Induced abortion - a continuing threat to maternal life

In Pakistan, therapeutic induced abortion is a controversial issue and continued to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of 2 years with special emphasis on maternal mortality and morbidity. This prospective study was aimed to determine the frequency of induced abortion, to know the reason for requesting abortion, assess the associated maternal morbidity and mortality in our setup. Descriptive study. This study was conducted at the Department of OBGY, PUMHSW Nawabshah from 1[st] January 2009 to 31[st] December 2010. Hospital record of patients who were admitted with unsafe abortions in 2 years [2009- 2010] were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication and method of abortion, qualification of abortion provider and maternal mortality. Unsafe abortion contributes 4.4% of total patients admitted with abortion over 2 years. Mean age of them was found +/- SD 30.14 + 8.56 and mean parity was 6.07 +/- 3.00. 78.6% patients belong to poor community and > 70% patients were married and used it as a method of contraception. Uterine instrumentation was the commonest method [78%] used to induce abortion. Majority of women were admitted with life threatening complications like haemorrhage [75%], sepsis [53.57%], hypovolumic shock [39.28%] and faecal peritonitis in 21.42%. DIC in 10.71%, uterine perforation in 28.57% and mortality in 4 [14.28%]. 5 [17.85%] were managed conservatively, 13 [46.42%] had re-evacuation, 10 patients had exploratory laparotomy, out of them 2 needed peritoneum toilet, while in 5 patients gut resection and anastomosis and in one permanent colostomy was done. Uterine trauma found in 8 patients [28.57%] in whom 3 [10.70%] ended up in hysterectomy. Unsafe abortion contribute 14.28% of death in study group. The present study conclude that unsafe abortion is a major neglected health issue needs attention and high degree of commitment. Its elimination requires advocacy, policies to support woman right and improving access to family planning services

Unruptured ectopic pregnancy is still uncommon in our setup

To analyze the frequency of ectopic pregnancy, treatment modalities, maternal outcome and why the unruptured ectopic pregnancy is presented less frequently in our set up. Cross sectional descriptive study. This study was conducted at the Department of OBGYN PUMHS Nawabshah from January 2008 to December 2010. All the patients who have a clinical suspicion for ectopic pregnancy or diagnosed by ultrasonography included in the study. Verbal interviews were taken in the post operative period for assessment of educational and socio economic status of patient along with the behavior of the referring authority. Patients' records were reviewed for clinico surgical finding and maternal outcome. Eighty eight [88] women were presented with ectopic pregnancy out of 13286 deliveries at PUMHS Hospital Nawabshah during 03 years study period making a frequency of 0.66%. No risk factor identified in 58[65.9%] of cases. 56[63.63%] patients presented in acute way. Regarding treatment modalities 86[97.72%] patients underwent laparotomy amongst them salpingectomy was performed in 50[56.81%], salpingo-oophorectomy in 28[31.81%], milking of tube were carried out in 03[3.40%] patients and complete tubal abortion was found in 05[5.86%] patients. 02 patients with unruptured ectopic pregnancy were selected for medical treatment, 01 was successful and other failed and treated by salpingectomy. Maternal outcome was satisfactory; no maternal death was found in the study group. Blood transfusion was required in 100% of patients [1-4 pints]. Regarding the aspect of why we are not receiving the patients with unruptured ectopic pregnancy, we found that > 90% of our patients belong to poor socioeconomic group and uneducated. Remaining patients belong to middle social class and were able to write their name. We found it an important factor in starting late antenatal care. We also assessed the behavior of referring authority as well as in our out- patient department; urine for the P.T was the preferable method of diagnosing first trimester pregnancy. Ultrasound was only advocated once patients presented with acute symptoms of ectopic pregnancy. The detection of unruptured ectopic pregnancy is almost nil in our setup due to late reporting to hospital by women when pregnant and inability of the health care providers to suspect it when faced with early pregnancy problems of lower abdominal pain and irregular vaginal bleeding. A change in the health professional behavior, provision of beta HCG estimation and transvaginal ultrasound in public sector hospitals are the modalities to improve the detection of unruptured ectopic pregnancy

