Primary amenorrhea with bilateral endometriotic cysts

Primary amenorrhea is a common problem. Diagnosis is usually by going through systematic approach of history, examination and investigations. This case had bilateral large endometriotic cysts in the adnexal region. Uterus was normal sized with well-formed endometrium. She underwent laparotomy followed by drainage of endometriotic cysts, stripping and reconstruction of ovaries was performed. Patient was given a trial of combined oral contraceptive pills for two consecutive cycles to observe withdrawal bleeding, but it failed. Till now we are unable to find out such case in literature. Exact case of primary amenorrhea could not be found

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

Retrospective analysis of acute hepatitis e infection in hospitalized pregnant cases

Hepatitis E virus [HEV] is endemic in Pakistan with 16-19% seropositivity of HEV IgG antibodies. The HEV is considered fatal during pregnancy as compared to general population. The objective of the study was to determine the maternal and fetal morbidity and mortality in HEV IgM positive pregnant cases. The study was conducted in four hospitals i.e. Pakistan Institute of Medical Sciences, Islamabad, Isra University Hospital Jamshoro, Sindh, Lady reading Hospital and Hayatabad Medical Complex, Peshawar, Khyber Pakhtoonkhwa. The medical record of pregnant cases from 2008 to 2011 was retrieved who were positive for HEV IgM. Information about age, gestational age, viral markers [HEV IgM, HBsAg, anti HCV], complications during pregnancy and outcome were recorded on pre design questionnaire. Data was analyzed using SPSS version 15. Medical record of 70 HEV positive pregnant cases was retrieved and out of these, 34 were found complete and analyzed further. The median age was 26 years. Twenty six pregnancies [76%] were in 3[rd] trimesters, 05 in 2[nd] trimester and 01 in 1[st] trimester. Pruiritis was the commonest symptom [28 cases], followed by jaundice [27], nausea/ vomiting [25] and encephalopathy [18]. Of 34 cases, 12 were artificially induced, 08 had premature labor, 04 delivered spontaneously [full term], 04 died undelivered and 04 continued till term. One got delivered at home and another had an abortion at home before coming to hospital. A total of 12 mothers along with their undelivered babies died, of these 08 were in 3[rd] trimester and 04 in 2[nd] trimester. Four out of 07 babies who were delivered prematurely also died. Maternal mortality was directly associated with delivery as 24 out of 34 mothers survived who were delivered either naturally or were induced while 12 out of 34 who continued their pregnancy died [p<=0 .004]. Third trimester had the highest maternal death. Acute hepatitis E during pregnancy led to 35% maternal and 47% fetal mortality. Acute hepatitis in pregnancy should always be screened for HEV and if found positive should be vigilantly followed to save mother and child

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

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

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

audit of change in rate and indications of caesaren section in a tertiary care hospital of Peshawar

To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively. This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study. During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 [59.81%], followed by grandmultigravida n=93 [21.98%] while n=77 [18.20%] were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680 [47.61%] but it was followed by primigravidas n=480 [33.61%] and least n=268 [18.76%] in grandmultigravidas During 1996, the commonest indications in order of frequency were dystocia n=120 [31.20%], previous caesarean section n=71 [16.78%], placenta praevia n=56 [13.23%] and fetal distress n=48 [11.34%] respectively while during 2006, they were dystocia 310 [21.70%], fetal distress n=197 [13.79%], previous caesarean section = 191 [13.37%] and breech presentation n=180 [12.60%] respectively A significant increase [14.84%] in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006

Single dose versus multi dose cephradine as antibiotic prophylaxis in elective abdominal hysterectomy: a randomized control trial

