Paraurethral leiomyoma

Vaginal leiomyoma is a rare solid tumour with a variable presentation that can lead to pre-operative misdiagnosis. Local recurrence and transformation into sarcoma are also rare and surgical excision is recommended. Here, we present the case of a 23-year-old woman with a painless vaginal mass associated with severe dyspareunia since marriage [2 months ago] and dysmenorrhoea. She underwent surgery by vaginal route and histological findings confirmed a leiomyoma. After 2 months, the patient was disease-free and symptoms disappeared

Degenerative uterine fibroid in a pregnant patient

Uterine leiomyomas are the frequently found benign solid tumours of the female genital system, which usually develops 20-50% of all women between the ages of 30 and 50. Here we present the case of a 40 years old lady gravida 8 para 7+0 at 24 weeks of gestation with anterior wall uterine fibroid with complain of spotting and leaking per vagina. She expelled dead fetus 800 gm, the placenta was removed under general anaesthesia in pieces. It seems to be submucous degenerated fibroid. Histological finding confirmed the diagnosis. After few months she was admitted for hysterectomy due to menorrhagia and passage of clots. Ultimate treatment of fibroid is surgery

Placenta previa; etiology and fetomaternal outcome

To analyze the causative factors and short term complications in cases of placenta previa. A retrospective study carried out in Obstetrics and Gynecology Department of Sheikh Zayed Post Graduate Institute Lahore. From June 2004 to June 2007. Fifty patients with placenta previa. Main outcome measures: Age, parity, previous cesarean section, previous history of evacuation/myomectomy, average hospital stay, need for blood transfusions, emergency/elective LSCS, associated maternal and fetal morbidity and mortality. There were 50 cases of placenta previa over the period of 3 years. Most frequently occurring intra operative complication was postpartum hemorrhage in 19 patients [38%]. Highest morbidity was due to anemia which was in 23 patients [46%]. Maternal mortality was 2%, while neonatal mortality was 14%. Placenta previa is a multifactorial disease. No doubt that the rising incidence of cesarean section is increasing the intraoperative complication associated with the condition but other risk factors are also important like age, parity, history of evacuation etc

Post menopausal bleeding

To find out the causes of postmenopausal bleeding and their correlation with medical illness. Single centre, cross sectional study. The department of obstetrics and gynaecology, Shaikh Zayed Postgraduate Medical Institute and hospital, Lahore from 1[st] August 2000 to 30[th] June 2002. All the patients with post menopausal bleeding diagnosed during the study periods were included, except patients after hysterectomy and premature menopause. Relative informations were filled in a Performa and informations were taken from case records. Total 50 patients were included in the study. Maximum number of patients with postmenopausal bleeding were between 56-60 years [32%]. Most of the patients were having parity between 4-6 [48%]. Majority of patients [32%] had symptom about 10 years after menopause. Hypertension, diabetes and obesity were commonly found medical illness in these patients, especially when cause is endometrial carcinoma, ultrasound scan, Pap smear and endometrial biopsy are essential to rule out cause of post menopausal bleeding. 70% patients were having benign cause while 30% patients had malignant cause for post menopausal bleeding. Carcinoma of genital tract is one of the most important cause of postmenopausal bleeding, so early detection of the cases can be life saving. Detailed medical evaluation, aid of ultrasonography, Pap smear and endometrial biopsy is required to find the cause of postmenopausal bleeding

Abdominal versus vaginal hysterectomy; an audit

To evaluate abdominal versus vaginal hysterectomy in relation to operative and postoperative complications. Single centre cross sectional study. Place and duration: The Department of Obstetric and Gynaecology, Shaikh Zayed post graduate Medical institute and Hospital, Lahore from 1[st] November 2005 to 31[st] October 2006. All the patients with benign indications for hysterectomy [abdominal and vaginal] were included except patients with serious / complicated medical disease. Relative informations were filled in a Performa and informations were taken from case records. This audit report included 200 women. 23.3% patients of vaginal hysterectomy were in the age group of 40-45 years while 35.7%patients of abdominal hysterectomy were in the age of 51 -55 years. Main indication for abdominal hysterectomy [85.5%] was fibroid uterus while for vaginal hysterectomy [66.6%] was uterovaginal prolapse. Most common immediate post operative complication in abdominal and vaginal hysterectomy was fever in 42.8% and 20.0% respectively. Intraoperative visceral injuries were done in 4 patients in abdominal hysterectomy while no injury was done in vaginal hysterectomy. 44[80%] patients of vaginal hysterectomy were discharged within 7 days of hospitalization while 64 [44%] patients of abdominal hysterectomy were discharged within 7 days of hospitalization. Hysterectomy either abdominal or vaginal is very safe and there were no lethal complication except few minor complications and also there was no mortality

Intrauterine growth retardation in pregnancy associated with hypertensive disorders

A prospective study was carried-out in 1995, to know the prevalence of intrauterine growth retardation with associated risk factor of hypertension and their outcome. Total of 1642 antinatal patients delivered. Out of these 100 patients were diagnosed as cases of IUGR, while, 48 of these had associated hypertension. Twenty-three patients were delivered pre-maturely and 25 patients delivered at term. Ninteen patients were delivered vaginally, 6 cases with elective and 23 with emergency caesarean section. Twenty-two babies weighed between 2-2.5 Kg., 19 were between 1.5-2 Kg. and 7 weighed less than 1.5 Kg

Cervical Incompetence: a cause of recurrent abortion

A prospective study was carried-out in 1996, to find out the prevalence of cervical incompetence in pregnant patients coming to outpatient department and emergency and the effectiveness of cervical cerclage applied to the cases of documented cervical incompetence. Total No. of patients included were 1506. Out of them 19 [1.26-%] patients presented with cervical incompetence. Eight presented with advanced cervical effacement and dilatation, they subsequently expelled their babies, 5 patients had some degree of dilatation ranging from 1 - 3cm and 6 were diagnosed on ultrasound after clinical suspicion. So 11 patients were applied McDonald's stitch; at the gestational age of 15 -20 weeks in 7 patients and 26 - 28 weeks in 4 patients. The mean interval to delivery in the group with no cervical dilatation was 20 weeks, whereas, in cases of cervical dilatation it was 2-11 weeks. Complications were PROM [18%] premature contraction [9%], cervical laceration [9%] and cervical dystocia [9%]