Post-placental intrauterine contraceptive device at cesarean section

Objective: the objective of this study is to determine the efficacy of immediate post placental insertion of intrauterine contraceptive device [PPIUCD] at cesarean section in terms of expulsion and continuation

Study design: descriptive case study

Place and Duration of Study: department of obstetrics and gynecology, PMC and affiliated hospitals Faisalabad from 06/12/2012 to 05/06/2013

Material and Methods: a total of 146 patients were included in my study. The copper intrauterine contraceptive device [IUD] was placed at the time of cesarean section immediately after the delivery of placenta. Final outcome was observed at the end of six months at follow up visit and efficacy was labeled as per operational definition

Results: mean age of patients was 26.6+_4.5 years. Out of 146 patients, 98 [67.1%] patients were Para 1-3 and 48 [32.9%] were Para 4-6. At the end of six months expulsion of IUD were seen in 18 [12.3%] patients and 123 [84.2%] patients were willing to continue this method of contraception

Conclusion: immediate transecaesarean section PPIUCD is a safe, effective and acceptable method of contraception and should be offered to women undergoing cesarean section who are desirous of contraception

Facial abuse of topical steroids and fairness creams: a clinical study of 200 patients

To estimate the magnitude of problem with reference to social demography, motivation and to record adverse effects of topical steroids [TCs] and fairness creams abuse on face. This study was conducted at Dermatology Department of Nawaz Sharif Social Security Teaching Hospital affiliated with University of Lahore. Patients with steroidal rosacea reporting to the investigator were asked about their current use of topical steroids and fairness creams and observations recorded. Out of 200 patients studied 152 [76%] were females and 48 [24%] males, the majority belonging to low income group from urban area. Sixty six [33%] patients used potent TCs, 100 [50%] patients used TCs in combination with various fairness creams and 34 [17%] patients used fairness creams exclusively. The main indications for these creams, in order of preference were acne, improving dark complexion and melasma. Patients were ignorant of the ingredients and the adverse effects of TCs versus fairness creams among abusers were comparable. Unwarranted cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea.

Prevention of fall in platelet count by carica papaya leaf juice in carboplatin induced thrombocytopaenia in mice

There are no effective methods to treat thrombocytopenia once it occurs. Transfusions, growth factor injections and bone maiTow transplant have their limitations. So there is increased need for research of drugs that could prevent and treat thrombocytopenia. The objective the study to deter-mine the effect of different doses of male and female papaya leaf juice on prevention of carboplatin induced thrombocytopenia in mice. A total of 55 Swiss albino mice were randomly divided into five groups [C, M[10], M[5], F[10] and /y. Thrombocytopaenia was induced in all groups by a single intraperitoneal injection of carboplatin. Male papaya leaf juice was given to prevent of thrombocy topaenia to groups M[w] and M[5] and female papaya leaf juice was given to F[w] and F[5]. On days o, 7,14 and 21 blood samples were collected by cardiac puncture for platelet count. Significance of difference was calculated by one wayANOVA. After carboplatin injection, platelet count decreased. Papaya leaf juice prevented fall in platelet count throughout the study period with p-value < 0.001. Difference between male and female papaya leaf juice was not significant while higher dose [10 ml/kg] produced significantly higher responses as compared to low dose [5 ml/kg]. Papaya leaf juice prevents reversible thrombocytopaenia induced by carboplatin in a dose dependent manner. There is no difference between male and female plants in this respect

Risky grand multiparas

Grandmultiparity has long been classified as constituting a high risk factor in pregnancy. The complications associated with grandmultiparity have been divided into ante-partum, intra-partum and the postpartum. Intrapartum complications most commonly thought to be associated with grandmultiparity are malpresentations, placental disorders, postpartum hemorrhage and uterine rupture. Concerted effort should be instituted for effective family planning initiatives and specialized antepartum and intrapartum management

