Comparison of outcome of caesarean section with and without post placental intrauterine contraceptive device insertion a randomized controlled trial

Objective: to compare the outcome of Caesarean Section with and without post placental Intrauterine Contraceptive Device [IUCD] insertion in terms of frequency of bleeding and wound infection

Study Design: randomized controlled trial

Place and Duration: Department of Obstetrics and Gynaecology, Allied Hospital, Faisalabad from 1[st] January 2013 to 30[th] June, 2013

Methodology: three hundred and two pregnant women admitted for elective emergency caesarean section, willing to use intrauterine contraceptive device as a method for temporary contraception were randomly divided into two groups A and B. Group A had intrauterine contraceptive device inserted after delivery of placenta and membranes. Group B did not have intrauterine device inserted. In post-operative period both groups were evaluated for heavy lochia or abdominal wound infection on day 3 and day 7

Results: in the experimental group [A] ten patients [6.6%] and in control group [B] 8 patients [5.3%] had wound infection. P value calculated as 0.627 which shows no statistical difference in 2 groups. Regarding heavy lochia in group A 4 patients [2.6%] and in group B 2 patients [1.3%] had heavy lochia. P value calculated as 0.410 which was statistically not significant

Conclusion: there is no significant difference in outcome of caesarean section with and without post placental IUCD insertion

stitch in time, saves life; should B-Lynch suture be the first line surgical option for control of massive primary PPH due to refractory uterine atony? An experience at D.H.Q Hospital Faisalabad

Objective: to see the effectiveness of B-Lynch brace suture as first line surgical option to control massive primary postpartum hemorrhage due to uterine atony refractory to medical treatment

Study Design: quasi experimental

Place and duration of study: this research work was done in D.H.Q Hospital Faisalabad from 2002-2004. During the study period 21 women underwent B-Lynch Brace suture to halt bleeding resulting from refractory uterine atony. Data was collected in prospective manner on a specialized proforma from attending house officers and postgraduate trainee registrars. The B-Lynch technique was used. Postoperatively the patients were kept in high dependency area within labor room for 24-48 hours. Follow up was done in O.P.D after discharge

Materials and Methods: the women who had severe/ persistent primary postpartum hemorrhage due to uterine atony were initially resuscitated and simultaneously managed with ecbolics as per unit protocol [i-e; 40 units oxytocin in 1000cc Normal Saline infusion, inj. methergen [withheld women with specific contraindications for methergen], inj. F2 alpha in each uterine cornu, and per rectal misoprostol. However those women who remained unresponsive to the medical treatment, underwent B-Lynch Brace suture as first line surgical option

Results: the success rate was 85.7% [n18] in terms of control of hemorrhage and hysterectomy was averted in 95% [n20] of women. Whereas in two women it needed to be integrated with stepwise uterine de-vascularization procedures

Conclusion: B-Lynch suture is effective as first line surgical option to arrest postpartum hemorrhage due to refractory atonic uterus

Vaginoplasty using Sheare's Method followed by amnion graft in patients of vaginal agenesis associated with mayer-rokitansky-kuster-hauser syndrome

Objective: to evaluate outcome of vaginoplasty by Sheare's method followed by amnion graft in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser [MRKH] syndrome

Study Design: descriptive observational

Place and Duration: Department of Obstetrics and Gynaecology, Allied Hospital, Faisalabad from 1[st] January 2012 to 31[st] December, 2014

Methodology: nine patients with MRKH syndrome underwent vaginoplasty by Sheare's method in which the space between two labia was dilated with Heagar's dilator along the vestigial Mullerian ducts. Thus two tunnels were created and the central septum excised to form a single vagina. A mould covered with amnion was then placed in the neovagina. All cases were followed up for six months

Results: amnion graft was taken completely and presented no intra-operative or post-operative complications in all 9 cases. There was contracture of neovagina in one case only and this was due to non-compliance with continued mould placement after discharge from Hospital

Conclusion: Sheare's method of vaginoplasty followed by amnion graft is an easy procedure with minimal or no complications and provides excellent anatomic and cosmetic results