Eclampsia: still a dreadful situation

To study the prevalence of eclampsia, its related maternal morbidity, mortality and perinatal outcome. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Nawabshah from 1st January 2009 to 31st December 2009. All the patients admitted with eclampsia were included in this study and they were analyzed according to their age, parity, duration of gestation, timing of convulsions, mode of delivery, complications and feto-maternal outcome. 107 patients of eclampsia presented during the study period, giving a frequency of 2.43%. Mean age group involved was 15-24 years [47.7%] and 25 - 34 years [44.9%] while 7.5% were > 35 years. Majority of the patients belong to 15-24 years age group and found to be statistically significant [p-0.000]. Primi gravida [65%] were highly effected population. 57% [62] patients had fits in antenatal period while 9.3% [10] patients had intrapartum and 32% [35] patients had postpartum fits. Vaginal was the commonest mode of delivery 49 [45.5%]. Assisted vaginal delivery in 21 [19.6%], while cesarean section was performed in 37 [34.6%] patients. 39 [36.44%] maternal deaths occurred during study period, while 7 materanl deaths were attributed to eclampsia. Regarding the neonatal outcome, 64.5% [69] were born alive, 20.6% [22] were IUD and 15% [16] were dead during neonatal period mostly due to prematurity [75.7%].Eclampsia is a big challenge in obstetrics, it can lead to very high maternal and perinatal mortality and morbidity. It is a 3rd commonest cause of maternal death in developing countries. Community health education coupled with availability of emergency obstetric and neonatal care service at doorstep would reduce the incidence of eclampsia and its associated morbidity and mortality in Pakistan

Female genital tract-reproductive performance with its variable anomalies

To observe the different presentation and reproductive performance of women with congenital anomalies detected by ultrasound, hysterosalpingography and on laparotomy. Prospective observational study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2004 to December 2009. All the women with congenital anomalies of genital tract detected clinically, by ultrasound and hysterosalpingography, attended the outpatient department or presented with a complication and operated; and or those who were incidentally diagnosed during cesarean section or on laparotomy were included in this study. 48 patients with different mullerian duct anomalies were detected during the study period. Their age varied from 15 to 40 years. Mullerian agenesis with absent vagina was found in 6 cases, transverse vaginal septum was found in an other 6 patients. These patients presented with primary amenorrhoea, haematometra and haematocolpos. Imperforated hymen was found in 10 patients. They also present with a primary amenorrhoea, mass in lower abdomen and cyclical pain, few patients presented with acute retention of urine. Longitudinal vaginal septum was found in 3 cases. They presented with dyspareunia and difficult labour. Bicornuate uterus was found in 9 cases. They presented with maipresentations, recurrent abortion and preterm labour. Unicornuate uterus was found in 3 cases. Who were presented with ectopic pregnancy. Uterus dideiphys was found in 3 cases, 5 patients had arcuate uterus, 3 patients presented with congenital second degree uterovaginal prolapse. Uterine abnormalities are not uncommon, although not all the types of uterine anomalies can affect the fertility but most of the time they have bad impact on fertility. Early diagnosis and treatment of these conditions may improve the fertility prospectus and also prevents various obstetrical complications

study of vesicovaginal fistulae repair at gynaecological surgical camp at peoples medical college hospital Nawabshah

To evaluate the predisposing factors for vesicovaginal fistulae [VVF], route of fistula repair and outcome of surgery. Total 21 patients of VVF were admitted. 15 - 24 October 2002 Department of Obstetrics of Obstetrics and Gynaecology at PMCH Nawabshah, Sindh Out of 2I VVF, 14 of them were due to obstetrical trauma, 5 occurred due to gynaecological surgery and 2 were congenital. 18 cases were repaired vaginally and 2 were repaired with abdominal approach. One case was not repaired due to impacted bladder stone. Success repair was in 18 cases and 2 were failed. The success rate was 90%. The key for success was adequate tissue mobilization, division of scar tissue and good postoperative care