Endometrial stromal sarcoma: a rare entity

Endometrial Stromal Sarcoma [ESS] is a hormone sensitive tumor. It is a rare gynecological tumor and is considered to occur more often in pre-menopausal women. A proper pre-operative diagnosis is difficult and confirmed in most cases after hysterectomy for a presumed benign disease. Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. For early disease complete surgical cure is possible, however, adjuvant therapy is available for recurrence. This case of Low Grade Endometrial Stromal Sarcoma [LGESS] in a 21 years old woman was presented as irregular vaginal bleeding. Clinical diagnosis of fibroid was made but analysis of endometrium showed ESS confirmed on hysterectomy specimen. One should consider it in any case with rapid fibroid enlargement

Maternal morbidity and mortality; Association with unsafe abortion

To assess the demographic features of unsafe abortion and associated maternal morbidity and mortality, and availability of post abortion care. A Case-Series. The study was carried out in Gynae Unit-1 of Bahawal Victoria Hospital [BVH], Bahawalpur from 1st January 2009 to 31st December 2009. Patients admitted with complicated unsafe abortion were evaluated regarding age, parity, marital status, educational status, socio-economic status, indication of abortion, qualification of abortionist and method used for abortion, contraceptive usage, immediate complications and death rate in abortion seekers. Descriptive statistics were used for describing variable. 119 patients were admitted with unsafe abortion. The mean age was 28.5 years. 90.8% women were married, 59.6% multiparous, 21% got secondary and higher education, 62 belonged to poor socio-economic status. ln 72% cases unsafe abortion was done during 1st trimester and 80% of women had previous history of unsafe abortion, 95% approached unqualified / semi skilled abortion providers who used instrumentation in 53% cases. The most common reason for abortion was multiparity [48%], and poorsocio-economic status [19%], 0nly 26.5% were using some kind of contraception. Most common complications were continued ongoing haemorrhage [incomplete abortion in 44%], followed by septic complications in 25% of cases and trauma to urogenital tract [22%] which also involved gut in 6% of cases. 2.5% patients reached in very critical stage and could not survived. Post abortion care provided to all patients of which 22% managed conservatively and 78% managed surgically. Contraception services offered to all but 24% refused them totally. Unsafe abortion constitutes a major threat to health and lives of women. Most of them are multiparous, married at peak of their reproductive life and belong to poor economic status. The associated immediate morbidity is much higher than mortality in terms of continued haemorrhage, sepsis, and trauma. The study focused on the need of post abortion care and easy accessibility to contraception to improve quality of life.

Maternal mortality

To estimate maternal mortality ratio [MMR], obstetrical causes and determinants of maternal mortality. A descriptive study. The study was conducted in Obstetrics and Gynaecology Department at Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College, Bahawalpur. This was a 3 years study conducted from January 2006 to December 2008. All direct and indirect maternal deaths during pregnancy, labor and perpeurium were included. The patients who expired after arrival were analyzed on specially designed performa from their hospital records and questions asking from their attendants. The reason for admission, condition at arrival, cause of death and possible factors responsible for death were identified. The other information including age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospital was recorded on Performa and analyzed by SPSS version 11. There were a total of 21501 deliveries and 19462 live births with 2039 peri-natal moralities. Total 133 maternal deaths occurred during last 3 consecutive years revealed MMR 683 per 100000 live births. Majority of the women who died were un-booked [91%]. The highest maternal mortality age group was 20-30 years in which 54.2% deaths were observed. Out of 133 maternal deaths, 21% were primigravida. Obstetrical hemorrhage [44.4%] was the most frequent cause followed by hypertensive disorders [21.8%] and sepsis [15%]. There were 33.8% of patients who were brought at compromised stage and 52.6% brought critical, only 13.5% died were stable at the time of arrival at hospital. Obstetrical haemorrhage was the leading cause of maternal deaths. This dreadful cause is preventable and manageable if steps are taken in time during antenatal period for risk detection and in postnatal period. Community awareness, training of traditional birth attendants to recognize the severity of disease and importance of being in time and improving referral can reduce the maternal deaths

Risk factors for preterm labour

To identify most common risk factors related with preterm labour existing in the study area and to recommend some suggestions for preventive measures in high risk patients. It was a case control [analytical-observational] study. Department of Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 16[th] April 2005 to 16t October 2005. Fifty eligible consecutive cases and 250 matched controls were selected by purposive sampling technique. Results revealed that preterm labour was more prevalent in patients with previous history of preterm labour or second trimester miscarriages with odds ratio 4.3. Preterm labour was associated with bacterial vagenosis and cervical incompetence with odds ratio 18.6 and 3.4 respectively. Twin pregnancies and anaemia were also significant factors for preterm labour with odds ratio 4.7 and 2.6 respectively. Previous preterm labour, second trimester miscarriages, bacterial vagenosis, twin pregnancies and anaemia proved to be risk factors for preterm labour