Frequency of smear positive precancerous cervical lesions in patients attending outpatient department of a tertiary care hospital

To find out the frequency of precancerous cervical lesions by doing Pap smear. It was a descriptive study conducted by Pakistan Medical and Research Council in outpatient department of Obstetrics and Gynaecology at Hayatabad Medical Complex Peshawar from 1st July 2007to 3oth June 2008. Four hundred and fifty patients all married, sexually active, between 20 and 60 years of age were included in the study. Those who were menstruating or with a suspicious looking cervix, a history of Cervical Intraepithelial Neoplasia [CIN], Carcinoma of the Cervix, Ovary or Endometrium or pregnancy were excluded from the study. A detailed history and examination was done and a Proforma was filled. Pap smear was done in the outpatient department and was sent to cytologist for reporting. Data was analyzed by SPSS version 13. The Pap smear result showed inflammatory smear in 112 [24.88%] cases, 248 [55.11%] cases had a normal smear, 85 [18.88%] reported to be inadequate. Low grade squamous intraepithelial lesion was reported in 5 [1.11%] cases and none of these cases on colposcopic guided punch biopsy had CIN. The most frequent abnormality found in Pap smear study was infective bacillary background. The frequency of premalignant lesion was found to be very low in this largest study conducted in KPK. More studies are needed to confirm this finding in this ethnic population

diagnostic validity of pre-operative serum CA125 level in women with ovarian masses

To determine the validity of serum CA125 levels in differentiating benign and ovarian cancer in patients with ovarian masses, using histopathology as a gold standard. In this cross sectional study, blood samples were obtained from 85 women with ovarian masses who fulfilled the inclusion criteria and sent for the assay of serum CA125 levels. They were scheduled for elective surgery at Hayatabad Medical Complex Hospital between 1[st] April, 2009 and 31[st] March 2010. Of the 85 women enrolled, ovarian cancer was found in 27 cases [31.8%] and benign ovarian mass in 58 cases [68.2%]. The sensitivity, specificity, and accuracy of serum CA125 at the cutoff level of 35 U/mL for prediction of ovarian cancer were 74.14%, 92.5%, 80% respectively; with 95.56% positive predictive value and 62.5% negative predictive value. As stand-alone modality, serum CA125 of more than 35 U/mL in predicting ovarian cancer revealed modest diagnostic accuracy

Magnesium sulphate therapy in eclampsia: a 5 years experience at a teaching hospital

To describe the presentation of eclampsia, its management and associated outcomes using magnesium sulphate [MgSO4], over a five years period at a tertiary care hospital. This descriptive study was conducted at Obstetrics and Gynecology Unit, Hayatabad Medical Complex, Peshawar from January 2004 to December 2008. Data was collected from all patients presenting with eclampsia. A total of 146 patients had eclampsia. Unbooked were 124 [84.93%]. Mean age 23 years +/- 5.3 years [range 18-38 years], primigravida were 69.17% [101 cases]. Antepartum fits in 72.6% [106 cases], intrapartum 14 [9.58%] and 27 [18.49%] postpartum. MgSO4 was used in all except 4 with oliguria, they were given diazepam. Recurrent fit occurred in only 20[13.69%]. MgSO4 toxicity occurred as respiratory depression in 9 cases, depressed tendon reflexes in 10 and decreased urine output in 13 cases Total deliveries were 23021, prevalence of eclampsia was 0.63%. Mode of delivery was Vaginal in 97 [66.43%], instrumental in 29 [19.98%] and cesarean section in 20 [13.69%] cases. There were 26[17.2%] stillbirths and 4 neonatal deaths. Complications included HELLP in 17 [11.64%], pulmonary complications in 17, renal failure in 7 [4.79%], DIC in 16[10.95%] and temporary blindness in 16 cases. Eleven [7.53%] maternal deaths occurred, causes included DIC in 1case, HELLP in 2, renal failure 1, cardiopulmonary failure in 2 and CVA [received deeply unconscious] in 5 cases. All were unbooked cases and with delay in reaching hospital. Eclampsia is common antenatally and in primigravidae, and a major cause of maternal morbidity and mortality in our region. It was effectively controlled with MgSO4, preventing recurrent fits and safe for both mother and fetus

Serum ca-125 versus ultrasound examination in differentiating between benign and malignant ovarian masses

