Efficacy if progesterone therapy in the prevention of preterm labour

Objective: To determine the efficacy of progesterone therapy in prevention of preterm labour

Methods: This Experimental Study was designed at Department of Gynaecology and Obstetrics [Unit-II], Lady Willingdon Hospital, Lahore. Non-probability, purposive sampling technique was used and 100 patients were taken who had singleton pregnancy with previous history of one or 2 preterm delivery or cervical length of <25 mm between 16 to 20 weeks of gestation were included in the study. The drug was given according to the proposed dosing regimen i.e. weekly intramuscular injection of 250gm of 17 alpha hydroxyprogesterone caproate beginning at 16weeks 0days to 20weeks 6days gestation and used till 36 weeks 6days gestation and the patients were followed till delivery to see the efficacy of the drug [as per operational definition] information was noted on predesigned proforma. The data was analyzed by using SPSS-20 software

Results: In this study, the mean age of patients presented in active phase of labor was 25.85+3.13 years. The mean gestational age at time of presentation was 19.2+1.13weeks. Out of the 100 females given progesterone therapy showed that there were 71 [71.0%] females who delivered after 37 weeks of gestation while 29 [29.0%] females delivered before 37 weeks of gestation and had gone into preterm delivery. In this study, Progesterone therapy showed efficacy in 71 [71.0%] females who delivered after 37 weeks of gestation according to the operational definition of efficacy, while 29 [29.0%] females did not fulfill the operational definition of efficacy and delivered before 37 weeks of gestation

Conclusion: Through this study, we come to know that progesterone therapy is effective in prevention of preterm labor

Prevalence of usual and unusual skin manifestations of systemic lupus erythematosus in a tertiary care hospital

Objective: To determine prevalence of different types of skin manifestations in SLE in our country

Methods: The study was carried out at the Rheumatology and Immunology Department, Shaikh Zayed Hospital, Lahore. 125 patients who were diagnosed with SLE on basis of American College of Rheumatology classification criteria for SLE and also having skin manifestations were included from June 2011 till June 2015 from outdoor and inpatient departments

Results: SLE specific skin manifestations were as follow: malar rash was seen in 83 [71.6%] patients, photosensitivity in 61 [49.12%] patients, oral ulcers in 39 [31.35%], maculopapular rashes in 29 [23.46%], discoid rash in 26 [20.7%], subacute cutaneous lupus erythematosus [SCLE] in 6 [5.18%] patients. The SLE non-specific skin manifestations included: vasculitic rash in 50 [40.0%], non-scarring alopecia in 39 [30.9%], palmar erythema in 26 [21.1%], vasculitic ulcers in 7 [4.9%], livedo reticularis in 5 [3.8%], digital gangrene in 3 [2.7%], and Raynaud's phenomenon in 3 [2.2%] patients. Patients having SLE specific skin manifestations like malar and discoid rash were more likely to have internal organ involvement, while with those having SLE non-specific skin manifestations were seen with acute flare of disease. ANA and anti-ds DNA antibodies were positive in 92% and 63% patients, respectively

Conclusion: Skin manifestions in SLE are important disease parameters which can give important diagnostic and disease activity information. Thorough focus on dermatological aspect is very important for diagnosis and treatment in this entity

Fetal outcome of pregnancy with hypertension

Objective: to assess relationship of neonatal morbidity and mortality with severity of hypertension. The effect of severity of hypertension on time of delivery and neonatal outcome including birth weight, APGAR score, neonatal nursery admission, intrauterine death and neonatal deaths was studied

Methods: all pregnant patients with diastolic blood pressure of at least 90 mmHg or systolic blood pressure of 140 mmHg taken at two occasions at least 6 hours apart, with singleton pregnancy at any gestational age were included in the study. They were categorized in two groups according to diastolic blood pressure at the time of presentation. Mild to moderate hypertensive patients were those with diastolic blood pressure up till 109 mmHg. Patients with diastolic blood pressure 110 mmHg or more were labeled as severely hypertensive patients. AU patients were followed throughout antenatal period till delivery. Time of delivery was decided by senior consultants according to obstetrical parameters. All babies delivered were attended by pediatricians and admission in neonatal nursery was decided by pediatricians. Babies admitted in nursery were followed till discharge or expiry

Results: out of 1661 screened patients, 119 hypertensive pregnant patients were detected [an incidence of 7 .16%]. Out of these 78.2% were mild to moderate hypertensive and 21.8% were severely hypertensive patients. The effect of severity of hypertension was significant on time of delivery. There were 74% preterm deliveries in severely hypertensive patients as compared to 13% in mild to moderate group [p; 0.0001]. The effect of severity of hypertension was significant on birth weight, APGAR score, intrauterine and neonatal deaths

Conclusion: fetal morbidity and mortality is directly related to severity of hypertension in terms of birth weight, pre-term deliveries, APGAR score and perinatal mortality rate

Appropriate gestational age for elective C-section

Timing of elective caesarean delivery is a relevant public health issue. Neonatal outcome is associated with the duration of gestation at the time of delivery. Rate of C-section is increasing worldwide even in USA it increased from 20.7% in 1996 to 31.1% in 2006. The objective to determine the appropriate age of gestation for elective C-Section in order to have good neonatal outcome and decrease perinatal morbidity. It is a cross sectional study that is retrospective. It will be carried out in the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore from March 2011 to Nov. 2011. One hundred consecutive subjects who had elective C-Sections during the study period were included in the study. Gestation of pregnancy was correlated with the outcome of babies. The newborns were assessed by 5 minutes apgar score and by admission in neonatal unit. In a total of 100 patients 9 had C-Section at 39 completed weeks and 47 had C-sections at 38 completed weeks and 44 had C-Sections at 37 completed weeks of gestation. Most of the babies who had respiratory problems and shifted to nursery were those who were delivered at 37 weeks gestation. Timing of elective Caesarean delivery at term has a relationship and influence on neonatal outcome. The perinatal morbidity can be reduced by decreasing elective caesareans before 39 completed weeks of gestation

Congenital adrenal hyperplasia with polycystic ovarian disease: a rare cause of hirsutism

Hirsutism may be defined as presence of terminal hairs in women with a male-like pattern of distribution. Hirsutism is related to serum androgen and cutaneous sensitivity to other hormones. The most prevalent causes of hirsutism are polycystic ovary syndrome and isolated hirsutism. Nonclassical congenital adrenal hyperplasia [21-hydroxylase deficiency] and drug induced type are less frequent rather rare causes. Diagnostic evaluations should address identifying etiology and its associated co-morbidities to properly manage the patients. We present a case of 22-year-old unmarried female who presented with hirsutism and on detailed evaluation she was diagnosed as a case of nonclassical adrenal hyperplasia and polycystic ovaries. Along with laser hair removal,proper treatment of underlying etiology led to reversal of her symptoms