Manual Vaccum Aspirator: a changing trend

Objectives: to compare manual vacuum aspiration [MVA] and uterine curettage [DandC] for first trimester abortions, in terms of the frequency of complications, incomplete procedure, blood loss, duration of patients' hospitalization and patient satisfaction

Methods: in a prospective study, 100 patients in the MVA group A and 100 in the DandC group B were randomly included. Inclusion criteria included patients with missed or incomplete miscarriage at gestational age less than 12 weeks calculated from last menstrual period. In case of incomplete miscarriage, endometrial thickness should be more than 16mm on endovaginal scan. Pre evacuation hemoglobin more than 1 Og /dl, afebrile state. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Both groups were evaluated intra and post operatively as regard to: uterine perforation, blood loss [pre and post hemoglobin], pelvic infection, retained products of conception [incomplete procedure] duration of hospitalization and patients satisfaction

Results: characteristics of the study population at enrollment were similar in two groups regarding age, gestational age in weeks and ultra-sonographic parameters and indications for procedure. However more patients in group A are multigravida whereas more patients in group B are either primigravida or para 1 or 2. Both groups showed the same efficiency in emptying of the uterus with 6 incomplete procedures in group A and 4 incomplete procedures in group B [p value>0.05].1 uterine perforation was observed in group A and 3 in group B [p value<0.02].There were 2 cases of pelvic infection in group A and 4 in group B [p value>0.05]. In the patients who have undergone the uterine curettage, the duration of hospital stay was on average, 18.32 hours [+/- 8.01], and in the patients who underwent vacuum aspiration the mean time was 7 .12 hours [+/- 1.44] [p <0.0001]. All the patients who had manual vacuum aspiration are satisfied with the modality whereas patient satisfaction rate was 95% in group B who had curettage [p value<0.0001]. The decrease in hemoglobin rates was higher in the Group of patients subjected to uterine curettage, i.e. from 12.44mg/dl to 11.39mg/dl as compare to patients subjected to MVA i.e.from12.55mg/dl to 11.92mg/dl [p value<0.0001]

Conclusions: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization

Effect of obesity on obstetrical practice and outcome

Objective: to find out frequency of various pregnancies related complications in obese and to compare these with non-obese females in our set up

Material and Methods: this cross sectional study was conducted in department of Gynecology and Obstetrics, Fatima Memorial Hospital, Lahore. Sixty pregnant females with singleton pregnancy were selected. Women with BMl >30 were taken as obese and those less than 30 were taken as non-obese. Complications like gestational diabetes, hypertension, induction of labour, delay in second stage of labour, instrumental vaginal deliveries or operative deliveries, third or fourth degree perineal tear, wound infection and thromboembolism were assessed in all patients

Results: the mean age in group A was 25.31 +/- 2.9 years and in group B was 25.0 +/-2.7 years. The complications during pregnancy were as follows: gestational diabetes and gestational hypertension were found in 6 [20%] and 14[44.7%] in group Awhile 3 [10%] and 1 [3.3%] in group B respectively. 16 [53.3%] patient had induction of labour in group A and 8 [26.7%] in group B. In group an only 8 [26.7%] patients had spontaneous vaginal delivery [SVD], 7 [23.3%] patients delivered by instrumental vaginal deliveries and 15 [50%] patients underwent Caesarean section. In group B, 18 [60%] were delivered by SVD, 4 [13.3%] had instrumental vaginal delivery and 8 [26.7%] had caesarean section. Third degree perinea! Tears occurred in 6 patients from group A and 5 patients from group B. Fourth degree perinea! Tears occurred in four patients only from group A. During postpartum period seven patients from group A and two patients from group B had wound infections. One patient from group A had thromboembolism

Conclusion: obese pregnant patients have more complications during pregnancy, delivery and postpartum period than non-obese pregnant women

Diagnostic accuracy of spot urinary protein: creatinine ratio for quantification of Proteinuria in hypertensive pregnant women

Objective: To determine the diagnostic accuracy of spot urinary protein-creatinine ratio keeping 24 hours urinary protein as gold standard in hypertensive pregnant women. Design: Cross Sectional Analytical Study

Place and Duration of Study: Department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Lahore during July 2009 to December 2009

Patients and Methods: Urine collection for 24 hours was performed in 101 pregnant women with hypertensive disorders of pregnancy. Protein-creatinine ratio in spot urine sample was determined keeping 24 hours urinary protein as gold standard. Sensitivity, specificity, false positive and false negative rate along with diagnostic accuracy was calculated from data

Results: Sixty five of the included women were recorded positive on the basis of twenty four hour urinary protein > 0.30 mg/dl cutoff. The protein creatinine ratio on the basis of cutoff value 0.33, detected 50 cases as positive. The sensitivity of protein creatinine ratio was found 73.8%, and specificity was 94.4%. The diagnostic accuracy was found to be 81.2%

Conclusion: Random spot protein creatinine ratio is accurate, reliable and steadfast, time saving test for diagnosis of preeclampsia and it can substitute 24hours urinary protein excretion estimation in clinical practice

Impact of obesity on obstetrical practice and outcome

To find out the complications occurring during pregnancy, delivery and in post partum period in obese and non-obese pregnant women. This cross sectional study was conducted in Department of Gynaecology and Obstetrics, Fatima Memorial Hospital, Lahore. Sixty pregnant females with singleton pregnancy were selected. Women with BMI>30 were taken as obese and those less that 30 were taken as non-obese. Complications like gestational diabetes, hypertension, induction of labour, delay in second stage of labour, instrumental vaginal deliveries or operative deliveries, third or fourth degree perineal tear, wound infection and thromboembolism were assessed in all patients. The mean age in group A was 25.0 + 2.9 years and in group B was 25.0+2.7 years. The complications during pregnancy were as follows: gestational diabetes and gestational hypertension were found in 6 [20%] and 14 [44.7%] in group Awhile 3 [10%] and 1[3.3%] in group B respectively. 16 [53.3%] patient had induction of labour in group Aand 8 [26.7%] in group B. In group Aonly 8 [26.7%] patients had spontaneous vaginal delivery [SVD], 7 [23.3%] patients delivered by instrumental vaginal deliveries and 15 [50%] patients underwent Caesarean section. In group B, 18 [60%] were delivered by SVD, 4 [13.3%] had instrumental vaginal delivery and 8 [26.7%] had caesarean section. Third degree perineal tears occurred in 6 patients from group A and 5 patients from group B. Fourth degree perineal tears occurred in four patients only from group A. During postpartum period seven patients from group Aand two patients from group B had wound infections. One patientfrom groupAhad thromboembolism. Obese pregnant patients have more complications during pregnancy, delivery and postpartum period than non-obese pregnant women