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

Hemoglobin status of pregnant women visiting tertiary care hospitals of Pakistan

To determine the status of haemoglobin levels in pregnant women who visited tertiary care hospitals of various cities in Pakistan for their antenatal care from January 1 to April 30, 2007. This was a descriptive cross-sectional multi-centre study This study was conducted at the Aga Khan University Hospital [AKUH], Karachi, Civil Hospital, Karachi [CHK] and Nawabshah Medical College Hospital [NMCH], Nawabshah. Copies of medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected from January 1 to April 30, 2007. Reports or results of hemoglobin concentrations were also obtained from the patients. A total of 1709 pregnant women were recruited. Majority 1145[67%] were from the age group of 25 to 34 years and 1555[91%] had some degree of anemia. The number of women with moderate to severe anemia [hemoglobin levels < 8 or 8-9.9 gm/dl, respectively] was significantly higher in CHK and NMCH compared to AKUH [p < 0.001]. Whereas mild anemia [hemoglobin levels 10-10.9gm/dl] or normal hemoglobin levels was significantly higher at AKUH [p < 0.001]. Moderate anemia [hemoglobin levels of 8-9.9gm/dl] was statistically more frequent in second and third trimester, while mild anemia [hemoglobin levels of 10-10.9gm/dl] was more in first trimester of pregnancy. The distribution of severe anemia however; was not different is the three trimesters. About 90-92% subjects received iron/vitamin/mineral supplements irrespective of the hemoglobin status of the woman. Prevalence and severity of anemia in pregnant subjects attending the tertiary care hospitals of Pakistan is exceptionally high. Current findings highlight the anemia in pregnancy as a priority area of concern

Pre-eclampsia/eclampsia: the time taken to become study normotensive. a prospective study

1.To determine the time taken for pre-eclampsia / eclampsia patients to become normotensive. 2.To counsel the patient for regular postnatal follow up. 3.To select the patient with persistent hypertension Prospective descriptive study. Obstetrics and Gynaecology Unit III, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. September 2000 to August 2001 All diagnosed cases of pre-eclampsia / eclampsia were followed after delivery till 6 weeks to see the time taken to become normotensive. Patients were selected from labour room, postnatal wards and postnatal clinic. Standardized performa were filled by trained researchers. Patients with raised B.P at or after 6 weeks were labeled as persistent hypertension and referred to medical specialty. 92 patients out of 1699 were diagnosed as pre-eclampsia / eclampsia. Most of the patients were 20-30 years old [61.96%], primigravida [51.09%]. Most of the patients presented at gestational age >34 weeks [72.83%]. In majority of patients B.P returned to normal within 1 week [41.30%] while 5.43% remained persistently hypertensive. All pre-eclampsia and eclampsia patients should be followed in post natal period till they are either normotensive without medicine or remain hypertensive beyond 6 weeks. They should be referred to expert physician for control of B.P on long term basis

Maternal morbidity in obstructed labour - retrospective descriptive study

I. To determine the frequency of maternal morbidity in obstructed labour. 2. To counsel the family about the seriousness of the condition. Retrospective descriptive study. Obstetrics and Gynaecology Unit III, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. 1st January - 3rd December 2004. A total of 94 women with obstructed labour were included in the study. More than half of the study group were primigravida and aged below 25 years. A total of 61 [64.89%] were primigravida. Peak cases were between 20- 25 years of age that was 42 [44.7%]. Mode of delivery was Caesarean section in 82 [87.23%] cases, abdominal delivery with repair of ruptured uterus was done in 10 of cases [10.63%] and Caesarean hysterectomy in 5 cases [5.31%]. Maternal morbidity varies with Puerperal sepsis [34.04%], cystitis [25.53%], wound sepsis [22.34%], ruptured uterus [11.7%], primary postpartum haemorrhage [8.51%] and V. F. [1.06%]. Maternal mortality was one [1.06%]. The incidence of obstructed labour is almost unchanged in tertiaty level hospitals. This carries grave maternal morbidity and work load 011 the hospital

Risk factors for tubal ectopic pregnancy

To determine the risk factors for tubal ectopicpregnancy. A case control study. This study was conducted at the Gynaecology and Obstetrics Unit III. Civil Hospital Karachi from it January. 2003 to 31[st] May. 2005. All the patients diagnosed as a case of ectopic pregnancy during the twenty nine months period were included in our study. While the control group constituted pregnant women selected at random from the antenatal clinics and through person to person communication. All the relevant data was recordedon a questionnaire and the final results were analyzed. The incidence of ectopicpregnancy was found to be 1:90, when compared with normal deliveries. Age group of 25-

Ectopic pregnancy: presentation and risk factors

To describe the clinical features and risk factors in ectopic pregnancy. A descriptive study. The study was conducted in Unit III of the Department of Obstetrics and Gynaecology, Civil Hospital, Karachi from January 2002 to December 2003. A total of 38 women diagnosed with ectopic pregnancy were included in the study. Data was retrieved from the charts of all the patients diagnosed with ectopic pregnancy through a structured proforma. The variables studied included age, parity, symptoms and signs, risk factors, treatment and associated maternal morbidity. Among the clinical features, the most common presenting symptom was abdominal pain in 37 [97.3%] patients whereas history of amenorrhea and vaginal bleeding were found in 28 [73.6%] and 22 [57.8%] patients respectively. The most common physical sign was tenderness: abdominal tenderness in 28 [73.6%] and pelvic tenderness in 23 [60.5%] patients. Cervical excitation was only present in 19 [50%] patients. Risk factors were present in 23 patients [60.5%], the most frequent being infertility in 9 patients [23.6%]. Other risk factors were tuberculosis in 6 patients [15.7%], previous ectopic pregnancy in 3 [7.8%] and previous tubal surgery in 1 [2.6%] patient. History of IUCD was present in 1 [2.6%], injection Depo-provera in 4 [10.5%] and OCP in 3 [7.8%] patients. History of D and C and C-section were present in 7 [18.4%] and 4 [10.5%] patients respectively. Abdominal pain was the single most consistent feature of ectopic pregnancy. Risk factors may not always be present. Therefore, ectopic pregnancy should be suspected in every woman of reproductive age who presents with unexplained abdominal pain, irrespective of amenorrhea and vaginal bleeding and whether risk factors were present in the past history or not

Urinary fistulae, surgical experience, retrospective study

This study analyses 53 cases of urinary fistulae during five year period from August 1989 to August 1994, in a tertiary referral hospital. Total number of gynaecology admissions were 4200/five year. Per year admissions were 840. The incidence of urinary fistulae being 1.2 percent. Majority of the fistulae were due to obstetric complications, while 20 percent were iatrogenic. Majority of patients were operated vaginally, 36 cases [68 percent]. Overall success rate was 69.7 percent [37 cases]. Success after first attempt was 67.6 percent [25 cases]

Rupture of the uterus

Fifty cases of uterine rupture were managed in 4 years giving a frequency of 1 per 89.9 deliveries. There was an obvious difference between those with a previously scarred uterus [34] vs those without a scar [16] cephalopelvic disproportion, grand multiparity and mismanagement of cases by traditional birth attendant [TBAs] were the common etiologic factors in the unscarred uterus, cephalopelvic disproportion, forceps delivery, grand multiparity and prolonged first stage of labour were the common etiologic factors in patients with previously scarred uterus. In the unscarred group both maternal and foetal [81.6%] mortality was high