Umbilical cord blood pH in intrapartum hypoxia

To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. Descriptive analytical study. Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures [healthy, NICU admission or neonatal death], color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. A total of 204 newborns were evaluated. The mean pH level was found to be significantly different [p=0.007] in two groups. The pH value 7.25 had significant association [p < 0.001] with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor [MSL] also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSL had pH > 7.25. Majority [63.6%] cases needed caesarean section as compared to 31.4% controls. There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive

Women's perception towards menopause

To determine knowledge and attitude towards menopause among women aged 40 - 60 year presenting with gynecological complaints. Descriptive cross sectional survey. Obstetrics and Gynaecology Unit III, Civil Hospital Karachi from February 2009 to January 2010. Two-hundred premenopausal and postmenopausal women of 40 - 60 year of age were recruited in the study. They were interviewed after informed consent to obtain information about knowledge and attitude towards menopause. Data entered and analyzed by SPSS version 10. Descriptive statistics like frequencies, percentage proportions were calculated to present all categorical variables. The mean age of the participants was 46.8 year, 54.5% were premenopausal and 45.5% postmenopausal, out of them 10% had surgical menopause. 99% were married and 98.5% multiparous and grand multiparous. Only 22% were educated. 94% had heard about menopause, only 30% knew about symptoms, consequences [22%] and treatment of menopause [11%] especially hormone replacement therapy [HRT - 2%]. Ageing and natural transition were considered the common reasons of menopause. Only 21.5% had negative attitude towards menopause due to reason of somatic problems, loss of fertility and feminity. 58.5% considered treatment for menopause unnecessary. Majority of women knew about menopause but lacked knowledge because of limited source of information, education and cultural taboos

Perinatal mortality contributors in singleton gestation

To determine the feto-maternal factors contributing to perinatal mortality [PNM] in singleton gestation. Descriptive study. Gynae Unit-III, Civil Hospital, Karachi, from January to December 2002. All obstetric patients with singleton pregnancy and gestation age greater than 24 weeks, regardless of age, parity and gravidity attending the gynae unit III in labor room and ward were recruited. Patients with gestational age less than 24 weeks or multiple pregnancy were excluded. Relevant data regarding history, risk factors in mother and baby were recorded on a pre-designed proforma and later analyzed on SPSS 10 for descriptive statistics and comparison of proportions using chi-square statistics. Neonatal death was defined as live born infant who died before 28 days of age. Still birth encompassed any death of a fetus after 20 weeks of gestation or 500 gms, and perinatal mortality was considered as the sum of the still birth and neonatal death. In the 1505 studied mothers, the perinatal loss was 187[12.43%] including 140 still births and 47 neonatal deaths [3.12%]. Perinatal mortality rate [PNMR] was 124/1000 total live births and neonatal death rate [NNDR] was 34/1000 live births. The commonest cause of still birth was antepartum hemorrhage [33.5%] and the commonest cause of NND was birth asphyxia [64%]. PNM in relation to neonatal birth weight was highest in the 2.5 - 3.5 kg range i.e. 70 [50%, p=0.86]. The proportion of primi/multi parity was 60 [45%] and 23 [49%] in still birth and neonatal deaths respectively [p=0.308]. The leading causes of prematurity were antepartum hemorrhage, hypertensive disorders and chorioamnionitis. Perinatal mortality is markedly affected by fetal maturity. Parity and fetal weight have an insignificant effect on perinatal mortality

Complications and management of unsafe abortion

To determine the frequency of unsafe abortion and its morbidity and mortality in patients presenting at Civil Hospital Karachi Descriptive study. Department of Obstetrics and Gynecology, Unit III Civil Hospital Karachi, from 1st January 2001 to 31st December 2005 All patients with history of induced abortion were admitted. The particulars related to each case like age, marital status, parity, reason for requesting abortion, place and expertise of person carrying out the procedure and outcome were recorded. Once patient arrived in our unit detailed examination was done and relevant investigations sent. After primary resuscitation and optimization, the patients were managed according to their complications in collaboration with general surgical department Fifty nine mostly young ladies with age range of 17 to 47 years and mean age of 30.76 years, presented with complications of induced abortion. Fifty four patients were married and 5 were single mothers. Fourteen patients [24%] were nullipara and remaining 45 [76%] were having 5 or more children. Only 7 out of 59 patients were booked cases, who underwent elective therapeutic medical termination of pregnancy [for foetal congenital anomalies in 5 cases and maternal grade III cardiac disease in 2 cases] They had no complication. Fifty two patients presented with induced and unsafe abortion. They were referred cases, and had multiple complications. Two patiens were brought dead and one patient died during pre-operative resuscitation. Out of remaining 49 patients, five [10%] were managed conservatively, 25 [51%] had re-evacuation and 19 [39%] underwent exploratory laparotomy. Ileal perforation was found in 5 cases. These were treated by primary repair and resection and anastomosis [2 cases each] and ileostomy in 1 case. Sigmoid perforation was found in 3 cases and managed by colostomy. Repair of uterine perforation only was done in 4 cases. Hysterectomy was performed in 4 patients. In three patients peritoneal toilet was also done. Overall mortality was 9.6% [n-5] Our data shows high morbidity and mortality associated with induced unsafe abortion in the form of prolonged hospital stay, multiple blood transfusions, laparotomies, hysterectomies that compromises the obstetrical future of young patients