Ultrasonography; Its value in the management of first trimester vaginal bleeding

To find the value of ultrasound in the management of first trimester vaginal bleeding. All patients reporting with vaginal bleeding in obstetrics and gynaecology Unit-Ill, Nishtar Hospital, Multan were included in the study. Non-pregnant patients and patients with vaginal bleeding due to the cause other than conception were excluded. After history, clinical examination and pregnancy test, ultrasonography was done with abdominal convex probe [3.5 Mhz] and/or vaginal [5 Mhz] probe to every patient. Overall incidence of first trimester vaginal bleeding was 12.23%. Disparity between clinical and ultrasonic diagnosis was 17.3% in cases of incomplete abortion, 11.6% in cases of inevitable abortion, 9.7% in cases of threatened abortion, 3.8% in cases of missed abortion and 1.9% in cases of lghted ovum and 1.9% in cases of molar pregnancy. The confirmation of diagnosis after histopathology of surgically obtained specimen revealed least percentage of misdiagnosis on ultrasound evaluation. While in ectopic pregnancy no disparity found on clinical, ultrasonographic and surgical results, but it was misleading as only late cases with ruptured ectopic pregnancy and obvious clinical signs and symptoms were referred to the hospital. Otherwise USG would have shown increased sensitivity and specificity. Study has confirmed the superiority of USG scanning over conventional methods in earlier and more precise diagnosis and thus better treatment of patients having first trimester vaginal bleeding. It is more accurate, safe, non-invasive and quick in diagnosis and management. It prevents from undue surgical intervention as well as undue delay in surgery when required. Once bleeding has occurred repeat pregnancy test should he ignored and better not done at all, Thus USG should he an important diagnostic tool in every emergency unit but importance of clinical diagnosis cannot be overlooked

Prevailing cases of genito-urinary fistulae in Multan

To find out the trend of causation of urinary fistula amongst female in Multan. Descriptive study. Obstetrics and Gynaecology Unit-II, Nishtar Hospital, Multan. Prospective data from March 2004 to March 2005 from Gynaecological admission. All patients of genito-urinary fistula were included. Out of 2350 patients, 10 were diagnosed as a case of urinary fistula with predominance of [80%] vesicovaginal fistula. Latrogenic causes were found to be 50% while obstetric cause, were also 50% showing increasing trend towards iatrogenic causes. Mean age of patient was 34 years and parity 4. Size was 1-3.5 cm. success rate was 90%. Iatrogenic fistulae are increasing for last many years. Attempts should be made to make strategies to at least decrease this dilemma