Grand multiparity and maternal outcome in absence of adequate antenatal care

Objective: To find out the effect of grand multiparity on maternal outcome in absence of adequate antenatal care

Methodology: All un-booked grand multipara with singleton pregnancy at term admitted to Gynae A Unit, Lady Reading Hospital Peshawar were included in the study. Cross sectional study was carried out from 1st June 2012 to 1st Dec 2012. Assessment was done by detailed history, general physical examination, per-abdominal and per-vaginal examination and by obstetrical ultrasound. Mothers were assessed for antenatal and obstetrical complications, mode of delivery and post-partum complications

Results: A total of 50 patients were included in the study. Regarding antenatal complications 6[12%] patients had anemia, 2[4%] had pregnancy induced hypertension, 4[8%] had pre-eclampsia, 2[4%] had eclampsia and 36[72%] didn't had complications. Regarding obstetrical complications 3[6%] patients had placenta previa, 3[6%] had placental abruption, 7[14%] had mal presentation, 3[6%] had obstructed labor and 34[68%] didn't had complications. Regarding post partum complications 5[10%] patients had post partum hemorrhage due to uterine atony, 4[8%] had post partum hemorrhage due to retained placenta, 2[4%] had perineal tears, 3[6%] had subtotal hysterectomy and 36[72%] didn't had complications

Conclusion: In the absence of adequate antenatal care, there was increased likelihood of perinatal complications in grand multiparous women

Renal colic patient; comparison of un-enhanced helical computed tomography, intravenous urography and ultrasound + Plain X-Ray"

To compare Un-enhanced Helical Computed Tomography [UHCT], Ultrasonography [US] + Plain X-Ray and Intravenous Urography [IVU] in the evaluation of patients with suspected renal colic. In 70 patients with renal colic US, plain X-ray, IVU and UHCT were performed to demonstrate urinary stones and other relevant pathologies. Patients were then followed-up to stone passage or removal, and the course of clinical symptoms were noted. 57 patients had ureteral stones based on stone passage or removal. 13 patients did not have ureteral stones based on failure to recover a stone, disappearance of symptoms, and diagnosis unrelated to stone disease. Un-enhanced helical computed tomography was found to be the most useful method in the demonstration of ureteral stones with a sensitivity of 97%. Reformatted images clearly depicted the intraureteral location of stones in most cases. Spiral UHCT showed renal calculi in 15 patients, USG + KUB in 12 and IVU in 9 patients. Non-contrast axial and reformatted spiral CT [UHCT] images were found superior to USG + KUB and IVU in the depiction of ureteral and renal calculi. Reformatted images offer a good alternative to IVU in problematic cases

Is there any impact of employment status on premenstrual symptomatology?

Objective: to find out the difference between various premenstrual symptoms in employed and unemployed women

Methodology: this was a cross sectional, prospective, comparative study conducted from May 2010 to April 2011, in Emergency and Out Patient sections of Obstetrics and Gynecology department, Lady Reading Hospital, Peshawar. By purposive non-probability sampling technique, 150 subjects were selected among attendants of regular patients, after fulfilling inclusion criterion of employed and unemployed women, in age group of 15-40 years. Premenstrual symptoms were recorded as, Quantification of severity of psychological, social and physical symptoms, for two consecutive symptomatic cycles. SPSS 16.0 was used to analyze the data. Chi-Square test was used to compare the premenstrual symptoms between employed and unemployed women. P value

Results: a total of 150 female patients recruited in the study. Out of these 50.7% [n=76] were employed and unemployed were 49.3% [n=74]. Mean age was 26 +/- 6.2 years [15-45]. Overall 72% [n=109] of subjects were symptomatic with one or more premenstrual symptoms. Psychological symptoms were found in 68 of 150 women [45%]. About 50% of women in the employed group had psychological symptoms as compared to 40% in the un-employed group. Social symptoms were present in 64 of 150 women [42%]. About 36 out of 76 employed women [47%] whereas 28 out of 74 un-employed women [37%] reported social symptoms. Physical symptoms were present in 89 of 150 women [59%]. These were present in 43 out of 76 employed [56%] and 46 out of 74 un-employed women [62%]

