Frequency of anemia among patients of abruptio placentae

To determine the frequency of anemia and need for blood transfusion in patients of placental abruption. This prospective cross sectional study was conducted at Department of Obstetrics and Gynecology for a period of 15 months from September 2010 to December 2011. All pregnant ladies who presented with Abruptio Placentae were included by completing a proforma for each patient After confirming the diagnosis, the blood of these patients was sent to laboratory for hemoglobin level, blood group and other routine investigations. According to hemoglobin level and the amount of bleeding, the number of blood units required by each patient was analyzed on SPSS v 15. 100 patients suffering from placental abruption were studied. 83% ladies were anemic and 61 were moderate to severely anemic. 98% received blood transfusion and 91% received 1-4 units of blood. Majority of patients presenting with placental abruption were found to be anemic and required multiple blood transfusions. The association between anemia and placental abruption is well documented, however, it needs to be established whether anemia leads to abruption or anemia is the consequence of abruption

Vacuum extraction and forceps deliveries; comparison of maternal and neonatal morbidity

To compare the maternal and neonatal morbidity between vacuum extraction versus forceps vaginal delivery. Quasi-experimental study. January 2009 to December 2010. Setting: Department of Obstetrics and Gynecology CMC, SMBBMU Larkana. All patients delivered by forceps or vacuum with singleton pregnancy were included, the patient with multiple gestation, breech presentation and gestational age less than 34 weeks were excluded. Data collected in pre-set Proforma include type of instrument used, indication of instrumental delivery, maternal and neonatal complications of procedure. Data was analyzed; frequency and percentage will be calculated for maternal age, gestational age, and degree of perineal and cervical tears. .chi-square test was applied to compare the degree of neonatal and maternal complications. P-value less than 0.05 taken as significant. Total 9, 5600 deliveries were conducted, among them assisted vaginal deliveries were169 making the frequency of 2.66%, among which 96 have forceps and 64 were ventouse vaginal deliveries. Majority of women were primigravida. In infants of less than 37 weeks of gestation the use of forceps was significantly more common, delay in second stage of labor was the most common indication for vacuum extraction while fetal distress was more common reason for forceps delivery. Severe birth canal injuries [third and fourth degree perineal tears] and procedure related blood loss of more than 500 ml was significantly more common in forceps delivery group. Cephalhaematoma, neonatal jaundice and severe caput succedanum at discharge were more seen in vacuum deliveries, but facial injuries were more common after forceps delivery. Intracranial hemorrhage was identified in two infants born by vacuum extraction and none in forceps group. Two infants delivered by vacuum extraction expired, one due to respiratory distress and other due to intracranial hemorrhage, and one of the infants delivered by forceps expired due to meconium aspiration syndrome [MAS]. Each instrument has its own merits and demerits .Maternal and neonatal outcome depends on indications of instruments, patient selection and skill of operator. We conclude that forceps delivery is more associated with maternal genital tract trauma and vacuum delivery is associated with more neonatal complications. So it is the choice of obstetrician to select the proper instruments. We also suggest that obstetricians learn these skills not on patients but in a skill laboratory using models

Magnesium sulphate therapy in edampsia: an experience at Chanilka medical college Larkana

To evaluate the role of magnesium sulphate [MgSo4] in the management of eclamptic patients in terms of efficacy, safety, recurrence of convulsion and fetomaternal out come. This descriptive case series study was conducted over a period of one year from 1[st] October 2007 to 30[th] September 2008 at Gynae and Obs Unit-1 Sheikh Zayed Hospital for women CMC Larkana. All the patients admitted with eclampsia during the study period were included in the study. All patients were managed accordingly to the protocol. MgSO4 was given to eclamptic patients according to protocol who had no contra indications to this drug. Recurrence of convulsions, side effects of MgSO4, maternal and fetal outcome were noted. During the study period total no: of obstetrical admissions were 4051 and total deliveries were 3200. Sixty seven patients presented with eclamptic fits which accounts for 1.6% of total deliveries. Only 13 patients [19.4%] were booked and the rest were un-booked. Majority was primigravida and common age group was 21-30 years. In the antepartum period eclampsia were accounted for 29.6%, intrapartum 43.6% while 26.8% were postpartum eclampsia. Fits occurred in the 3[rd] trimester after 32 weeks in 32 cases [58%]. All patients received MgSO4. 94% had no side effects, 2.9% developed diminished reflexes, 1.4% developed hypotension, 1.4% developed renal failure, recurrence of fits was observed in 4 cases [5.9%]. 3 patients were expired due to cardiopulmonary failure with in 24 hours after arrival at Hospital. Fetal out come was analyzed 48 retuses born alive, 4 were IUL 9.were FSB, and 4 were NND. In conclusion MgSO4 was found to be were effective and cheap for control of fits and has lower risk of recurrent convulsions. The occurrences of drug complications were very low with standard protocol. Maternal mortality was also 12w 2nd fetal outcome was found to be good. Clinical monitoring seems to be sufficient in this study

Outcomes of open mesh hernia repair: five years' experience at Chandka medical college hospital Larkana

Objective: to document the outcomes of open mesh repair in the management of various Hernias

Study design: a descriptive case-series study

Sampling technique: non-probability purposive

Place and duration of study: department of Surgery, Unit-I Chandka Medical College Hospital, Larkana, from July 2003 to June 2008

Patients and methods: two hundred and eighty patients of hernia operated by sublay mesh repair were analyzed for postoperative outcomes as pain, surgical site infection, hematoma/seroma, sinus formation and recurrence. Data were collected by filling specially designed proforma for each patient. Follow up visits were scheduled at three weeks, six weeks, three months and six months postoperatively

Results: polypropylene sublay mesh repair was performed in 280 patients of hernia comprising of 174 males and 106 females with male to female ratio of 1.6:1. Age ranged from 20 to 78 years, mean 51 years. Inguinoscrotal hernia was the commonest type [52.5%], followed by periumbilical hernia [26.25%] and incisional hernia [13%]. Postoperatively 254 [91%] patients had uneventful recovery, 15 [5.3%] had surgical site infection, while 11 [3.9%] patients developed seroma. Neither recurrence nor chronic discharging sinus was noted

Conclusion: open mesh repair for hernia is a safe and effective technique, associated with low morbidity. Technique has proved to be simple and easy to perform, with minimal postoperative pain and early mobilization