampsia, severe pre-eclampsia and eclampsia in 46%, 51% and 61% of patients respectively. The main fetal complications were found to be still birth [14% in pre-eclampsia, 18% in severe pre-eclampsia and 15% in eclampsia] and low birth weight [31% in pre-eclampsia, 49% in severe pre-eclampsia and 52% in eclampsia]. Hypertensive disorders in pregnancy are an important cause of maternal and perinatal mortality and morbidity

Socio-demographic characteristics and the three delays of maternal mortality

To describe the socio-demographic characteristics and the three delays of maternal mortality in a tertiary teaching hospital. Retrospective, observational study. Department of Obstetrics and Gynaecology, Unit III, Civil Hospital, Karachi, from April 2005 to May 2008. One hundred and four consecutive maternal deaths were reviewed. Data regarding age, parity, sociodemographic characteristics, booking status, referral source, cause of death and the three delays was collected on structured proformas, analyzed by the statistical software, SPSS version 13, and presented in the form of frequencies and percentages. The projected maternal mortality ratio was 1650/100,000 live births. The mean age was 28 +/- 6.2 years and median parity was two. Seventy-one women [68%] were uneducated, 65 [62.5%] belonged to lower socioeconomic class and 60 [58%] had received no antenatal care. Ninety-eight women [94%] had one or more delays, with 70 [71%] having the first delay, 73 [74%] having the second delay and 47 [48%] the third delay. The most frequent reasons for first, second and third delays were lack of awareness in 88.5% women, long distance in 39.7% women and difficulty in getting blood in 49% women respectively. The very high maternal mortality ratio suggests lack of access of women to quality healthcare facilities. A majority of these women suffered first and second delays in their management, which could be due to their poor sociodemographic factors

Stromal Tumour Of Jejunum

Gastro-intestinal Stromal Tumours are extremely rare and of unknown etiology. As a result their timely diagnosis is difficult. We are reporting a very interesting patient who presented to a general practitioner with clinical features of weakness and anaemia. Later on she also developed an abdominal lump. This unique case illustrates the need of a high index of suspicion in order to diagnose the condition

Partial hydatidiform mole

A case of partial hydatidiform mole is presented, occurring in a young primiparous woman after natural conception. She presented with incomplete miscarriage. Histological diagnosis of partial mole was made. Failure of beta HCG to fall resulted in the start of chemotherapy. WHO scoring placed her in low risk group. In spite of the low risk, she required third line chemotherapy for complete eradication of disease

Use of recombinant factor VII for massive posrtpartum haemhorrage: Case serie and review of literature

Recombinant activated factor VII is indicated mainly for the treatment of patients with haemophilia inhibitors. It has also been found successful in the treatment of platelet disorder Glanzmann's thrombasthenia. Recently, its use in trauma patients and in patients with intracereberal haemorrhage has become well established. We present three cases of massive post partum haemorrhage treated with rFVIIa, following caesarean section. The response of these three patients is discussed along with review of literature

Frequency of thrombophilia in patients with adverse pregnancy outcome

To determine the association between adverse pregnancy outcomes and thrombophilia. This is a descriptive study, incorporating retrospective analysis of patients with recurrent pregnancy losses, intrauterine deaths, abruptio placenta and early onset pre eclampsia. Patients with adverse pregnancy outcomes in whom co-morbid factors were excluded underwent screening for both acquired and inherited thrombophilia. A total of 40 patients were screened for acquired and inherited thrombophilia with adverse pregnancy outcomes. Anticardiolipin antibodies were found positive in 55% of patients and 45% of patients were found deficient for natural anticoagulants protein C and S. Two patients were found positive for both acquired and inherited thrombophilia. Thrombophilia, both acquired and inherited are associated with adverse pregnancy outcomes. Patients in whom other co-morbid factors are excluded, should be offered screening for thrombophilia. Liaison between hematologist and obstetrician is the corner stone for success

Ectopic pregnancy: a local experience

An analysis of women who were identified clinically to have ectopic pregnancy was done at the Department of Obstetrics and Gynaecology, Unit 2, Dow Medical College and Civil Hospital Karachi. The study period was from January 2002 to January 2003, over a period of 12 months. The objective of the study was to idents the risk factors for ectopic pregnancy, and to see the correlation between clinical sign and symptoms and the final diagnosis. A total of 35 cases were managed in the unit during the study period. Palpable adnexal mass was the most common sign observed in 28 [80%] patients, followed by amenorrhea and abdominal pain which were observed in 24 [68%%] cases. 80% of the patients gave no history of contraception, a factor which has been found significant for tubal rupture. Left fallopian tube was the most common site of rupture, seen in 60% of patients. All the patients presented late with either confirmed ectopic pregnancy on ultrasound, or with sign and symptoms of hypovolemic shock, characteristic of tubal rupture

Medical management of second trimester fetal demise using misoprostol

Surgical termination of pregnancy carries high risk for the women's health. Medical methods including prostaglandins are safe and reduce the above risk. This study was done to assess the efficacy of misoprostol as a medication for the termination of second trimester fetal demise. Design: Observational study. Setting: Department of Obstetrics and Gynecology Unit 2, Civil Hospital, Karachi and Dow Medical College. The study period was from January 2001-December 2001. A total of 50 patients requiring termination of pregnancy for fetal demise between 14 to 20 weeks of gestation were included in the study. Each woman received misoprostol vaginally. The dose was repeated at six hour interval, until adequate contraction or cervical ripening were achieved. Maximum dose given was 800 ug. [4 tablets]. The dose was not repeated after 4 tablets. Outcome measures included successful termination rates, mean expulsion time and side effects of medication. The mean dose of drug required was 200 ug. The average expulsion time was 9.3 hours. Evacuation of uterus was required in 2 patients and in 2 patients procedure failed, requiring other method of termination. The efficacy of the method was as high as 96%. Use of misoprostol in second trimester for fetal demise is recommended. It is not only safe but is effective as well

Uterine rupture in labour

A retrospective analysis of women, identified clinically with uterine rupture, in labour, was carried out at the Department of Obstetrics and Gynaecology unit 2 Civil Hospital Karachi between December 2000 to December 2001. The objective of the study was to identify the risk factors for uterine rupture in labor, to report maternal and fetal outcome and to identify preventive measures. There were 24 cases of uterine rupture. Of these, 4 were incomplete. The risk of uterine rupture was increased in grand multipara, women with previous caesarean section scars and those who had injudicious use of uterine stimulants. Lower uterine segment anteriorly was the commonest site of rupture. Vesico vaginal fistula, a serious morbidity was observed in 12.5%. There was one maternal death and 20.[83%] fetal losses

Practice of peritoneal closure at cesarean delivery

To determine whether non-closure of visceral and parietal peritoneum at lower segment caesarean section has advantages over closure in terms of febrile morbidity endometritis, analgesic requirements, operative time and bowel activity. Department of Obstetrics and Gynaecology, Unit-II, Dow Medical College and Civil Hospital, Karachi. A prospective randomized trial of 100 women undergoing caesarean section, fifty women were randomized to norclosure group and fifty women were randomized to closure group. The incidence of febrile morbidity and analgesic requirement was greater in closure group. Operative time was also greater in-patients of closure group. Closure of peritoneum at lower segment caesarean section doesn't offer any additional advantage, rather is associated with more complications. Closure of the peritoneum should be abandoned at caesarean section