Vaginal hysterectomy: outcomes as 24 hr short stay surgery

OBJECTIVES: To find out feasibility, acceptability and Patient satisfaction with vaginal hysterectomy performed as 24 hour hospital stay case

Study settings:- This study was carried out at Gynae Obs. Unit-IV of Liaquat University Hospital Jamshoro [tertiary care hospital] from Feb 2011 to july 2012

METHODOLOGY: This is a descriptive observational studyin which women with utero vaginal prolapse, non-obese, with adequate home support and telephonic accessibility are included. Patients with un-controlled co-morbidities like hypertension, diabetes,obstructive lung disease etc requiring monitoring were excluded from the study, along with the women having adnexal pathology requiring removal vaginally. All parameters of post-operative recovery and satisfaction of patients were noted, compiled and presented

RESULTS: Out of 57 suitable candidates for vaginal hysterectomy as 24 hour hospital stay surgery only 20 gave consent for participation in study and one refused to go after surgery because of vomiting .None of the19 patient returned back before their first follow up visit that was 9th post-operative day .Three [15%] complained about offensive vaginal discharge,1 [.2%] woman had an episode of heavy bleeding after reaching home but that was controlled by the instructions given on phone. Four [20%] patients, who initially agreed for 24 hour stay, did not want a discharge. Seventeen [85%] patients were not satisfied because lot of apprehension for post-operative home care,and multiple visits to out-patient-department before admission causing financial burden on the family

CONCLUSION: Vaginal hysterectomy can safely be performed as short hospital stay surgery but lack of infra-structure and awareness of community as well as of primary healthcare provider make it less acceptable, less satisfying and costly at receivers end

Routine skin preparation with 70% isopropyl alcohol swab: is it necessary before an injection? quasi study

BACKGROUND: The world is facing economical crises and it has particularly affected third world countries. Therefore we must review the controversial health related procedures to save the cost and time without compromising health. The main goal of this study was to assess the need of skin preparation with 70% isopropyl alcohol swab wiping as an antiseptic measure, to prevent infections before intramuscular, subcutaneous and intradermal injections

DESIGN AND METHOD: Quasi experimental design. Microbiological as well as clinical assessment of pre-injection use of alcohol swabs was studied among the patients who need an injection at King Khalid University Hospital, Riyadh from August 2012 - December 2012

RESULTS: The mean CFU [Colony Forming Units] per ml over the injection site before alcohol swab wiping were significantly higher [2.47 +/- 3.86] than after alcohol swab use [1.31 +/- 1.93]; p = 0.002. Although, 70% isopropyl alcohol swab reduced skin bacterial counts by 47%, there were no significant difference in clinical signs and adverse local or systemic effect with or without skin preparation by alcohol swab before intramuscular, intradermal or subcutaneous injections

CONCLUSION: Routine skin preparation with alcohol swab before an injection is quite unnecessary and is of no significant value in safeguarding infection. Omitting skin cleaning with alcohol swab prior to an injection would save time and money

Age and symptoms at natural menopause: a cross-sectional survey of rural women in Sindh Pakistan

Age at menopause and symptoms vary among populations and societies. Scarce data is available about menopausal age, symptoms and socio-demographic and reproductive factors from rural women of Sindh, Pakistan. The present study was conducted to find out the self reported age at natural menopause, prevalence of menopausal symptoms, and to identify sociodemographic and reproductive factors that may influence the onset of menopause. A survey was carried out on women aged 40-70. A multistage random sampling technique was used to retrieve 1,355 women with natural menopause from 10 union councils of district Matiari. These women were further categorised into 3 groups, I, II, and III having menopause for 1-5, 6-10, >10 years respectively. Pearson's chi-square test was used to analyse the percentage of symptoms distribution. ANOVA was used to analyse the relationship between demographic, reproductive factors and the age at natural menopause. Age at menopause in our subjects was 46.2 +/- 6.4 years. The prevalence of menopausal symptoms ranges from 26% to 83%. Frequency of somatic, psychological and urogenital symptoms was high in group II. No significant association was found between parity, socioeconomic status and age at natural menopause. The results have shown the early age at menopause. The prevalence of menopausal symptoms is high. Results regarding correlation of age at menopause with socio-demographic and reproductive characteristics were different from literature.

Knowledge and need of emergency contraception among married women attending a public sector university hospital in Sindh

Objectives: To assess knowledge and need for of emergency contraception among the women coming to Liaquat university hospital

Methods: A questionnaire based survey was conducted among 200 married women presenting at department of obstetrics and gynecology, Liaquat University Hospital Hyderabad, Sindh during the period of September to December 2009. The administered questionnaire served to find the status of knowledge and need for emergency contraceptives among these women. Ethical consideration and confidentiality was ensured. The data entry, processing and analysis were done using SPSS version 11

Results: Out of 200 women 172 [84.3%] were aware of contraception but only 47 [23%] had knowledge about emergency contraception. Eighty-seven [42%] women were without any formal education. Lady health workers and doctors were source of contraceptive knowledge in 104 [52%] cases. Unplanned pregnancy was observed in 134 [65.7%] women but unwanted was only in 39 [19.1%] women. Drugs were used to get rid of pregnancy by 12 [5.9%], and 13 [6.4%] went for termination of pregnancy

