Neonatal outcome of meconium stained liquor

Background: Meconium staining may have its effect on neonates

Objective: To determine the neonatal outcome in meconium stained liquor

Methodology: Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynaecolgy, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of Study: From 12[th] May to 11[th] November 2013. Sampling Technique: Nonprobability consecutive sampling. Data Collection Procedure: Total 149 cases of pregnant women meeting the inclusion criteria, presenting with complaint of watery, vaginal discharge and labour pain were registered. Patient included in the study were followed throughout the labour till delivery. Strict fetal heart rate monitoring was done by intermittent cardiotocography. A pediatrician attended all the babies. APGAR score, NICU admission, neonatal death, meconium aspriration syndrome, and birth weight of the babies was recorded on specially designed proforma. Data Analysis Procedure. Collected information was entered into SPSS version 17 and analyzed

Results: A total of 149 patients were included in this study. Mean age of the patients was 23.47 + 4.13 years, gestational age was 37 + 4.13 weeks, APGAR score 6.73 + 2.37 and mean birth weight of neonates was 3.59 + 0.59 Kg. 57 babies [38.3%] were admitted to NICU, 21 neonates [14.0%] expired, satisfactory Apgar score was observed in 73 [49%] neonates, meconium aspiration syndrome was found in 26 cases [17.5%]

Conclusion: Meconium staining of amniotic fluid is commonly observed phenomenon in labour and is frequently associated with prolonged labour. Meconium stained liquor is associated with increased incidence of poor APGAR score, neonatal nursery admission, meconium aspiration syndrome and neonatal death

Histopathological pattern of endometrium in patients with abnormal uterine bleeding

Background: Assessment of histopathological pattern of endometrium among women with abnormal uterine bleeding is important for management of this condition

Objective: This study was conducted to find out the histopathological pattern of the endometrium in patients with abnormal uterine bleeding

Patients and Methods: This cross sectional study was conducted in the department of Obstetrics and Gynaecology Unit-II, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] January, 2011 to 31[st] December, 2013. Patients with history of abnormal bleeding were assessed and admitted in Gynae Unit-II, after detailed evaluation by history, examination and pelvic ultrasound, their endometrial sampling was taken and sample was sent for histopathological examination in pathology department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Inclusion Critaria: Patients with irregular P/V bleeding at any age, menorrhagia, polymenorrhagia, endometrial polyp, post-menopausal bleeding and post-menopausal discharge. Exclusion Critaria: Patients with pregnancy complications [threatened, incomplete miscarriage, molar pregnancy and ectopic pregnancy] acute pelvic infection and IUCD insertion. Data was entered and analyzed by using SPSS version 16

Results: A total of two hundred and thirty six endometrial sampling were performed over a period of three years. In three years majority 166 [70.30%] of patients presented in age of 35-50 years, 47 [19.9%] were between 30-35 years and 23 [9.8%] were more than 50 years of age. The commonest histopathological finding in our study was chronic endometritis [41.5%], followed by simple hyperplasia [19.9%], proliferative endometrium [9.3%], secretary endometrium [7.6%], complex hyperplasia without atypia [5.9%] and complex hyperplasia with atypia [5.1%]. Other findings constitute disordered proliferation [3.4%], adenocarcinoma [1.7%], atrophic and inactive endometrium [1.3%], endometrial polyp [0.4%]

Conclusion: Histopathological pattern of endometrium in patients with abnormal bleeding is quite variable. Main reason for performing endometrial biopsy in women with abnormal uterine bleeding is to confirm the benign nature of the problem by ruling out endometrial carcinoma

Role of induction of labour versus expectant management at term in pre labour rupture of membranes

Background: Pre-labour rupture of membranes [PROM] is defined as spontaneous leakage of amniotic fluid pricr to the onset of labour. It is further categorized into preterm PROM [PPROM] when gestational age 37 weeks

Objective: To compare the induction versus expectant management in the management of PROM in terms of maternal and fetal outcome

Material and Methods: Study Design: Randomized controlled trial. Setting: Department of obstetrics and Gynaecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 15[th] December 2011 to 14[th] August 2012. A total of 158 patients were included in the study divided in two groups A and B, each having 79 patients. Group "A" were treated with expectant management and group "B" underwent induction of labour with prostaglandin E2. The data was entered and analyzed in SPSS version 10

