Toxic metals in maternal blood, cord blood and meconium of newborn infants in Pakistan

Toxic metals and deficiency/excess of trace elements can have adverse effects on health. The aim of this study was to quantify toxic metals lead, cadmium and trace elements zinc, copper, aluminium [Al] and Iron [Fe] levels in pregnant women, cord blood and meconium of new-born infants from industrial zones of Karachi, Pakistan. Analytical research was performed from 2011–2012 in low socio-economic pregnant mothers and newborn infants from 20 towns near Sindh Industrial Trading Estates, Federal B industrial area and Korangi industrial areas, Karachi, where environmental pollution was anticipated. Blood samples of pregnant women [n = 416], cord blood [n = 309] and meconium [n = 309] were analyzed quantitatively for metals and trace elements. Results indicated that mothers residing in steel towns were found to have the highest levels of lead. Meconium contained high levels of toxic heavy metals and trace elements compared to cord blood and maternal blood. Maternal blood toxic metals were present in high quantities. Therefore, safety measures should be taken when industrial waste is disposed of in order to prevent population contamination

Chemoprophylaxis in caesarean section

To determine the usefulness of two different regimens of antibiotics on post caesarean infectious morbidities. A comparative study drug trial. Department of Obstetrics and Gynaecology Lyari General Hospital and private hospitals of Karachi, from January 2009 to June 2009. Patients who underwent caesarean section were recruited. The patient were divided into two groups of 74 each. Group A received triple antibiotic therapy including injection cephradine, aminoglycoside and metronidazole for first 48 hours. Followed by oral therapy for 5 days. Group B received injection ceftriaxone and metronidazole for first 48 hours followed by oral therapy for 5 days. In both groups therapy was started before skin incision. Those who had established infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the infection prior to surgery or who received antibiotics in last 24 hours or allergic to any of the antibiotics used, were excluded. Patients were assessed post operatively for infectious complications including febrile illness, dysuria, offensive lochia and abdominal wound infection. No significant difference was found between the two groups. Complications found were febrile morbidity [23.0% Vs 18.7%], urinary tract infection [13.3% Vs 16.0%] wound infection [14.7% Vs 10.7%] and lochia [6.7% Vs 8.0%] respectively in Group A and Group B. There was a significant difference in terms of cost effectiveness of 3[rd] generation cephalosporin that was more. Both first and third generation cephalosporins are equally effective in caesarean section as prophylaxis

Emergency contraception: knowledge and attitude among females

To assess women's knowledge of emergency contraception. Descriptive study. Gynaecology Unit IV, Lyari General Hospital Karachi, In January 2009. Women aged between 18 to 45 years visiting Gynaecology OPD at Lyari General Hospital Karachi were interviewed and responses entered in a specially designed questionnaire of knowledge and attitude about emergency contraception. Of the 300 respondents, 129[43%] had practiced contraception while 9[3%] admitted to having an induced abortion. Only 144[48%] had heard of emergency contraception [EC]. 123[41%] knew only about hormonal method of EC. Only 6[2%] knew the correct timing of EC. Six requested for EC previously. Many women were uninformed about the action and timing of EC. Health facilitator should educate masses about EC, emphasizing available methods and correct timing of use

clinicopathological review of elective abdominal hysterectomy

To review correlation between indications and histopathology of elective abdominal hysterectomy. Descriptive study. Lyari General Hospital, Dow University of Health Sciences Karachi from June 2005-to May 2007. Data including age, parity, presenting symptoms and indications for hysterectomy was extracted from files and histopathology of all hysterectomy specimens was collected for detailed study. During 2 years a total of 54 elective abdominal hysterectomies were performed. Abdominal hysterectomy rate was 4.4 /1000 during study period. In 97% indications were for benign conditions. Peak age incidence was 41-50 years and peak parity was 4-6. In 27.7% indication for hysterectomy was menstrual problem followed by lieomyoma in 22.2%. On histopathology of uterus in 59.2% leiomyoma and in 24% adenomyosis were confirmed. There was no mortality associated with the procedure. Menstrual disturbance is leading indication of hysterectomy and leiomyoma is the commonest pathology. Adenomyosis is main cause of menstrual problem

