Use of pedicled omental graft as an aid to vesicovaginal fistula repair

Objective: To determine the role of omental graft in the outcome of vesicovaginal fistula [VVF] repair

Place and Duration of study: Department of Obstetrics and Gynecology Unit 1, Bahawal Victoria Hospital / Quaid-e- Azam Medical College Bahawalpur, from June 1997 till December 2016

Methodology: All patients with VVF were included in this study. All had uncontrolled continuous loss of urine. In all cases examination under anesthesia was done. Transabdominal approach was used in all patients. Adequate dissection of bladder from anterior vaginal wall was achieved and fistula repaired. Omental pedicle graft was interposed between bladder and vagina. The distal part of the omentum was stitched to the distal limits of the space between bladder and vagina. Bladder drainage with three way Foley catheter was maintained for 21 days

Results: Of the total 144 patients with VVF, 43 [29.8%] developed this complaint after obstructed labor, 23 [15.9%] following cesarean hysterectomy, 6 [4.1%] after cesarean section, 44 [30.5%] after total abdominal hysterectomy [TAH], 6 [4.1%] after vaginal hysterectomy, 3[2%] after post coital trauma, 19 [13.2%] after failed earlier repair. Of the total, 140 [97.2%] fistulae healed successfully with the technique of pedicled omental graft. Failure rate was 2.7%

Conclusion: Successful management of VVF largely depends upon the judicious use of omental graft with minimal recurrence rate

Use of calcium dobesilate and norethisterone in treatment of menorrhagia of dysfunctional uterine bleeding origin

Objective: To find the success rate of calcium dobesilate and norethisterone in treatment of menorrhagia of dysfunctional uterine bleeding [DUB] origin

Study design: Descriptive case series

Place and Duration of study: Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital / Quaid-e-Azam Medical College Bahawalpur, from December 2013 to December 2016

Methodology: Patients with dysfunctional uterine bleeding were included in this study. They were divided into two groups. Group A was given calcium dobesilate and Group B was given norethisterone for menorrhagia of DUB. The outcome in terms of resolution of symptoms was noted at follow up on 8,10 and 12 weeks in outpatient department

Results: A total of 600 patients of 19 year to 35 year of age were enrolled. The success rate in terms of cessation of bleeding was 83.3% in group A. This was observed within 3-5 days of starting treatment and patients remained symptoms free for the next 10-12 weeks after discontinuation of the medicine. Success rate of 98% was observed in group B however on withdrawal of medicine bleeding started again. More side effects were also observed in group B

Conclusions: Arrest of bleeding in patients with menorrhagia of DUB was more frequently noted in group B where norethisterone was used, however, it recurred on withdrawal of medicine. More side effects were also observed in group B. In group A though success rate was low but no withdrawal bleeding occurred after cessation of medicine

Presentation and management of vaginal vault hematoma after hysterectomy

Objective: to detect and manage vaginal vault hematoma following abdominal and vaginal hysterectomy

Study design: descriptive case series

Place and Duration of study: department of Obstetrics and Gynaecology Unit-1, Bahawal Victoria Hospital/Quaid-e-Azam Medical College Bahawalpur, From January 2009 to December 2013

Methodology: during the period 921 women underwent hysterectomy, 276 through vaginal and 645 through abdominal approach. Patients were scanned on 1[st] and 3[rd] postoperative day. A transabdominal scan was done in patients who underwent vaginal hysterectomy and a transvaginal scan was done for those who had undergone abdominal hysterectomy. The findings were used to relate the postoperative morbidity in cases of vault hematoma

Results: of the total 921 hysterectomies during the study period overall frequency of vault hematoma was 5.32% [n=49]. It was 2.89% [n=8/276] in with vaginal hysterectomy and 6.35% [n=41/645] in abdominal hysterectomy. The most common presenting symptom in postoperative period was unexplained fever [n=23/82 - 28%] in abdominal hysterectomies. In vaginal hysterectomies most of the patients were diagnosed by presence of collection on rescan [n=8/21 - 38%]. Majority of patients in vaginal hysterectomy group were managed conservatively and only 25% underwent colpotomy. In abdominal hysterectomies hematomas were mostly [78%] drained by colpotomy

Conclusion: ultrasonography to detect postoperative hematomas on 3[rd] postoperative day following hysterectomy identified high risk group of patients who need further management or follow up before discharge

Continuous versus interrupted sutures for episiotomy wound repair

To compare continuous suturing technique with interrupted method for the procedure of Episiotomy. A comparative study. Gynaecology Unit 2, Bhawal Victoria Hospital Bahawalpur, from January 2008 to December 2009. Patients were randomized into two groups; One group [C] was repaired with continuous, non-locking sutures involving the vagina, perineum and subcutaneous tissues for skin. The other group [I] with the same match had continuous locking sutures of vagina, interrupted sutures in the perineal muscles and interrupted transcutaneous sutures for skin. The threads used for stitching were identical in both the groups. The participants were asked about pain during defecation, urination, in sitting position and during movement, the use of analgesics on the 2[nd], 10[th] day and 3 months postpartum. A total of 547 women underwent vaginal deliveries with episiotomies. Less repair time [one minute - p=0.017] was noted in continuous technique group and suture material consumed was also less [RR 3.2, 95% CI: 2.6-4.0]. The comparison of pain on the 2[nd], 10[th] day and 3 months after delivery showed no significant difference between two techniques [RR 1.08, 95% CI:0.74-1.57, RR, 0.96, 95% CI: 0.59-1.55 and RR, 0.68, 95% CI:0.19-2.46 respectively]. There was no difference between the severity of pain in short and long term period in both the techniques. Repair with continuous suturing was quicker and less suture material was used in comparison with interrupted suturing.

