Efficacy of single rod contraceptive implanon

Objective: to evaluate the efficacy of implanon in women in postpartum period

Material and Methods: the Study was carried out in one year period from 01-01-14 till [31-12- 14, in Gynae Unit-II, Services Institute of Medical Services /Services Hospital Lahore· Women recruited were within three days after child birth. First f9llowup was advised after one week and then at six weeks

Results: total 152 patients had implanon insertion in one year period. Total births were 3502, caesarean section 1804 and spontaneous vaginal delivery 1698. Among side effects 1rregular bleeding in 37 [24.3%] patients, expulsion 7 [4.6%], weight gain 12 [7.8%], mood changes 15 [9.8%] and no pregnancy occurred in one year follow up

Conclusion: implanon demonstrated excellent contraceptive efficacy and was well tolerated

Safety and acceptability of postpartum intrauterine contraceptive device [PPIUCD]

Objective: to evaluate the safety and acceptability of immediate postpartum insertion of IUCD in women delivering vaginally or by caesarean section in a tertiary care facility

Material and Methods: the study was carried out between 1st Oct 2013 and 31st March 2014. Women recruited had Cu T 380A insertion within 10 minutes of delivery vaginally or by caesarean section. Women having postpartum hemorrhage, anemia, prelabour rupture of membranes greater than 18hrs, obstructed labour and distorted uterine cavity by fibroid or malformation were excluded. Counseling was done in antenatal period and early labour. Those who refused for insertion were also excluded. Women were followed for six weeks after delivery

Results: total of 950 patients was enrolled in the study. 530 were delivered spontaneously while 930 underwent caesarean section [C/S]. PPIUCD insertion was done in 145 women, SVD 71 and C/S 74. Among the side effects, bleed ng problems occurred in 7.5% patients, infection in 1.3% patients and lost string was seen in 4.8 % patients. There was no expulsion or perforation in any patient

Conclusion: benefit of providing highly effective contraception immediately after delivery outweighs the disadvantage in country where women have limited access to medical care. Awareness of PPIUCD is low in community that leads to its low appetence

Internal iliac artery ligation· lifesaving procedure in massive postpartum hemorrhage

Objective: to study the role of bilateral internal iliac ligation in arresting postpartum Hemorrhage

Material and Methods: the study was carried out from 1st July 2012 to 30th June 2014 in the department of Obstetrics and Gynecology unit 11, Services Institute of Medical Sciences / Services Hospital Lahore. Total births were 4496 in the duration of two years. Out of them 3366 were caesarean section and 1130 were spontaneous vaginal deliveries. Total massive postpartum hemorrhage that is blood loss > 1 liter was in 46 patients. Internal iliac ligation was carried out in fifteen patients. In all these patients they were failed medical treatment. Even after B-Lynch suture and abdominal hysterectomy bleeding did not stop

Results: total patients enrolled in the study were fifteen. Two [13%] patients were primigravida in which uterus was saved and bilateral internal iliac ligation was done due to uterine atony. In five [33%] patients due to uterine rupture and in eight [53%] patients due to morbidly adherent placenta there was massive hemorrhage and bilateral internal iliac ligation was done. In thirteen [86%] patient's total abdominal hysterectomy was done along bilateral internal iliac ligation. In five [33%] patients packs were inserted after ligation at bladder base in case of morbidly adherent placenta. Packs were removed after 48 hours in second laparotomy. All the patients were saved and discharged in satisfactory condition except one who already came with disseminated intracoagulation disorder. Among complications in three [20%] patients there was injury to bladder that was stitched and in seven [46%] patients there was wound infection

Conclusion: early resort of bilateral internal iliac ligation effectively prevents hysterectomy in women with atonic uterus and in uterine rupture and morbidly adherent placenta it saves the life if done on time