Conclusion: the results suggest that the distribution of premenstrual symptoms does not vary significantly between employed and un-employed women. Although different groups of females may have different manifestations, these are not statistically significant to emphasize the role of environmental factors in its causation

Isolated bilateral zygomatic arch fracture; an unusal case

Zygomatic fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton hence it is frequently exposed to fractures. This case report presents an isolated bilateral zygomatic arch fracture that was been reduced by Gille's temporal approach and stabilized using foley's balloon catheter. This study highlights the importance of early diagnosis and timely treatment to reduce the morbities

Abnormal cardiotocography; perinatal outcome

To observe the effect of abnormal Cardiotocography to delivery interval on perinatal outcome in terms of Apgar score. Descriptive case series study. Baqai Medical University department of obstetrics and gynecology Fatima Hospital Karachi from Jan 2011 to July 2011. One hundred patients were registered who had pathological Cardiotocography. Bishop's score was noted and decision to deliver the patient was made according to the abnormality, and bishop's score. If bishop's score was good and vaginal delivery was imminent, then her second stage was shortened by operative vaginal delivery. Fetal distress was managed by left lateral position, O2 inhalation and hydration. If delivery was not imminent then decision of urgent LSCS was made, meanwhile fetal distress was managed. Decision - delivery interval was recorded, and fetal outcome was noted in terms of Apgar score and resuscitation needed. During this period one hundred pregnant women at term had pathological CTG for which they were delivered urgently. Among them 12% of parturients were delivered within 30 min, 68% delivered within 30-60 min, 12% delivered in 60-90 min and only 8% were delivered in 90-120 min. Seventy four [74%] of parturients were delivered by emergency lower segment caesarean section and 26% of parturients were delivered by instrumental vaginal delivery. Fetal outcome in terms of 1 min Apgar score, 38% of neonates had Apgar score of <7, 46% had >7 and 16% had Apgar score of <5. This group of neonates required resuscitation and 5 min Apgar was good. No neonate was admitted in Neonatal unit. In this study it is concluded that with fetal heart rate abnormality, if fetus is delivered within 60 min, it is not associated with poor fetal and neonatal outcome, provided fetal distress is managed while preparing for emergency lower segment caesarean section

Gynaecological hysterectomy; an audit in tertiary care hospital

Objective: To audit indications and outcome of hysterectomies in Fatima Hospital Baqai Medical University Karachi so as to improve the quality of care provided to patients. Study Design: Descriptive observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Fatima hospital, Baqai Medical University Karachi from November 2009 to November 2011

Patients and Methods: All patients undergoing hysterectomy for gynaecological conditions from 2009 to 2011were included in the study

Results: Hysterectomies for gynaecological conditions accounted for184 cases during the study period. Mean age of patient was 49 [range 30-60 years]. Mean parity was 6 [range 0-11]. The most common indication for hysterectomy was fibroid uterus 56[30.4%] cases, dysfunctional uterine bleeding 38 [20.6%] cases, and uterovaginal prolapse 10 [5.4%] cases. Abdominal hysterectomy accounted for 174[96.6%] and vaginal hysterectomy accounted for 10 [5.4%] cases. Twenty six [14%] patients were found to be suffering from hypertension, 6[3.3%] patients were suffering from diabetes mellitus. Wound infection occurred in 11 [6%] cases. No mortality was associated with hysterectomy during the study period. The duration of hospital stay was less in vaginal route as compared to abdominal

