Frequency of pregnancy induced hypertension in teenage pregnancy

To determine frequency of Pregnancy Induced Hypertension in teenage pregnancy. Descriptive Cross Sectional Study. This study was conducted at Shaikh Zaid women hospital Chandka Medical College Hospital Larkana from 1[st] June 2013 to 1[st] December 2013. A total of 163 women with singleton pregnancy having gestational age from 20 weeks onwards were included in this study. Gestational age was diagnosed on earlier dating ultrasound and from last menstrual period [LMP]. Pregnancy induced hypertension was diagnosed on the basis of clinical examination which was done by measuring blood pressure via well maintained sphygmomanometer. Data was recorded on predesigned proforma including age, parity, gestational age and frequency of teenagers with high blood pressure. Frequency of pregnancy induced hypertension in teenage pregnancy was observed in 21.47% in our study population. The age group of patients affected mostly with pregnancy induced hypertension was 16 to 17 years of age, and their mean age was16.35 +/- 1.68 years while mean gestational age of the patients was and 27.04 +/- 3.44 weeks. Looking in to parity of patients, 64 [39.26%] women were primigravida, 64 [39.26%] were primipara [having already given birth to one baby] and 35 [21.47%] had Parity of 2. Teenage pregnancy is associated with higher risk of pregnancy induced hypertension. Teenage mothers generally encounter more problems during pregnancy and child birth than older women. Early booking, good care during pregnancy and delivery and proper utilization of contraceptive services can prevent the complications in this group

Bacterial vaginosis; frequency of asymptomatic pregnant women

To establish the frequency of bacterial vaginosis in asymptomatic pregnant women. Cross Sectional Descriptive study. Private tertiary care hospital of Larkana. 1 June 2011 to 31[st] December 2011. 120 asymptomatic pregnant women at 14-28 weeks of gestation were included in this study after fulfilling selection criteria. A high vaginal swab stick was dipped into secretion through speculum and slides were made and sent to attached laboratory for clue cells. Vaginal PH was tested with PH paper [change in color noted]. Whiff test was performed by adding two drops of KOH on posterior blade of speculum for fishy odour. The diagnosis of bacterial vaginosis was made with the help of Amsel's criteria. Presence of >3 signs was labeled as bacterial vaginosis positive. Data analysis was done on statistical package of social science [SPSS version 13]. Although total 120 patients who were recruited in our study, all did not present with any symptom of vaginal discharge, but the frequency of pregnant women having Bacterial Vaginosis was quite high. A total of 77 [64.1%] patients discovered positive for bacterial vaginosis, while only 43 [35.8%] patient's samples were negative for bacterial vaginosis. The mean age of our patients was 28.56 +/- 3.71 years, while mean gestational age was 24.65 +/- 2.34 weeks. Homogenous milky discharge was observed in total 65 [54.16%] patients, while in rest of patients, we did not detect any discharge. Bacterial Vaginosis was more prevalent in women belonging to low socioeconomic group and who had low literacy rate. The frequency of bacterial vaginosis was found to be very high among asymptomatic pregnant women. Timely diagnosis can be helpful in treating complications related with it

Vaginal discharge; syndromic management among internally displaced women living in camps at Larkana

To observe the results of syndromic management in women living in IDPs camps complaining of chronic vaginal discharge. Descriptive study. Medical Camps at Larkana set by Chandka Medical College Hospital for Internally Displaced Persons [IDPs] due to floods. 1st September 2010 to 31st December 2010. Total 200 symptomatic patients aged from 20 to 50 years suffering from chronic vaginal discharge having history of more than 6 months duration were included in the study. Asymptomatic as well as pregnant women and patients with abnormal cervix and having abnormal growth on cervix were excluded from the study. A detailed history and examination [including speculum and vaginal] was done and a proforma was filled. All these patients were given empirical treatment recommended by WHO as syndromic management consisting of stat doses of antifungal along with antibiotics, where no laboratory tests are required before treatment. Next to vaginal discharge which was main symptom in all patients, the other symptoms like dusparunia, dysuria, itching ,lower abdomen pain and low backache was reported 9%, 16%, 20%, 24% and 31% respectively. Also 8% patients reported post coital bleeding. All patients were married and the mean age of the patients was 28+0.2 years and 15% of them were over 40 years. Mean parity was 4 +/- 1.Vaginal infection improved in 65% of the patients excellently with a first line single course of antibiotic and percentage raised up to 88% with second course. 19[9.5%] patients couldn't be followed as they left that camp and 5[2.5%] patients who did not improve with two courses of antibiotics had big cervical erosions, referred to nearby tertiary care hospital for further management. IDPs live in poor conditions in camps without basic facilities and where it is difficult to perform bedside tests like microscopy, Potassium Hydroxide, wet mount films and tests for Sexually transmitted diseases like Chlamydia and gonorrhea are not available, syndromic management there is a rational way of treating cases of chronic vaginal discharge to get quicker response in such desperate women

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Ovarian tumors under 20 years of age

To analyze the cases of Ovarian Tumors in less than 20 years of age and to know its outcome in same patients. A Case Series Descriptive Study. This study was conducted at Sheikh Zaid Women Hospital, Gynaecology Unit II, Chandka medical college Larkana over the of period of two years from December 2007 to December 2009. Over the period of 2 years, a total of 30 patients with ovarian tumors of less than 20 years age were studied. Patients with more than 20 years of age were excluded. All the patients received as out patient department except 4 cases, were admitted through emergency. Detailed history taken to know their presentation and all the patients were investigated for complete blood picture, ESR, Random Blood Sugar, Urine detailed report, Urea, Creatinine, Serum Electrolyte, LFTs, Ultrasound and X.Ray Chest. In some patients IVP, CT scan and Serological markers e.g. CA-125 were done. Management done in all patients noted and statistically analyzed. In two years period 30 patients under 20 years of age reported. Mean age of presentation was 15 +/- 2 years. Out of 30 patients 25 [83.33%] had benign ovarian tumors while 5 patients only [16.66%] had malignant tumors. Of the benign ovarian tumors mature teratoma were 10[40%], serous cyst adenoma were 5[20%], mucinous cyst adenoma were 3 [12%], endometriotric cysts were 3 [12%], corpus luteal cysts were 3 [12%], para-ovarian cyst was 1 [4%]. Of the malignant variants immature teratoma was 3 [60%], dysgerminoma was 1 [20%] and endodermal sinus tumor was 1 [20%]. Most of patients had benign ovarian tumors e-g germ cell tumors. Almost in all of the patient's diagnosis was confirmed by laparotomy and histopathology. No complication was encountered ttendance ly and post operatively. Patients, less then 20 years of age, had mainly benign ovarian tumors, and were germ cell tumors. For benign tumors adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue