Efficacy and safety of iron sucrose complex [ferotein-s] in the treatment of iron deficiency anaemia in pregnant women

To determine the efficacy and safety of intravenous iron sucrose complex in pregnant women suffering from iron deficiency anaemia. This interventional study was conducted at Holy Family Hospital, Rawalpindi from January 2010 to May 2010. Forty pregnant patients with gestational age of 16-32 weeks were enrolled. Iron deficiency anaemia was diagnosed on haemoglobin [Hb] levels <8.25 gm/dl, peripheral film and serum ferritin level <50 ng/ml. All the patients received the calculated total dose of iron sucrose in infusion form with the aim to correct the iron deficiency as well as to replenish the iron stores. They were observed for any side effects. Hb level, Mean Corpuscular Volume [MCV] and serum ferritin level were performed before initiating the therapy, two and four weeks after completion of therapy. Statistical analysis was done with SPSS version 17. Paired student t test and Mann-Whitney U test were used where applicable. Forty women were included in the study. Mean blood indices before therapy were, Hb less than 8.025 gm/dl, MCV 69.6 fl and serum ferritin 37.6 ng/ml. None of the patients had grade II allergic reaction whereas only two patients experienced grade I allergic reaction. Mean duration of therapy was 4.3 +/- 0.9 weeks. After 2 weeks of completion of Iron Sucrose [Ferotein-S] I.V infusion therapy the mean Hb level rose to 9.7 gm/dl, mean MCV became 88.6 fl and mean serum ferritin level was 60.3 ng/ml. After 4 weeks of completion of Iron Sucrose [Ferotein-S] infusion therapy the mean Hb level rose to 11.3 gm/dl, mean MCV became 85.5 fl and mean serum ferritin level was 131.1 ng/ml. The differences in values were statistically significant. Significant improvement of hemoglobin and iron stores were possible in pregnant women given total calculated dose of Intravenous Iron Sucrose Complex [Ferotein-S] infusion. It was safe and well tolerated.

Role of labetalol in control of severe hypertension in pregnancy

To determine the efficacy of Labetalol in the control of severe hypertension in pregnancy. Therapeutic Clinical Trial. Gynae unit 1, Holy Family Hospital, Rawalpindi. 1stApril 2010-31st Dec 2010. All the pregnant women with BP of >/= 160/110 mm of Hg admitted in labour ward were included in the study. Those with bronchial asthma, cardiac failure, heart block, cardiogenic shock, severe bradycardia and hypersensitivity to the drug were excluded from study. Data was collected on a pre-designed proforma. Outcome measures were dose required to achieve the target BP, time taken to achieve the target BP[diastolic BP< 100mmHg], adverse reactions and feto-maternal outcome. Analysis of data was done on SPSS Version 16. Total patients included in the study were 71. Women between 21-30 years were 54 [76%] and 17 [24%] were between 31-40 years. Twenty seven [38%] were Primigravida, 38 [53%] were P1-P4 and 6 [9%] were P5 and above. Out of 71 patients, 10 [14%] presented with PIH, 18 [25%] with Preeclampsia, 39 [55%] with Eclampsia and 4 [06%] with Chronic HTN. Sixty four [90%] of patients presented in 3rd trimester. Range of BP at the time of presentation was from 160/110-250/140 mm of Hg. In 45 [64%] women BP was controlled with labetalol 20-100 mg, while 13 [18%] required >100-200mg and13 [18%] >200-300 mg of labetalol. Time taken to achieve the target BP was 1hour in 43 [60%] women, 2 hrs in 14 [20%], 3 hrs in 14 [20%]. Thirty six [50%] women experienced no side effects and in the remaining 50% nausea and vomiting were the common side effects. None of our patients experienced arrhythmias. After the achievement of target BP, 2/3rd [n=52] were switched over to oral preparation of labetalol. Thirty two patients [45%] delivered vaginally and 39 patients [55%] delivered by caesarean section. Regarding the neonatal outcome 59 [83%] delivered alive and 12 [17%] delivered dead babies. Out of the babies delivered alive, 19 [32%] were shifted to nursery, one baby expired and remaining, 18 were discharged. Majority of women were discharged in healthy state [n= 63] [89%], 08 [11%] were transferred to ICU/ medical unit, out of whom 2 expired later. Labetalol is an effective drug in controlling severe HTN in pregnancy and is associated with mild side effects Foetomaternal outcome was good.

