Comparison of active versus expectant management of third stage of labour

To find out the difference between active and expectant management of third stage of labour in terms of amount of blood loss and duration of third stage of labour. This quasi experimental study was conducted in the Unit "B" of department of Obstetrics and Gynaecology, Lady Reading Hospital from June - December 2006. A total of 100 patients were included in the study, out of which 50 patients under went active management of third stage of labour [AMTSL] and 50 patients had expectant management. Formal consent was obtained from all the patients. Apart from the demographic data, details regarding the amount of blood loss and duration of third stage were recorded on a semi structured proforma and analyzed by using Chi Square test, with p value of <0.05 considered as significant. In the active management group most of the patients had blood loss less than 100ml while in the expectant group most of the blood loss was between 100-200ml. Mean blood loss in the active group was 72.5 +/- 36.83ml and expectant group was 177.4 +/- 59.65ml, p value <0.001. Similarly the difference in the duration of the third stage was statistically significant between the two groups [p value <0.001]. AMTSL was associated with statistically significant decrease in the blood loss and shorter duration of third stage of labour

To determine the most common semen abnormalities and risk factors associated with different types of semen abnormalities in infertile male

To determine the most common semen abnormalities and risk factors associated with different types of semen abnormalities in infertile male. Cross sectional study. This study was conducted in the Department of Obstetrics and Gynaecology, Unit B, Lady Reading Hospital Peshawar, for a period of one year from 1[st] January 2009 to 31[st] December 2009. Hundred male patients with abnormal semen analysis were recruited after fulfilling the inclusion criteria. Semi structured Questionnaire was filled and data was collected regarding association of male infertility with common risk factors. Results were expressed in percentages. Descriptive statistics was applied using Microsoft Excel and the frequency and percentages were calculated. Among 100 infertile male patients, 44% patients had asthenospermia, 17% had oligospermia 14% had azoospermia, 13% had pyospermia and 12% had oligoasthenospermia. Drug addiction was [cigarette or cigarette plus THS] observed in 55% [n=55] of patients. Among all participants 46% [n=46] were overweight or obese, In 40% [n=40] infertile males, there were coital problems. Systemic illness was found to be in 34% [n=34] of males with infertility, of all the participants largest number of infertile males were farmers 19% [n=19]. Asthenospermia accounted for the frequently associated problem of abnormal semen analysis followed by oligospermia, azoospermia pyospermia and oligoasthenospermia respectively. Cigarette smoking and obesity are the most frequently associated risk factors

Frequency and pattern of distribution of antenatally diagnosed congenital anomalies and the associated risk factors

To find the frequency and pattern of distribution of antenatally diagnosed congenital anomalies and the associated risk factors. This descriptive study was carried out at the department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar from March 2012to April 2013. Women with ultrasound report of congenitally abnormal fetus irrespective of the gestational age were included. They were evaluated for the presence of risk factors including periconceptional use of folic acid, maternal medical disorders e.g diabetes, epilepsy and history of smoking, maternal and paternal ages, consanguineous marriages and family history of anomalies. A total of 62 women were included in the study. Fifty seven [91.9%] were having isolated anomalies while 5 [8.1%] presented with complex anomalies. Central nervous system [CNS] was the most commonly involved system [79%]. Lack of folic acid use and consanguineous marriages were two most important risk factors; however their correlation with congenital anomalies was not significant. Forty eight [77.4%] women have never used folic acid and consanguineous relation was present in 52 [83.9%]. Other risk factors like maternal medical disorder e.g. diabetes, epilepsy, maternal and paternal ages, family history and maternal smoking were non-significant. Lack of periconceptional use of folic acid and consanguineous marriages were two most important risk factors. Awareness among the general population and improvement in the antenatal care can help in the early detection and management of congenital anomalies

Twin delivery: perinatal outcome of the second born twin

The objective of this study was to compare the perinatal outcome of first and second twin in terms of perinatal morbidity and mortality in vaginal delivery. This comparative study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from April 2006 to February 2007. Fifty patients with twin gestations admitted to labour ward for delivery at and above 36weeks´ gestation were selected according to the inclusion/exclusion criteria. Information including maternal age, parity, birth weight, Apgar score, perinatal morbidity and mortality of both twins were recorded on a semi structured proforma and analysed by chi square test using SPSS v 12. The differences of the Apgar scores at one minute and five minute were significantly increased in the second twin compared to that of the first twin [p =0.040, and 0.038 respectively]. The admission to nursery was also found to be significantly increased in second twins as compared to first twins [p = 0.43]. The perinatal morbidity was also found to be significantly increased in second twins than the first twins [p= 0.05], while neonatal mortality was not statistical significant. The perinatal outcome of vaginally delivered twins at or after 36weeks' of gestation showed that second twins are at greater risks of perinatal morbidity than the first born twins. But the early neonatal mortality was not significantly different between the two groups

Maternal morbidity associated with emergency versus elective caesarean section

To compare maternal morbidity in elective versus emergency caesarean section in a tertiary care teaching hospital. This comparative study was conducted at Department of Gynecology and Obstetrics, Lady Reading Hospital Peshawar, Pakistan, from July 2006 to June 2007. A total of 100 patients, 50 in emergency and 50 in elective caesarean section group through convenient sampling were included in the study. The sample size was calculated as 100 by keeping 8% prevalence of caesarean section in Pakistan and using WHO software for sample size estimation. The complications were compared in both groups using a semi structured proforma. The comparison was done by using Chi-square test and p-value