Uterine arteriovenous malformation [UAVM] - a case report

Uterine arteriovenous malformation [UAVM] is a rare condition with less than 100 reported cases. This case report describe a 32 years old, P[2] patient who presented with abnormal uterine bleeding and severe anemia. Gray scale ultrasonography alongwith colour Doppler showed increase vascularity within the myometrium. Pelvic angiography was done to confirm the diagnosis. Patient's anemia was corrected by blood transfusion and uterine artery embolizaiton [UAE] was planned. Meanwhile, she developed a heavy episode of vaginal bleeding and went into shock. Patient opted for hysterectomy as a life saving measure

Uterine rupture in pregnancy-one year experience

Objective: To determine the frequency, risk factors,maternal and fetal morbidity and mortality in uterinerupture

Study Design: A cross-sectional study

Patients and Methods: The study was conducted inDepartment of Obstetrics and Gynaecology, AlliedHospital, Faisalabad [a tertiary care centre] fromJanuary 2010 to December 2010. All cases ofruptured uterus who where admitted with or whodeveloped this complication in the hospital wereincluded in the study

Results: The frequency ofuterine rupture was [0.39%]. Out of these, only 7patients [18%] were booked. The main risk factor wasscarred uterus in 30 cases [79%] and [21%] was inunscarred uterus. Amongst unscarred uterine rupture,risk factors were grand multiparity [9%], obstructedlabour [5%], oxytocic agents [5%] and forcepsdelivery [2%]. Repair of uterus was done successfullyin 29 cases [76%]. Obstetrical hysterectomy wasdone in 9 cases [24%]. There were two maternaldeaths [5.2%] and 32 [84%] still births

Conclusion:This study showed high frequency of seriousobstetrical problem which can lead to highfetomaternal mortality. The leading cause of uterinerupture was scarred uterus [cesarean scar]. Toprevent this serious complication from occurring,most important is assessment of risk factors foruterine rupture both antenatally and in intrapartumperiod and to counsel the patient properly.Improvements which could also be implementedinclude availability of transport facilities for thepatients and training sessions for the staff inemergency

Abdominal sacrohysteropexy in young women with uterovaginal prolapse

Objective: To study the results of sacrohysteropexywith Prolene Mesh for treatment of uterovaginalprolapse in women who desire to preserve theiruterus

Study Design: Prospective observationalstudy

Place and duration of study: This study wascarried out in Allied Hospital, Faisalabad over aperiod of one year from April 2010 to April 2011

Methods: 12 women with uterovaginal prolapsewishing to retain their uterus underwentSacrohysteropexy with Prolene Mesh attached touterine isthmus and to the anterior longitudinalligament of the first or second sacral vertebra in atension free fashion. Subjective and objective cureof uterine prolapse and operative and postoperativecomplications were noted

Results: 12 patientsunderwent Sacrohysteropexy for uterovaginalprolapse during this study period. The mean age ofpatient was 30 years [range 16-40 years]. Ten[83.3%] were multipara while two [16.7%] werenullipara. All women had second degreeuterovaginal prolapse. The mean follow up periodwas 12 months. No women developed intra andpostoperative complications. No single case of mesherosion was detected success rate was 83.3%.Recurrent prolapse was recorded in 2 [16.7%]women which was symptomatic and required repeatsurgical treatment

Conclusion: Sacrohysteropexyis effective and safe procedure in women withuterovaginal prolapse who want to preserve theiruteri