Conclusion: Contraceptive knowledge among 84% women is partial; as knowledge regarding emergency contraception is seen in only 23% and this indicate lack on part of knowledge provider. Lady health worker have been the main source of contraceptive knowledge among the community according to our findings. A prevalence of 67% of unplanned pregnancies is liable to increase acceptance of emergency contraception. The unmet need for emergency contraception is demonstrated by 13% who tried termination. Quality training of community health care workers to ensure complete knowledge will be helpful in increasing use of emergency contraception

Abdominal pregnancy

Abdominal pregnancy is a rare form of ectopic pregnancy associated with high maternal [0.20%] and perinatal [40-95%] mortality; surprisingly we had three consecutive cases of this condition. Case 1: Was referred from Taulka hospital where the patient presented as, four months gestational amenorrhea with acute diarrhea vomiting and severe anemia. She was treated symptomatically, transfused two units of blood and referred to Liaquat University Hospital with Ultrasound report showing suspicion of abdominal pregnancy. Case 2: Was newly married primipara who presented with four months gestational amenorrhea and severe lower abdominal pain. Ultrasound report showed a complex mass of 8.0cm just below the anterior abdominal wall [over the uterus] with alive fetus. The uterus was empty, so the diagnosis of abdominal pregnancy was made. Case 3: Was a young 19 years old lady, initially admitted in surgical unit as case of acute abdomen with history of five months pregnancy followed by D and C two weeks back by LHV [Lady Health Visitor], they collaborated with gynae unit due to this history. Examination showed septic, tender on palpation, on P/V examination some dry shrunken cord like structure with foul smelling discharge hanging out from vagina, identified a gut loop with uterine perforation. In this case abdominal pregnancy was diagnosed on surgery as ultrasound report could not give the clear picture. All cases were managed with surgical intervention. In first two cases fetuses were delivered alive but non viable, in third case fetus was dead macerated found within abdominal cavity in right side. In first case placenta was removed completely and in second case, it was adherent with adjacent structures not actively bleeding so left in situ and post operatively three doses of injection methotrexate were given. First two cases recovered completely while in third case patient required ICU care after surgery. All three cases who had different clinical presentations were diagnosed and managed successfully

Antenatal screening for hepatitis B and C virus carrier state at a University Hospital

To determine hepatitis B virus [HBV] and hepatitis C virus [HCV] carrier state among pregnant women at gynaecology and obstetrics department of Liaquat University Hospital, Hyderabad -Sindh. A descriptive study. Maternity units of Liaquat University Hospital, Hyderabad - Sindh from January 2003 to December 2003. One hundred and three pregnant women with 35 to 40 weeks of pregnancy admitted in maternity units due to obstetrical reasons were screened for hepatitis B and C seropositivity after they gave informed consent. Immuno- chromatography and ELISA technique were used for blood testing. Pregnant women with symptomatic liver disease were excluded from the study. Convenient sampling approach was adopted for the data collection. Among screened population, 29.1% of pregnant women were found positive for HBV or HCV. Out of these, 16.5% women were positive for HCV where as 12.6% for HBV. All women had history of injections and ear and nose prick where as 20% had positive history of blood transfusions, followed by history of jaundice among them or with their partner. In our set up, frequency of 29.1% sero-positivity for HBV and HCV among pregnant women is alarming. These sero-positive mothers are not only at risk of having cirrhosis and liver cancer later on, but also are a continuous threat to their offsprings and care providers. Hence, there is a dire need to conduct more epidemiological studies on this problem and take measures for prevention and control of the disease

Secondary postpartum haemorrhage due to rupture of uterus

We report a very unusual case of secondary postpartum hemorrhage due to uterine rupture. Our case was a 23 years old lady who presented with heavy bleeding per vagina and gave history of home delivery. Rupture was most probably caused by injudicious use of oxytocic injection by a Traditional Birth Attendant at home. Surprisingly, after recovering completely from primary episode she again had heavy blood loss after 5 days. An emergency hysterectomy of the patient was performed to save the life

Pre-eclampsia: Prevention strategies

The objective of the study was to assess the use of pharmacological prophylasix by health care providers in women with risk factors of pregnruy induced hypertension. One hundred hypertensive women who were referred to Gynecology Unit - I of Liaquat University Hospital during one year period from 1st January, 2000 to 31st December, 2000 were evaluated thoroughly by history, examination and management out come. The inclusion criteria were women with pregnancy of > 20 weeks, with diastolic B.P > 100 mm of Hg on two occasions 4 hours apart. Eight-three women had at least one of the risk factors and 40 of them visited some kind of healthcare facility. None was prescribed prophylactic medication. A total of 50 women had eclampsia. Perinatal mortality was 20 and maternal mortality was 7. We conclude that the lack of awareness about prophylaxis among care givers may be responsible for high maternal and perinatal mortality

Perineal pain after vaginal delivery

The objective of this study was to assess pain morbidity after vaginal delivery and effect of episiotomy on it. Fifty women delivering vaginally at Liaquat University Hospital and Aga Khan Maternal and Child Care Center Hyderabad were followed through a pre-developed questionnaire at 24-48 hours after delivery, 10th post partum day and 10th post partum week for assessment of pain All women with episiotomy [n-25] required oral analgesia following delivery, 2 required parenteral analgesia for 24 hours compared to no analgesia for perineal pain in control group. At day 10, 4 [16%] among episiotomy group had inflamed and gaping wound requiring local treatment and removal of stitches. Two [8%] required admission for restitching Dyspareunia was more common among episiotomy group, Two required medical / surgical intervention for it. Episiotomy adversely affect the pain morbidity after vaginal delivery