Pattern of menstrual irregularities amongst women presenting to gynecological outpatient department

The length and regularity of menstrual cycles reflects the pattern of changes in ovarian steroid production. Disturbance of menstrual bleeding is a major social problem for women and accounts for high percentage of gynecological outpatient visits. To look into various patterns of menstrual irregularities among the gynecological patients, its associated symptoms and its effect on their marital life. This cross sectional study was carried out in outpatient department of gynaecology and obstetrics of Punjab employee social security hospital Islamabad from January 2012 till December 2012. Patients presenting with menstrual irregularities, from the age of menarche till the age of menopause, were included in this study. A pre structured proforma was used to collect the data regarding descriptive statistics such as age, parity, marital status. Data regarding detailed menstrual history as well as various patterns of menstrual irregularities and its associated symptoms were also collected. Amongst a total of 100 patients studied, mean age was 33 years +/- 2.37 SD. Eighty percent patients were married, and amongst them 75% had parity more than five and 25% had parity less than five. Prevalence of menstrual irregularities was found to be 70%. Regarding various patterns of menstrual irregularities, 30% complained of menorrhagia with mean duration of bleeding days of 8 SD +/- 0.83. Oligomenorrhoea was reported by 20% patients and 50% patients complained of dysmenorrhoea, 30% experienced easy fatigue ability and 20% had generalized weakness. Menstrual irregularity had effect on daily life activity in 86% of cases. Additionally, among the 80 married females, 88% complained that menstrual irregularity had affected their marital life. There is lack of information regarding menstrual problems and when to seek help. There is a need to educate the females regarding menstrual problems not only to improve their health but also as a possible indicator of existing pathology

Epidemiology, risk factors and sites of ectopic pregnancy in madina maternity and children hospital, Kingdom of Saudi Arabia

The objective of the study was to study the epidemiology, risk factors and sites of ectopic pregnancy in the Saudi women and correlate the data to international incidences. The retrospective descriptive study was conducted from May 2002 till April 2004 at Madina maternity and children hospital, Saudi Arabia. Seventy patients diagnosed as ectopic pregnancy, which constituted 2.32/1000 of 30,066 deliveries conducted during this period were included. Patients were divided into 6 categories based on age ranging from 15-40 years [5 groups] and more than 40 years [group 6]. Data were collected on predesigned proforma, including the relationship of ectopic pregnancy to age, parity, associated risk factors and the sites of ectopic pregnancy. The data were analyzed on SPSS version 14. Majority of the cases were between 20 to 34 years of age i.e., 60%. The parity was studied from nulliparous to Para 8 and mean parity was 4. Risk factors were classified into 3 categories: surgical, clinical and contraceptive. Most of the cases had two or more factors. The surgical factors were present in 41 cases; clinical factors were present in 44 cases while contraceptive use was present in 11 cases. The sites of ectopic having nearly an equal incidence in the right and left fallopian tubes were 61 [91%] cases. There were 3 ovarian, 2 Broad ligament and 1 abdominal secondary ectopic pregnancy. The frequency of ectopic pregnancy was nearly 0.23% in our study. Association with risk factors and demographic features is consonance with international literature

Prevalence of anaemia and its relation to duration of pregnancy in antenatal clinic in a teaching hospital

During pregnancy there is an immense burden on mother and hemoglobin level falls progressively as the pregnancy proceeds. Anemia itself may have ill effects on the outcome of pregnancy, and its early recognition forms an important aspect of antenatal care. To determine the prevalence of anemia and its relation to duration of pregnancy amongst pregnant females presenting at Social Security Hospital. A cross sectional study was conducted at Social Security Hospital Islamabad, from May-Oct 2011. All pregnant females presenting at antenatal clinic with haemoglobin <11g/dl were included in this study. In a total of 2,300 females included in the study, the majority belonged to age group of 19-37 years with mean age of 26 years +/- 1.30 SD. Mean level of haemoglobin was found to be 9 gm/dl +/- 1.19 SD. We observed mild anaemia [Hb 10-10.9 gm/dl] in 55%, moderate anaemia [Hb 8-9.9gm/dl] in 35% and severe anaemia [Hb<8gm/dl] in 10% of our cases. In first trimester majority had mild anemia [p <0.05] and in second and third trimester majority had moderate degree of anemia [p <0.05]. High prevalence [92%] of anemia was observed in females visiting social security hospital with statistically significant relationship between 3 trimesters of pregnancy and severity of anemia

