Recurrent strokes secondary to moyamoya phenomenon in a child with Down's syndrome

A 6 year-old girl with Down's syndrome presented to the paedriatic emergency department with sudden onset weakness of the left half of body. Evaluation leads to the eventual diagnosis of stroke secondary to Moyamoya syndrome. This is an unusual presentation of stroke and highlights the need to expand the differential diagnosis to include rare diseases in children with predisposing conditions. This case highlights the relationship between trisomy 21 and Moyamoya syndrome

Pattern of cesarean delivery in Bolan medical complex hospital Quetta

Objective: To analyze contemporary practices of cesarean section [CS] at a public sector hospital

Study design: A retrospective study

Place and Duration of study: A Department of Obstetrics and Gynecology Unit-4, Bolan Medical Complex Hospital Quetta, from January 2011 to December 2015

Methodology: In this study clinical records of all the patients who underwent cesarean section were reviewed. This included booked, un-booked or referred cases. Data regarding the indications, type of cesarean deliveries and demographic features as well as outcome were noted

Results: Out of 27791 total births, 2951 were cesarean deliveries, giving a cesarean section rate of 10.6%. The highest number of CSs were performed in multigravidas [54%] followed by primigravida [28.5%] and grand multigravida [17.5%]. The commonest indication for CS was previous cesarean section [50.1%] in which previous one LSCS was 29.9% and previous two or more LSCS were 20.2%. Other common indications were obstructed labor [12.1%], cephalo-pelvic disproportion [CPD - 6.1%], placenta previa [5%], labor dystocia [4.7%] and breech presentation [4.7%]

Conclusions: Previous ceserean section was the commonest indication for CS. Multigravida ranked highest among women who underwent CS. The ceserean section rate in this study was 10.6 indicating better obstetric care

Successful conservative treatment of emphysematous pyelonephritis in a diabetic patient

Emphysematous pyelonephritis is an uncommon condition, with severe potentially fatal necrotizing pyelonephritis due to gas producing organisms [generally gram negative bacilli, esp. E. coli, proteus, pseudomonas, enterobacter and klebsiella].It occurs usually in elderly diabetics with poor glycemic control and frequently associated with ureteric obstruction. Though most of the patients still require nephrectomy albeit improvement in medical treatment, we present a case of successful conservative treatment of emphysematous pyelonephritis in a diabetic patient

Management of patients with uterine rupture

To find out the frequency, predisposing factors, maternal and fetal outcomes and mode of management of uterine rupture at a tertiary care hospital. Descriptive case series. Department of Obstetrics and Gynaecology Unit-4, Bolan Medical Complex Hospital Quetta, from January 2001 to December 2012. All patients who presented with ruptured uterus during labor were included in the study. Data on various variables were recorded. This included patient related demography, obstetrical history of previous and present pregnancy and care during labor, hospital course, surgical procedure performed and maternal and fetal outcome. Out of 38,747 deliveries, 201 cases of ruptured uterus were dealt with. This constitutes a frequency of ruptured uterus as 1 in 193 deliveries. Predisposing factors noted were lack of antenatal care [n=180, 90%], grand multiparity [n=100, 49.7%], injudicious use of oxytocin or misoprostol [62.7%], uterine scar [n=74, 36.8%] and residing more than 100 km from tertiary care hospital [n=69, 34.3%]. Of the total 41 [20.4%] patients had subtotal abdominal hysterectomy, 60 [29.8%] had repair of ruptured uterus with bilateral tubal ligation and 93 [46.3%] had repair of uterus only. Bladder repair was done in 7 [3.5%] patients. Eighteen maternal deaths occurred in this series. Perinatal mortality was 86.7% [n=185]. Uterine rupture remained one of the major causes of maternal and newborn morbidity and mortality. Use of oxytocin, misoprostol and herbs during labor and lack of monitoring were important observations

Internal podalic version still has a role in the management of transverse lie

To analyze the cases of undiagnosed transverse lie presented in labour room of BMCH which were managed by IPV or LSCS, thus emphasizing the continuing importance of IPV in the developing countries. To study the role of internal podalic version in the management of undiagnosed transverse lie presenting in active labour. Retrospective case series study. This study was carried out at the Department of Obstetrics and Gynecology Unit-I, Bolan Medical Complex Hospital Quetta, Baluchistan, from January 2001 to December 2012. This is a retrospective case series study of 144 cases of transverse lie who presented in active labour. The relevant data of 11 years was collected from the labour ward register and was analyzed. There were total 144 cases of undiagnosed transverse lie that came to hospital out of which 74[51.38%] were managed by internal podalic version and cesarean section was performed in 70[48.62%] cases. None of them had any form of antenatal care. 44[30.55%] of them were 2[nd] twin. Internal podalic version still has a role in the management of transverse lie. It is almost always successful in the delivery of second twin but singleton pregnancies can also be delivered with this skill if proper patient selection is done. It has shown a good maternal and fetal outcome