Active versus conservative management of prelabour rupture of membranes at term

To compare maternal and foetal outcome of active versus conservative management of premature rupture of membranes after 37 completed weeks of pregnancy. This quasi-experimental study was carried out at Gynae unit, Lady Reading Hospital, Peshawar from September 2004 to September 2005 and included 100 patients out of which 50 were managed conservatively and 50 actively. After confirming the leakage of amniotic fluid, patients were randomized by lottery method to conservative or induced group. The patients in the group that was managed conservatively were shifted to obstetrical ward to await the onset of regular uterine activity for at least 48 hrs. After Bishops scoring, patients were induced with vaginal prostaglandin E2 tablet. Both groups received intravenous antibiotics. Total number of patients with PROM at term was 3.84%. Total cost of stay in hospital and management was greater in induced group [P. value <0.05%]. Latent time was short in induced group whereas hospital stay was prolonged in induced group. About 80% of patients in conservative group delivered by NVD as compared to 60% in induced group. Among complications mild fever and PPH were significantly [P. value <0.05] more common in conservative group. There was neither neonatal death nor stillbirth in both groups. No statistically significant difference [P. value >0.05] was observed in respect of perinatal outcome and infectious morbidity in babies. Conservative management of PROM at term should be viewed more positively for at least 48 hrs under appropriate antibiotic cover and with active management of 3[rd] stage of Labour

Comparison of mode of delivery in undiagnosed breech presentation in labour

To compare vaginal delivery and cesarean section in terms of neonatal morbidity and mortality in undiagnosed breech presented in labour. This comparative study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from January to December 2011. Total of 119 undiagnosed breeches admitted in labour ward were included in the study. Apart from the demographic details neonatal outcome including Apgar score, intrapartum fetal death and neonatal intensive care unit admission were recorded on a semi structured proforma and analyzed by Chi square test using SPSS v. 17. The mean age of the women delivered vaginally was 27.91 +/- 6.37 years while the mean age of those that underwent cesarean section was 23.88 +/- 3.32 years. The overall mean age of the sample was27.03 +/- 6.06 years. The mean gestational age of the fetuses in both the groups was between 37-40 weeks. Out of 93 breeches which were delivered vaginally, 12[12.9%] neonates were having Apgar score <7. While those delivered by cesarean section only 2[2.1%] neonates were having low Apgar score [p-value=0.511]. Two[2.1%] neonates were admitted in neonatal intensive care unit in the vaginally delivered group, while among in the cesarean section group there was no neonatal intensive care unit admission[p value=0.462].There was no intrapartum death in both the groups. Undiagnosed, uncomplicated breeches presenting in labour can be safely delivered vaginally, but large randomized study is needed to decide about the best mode of delivery

Role of metformin in polycystic ovarian syndrome

To assess the role of Metformin in Polycystic ovarian syndrome [PCOS]. This interventional, quasi-experimental study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from October 2004 to October 2006. A total of 35 patients with PCOS were included fulfilling Rotterdam Criteria. Metformin was given in a dose of 850 mg twice a day. Patients' reassessment was done clinically on a three monthly basis while laboratory investigations and Transvaginal scan was done after two years. Data was analysed using SPSS v. 16. The mean age of the sample was 27 +/- 5.2 years. Out of 35, 29[82.8%] had primary infertility while 6[17.2%] had secondary and only 7[20%] of those conceived. Menstrual irregularities were present in30[85.7%] patients, 27[55.5%] with oligomenorrhea, 2[5.7%] with amenorrhea and 1[2.86%] with polymenorrhea. Out of these 15, 2 and 1 showed improvement, respectively. Regarding hyperandrogenism,22[62.8%] patients were with hirsutism, 3[9.4%] had acne and 10[28.5%] had hair loss. Out of these 0, 2and 3 improved, respectively. Transvaginal scan showed polycystic ovaries in all patients at baseline while the cysts dissolved in 15[42.8%] patients. Biochemical investigations like Leutinizing Hormone: Follicle Stimulating Hormone[LH:FSH], Serum Testosterone, Serum Prolactin, Random Blood Sugar[RBS] and Serum Insulin was raised in 32[91.4%], 24[68.5%], 9[25.7%], 3[8.5%] and 10[28.5%] patients respectively and 17[53.1%], 13[54.2%], 4[44.4%], 1[33.3%] and 4[40%] patients improved respectively. Metformin is an effective drug to improve the menstrual irregularities, LH:FSH and serum testosterone but it does not show improvement in clinical signs and symptoms of hyperandrogensim

Decreased amniotic fluid index and adverse pregnancy outcome at term

To find out the effect of decreased amniotic fluid index [AFI] on adverse pregnancy outcome at term. This experimental study was conducted at Gynae [B] unit Lady Reading Hospital Peshawar from September 2004 to August 2005. A total of 100 pregnant women admitted in labour ward were included in the study. Fifty cases with an amniotic fluid index of <5cm comprised the patient group. Fifty controls having AFI>5cm were matched with the cases regarding age [ +/- 3years], parity and antenatal complication [hypertension, diabetes]. Apart from demographic details, maternal outcome measures such as induction of labour; mode of delivery; meconium stained liquor; and fetal outcome measures such as Apgar score and admission to neonatal intensive care unit were recorded on a semi structured proforma for both the groups and analyzed by Chi square test using SPSS v.ll. Labour induction was significantly higher in patients having AFI<5cm as compared to the control group [p-value=0.009]. Meconium stained liquor [p-value=0.023] and cesarean section rate for fetal distress [p-value=0.000] were higher in patients having AFI<5cm. Neonatal complications were found to be more frequent in the patients having AFI<5cm and these include, low Apgar score <7 [p<0.00l] and neonatal intensive care unit admission [p=0.078]. There was no perinatal mortality in both the groups. Amniotic fluid index of <5cm was associated with adverse pregnancy outcomes in the form of meconium stained liquor, induction of labour, cesarean section for fetal distress, low Apgar score and neonatal intensive care unit admission