Frequency of retinopathy in type 2 diabetic patients with or without microalbuminuria

Objective: To determine the association of diabetic retinopathy among type 2 diabetic patients with microalbuminuria

Study Design: Comparative cross-sectional study

Place and Duration of Study: Medical wards combined Military Hospital Peshawar from 12[th] Jim to 12[th] Dec 2013

Material and Methods: One hundred and eighty six patients [93 in each group] with type 2 diabetes fulfilling the inclusion criteria were included in study through consecutive sampling

A standard protocol was followed for testing spot urine for micro, on the basis of which patients were divided into cases and control groups depending upon presence or absence of microalbuminuria. Fundos copy was done for any evidence of diabetic retinopathy including micro aneurysms dot and blot hemorrhages, new vessel formation and maculopathy

Results: 51.61% [n=48] in cases and 29.03% [n=27] in controls were having diabetic retinopathy while remaining 48.39% [n=45] in cases and 70.97% [n=66] in controls were not having diabetic retinopathy

Conclusion: We concluded a significant association between diabetic retinopathy and microalbuminuria

Early onset neonatal sepsis in preterm premature rupture of membranes

To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis

Gestational diabetes; sensitivity, specificity and diagnostic accuracy of glucose challenge test in diagnosis

To find sensitivity specificity and diagnostic accuracy of Glucose Challenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomical and educational status, dietary habits and ignorance regarding pregnancy related problems probably increase the prevalence and burden of gestational diabetes mellitus [GDM] and its complications in pregnancy. Best and simple strategy to identify women with gestational diabetes is still lacking and unclear. Cross sectional study. This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. A glucose challenge test [GCT] was performed on 500 selected pregnant women by giving 50-g glucose in water orally. A serum glucose level ?140 mg/dl after an hour was taken as positive test. To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs by Glucometer, >200 mg/dl confirmed GDM. An increasing trend in age, gestational age and BMI and a significant difference regarding positive family history of diabetes and gravidity was seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM 2 was noted in multigravida, between 25-29 years, BMI >28kg/m, and a gestational age of 28 weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%. Screening is necessary to identify women with GDM. A 50-g glucose challenge test might be acceptable as a screening test for GDM as it has high sensitivity, specificity and diagnostic accuracy

An audit of cesarean sections in Military Hospital Rawalpindi

To analyze the rate, the frequency of different indications and the most common indication of cesarean sections in Military Hospital Rawalpindi. Cross sectional study. Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to February 2012. A total of 3555 pregnant females delivered during study period were enrolled in the study. Health volunteers and the cases of uterine rupture, pregnancy with fetal anomaly, or termination of pregnancy were excluded from the study. All patients were admitted in labor room. Detailed obstetric and gynecological history was taken. Detailed general physical examination and obstetric examination was done. Baseline investigations were checked. Fetal anomalies were ruled out by anomaly scan. Strict fetomaternal monitoring was done during labor. Cervical foley catheter and prostaglandin E2 [Prostin] tablets were used for induction according to Bishop score. Clinical record of all patients, including mode of delivery and indication, was analyzed in terms of percentage and frequency and documented in a special performa after written informed consent. Filled performas were attached with patient's case notes. Patients enrolled in the study over six months were 3555, out of which 1620 [45.5%] were delivered by cesarean section, 1901 [53.4%] were spontaneous vaginal deliveries and 34 [0.9%] were delivered by vaginal birth after cesarean [VBAC]. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section [44.4%], followed by failed trial of labor [27.1%] and fetal distress seen in 165 [10.1%] cases. The rate of cesarean section in our study was 45.5% and the most common factor was repeat cesarean section 44.4%

Induction of labour; routive induction at 40 weeks of pregnancy

The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Quasi experimental study. Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients [60%], 4 by vaccum[8%], 3 by forcep delivery [6%], 13 patients ended up into emergency LSCS [26%]. In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 [46%]. MAS was in 9[18%] babies as compared to 2% in group A and, Fetal distress [type 2 dips] were found in 3[6%] cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A [74%] induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks

Induction at poor bishop is justified

Objectives: To prove that induction at poor bishop is not justified

Study design: A Prospective study

Place and duration: Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to Feb 2012

Methodology: Total of 1852 women were included by non-probability consecutive sampling technique, irrespective of parity at term with singleton healthy pregnancy in vertex presentation and were divided into two groups on basis of their bishop score. Health volunteers, cases of uterine rupture, previous cesareans, uncontrolled medical disorder and pregnancy with fetal anomaly for termination were excluded. Ultrasound for fetal wellbeing were done and strict feto maternal monitoring was done during labor. Medical and elective indications and Bishop Scores were recorded before labor induction. Cervical foley no 16 was used in patients with B/S >3. [Group - A] and tablet Prostin E2 was used in patients with B/S< 3 [Group - B] as an initial agent to induce labor. Outcomes like mode of delivery, mean parity and mean age was analyzed by spss11 and P value was found out Performas were attached with patient's case notes

Results: The cesarean section rate was 32.6% [n=605], SVD were [n=1247]. Induction for medical reasons were 14.8% [n=275], with PROM 12.7% [n=237], women with fetal compromise were 11.7% [n=218], with macrosomia 9.07% [n=24], with mild pains 15.3% [n=285], with postdate pregnancy 16.4% [n=340], post term 18.4% [n=305] and patients with oligohydramnios were 1.2% [n=168]. Among 1852 from 38 week to 41 week, 1372 patients in group A, with bishop score >3. Rest of 480 were in group B, induced at bishop score <3. In group A, who were induced at B/S >3, total CS were 215, [150 with failed trial of labour] and 1157 were SVD. 65 CS were due to fetal distress. Total CS in group B, with failed trial were 300, C-Section due to fetal distress n=90. SVD were 90 and p=0.001. Mean age was 33.8 years. Mean parity found to be was 2.8 para. Difference in no of CS and SVD in both groups on basis of their bishop score was statically significant and was = 0.001

Conclusion: Bishop Score at time of induction should be >3 and induction at poor bishop should be avoided to control the rate of cesarean section