Objective: To determine the frequency of intrapartum complications and mode of delivery in grandmultipara

Material and Methods: It is descriptive case series study conducted in department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad from March 11, 2010 to September 10, 2010

Results: Grandmultipara women who fulfilled the inclusion criteria were studied for intrapartum complications and mode of deliveries. One hundred and thirty nine patients were included in my study. Mean age of the patients was 32.38 years. Mean gestational age for delivery was 37.06 weeks. Grandmultiparas had more intrapartum complications including malpresentation [19.4%], placental abruption [5.8%], placenta previa [8.6%], postpartum hemorrhage [6.5%] and ruptured uterus [1.4%]. Mode of delivery was also assessed and 59%, 7.9 %, 31.7% of patients had normal vaginal delivery, instrumental vaginal delivery and cesarean section respectively

Conclusions: It is concluded that in the developing countries the incidence of grandmultiparity is still high with a significantly increased risk of complications. Grandmultiparity should be considered high risk and needs active intervention by improving literacy, health care facilities, provision of safe and effective contraception and reproductive health status

PROM; expectant vs active management

PROM is not uncommon in pregnancy. It occurs in 10% of term pregnancies. At term about 75% of women will go into labour within 24 hours of rupture of membranes. At term there are two options, either wait for spontaneous onset of labour or immediate induction to establish labour. For induction of labour different kinds of drugs are used according to Bishop score. If Bishop score is favorable [>/= 6], oxytocin can be used. It decreases the risk of chorioamnionitis and is more satisfying for mother. To compare the immediate induction with expectant management in PROM at term with favorable cervix in terms of frequency of caesarean section. This prospective randomized controlled trial was conducted in the department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad from 1st June to 30th November 2010. One hundred and twenty pregnant ladies were randomly divided into two equal groups. Odd numbers were placed in group 1 who were given expectant management for 24 hours for spontaneous onset of labour. Even numbers were placed in group 2, who were started immediate induction with oxytocin infusion. In my study overall age was 25.64 +/- 2.98. In expectant group mean age was 25.18 +/- 3.21 and in induction group mean age was 26.10 +/- 2.69. The rate of c-section in immediate induction group was 8.3% while in expectant group it was 11.6%. In my study there was no significant difference regarding rate of c-section in both groups [p= 0.543]. Both expectant and immediate inductions are common management options in women with PROM, but immediate induction was favorable approach for both mother and fetus. The later was more satisfying for mother and decreased risk of maternal and neonatal infection

Maternal mortality: an ice berg one year review at DHQ Hospital, Faisalabad

Objectives: To find out the major causes of maternal death and determine the maternal mortality ratio

Study Design: A Descriptive study

Setting: This study was carried out at Gynae and Obst. Unit-II DHQ Hospital Faisalabad from Jan-2011 to Dec-2011 [I year study]

Material and methods: All maternal death during pregnancy, labour and perpeurium were included. The data regarding age, parity, booking status, gestational age, risk factors, cause of death and distance from hospital was recorded on a proforma. The data was analyzed and was presented as frequencies and percentages

Results: The maternal mortality ratio was 412/100,000 live births during the period of one year. The most common cause of maternal death was hemorrhage 51.6% [16] followed by hypertensive disorders [22.5%]. The othercauses were septicemia 3.2% [1] thromboembolic disease 3.2% [1], cardiac disease 6.5% [2], anaemia 6.5% [2] and anaesthetic complications were seen in 9.7% [3] patients

Conclusion: Health care by skilled professionals before during and after child birth can save the lives of women and their babies. Antenatal care by skilled health worker, educating the community, appropriate referral system, provision of fast and reliable transport facilities, availability of emergency obstetric care [EMOC], regular emergency drills and reduction in rate of caesarean section to decrease the risk of placenta accreta and uterine rupture, and finally establishing comprehensive nationwide system to collect and analyze data of maternal death are the key steps towards decreasing maternal mortality

