Audit of leiomyoma uterus at Khyber Teaching Hospital Peshawar

Fibroid is the commonest tumor of the reproductive tract and frequently encountered problem in gynecological practice. This study was carried out to observe the frequency of fibroids in relation to age, parity and clinical manifestations along with a critical review of its management. This study was carried out over a period of one year from 1st January to 31st December 2000 in Gynae "A" unit of Khyber teaching hospital, Peshawar. All patients presenting with fibroid uterus were included in the study. Data collection included age, parity, menstrual pattern, presenting symptoms, medical and surgical treatment history. Diagnostic criteria were clinical and ultrasonography. Evaluation of medical treatment and surgery were carried out. Management outcome of minimal invasive surgery was also observed. Results and Total 146 cases were observed. Greater frequency was found in late reproductive and perimenopausal years [65.7%]. There were 34.2% cases in reproductive age group. Majority was multiparous [72%] and 28% were nulliparous. Infertility was noticed in 16%. Myomas were mostly symptomatic [70%]. Menstrual symptoms were commonest [81.5%], pain was second common symptom [27.3%]. About 24% presented with abdominal mass and hyaline degeneration were in 50% of cases. Leiomyomas were multiple in 63.1% and commonest variety was interstitial [60.4%]. Familial factor noticed in 5.4%, clinical diagnosis was made in 582% of cases, while ultrasound was used in 40.4% of patients, conservative treatment was given in 37.6% including medical therapy [8.2%], Surgery was performed in [62.3%]. Myomectomy [10.2%] and hysterectomy was carried out in 52.05%. Minimal invasive surgery was not possible in our set up

Uterine rupture: a review of 34 cases at Ayub teaching hospital Abbottabad

Uterine rupture is a deadly obstetrical emergency endangering the life of both mother and fetus. This descriptive study was conducted to determine the frequency of ruptured uterus at Ayub Teaching Hospital Abbottabad and to elicit possible causes/reasons of ruptured uterus. The study was conducted at the department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad, Pakistan over a period of one year from July 1st, 2001 to June 30th, 2002. All cases of uterine rupture presenting during the study period were recorded and managed in the department using a protocol prepared for the purpose of this study. Data was recorded on pre-designed Proforma. There were 34 cases of ruptured uterus out of a total of 3435 deliveries [including 1128 Caesarian sections] over a one-year time period [incidence of 1/100 deliveries] with 31 intra-partum deaths. The most common age group was from 31'35 years [16/34, 47%], followed by the 26'30 years age group [13/34, 38.2%]. A majority [29/34, 85.3%] were cases of unscarred uterus presenting with rupture; the most common cause of rupture in all cases was inappropriate injections of Oxytocin [11/34, 32.35%], followed by obstructed labour [9/34, 26.5%]. All were anemic and most of them were in shock. The leading cause of ruptured uterus was found to be mismanagement by traditional birth attendants. We can reduce maternal mortality due to rupture uterus by giving proper training to traditional birth attendants and by mass education through electronic media