Comparison of manual vacuum aspiration, and dilatation and curettage in the treatment of early pregnancy failure

Objectives: To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration [MVA] with dilatation and curettage [DNC] in the management of early pregnancy failure. Methods: One hundred patients of spontaneous abortion, incomplete or missed, with gestational age <12 weeks were included in the study. Using a Random Number Table, these patients were assigned to undergo either DNC or MVA. Results: The distribution of age, parity and gestational age was similar in both groups. The mean duration of procedure was significantly higher [p<0.0001] in DNC [8.98 +/- 2.64 minutes] as compared to 5.88 +/- 2.43 minutes in MVA. The duration of hospital stay was significantly lower [p<0.0001] in MVA group [3.48 +/- 1.2 hours] as compared to 7.42 +/- 1.93 minutes in DNC group. Similarly the cost of procedure was also significantly lower [p=0.0001] in MVA group [PKR 1410 +/- 243.4] compared to PKR 3460 +/- 908.24 in DNC group. Conclusion: MVA is as effective as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less blood loss, is less time consuming, requires a shorter hospital stay and thus costs less. It does not require general anaesthesia and complication rate is less than dilatation and curettage. Keywords: manual vacuum aspiration, dilatation and curettage, early pregnancy failure

B-Lynch suture for the management of post partum hemorrhage - a local experience

Objectives: To assess the efficacy of B-Lynch suture in the management of postpartum hemorrhage

Study Design: Case series report

Study Setting: Department of Obstetrics and Gynecology unit I, Jinnah Hospital, Lahore

Materials and Methods: The data was collected retrospectively from hospital record during July 2003 to June 2004, of patients with PPH in whom B-lynch suture was applied to control hemorrhage. The study included 45 women who were admitted through emergency or out patient department during last one-year period who fulfilled the inclusion criteria. Data was collected according to a pre-set proforma which included age, parity, gestational age, cause of PPH, estimated blood loss, number of transfusions needed and duration of hospital stay and was reviewed and evaluated in terms of treatment outcome, potential side effects and the efficacy of B-Lynch suturing technique as treatment of postpartum hemorrhage. Ratio and proportions were calculated and Chi- square test was used for significant associations

Results: The age of the patients ranged from 2035yrs and parity from 1-6. Gestational age was from 34-41wks. 36 [80%] women had PPH due to uterine atony, while 9 [20%] had PPH due to placental causes, and none of them had bleeding disorders. The estimated blood loss was 1000-1500cc in 15 patients [33.33%], 1500-2000cc in [62.22%] and 2 patients [4.44%] had blood loss more than 2000cc. 15 [33.33%] patients required 3 transfusions, 28 [62.2%] required 4 transfusions and only 2 [4.44%] women required 5 transfusions. Suturing technique has been applied successfully in 44/45 patients with failure rate of 2.22%

Conclusion: The B-Lynch suture is a valuable addition to the surgical treatment of postpartum hemorrhage because of its simplicity of application, relative safety, life saving potential and its capacity for preserving the uterus and thus fertility. Satisfactory haemostasis can be assessed immediately after application

Anemia in grandmultipara

Objectives: To determine the prevalence of anemia in the grandmultiparas and compare it with the prevalence of anemia in women of lesser parities

Design: A prospective comparative study in which data was analyzed using p value and tests of significance

Patients and methods: Two thousand two hundred and ninety eight pregnant patients visiting the out patient department of Jinnah Hospital Lahore were evaluated for anemia. Among them 536 were grandmultiparas and 1762 were of lesser parity. Hemoglobin [Hb] percentage in both groups of patients was measured, on this basis anaemia was classified as mild, moderate or severe

Results: There was no significant statistical difference in the prevalence of mild and moderate anemia but severe forms of anemia were found in grandmultiparas as compared to females of lesser parity. Mild anaemia with haemoglobin [Hb] between 10-11 gm/dl was present in 54[10%] patients of group A and 170 [10%] of patients in group B. But the difference between these two groups was not significant statistically [p>0.05]. The patients suffering from moderate anaemia Hb 7-10 gm/dl were 460 [86%] in group A and 1550 [88%] in group B. The difference in moderate anaemia in the two groups was not statistically significant. The prevalence of severe anaemia was however significantly higher [p<0.05] among GMPs. Severe anaemia with Hb <7 gm/dl was present in 21 [4%] patients in group A out of total 536 and in group B out of total 1762 patients 36 [2%] had significant anaemia

