Comparison of efficacy and safety of magnesium sulphate in 12 hours versus 24 hours after last fit in eclamptic patients

To compare the efficacy and safety of magnesium sulphate in 12 hours regime versus 24 hours regime after last fit in eclamptic patients. Randomized controlled trial study. This randomized controlled trial was carried out at Department of Obstetrics and Gynaecology, Unit-Ill, Nishtar Medical College/Hospital Multan from 01.06.2013 to 31.05.2014. Total 120 patients with eclampsia were included. All patients were given 4g of magnesium sulphate [20% solution] intravenously slowly [15 mins] as loading dose. After receiving the loading dose randomization was performed by block design. So 60 patients for 12 hour regime while 60 patients for 24 hour regime [control group]. In 12 hour regime group magnesium sulphate maintenance dose of Ig [20% solution] was given 1 hourly intravenously for 12 hours after last fit. In 24 hour regime group magnesium sulphate maintenance dose of ig [20% solution] was given 1 hourly intravenously for 24 hours after last fit. Efficacy in shape of recurrence of fits, number of fits and safety in shape of pulmonary oedema, oliguria and loss of knee jerk reflex,Nausea and flushing was noted. Total 120 patients were studied falling in age group of 20 to 40 years. Eclampsia was most commonly occurring in young and primigravida patients. Majority of eclamptic patient had diastolic B.P 110 or > 1 l0mmHg. None of patients in either group had eclamptic fit. Loss of knee jerk reflex seen in 5 patients in 24hrs regime group. Minor side effects were more commonly observed in 24hrs regime group. [n=38] of the students were underweight and 36 % [n=21] were obese. Twelve hours regime is equally effective as 24hours regime but with lesser side effects and so more cost effective. 12hours regime was observed to promote shorter hospital stay decreasing work load

Frequency of live births in patients with unexplained recurrent abortions treated with low molecular weight heparin and aspirin

To determine the frequency of live birth in patients with unexplained recurrent abortions treated with low molecular weight heparin and aspirin. Descriptive study. This study was carried out at Department of Obstetrics and Gynaecology, Unit-Ill,Nishtar Medical College and Hospital, Multan from 01.01.2014 to 31.12.2014. Sixty women with past history of two or more previous unexplained recurrent abortions who received low-molecular weight heparin [LMWH] and low dose aspirin [LDA] were included in the study and followed subsequently for the pregnancy outcome in the form of live birth measure. The age range between 20 to 40 years with mean 32.38 +/- 3.64 years. A total of sixty patients were studied with a 58.3% patients were belong to age group of 31-35 years. Previous abortion percentage was 36.7% with 2 abortions while 63.3% with 3 abortions with mean 2.63 +/- 0.49 abortions. Live birth was recorded in 51 out of 60 patients with percentage of 85%. An enhancement in the live-birth rate was observed after low-molecular weight heparin [LMWH] and low dose aspirin [LDA] administration, in patient with 2 or more consecutive unexplained recurrent abortions

Breech presentation

To determine the frequency of breech presentation at term. Cross sectional study. Department of Obstetrics and Gynaecoogy, Unit-III, Nishtar Hospital, Multan. June 2010 to May 2011. This study was carried out in women with the age group 0-40 years. Breech presentation at term [37-41 completed weeks]. The frequency of breech presentation at term was found to be 6.2%. 91% [215] of the patients were delivered by caesarean section and 9% [20] were delivered vaginally. Placenta previa and multiple pregnancy 8.51% each, congenital anomalies 4.25% and in 16.17% of the patients, no obvious cause was found. It is concluded from the study that the frequency of the breech presentation at term increased