To differentiate between benign and malignant ovarian masses by using serum CA125 versus ultrasound examination. This descriptive study was conducted at Department of Obstetrics and Gyneecology, Hayatabad Medical Complex from 1[st] January 2010 to 31[st] December 2010. Women fulfilling inclusion criteria were admitted. They underwent transabdominal gray-scale ultrasound examinations by an experienced examiner before surgery. Pattern recognition was used to classify a mass as benign or malignant. These women also had blood withdrawn preoperatively for measurement of serum CA-125 with cut off value of < 35 IU as normal. Results from both radiological finding and serum CA125 were then compared with histopathological findings which was used as gold standard. Pattern recognition by ultrasound correctly classified 69.64% of the tumors as benign or malignant. Serum CA-125 correctly classified at best 74.14% of the masses. Combining both parameters the diagnostic accuracy increased to 86.75% with sensitivity 80.36%, specificity 100%, positive predictive value 100% and negative predictive value of 71.05%. Pattern recognition alone was inferior to serum CA-125. Combining both parameters for differentiating between benign and malignant ovarian masses further increased the diagnostic accuracy

Outcome of syndromic management in cases of chronic vaginal discharge

To see the outcome of syndromic management in 100 patients of chronic vaginal discharge. This descriptive study was conducted in outpatient department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar from 1[st] January 2007 to 30[th] June 2007. Patients aged from 16 to 50 years with chronic vaginal discharge of more than 6 months duration were included in the study. Pregnant patients and those with the history of Cervical Intraepithelial Neoplasia [CIN], Carcinoma of the cervix, ovary or endometrium were excluded from the study. A detailed history and examination was done and a Proforma was filled. All these patients were treated with the syndromic management as recommended by the World Health Organization [WHO] in which no laboratory tests are done and patients are treated empirically with the antibiotics as per criteria of WHO. The mean age of the patients was 32 +/- 8.08 years. Vaginal infection improved in 56% of the cases with a single course of antibiotic, in 84% with a second course, 12 patients were lost to follow up and 5 patients who did not improve with two courses of antibiotics had big cervical erosions, were subjected to Cryo therapy. In settings, where bedside tests like microscopy Potassium Hydroxide, wet mount films and tests for Chlamydia and gonorrhea are not available, syndromic management is a reasonable way of treating cases of chronic vaginal discharge

Laparoscopic evaluation in infertility

To describe the different causes of infertility based on findings of diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. A cross-sectional study. Obstetrics and Gynaecology Unit of Hayatabad Medical Complex, Peshawar, from January to December 2005. All patients undergoing diagnostic laparoscopy for primary or secondary infertility were included. Male factor infertility cases was excluded. Frequency of the causes and finding was determined. One hundred and thirty six [70.46%] patients with primary and 57 [29.54%] with secondary infertility underwent diagnostic laparoscopy. Seventy [51.47%] with primary and 26 [45.51%] with secondary infertility had no visible abnormality. Bilateral tubal blockage was found in 32 [23.53%] primary and 16 [28.07%] cases of secondary infertility. Dense pelvic adhesions forming adnexal mass were found in 9 [6.61%] and 6 [10.5%] of primary and secondary respectively. Two cases each of bicornuate uterus and double uterus in primary infertility patients. Ovarian pathology was found in 18 [13.23%] primary and 4 [7.01%] cases of secondary infertility. PCO [polycystic ovaries] were detected in 12 [8.82%] and 2 [3.5%] cases of primary and secondary infertility respectively. Endometriotic cysts and deposits were found in 15 [10.29%] cases of primary and 3 [5.26%] cases of secondary infertility. Tubal disease is a common factor responsible for infertility and diagnositc laparoscopy is a valuable technique for complete assessment of female infertility and making treatment decisions according to the cause

Impact of external cephalic version [ECV] on mode of delivery of the term singleton breech

