Adverse outcome of a teenage pregnancy

Introduction: Pregnancy at very young age is a high risk pregnancy. It can lead to the vicious cycle of medical, physical and social problems from which a pregnant girl and her fetus can hardly escape. Approximately 90% of the teenage births occur in developing countries. In teenage pregnancy both mother and her child are at high risk of disease and death. Early pregnancy in teenage is considered as an independent risk factor for adverse pregnancy outcome

Objective: To determine the adverse fetomaternal outcome in teenage pregnancies

Methodology: This retrospective study was conducted in department of obstetrics and Gynecology unit-II , Liaquat University Hospital Hyderabad from 1[st] January 2015 to 31[st] December 2015. Data was collected from hospital records of all nulliparous women aged between13-19 years with a singleton birth of 28 weeks or above. Multigravida women, with multiple pregnancies, alcoholics, smokers, having any medical disorder and those with strong family history of hypertension were excluded from the study. Maternal and Perinatal outcome measures recorded were anemia, pregnancy induced hypertension, pre-eclampsia, preterm labour, operative delivery, stillbirth and low birth weight

Results: The mean age of subjects included in this study was 17.35 years +/- SD1.06 years. Average gestational age at delivery was 36.86 +/-SD 2.15 weeks. Common complications seen in adolescent mothers were Anemia [34.2%], Pregnancy induced hypertension [33.3%] and preterm delivery [23.9%]. Most of the deliveries carried out vaginally however caesarean section was done in 33.33% cases. Regarding fetal outcome, 12.82% deliveries ended in stillbirth and out of live newborns, 21.57% were low birth weight

Conclusion: Teenage Pregnancy are associated with increased risk of unfavorable obstetric outcome, so every effort should be taken to provide optimal care and support to these young mothers

Rifled fire-arm: the predominant weapon in all medico-legal deaths in Lahore

Objective: The main objective of Medico-legal autopsy is to find out the cause of death but it also helps in finding the manner of death. From this we also find out the criminal behavior of the society and usage of different kinds of weapons related with the cause of death and particularly the types of fire-arm weapons which is more in concern with the present study. This study was especially conducted to find out the predominance of rifled fire-arms weapons amongst all fire-arm deaths

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Department of Forensic medicine and Toxicology K.E.M.U. Lahore during the period of 2006-2008

Materials and Methods: This study includes 2979 medico-legal autopsies. The information was gathered from post-mortem reports, police documents and hospital records. Not only the kind of weapon was studied but all other parameters were taken into consideration like, cause and manner of death, sex, age, season and areas of injuries on the body

Results: The analysis quite distinctly highlighted that amongst 2979 deaths 1285 were because of fire-arms weapons [43.13%]. Out of these 1192 [92%] deaths were by rifled weapons, whereas 103 [8%] were by smooth bored fire-arm weapons. Total number of male deaths by fire-arms was 1066 [82.95%], whereas females were 219 [17.05%]. All homicidal cases were 788, 46 suicidal, 97 accidental and in 354 the manner remained un-determined. The manner amongst males was, 652 homicidal, 42 suicidal, 82 accidental and in 290 it was un-determined. And in females 136 were homicidal, 4 were suicidal, 15 accidental and in 64 the manner remained un-determined. The ratio of homicidal to suicidal was 17.1:1 and homicidal to accidental ratio was 8.1:1. In 92% cases the rifled fore-arms weapons was used and in 8% it was smooth bored. The rifled fire-arms injuries had multiple entry wounds in 52.9% of deaths and there was single entry wound in 47% deaths. While there was single entry wound in 66% deaths in smooth bored weapons and in 34% of cases multiple wounds were observed. The range of fire in [56.8%] homicidal deaths was distant, whereas in 30.4% it was close range. Close contact fire was seen in 1.4% of suicidal deaths. 16% cases showed blackening, 10.58% cases had tattooing and in 2.25% cases there was burning

Conclusion: The fire-arms weapon is the most predominant mean of un-natural deaths. Amongst them the usage of rifled weapons is more than the smooth bored. So this needs formulation of effective law for control of these weapons

Homicidal strangulation: the leading cause in all asphyxial deaths in Allama Iqbal medical college, Lahore during the year 2013

Objective: The objective of this study was to find out the commonest cause of death in these asphyxial deaths during the period of study and to compare it with other studies previously carried out on this subject