role of metformin therapy in women with polycystic ovarian syndrome

To determine the efficacy of metformin therapy in women with PCOS in terms of ovulation induction and pregnancy. The study was carried out in Outpatient department Gynaecology Unit-1, Nishtar Hospital, Multan from January 2007 to March 2008. A total of 285 patients fulfilling the inclusion criteria [oligo/hypomenohorea, infertility, weight gain, hyperandrogenism] were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in one or both ovaries was the cut off number for positive ultrasound. Patients with other causes of infertility were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were evaluated for response to metformin therapy. At the start of the study, 78% women had menstrual irregularity, 54% had primary and 46% had secondary, ultrasound features were found in 94% patients, hirstism in 70% and weight gain was found in 64% of patients. After six months of metformin therapy, ovulation was observed in 66% of women while 52% of patients conceived on metformin, therapy alone. Metformin alone was an effective treatment for PCOS in terms of ovulation induction and pregnancy

role of metformin therapy in women with polycystic ovarian syndrome

To determine the efficacy of metformin therapy in women with PCOS in terms of ovulation induction and pregnancy. The study was carried out in Outpatient department Gynaecology Unit-I, Nishtar Hospital, Multan from January 2007 to March 2008. A total of 285 patients fulfilling the inclusion criteria [oligo/hypomenohorea, infertility, weight gain, hyperandrogenism] were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in one or both ovaries was the cut off number for positive ultrasound. Patients with other causes of infertility were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were evaluated for response to metformin therapy. At the start of the study, 78% women had menstrual irregularity, 54% had primary and 46% had secondary, ultrasound features were found in 94% patients, hirsutism in 70% and weight gain was found in 64% of patients. After six months of metformin therapy, ovulation was observed in 66% of women while 52% of patients conceived on metformin, therapy alone. Metformin alone was an effective treatment for PCOS in terms of ovulation induction and pregnancy

role of laparoscopic ovarian surgery in women with polycystic ovarian syndrome

To determine the efficacy of laparoscopic ovarian surgery [LOS] in women with polycystic ovarian syndrome in terms of ovulation induction, conception rate and regulation of menstrual cycle. The study was carried out in the Department of Gynaecology, Nishtar Hospital, Multan from March 2007 to February 2009. A total of 200 patients fulfilling the inclusion criteria were enrolled. LH/FSH ratio and ultrasound pelvis was done in all women. Presence of eight or more follicles in one or both ovaries was the cutoff number for the positive ultrasound. Patients with other causes of infertility were excluded from the study. Laparoscopic ovarian drilling [LOD] was done in all patients. In this study 100% patients [n=200]were infertile due to PCOS. 70% women had menstrual irregularity, 30% had hirstuism, 35% had weight gain. Raised LH/FSH ratio was observed in 52% of patients while ultrasound features were seen in 81% of women. After LOD regulation of menstrual cycle was seen in 70% of patients, ovulation was observed in 75% while 55%of patients conceived after laparoscopic ovarian drilling. Laparoscopic ovarian drilling is the preferred second line for induction of ovulation after clomifene citrate resistance/failure

Frequency of menstrual disorders with depot medroxy progesterone acetate [DMPA] as contraceptive

Increasing population growth rate in developing countries like Pakistan is a major problem requiring fertility control. The introduction of injectable hormonal contraceptives has increased the number of women practicing contraception and compliance as well. To assess the frequency of menstrual disorders with depot medroxy progesterone acetate. This descriptive study was carried out in Obstetrics and Gynaecology Unit I, in collaboration with Reproductive Health Services, Master Training Centre, Nishtar Hospital Multan during the period from July 2005 to December 2006. One hundred and fifty non-pregnant women of reproductive age were selected and after complete history, examination and investigations, all women suitable for DPMA were included. In our Study the main complaint was menstrual disturbance. More than one fifth of the clients i.e. 32 [21%] enjoyed normal menstrual patterns. Sixty two [41%] ladies developed amenorrhoea by the end of one year. Seventeen [12%] cases complained of irregular vaginal bleeding and 39 [26%] had heavy regular periods. One hundred and thirty three [89%] patients revealed complete satisfaction with the product while 17 [11%] complained about discomfort due to menstrual problems. Out of these seventeen, nine discontinued as menstrual irregularities had handicapped their life so there were 141 [94%] patients who continued while 6% discontinued. Despite bleeding disturbances caused by DPMA, high continuation rates showed that this contraceptive method is acceptable to women