large unilocular mucinous cystadenoma in third trimester of pregnancy

Ovarian malignancy is the second most common gynaecological malignancy diagnosed during pregnancy. A grand multipara, aged 30 years presented with gestational amenorrhea with abdominal discomfort and breathlessness for last 15 days. Sonographic examination demonstrated a huge, unilocular ovarian cyst and an alive fetus of about 30 weeks gestation. Intraoperative findings were huge left ovarian cyst [42x40x20 cm] with straw coloured mucinous fluid. Left salpingo-oophorectomy was performed followed by peritoneal washings and omental biopsy. Histopathology revealed mucinous cystadenomas with inflammatory changes in omentum and no malignant cells in peritoneal washings. She delivered vaginally a female baby of 3.5 kg at 38 weeks with good Apgar score

Abruptio placentae: risk factors and feto maternal outcome

To determine the frequency of risk factors and feto-maternal outcome in patients with placenta abruption. Descriptive study. Department of Obstetrics and Gynaecology Unit-II, Holy Family Hospital, Rawalpindi from January 2002 to December 2002. A total of 54 patients with placental abruption were studied. All the data collected through history, examination and investigations were recorded on a predesigned proforma and analyzed by computer. During the study period of one year, 4121 deliveries were conducted and 54 [1.3%] cases of placental abruption were found. Hypertension was the most common risk factor for placental abruption followed by polyhydramnios, preterm premature rupture of membranes, twin pregnancy and trauma. 33 [61.11%] delivered vaginally and remaining 21[38.89%] had emergency caesarean section for various indications. Out of 57 babies delivered, 36 [36.16%] were born alive and 21 [36.84%] were still born. Total perinatal deaths were 24 [42.10%]. Twenty nine [50.87%] of the babies were low birth weight and 14.24% babies were having congenital anomalies. Major maternal complication was primary postpartum haemorrhage. There was one maternal death due to disseminated intravascular coagulation secondary to massive haemorrhage. Abruption placentae is a major risk factor for maternal and fetal morbidity and mortality. Antenatal services should be provided to all women to reduce the incidence of abruption placentae

Oral misoprostol for induction of labour

To determine the effect of oral Misoprostol in labour induction with respect to ease of administration and induction-to-delivery time interval. Observational study. Gynaecology/Obstetrics Department, Holy Family Hospital, Rawalpindi, from March to August 2006. Women with live singleton pregnancy of >37 weeks gestation with cephalic presentation, with an indication for induction of labour were inducted. Oral misoprostol 50 microg to 400 microg was given in divided doses at 4 hours interval upto a maximum of 4 doses, till labour was induced. Fetomaternal outcome and induction to delivering time interval in hours was noted. In 6 months duration, 250 mothers were recruited for the study. The main indication for labour induction was post date pregnancy [52%] and oxytocin was given in 50% cases. The majority [96%] of mothers went into labour but 4% [9] had failed induction. The majority [73%, n=176/241] of mothers delivered vaginally, 99% being delivered in the first 24 hours. Mean induction-delivery interval was 11 +/- 2.7 hours. Sixty five [27%] had to undergo emergency lower segment caesarean section, the major indication being fetal distress [41.5%, n=27] and meconium staining of liquor [40%, n=26]. Again, a majority [95%] of the babies were delivered with good Apgar score. However, 10.8% developed meconium aspiration syndrome. Early neonatal deaths occurred in 0.8% [2] cases. Maternal hyper stimulation was seen in 1 case [0.4%]. Oral misoprostol as an agent for labour induction in term pregnancy was easy to administer and the majority of women [99%] delivered in the first 24 hours

Body weight and bleeding pattern changes in women using DMPA-SC

To determine the 1-year efficacy of contraception, changes in bleeding pattern and weight with the use of Depot medroxyprogesterone acetate-subcutaneous injected subcutaneously once every 3 months. Descriptive case-series. Gynaecology and Obstetrics Unit, Holy Family Hospital, Rawalpindi, from March 2003 to June 2004. Twenty five patients were selected by purposive sampling and followed up in Holy Family Hospital, Gynaecology and Obstetric Unit for a one-year period using DMPA-SC every three months. Hospital Ethical Committee permission was obtained prior to commencement of the study. Informed written consent was taken. Body weight was measured at baseline and every 3 months thereafter. Bleeding analysis in terms of blood flow and severity of bleeding was also done at 3 months interval using a 5-point scale. DMPA-SC showed 100% efficacy in preventing pregnancy in the 25 patients who were followed up. Mean and SD of age was 34.24 +/- 3.57 years. Mean and SD of weight was 63.44 +/- 13.81 kg. There was a mean weight gain of 0.1 kg at visit 1-3 [first 3 months] and an average weight gain of 1.036 kg at the end of the year. There was a trend towards amenorrhea with 56% of the patients included in the category of bleeding less than usual at the end of treatment period. DMPA-SC can be used in women desiring reversible contraception with unremarkable weight gain and overall bleeding pattern leading towards amenorrhea