Cesarean delivery rates and indications at a teaching hospital

A descriptive study was conducted to assess the cesarean delivery rates. Indications and fetomaternal outcome at the Department of Gynecology and Obstetrics, Unit 1V, Sindh Govt. Lyari General Hospital, Karachi, from June 2005 to May 2008. Demographic and obstetrical data of the subjects under going cesarean section was collected. During the study period, 506 cesarean sections were performed at the rate of 22.92%, 22.78% and 22.83% in respective years. Unbooked cases were 47.43%. Primiparous women were 33.5%. Majority [80.83%] were between 21-30 years of age. Elective cesarean sections were 16.2% and emergency section were 83.79%. Main indications of cesarean sections in primiparous women were dystocia [35%], malpresentation [17.6%] and fetal distress [16.4%]. In multiparous women, main indications were previous cesarean section [53%], malpresentation [12.7%] and dystocia [12.5%]. Projected maternal mortality ratio was 197.6/100,000 live births and perinatal mortality rate was 69/1000 live births

Ruptured ectopic pregnancy: clinical presentation and management

To determine the clinical presentations and the management modalities of ruptured ectopic pregnancy [EP]. This is a cross-sectional analytical study. The study was conducted in Obstetrics and Gynaecology Department of Sindh Government Lyari General Hospital, Karachi, from 1st June 2002 to 31st May 2005. All women diagnosed with ruptured ectopic pregnancy were included in this study. Data were collected on a structured proforma. The variables studied included age, parity, presenting symptoms and signs, haemoglobin level, urinary HCG, beta HCG level, ultrasonographic findings, type of treatment provided and associated morbidity and mortality. Mean +/- SD of continuous variables like age, parity and haemoglobin level were calculated while categorical variables like amenorrhea, abdominal pain, vaginal bleeding, anaemia, shock, abdominal tenderness, adnexal mass, cervical excitation and the other findings were given in numbers and percentages. A total of 34 women were diagnosed as having EP. Frequency of ectopic pregnancy found was 1.22% of total 2790 deliveries. Out of these 33 patients [97.6%] had ruptured EP. The mean age was 26.18 years and the mean parity was 1.9. Common presenting symptoms were amenorrhea and abdominal pain, both found in 27[81.8%] patients and vaginal bleeding was present in 9[27.3%] cases. Common physical signs detected were abdominal tenderness and cervical excitation in 24[72.7%] and 21[63.6%] respectively. Anaemia was found in 21 subjects [63.6%] and mass in adnexa in 12 cases. Laparotomy was done in 32[96.9%] out of 33 patients. Salpingectomy was carried out in 22[66.7%] cases and salpingostomy in 6[18.2%]. One patient underwent hysterectomy having cornual ectopic pregnancy. There was no maternal death in this study. Blood Transfusion was required in 27[81.8%] patients. Medical treatment was offered in only one patient who presented with a mass in adnexa and was haemodynamically stable but she left against medical advice. Abdominal pain, amenorrhea, anaemia and cervical excitation were the most consistent features of ruptured ectopic pregnancy. Therefore EP must be kept in mind in women having these features as conservative management is an option for early diagnosed cases. Shock and shoulder tip pain are late findings to appear therefore found in less number of patients. Surgical treatment was done in most of the cases because of late referrals. Early diagnosis and intervention would also reduce the maternal morbidity and mortality

Caesarean section rate: current trends

To determine the rate and analyze indications of caesarean section. Observational study. The study was conducted in Obstetrics and Gynaecology Unit four, Sindh Govt Lyari General Hospital attached to Dow University of Health Sciences from April 2005 till March 2006. All pregnant women booked in antenatal clinic and unbooked patients admitted in early labour on whom caesarean section [CS] was performed, were included in the study. The medical records of all patients were examined to study the socio-demographic variables, nature of procedure and the indication of abdominal delivery. The total number of births during study period were 930 of which 186 patients underwent caesarean section which makes 20% caesarean section rate [CSR] in our unit. Out of 186 CS done, 144 were performed in emergency and 42 as elective cases. The mean age was 30 years and the mean parity was 1.9. Primigravidas were 71[39%], multigravidas 75[40%] and grandmultiparas 40[21%]. Commonest indication for caesarean section was repeat caesarean section. Failed progress of labour was the 2nd commonest indication among the 15% of cases. Obstructed labour and fetal distress were indications in 9.6% of cases. Other indications include breech presentation, ante partum hemorrhage, hypertensive disorders, twin pregnancies and transverse lie. The most effective mean to control increasing CSR is the prevention of first caesarean section which could be achieved by adopting the policy of trial of vaginal birth after previous C-section, selective vaginal breech delivery and regular audit of C-section in the department

