Efficacy of cervical cerclage using McDonald's technique in preventing preterm births

To study the efficacy of cervical cerclage using McDonald's technique in prevention of preterm deliveries. Study Design: Quasi- experimental study. September 2008 to January, 2010 in CMH Mardan. Patients with singleton pregnancy having a history of one or more second trimester losses were selected on the basis of history, physical examination and ultrasound assessment of cervical length with a cut off of 2.5cm. Patients in advanced labor, fetal anomalies, polyhydramnios, or chorioamnionitis were excluded. Cervical cerclage using the McDonald's technique was applied at 14 - 22 weeks of gestation under general anesthesia and later removed after 37 completed weeks or when the patient went into labor. A total of 52 patients were included. The rate of term deliveries was 80.77% while preterm were 19.23%. The live baby rate was 96.15% with a neonatal morbidity of 3.85%. The average prolongation in the gestation was 20.34 weeks. Most of the patients delivered normally with minimal rate of complications. The use of cervical cerclage in patients with short cervices as assessed by examination and ulrasound scan is effective in preventing preterm births and prolonging gestations

Term prelabor rupture of membranes: management and outcome

To review the management of term prelabour rupture of membranes and its outcome. Interventional and descriptive. Military Hospital Rawalpindi from 10th June 2002 to 9th March 2003. 110 patients including both primigravidas and multigravidas with singleton pregnancy having term prelabour rupture of membranes were recruited by convenience sampling. They did not have any other complicating factor. They were managed according to their Bishop's score either expectantly or actively by inducing them. 64.54% of patients went into spontaneous labour within 24 hours and only 35.45% required active intervention. Deliveries by the vaginal route were 89.2% with 61% normal and 28.20% instrumental. Cesarean section rate was 10.90%, higher in those induced and primigravidas as compared to the expectantly managed and multigravidas. Chorioamnionitis was seen in 5.45% cases, 3.6% developed postpartum fever, 1.8% wound infection with no case of endometritis or neonatal mortality. 43.64% neonates were put on antibiotics but significant infection was seen in 5[4.54]% cases. Both active and expectant management are equally effective with a significant percentage delivering vaginally. However the cesarean rate was higher among the actively managed

Sacrohysteropexy with Prolene - I for the management of uterovaginal prolapse

A descriptive study was carried out in the gynae department of Military hospital Rawalpindi to observe the results of sacrohysteropexy using Prolene-1 suture in patiens with major uterovaginal prolapse. The duration of study was from January to August 2004. Patients with major uterovaginal prolapse were selected by convenient sampling and underwent sacrohysteropexy using Prolene-1 suture to anchor the uterus to the anterior longitudinal ligament of first or second sacral vertebra in a tension free fashion. All operations were performed by the same surgeon. The study included 30 patients who underwent surgery. The results revealed both subjective and objective improvement of symptoms in short term outcome. None of the patients had any intra or post-operative complications. None of the patients required any blood transfusion. The duration of the surgery was short ranging from 15- 20 minutes. We concluded the sacrohysteropexy using prolene-l suture an effective, simple and safe surgical procedure for the management of major prolapse as an alternative to vaginal hysterectomy especiallyPelvic organespecially in elderly patients where longer surgical procedures need to be avoided