Three-year prospective study of the prognosis of cardiomyopathy with pregnancy and its outcome at a single institution

To describe the characters of pregnancy with cardiomyopathy and its outcome. A case series study. This study was done in the Armed Forces institute of Cardiology [AFIC] and Military Hospital Rawalpindi from October 2003 to October 2006. The study of case series consisted of thirteen consecutive women who were admitted with diagnoses of Cardiomyopathy with pregnancy. For the diagnosis of Peripartum Cardiomyopathy [PPCM], strict 4 point criteria were used. During the study period we managed a total of 13 pregnancies with Cardiomyopathy as outdoor cases, 08 with PPCM 4 with hypertrophic Cardiomyopathy and one due to thyroid disease. The number of patients were only 11 as 2 were back again within a year. We had one mortality with peripartum Cardiomyopathy who presented within 20 days of delivery with sudden cardiac failure. For peripartum Cardiomyopathy the average age at presentation was 28 years. Most patients presented with dyspnoea 4 cases, palpitations 7 and one patient with syncope. Left Ventricular Ejection Fraction [LVEF] was 0.35 on the average. The time of diagnosis was antepartum for three patients and postpartum for five. There were no cases of multiple pregnancies in this series. In hypertrophic cardiomyopathy majority of the patients had caesarean sections, less so in other categories. These were performed under general anaesthesia due to uncertainty about the safety of regional anaesthesia in these cases. Cardiomyopathy is a poorly understood ominous complication of pregnancy. It accounts for a rising proportion of maternal mortality. Diagnosis should be considered whenever women present with heart failure in peripartum period. Improved case ascertainment requires heightened awareness among obstetricians and cardiologists

Abdominal sacrocolpopexy vs vaginal sacrospinous ligament fixation for vaginal vault prolapses

To compare the success rate and outcome of two operations for vaginal vault prolapses-Vaginal Sacrospinous Ligament Fixation [SSL] versus Abdominal Sacrocolpopexy [SCP]. Prospective randomized controlled trial. Department of Obstetrics and Gynaecology CMH Peshawar between Jan 99 to Sep 2003 and Department of Obstetrics and Gynaecology MH Rawalpindi between Sep 2003 to Feb 2008. Thirty Women were randomly allocated to either procedure. There were a total of 15 patients in either arm. Follow up was at 3 and 6 months. Thirty women with vault prolapse were selected and out of these, 15 each were randomized to SSL and SCL. The mean age of women was 54 years [range 42-70], mean weight 68 Kg [range 50-95 Kg], the duration of surgery was longer for SCP [46.1 versus 75.3 min, [p<0.001] versus SSL. Average blood loss was also more for SCP versus SSL [320.2 versus 407 ml [p<0.001]. Post operative hospital stay was less for SSL [3.4 days] versus SCP [6.1 days] [p<0.001]. Regarding symptoms of persistent prolapse at 3 and 6 months only one patient had symptoms in sacrocolpopexy arm due to cystocoele. There was no evidence of recurrent vault prolapse. Objective assessment of prolapse was superior for abdominal surgery, but patient satisfaction was equal. Anatomical result of abdominal procedure seemed superior with vault mean vaginal length [5.09 versus 6.8 cm [p<0.001], but sexual function was preserved equally in both h arms. SSL is a patient friendly operation with shorter operation time and hospital stay. The anatomical results of SCP seem superior whereas functional results were equal in both arms

Adolescent ovarian tumors: a clinicopathlogical review of 15 cases

To prospectively review the clinicopathologic pattern and out come in 15 patients with adolescent ovarian tumours in Military Hospital Rawalpindi between Jan 2004 to Sep 2007. All cases of adolescent ovarian tumours reporting to the gynaecology department of Military Hospital Rawalpindi during the period of enrolment. Out of 15 cases 12 were managed surgically. Data was recorded regarding clinical presentation, patient's age, size of tumour, bilaterality, histopathology, staging if tumour was malignant and sites of extra ovarian involvement. All patients were followed up for one year. Majority of patients fell in the subgroup 14-16 year age. Majority harboring ovarian malignancy belonged to subgroup 17-19 years. Clinical presentation in the majority was mass abdomen and abdominal distension. Approach was transcutaneous in 3 [20%], laparoscopic in 2[20%], and open laparotomy in 10 [60%]. Frozen section was performed in 3 cases. Histopathology was benign in 11 cases and malignant in 4. In 3 cases cyst fluid was negative for malignancy. In 2 cyst wall biopsy and one patient where entire cyst was removed histopathology revealed benign serous cyst adenoma/luteal cyst [26%]. There were 5 cases of dermoid cysts [33.3%], one patient had bilateral dermoids, one malignant and one benign. All 4 malignancies were found to be to non-epithelial on histopathology. One case had surgery twice. Unilateral oopherectomy followed by recurrence and total abdominal hysterectomy and contralateral salpingo-oopherectomy after 2 years. This study shows the preponderance of non-epithelial tumours and high percentages of malignant germ cell tumours in adolescents. The incidence of malignant tumours in adolescents is higher than in adults. Early correct diagnosis could be reached by careful physical examination, imaging and tumour markers Surgery should as much as is safely possible be fertility preserving

