Comparison of nitroglycerine patch and nifedipine in treatmetn of preterm labour

Background: Preterm labour and resulting preterm birth of baby is challenge for gynaecologists

Objective: To compare the efficacy of transdermal nitroglycerine with oral nifedipine in inhibition of preterm labour. Methodology: This experimental study was conducted in the department of Obstetrics and Gynaecology in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. This study enrolled 60 women with preterm labour, first 30 patients received oral Nifedipine and next 30 patients used transdermal nitroglycerine [NTG] patch. The data was entered and analyzed by using SPSS version 16

Results: Mean prolongation of pregnancy was more with nitro glycerine [30.13+3 days] compared to Nifedipine [29.57+ 6days]. Nifedipine was more successful in prolonging pregnancy beyond 48 hours. Failure of acute tocolysis defined as delivery within 48 hours, was more common with NTG [33.3%] as compared to Nifedipine [23.3%]. Headache was higher in nitrglycerine group [3.3%] compared to Nifedipine group [0%]. The neonatal outcomes in terms of respiratory distress was higher in Nifedipine [76.7%] than Nitroglycrine group [63.3%].There was no statistically significant difference between two groups

Conclusion: Nitroglycerine patch is as effective as Nifedipine in suppression of preterm labour and in prolonging pregnancy

Effect of ferric carboxymaltose in the management of postpartum iron deficiency anemia

Background: Iron deficiency is the most common cause of anemia, around the world, with postpartum hemorrhage one of the reasons. Different treatment options are available for correction of iron deficiency, ferric carboxymaltose being the most recent

Objective: To determine the effectiveness of ferric carboxymaltose in the management of iron deficiency anemia in the postpartum period

Methodology: An experimental study was conducted at Sheikh Zayed Medical College/Hospital Rahim Yar Khan. 30 female patients, with documented iron deficiency anemia within 10 days of post partum period and with no history of renal or hepatic disease, infection, anemia due to any other causes, severe anemia requiring blood transfusion and no parenteral iron therapy in last 20 days, were included in the study. All the patient were given ferric carboxymaltose 15mg/kg body weight [max 1000mg] intravenous infusion. Pre and post therapy complete blood picture including hemoglobin and serum ferritin levels were compared after 1 week. The data was entered and analyzed in SPSS version15

Results: Significant increase in both hemoglobin and serum ferritin levels was noted in patients with mean rise being 2.4g/dl and 338.3 ng/ml in hemoglobin and serum ferritin levels, respectively. Mild rash and fever were the only adverse events noted, in only one patient, each

Conclusion: Ferric carboxymaltose appears to be a very effective drug for the treatment of iron deficiency anemia both in terms of rise in hematological indices and low adverse event profile

Endometrial carcinoma; incidence in women with abnormal uterine bleeding

Background: Bleeding from the reproductive tract in women is a naturally occurring event, generally the result of menstruation and childbirth, and is not associated with a bleeding disorder in most cases. Dysfunctional uterine bleeding is the most common reason for women to undergo an interventional gynecologic procedure. The major task of the clinician is to exclude endometrial carcinoma in women and to identify organic pathology in order to manage it effectively

Objective. To determine the incidence of endometrial carcinoma in women with abnormal uterine bleeding

Study Design: Cross sectional study

Setting. Department of Obstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan

Duration of study: Six months [16th February 2013 to 15th August 2013]

Material and method: One hundred and sixteen women with complaint of abnormal uterine bleeding, meeting the inclusion criteria were selected. All the patients were undergone endometrial sampling and assessment of endometrial thickness was done which was confirmed by endometrial biopsy to evaluate endometrial pathologies. The collected data was noted on pre-designed proforma

Results: The mean age was 42.07 years. According to parity, 56 women [48.2%] have 1-4 parity, 48 women [41.4%] have 5-8 parity and 12 women [10.4%] have 9-14 parity. The mean duration of dysfunctional uterine bleeding was 14.64 +/- 7.87 months. Six women [5.2%] have endometrial carcinoma while 110 women [94.8%] have no endometrial carcinoma

Conclusion: This study thus proved that in our setup the incidence of endometrial carcinoma is very high. So every patient with abnormal uterine bleeding should undergo endometrial biopsy to rule out endometrial carcinoma

Vitamin D deficiency among pregnant women attending a tertiary care hospital

Background: Vitamin D deficiency was considered to be the sole cause of rickets and osteomalacia but now by the discovery that most tissues and cells in the body have vitamin D receptors and many tissues have enzymes that convert primary circulating form of vitamin D to its active form has provided new insight into the function of this vitamin. In different studies, its role has been highlighted in decreasing the incidence of autoimmune diseases, infectious diseases and cardiovascular diseases

Objective: To determine the frequency of vitamin D deficiency among pregnant women attending a tertiary care hospital

