Safety and efficacy of hyderalzine in hypertensive disorders of pregnancy

To find out safety and efficacy of IV bolus hydralazine in reducing blood pressure in severe hypertension during pregnancy. All pregnant patients with systolic blood pressure 160 or above and diastolic blood pressure 109 mmHg with eclampsia and hypertensive emergencies were included. The initial dose of hydralazine was 5 mg IV bolus then repeated 1mg at 20 minutes interval. Outcome measures to start treatment were, systolic and diastolic blood pressure, time required for achieving the desired BP level, total dose needed, side effects of drugs, maternal and fetal outcome in terms of safety and efficacy. One hundred and ten patients with eclampsia and hypertensive emergencies were included in the study. The mean + SD [range] of maternal age was 26.70 + 6.70[18 -45 years]. Blood pressure before starting therapy was systolic 165.5 + 16.65, and diastolic blood pressure was 115.45 + 8.25mmHg. After starting therapy, a significant difference [P=< 0.001] was observed with fall in systolic blood pressure 131.2 + 9.49 and in diastolic blood pressure 93.68+6.30mmHg. In 94[85.5%] patients, IV bolus hydralazine took 60 minutes, however, in 3[2.7%] > 180 minutes time was required to control the blood pressure. Total dose of drug required was <6mg in 40[38.4%] patients, 6 to 14mg in 44[40%] and in 17[15.5%] women 15 to 20 mg of dose was needed to control the blood pressure. Only 9[8.18%] needed dose between 21 to 30 mg IV bolus hydralazine. Hydralazine is safe and effective in controlling the blood pressure in severe hypertension during pregnancy and after delivery

Pattern of pelvic mass among women attending a gynaecology department of university hospital in Sindh

To analyze patients with pelvic mass according to age, parity, clinical presentation, pathology and operative procedures according to the type of mass, at a tertiary care hospital of Sindh-Pakistan. Descriptive case series. Department of Obstetrics and Gynaecology [Unit I], Liaquat University Hospital, Hyderabad; from January to December 2007. All women of any age and parity presenting with pelvic mass, diagnosed on history, clinical examination and/or on ultrasound were included. Type of pelvic mass was confirmed at surgery and on histopathology. In total, 110 patients were studied. Sixty-one [55.45%] participants were aged between 30-50 years while only one patient was under 20 years and 2 over 70 years. The majority of women were parous. The main clinical presentation was lower abdominal pain in 42 [38.18%] patients, followed by menstrual disturbances in 38[34.54%] women. Eighty-four [76.36%] patients were diagnosed on first clinical examination, and confirmed further by ultrasound. Among all, 104 [94.54%] patients were diagnosed through ultrasound. Sixty-eight [61.82%] patients had genital tract tumors while 4 had non-gynaecological mass. In 10[9.1%] patients, size of mass was >20cm; however, malignant lesions were less common and under 10 cm in size. Every women presenting with pelvic mass irrespective of age and parity must be thoroughly investigated and treated. Non-gynaecological masses may also be diagnosed; therefore, surgeon must be competent enough to deal with these masses

Frequency of grand multiparity and its fetomaternal outcome at Liaquat university hospital, Hyderabad

To determine the frequency of grand multiparity and its effects on maternal and fetal outcome in our tertiary care facility. A descriptive study. Department of Obstetrics and Gynaecology [Unit I], Liaquat University Hospital Hyderabad-Sindh, Pakistan; from 20 February to 20 July 2006. All unbooked and referred grandmultipara women were included in the study. Booked primipara women and women with preexisting medical disorders were excluded. All the information collected on a form by taking history, performing an examination and laboratory investigations was analyzed using SPSS version 10.0. During the study period, a total of 630 deliveries were conducted in our unit and among them 100 [15.9%] women were grand multipara. Most of these women belonged to age group 26-30 years [n=40]. A high frequency of anaemia [90%], followed by antepartum haemorrhage [28%], obstructed labor [21%], postpartum haemorrhage [19%] and hypertension [18%] was found in these cases. Fetal loss was observed in 25% of grand multiparas. Grand multiparity is still a high risk pregnancy in our facility. The causes are complex, multiple and interrelated but mostly preventable. In our study, grand multiparity was also associated with adverse maternal and fetal outcomes. Hence, there is a need for proper pregnancy evaluation and regular antenatal checkup, intrapartum care and postnatal follow up to improve the maternal care in women

Puerperal sepsis: an outcome of suboptimal obstetric care

Objective: to determine the frequency, causative factors and outcome of delivery by trained or untrained personnel