Pregnancy outcome in cardiac disease

To determine pregnancy outcome in patients presenting with heart disease during pregnancy and labour. Descriptive study. This study was conducted in Gynae Unit-l, Allied Hospital affiliated with Punjab Medical College, Faisalabad, during a period of 2 years from January 2009 to December 2010. This study included 74 patients who presented with congenital or acquired heart disease during pregnancy or labour. Patients were evaluated for their cardiovascular status by cardiologist. Relevant investigations done to assess maternal and fetal condition. 50 patients [67.6%] were in age group 20-25 years. Congenital heart disease was present in 8 [1.8%] patients while acquired heart disease was present in 66 patients [98.2%]. 52 patients [70.3%] achieved term delivery, while 8 patients [10.8%] had spontaneous miscarriage and 14 patients [18.9%] had preterm delivery. 50 patients [76%] had live birth with normal birth weight, 12 patients [18%] had fetuses which were small for gestational age [SGA], 2 patients [3%] had stillbirth and 2 patients [3%] had early neonatal death due to prematurity. Heart disease in pregnancy is a high risk condition. Multidisciplinary approach should be adopted in the management of cardiac patient to achieve good obstetric and fetal outcome

Efficacy of magnesium sulphate in prevension of fits in severe pre-eclampsia

Objective: To evaluate the efficacy of magnesium sulphate as prophylactic agent in prevention of fits in severe pre-eclampsia

Study Design: Interventional Quasi experimental study

Setting: Department of Obstetrics and Gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad

Subject: Sixty patients of severe pre-eclampsia fulfilling the inclusion and exclusion criteria

Main Outcome Measures: Occurrence of fit in case and control group, side effects of the drug like flushing, diminishing of reflexes, respiratory depression and hypotension in the case group

Method: Sixty patients with severe pre-eclampsia were divided into two groups: Group A was taken as case and treated with MgSO[4], group B was taken as control and was not given MgSO[4]

Results: Out of the 30 patients treated with MgSo[4] none [0%] had eclampsia in group A. In group B 4 [13.3%] patients developed eclampsia. Side effects of the drug were looked for in group A. Flushing was seen in 6 [20%] patients diminishing of reflexes was deserved in 1 [3.3%] patient

Conclusion: MgSO[4] is an effective drug for prevention of fits in patient of severe preeclampsia

Diagnosis and management of congenital anomalies of vagina

Objective: To create awareness by presenting case series of congenital anomalies of the vagina, their diagnosis and management

Design: Interventional case series

Setting: Allied Hospital PMC Faisalabad

Materials and Methods: 18 patients with vaginal anomalies were reviewed between March 2008 and February 2011. Patients were evaluated by symptoms, physical examination and investigations. After management they were followed up to a period of minimum 3 months to a maximum of 2 years

Main Outcome Measures: Improvement in symptoms, creation of vagina with at least a 3-5cm in width leading to perfection of sexual life and fertility

Interventions: were done in 16 [88.88%] cases of transverse and longitudinal vaginal septum, imperforate hymen and absent vagina. Transverse vaginal septum and longitudinal septum was removed, imperforate hymen incised and no postoperative contractures occurred. Mayervon Rokitansky-Küster-Hauser's Syndrome [MRKH] was managed by non surgical method. While absent vagina and cervix with functioning uterus was treated with abdominal hysterectomy followed by vaginoplasty and absent vagina with rudimentary/hypo plastic uterus treated with vaginoplasty

Results: 7[38.88%] cases of vaginal septum, 4[22.22%] cases of imperforate hymen, 1 [5.55%] case of vaginal atresia with absent cervix and functioning uterus, 1[5.55%] hypo plastic uterus with absent lower vagina were operated for creation of vagina. Functioning vagina with a minimum of 4-5cm width in the former area of the septum and atretic vagina was created. 3[16.66%] longitudinal vaginal septum were operated during labor, a satisfactory sexual life was reported by all except in one of the group. We achieved 88.23%[15/17] successful results. While 1[5.55%] cases of absent uterus and vagina in non Inter- vented group did not follow back

Conclusion: Congenital anomalies of the vagina have long term impact on patient sexual and reproductive life. New born girls must be examined for vaginal defects initially so that investigations could be arranged for further abnormalities such as upper mullerian duct and renal tracts

Successful pregnancy in a patient with Eisenmenger's syndrome

Pregnancy with Eisenmenger's syndrome having high maternal mortality as pulmonary hypertension is aggravated often leads to poor outcome. But a multidisciplinary approach and close follow up can achieve a good maternal and fetal come. Here we report a case of successful pregnancy in a patient with Eisenmenger's syndrome