Subjects and Methods: Study Site: Department of Gynaecology and Obstetrics, Sheikh Zayed Medical College and Hospital Rahim Yar khan. A total of 108 pregnant women were recruited from SZMC/Hospital with the exclusion criteria of women having chronic renal or liver diseases, known asthmatic or diabetics and women on antituberculous or antiepileptic drugs. This was a descriptive study, a part of an ongoing prospective study. All pregnant women irrespective of age or gestational age were selected. Data was collected on a predesigned proforma and analyzed in SPSS version 17

Results: A total of 108 pregnant women were included. 77 women [71%] were deficient in vitamin D, 18 women [16.7%] were insufficient and only 13 [12%] women were having normal vitamin D levels with the mean level of 15.9ng/dl. There was no statistically significant association between vitamin D levels and any specific age groups, parity and gestational ages

Conclusion: There is high prevalence of Vitamin D deficiency among pregnant women and vitamin D deficiency is present in all age groups, with any parity and gestational ages. This raises concerns about the health consequences for the mother and baby. Awareness programs should be started at local and national levels regarding importance of exposure to sunlight and intake of healthy diet. A targeted screening strategy to detect and treat women at risk of severe vitamin D deficiency is required in Pakistan

Audit of the maternal mortality in a tertiary care hospital

Background: Maternal mortality is an important measure of maternal health

Objectives: To determine the maternal mortality ratio and determinants of maternal mortality in a tertiary care hospital

Patients and Methods: A descriptive study, was conducted in Obstetrics and Gynaecology Department at Sheikh Zayed Hospital Rahim Yar Khan. This was a 3 years study conducted from 1[st] January, 2010 to 31[st] December, 2012. All direct and indirect maternal deaths during pregnancy, labour and perpeurium were included. The reason for admission, condition at arrival, and possible factors responsible for death were identified. The other information including age, parity, gestational age and relevant features of index pregnancy were recorded on a proforma and analyzed by SPSS version 16

Results: There were a total of 30563 deliveries and 29139 live births. Total 168 maternal deaths occurred during 3 consecutive years, with a MMR of 576 per 100000 live births. The highest maternal mortality age group was 20-30 years in which 61.3% deaths were observed. Out of 168 maternal deaths, 26.78% were primigravida. Obstetrical hemorrhage [48.2%] was the most frequent cause followed by hypertensive disorders [20.8%] and sepsis [15%]

Conclusion: Birth facilities in our hospitals should be up to the mark to manage the pregnancy related complications promptly. Our study revealled high maternal mortality ratio in hospital setting with obstetrical haemorrhage, hypertensive disorder and septicemia as leading direct causes of maternal mortality whereas blood reaction as leading indirect cause of maternal mortality

Uterine atony; association of low serum vitamin D

Uterine atony is one of the causes of postpartum hemorrhage, resulting in increased maternal morbidity and mortality. To determine the association of low serum vitamin D level with uterine atony, among women delivering in a tertiary care hospital. Case control Study. Gynae and Obstetrics department of Sheikh Zayed Medical College, Rahim Yar Khan. 1st January to 31st December, 2013. A total of 130 patients were recruited and grouped as A [Cases] including patients with uterine atony [100 patients] and group B [Controls] patients having no uterine atony [30 patients] after cesearean section or vaginal delivery and fulfilling the inclusion or exclusion criteria. The test for 25 OH vitamin D was performed on Elecsys 2010 Roche by using electrochemiluminescence technique. Oral informed consent was taken from all subjects and approval from institutional ethical committee was obtained. Chi square test was applied to compare atony and non atony groups in terms of presence or absence of vitamin D deficiency. The data was entered and analysed on SPSS version 17. It was noted that those who have uterine atony 87% were having vitamin D deficiency or insufficiency as compared to 68% in group with no uterine atony. This difference was statistically significant. [p=0.02] so uterine atony was significantly associated with vitamin D deficiency or insufficiency. In atony group mean age was 25+/-4 years, gravida 2.64+/-1.2, gestational age, 37+/-1.2, blood loss 1032+/-400, and serum vitamin D level 15.9+/-6, ng/ml. In non atony group, group mean age was 26+/-3 years, gravida 2.7+/-1, gestational age, 38+/-.8, blood loss 309+/-92, and serum vitamin D level 23+/-9 ng/ ml. The mean level of serum vitamin D level was significantly low [15.9+/-6 ng/ml] in atony group as compared to non atony group[23+/-9 ng/ml]. Mean blood loss was significantly high [1032ml] in atony group as compared to non atony group [309ml]. Our results revealed that low vitamin D level is strongly associated with uterine atony and hence is a risk factor for uterine atony

Diagnostic value of colposcopy in the diagnosis of carcinoma of cervix

Background: Carcinoma cervix is one of the common female cancer worldwide, which has excellent cure rate if diagnosed early

Objective: To determine the accuracy of colposcopy in the diagnosis of early carcinoma of cervix using histopathology as the gold standard