Morbidity with placenta previa

Introduction: Placenta previa is a rare obstetric catastrophe associated with high maternal morbidity and mortality. This condition is multifactorial and can lead to life threatening conditions like postpartum hemorrhage, obstetrical hysterectomy and placenta accreta. A concerted effort should be made towards careful evaluation, timely delivery and provision of skillful management to reduce the associated morbidity. In low socio-economic background and poor settings, these complications may even lead to maternal death

Objective: To determine the frequency of maternal morbidity in placenta previa in terms of placenta accreta, obstretical hysterectomy and postpartum hemorrhage in patients with placenta previa

Study Design: It is a descriptive case series study

Setting: Department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad

Duration of Study with dates: The study was carried out over a period of six months from 01-04-2011 to 01-10-2011

Subjects and Methods: A total 215 cases were included in the study. The patients with diagnosed placenta previa or those with painless vaginal bleeding subsequently diagnosed on ultrasonography to have placenta previa were included in the study. Majority of patients were delivered by caesarean section. Active management of third stage was done to prevent primary postpartum haemorrhage [PPH]. In cases of PPH, conservative management was done first in the form of intramuscular syntometrine [Oxytocin 5 IU/ergometrine 0.5mg] and intravenous infusion of syntocinon [40 IU in 500ml 0.9% saline over 4-6 hours]. In cases of failed medical management of PPH and morbidly adherent placenta [placenta accreta] obstretical hysterectomy was carried out

Results: Mean age of the patients was 28.14 +/- 5.57 years. Distribution of cases by gestational age shows that the majority of patients 147 [68.36%] were between 32-37 weeks of gestation and 25[11.62%] patients were <32 weeks while 43 [20%] were >37 weeks. Mean gestational age was 34.60 +/- 2.95 weeks. Parity distribution was as follows: 31 [14.40%] patients had parity 0-3, 89 [41.39%] patients had parity 4-6 and 95 [44.18%] had parity > 6 with mean parity of 5.46 +/- 1.82. Postpartum hemorrhage developed in 61[28.4%] of patients. Placenta accreta was present in 18 [8.37%] patients. Obstetrical hysterectomy was done in 13 [6.04%] of patients and none of the patients expired

Conclusion: Placenta previa usually leads to life threatening complications. Close attention should be paid to massive hemorrhage. Adequate blood transfusions and prompt intervention to deliver by cesarean section and anticipating the risk of placenta accreta and necessity of obstetrical hysterectomy can reduce the maternal morbidity

comparison of effectiveness of hydrostatic membrane sweeping with intracervical foley's catheter ballooning alone in pre induction cervical ripening

Induction of labor is a keystone in modern obstetricpractice and a safe procedure. The success ofinduction, however depends upon whether thecervix is ripe or unripe. Hydrostatic membranesweeping is a better option as this is more effectiveand can be used in situations where pharmacologicalmethods are contraindicated

Study design:Randomised clinical trial

Place and duration:Department of obstetrics and gynaecology unit II,Punjab Medical College and affiliated hospitals,Faisalabad from 15-12-2008 to 15-6-2009

Subjectsand methodology: 260 Patients each in group Aand B were randomly assigned for cervical ripeningby Foley's catheter ballooning alone [foley] andhydrostatic membrane sweeping [HMS] methodrespectively. The patients were reassessed at thetime of spontaneous expulsion of the catheter or atthe onset of effective uterine contractions or after 18hours of insertion. Amniotomy was done andsyntocinon infusion was started at this point. Theimprovement in Bishop score and mode of deliverywere studied

Results: 260 patients were allocatedeach in Group A and B. Improved Bishop score [>8]was achieved in 67.3% [175/260] of patients inGroup A and 76% [197/260] of patients in Group B.Out of 260 patients in Group A 70% [182] hadvaginal delivery and 30% [78] were delivered bycaesarean section. In Group B, out of 260 patients,78% [203] delivered vaginally and 22% [57] bycaesarean section. P value was 0.036

