Labour induction with gestational hypertension: a great obstetric challenge

Objective: To observe the fetomaternal morbidity and mortality with induction of labour in pregnant women with gestational hypertension

Methods: The subjected study population included was 138 pregnant women with gestational hypertension. These pregnant women were between 34-40 weeks of gestational period in whom labour was induced, while the pregnant women who had labour induction for other reasons were excluded. These women were registered on the predesigned proforma. The data was collected and analyzed on SPSS version 21

Result: Out of the 138 cases, mean age of the women was 25.93 +/- 5.037, prim gravid women were 78[56.5%], gestational period in majority of these women 71[51.4%] varied between 35-38 weeks. The common presenting symptoms were oedema 119[86.23%], headache 90[65.21%]. Labour induction in majority of the cases 81[58.7%] was carried with prosten pessary. The Caesarean section was needed in 39[28.3%] women in emergency due to maternal and fetal reasons or due to failed induction. Maternal complications were uncontrolled hypertension 23[16.7%], intensive care unit admission 21[15.2%], fits 15[10.9%], post partum haemorrhage 13[9.4%]. Fetal complications were birth asphyxia 49[35.5%], neonatal intensive care unit admission 17[12.3%], neonatal death 14[10.1%]

Conclusion: The emergency Caesarean section rate was quite high with induction of labour in pregnant women with gestational diabetes. The maternal morbidity as well as fetal morbidity and mortality rate was also high

Acute renal morbidities with obstetrical emergencies: an important women health issue

Objective: To observe the impact of acute renal morbidities with obstetrical emergencies on maternal health

Methods: In this study pregnant women between 28-40 weeks gestational period and delivered women in their puerperal period up to 42 days after delivery having acute renal problems associated with obstetrical emergencies were included. Pregnant and delivered women with obstetrical emergencies and associated other morbidities were excluded. These women were registered on the predesigned proforma after taking written informed consent and taking approval from institutional ethic research committee. The data was collected and analyzed on SPSS version 21

Result: Out of these 196 total registered women, majority of these women 81[41.32%] were between 21-30 years of age and multiparous women with parity four and above were 83[42.34%]. Commonest presenting symptoms were generalized oedema 123[62.75%] and oligouria 92[46.93%]. Frequent obstetrical emergencies observed were pre-eclampsia 53[27.04%], post partum haemorrhage 48[24.48%] and ante partum haemorrhage 36[18.36%] women. The complete recovery was observed in 86[43.87%] women, while mortality was seen in 56[28.57%] women

Conclusion: Renal morbidities were more frequently observed in obstetrical emergencies leading to high morbidity and mortality rate

Acute hepatitis E viral infection in pregnancy and maternal morbidity

Objective: To determine the maternal morbidity in pregnant women with acute hepatitis E viral infection

Study Design: Observational, cross-sectional study

Place and Duration of Study: Departments of Obstetrics and Gynaecology and Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Red Crescent General Hospital and Saint Elizabeth Hospital, Hyderabad, from January 2011 to December 2013

Methodology: The study population was pregnant women with acute hepatitis E infection confirmed by ELIZA technique. Pregnant women with other hepatic viral infections were excluded. All medical and obstetric conditions, and mortality were noted on the predesigned proforma

Results: Out of the total 45 admitted pregnant women with hepatitis E viral infection, 22 women [48.9%] had severe morbidity. The most common were hepatic coma in 8 [36.36%] cases and disseminated intravascular coagulation in 14 [63.63%] cases. Highest mortality rate was seen in women with hepatic coma [100%], while in those with disseminated intravascular coagulation, one out of the 14 cases [7.14%] died

Conclusion: The acute viral hepatitis E infection in pregnant women is associated with maternal morbidities and high mortality rate

Elective caesarean section for breech presentation in first pregnancy and subsequent mode of Labour