Conjoined twins in a triplet pregnancy

Conjoined twin is a rare event. Triplet pregnancy in conjunction with conjoined twin is even rare. In this report we present the outcome of female, monochorionic, diamniotic triplets consisting of two monoamniotic conjoined fetuses and a normal baby in separate amnion. Emergency cesarean section was done due to non progress of labor in a female who was un-booked case. Conjoined twins [thoraco-omphalopagus] died due to birth asphyxia during the section while third baby was normal and remained well

Pelvic organ prolapse in peri urban area of Karachi

To study prevalence, presentation and management of utero vaginal prolapse in Lyari [a periurban area of Karachi] A cross sectional study The study was conducted in Gyn/Obs department of Lyari General Hospital from 1st July 2005 to 30th June 2006. During this period 40 gynae admissions were cases of utero vaginal prolapse. After detailed history, examination and initial work up planned surgery was performed. All patients were followed in OPD after 6 weeks of operation During 1 year study period out of 376 gynae admissions 40 were cases of uterovaginal prolapse. So prevalence of utero vaginal prolapse in Lyari is 9.4. All were OPD admissions except 1 with incarcerated prolapse admitted through emergency. Around 50% were >50 years of age and 75% were grandmultipara. Main presenting complaint [100%] was vaginal protrusion. vaginal hysterectomy with anterior and posterior repair was done in 62.6%. Median length of stay was 5-7 days. Very few cases had intraoperative and postoperative complications. None had mortality

Control of postpartum and post abortal haemorrhage with uterine packing

To determine safety and effectiveness of uterine packing to stop hemorrhage in postpartum and post abortal cases. Patients who delivered either vaginally or via Caesarian section who developed primary post partum haemorrhage and post abortal patients developing primary post partum haemorrhage refractory to conventional medical treatment, were included in the study. Packing was done using 8-10 meters sterilized gauze from the fundus to cervix and was left for 12-24 hours or removed earlier in cases of failure to control hemorrhage. Morbidity and effectiveness was assessed. Intractable primary hemorrhage was encountered in 20 patients of whom 2 had bleeding after caesarian section, 14 after vaginal delivery and 4 patients had post abortal haemorrhage. Uterine atony was the commonest cause. Failure of packing to control haemorrhage was seen in 3 cases. It was successful in 17 cases. Whether used early or late in the management of post partum haemorrhage, uterine packing is a safe, quick and effective procedure

Illegally induced abortions: a study of 37 cases

Over a period of 3 years, there were 5230 pregnancy related admissions to Unit II, Department of Obstetrics and Gynaecology, Dow Medical College, Civil Hospital, Karachi. Of these, 1201 [22.96%] cases were identified as having abortion related complications. Thirty-seven [3.08%] cases amongst the total abortions were illegally induced. A prospective study of various aspects of these cases shows that maternal mortality was high, sepsis and trauma in some form being responsible for the majority of maternal deaths. The aim of this study was to identify the contributory factors responsible for maternal morbidity and mortality

Rupture of gravid uterus still an obstetrical problem: a three year clinical analysis

Thirty-five [1.15%] cases of complete rupture of uterus in pregnancy were identified among 3037 deliveries at the Civil Hospital, Karachi between 1993 and 1995. the most common cause [33%] was spontaneous rupture from obstructed labour in multiparas; there were only 2 cases of rupture of uterus in primiparous women. Other common etiological factors were foetopelvic disproportion, foetal malpresentation and contracted pelvis. Rupture of a previously scarred uterus occurred in 15 cases. A previous Caesarean scar [in 13 patients] was not the only predisposing factor-a history of dilatation and curettage [in two patients] and laparotomy for perforation of uterus [in one] were also implicated. Uterine hyperstimulation by oxytocin [3 cases] and unwise obstetrical interference [2 cases] were among the etiological factors. Perinatal mortality was 80% while maternal mortality was 20%. Hysterectomy was performed in 15 [42.86%] cases and repair of the uterus was done when the rupture was small, simple, transverse, in the lower segment and without any sign of infection