Conclusion:Both Foley's catheter ballooning and hydrostaticmembrane sweeping are effective methods ofcervical ripening however the later was moreeffective for improvement in Bishop Score and inachieving vaginal delivery

To study the effects of simvastatin on lipid profile in obese patients with changing lifestyle

Simvastatin is a competitive inhibitor of HMG-CoA [3-hydroxy 3-Methyl glutaryl Coenzyme A] reductase. Present study proposed that the lipid lowering effect of simvastatin may be enhanced, if it was taken with fat free diet and morning walk. Cross Sectional Study. This study was conducted at Fatima Jinnah Medical College, Lahore for a period of six months from December 2009 to May 2010. 20 male and 20 female obese patients were selected. The obese patients were re-examined three times i.e. before giving the simvastatin, then after 6 and 12 weeks. The patients were advised to take fat free diet and a morning walk. Serum Cholesterol, serum Triglycerides and serum Lipoprotiens [HDL, LDL] were determined. This study shows that with use of simvastatin, serum cholesterol, serum triglycerides, and serum LDL-Cholesterol was reduced significantly and serum HDL-Cholesterol increased significantly in both sexes. It was also observed that the fat free diet and some exercise causes weight reduction. It is therefore concluded that simvastatin shows significant lipid lowering effects augment process of body weight reduction, if patients used calorie restricted diet with some morning walk

effect of crataegus [hawthorn] extract alone and in combination with simvastatin on serum lipid profile in hyperlipidemic albino rats

Cardiovascular diseases are the most common causes of death in first world countries. Hyperlipidemia is one of the high risk factors for cardiovascular diseases. Crataegus monogyna has acquired an eminent position in remedies for hyperlipidemia. Study Design: It is a case-controlled interventional study of eight weeks' duration. Sample: 100 adult male albino rats weighing about 250-300g divided randomly into five groups A, B, C, D and E. Crataegus is as effective in lowering cholesterol as simvastatin. However, when compared with combination of Crataegus and simvastatin, Crataegus alone was found to yield better results. Both of the drugs are equally effective in lowering triglycerides. HDL level significantly increases in all groups whereas LDL level decreases in groups C, D and E. However only group E was close to normal control group A. Crataegus shows tremendous potential as natural lipid lowering agent, devoid of side effects. In future there is scope in study and use of this 'miracle herb' as anti-hyperlipidemic agent

Asymptomatic bacteriuria among pregnant women

Objective: To determine the prevalence of asymptomatic bacteriuria [AB] during pregnancy

Study Design: Non interventional, cross sectional study

Place and Duration of Study: Department of Obst. and Gynae DHQ Hospital Faisalabad from May 2010 to July 2010

Materials And Methods: A total of 400 consecutive pregnant women were recruited for this study. All subjects were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into sterile container. The urine samples were examined microscopically and by cultural method

Socioeconomic Status and Education: Socioeconomic status is defined by key demographic and economic characteristics [reported in Government of Pakistan Economic Survey of Pakistan-2001-2, Islamabad, Ministry of Finance, June [2002].The most important variable describing and classifying SES was annual house hold income [US$<500 = Low, US$500-1000 = Middle]

Result: A total of 20 [5%] were positive for significant bacteriuria. Significant relationship was found between ASB with ages, parity and socioeconomic status. With regard to age, 5 [25%] women were below 25yrs 11[55%] between 25-35 and 4[20%] were above 35yrs. Regarding parity, 4[20%] were primigravida and 16[80%] were multigravida. As far as socioeconomic status is concerned 12 [60%] belong to low socioeconomic class and 8[40%] from middle. No significant relationship was determined between AB and gestational age and diabetes

Conclusion: Asymptomatic bacteriuria is not uncommon among antenatal patients. Routine urine cultural test should be carried out on all antenatal patients in order to identity any unsuspecting infection