Study of ovarian tumor in young girls

To analyze various clinical presentation and the surgical management of ovarian pathology in young girls ranges from 15-25 years. Case series. Gynae Department 1, Lahore General Hospital Lahore. From January 2008 to December 2009. All young girls in the age group mentioned above having an ovarian pathology and managed during study period were included. Age of patients, presenting symptoms, USG findings, surgical management and finally histological diagnosis were noted. There were 20 cases with ovarian lesions. Most of patients presented at the age of 20-25 years [55%]. Mass abdomen seen in [30%] cases, followed by pain abdomen in [20%]. Lapratomy was done in most of cases and main aim was toward ovary sparing surgery as Cystectomy was done in [50%] cases and Oophorectomy was done in [30%] cases. 85% cases were benign on histology report and 15% were malignant. Ovarian tumors are rare in young age group. Benign lesions such as simple ovarian cysts are very common in this age. In young girls main interest is toward conservative and fertility sparing surgery

Feto-maternal outcome in booked and unbooked pregnant patients with cardiac disease

To compare feto-maternal outcome in pregnancy complicated by cardiac disease in booked and unbooked patients. Descriptive case series study carried out in the Department of Obstetrics and Gynaeeology, Unit I, Services Institute of Medical Sciences/Services Hospital, Lahore, from October 2007 to January 2008. 1629 deliveries were performed during the study period, 30 were cardiac patients [1.8%]. Out of these 17 [56.6%] were unbooked. 23 [77%] patients had valvular heart disease while 7 patients [23%] had congenital heart disease. 65% of unbooked patients had NYHA class 3 or 4, 61% of booked patients were of class 1 or 2. Among unhooked patients 41% suffered from cardiac failure and pulmonary edema and 17% of these patients required ICU admission. Prematurity was five times more in unhooked cardiac patients [29% vs 7.6%]. In unbooked group 82% neonates weighed less than 2.5 kg. The cumulative neonatal complications were higher in unbooked group. Antenatal care and management of cardiac disease reduces the serious consequences of maternal cardiac disease and improve feto-maternal outcome

Frequency of impaired glucose tolerance in polycystic ovarian disease

Objectives: The study aims to assess the frequency of impaired glucose tolerance [IGT] in women with polycystic ovarian disease [PCOD]

Place and Duration: Department of Obstetrics and Gynaecology, Unit-II, Services Hospital, Lahore, for a period of one year, from 01.07.2001-30.06.2002

Patients and Methods: The study included 50 patients of polycystic ovarian disease, diagnosed by ultrasonography. These patients were advised 75g oral glucose tolerance test

Results: The frequency of impaired glucose tolerance in diagnosed patients of polycystic ovarian disease was 20%. PCOD patients with abnormalities in glucose metabolism had a greater body mass index, higher fasting glucose and 2 hours post-load glucose levels than those with normal glucose tolerance. Frequency of unpaired glucose tolerance in diagnosed patients of polycystic ovarian disease is 20%

Trends of delivery in patients with previous one caesarean section

Objective of the study was to monitor the mode of delivery in patients with previous one Caesarean section. This study was carried out at Services hospital on five hundred patients with previous one Caesarean section [CS] over a period of ten months. Out of 500 patients 211 had repeat elective Caesarean section, while 289 were selected for trial of labor. Out of these patients two thirds achieved vaginal delivery [VBAC]. The overall Caesarean section rate was 57.6% and VBAC rate was 42.4%. It was thus concluded that repeat Caesarean section could be avoided in well selected patients with low morbidity

Cause of bleeding in early pregnancy

One hundred and eighteen consecutive patients who presented with bleeding per vaginum in early pregnancy were evaluated. Abortion related bleeding was present in one hundred patients, ectopic pregnancy was the cause in fifteen, molar pregnancy in one and local incidental causes were diagnosed in two women. Seventy-eight patients had evacuation of uterus. Of those diagnosed having ectopic pregnancy, nine [60%] required straightaway laparotomy and six [40%] underwent laparoscopy [40%] for confirmation of diagnosis. In the two patients with local causes pap smear revealed no abnormality and conservative management was opted