Results: Mean PROM to delivery interval in Group "A" was 19.65 + 2.38 hours and in Group "B" it was 15.16 + 2.79 hours. In Group "A" 48 [60.7%] patients ended up with normal vaginal delivery 13 [16.5%] had instrumental and 18 [22.8%] had cesarean section. In group "B" 13[16.4%] have normal vaginal delivery and 35[44%] have cesarean section. In Group "B"] 13 [16.4%] have normal vaginal delivery, 31 [39.3%] had instrumental delivery and 35 [44.3%] ended up in. Regarding chorioamnionitis 15 [19%] in Group "A" and 8[10.1%] in Group "B" had this complication. In Group "A" 11[14%] and in Group "B" 8[10.1%] developed puerperal pyrexia. 3 neonates in Group "A" had APGAR score APGAR score <7 at 5 minutes [03.7%] while no neonate have such problem in Group "B"

Conclusion: Expectant management is better option for women who presented with PROM at term with good fetal and maternal outcome

Fetomaternal outcome in cases referred to tertiary care hospital after trial of Labour

Background: All pregnant women are at risk of obstetrical complications and most of these occur during labour. In our community local dai, trained birth attendants, lady health visitors and nurses contribute a major part in home deliveries which may be associated with increased risk of fetomaternal complications

Objective: To determine the fetomaternal complication in cases referred to tertiary care hospital after trial of labor outside the facility

Patients and Methods: Study design: Descriptive case series

Setting: Department of Gynaecology and Obstetrics, Sheikh Zayed Hospital, Rahim Yar Khan. Duration of study: One year from 1st January, 2012 to 31st December, 2012. A total of 240 patients who had a trial of labour outside the tertiary care Hospital, were selected for the study. The data was collected on a redesigned questionnaire, having demographic data fetal and maternal outcome. The outcomes assessed were fetomaternal complications i.e prolonged labour, obstructed labour, prolonged rupture of membranes, uterine rupture, abnormal presentation and primary postpartum haemorrhage. Foetal outcome in terms of Apgar score at birth and still births were studied. The data was entered and analyzed in SPSS version 15

Results: 240 patients admitted through emergency after trial of labour by Traditional birth attendants [TEA], Lady health Visitor [LHV] or doctors at home or private clinics were analyzed for fetomaternal outcome. Out of 240 patients in study, 118 [49%] were primigravida while 40 [16%] were grandmultipara. About 90% of patients never had any antenatal checkup. Majority of the patients [94%] were under care of TEA and LHV. The maternal morbidities were prolonged labour 128 [53.3%], obstructed labour 76 [31.6%], prolonged rupture of membranes 60 [25%], abnormal presentation 50 [20.83%], and primary postpartum hemorrhage 30 [12.5%]. Two thirds of the mothers were in need of emergency obstetric care: 70 patients [29.16%] required forceps or vacum extractions and 118 patients [49.16%] required caesarean section. Laparotomy was carried out in 10 patients due to ruptured uterus, out of which four had hysterectomy. There were two maternal deaths due to ruptured uterus. Regarding perinatal outcome there were 64 stillbirths, while 102 had Apgar score below 5 at five minutes. 24 babies died in first 12 hours

Conclusion: This study concludes that complications of labour if not timely diagnosed and rectified results in adverse fetomaternal outcome. Provision of skilled birth attendant at doorstep will be an ideal solution

Role of induction of labour versus expectant management at term in pre labour rupture of membranes

Background: Pre-labour rupture of membranes [PROM] is defined as spontaneous leakage of amniotic fluid pricr to the onset of labour. It is further categorized into preterm PROM [PPROM] when gestational age <37 weeks and PROM when it is >37 weeks

Objective: To compare the induction versus expectant management in the management of PROM in terms of maternal and fetal outcome

Material and Methods: Study Design: Randomized controlled trial. Setting: Department of obstetrics and Gynaecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 15[th] December 2011 to 14[th] August 2012. A total of 158 patients were included in the study divided in two groups A and B, each having 79 patients. Group [A] were treated with expectant management and group [B] underwent induction of labour with prostaglandin E2. The data was entered and analyzed in SPSS version 10

