Plasminogen activator inhibitor-1: is it a risk factor for recurrent miscarriage?

Background: About 50% cases of recurrent miscarriages are idiopathic. The association of fibrinolytic defects with recurrent pregnancy failure is a novel research avenue and was first recommended in early 1990s. High Plasminogen activator inhibitor-1 [PAI-1] levels are found to be associated with recurrent miscarriage in various studies. The association of Plasminogen activator inhibitor -1 with recurrent pregnancy loss and its various variables are detrermined

Methods: This study was conducted at Ziauddin University Hospital Karachi, from Feb 2014 to Nov 2014. All non pregnant and non-obese women with history of consecutive two or more miscarriages, with no co-morbid diseases, visiting a gynecologist were included. Studied variables included were age, BMI, no. of miscarriages, time of miscarriage and plasma PAI-1 levels. The data was expressed in terms of median and percentages with a confidence interval of 95%. Analysis was done on SPSS version 20

Results: The median age of females was found to be 27.34+/- 5.09 years. Out of seventy five females with history of recurrent miscarriages, [81.3%] [n=61] women had Plasma PAI-1 levels within normal range whereas [18.7%] [n=14] had value greater than normal. The median plasma PAI-1 was found to be 29.6+/-22.16 ng/ml

Conclusion: PAI-1 was not found to be a risk factor for recurrent miscarriages in a local population of Karachi. Furthermore, studies on a large sample size need to be undertaken to assess the role of PAI-1in our population

Fibroid uterus updates in treatment

Fibroids or leiomyoma of myometrium are the most common benign tumor in females. There are currently many modalities, both medical and surgical, for the management of fibroid in today's practice such that it is often confusing as to which treatment to apply to which patient. Fibroid patients often present with a variety of symptoms and demographic aspect. Therefore a single guideline is not sufficient to encompass the case management for a specific Fibroid patient. Similarly the incidence of uterine sarcoma in patients undergoing fibroid treatment is thought to be minimal, but there is a current debate whether this risk is underestimated. The novel approach towards fibroids has allowed greater extent of uterine preservation but at the cost of decreased direct histological access, hence resulting in delay of diagnosis, especially in the case where uterine sarcoma is a possibility. Therefore gynecologists have to face the clinical dilemma to diagnose accurately and choose the most suitable treatment from the vast array of options available for each patient. The purpose of this article is to reconsider the different methods of treatments available and apply the most tailored treatment in each patient. This is a platform to better counsel for fibroid patients and their management

Maternal and perinatal outcome in threatened miscarriage in first trimester

Objective: To see the consequences of first trimester threatened miscarriage on maternal and fetal outcomes

Study design: A prospective case-control study

Place and duration: Study conducted at Ziauddin University and Hospitals Karachi from 1st January 2012 to 31st January 2013

Methodology: 100 females attending the Antenatal clinic with threatened miscarriage who matched the selection criteria were included as cases.106 women without any history of threatened miscarriage were selected as controls. These patients were then followed to evaluate complications in later pregnancy

Results: Women with threatened miscarriage were more prone to be delivering prematurely, experience pre labour premature rupture of membranes and to deliver babies with intrauterinegrowth restriction as compared to those women without any bleeding. Women with first trimester threatened miscarriage had a statistically significant higher likelihood of Antepartum haemorrhage [18%] as compared to controls [4.6%] and were found to be significantly associated with Pregnancy induced hypertension and preeclampsia. Regarding fetal outcomes it was found that higher rates of perinatal mortality were found in females with 1[st] trimester bleeding and more babies with congenital anomalies were born to these women

Conclusion: Threatened miscarriage during first trimester of pregnancy is a predictor of increased incidence of adverse maternal and fetal outcomes

Trial of labor; success in women with previous caesarean section

To determine the frequency and types of vaginal delivery in women with previous one caesarean section and to observe the effect of women age on success of vaginal birth. A descriptive study was carried out in the department of obstetrics and gynecology, Ziauddin University Hospital Kemari campus Karachi from January 2011 to January 2013. 200 patients with previous one caesarean section for a non recurrent cause were included in the study after fulfilling the inclusion and exclusion criteria. The women selected were evaluated and counseled for trial of labor. The frequency and mode of vaginal delivery was recorded in cases of successful trial of labor and caesarean section was performed in case of failed trial of labor. Successful vaginal delivery was achieved in 67% of the patients and repeat emergency caesarean section was carried out in 33% of the patients. Leading indication for repeat caesarean section was failure to progress, fetal distress and scar tenderness. No maternal and fetal complication occurred. We also observed that patients of less than 30 years were more likely to have a successful vaginal delivery [82%] as compared to patients older than 30 years [18%]. The trial of labor should be encouraged with vigilant monitoring in patients with previous one Caesarean section and is a safe and successful option if carefully selected and monitored

Multiple uterine fibroids in an young adult

Uterine leiomyoma's are noncancerous growths of the uterus1 and represent the most common benign tumors of the female reproductive tract. Fibroids affect 20-50% of women of reproductive age, while its presence in the adolescent population has not been well documented. The etiology of uterine fibroids is unclear; however, their growth is regulated by ovarian steroids, and growth factors. Multiple uterine leiomyoma's represents a great challenge for diagnosis and therapy. Several new therapies show promise, but are still at the experimental stage 2. This report illustrates the case of a 22 year old woman presenting to the gynecology department with an 8-month history of progressively increasing abdominal size associated with pain. There was no history of nausea, vomiting, weight loss, loss of appetite or menstrual irregularities. Physical examination and ultrasound pelvis suggested multiple enlarged uterine fibroids. A myomectomy was performed and multiple fibroids were resected weighing 4.5kg. The patient's postoperative evolution was uneventful and she was discharged from the hospital on the fourth postoperative day