Molar pregnancy - experience at a tertiary care hospital of South Punjab

To determine the frequency, clinical presentation and management outcomes of molar pregnancy. Descriptive cases series. Department of Obstetrics and Gynaecology Unit-II. Bahawal Victoria Hospital, Bahawalpur, from January 2005 to December 2007. The case records of all the gestational trophoblastic cases during the study period were analyzed regarding their history, clinical examination, investigations, treatment and follow up. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow up. There were a total of 21499 admissions during study period which included 54 cases of molar pregnancy. Hence frequency of Molar pregnancy was 2.5/1000 pregnancies. Most of the patients belonged to the extremes of ages. Most common presenting complaint was bleeding per vagina in 39[72.2%]. Out of 54 patients, suction evacuation was done in 51[94.4%] patients and in only 3[5.5%] patients, ended up in hysterectomy. Forty one [75.9%] patients received no adjuvant therapy, 13[24.1%] received chemotherapy. Among all 54 cases, 51[94.4%] patients fully recovered and 3[5.6%] died because of extensive disease and reported late. In this series, frequency of molar pregnancy was as equal as in different parts of the world. Proper management in the early stages influences the outcome of the disease. Hence the key point of whole discussion is to detect the disease in early stage to decrease the mortality and morbidity of patients

Sacrocolpopexy "gold standard" for vault prolapse

To evaluate and compare the efficacy, blood loss, operative time and complications with the use of Prolene thread vs. Rectus Sheath. Cross sectional, analytical study. Department of Obstetrics and Gynaecology Unit-II, Bahawal Victoria Hospital, Bahawalpur from Jan 2000 to Dec 2007 [eight years]. All the cases of vault prolapse during the eight year study period were included and booked from the out patient and emergency department of BVH. A total of 40 cases were divided into two group. Group A having 20 patients who were managed by prolene No.1 and Group B also containing 20 patients managed by rectus sheath. All cases were analyzed regarding their complaints, preceding operations, clinical examination, investigation, treatment and follow-up. Total 40 cases were analyzed. It was found that no recurrence was seeen in Group A [with Prolene Thread]. The blood loss was minimal, operative time range was only 0.5 to 1 hour. It was very economical whereas in Group B, Two patients had recurrence of complaints "Mass coming out of vagina [10%]. Time required to remove rectus sheath strip to complete the procedure of sacrocolpopexy was 1.5 to 2.5 hours in Group B. Blood loss was more in Group B than Group-A. Two patients [10%] had incisional hernia. Equal no of patients in each group had low persistant backache. Sacrocolpopexy is gold standard procedure for the treatment of vault prolapse. If it is performed with the help of prolene, give excellent results

Efforts to reduce caesarean section rate

The objective of present study was to fund out the effectiveness of methods for the reduction of Caesarean section rate [CSR]. It was conducted in Obstetric and Gynaecology Unit II, Bahawal Victoria Hospital, Bahawalpur from January 2001 to December 2001. A total of 3753 patients were admitted during the year 2001 in Gynae Unit II, out of which 2170 were obstetric patients. The total number of vaginal deliveries were 1591 [73.3286] and the total number of caesarean sections were 579 [26.6896]. With external cephalic version [ECM, 87.5 96 success rate was observed in vaginal deliveries. In case of vaginal births after previous Caesarean section the success rate turned out to be 61.3146. Trial of scar, ECV and careful decision about primary Caesarean section significantly reduce the CSR

Anaemic heart failure in labour; management protocols

To define accurate management protocols for better outcome in patients of anaemic heart failure during labour. DESIGN: Prospective study. PLACE AND DURATION OF STUDY: Obstetrics and Gynaecology Unit II of Bahawal Victoria Hospital, Bahawalpur from January 2000 - December 2001. PATIENTS AND METHODS: Patients were randomly selected from outdoor and emergency department. Referred patients from other units were also included. Record of patient's age, parity, haemoglobin percentage, severity and sign / symptoms of cardiac failure were noted. 34 patients with anaemic heart failure were included in this study. Most common complication found was pulmonary oedema [29.41%]. It was found that 61.76% [21] patients had haemoglobin percentage between 4 - 5gm% and occurrence of cardiac failure was common with the parity 6 -10 [41.17%] births. Mostly the patients with anaemic heart failure were between 31 - 40 years of age [41.24%].29 [85.3%] out of 34 foetuses were delivered alive. Three patients died due to cardiac arrest and pulmonary oedema so, the maternal mortality was 8.82% in this study. Anaemic heart failure and maternal mortality can be prevented if simple frusimide ferrous sulphate tablets are advised during period, supported with ionotropic drugs like digoxin etc. Active management protocol should be observed for delivering such patients