Study design: descriptive study

Setting: this study was done in the Gynaecology / Obstetric Unit-II, Liaquat University Hospital, Hyderabad Pakistan from 1st January 2006 to 30th December 2006

Patients and mehtods: all the patients who developed puerperal sepsis, delivered outside the university hospital were included in this study, while those who were referred as a case of retained placenta, other obstetric related postpartum morbidities like anaemia, puerperal psychosis, breast abscess, UTI, or who developed postoperative surgical problem delivered at university hospital were excluded from study

Results: out of total 2885 maternal admissions 135 patients had various postpartum problems, 61 patients had puerperal sepsis. Majority [67.2%] was less than 30 years of age and 52.5% of low parity. Among study population 67.2% belonged to low scio-economic group and 96% were illiterate. Majority [67%] of women did not receive any level of care, only 9.8% had level 3 care. Patients who had vaginal delivery were 93.4% while 6.6% had caesarean section. In majority of patients [57.4%] high grade fever was the major symptom followed by distension of abdomen in 26.2% . Evacuation of uterus and laparotomy were done in 39.3% , only evacuation of uterus was carried out in 24.6% and 3.3% had hysterectomy. One third [32.8%] had prolonged hospital stay and other one third [32.8%] died inspite of all possible measures

Conclusion: the study conclude that in majority of women sepsis as well as maternal death was preventable. It can be reduced by proper counseling of women about importance of antepartum, intrapartum and postpartum care and training of Dais and refreshing courses of trained birth attendants [TBAs]

Feto maternal outcome among abruptio placentae cases at a university hospital of Sindh

Objective: To determine fetomaternal outcome in women presenting with abruptio placentae at our setup. Design: A descriptive study. Setting: Department of Obstetrics and Gynecology Unit-II, Liaquat University Hospital Hyderabad, Sindh - Pakistan. Study was carried out from January to December 2007

Methods: All patients presenting with antepartum hemorrhage due to abruptio placentae at any gestational age after 28 weeks to term were included in the study. Women having bleeding due to causes other than abruption like placenta previa, vasa previa, carcinoma cervix and other local lesions were excluded. All the data collected through history, examination and investigations were recorded on a predesigned proforma. Data were analyzed using SPSS version 10.0

Results: Total number of cases admitted in labour ward was 2563. Forty-eight [1.87%] women had abruptio placentae. Maternal complications were postpartum hemorrhage [16.6%], disseminated intravascular coagulation [4.16%] and renal failure [6.25%]. Maternal death occurred in 4 women [8.33%]. Adverse fetal outcome was noted in severe cases of abruption. Still birth occurred in 41.6% cases

Conclusion: In our setup, frequency of abruptio placenta is comparable with local and international literature. Incidence of abruptio placenta is high in our women as most of the women belong to poor socio-economic class. Antenatal care plays an important role in decreasing the incidence of abruptio placenta

Frequency of primary amenorrhea and the outcome of treatment at Liaquat university hospital

Objective: To determine the frequency of primary amenorrhea and to enlist etiological factors and outcome of treatment of primary amenorrhea. Design: A descriptive case series. Setting: Department of Obstetrics and Gynaecology [Unit-II] Liaquat University Hospital Hyderabad, Sindh - Pakistan, from January 2006 to December 2007

Methods: All patients presenting with primary amenorrhea were included in the study and patients having secondary amenorrhea including pregnancy were excluded. All the data collected by history, examination and investigations were recorded on a proforma. Data were analyzed using SPSS version 10.0

Results: Total number of patients admitted was 2, 505. Frequency of primary amenorrhea was 0.75%. Imperforate hymen was found in 21.05% cases, pure gonadal dysgenesis in 15.7%, constitutionally delayed puberty in 10.52%, hyperprolactinemia in 10.52%, polycystic ovaries in 5.26%, Turner's syndrome in 10.52% and testicular feminization in 10.52% cases. Patients with constitutionally delayed puberty had spontaneous onset of menstruation. Outcome was good in all patients with cryptomenorrhea. Two of them got married and conceived successfully. The patients with primary amenorrhea due to polycystic ovaries and hyperprolactinemia had resumption of normal menstruation after medical therapy. In patients with testicular feminization, testicular tissue was removed and estorgenprogestogen therapy was given

Conclusion: Primary amenorrhea is one of the important reasons for distress of family and patient herself. Literature review has shown that low frequency and fear of exposure of defect may be the reason for not seeking medical advice. In our setup too, these observations were found. Patient awareness and the proper counseling of parents regarding the treatment options available and need for follow up can help in deciding the sex of rearing and even restoring the fertility in many of these women