Comparison of the efficacy and safety of misoprostol for termination of pregnancy in second trimester in scarred versus unscarred uterus

Objectives: To compare the efficacy and safety of Misoprostol for termination of pregnancy in second trimester in scarred versus unscarred uterus

Study Design: Quasi-experimental study

Setting: Obstetrics and Gynaecology unit of Allied / DHQ Hospitals affiliated with Punjab Medical College, Faisalabad

Subjects and Method: During 6 months period from 22nd March, 2007 to 22nd September, 2007. 60 patients [30 with scarred and 30 with unscarred uterus] were admitted for second trimester termination of pregnancy for maternal reason, fetal congenital anomalies and intrauterine fetal demise and induced with vaginal misoprostol. Loading dose of 400 mcg followed by maintenance dose of 200 mcg at 4 hourly interval to a maximum of 4 doses

Main Outcome Measures: Efficacy included induction to delivery interval and safety included maternal complications and side effects like uterine rupture, hysterectomy, severe haemorrhage, pyrexia, nausea and vomiting

Results: Success rate of T.O.P. was 96.7% in group A [scarred uterus] VS 93.3% in group B [unscarred uterus] Maternal complications were nausea and vomiting 3.3% in group A VS 0% in group B, Pyrexia 3.3% in each group, no case of uterine rupture was recorded

Conclusion: Misoprostol is safe and effective drug for Midtrimester T.O.P. in scarred as well as unscarred uterus

Emergency obstetric hysterectomy - one year review at Allied hospital, Faisalabad

To study the cases of obstetric hysterectomy performed over a period of one year [Jan. 2008 to Dec. 2008] in a teaching hospital to determine the incidence, indications, associated risk factor and maternal outcome of patients with a view to suggest ways of improving outcome. One year retrospective study of 38 consecutive cases of obstetric hysterectomies performed during the study period were analyzed. Total number of deliveries during the study period were 8988 and 38 emergency obstetric hysterectomies were undertaken; frequency being 0.42%. Only 26.3% women were booked. The most common indication for procedure were uterine rupture, uterine atony and morbidly adherent placenta. Total hysterectomies were undertaken in 73.6% and sub total in 26.3% women. There were 4 [10.5%] maternal deaths. Patients who died were received in critical condition and with massive haemorrhage. Late arrival and non availability of blood because of incooperative attendants were the main factor in maternal mortality. Emergency obstetric hysterectomy remains an essential life saving procedure. Proper antenatal care and early admission in labour ward, training and retraining of traditional birth, attendants, prompt resuscitation and referral of patient in time will go a long way to reduce the incidence of this procedure

Indication and maternal outcome of emergency peripartum hysterectomy

To analyze the maternal outcome of peripartum hysterectomy in badly handled cases with ruptured uterus and severe post partum haemorrhage. A retrospective study carried out in Obstetric and Gynaecology Unit-II, Divisional Headquarter Hospital [D. H. Q.] Faisalabad over a period of two years. Thirty patients who underwent emergency peripartum hysterectomy during the study period of two years. Indications, associated maternal morbidity and mortality of peripartum hysterectomy. There were 30 cases of emergency peripartum hysterectomy over a period of two years. The most common indication was uterine rupture [42.9%], followed by uterine atony [26.6%]. All women required blood transfusion, five [17%] developed coogulopathy, four [13.3%] had bladder injuries, two [6%] required salpingoophorectomy for uncontrolled adnexal bleeding and two [6%] patients underwent a repeat laparotomy for internal haemorrhage. Maternal mortality was 6% [n=2]. Peripartum hysterectomy continues to have a high incidence in our community. High parity, illiteracy and ignorance coupled with inadequate maternity services, injudicious use of syntocinon, improper third stage management, abnormal placentation and uterine atony were identified as risk factors for emergency peripartum hysterectomy. An early decision of obstetrician can save blood loss and prevent complications

