Role of antenatal checkup on caesarean section rate - study at CMH Attock

Objective: The present study was designed to study the role of antenatal check upon caesarean section [C-Section] rate in patients reporting to labour room

Study Design: Prospective cohort study

Place and Duration of Study: The study was carried out at Combined Military Hospital [CMH] Attock, from Oct 2014 to Mar 2015

Material and Methods: A total of 447 patients who underwent treatment in CMH Attock were included in this study. Patients were divided into two groups: 1] Booked patients - the ones who consulted obstetrician regularly during pregnancy, 2] Unbooked patients - These patients do not consult obstetrician for ante-natal checkup during the pregnancy. The data was collected on a proforma and was statistically analyzed

Results: About 77.85% of the total recruited patients in the study were booked while 22.15% were un-booked. A 37.6% of the booked patients had to undergo caesarian section [c-section] while 62.4% patient underwent spontaneous vaginal delivery [SVD]. Whereas 51.5% un-booked patients had c-section while 48.5% patients underwent SVD. Point two percent and 2.5% of the overall patients had gestational diabetes and anaemia respectively. Three percent of the total pregnant patients were diagnosed as being hypertensive. Patient history revealed that 3% patients had bad obstetrics history and 76.9% of them attended ante-natal clinic

Conclusion: In our set up overall C-section rate was 42.6% but in the booked group the rate was 37.6% as compared to the much higher 51.5% in the un-booked group thus indicating that high C-section rate in the unbooked group contributed in a major way to the overall C-section rate

Clinicopathological review of gynaecological hysterectomies -local experience

To share clinicopathological spectrum of hysterectomies performed at CMH Rawalpindi. A cross sectional descriptive study. This study was carried out at Obstetrics and Gynaecology department CMH Rawalpindi, from October 2010 to June 2012. Total of 54 patients who underwent hysterectomy were selected for the study. Detailed history and examination of the patient pre and post-operatively were carried out to observe the indications and complications of hysterectomy. In total 54 hysterectomies were carried out; all of which with the exception of one were total abdominal. The patients who underwent hysterectomies were in the 4th decade of life. The most common [48%] indication of hysterectomy in our study was found to be menstrual irregularities like menorrhagia, irregular vaginal bleeding, DUB and post-menopausal bleeding give frequently of complication as well. Delayed wound healing was the most common complaint [7%]. Histopathology carried out on the uterine specimen showed adenomyosis 17[31%] being the most common finding. Abdominal hysterectomies carried out in our setup are most commonly done for menstrual irregularities and complication rate is low

Presentations of polycystic ovarian disease- study at a tertiary care hospital

To identify the different clinical and biochemical presentations of patients having polycystic ovarian syndrome. A descriptive observational study. This study was carried out.at Obstetrics and Gynaecology department of CMH Rawalpindi, from October 2010 to Sept 2011. This observational study was conducted to identify the different presentation of patients suffering from polycystic ovarian syndrome. Seventy five cases of polycystic ovarian syndrome who reported in OPD were selected for the study. The patients mostly presented between 20-30 years of age with symptoms of oligomenorrhea, infertility and hirsutism. Ultrasonography showed the morphology of polycystic ovary and deranged FSH, LH and testosterone levels

Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy

We evaluated the effect of low-dose bupivacaine plus fentanyl administered intrathecally in elderly patients undergoing transurethral prostatectomy. Patients were randomly assigned to one of two groups. Group F received plain bupivacaine 4 mg with 25 mg of fentanyl and sterile water to a total of l.5 ml, and Group B received only 0.5% plain bupivacaine 7.5 mg for spinal anaesthesia. Sensory block was adequate for surgery in all patients. The mean level of motor block was higher and the duration of motor block was longer in Group B [p < 0.0001]. Hypotension and shivering were significantly more common in Group B [p < 0.05]. The addition of fentanyl 25 mg to plain bupivacaine 4 mg provides adequate analgesia for transurethral prostatectomy with fever side-effects in elderly patients when compared with the conventional dose of bupivacaine

Pre - emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery

Studies of pre-emptive analgesia in humans have shown conflicting results. This prospective, randomized, double- blind, controlled study was designed to test the hypothesis that a reduction in postoperative morphine consumption can be achieved by tramadol administered after induction of anaesthesia. Ninety Patients were allocated randomly to receive i.v. tramadol [1 mg kgBiops -1] [Group T], morphine [0.1 mg kg -1] [Group M] or saline 2 ml [Group S] after induction of anaesthesia. At pentoneal closure, a standardized [0.1 mg kg -1] morphine loading dose was given to all patients for postoperatrive pain management. Patients were allowed to use a patient-controlled analgesia [PCA] device giving bolus doses of morphine 0.025 mg kg -1. Discomfort, sedation, pain scores, cumulative morphine consumption, and side effects were recorded at 1, 2, 6, 12 and 24 h after the start of PCA. There were no significant differences between groups in mean pain, discomfort, and sedation scores at any study period. Cumulative morphine consumption was significantly lower in Group M at 12 and 24 h after starting the PCA than in Group S. In Group T, it was lower only after 24 h [28% less in Group M and 17% less in Group T; P < 0.017]. There were no significant differences in morphine consumption between Groups T and M. Conclusions. Tramadol [1 mg kg -1], administered after induction of anaesthesia, offered equivalent postoperative pain relief, and similar recovery times and postoperative PCA morphine consumption compared with giving morphine 0.1 mg kg -1. These results also suggest that presurgical exposure to systemic opioid analgesia may not result in clinically significant benefits