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at Forensic Medicine Department AIMC, Lahore from January 2013 to December 2013

Materials and Methods: Total medico-legal autopsies were 221. Out of these 32 were the cases of mechanical asphyxial deaths, which were selected for this study. The documents scrutinized for this purpose was, autopsy reports, police papers and hospital charts

Results: Out of all post-mortems conducted, the mechanical asphyxial deaths were 32 [14.47%]. Amongst them the cases of strangulations were the most 16 [50%], next in number were the cases of drowning 8 [25%]. There were 6 [18.75%] cases of throttling, and only 2 [6.25%] cases were of hanging. None of them was the case of traumatic asphyxia. In 32 cases of all asphyxial deaths males were 17[53.12%]. Amongst these 16 cases of strangulation the 3[rd]and 4th decades showed higher incidence. In all asphyxial deaths male [17] and females [15] show almost equal distribution. Strangulation is the most prevalent cause of death in all 32 asphyxial deaths. Almost all strangulation deaths were homicidal and hanging was suicidal. Similarly all throttling cases were homicidal. Ligature strangulation and throttling were the methods used in homicidal manner [50.00%] while hanging was used for suicide [6.25%]. In hanging the position of the knot was at occiput in all cases. In ligature strangulation showed the knot on the front in almost all cases

Conclusion: Amongst all asphyxial deaths the most prevalent cause was strangulation and manner in all was homicidal, it is one of the commonest causes of deaths in our country. So strangulation remains the most preferred method of homicidal asphyxial killings

Abruptio placentae: risk factors and maternal outcomes at a tertiary care hospital

OBJECTIVE: The objective of this study was to determine risk factors and maternal complications in cases of abruptio placentae

STUDY DESIGN: It was an observational and descriptive study

SETTING: This study was conducted in Obstetric and Gynaecology Unit-I of Liaquat University Hospital Hyderabad from November 2011 to October 2012 [12-months]

METHODOLOGY: All the pregnant women with gestational age 24 weeks or greater on ultrasound having retroplacental clot on ultrasound and/or painful vaginal bleeding were included in this study by using non-probability purposive sampling technique whereas women presenting with vaginal bleeding due to causes other than abruptio placentae were excluded from the study

RESULTS: During the study period total 3329 women delivered among which 115 presented with abruptio placenta making the proportion of 3.46%. Among these 115 cases only 11 [9.57%] were booked. Women delivered vaginally were 74 [64.35%] whereas 41 [35.65%] underwent operative delivery. In this study the most frequent age group was >30 years [51, 44.35%] with mean+/-SD age of 30.02+/-7.648 years. Majority [62, 53.91%] were grandmultiparous with mean+/-SD parity of 4.98+/-3.068. Most of the women [76, 66.09%] presented with gestational age >37-weeks. Gestational age >37 weeks was most frequent risk factor followed by hypertension [59.13%], grandmultiparity [53.91%], anemia [38.26%], poverty [19.13%], smoking [12.17%] and trauma [2.61%]. Maternal outcomes were postpartum anemia [44.35%], shock [35.65%], PPH [28.70%], PROM [13.91%], postpartum infection [6.96%], DIC [4.35%], renal failure [4.35%] and maternal mortality [2.61%]

CONCLUSION: Abruptio placentae is still one of the major threat to the well being of pregnant women in our population with alarmingly high rate of 3.46% as compared to worldwide rate of 0.7-1%. Gestational age >37-weeks, hypertension, grandmultiparity and anemia are found to be major risk factors for abruptio placentae whereas maternal age does not seem to have any association

Non-B, Non-C Hepatitis as a cause of advanced chronic liver disease requiring medical admission at a rural centre in Pakistan

To study the frequency and mortality of hepatitis B and C negative chronic liver disease [CLD] at a rural tertiary centre in Pakistan. Data was collected retrospectively from the case notes of all the 176 patients consecutively admitted with advanced CLD in our medical ward during one year period. Patients, who were seropositive for hepatitis B and / or C, were separated from those who were negative for them, and the data was analysed. Thirty five patients [20%] were negative for both viral markers. They were more likely to die during the admission than those who were seropositive [11% VS 25% - p = 0.029]. A significant proportion of patients with CLD are negative for viral markers. These patients are at higher risk of mortality, and need testing for other causes of CLD as some of them may benefit from curative treatments available