To assess the impact of external cephalic version [ECV] on the mode of delivery of the uncomplicated term, singleton breech at teaching hospital. This observational study was conducted in Obstetrics and Gynecology department, Hayatabad Medical Complex, Peshawar from 1st December 2003 to 31st January 2005 on all singleton term breech presentations from 37 to 41 weeks of gestation. Out of 265 women presenting with breech presentation at 37 completed weeks or more at our unit during the study period, 188 patients met the selection criteria. Of these only 40 patients [21.3%] had ECV. Twenty seven of these were successful [67%]. A total of 161 patients continued their pregnancies as breech. Of these the mode of the delivery was: Vaginal Breech Delivery in 97 cases [60.24%] and CSection in 64 [39.76%]. Reasons for failure to offer ECV included; 129 [80.12%] cases were unbooked and admitted in emergency when ECV services were not available. 145 [90%] were admitted in labour, and majority of these were in active and advanced labour. ECV was not found to decrease significantly the number of non-cephalic presentation at term. The reasons were that in spite of good success rates it was not feasible to perform enough ECV to have an impact on mode of delivery of singleton term breeches

Eclampsia-management and outcome with magnesium sulpate as the anticonvulsant

To study the maternal outcome in terms of morbidity and mortality with the use of magnesium sulphate in eclampsia for seizure control and prophylaxis. A quasi experimental study. This study was conducted in Obstetrics and Gynaecology Unit of Hayatabad Medical Complex, Peshawar, from 1st September 2002 to 31st December 2003. All the patients admitted with eclampsia during this period were included in the study. A detailed history and clinical examination were recorded. Patients were monitored for number of fits, rise in blood pressure [BP], dose of magnesium sulphate administered and its side effects, development of complications of eclampsia, duration of labour, mode of delivery and use of other medications as well as maternal and perinatal outcome. During this period, 52 patients were admitted with eclampsia. Majority were unbooked. Primigravida were 31 [59.6%]. Common age group was between 21 and 30 years having 34 [65.4%] patients while 16 [30.7%] patients were 20 years or less than 20 years of age. Thirty-three [63.4%] patients had antenatal fits, 9 [17.3%] intrapartum fits and 11 [19.2%] had postpartum eclampsia. Twenty-six patients had term pregnancy, 22 patients with 28-36 weeks gestation while 4 patients developing eclampsia before 28 weeks gestation. Eighteen patients had spontaneous vaginal delivery; labour was induced in 21 patients while 6 patients underwent cesarean section. Maternal complications included pulmonary oedema, tongue bites, HELLP syndrome, placental abruption and coagulopathy. Side effects of magnesium sulphate were low. There were 4 [7.6%] maternal deaths due to eclampsia. Perinatal outcome was good with 33 [63.4%] live births, 3 IUDs and 10 still births, mostly due to prematurity. Magnesium sulphate was found to be an effective anti-convulsant both for control and prophylaxis of seizures in eclampsia and improved maternal and fetal outcome

Management of gestational trophoblastic tumours: a five-year clinical experience

An analysis of a 5-year clinical experience in the management of gestational trophoblastic tumours in a tertiary care hospital. Design: A prospective cohort follow-up study. Place and Duration of Study: The study was conducted at Hayatabad Medical Complex, Peshawar from 1998 to 2003. Patients and A total of 30 cases were managed and a detailed analysis of these patients was done. Of these 13 followed Hydatidiform Mole, 10 after abortion and 7 after a term pregnancy. Out of 30 cases of gestational trophoblastic tumour, 63.3% were between 21 and 38 years of age. Ninety% of the patients presented with vaginal bleeding, while life-threatening hemorrhage occurred in 23.3%of the cases.43.3% of the patients had hydatidiform mole as an antecedent pregnancy and 36.7% of the patients presented within four months of the antecedent pregnancy. Blood groups O and B were most frequently encountered i.e. in 40% and 33.3% of the cases. Metastatic disease was present in 46.6% of the cases, of which 8 were high risk and one was of medium risk group. Major sites of metastasis were lungs [33.3%] and vagina [30%]. Serum BHCG of 40,000 miu / ml and above was present in 53.3% of the cases [P=0.016] and number of metastasis >8 were found in 16.7% cases [P=0.001]. Prior chemotherapy was given in only 2 patients and both of them died due to resistance. Chemotherapy was given to 100% of patients; survival was 100% in low-risk group and 50% in high-risk group [P=0.004]. Overall mortality was 20% i.e. 6 patients died of the disease. Major side effects of chemotherapy were stomatitis [66.6%], alopecia [56.6%], low hemoglobin [60%], weight loss and recurrent infection. Late diagnosis, previously failed chemotherapy and high WHO prognostic scores are major risk factors affecting outcome in these patients. Hence every female in reproductive age group with unexplained bleeding per vaginum should be investigated with serum BHCG [Beta human chorionic gonadotrophin]