To determine the effect on subsequent mode of labour in case of previous elective caesarean for breech presentation in primiparous women. A cohort study. Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences, Jamshoro, Unit-1 and 1V, from January 2005 to December 2009. All women with previous one elective caesarean section for breech or cephalic presentation visited OPD for antenatal checkup or admitted in emergency in maternity or labour ward were recruited for the study, while the women with previous 2 and 3 caesarean section were excluded from the study. The case records of these women were reviewed thoroughly, and entered in predesigned proforma. The main outcome measure was mode of labour in current pregnancy decided electively or adopted in emergency. Out of the total, 131 [16.92%] women had previous elective caesarean section due to breech presentation while 643 [83.07%] women had previous elective caesarean section with cephalic presentation. Overall repeat caesarean section rate was 92 [70.22%] in women with previous breech presentation [n=131] in comparison with 475 [73.87%] women with previous cephalic presentation n=643 [RR=1.04, p=0.32]. The vaginal birth rate after elective caesarean section due to breech presentation was 39 [29.77%] in comparison with 168 [26.12%] cases with previous cephalic presentation [RR=0.98, p=0.83]. Women having elective caesarean section for breech presentation in their previous pregnancy had about 1 in 6 chance of having repeat elective caesarean section

Iatrogenic risks and maternal health: issues and outcomes

To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit [ICU] admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41[80.39%], multiparous 29[56.86%], unbooked 38[74.50%], referred from periphery 39[76.47%], common iatrogenic factors were misuse of oxytocin 16[31.37%], fluid overload/cardiac failure 8[15.68%], blood reaction 7[13.72%], anesthesia related problems were delayed recovery 3[5.88%], cardiac arrest 2[3.92%], spinal shock 2[3.92%], surgical problems were bladder injury 5[9.8%], post operative internal haemorrhage 3[5.88%], 37[72.54%] women recovered and 14[27.45%] expired. The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable

Infertility and weight reduction: influence and outcome

To assess the effect of weight reduction in obese infertile women on conception rate spontaneously as well as with ovulation induction and pregnancy outcome. Observational experimental study. Different private clinics at Mirpurkhas, Thana Bola Khan and Hyderabad, Sindh, Pakistan, from March 2008 to February 2011. Infertile women who were obese with the body mass index [BMI] > 30 kg/ m[2] and failed to conceive within 2 - 5 years after taking treatment of infertility for many cycles were inducted. These women underwent life style change program related to exercise and diet for 6 months and in the next 6 months they were observed for spontaneous conception. Those women who failed to conceive were prescribed ovulation induction [clomifene citrate] for the next 6 months and were observed for conception. After conception, they visited regularly during antenatal period till delivery. The data was collected and analyzed on SPSS version 17. The mean decrease in the body index observed was 9.6 +/- 1.23 kg/m[2], spontaneous conception rate was [n = 35, 41.17%] and miscarriage rate was [n = 9, 16.66%]. Weight reduction leads to high spontaneous conception rate as well as with ovulation induction therapy and improves the pregnancy outcome.

Risk factors and complications of puerperal sepsis at a tertiary healthcare centre

To determine the risk factors and complications of puerperal sepsis. This was an observational prospective Cohort study conducted from January 2011 to December 2011 at the Obstetrics and Gynaecology Department Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad, Sindh Pakistan. During this study period, all the women who delivered in this hospital or referred to this hospital within 42 days after delivery with puerperal pyrexia/sepsis diagnosed on clinical examination as well as with relevant investigations were included in the study. Women with other ailments like malaria, typhoid fever and postpartum eclampsia during the puerperal period were excluded. The subjects were registered on predesigned proforma after giving informed written consent. The data was collected and analyzed using SPSS version 17. During this period there were 3316 obstetrical admission and out of these 129[3.89%] women had puerperal sepsis. Most of these women 84 [65.11%] were aged 31 years and above, multiparous 101 [78.29%], and unbooked 98 [75.96%] cases. Common risk factors found were absent membranes in 108 [83.72%] of the women, delivered or undelivered and mismanaged, referred cases 95 [73.64%], are being delivered in this hospital 34 [26.35%]. Morbidities seen were septicemia in 35 [27.13%] cases, and disseminated intra vascular coagulation in 23 [17.82%] cases, while 11 [8.52%] of the women died. Common risk factors were anaemia; suboptimal personal hygiene as well as improper sterilization which resulted in severe health hazards such as septicemia, disseminated intravascular coagulation as well as death

Adverse drug reactions: clinical assessment of drug induced disease

Physicians are often confronted with patients who state that they are 'allergic' to a drug. The goal of this review article is to help physicians to develop management plans for patients who present with drug induced diseases. It provides information that allows physicians to differentiate between reactions that are truly allergic in nature and those that are not immunologically mediated. The suggestions which may be helpful in the assessment are discussed and guidance is provided whether a drug may be safely readministered. Unfortunately until we are unable to thoroughly understand the mechanisms responsible for drug induced reactions, our management tools will remain limited