3rd trimester of pregnancy; frequency of anemia

To see the frequency of anemia in pregnant ladies and its possible outcomes. Descriptive cross sectional study. Fatima Jinnah Women Hospital, Multan. Six months. This prospective cross sectional study was conducted at Gynae and Obst. OPD at Fatima Jinnah Women Hospital, Multan. Non probability convenient sampling technique was used. All the pregnant women between 20-35 years irrespective of gestational age or any concurrent illness having parity upto 5 were registered for the study after getting written consent for participation. The pregnant ladies were evaluated by asking history of blood loss, parity, multiple pregnancy, worm infestation, use of NSAIDS and blood transfusion. They were especially asked about dietary habits which were rated as good, average and poor. Their socio economic status was assessed and was placed into high, middle and low income groups. Blood samples were drawn for blood counts and hemoglobin estimation in all the women presenting at hospital. Reflotron photometer, Roche Diagnostic was used for the blood testing. A cut off value of< 11 g/dl irrespective of duration of pregnancy was used for anemia. Peripheral blood film was examined for RBC morphology. Mean corpuscular volume [MCV] was used to categorize into micorcytic [< 76fl], macrocytic [>98fl] and normocytic [78-98fl]. Fetal well being was evaluated by serial abdominal ultrasounds. Three hundred pregnant women attending Gyne and Obst. OPD, Fatima Jinnah Women Hospital, Multan, were registered according to the study protocol. The duration of the study was 6 months. Maternal age was between 25-35 years. 86 % women were multiparous, 79% women presented during 3rd trimester, 15% during the 2nd trimester and 6% during 1st trimester. Thirty eight percent women had hemoglobin 8-9.9 g/dl, 48% had from 7-7.9 g/dl and 10%were falling between 5-7 g/dl. Eighty eight percent had microcytic hypochromic anemia, 12% with dimorphic picture and 4% were having low MCV and MCH but normal MCHC and these were referred for hemoglobin electrophoresis. Fifty eight percent had monthly income 2-4 thousands rupees and only 10% were earning 4-10 thousands per month. Seventy eight percent had poor diet and 22% had an average and no women were fit into the criteria for good diet. History of breast feeding was positive in 92% of the women. History of use of iron supplement was also asked, 28% had used various preparations of iron and folate for a variable period from 1-4 months, 72% never used hematinic supplements. History of previous blood transfusion during pregnancy and labour was present in 16% of the women. Three percent had fetal growth retardation. Prevalence of anemia during 3rd trimester of pregnancy in is high our society. It can have significant effects on maternal and fetal out come. It is a preventable cause which can be treated easily. Poverty and lack of education are the most important causes of anemia during pregnancy

Frequency of morbid adherence of placenta

To determine the frequency, causes and outcome of patients with morbidly adherent placenta. Descriptive case series. The study was conducted at Gynae unit I Nishtar Hospital Multan from April 2011 to Oct 2011. One hundred patients with previous uterine operations; like caesarean section, myomectomy, hysterotomy or diagnostic curettage patients with placenta praevia or those patients with retained placenta removed with difficulty under anesthesia; were included in the study. All the primigravidas and cases with retained placenta due to uterine abnormalities were excluded. The admitted patients meeting the inclusion criteria were registered for the study after taking informed consent. Patients were clinically examined and appropriate investigations were done. All relevant information was recorded in a proforma especially designed for this study. All the data was entered and analysed through SPSS version 10. Only 6 patients out of 100 selected cases had morbidly adherent placenta, out of whom 4 were booked and 2 were unbooked. Five cases were between 25-30 years and one was 20 years of age. Their parity ranged from 1-6. Five patients had previous history of caesarean section. Placenta was found in lower uterine segment in 5 cases. One patient presented with preterm labour and one with antepartum haemorrhage. Post partum haemorrhage occurred in two cases. One patient was delivered vaginally and five had caesarean section. Three of the latter had placenta accreta, 2 had placenta percreta and one had placenta increta. Placenta was removed piecemeal followed by caesarean hystrectomy in 5 cases. In one case a conservative trial, followed by postpartum hysterctomy, was done. Blood transfusions were required in all cases ranging from 3-5 units. Duration of hospital stay was 5 - 10 days and maternal mortality was nil. Morbid adherence of placenta is an obstetrical emergency, which carries an increased risk of perinatal and maternal mortality and morbidity Antenatal care needs to be improved and morbid adherence of placenta should be diagnosed at the earliest possible time. Previous caesarean section and placenta previa in current pregnancy were the major risk factors observed in 5[83%] of the cases. Previous history of dilatation and curettage was present in 1[16.6%] case.

Saline Contrast Hysterosonography in Women with Abnormal Uterine Bleeding; A hospital based study

To assess the diagnostic accuracy of saline contrast hysterosonography in the evaluation of the uterine cavity in women complaining of abnormal uterine bleeding. Fifty patients with abnormal uterine bleeding presenting at Gynae Department, Nishtar Hospital Multan were selected. Saline contrast hysterosonography performed and results compared with the gold standard diagnostic hysteroscopy. Majority of the patients were between 31-40 years of age. 60.00% of the patients were P[5] or above. The sensitivity and specificity were 97.2% and 83.3% respectively. Saline contrast hysterosonography is accurate in the evaluation of the uterine cavity in Pre-and postmenopausal women suffering from abnormal uterine bleeding. The feasibility of saline contrast hysterosonography is high, although significantly better in pre-menopausal women compared with postmenopausal women. We conclude that saline contrast hysterosonography, in combination with an endometrium aspiration can become the standard diagnostic procedure in women with abnormal uterine bleeding