Patients and Methods: Study Design: Comparative cross sectional study

Place and Duration of study: Department of Obstetrics and Gynaecology Unit-1, Sir Ganga Ram hospital, Lahore from 25[th] July, 2006 to 24[th] January, 2007. One hundred patients were included having symptoms of lower genital tract like: chronic vaginal discharge and irregular or post coital bleeding. Women with obvious naked eye lesion of cervix or abnormal Pap smear report were also recorded. Exclusion criteria included pregnant women, asymptomatic women and women on exogenous hormones. Colposcopy findings were noted, along with menstrual, family history and parity. Sensitivity, specifically, positive and negative predictive values were calculated. Data was entered and analyzed by SPSS version 12

Results: The age group ranged from 15-60 years, with Mean +/-SD of 36.7+/-10 years. By age classification the age group 26-35 years were highest in proportion [40%]. Sensitivity, specificity, diagnostic accuracy, positive predicate value [PPV] and negative predictive value [NPV] was found to be 86.6%, 91.7%, 91%, 65%, 97.7%, respectively

Conclusion: Although cervical cancer is a case of significant morbidity and mortality among gynecological malignancies, but with the help of non invasive technique like colposcopy cervical cancer can be detected in its earlier stages where definitive cure is possible. So, it is advocated that colposcopy should become an integral part of all gynecological services, especially in the teaching hospitals as well as in tertiary referral centers of our country

Fetomaternal outcome in eclamptic patients: a study in a tertiary care centre

Background: Eclampsia contributes significantly to maternal and perinatal morbidity in our country

Objective: The objective of this study was to determine the frequency of the disease, its management and outcome in tertiary care hospital; moreover the effect of introduction of modified dose of MgSo4 in the control of eclamptic seizures was also assessed

Patients and Methods: This descriptive study was carried out in Gynae unit I, Sheikh Zayed Hospital, Rahim Yar Khan from 1[st] January 2008 to 31[st] January 2009. Diagnosis was based on history and on clinical findings of hypertension, oedema, protienuria superimposed with fits. All pregnant ladies presenting with fits, oedema, proteinuria and increased blood pressure were included in this study and their history, physical findings and baseline investigations were noted. Patients with history of fits in pregnancy, during labour or in perpuerium other then eclampsia were excluded from the study. All the patients with eclampsia were treated with MgSO4 gm intravenous loading dose and 10 gm intramuscular maintenance dose. The data was entered and analyzed in SPSS version 15

Results: 12049 pregnant patients were admitted during this time period in labour room. Out of these, eclamptic patients delivered were 120 [0.99%]. Primigravida were 49%, multigravida were 51%. Regarding mode of delivery patients delivered vaginally were 80 [66.6%] and with caesarean section were 40 [33.3%]. Regarding fetal outcome fresh still births were 15 [12.5%]. Early neonatal deaths were 10 [0.8%]. Perinatal mortality rate in our study was 20.8%. Regarding maternal outcome 17 patients out of 120 eclamptic patients develop complications. 4 patients developed renal failure [3.3 %]. 2 patients develop Hellp syndrome, 4 patients shifted to ICU due to Hellp syndrome and DIC. 5 patients [4.1%] died despite of intensive care. These patients were received in critically ill condition. Almost all of these patients present with eclamptic fits were unbooked patients. In this study MgSo4 was the drug of choice to control the seizures. It helps in reducing the maternal morbidity and mortality which is comparable with the other studies in world

Conclusion: This study is in the favor of the findings that MgSo4 is superior drug in the reduction of maternal morbidity and mortality. Eclampsia occurring in unbooked patients is still one of the major cause of maternal mortality and morbidity and antenatal care will significantly reduce the incidence and improve the outcome especially in teenage nullipara who are mostly susceptible

Education, the only vaccine available for the control of HIV/AIDS

Back ground: HIV/AIDS is a potentially fatal disease. However, vast majority of the world's youth are unaware about the modes of transmission and prevention

Objectives: the objective of this study was to assess the impact of health education on the knowledge and beliefs of college students toward HIV/AIDS in Pakistan

Patients and Methods: this was an interventional study conducted in the Government Khawaja Fareed Post Graduate Degree College, Rahim Yar Khan, during the year 2009. It was conducted in two phases. In first phase, baseline data was collected to assess level of knowledge and belief of students about HIV/ AIDS. 350 students of different classes participated in this study. Then a comprehensive lecture was delivered regarding transmission and prevention of HIV/AIDS. After a period of three months of this medical education intervention, the participants of first phase were asked to take part in second phase. A total of 314 students of previous group participated i.e 89.71% of the participants of the first phase. The data was collected and analyzed by SPSS version 14

Results: the mean age of the students was 17.44 +/- 1.28 years. The knowledge of the students of 13th and 14th years of education was better as compared to 11th and 12th years of education. In the second phase, 314 participants joined the study. There was significant improvement in the knowledge of students about HIV [p<0.000] and its modes of preventions [p < 0.000]

Conclusion: it is necessary that sufficient knowledge about transmission and prevention of HIV/AIDS should be given to adolescents especially college students. College students should be encouraged to discuss about HIV/AIDS sequelae and prevention