Prevalence and severity of dysmenorrhoea among medical students: a cross sectional study

Dysmenorrhoea is recognized as the most common gynecoiogical complaint which affects most of the females and adolescents. Dysmenorrhoea not only affects the daily routine activities but it has profound effect on quality of life of students. To determine the prevalence of dysmenorrhoea, its severity among medical students and its effects on college/class absenteeism of students. Cross sectional study. This study was conducted on 100 female medical students. Young unmarried undergraduate female medical students between the ages of 18-22 years were included in this study. All participants were given a questionnaire to complete. Questions were related to age of the students, age of menarche, length of menstrual cycle, duration of menstrual flow, dysmenorrhoea and its severity and absenteeism from college and/or class due to dysmenorrhoea. To detect the severity of dysmenorrhea we used the verbal multi-dimensional scoring system. Participants were given 30 minutes to complete the questionnaire. Mean age of students was found to be 21 years with SD +/- 1.7. Mean age of menarche among the students was found to be 13 years with SD +/- 0.8. Mean length of menstrual cycle was found to be 29 days SD +/- 2.1. The average duration between two periods and the duration of menstrual flow were 28.34 days SD +/- 7.54 and 4.5 days SD +/- 2.45 respectively. Regarding dysmenorrhoea 78% of the students complained of dysmenorthoea while 22% did not have this complaint. Regarding severity 46% had mild dysmenorrhoea, 19% had moderate dysrnenorrhoea and 13% had severe dysmenorrhoea. Among female medical students who reported dysmenorrhe a 21% were frequently missing classes. Dysmenorrhea is highly prevalent among female medical students; it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. A few of the students consult physician for the problem and many adopt self-medication with over the-counter medicines or home remedies.

Audit of post caesarean section fain management in tawam hospital, Al Ain, United Arab Emirates

To evaluate the consistency in management of postoperative caesarean section pain in Tawam Hospital according to evidence based practice and to introduce change in practice and to bring uniformity in practice for post cesarean section pain relief. A retrospective audit of hundred consecutive women undergoing cesarean section in Tawam hospital, Al Ain, UAE from l[st] January 2008 till 30[th] April 2008. A purpose-designed performa was used to collect the data including the Body mass index BMI, Type of cesarean section, Duration of cesarean section, types of anesthesia, First pain scoring [day 0] and type, dosage and route of pain relief used and finally post medication pain score of patient. Tawam Hospital is a 500 bedded hospital with a delivery rate of 4000 per year and cesarean section rate of 15%. Patients who had a BMI >30kg/m[2] were 42%. Emergency caesareans were done in 60% of the patients. Most of the caesareans were completed within 1.5 hrs. Regional anesthesia was given in 59% of the cases. Analgesia requirement was reduced after regional anesthesia. Only 30% of the patients had pain scoring within the 1[st] hour of cesarean section. Patients received variable pain relief medications without correlation to the pain score. Post analgesia pain score was done in 62% of the patients only. There is no uniform or evidence based practice for post operative analgesia in cesarean section in our Institution therefore a Clinical practice guideline is issued to achieve evidence based practice and to reaudit to review change in practice.

Mesenteric cyst of abdomen in a young girl- a rare entity

Mesenteric Cysts are often asymptomatic and are found incidentally, although patients may present with lower abdominal pain. Due to non specific clinical presentation, very low incidence and lack of adequate classification these cysts represent a diagnostic and therapeutic challenge. Clinical examination, ultrasound and CT imaging combined together help in the diagnosis. We present a case of mesenteric cyst in a 4.9 years old girl that was successfully removed surgically. She presented with history of intermittent abdominal pain for the previous 8 months and it was associated with high grade fever. It was successfully treated by complete excisional surgery.

