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Background: Intrauterine device [IUD] insertion after cesarean section and vaginal delivery are practiced widely
Objective: To compare the frequency of expulsion of postpartum intrauterine contraceptive device between vaginal and caesarean delivery
Methodology: Study design: Descriptive case series. Place and duration: Department of Obstetrics and Gynaecology Sheikh Zayed Medical College, Rahim Yar Khan from 1st July to 31st December 2016. One hundred and thirty two patients fulfilling inclusion criteria were included this in cross sectional study. Sixty six patients delivering vaginally and sixty six delivering after Caesarean section underwent IUD insertion immediately after delivery and were followed after 6 weeks postnatal to determine expulsion. Data was entered and analyzed by using SPSS version 20
Results: The expulsion rate between two groups, showed that in vaginal delivery group expulsion of IUD occurred in 11 patients [16.6%] while in Cesarean group expulsion occurred in 2 patients[3%].[p=0.009]
Conclusion: Rate of IUD expulsion was significantly lower in group of women delivering by Cesarean section as compared to those delivering vaginally
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Background: Initiation of labour in cases when it is full term pregnancy has multiple options, before spontaneous onset for delivery of fetoplacental unit
Objective: To compare the efficacy of misoprostol with dinoprostone for the labour induction, in full term pregnancies
Methodology: Study Design: Randomized controlled trial. Setting: Department of Gynaecology and Obstetrics, Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan. Duration: 1st August 2011 to 31st January 2012. A total of 118 patients [59 in each group] were included in this study. Patients in group A were induced with 50 Mug misoprostol, vaginal tablet repeated at 4 hourly intervals with maximum of 3 doses. Patient in group B dinoprostone, vaginal pessary repeated as 6 hours interval or maximum of two doses. Ethical approval was sought from Institutional Review Board. Data was entered in and analyzed by suing SPSS version 11
Results: In group A and group-B mean age of the patients was 31.2 +/- 1.3 years and 31.9 +/- 1.8 years respectively. Mean induction to delivery time [hours] was low in misoprostol group than dinoprostone group. [11.90 +/- 6.46 vs 17.20 +/- 11.31]. [p=0.002]
Conclusion: This study showed that misoprostol was more effective for induction of labour in terms of duration of induction time than dinoprostone
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Background: Infertility poses a great impact on individuals personal and social life and sometimes is associated with many underlying diseases
Objective: To determine the frequency of pelvic inflammatory disease and tubal blockage in infertile women, as diagnosed on laparoscopy
Methodology: This cross sectional study was conducted on 200 cases over the period of 2 years from 1[st] January 2014 to 31[st] December 2015 at Department of Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan. The adult cases of fertile age, irrespective of primary or secondary infertility were included. These cases then underwent laparoscopy to assess for PID and transvesical methylene blue was injected to assess for tubal blockage. The data was entered SPSS version 19 and analyzed
Results: In this study, there were 200 infertile cases with mean age of 30.65+/-6.34 years and mean duration of infertility was 3+/-0.54 years. Primary infertility was seen in 159 [79.50%] and secondary in 41 [20.50%] cases. Out of 200 infertility cases, PID was seen in 43 [23.50%] while tubal blockage was seen in 85 [42.50%] cases. Regarding PID, there was no significant association with type of infertility or any age group with p value of 0.74 and 0.34 respectively. However, the cases with infertility more than 3 years had significant association with secondary infertility with p= 0.03. Similarly in cases with tubal blockage there was no association with any age group.[p= 0.92] However its association was significantly seen in primary infertility [p= 0.04] and with infertility less than 3 years.[p= 0.01]
Conclusion: In our study tubal blockage and PID was found among two third cases with female infertility. PID was significantly associated with infertility more than 3 years while tubal blockage revealed significant association with primary infertility and duration of infertility less than 3 years
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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
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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
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Background: Labour has challenging effects, on mother, with adequate hydration may have favorable effects
Objective: This study was carried out to determine the effect of intravenous fluids on the total duration of labour
