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

Maternal outcome after conservative management of "placenta accreta"

Objective: to find out maternal outcome after conservative management of "placenta accreta"

Study design: case series

Place and Duration of Study: Allied Hospital, Faisalabad from 1[st] July 2006 to 30[th] June 2015

Material and Methods: 22 patients with placenta accreta, where fertility was desired were selected for conservative management. Patient who were hemodynamically unstable after delivery of the fetus due to massive hemorrhage or those who presented with prolonged rupture of membrane were excluded from study

Results: conservative management was successful in 19 [86.36%] patients in terms of uterine conservation. However, 03 [13.64%] patients developed PPH and 02 [9.09%] developed postpartum endometritis. Hysterectomy was done in 03 [13.64%] patients. No mortality took place

Conclusion: conservative management of placenta accreta is a reasonable option in selected cases where fertility is desired. However, it requires regular follow-up till complete resorption or expulsion of placenta

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

Mullerian duct anomalies: presentation and reproductive outcome

The aim of this study was to analyze various presentations of mullerian duct anomalies and to determine its impact on reproductive outcome. Gynae Unit 1, Allied Hospital, PMC Faisalabad. From 01-06-2007 to 31-12-2008. Case Series. A total of 40 patients were included in study. Their detailed history and examination was done. Relevant investigations TVS, IVU and MRI were done to diagnose mullerian duct malformations. 16 patients [40%] presented with obstructive genital tract malformation while 8 patients [20%] presented with absence of uterus and vagina. Among those who presented in pregnancy, malpresentation [15%] was the commonest presentation. Obstructive anomalies of genital tract are commonest among mullerian duct malformations and are mostly diagnosed at puberty. Other uterine malformations may remain asymptomatic and may have both normal and adverse pregnancy outcome

Maternal mortality; one year review at Allied Hospital Faisalabad

To find out maternal mortality ratio [MMR] and to determine major causes of maternal death. A descriptive study. Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. From 01.01.2008 to 31.12.2008. All cases of maternal death during this study periods were included except accidental deaths. There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births. The most common cause of maternal death was hemorrhage [34.5%] followed by hypertensive disorders/eclampsia [31%]. Most of the patients [75.86%] were referred from primary and secondary care level. Maternal mortality is still very high in underdeveloped countries including Pakistan. We must enhance emergency obstetric care [EOC] to achieve the goal of reduction in MMR

Abdominal hysterectomy; performed by postgraduate [PG] trainees

[1] To audit cases of abdominal hysterectomy performed by post graduate tainees. [2] To evaluate mortality and morbidity rate. An observational Study. Department of Obstetrics and gynaecology, Allied Hospital Faisalabad. From 01-01-2005 to 30-06-2006. 120 cases of abdominal hysterectomies done for non obstetric and benign gynaecological conditions were selected for study. The most common indications for hysterectomy was DUB [43.3%]. Overall intra operative complications developed in 5 patients [4.1%]. Post operative complications developed in 9 patients [7.5%]. The mean duration of hospital stay was 5.5 days. No case of death was recorded in the study. This study demonstrates that abdominal hysterectomy can be safely done even during the learning curve of the post graduate trainees with the low complication rate, shorter hospital stay and without significant mortality