Clinical use of misoprostol prior to transcervical procedures in non-pregnant women

Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming and the management of miscarriage, induction of labor and the management of postpartum hemorrhage. It can be given orally, sublingually, vaginally and rectally. It has been widely used in non-pregnant women because of its cervical ripening and uterotonic effects. A large number of studies have demonstrated its effectiveness in enhancing ease of cervical dilatation. This review article describes the pharmacokinetics and clinical use of the drug misoprostol in non-pregnant women including cervical priming before hysteroscopy, before insertion of an intrauterine device, in endometrial biopsy and before intrauterine insemination to improve pregnancy rates.

effect of 1000 microgram vaginal misoprostol on preoperative cervical ripening before diagnostic hysteroscopy

To compare the effect of 1000 microgram vaginal misoprostol on preoperative cervical ripening before diagnostic hysteroscopy in premenopausal -women with abnormal uterine bleeding. This study was conducted in Gynae/Obs Unit-II, Holy Family Hospital, Rawalpindi, from 22[nd] of January 2009 to 22 of July 2009. The data were collected from 70 women on a pre-structured proforma admitted to inpatient department for diagnostic hysteroscopy with abnormal uterine bleeding, Inclusion criteria were women above 40 years of age, previously delivered vaginally or by caesarean section and with previous cervical dilation and biopsy. An exclusion criterion was pregnancy, pelvic infection, and cervical cancer. The women were randomized to two groups of 35 each. In group A: women were given 1000mcg misoprostol vaginally 12 hours preoperatively to diagnostic hysteroscopy and in group B: women were taken as controls i.e. they underwent hysteroscopy without any drug for cervical dilatation. The effect of preoperative cervical dilatation was measured by passing Hegar dilators. Cervical dilatation of >/= 5 mm was considered as satisfactory and the duration of cervical dilatation and hysteroscopy were noted in both groups. Among the premenopausal women receiving misoprostol, 88% [n=31] achieved cervical dilatation of >5mm compared with 65% [n=23] in the control group. The mean cervical dilatation in group A was 6.4 mm and 4.8 mm in group B. The mean difference in cervical dilatation was 1.6 mm [95% CI 0.5- 2.7], with a p- value<0.001. The mean time for cervical dilatation was 47 seconds in group A and 68 seconds in group B, with a p-value <0.001. Mean duration of hysteroscopy in minutes, in group A was 15 minutes whereas in group B it was 23 minutes. One thousand micrograms of vaginal misoprostol 12 hours prior to hysteroscopy has a significant cervical ripening effect requiring less instrumentation as compared with control group in premenopausal women. Duration of hysteroscopy is also reduced in women treated with vaginal misoprostol as less instrumentation was required for cervical dilatation. Vaginal misoprostol 1000 microgram before hysteroscopy is safe, and is highly acceptable by the patient.

Analysis of abdominal hysterectomy performed for benign gynaecological conditions in a Hospital [WAH] Pakistan

To review the indications of abdominal hysterectomy for benign gynaecological conditions in a tertiary care hospital in Wah Cantt, Pakistan. Cross-sectional study. Gynaecology and Obstetrics department of Wah Medical College and allied Pakistan Ordnance Factory Hospital [POP] Wah Cantt, for eighteen months, from January 2007 to June 2008. Retrospective review of the medical record of 159 patients was done. Data analysed in the form of frequency and percentages by using SPSS version 10. Patients having abdominal hysterectomy for benign gynaecological conditions during the study period were included. Exclusion criteria included uterovaginal prolapse, malignancies and hysterectomy for obstetrical reasons. Review of the indications showed that out of 165 patients undergoing abdominal hysterectomy, benign conditions were present in 159 [96.4%] patients. The large number [96.4%], of hysterectomies being performed for benign lesions emphasize the need to periodically review the indications for which hysterectomies are being performed in a unit. This will reduce the burden on the ancillary staff, hospital budget and also reduce the psychological trauma of a woman, associated with the loss of an organ