Results: Mean PROM to delivery interval in Group [A] was 19.65 + 2.38 hours and in Group [B] it was 15.16 + 2.79 hours. In Group [A] 48 [60.7%] patients ended up with normal vaginal delivery 13[16.5%] had instrumental and 18 [22.8%] had cesarean section. In group [B] 13[16.4%] have normal vaginal delivery and 35[44%] have cesarean section. In Group [B] 13 [16.4%] have normal vaginal delivery, 31 [39.3%] had instrumental delivery and 35 [44.3%] ended up in . Regarding chorioamnionitis 15 [19%] in Group [A] and 8[10.1%] in Group [B] had this complication. In Group [A] 11[14 %] and in Group [B] 8[10.1%] developed puerperal pyrexia. 3 neonates in Group [A] had APGAR score <7 at 5 minutes [03.7%] while no neonate have such problem in Group [B]

Conclusion: Expectant management is better option for women who presented with PROM at term with good fetal and maternal outcome

Emergency obstetrical hysterectomy; determinants and complications

Background: Obstetrical hysterectomy is one major marker of obstetric morbidity. It still complicates the substantial number of pregnancies in third world

Objective: This study was carried out to determine the frequency and causes of obstetric hysterectomy and morbidity and mortality related to it in Sheikh Zayed Hospital, Rahim Yar Khan

Patients and Methods: This was a descriptive study including all the patients who underwent obstetrical hysterectomy from 1[st] January 2010 to 30[th] June 2010, in Sheikh Zayed Hospital. Data was collected through predesigned proforma and analyzed through SPSS version 10

Results: During the study period 6,541 deliveries were conducted including both vaginal and through cesarean section. 19 [0.29%] patients underwent obstetrical hysterectomy. Among them 42% were due to atonic uterus, septic RPOCs [10%], 21% due to morbid adherence of placenta and 5% due to uterine inversion. The developed complications were bladder trauma [21%], repeat Laparotomy [15.8%], fever [21%], wound infection [21%], DIC [15.8%] and mortality [5%]. All the patients were unbooked

Conclusion: Incidence of obstetric hysterectomy in our area is relatively high probably due to large number of referred cases from rural Sindh, Boluchistan and Punjab. These patients had many avoidable factors such as high parity, inadequate maternity and family planning services and unbooked status

Primary postpartum hemorrhage; efficacy of oral misoprostol in comparison to intravenous oxytocin

It is to compare efficacy of Oral Misoprostol with intravenous oxytocin in the management of primary post partum hemorrhage. Quasi experimental study. Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 1st December, 2006 to 1st December, 2007. The study was conducted on 90 patients who went into post partum hemorrhage during the study period. Cases were divided into two groups each having 45 patients fulfilling the inclusion criteria. Group 'A' had those who received oral misoprostol 600microg and group 'B' those who received 5 UNITS intravenous oxytocin. The variables analyzed were failure of drug, time taken to control bleeding and side effects of drugs. Students t-test was used for comparison between means and chi-square test for comparison between percentages. Significance was taken at P<0.05. It was noted that failure rate of oral misoprostol was 11.1% and that of oxytocin was 22.2%. Mean time taken to control bleeding by misoprostol was 16.6 minutes and 1.311 minutes by intravenous oxytocin. Side effects was observed in 35.5% cases of misoprostol group and 2.22% cases of oxytocin group. The time taken to control bleeding and side effect profile is more better in intravenous oxytocin as compared to oral misoprostol in the menagemnt of primary postpartum hemorrhage, but number of patients responded to oral misoprostol are more, so it can be used as in combination of oxytocin where oxytocin alone failed to work

Vaginal delivery versus cesarean section; birth outcome in primi gravdae breech

It is to compare neonatal morbidity in terms of birth trauma, respiratory distress syndrome, APGAR score in Primigravida with breech presentation delivered vaginally and emergency cesarean section. Cross-sectional comparative study. Obstetrics and Gynaecology Unit-l, Bahawal Victoria Hospital, Bahawalpur from 1-5-2007 to 30-4-2008. The study was carried out on all Primigravida with breech presentation reported through emergency in labour delivered vaginally and by emergency cesarean section. The variable analyzed were birth trauma, respiratory distress syndrome and APGAR score at 1 and 5 minutes. Students-t test was used for comparison between means and chi square test for comparison between percentages. Significance was taken at P<0.05. It was found that mean APGAR score at 1 and 5 minutes is 7.31 and 9.066 in vaginal and 8.533 and 9.644 in cesarean group. Respiratory distress syndrome is more in cesarean [4.4%] than vaginal group [2.2%]. Observed neonatal trauma is more in vaginal group [6.7%] than cesarean section [2.2%]. Neonatal morbidity appears to be more in vaginal breech delivery than I cesarean section for Primigravida with breech presentation at term