Efficacy of umbilical artery doppler in detection and management of intrauterine growth retardation

To evaluate the efficacy of doppler flow study in umbilical artery in the diagnosis and management of fetal growth retardation in small for gestational age fetuses detected by clinical examination. Descriptive case series.This study was conducted at the Department of Obstetrics and Gynecology, Nishtar Hospital Multan from September 20, 2007 to June 19, 2008. Subjects were selected from clinically diagnosed pregnant ladies visiting antenatal clinic or admitted in labour. Umbilical artery doppler flow study was done and perinatal outcome was assessed. On the basis of umbilical artery doppler flow study, the subjects were categorized into abnormal [group A] or normal [group B]. Perinatal outcome of both these groups was compared on the basis of criteria mentioned in the proforma. Out of 50 patients, 21 [42%] patients were having abnormal umbilical artery doppler flow study [Group A] and 29 [58%] patients were having normal umbilical artery doppler flow study [Group B]. Emergency cesarean section, Preterm delivery, Low birth weight, admission of newborn to nursery, Low Apgar score [

Role of PH and leukocyte count in prediction of preterm labour

The objective of this study was to determine the significance of pH and leukocyte count in the prediction of preterm labour. Case control study. This study was carried out at Department of Obstetrics and Gynaecology Nishtar Hospital Multan from 01-04-2008 to 30-09-2008 and 01-11-2008 to 01-05-2009. Women seeking antenatal care at outpatient department of Obstetrics and Gynaecology, Nishtar Hospital Multan between 22-28 weeks of gestation with singleton pregnancy were enrolled in this study. Vaginal pH was measured using a pH paper and leukocyte count by making a slide of vaginal secretions from posterior fornix and were sent to pathologist for counting number of leukocytes. Women with high pH and leukocyte count were enrolled to group A [cases] and those having normal pH were included in the group B [controls]. These women were followed till delivery and the number of women going into preterm labour were counted and matched with the results of pH and leukocyte counts. Mean age was 25.80 +/- 48 years in cases and 24.61 +/- 0.56 years in controls. Low socioeconomic status was evident in 43 [61.43%] cases and 34 [48.57%] controls, while 27 [38.57%] case and 36 [51.43%] controls had middle socioeconomic status. Preterm labour was observed in 42 [60%] cases and 7 [10%] controls, while preterm premature rupture of membrane was evident in 30 [42.86%] cases and 9 [12.86%] controls. Mode of delivery was vaginal in 44 [62.86%] cases and 54 [77.14] controls. 26 [37.14%] cases and 16 [22.86%] controls had lower segment caesarean section. Significantly more number of women with elevated pH and leukocyte count likely to have preterm delivery

Placenta previa major degree; obstetrical risk factors and maternal outcome

Placenta previa is implemented in lower uterine segment. Haemorrhage is likely to happen on digital examination. Causes of placenta previa have strong association with advanced maternal age multiparity, multiple gestation and previous caesarean section, spontaneous and induced miscarriage, smoking and cocaine abuse. Maternal and fetal well being was assessed by general physical examination. Management plan was according to diagnosis. Descriptive study. This study was conducted at Gynae Unit 3, Nishtar Medical College / Hospital, Multan from. Fifty patients who were booked and fifty were un-booked and their ages were between 20-39 years and they were diagnosed case of major degree placenta previa were taken. Risk factors and maternal outcome was seen through Performa. Total number of deliveries during study period was 4826, 98 patients 2% presented with APH and 50 [51%] patients were diagnosed having major degree placenta previa. Different maternal complications seen during Antenatal, Inter operative and Post-operative period. Operative complications were bladder injury in 1 [2%] cases, DVT in 1 [2%] cases, 2 [4%] cases of pulmonary embolism. Four patients had PPH, one required caesarean hysterectomy, three settled with conservative measures like syntocinon and PGF[2] alpha. There was a significant trend between increase in incidences of placenta previa and number of C-sections. The study has clearly identified the association between increase maternal age and incidence of placenta previa with increasing number of C-section. Clinical judgement and skill in the performance of C-section D and C and other forms of uterine invasive techniques may help to keep subsequent incidence at a reasonably low rate. Family planning should also be emphasized as a strategy towards reduction of parity and C-section rate and incidence of placenta previa

Prevalence of gross congenital malformations at birth in the neonates in a tertiary care hospital

To determine prevalence, pattern of distribution of congenital anomalies in newborn. Cross-sectional observational study. This study was carried out in the Department of Gynecology and Obstetrics, Ward 18, Nishtar Hospital, Multan. This was a cross sectional study. All the women giving birth to babies included. Demographic details, associated risk factors and the type of congenital anomalies in babies were recorded. Diagnosis of congenital anomalies was based on clinical evaluation of newborn by experienced neonatologist. A total of 611 consecutive neonates delivered in Nishtar Hospital Multan, were subjected to full clinical evaluation. Social data included parental consanguinity and social class. The prevalence of malformations in the 611 hospital live births and stillbirths was 2.95%. Malformed neonates [18] were classified into 06 groups according to the system affected using World Health Organization classification of congenital malformations. The most common anomalies were: central nervous system [38.88%], cleft lip and cleft palate [11.11%], musculoskeletal system [5.55%], ear, face and neck [5.55%], gastrointestinal tract [5.55%] and having more than one defect [33.33%].Parental consanguinity was found in 31.79% of all cases and in 55.5% of malformed cases, thus illustrating the deleterious effects of consanguinity. The commonest associated risk factor was consanguineous marriage the frequency of which may be reduced by creating awareness regarding the avoidance of consanguineous marriages. CNS related malformations were the most prevalent anomaly detected and early prenatal diagnosis is helpful in decreasing the indirect prevalence of perinatal mortality by offering early termination

Uterine torsion in twin pregnancy

A young married women in her 3rd ongoing pregnancy, having no alive issue presented at 37+ weeks with labor pains. Cesarean section was planned because of twin pregnancy and past bad obstetrical history. During operation, the uterus was found to have rotated to 180 degree to the right. A transverse incision was made on posterior wall of uterus to deliver babies. After suturing the incision site, the uterus was repositioned in right place. This paper presents a case of torsion of gravid uterus in which the delivery and repositioning of the uterus was successful