Risk factors in relation with uterine rupture

To determine the risk factors in relation with uterine rupture in patients coming to Abbasi Shaheed Hospital. Case Control Study. The department of Gynecology and obstetric Abbasi Shaheed Hospital Karachi from January 2001 - December 2002. All cases of ruptured uterus who were either admitted with or who developed this complication in the hospital were included in the study. These cases were compared with their control i.e. women who delivered normal at Abbasi Shaheed Hospital in the same period and did not develop rupture uterus; matched by same age parity socioeconomic status and area of residence. The cases were further divided in two groups, those with previously scarred uterus [n=20] and those with unscarred uterus [n=23]. Risk factors associated with uterine rupture included injudicious use of oxytocin by traditional birth attendants [TBAs] or unskilled persons [88%] no antenatal care [79%] or late referral by TBAs or Dais [58%] and obstructed labour [25.5%]. All cases referred by Dais had crossed the partographic alert line. In unscarred group oxytocin used injudiciously in all cases with no antenatal care [ANC] at all and late referral by Dais in 78% cases. Injudicious use of oxytocin and late referral by TBAs [Dais] and lack of Ante Natal Care are the significant risk factors for uterine rupture

Maternal and perinatal outcome in HELLP syndrome at Abbasi Shaheed Hospital

The Objective of this study was to determine the maternal and perinatal outcome in HELLP syndrome and to reflect the importance of early diagnosis of HELLP syndrome in eclampsia and preclampsia. A case control study was designed; where retrospective review of 15 cases of confirmed HELLP syndrome from January 1997 to January 2002 was undertaken at Gynae /Obstetrics Unit II, Abbasi Shaheed Hospital and thirteen controls were selected of eclampsia with no evidence of HELLP. Maternal and neonatal complications were recorded and resolution of laboratory indices was measured. Seventy five% of the women were delivered within 24 hours of diagnosis; out of this, 83.73% were delivered by caesarean section. There were 73.3% pre-term deliveries and 75% of the babies were admitted to the neonatal intensive care unit [NICU]. The peri-natal mortality was 46.66% while the maternal mortality was 20%. The mean interval of resolution of laboratory indices to within normal ranges was twelve [7-35] days. The neonatal morbidity was high and was closely related to the period of gestation at delivery

Effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section

To evaluate the effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section. A non- randomized controlled trial. Materials and Of the 50 evaluable subjects, 25 had parietal and visceral peritoneum left open whereas 25 were closed. Analgesia requirements assessed by visual and verbal scale, oral analgesia used after 24 hours postoperatively for four days and postoperative satisfaction assessed verbally, shorter surgical time length of postoperative hospital stay, reestablishment of intestinal motility were the main out come measures. Pain at 24 hours was similar in both groups but in subsequent days the non-closure group had decreased maternal pain and had a tendency to require less postoperative analgesics [1500 mg/day Vs 750 mg/day, P = 0.03], shorter hospital stay and early reestablishment of intestinal motility. Non-closure of both visceral and parietal peritoneum at the caesarean section produces a significant reduction in the postoperative use of analgesia and shorter hospital stay postoperatively

Spectrum of dysfunctional uterine bleeding and its conservative management

To find out the proportion of dysfunctional uterine bleeding [DUB] and the response of patients of DUB to medical treatment at Abbasi Shaheed Hospital. Design: Cross sectional and comparative study. Place and Duration of Study: The study was conducted in Gynaecology Unit II of Abbasi Shaheed Hospital, Karachi, from December 1999 to December 2000. Patients and The study included 210 Gynae patients between the age group 13 ' 50 years presenting with DUB. These patients were divided into adolescent, reproductive and perimenopausal group. They were initially assessed by general and pelvic examination, ultrasound of pelvis, Pap smear, hysteroscopy and diagnostic curettage. Results were recorded. The efficacy of treatment was assessed in terms of reduction in the amount of blood loss. Two hundred and ten out of 1300 patients were diagnosed as having DUB with the proportion of 16.1%. Response rate was 20 ' 30% with oral mafenamic acid, 50% with capsule tranexamic acid, 60% and 50% respectively with oral contraceptive pills containing ethinylestradiol and norethisterone, and norethisterone alone. The response rate with capsulated micronised flavonoid and derivative of ethinyltestosterone was 90% and 75% respectively. The patients in adolescent age group are good responders to conservative treatment. Most of the patients preferred micronised flavonoid over derivative of ethinyltestosterone for some misconceptions regarding this medicine. The former was better tolerated with less side effects