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

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

diagnostic validity of pre-operative serum CA125 level in women with ovarian masses

To determine the validity of serum CA125 levels in differentiating benign and ovarian cancer in patients with ovarian masses, using histopathology as a gold standard. In this cross sectional study, blood samples were obtained from 85 women with ovarian masses who fulfilled the inclusion criteria and sent for the assay of serum CA125 levels. They were scheduled for elective surgery at Hayatabad Medical Complex Hospital between 1[st] April, 2009 and 31[st] March 2010. Of the 85 women enrolled, ovarian cancer was found in 27 cases [31.8%] and benign ovarian mass in 58 cases [68.2%]. The sensitivity, specificity, and accuracy of serum CA125 at the cutoff level of 35 U/mL for prediction of ovarian cancer were 74.14%, 92.5%, 80% respectively; with 95.56% positive predictive value and 62.5% negative predictive value. As stand-alone modality, serum CA125 of more than 35 U/mL in predicting ovarian cancer revealed modest diagnostic accuracy

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