Labour induction at term; oral versus intravaginal Misoprostol

To compare oral misoprostol [100 ug] to vaginal misoprostol [25 uA] for cervical ripening and labor induction. Interventional study. The study was carried out at Lady Willingdon Hospital, Lahore, during August 2006 to January 2007. Fifty nine women with medical or obstetric indications for labor induction with undilated, uneffaced cervices were assigned randomly to receive 100 ug of oral or 25 ug of vaginal misoprostol every 4 hours for 24 hours. Intravenous oxytocin was then given using a standardized protocol. Among 59 subjects, 29 received oral and 30 received vaginal misoprostol. The mean interval from start of induction to delivery was 1240 + 845 minutes for orally treated women and 1381+802 minutes for vaginally treated women [P = .06]. More orally treated women delivered vaginally in 24 hours than vaginally treated women 17 versus 16 P= .14]. Twenty five women [86.2%] who received oral misoprostol delivered vaginally, compared with 26 women [86.7%] who received vaginal misoprostol [P = .07]. Oxytocin was given to 14 [49.6%] orally treated and 16[53.3%] vaginally treated subjects. More women in oral group had tachysystole, three compared with one [P = .06] and hyperstimulation. Frequencies of intrapartum complications and birth outcome were similar between groups. Oral misoprostol 100 ug and vaginal misoprostol 25 g were similarly effective for cervical ripening and labor induction. Oral administration was associated with trends toward higher likelihood of vaginal delivery and more uterine tachysystole

Assessment of tubal patency in infertile women: can hycosy be performed in place of Hysterosalpingography?

To determine the advantages and accuracy of hysterosalpingo-contrastsonography [HyCoSy] in the assessment of tubal patency with regards to conventional hysterosalpingography [HSG]. Interventional study. The study was conducted at Lady Willingdon Hospital Lahore. One year, from November 2003 to October 2004. Thirty infertile women were examined with hysterosalpingo-contrastsonography [HyCoSy] using air and saline as contrast medium. The results were compared with those obtained from conventional hysterosalpingography. [HSG]. Altogether 30 patients were included in the study. They were examined with both HyCoSy and conventional hysterosalpingo graphy [HSG] and the results were calculated. Of the patients investigated by salpingo-contrastsonography, 22 were found to have patent tubes whereas 8 were having blocked tubes. Unilaterality of bilaterality could not be detected by this method. Bilateral tubal patency was found by hysterosalpingography in 22 cases. Unilateral tubal patency was found in 5 cases. Bilateral tubal occlusion was detected in 3 cases using either technique. Sensitivity and specificity of HyCoSy was 90.9% and 89.4% respectively. Positive predictive value was 83.3% and negative predictive value was 55.55%. The outcome of the study shows that HyCoSy with combination of air and saline is cost effective, reliable and safe method and can replace conventional hystero salpingography as base line investigation of infertility on out patient basis

Dysfunctional uterine bleeding-association with bilateral tubal ligation?

To find an association between Dysfunctional uterine bleeding [DUB] and prior Bilateral tubal ligation [BTL]. Observational study. Unit II, Lady Willingdon Hospital, Lahore, from August to December 2006. Fifty two patients between the ages of 35 to 46 with abnormal uterine bleeding [AUB] were studied. Exclusion criteria included intrauterine device [IUD], evidence of pregnancy, leiomyoma or ovarian pathology on sonography, uterine size of greater than 10 cm, medical disorders and hormonal therapy. All patients were worked up for underlying cause of AUB, assessed for BTL and divided in two groups. Group A of 27 patients with previous history of BTL and Group B of 25 patients without previous history of BTL. In group A [with prior BTL], 22 patients [81%] had DUB as compared to 12 [48%] in group B [without prior BTL] and this difference was statistically significant [p<0.05]. In women undergoing diagnostic work up for AUB the likelihood of DUB being the underlying cause is greater if they have prior BTL

Causes postmenopausal bleeding in our population

To evaluate common causes of postmenopausal bleeding in our population. Observational Analytical study. Department of Obstetrics and Gynaecology unit II Lady Willingdon Hospital Lahore from June 2000 to May 2002. Hysteroscopically directed endometrial biopsies were taken from 100 cases of postmenopausal bleeding and were sent for histopathology. The data was collected with the help of Performa which was filled for every patient. In our part of world, Atrophic Endometrium is the commonest cause of Postmenopausal Bleeding [PMB]. Next common being Endometrial Hyperplasias. Out of malignant causes, Carcinoma Cervix is the commonest. Postmenopausal bleeding [PMB] should be taken seriously; no matter how less the bleeding is and malignant causes should be ruled out

Fine needle aspiration of unilocular ovarian cysts - a cytohistological correlation

To assess the diagnostic efficacy of Fine Needle Aspiration Cytology in differentiating neoplastic and non-neoplastic dysfunctional ovarian cysts - cytological findings to be verified with histology of excised cyst. In this prospective study fifty-three cases with unilocular nonseptate ovarian cystic masses,detected on ultrasound examination were subjected to ultrasound guided fine needle aspiration of the cyst contents at Department of Pathology, Allama Iqbal Medical College Lahore, from January 1999 - January 2000. Aspirated fluid was examined cytologicaly using Giemsa stain on the smears prepared from centrifuged deposit.The same cyst removed surgically was examined histologicaly and cytohistological correlation was carried out. In this series of 53 cases, histologically confirmed break up of various types of cysts was follicular cysts [n=25], leuteal cysts [n=6], serous cysts [n=15], mucous cysts [N=4] and Endometriotic cysts [n=3]. Non-diagnostic fine needle aspirate was obtained in 19/53 cases, majority being the follicular cysts. The cytohistological correlation revealed no false positive but 40% false negative results for follicular cysts on cytological examination of the aspirate. Hence the specificity and sensitivity for cytological diagnosis of follicular cyst was 100% and 60% respectively. For leuteal cysts, false positive and false negative results on cytological examination were 0% and 16.6% respectively with a specificity and sensitivity value of 100% and 83% respectively. For neoplastic serous cysts cytologically false positive and false negative diagnosis was 0% and 46.6% respectively with specificity and sensitivity of 100% and 53%. For mucinous cystadenomas sensitivity and specificity of cytological diagnosis was 100%. For endometriotic cysts a sensitivity of 67% and specificity of 100% was procured with cytological evaluation. Guided fine needle aspiration cytology may prove to be one of the most valuable and acceptable tools in the differential diagnosis of ovarian cystic lesions