Pattern of ovarian tumours in different age groups: in a gyneacological unit of a tertiary care hospital

To determine the frequency and pattern of ovarian tumours in different age groups in a unit of a tertiary level hospital. Retrospective study. Department of Obstetrics and Gynaecology [Unit-II] Liaquat University Hospital [LUH], Hyderabad, Sindh from January 2001 to December 2007. All cases of ovarian tumours with confirmed diagnosis on histopathological examination, managed in gynecological unit II from January 2001 to December 2007 were included in study. Medical case records and histopathological reports were reviewed. The patients with ovarian tumours were divided into three groups on bases of age at time of presentation. Data analysis included were frequency and percentage of histopathological pattern of ovarian tumours in different age groups. Over the study period of 7 years, the total gyneacological admissions in gynecological unit II were 17550, and 813 biopsies were studied in patients who presented with ovarian masses. Out of 813 boipsies, 602 were ovarian neoplasms on histopathological examination, giving a frequency of 3.4%. In relative frequency, 73.08% were benign, 22.75% were malignant and 4.15% were mixed ovarian tumours. Epithelial tumours were the most common type, followed by germ cell tumour and sex cord stromal tumours in all age groups. Mucinous adenocarcinoma was the most common malignant ovarian tumour, in reproductive and perimenopausal age group and germ cell tumour in very young women. Ovarian tumours can present at any age. In all age groups the most common ovarian tumours are epithelial. In younger age group the most common benign tumours are epithelial, and the most common malignant tumours are germ cell. The frequency of malignant and benign ovarian tumours was almost same in both reproductive and perimenopausal age groups, and the most common malignant tumour was mucinous adenocarcinoma.

Identification of the barriers in seeking definite treatment by patients with genitourinary fistulae

To identify the barriers in seeking definite treatment among the patients with urinary fistulae. Department of Obstetric and Gynaecology, Unit II of Liaquat University of Medical and Health Sciences Jamshoro, Pakistan. From 1[st] January 2007 to 31[st] December 2011. All patients with confirmed urogenital fistulae were included in this cross sectional study by consecutive sampling. A pre designed proforma was used to collect the information about demographic features, causes, duration of fistulae, and reasons for delay in reaching for treatment. SPSS program version 10 was used to analyze the data in terms of frequency and percentage. During the study period there were 5013 gynecology based admissions. 232 of these [4.6% of gynecological admission] were registered cases of urogenital fistulae. After the exclusion of 26 recent cases of urinary fistulae; study was carried out on 206 patients. There were 113 cases of obstetrical fistulae while 93 cases were due to iatrogenic insult during gynecological surgeries. Majority [n=164, 77%] of patients were outside from Hyderabad city. The time lapse from symptoms to presentation at treatment centre was longer than one year in patients with obstetrical fistulae, but was shorter [three to six months] in patients with iatrogenic fistula. The main barrier in seeking early treatments in cases with obstetrical fistulae was lack of knowledge about availability of treatment and treatment centre [87.6%]. Financial constraints [55.7%] and lack of attention by family [42%] were the added barriers. Regarding iatrogenic fistulae, a gross neglect of the attending surgeon was obvious. Majority of the cases were misguided about the problem [n=69, 74%]. Misdiagnosis as a case of chronic vaginal discharge was seen in eleven patients. There is a need to disseminate the awareness particularly at community levels with support of media regarding genitourinary fistulae. Fistulae should not occur but if they do, efforts should be made to shorten the time of this terrifying illness

Assessment of efficacy and safety of manual vacuum aspiration [MVA]

Objective: To assess the efficacy of manual vacuum aspiration [MVA] in term of complete uterine evacuation of product of conception. Secondary end point was to assess safety of procedure

Study Design: Retrospective descriptive study

Place and Duration: Department of Obstetrics and Gynecology, Unit-II Liaquat University Hospital Hyderabad Sindh from 15[th] October 2008 to 14[th] September 2009. PATIENT and METHOD: A retrospective review medical records of patients who underwent MVA was carried out. Primary out come measures were efficacy and secondary out come measures were to assess prevalence of complications

