Comparison of femodynamic changes caused by 2 units versus 5 units of oxytocin during elective caesarian section under spinal anaesthesia

Objective: to compare the effects of 2 units and 5 units bolus doses of oxytocin on heart rate

and mean arterial pressure during elective caesarian section under spinal anesthesia

Material and Methods: randomized control study, conducted over 6 months period on 150 patients at Maula Baksh Teaching Hospital Sargodha by dividing into 2 groups[group A and group B],through lottery method for randomization of oxytocin allocation

Results: in our study, majority of the patients i.e. 45.33% [n=34] in Group-A and 38.67% [n=29] in Group-B were between 26-30 years of age, mean +/- SD was calculated as 27.85+/-3.54 years. ,while 60% [n=45] in group A and 56% [n=42] in group B were between 37-39 weeks of gestation ,mean +/- SD was calculated as 38.63+/-4.61wks.Blood loss in both groups shows insignificant difference by recording 187.43+/-18.65 ml in Group-A and 194.24+/-21.47 ml in Group B, comparison of tachycardia in both groups was done which shows 32% [n=24] in Group-A and 61.33% [n=46] in Group-B while which shows a significant difference in both groups while hypotension was recorded as 4% [n=3] in Group-A and 17.33% [n=13] in Group-B, p value was calculated as <0.01

Conclusion: we concluded that frequency of tachycardia and hypotension in patients administered with 2 IU bolus dose of oxytocin is significantly lesser as compared to SIU bolus dose and there is no difference in the incidence of postpartum haemorrhage

Obstetrical prognosis after placental abruption

Placental abruption is the premature separation of normally situated placenta after 24 completed weeks of pregnancy and before delivery of a baby. It is self extending process with accumulation of blood clots leading to more separation of placenta. The study was conducted to assess the perinatal mortality, morbidity in relationship to the severity ofplacental abruption and to estimate the magnitude of abruption. It is a descriptive and observational study. The study was conducted in the department of obstetrics and gynaecology, Sir Ganga Ram Hospital, Lahore over a period of one year from May, 2009 to May 2010. A total of 80 patients with the diagnosis ofplacental abruption after 24 completed weeks of gestation were included in this study. Neonates were evaluated at the time of birth and followed upto 46 hours after birth. Among the 80 patients, only 14 were [17.5%] booked, while 66 [82.5%] remained unbooked. A total of 27 [33.75%] patients had pregnancy induced hypertension, 65 [81%] were anaemic. Polyhydramnios and multiple pregnancy were seen in 3 and 4 patients respectively. Majority of patients i.e. 47[58.75%] delivered by abdominal route. Regarding the fetal outcome alive born babies with placental abruption were 41 [51.25%] in which 23 [28.75%] were preterm and 18 [22.5%] were full term. Thirty six [45%] intrauterine dead fetus and in whome 25 [31%] were preterm and 11 [13.75%] were full term, only 3 were still births. Twenty four [30%] neonates required resuscitation, while 20 [25%] neonate were shifted to neonatal intensive care unit. latrogenic prematurity was the underlying cause of most complications. Perinatal morbidity and mortality is significantly high in patients of abruption placentae. Hypertension is a major predisposing factor for placental abruption

Multiple caesarean sections - an association with increasing frequency of placenta praevia

This study was conducted to look for risk factor for placenta praevia particularly the increasing frequency of placenta praevia in patients with multiple caesarean sections and their complications. The place of this work was obstetrics and gynaecology Unit of' Mola Buksh Teaching Hospital of Sargodha Medical College. The duration of study was 1 year from first June 2007 to 31[st] May 2008. Sixty patients with placenta praevia included in the study. Forty patients [67%] had major degree placenta praevia, 14 [23.3%] had history of previous caesarean section. Seven patients [11%] had severe PPH, out of which three, had hysterectomy due to morbidly adherent placenta. They had previous history of multiple caesarean sections. It was concluded that there is can increasing frequency of placenta praevia in patients with previous history of caesarean sections

Increasing severity of polyhydramnios: a risk factor for congenital malformation

This study was carried out to know the frequency of fetal anomalies in pregnancy complicated by polyhydramnios. The place of this work was Obstetrics and Gynaecology, Unit-III Lady Willingdon Hospital, Lahore. The study period was from 1st May to 31st Dec. 2005. Sixty consecutive patients with polyhydramnios were included in the study. Amniotic fluid volume was calculated by measuring amniotic fluid index [AFI] through ultrasound and type of fetal anomaly was also diagnosed on ultrasonography. Our results depicted that there were 22[61.2%] normal fetuses with mild polyhydramnios [AFI 24 to 29.9cm] whereas in severe polyhydramnios [AFI 35 cm or more] all fetuses [100%] had congenital malformations. It was thus concluded from this study that increasing severity of polyhydramnios is associated with increasing frequency of fetal anomalies