Postcoital bleeding in women attending a tertiary care hospital

To document the frequency of different pathologies in women with postcoital bleeding. To determine the frequency whether abnormal bleeding with positive cervical smear increases the risk of serious pathology. Descriptive study. Military Hospital Rawalpindi from 1st June 2000 to 30th June 2002. A descriptive study was carried out in Military Hospital Rawalpindi from 1st June 2000 to 30 June 2002. A total of 157 Women were included in the study. The inclusion criteria were women with postcoital bleeding and having positive cervical smear along with abnormal bleeding. Evaluation was done by a detailed history followed by cervical smear, followed by colposcomic examination as well as cervical and endometrial biopsies and in some cases vaginal biopsies. The main outcome measure was histopathological diagnosis. Eight women [5.1%] had invasive cancer. Five were cervical, one vaginal cancer and two endometrial cancer. Five of the 6 cervical or vaginal cancers were clinically apparent. One woman of the 6 had a normal smear before being further investigated for Postcoital bleeding. Cervical intraepithelial neoplasia was found in 15 women [9.6%] and 7 women [4.4%] had cervcal polyp. No explanation for the postcoital bleeding was found in 89 women [56.7%]. Invasive cancer is rare in women with postcoital bleeding. Postcoital bleeding should be regarded as an indication of high risk so all women must undergo colposcopic examination

Outcome of twin pregnancy in unbooked cases

A descriptive study was carried out to assess the outcome of twin pregnancy in unbooked cases. This study was conducted in Military Hospital, gynae department, Rawalpindi, over a period of 1 year from 1 July 2002 to 31 June 2003. Total of 60 patients with twin pregnancy was included. The inclusion criteria were all unbooked cases that had completed twenty-eight weeks of pregnancy with twin gestation. Evaluation was done by detailed history and data was collected. Antenatal, intrapartum and postnatal complications as well as perinatal mortality and morbidity were noted. All 60 cases were unbooked. Majority came from distant places and belonged to age group of 20-40 years. The rate of instrumental deliveries was 30% and frequency of caesarean section was 41.6%. Obstructed labour occurred in 4 patients [6.6%], and postpartum haemorrhage occurred in 9 patients [15%] the perinatal mortality was high in twin pregnancy as compared to singleton pregnancy. Twin pregnancy is a high risk pregnancy. Diagnosis before delivery is important. The patient should be provided with sufficient information regarding advantages of regular antenatal visits

Evaluation of cases reporting with bleeding per vagina during first 20 weeks of gestation

A descriptive study was carried out to determine prevalence of vaginal bleeding in pregnancy till 20 weeks of gestation to find out the causes and management of such cases. Out of the total 13200 pregnant patients admitted in the gynecology ward from January 1999 to December 2000, 1494 patients [11.3%] presented with bleeding in early pregnancy. The prevalence of bleeding before 20 weeks was calculated to be 11.3%. Amongst these cases, 1434 [95.9%] were abortions, 28 [1.87%] ectopic, 22 [1.47%] molar and 10 [0.66%] were due to local causes and trauma. The highest frequency of bleeding was in the first trimester, 81.7% as compared to 18.2% in the second trimester. The prevalence of abortion was 10.8% in this period. Women between 26-35 years of age experienced more abortions. The percentage of abortion increased as the parity increased. 42.5% and 30.3% abortions in fourth and fifth pregnancies respectively. The previous history of abortion 632 [44%] and the last pregnancy abortion 591 [41.2%] were the significant factors in the past obstetric performance of the patients. The main maternal risk factors were medical problems in 307 cases [21.4%], treatment for infertility in 265 cases [18.47%] and use of contraception in 266 patients [18.5%]. No cause was found in 200[13.9%] patients. The bleeding was conservatively managed in 345 cases and the pregnancy progressed in 108 patients. 101 women underwent dilatation and curettage for missed abortion and 695 evacuation and curettage for incomplete abortion. Laparotomy for ectopic was done in 28 females and suction curettage was carried out for molar pregnancy in 22 patients

study of 65 cases of ectopic pregnancy during one year period in military hospital

A one-year study from May 1999 to April 2000 of 65 cases of ectopic pregnancy was conducted in Military Hospital Rawalpindi. Total number of deliveries during this period was 6214. The incidence of ectopic pregnancy in this study was 1.04 i.e. one in 95 normal intra uterine pregnancies, an incidence higher than 1 in 150 in British Statistics. The commonest presenting symptom was abdominal pain [100%], and adnexal tenderness [95.3%]. All 65 cases were tubal ectopic, 59 were ampullary and 6 were at isthmus. 36 patients had unilateral salpingo-opherectomy, while 28 had unilateral salpingectomy. One patient had unilateral salpingectomy with ligation of second tube. There were no maternal deaths