To compare the efficacy of single dose versus 7 days cephradine prophlaxis for the prevention of post operative infection in patients undergoing elective abdominal hysterectomy. This study was conducted in the department of Obstetrics and Gynaecology, Lady Reading Hospital from January 2006 to March 2007. Twenty patients each were randomly allocated by card method to either group I or group II. Patients in group-I were given one gram of cephradine intravenously 30 minutes before surgery while patients in group-II were given one gram of intravenous cephradine 30 minutes before surgery 2 nd dose of one gram was repeated after 12 hours followed by 500 mg of oral dose for next 6 days. Wound was examined on 2nd, 4th and 7th day then after 2 weeks and after 6 weeks. The efficacy was measured in terms of febile morbidity, surgical and nonsurgical site infection and duration of hospital stay. The statistical analysis was carried out by chi square test. Febrile morbidity was equal in both groups [20%], surgical site infection was 10% in group I and 5% in group II, and duration of hospital stay was equal in both groups. Non surgical site infection occurred in 5% of patients in group-I. There was no statistically significant difference in out come in two groups. Single dose prophylactic antibiotic is as effective as multiple dose antibiotics in elective abdominal hysterectomy

Role of transabdominal sonography in diagnostic evaluation of pelvic masses

To find out the accuracy of ultrasound in differentiating different pelvic masses This descriptive study was conducted in the department of Obstetrics and Gynaecology unit A, Khyber Teaching Hospital Peshawar during the years 2001-2002. Total 69 cases with the clinical suspicion of pelvic masses were included in the study. All the patients were admitted and underwent detailed clinical examination and then Transabdominal Ultrasonography [US]. Final diagnosis was confirmed at operation findings. Out of 18 [26.1%] cases of fibroid uterus on US, 14 [77.8%] cases were confirmed on laprotomy. US showed 14 cases of simple ovarian tumours and 11 cases of malignant ovarian tumours while postoperatively 13 and 12 cases had simple and malignant ovarian tumours respectively. Out of 10 cases of chronic ectopic pregnancy on US, 7 cases were confirmed on laprotomy. Dermoid cysts, haemtocolpos and haematometra were correctly diagnosed in all case. Diagnosis was misleading in 8/69 [11.6%] cases. Out of 4 cases misdiagnosed as fibroid on US, 3 cases had endometriotic cysts and one case had fibroma ovary. Three patients labeled as chronic ectopic pregnancy on US had pelvic abscess, right broad ligament hemorrhagic cyst and right broad ligament fibroid [one case each]. One case of malignant ovarian tumour was misdiagnosed as simple ovarian tumour on US. Ultrasonography can be helpful in the diagnosis of various pelvic masses. It can help the surgeon to plan the technique of surgery and anticipate intraoperative complications

Screening for intra-uterine growth retardation

Ante-natal diagnosis of IUGR is usually difficult and inaccurate. Fifty two cases were studied to evaluate the foetus with IUGR. Sixteen were lost to follow up and the remaining 36 cases were studied until term. Both procedures were used simultaneously. By using SFH measurement 10 [27%] cases were detected as having IUGR, while at birth 9 [25%] infants were found to growth retard. This gave the procedure sensitivity and specificity of 90% and 96% respectively. By using ultrasound abdominal circumference measurement 13 cases were detected having IUGR giving sensitivity and specificity of 69% and 85% respectively. This small study significies the importance of measurement as screening test for identification of IUGR

Enlarged hyper-echogenic kidneys diagnosed in third trimester

Congenital abnormalities of urinary tract of the fetus are frequently detected by ultrasonography even during the first trimester. Enlarged hyper-echogenic kidneys which are detected during the third trimester pose problem regarding their management. Some of these cases are a normal variant while rest of them could be associated with chromosomal abnormalities or genetic defects. Two case reports of the enlarged hyper-echogenic kidneys are presented here. Both were detected during third trimester. Parents were informed and counseled regarding the prognosis and recurrence of the condition

Incidence of operative deliveries in cases of dystocia [obstructed labour] recommendation for reducing the rate

Three hundred and forty eight cases were studied for incidence of operative delivery in patients with obstructed labour in Gynae 'B' unit, Lady Reading Hospital, Peshawar. Total number of deliveries from Oct 1.1988 to Sep 30, 1989 was 2168. The incidence of operative deliveries was high when compared to developed countries. Approximately 162 [47%] patients underwent caesarean section the majority of who were multigravidae in whom malpositions, malpresentations and macrosomic babies were the commonest indication for Caesarean section. About 75% patients were delivered by forceps. Prolonged and difficult labour followed by delayed operative delivery resulted in increased incidence of maternal and foetal mortality and morbidity. Medical management could be a safe and effective alternative to immediate operative intervention