Outcome of Pregnancies associated with fibroids

To evaluate the behaviour of uterine leiomyoma, their frequency and impact on the course of pregnancy. It was a descriptive study. Gynaecology and Obstetric Unit, Hayatabad Medical Complex, PGMI, Peshawar. All the patients presenting to antenatal clinic or emergency having a pregnancy associated with fibroids from 1st July 2001 to 30th June 2002. Women diagnosed with leiomyoma during pregnancy were evaluated clinically and the findings were confirmed by ultrasound. Detection of leiomyoma during caesarean section also made the patient eligible for the study. In all there were 76 patients in the study. The size of leiomyoma, the type of leiomyoma, their effect on pregnancy outcome and complications were noted. Patients' obstetric and fertility history was recorded on a questionnaire. The concerned doctors were required to fill a performa regarding the outcome and complications the delivery of such patients. After data collection, the data was analyzed using various statistical tests like percentage, relative risk [R.R], ods ratio [O.R], mean, standard deviation [S.D] and confidence interval [C.I], using soft ware SPSS version 8.0 and Epi-Info 6. Main Outcome Measures: The main outcome measures were noted down as the frequency of spontaneous pregnancy loss, vaginal delivery or the caesarean section. Out of 76 patients [l.9%], 16 underwent spontaneous pregnancy loss [21%, O.R l.16, R.R 1.13, P 0.59], 31 had vaginal delivery [40.8%, O.R 0.21, R.R 0.62, P 0.0000] and 29 had caesarean section [38.2%, O.R 4.71, R.R 2.91, P 0.0000]. The frequency of complicated deliveries was 73.3%. The different complications occurring were antepartum haemorrhage, acute abdomen, laparotomy, preterm labour, dysfunctional labour, retained placenta and retained products of conception. Although abortions, preterm delivery, dysfunctional labour and cesarean sections were common, the neonatal outcome in viable pregnancies was fairly good in women with uterine leiomyomas. Because of increased risk of complications all the patients with leiomyomas having pregnancy should be considered as high-risk cases

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