Patients and Methods: This comparative cross sectional study was conducted in Obstetrics and Gynaecology department Unit-II, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from 1[st] April, 2013 to 30[th] September, 2013. A total of 63 women in true labour, gravida 2[nd] to 4 [th], age < 35 years, gestational age of 37 to 40wks, Hb% > 10g/dl with or without ruptured membranes were selected. These selected patients were randomly allocated in two groups. Group 1: oral fluid plus augmentation fluid. Group 2: Oral fluid plus intravenous fluid plus augmentation fluid. Confounders such as syntocinon dose and vomiting were controlled by stratification. Chi square test was used for comparing groups. Pearson correlation was used to corelate variables like duration of labour in hours and fluid intake in ml. Data was analyzed using SPSS version 16
Results: Mean age of the participants was 29 + 2.8 years, mean number of kids was 2 + 0.9, mean height in cm was 152 + 2.07, mean Hb% in gm/dl was 10.18 + 0.18, mean fluid in ml for augmentation was 284 + 43 ml with median of 250ml, mean amount of fluid in ml was 1814 + 1077 and a median of 1000ml. In fluid category of less than 2000ml, 42.9% have duration of labour 2000ml where 100% has duration of labour < 0.05]. It was noted that total fluid input was negatively corelated with duration of labour [r = 0.54] and it is significant at the 0.01 level. While controlling for syntocinon dose it was noted that increasing total amount of fluid intake of more than 2000ml has significant effect on reducing the duration of labour [P = 0.00]
Conclusion: Our study showed that adding intravenous fluids and so increasing hydration of labouring women has reduced total duration of labour
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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
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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
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To compare maternal and perinatal outcome in cases of PROM at term, following induction with vaginal misoprostol [P6E1] to shorten the duration of labour with those managed expectantly. Quasi Experimental study. The study was carried out in department of obstetrics and gynecology labour room unit-1, Bahawal Victoria Hospital, Bahawalpur. Term pregnancies [37-42 wks] with PROM and cephalic alive fetuses. Sixty patients with confirmed diagnosis of PROM were randomized into two groups i.e, A and B. Group A comprising 30 patients were induced with tab. Misoprostol 25 ug at 6 hrly interval max of four doses and group B was managed expectantly for 24 hrs followed by induction with intravenous oxytocin. Total duration of labour, mode of delivery, maternal infection rates and, APGAR score at 1 and 5 min. It was found that both groups had similar characteristics, but the misoprostol group had a significantly shortertime interval from PROM to delivery [18.9 vs 27.5 hours] i.e total duration of labour. Caesarean section rates were 20% in the misoprostol group and 30.7% in the other. There were no differences between them regarding fetal well being, complications during labour and delivery and neonatal or postpartum maternal morbidity. Within 24 hours, 44% of women had delivered in the expectant group against 73.3% in the misoprostol group. Immediate labour induction with misoprostol in cases of term PROM shortens the total duration of labour, and the time of maternal hospitalization without any maternal and perinatal outcomes disadvantages
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To compare the fetal outcome of elective cesarean section with elective vaginal birth for Term Breech presentation in terms of APGAR Score, Respiratory Distress Syndrome, Admission in Neonatology Unit and Neonatal mortality. Quasi experimental study. Department of Obstetrics and Gynaecololgy Bahawal Victoria Hospital, Bahawalpur. Total 120 cases were included in the study divided into two groups, each having 60 fulfilling the inclusion criteria. Group 'A' had those who delivered by planned cesarean and Group 'B' comprised those having planned vaginal delivery. It was found that neonatal mortality was 3.33 in vaginal and 0 in cesarean group. Mean APGAR Score at 1 and 5 minute was 8.47 and 9.53 in vaginal and 8.58 and 9.62 in cesarean group. RDS was more in cesarean [5] than vaginal group [1.6]. Admission in Neonatalogy Unit was more in vaginally delivered group [8.33] as compared to the cesarean section group [5]. Planned cesarean delivery in breech presentation at term is associated with a reduction in neonatal mortality and morbidity as compared to the planned vaginal birth
Asunto(s)
Humanos , Femenino , Cesárea , Parto Obstétrico/métodos , Resultado del Embarazo , Recién Nacido , Edad Gestacional , Mortalidad Infantil , Puntaje de ApgarRESUMEN
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
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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
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Background: Hypertension during pregnancy is a common medical condition worldwide, occurring in 12-22% of all pregnancies. In the developed world, the incidence of hypertension and the severity of its complications is reduced markedly, because of the effective and widespread antenatal care services. However, hypertension still remains one of leading cause of maternal morbidity and mortality in developing coutnries.