Conclusions: An audit should be carried out every year to improve the level of care of patients and also the expertise of surgeon should be checked. The study has shown that hysterectomy is a safe procedure but the high morbidity associated with this procedure is bothersome. The other options like endometrial ablation, intrauterine hormonal device like mirenaetc should also be considered. More efforts should be made on vaginal hysterectomies as it is economical and morbidity is less with it

Ovarian hyperstimulation syndrome; in spontaneous conception a case report

It is known that most cases of Ovarian Hyperstimulation Syndrome [OHSS] are associated with the therapies for ovulation induction. However, OHSS may rarely be associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism or polycystic ovarian syndrome. We report a case of moderate OHSS in spontaneously conceived twin pregnancy in a 24 years old woman. The clinical picture showed amenorrhea, nausea, vomiting, abdominal pain and moderate ascites. After examinations, imaging and laboratory investigations, the diagnosis was established. The patient was managed expectantly with no complications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious complications, which may develop rapidly

Correlation of increasing maternal gravidity with severity of polyhydramnios

To find correlation of increasing maternal gravidity with severity of polyhydramnios. This descriptive study was done in Gynecology and Obstetrics department, Khyber Teaching Hospital, Peshawar, from July 2010 to December 2011. Patients were included in the study by consecutive non-probability sampling after fulfilling the inclusion criterion and given informed written consent. Detailed history about the status of maternal gravidity was taken and thorough per abdominal and vaginal examinations were performed. Polyhydramnios was confirmed ultrasonographically and categorized as mild, moderate or severe on the basis of amniotic fluid index. SPSS 16 was used for analyzing the descriptive data. Spearman rank correlation analysis [gamma] was used to measure the strength of association between pairs of variables. The total number of patients were 532. Mean age was 30.30 +/- 6.28years and mean age of gestational amenorrhea was 35.6 +/- 3.35weeks [28-41]. The maximum number of patients [57.4%] were in the age range group of 23-30 years. The number of patients with primary gravida were 33.6%[n=180],38.8%[n=206] were with multigravida and 27.6%[n=146] with grand multigravida. Severe polyhydramnioswas in 10.4%[n=55] cases while moderate and mild in 25.5%[n=135] and 64.1%[n=341] respectively. Majority of the patients having mild polyhydramnios were primary gravida or multigravida while the grandmultigravida patients were mostly either having moderate or severe polyhydramnios. The spearman rank correlation coefficient between the pairs of variables was [gamma] + 0.02, [p=0.04]. Increasing maternal gravidity has weak positive correlation with severity of polyhydramnios

Scarred uterus; frequency of placenta praevia

To study frequency of Scarred Uterus in placenta praevia. Descriptive observational study. December 2008-December 2009 Holy family Hospital Rawalpindi. 50 patients with placenta praevia presented to Holy Family Hospital Gynae and Obs unit II during this period. All patients either admitted through emergency or Gynae outpatient department were included. The mean age of patients with placenta Praevia was 29.04 year with [SD =5.11].The mean gestational age was 34.6 weeks and [SD = 2.7]. Fourteen [28%] patients were gravida 2 and 13[26%] were primigravida. Fifteen [30%] patients were para 1 and 14 [28%] were para 0. Painless vaginal bleeding was the presenting complaint in 38[76%] patients, whereas 12[24%] patients were diagnosed on routine ultrasonography. Nine [18%] cases underwent spontanouse vertex delivery and 41 [82%] cases were delivered by caesarean section. Placenta Praevia type 1 in 7 [14%] cases. Placenta Praevia type 2 in 20 [40%] cases, type 3 in 14 [28%] cases, type 4 in 9 [18%] cases. Previous history of scarred uterus was found in 16 [32%] cases .Post partum haemorrhage occurred in 13 [26%] cases .caesarean hysterectomy in 5 [10%] cases. A scarred uterus leads to increase frequency of Placenta Praevia, scarring of uterus can be reduced by keeping the caesarean section rate within reasonable limits and instead of doing surgical evacuation of retained products of conception, suction and evacuation by suction canula