Conclusions: Severe forms of anemia in grandmultiparas were due to closely spaced pregnancies, inadequate dietary intake, lack of effective contraception and social aspects

psyche of caesarean

The present study was conducted to assess psychological, social and physical impact of caesarean on a woman. It is a Cross sectional and comparative study and was conducted at department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. The study included random selection of two hundred and twelve women with recent caesarean section [within 6 weeks] admitted in the ward or presenting in out patient department of Jinnah Hospital, Lahore From January 2004 to April 2004. They were divided in two groups. Group I with one caesarean section included 124 patients and Group II with repeat caesarean sections included 88 patients. The women were interviewed according to a preset proforma. Out of the two hundred and twelve women interviewed, the age, social and educational status were comparable between the two groups. 40.3% of the patients in group I and 56.8% in group II [P value < 0.05] were apprehensive because of pain. 40.3% of group I and 50% of group II [P value > 0.05] patients were scared of immobility. 40.3% in group I and 36.4% in group II [P value > 0.05] said that they had to stay longer in the hospital. 56.5% in group I and 56.8% in group II [P value > 0.05] were afraid of anaesthesia. 27.4% in group I and 15.9% in group II [P value < 0.05] had reservations because of excessive blood loss. 9.7% in group I and 18.2% in group II didn't like caesarean section because of risk of infection [P value > 0.05]. 38.7% in group I and 40.9% in group II felt bad of scar in the abdomen [P value > 0.05]. 37.1% in group I and 31.8% in group II [P value > 0.05] had social pressures. 58.1% in group I and 56.8% [P value > 0.05] in group II had problems with care of the neonate [Feeding]. 4.0% of group I and 6.8% [P value > 0.05] of group II patients had mild psychological problems like anxiety and postpartum blues, which settled with psychological support and anxiolytics. 35.5% of group I and 28.4% of group II [P value > 0.05] had fears about future fertility. 25.8% in group I and 40.9% [P value < 0.05] in group II did not mind having caesarean in next pregnancy. Although there are some fears in the minds of women about caesarean section, the common problem are benign and manageable, they can be alleviated through counseling and better care. Larger studies are required to assess each variable independently

Mid-trimester termination of pregnancy-comparison of sublingual with vaginal misoprostol

This paper compares the efficacy, side effects and patient's satisfaction of sublingual with vaginal misoprostol for mid-trimester termination of pregnancy. The study was performed in the department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. One hundred patients presenting for termination of pregnancy between 13-24 wks of gestation were selected. They were divided into two groups, group I was managed with sublingual and group II with vaginal misoprostol. The dose of misoprostol was 200 pg repeated at intervals of 6 hours up to a maximum of four doses. The primary outcome measure was induction expulsion interval and secondary outcomes were maternal complications, and women's acceptance of the termination procedure. Successful termination was achieved in 96% patients in group I and 94% in group II. The patients in the two groups were comparable regarding their parity, gestational age and indications for termination. As regards the dosage, 76% in each group required a dose of 400 - 600 ug [P value 0.000]. Induction expulsion interval was < 12 hrs in 92% patients in group 1 and 88% in group II, a difference not statistically significant [P value > 0.005]. Pyrexia > 38°C was found in 8% and 6% in each group respectively while 8% in group I and 4% in group II had nausea and vomiting. So, sublingual misoprostol is as effective as vaginal misoprostol but with more nausea and vomiting, which can be managed easily. As a conclusion misoprostol can play a very important role in the practice of obstetrics and gynecology in resource poor countries where cost of other prostaglandins is prohibitively high and temperature maintenance is a problem. In proper dosage the risk of complications is low and most of the patients achieve completion of expulsion in less than 12 hrs by both routes