Maternal and foetal outcome in cases of emergency caesarean sections at Nishtar Hsopital, Multan

The aim of this study was to determine the maternal and foetal outcome in cases of emergency caesarean section, to find out the causes of maternal and foetal mortality and morbidity and also to prevent the maternal and foetal complications by finding high risk cases in the antenatal period. Department of Gynaecology and Obstetrics, Nishter Hospital Multan. December 1999 to November 2000. It was an observational study. A total of 100 cases of emergency caesarean section were included. During this period the various indications for which we performed emergency caesarean sections included eclampsia [20%], placenta previa major degree [20%], severe pregnancy induced hypertension with failed induction of labour [18%], placenta previa type IV with previous two caesarean sections [2%], obstructed labour [2%], foetal distress [6%], previous caesarean section with scar tenderness [13%], transverse lie with hand prolapse [2%], abruptio placentae [2%], chorioamnionitis [5%], failed progress of labour [8%] and cord prolapse [2%]. Majority of the patients were non-booked with no pervious antenatal check up. During the study of these 100 cases of emergency caesarean sections no maternal mortality was observed but different maternal morbidities were observed in 18 patients like intraoperative excessive haemorrhage [38.8%], extension of uterine incision [16.33%], uterine atony [16.33%]. 16.33% cases of caesarean section ended up in caesarean hysterectomy. Emergency cases should be handled by senior staff and caesarean be done at earliest possible time to reduce drastic outcome. Furthermore, proper sterilization and prophylactic antibiotics can reduce the infectious morbidity after both emergency and elective caesarean section

Polycystic ovarian disease; the diagnosis and management

Poly Cystic Ovarian Disease [PCOD] is probably one of the most common endocrinological disorders amongst the women during their reproductive years. Using USG criteria only 20-33% of apparently healthy women in childbearing period, have been found to have PCOD in population study. Whereas prevalence of 4-10% in women of reproductive age is commonly reported when the diagnosis is based on clinical, biochemical and US scan features. Diagnosis and management of polycystic ovarian disease. Setting Seyal Medical Centre, Multan. Duration From January 2002 to December 2003. Sample size: 200 patients. Most of he patients were in the age group of 21-30 years. The youngest patient was of 17 years and eldest was of 42 years. Majority of the women were nulliparous or of low parity comprising 92% of cases. The commonest symptom was menstrual disorder in 168 Patients [84%]. Ultrasound is very helpful for diagnosis of POD. i. About 80% of patients were diagnosed as PCOD on ultrasound. There is increased level of LH in 72% patients, 8% have raised prolactin levels. All patients were first treated with clomiphene citrate while surgical treatment is done n only 30% of cases. GnRH analogue and purified FSH were not used because they are quite expensive. PCOD is found to be one of the commonest problem in reproductive years of life. Clomiphene citrate is first line treatment in PCOD for infertility. Laparoscopic drilling has very good results especially in clomiphene resistant cases

Cervical ripening. A double blind controlled trial of PGE2 pessary

OBJECTIVE: To determine the efficacy of PGE2 pessary in the cervical ripening and to study its effect on other parameters of labour and delivery. DESIGN: Prospective study. SETTING: Maternity Unit II Nishtar Hospital Multan. SUBJECT: A randomized double blind trail of PGE2 pessary was carried out in patients admitted for induction of labour. MEASUREMENT AND RESULT: We looked at the change in Bishop scoring, induction delivery interval, mode of delivery and fetal outcome. Fifty% of the patients who received prostin E2 pessary went into labour before planned amniotomy while only five% of the patients receiving placebo did so. No significant difference was found in mode of delivery and incidence of fetal distress between the two groups. The shortened induction delivery interval following pre treatment with PGE2 [3 mg] pessary