Incidence and outcome of preterm-premature rupture of membranes

To know the incidence and to evaluate the outcome of cases of preterm premature rupture of membranes [PPROM]. An observational study done over a period of 1 year between 31st January 1999 to 31st January 2000. 136 cases of PPROM admitted in the antenatal ward of Obstetric and Gynecology Unit II, Punjab Medical College, Divisional Head Quarter [DHQ] Hospital, Faisalabad. Main Outcome Measures: Incidence, latency period, perinatal mortality and morbidity and maternal morbidity. Incidence of Pre-term premature rupture of membrane was 5.4%. Most of the patients were below 25 years or above 30 years of age [74%, 66% respectively]. Majority belonged to low socio-economic group. Thirty-two patients had previous history of abortion or preterm delivery, seventy-eight patients delivered within first 48 hours. About 2.6% percent patients developed choriomnionitis. Eighty six percent patients delivered vaginally. Perinatal mortality was 19%. Retained placenta and abruption was seen in 0.7% cases each. PPROM is a major obstetric problem. Expectant management upto 36 weeks is a favourable option in our circumstances where neonatal intensive care units [N.I.C.U.] are not available. Prolongation of pregnancy to achieve fetal maturity can be possible by adopting strict clinical criteria thereby decreasing prematurity

Prevalence and management of anencephaly at divisional headquarter hospital Faisalabad

To determine the prevalence, establish diagnosis and management of anencephaly. Design: A prospective cross sectional study done over a period of one year [01.06.1999 to 31.05.2000]. Setting; Antenatal ward of Obstetric and Gynaecology Unit-II, Punjab Medical College, Divisional Headquarter Hospital [DHQ], Faisalabad. Thirteen pregnant ladies having fetuses with neural tube defect [NTD] admitted in antenatal ward of DHQ Hospital. Main outcome measures: Prevalence of anencephaly diagnosis, establishing any risk factor and possible causative factors. Prevalence of anencephaly was 3.2 per 1000 births and that of spina bifida 2 per 1000 births, 100% anencephalic and 80% infants of spinabifida were diagnosed by ultrasonography. 62% cases underwent termination of pregnancy through vaginal route. Maternal diabetes was found in 12% cases. Female sex was predominant in anencephalic fetuses [61.50%]. Improved maternity services, with facilities for prenatal diagnostic techniques for detection of anencephaly and early termination of affected fetuses can help curtail this congenital anomaly with its associated perinatal mortality. Prevalence can be decreased by giving folic acid supplementation before pregnancy and in first trimester

Management of diabetic pregnancy and its outcome

To find out the effect of optimal management of diabetes during pregnancy on maternal morbidity and perinatal morbidity and mortality. A prospective study of 171 consecutive admissions of diabetic pregnant women to Antenatal Ward of Gynaecology and Obstetrics, Unit II, Punjab Medical College [P.M.C.], Divisional Headquarter Hospital [D.H.Q.] Faisalabad. Setting: Antenatal Ward of Gynaecology and Obstetrics, Unit II, P.M.C., D.H.Q. Hospital, Faisalabad. One hundred and seventy one pregnant women with diabetes admitted in Antenatal Ward. Maternal morbidity, perinatal morbidity and mortality and causes of perinatal mortality. One hundred and seventy one cases of pregnancy with diabetes were booked for antenatal care. One hundred and forty five cases continued follow-up and were managed till delivery, one hundred and sixteen [77%] were booked in third trimester, 26 [17%] in second trimester, 8[5%] in first trimester. Hospital and home blood glucose monitoring was carried out. Two cases ended in first trimester abortion. More than half [59%] patients were delivered by caesarean section. Perinatal mortality was 4.82% with equal incidence of congenital malformations and unexplained still births. Diabetes is an important medical complication of pregnancy. Prenatal counseling for established diabetics, screening for diabetes for all pregnant women, good control of diabetes from conception till delivery, antepartum fetal surveillance and good neonatal care by neonatologists are the keys to successful outcome