Results: During study period 146 patients underwent surgical management for early pregnancy demise, incomplete miscarriage, retained product of conception after full term pregnancy. Out of 146, 112 patients were scheduled to undergo MVA. Efficacy of procedure was 88.18% [97/110]. Incomplete uterine evacuation was seen in 11 patients [9.82%], while 2 patients started to bleed heavily and shifted in Operation Theater in emergency

Conclusion: MVA was introduced in Liaquat University of Medical and Health Science [LUMHS] for last 1 year. It is effective, cheap and should be considered to avoid prolonged hospital stay and cost

Risk factors, clinical presentation and management of 62 cases of ectopic pregnancy at tertiary care center

Objective: to observe the risk factors, clinical pattern and management of ectopic pregnancy

Design: descriptive observational study

Place and duration: gynecological Unit II, Liaquat University of Medical and Health Sciences, Hyderabad from January 1st 2006 to April 1st 2008

Patients and methods: all patients with confirmed diagnosis of ectopic pregnancy were included in the study. A pre-formed proforma was used to record the details about the demographic features, pre-existing risk factors for ectopic pregnancy, clinical features at presentation, management and findings at surgery. Data fed to SPSS program version 11 to analyses the results in terms of frequency and percentages

Results: total maternity admissions were 8016 with 62 cases of ectopic pregnancy giving an incidence of 0.8% or 1:129. Mean age was 24 years. Majority of the patients were of low parity [n=34, 54.8%]. Pelvic inflammatory disease [n=22, 35.4%], previous abdominal pelvic surgery [n=16, 26%], previous ectopic [n=4, 6.4%] and infertility [n=22, 35.4%] were seen as the major risk factors. Regarding the clinical pattern; abdominal pain, amenorrhea and collapse appeared as the common clinical presentations. All patients required surgery. Open laparotomy was performed in 56 [90.3%] cases while 6 [9.7%] patients managed laparoscopically. None of the patients found suitable for conservative or medical management. There was no maternal death related to ectopic pregnancy and the postoperative recovery was uneventful

Conclusion: the classic clinical pattern of amenorrhea and abdominal pain was lacking in most of the cases with ectopic pregnancy and there were initial diagnostic difficulties. Pelvic inflammatory disease and history of infertility were the main risk factors. Due to the delay in making diagnosis at early stage, open surgery was required in all cases. This emphasizes the importance of a thorough clinical evaluation and appropriate investigations for patients with high suspicious to benefit our poor patients by the use of recent therapeutic modalities

Maternal mortality and morbidity due to induced abortion in Hyderabad

To determine the maternal mortality and morbidity due to induced abortion in our set up. Descriptive case series. Department of Obstetrics and Gynaecology [Unit-III] Liaquat University Hospital Hyderabad, Sindh from July 2001 to July 2004. Medical records of patients with complications of termination of pregnancy were analyzed retrospectively. All patients with history of induced abortion who presented within 40 days of termination of unwanted pregnancy were included in study. Patients with habitual or spontaneous abortion or who were admitted after 40 days of induced abortion were excluded. During study period, total admissions in this unit were 3015. Among these, 498 patients presented with different types of abortion. Of these 498 patients, 32[6.42%] presented with history of complication of induced abortion and were included in study. Among these cases, 21[65.6%] patients were in age group 20-40 years; 9[28.12%] below 20 years and 2 [6.25%] above 40 years. Nine [28.12%] patients were primigravidae, 4[12.5%] multipara while 19 [59.37%] were grand multipara. Twenty-four [75%] patients were admitted with sepsis, 5[15.62%] with visceral injury and 3[9.37%] with haemorrhage. Ten [31.25%] patients underwent hysterectomy due to septic perforated uterus while 7[21.87%] patients expired due to complications of induced abortion. Induced abortion for termination of unwanted pregnancy is a major cause of maternal morbidity and mortality in our set up