Objectives: To compare the efficacy and safety profile of hydralazine with glyceryl trinitrate [GTN] in women with severe pre-eclampsia and eclampsia
Patients and Method: This quasi experimental study was conducted in Department of Obstetrics and Gynecology, Sir, Ganga Ram Hospital Lahore, over a period of six months, from July 2006 to January 2007. A total of 100 patients were included in this study. 50 patients were given hydralazine and 50 patients received Nitroglycerine
Results: In groups A and B, mean age was 26.8 +/- 5.6and 25.4 +/- 4.8, respectively. In both groups, the systolic and diastolic blood pressures of patients were not significantly different from each other. Mean time needed to achieve effective blood pressure control in group A [hydralazine] was 31.0 +/- 13.9 minutes and in group B [GTN] was 23.+/- 20.3 minutes. Time interval between effective blood pressure control and new hypertensive crisis was significantly prolonged in group A [96.1 +/- 27.2 Vs 73.8 +/- 18.1, P < 0.05]
Conclusion: GTN takes less time for effective control of blood pressure than hydralazine and safety profile is comparable with hydralazine
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This case report describes combined intrauterine and intra-abdominal pregnancy. Case was presented in emergency where she delivered a dead macerated male baby. The abdominal pregnancy was diagnosed at Laparotomy done for 2nd twin. An alive female baby weighed 1800gm was delivered with good Apgar score. Both mother and baby were discharged on 7th post-operative day in good condition. Heterotop1c pregnancy at term is very rare only few cases have been reported
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To compare the effectiveness of Misoprostol with syntocinon in the prophylaxis of primary post partum haemorrhage during the management of 3rd stage of labour. Experimental study. Department of Obstetrics and Gynaecology Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Pregnant patient with term pregnancy in labour were admitted in labour room. After confirmation that the patient is in labour, they were randomly divided in two groups A and B with 50 patients in each group. 600 ug oral Misoprostol was given to patients in group A and 10 units I/V Syntocinon were given to patients in group B at the time of delivery of anterior shoulder of the baby. Amount of blood loss was observed and all the information were recorded and entered in predesigned proforma. Amongst the 100 pregnant patients the mean age was 28.86 + 2.94 and mean parity of patients was 3.94.57% of patients were presented with labour pains only and 27% presented with both labour pain and leaking liquor. In 59 patients duration of labour was between 2-12 hours. Total 9 patients develop PPH in both groups, three patients from Misoprostol group and six patients from syntocinon group. PPH was mild to moderate and settled down with other uterotonic drugs none of the patient required surgical intervention. Development of minor side effect was relatively high in Misoprostol group i.e. 10% such as nausea, vomiting while 4% in syntocinon group. Shivering and mild pyrexia was 12% in Misoprostol group while 5% in syntocinon group. In this study effectiveness of both syntocinon and Misoprostol has been found comparable Misoprostol being slightly more effective than syntocinon in managing 3rd stage of labour also prophylacticaly and it also has fewer minor side effects with no serious danger to life. It does not need skilled personnel for its use
Asunto(s)
Humanos , Femenino , Adulto , Misoprostol , Resultado del TratamientoRESUMEN
To know the frequency of NTD among total births in teaching Hospital Rahim Yar Khan and to know the possible causes of neural tube defects in area of Rahim Yar Khan. Prospective study. Department of Obstetrics and Gynaecology Sheikh Zayed Medical College/Hospital Rahim Yar Khan. One year from November 2006 to October 2007. All pregnant mothers were registered in the study but only those were selected who were diagnosed during pregnancy or after delivery as a case on NTD. Out of 6701 live births, a total of 52 cases were diagnosed at NTD. The information was collected by taking history along with ultrasound findings and biochemical tests. The incidence came out is 2-8/1000 live births. The maternal mean age was 28.9 years and more common in primigravida i.e. 33% and 30% were grand multigravida. 75.3% of women belonged to low income group, and were not taking proper balanced diet. 80% lived in Joint family and 96.2% females were house wives. 96% cases of NTD were detected by ultrasound at mean gestation of 21.66 wks. The most common NTD was anencephaly found in 67% of cases, spina bifida 29% and encephalocele was found only in 4% of cases. The male; female ratio was 2:3. 74% of women had Hb level less than 10 mg/dl and in 20 women the type of anaemia was macrocytic-hypochromic. Low socio-economic status, poverty and poor dietary habits may be factors for higher incidence of neural tube defects. Our study provides new data for the health care providers to improve health facilities and their utilization and iron and folic acid supplementation targeted to all women of child bearing age to prevent neural tube defects