Adolescent menorrhagia: causes and evaluation

To find out different causes of adolescent menorrhagia. Cross-sectional descriptive study. This study was conducted in Department of Gynecology and Obstetrics Fauji Foundation Hospital Rawalpindi from 1[st] April 2011 to 31[st] December 2011. Fifty one un-married patients aged 9-19 years with menorrhagia were selected by non probability convenience sampling. All the details of history including blood loss, clinical examination and investigations were recorded in a proforma for analysis. The most common cause of menorrhagia was dysfunctional uterine bleeding [76.5%] followed by thyroid disorders [13.7%] and bleeding disorders [9.8%]. Dysfunctional Uterine bleeding [DUB] was found to be the commonest cause of adolescent menorrhagia. Patients with adolescent menorrhagia should be carefully investigated for different causes as timely intervention can help these young patients

comparison of two protocols of intravaginal misoprostol for second trimestrer medical termination of pregnancy

To compare the efficacy and side effect profiles of two different dosage protocols of intravaginal misoprostol. Randomized control trial. Department of Gynaecology and Obstetrics, Combined Military Hospital, Rawalpindi, from May 2006 to December 2006. A total of 128 women's, aged 18-40 years, planned for 2nd trimester pregnancy termination, were randomly assigned to two groups of 64 each. Group - I women received vaginal misoprostol 400ug three hourly for a maximum of 8 doses in 24 hours. Women in group-II received vaginal misoprostol 400ug six hourly for a maximum of four doses in 24 hours. If abortion did not occur in 24 hours, the same regimens were repeated. Without successful abortion in 48 hours, misoprostol administration was abandoned in favour of surgical induction. The median induction to abortion interval in group - I [14.4 hours] was shorter than in group - II [182] [p< 0.001]. The frequency of fever was more common in group - I [p = 0.01]. The pregnancy related symptoms decreased in both groups after misoprostol and decrease in breast tenderness was most marked two to three hours after administration. Misoprostol induced fever was seen at least five hours after administration in up to 37.5% women, this peak being slightly higher and occurring earlier in group - I than in group - II. Lower abdominal pain peaked after three to four hours in group - I and after five to six hours in group - II, with no significant difference in pain intensity or analgesic requirements. Other common side effect were diarrhea followed by nausea and vomiting in both the groups. Protocol of 400ug misoprostol administered 6 hourly / 24 hours is more effective in reducing induction - abortion interval and inducing successful abortion within 48 hours without any major increase in side effects

Causes and management of high fetal head in primigravidae at term

To determine the causes of high foetal head and their relative frequencies in primigravidae presenting at term and to determine the proportion of these patients undergoing lower segment caesarean section or vaginal delivery. A descriptive study. The study was carried out at CMIH Rawalpindi from April 2002 to March 2003. A total of 100 primigravidae patients presenting at term and having a single pregnancy were randomly selected. On the basis of history, Physical examination and abdominal ultrasonography, patients having a high foetal head were recognized and their causes documented. Out of 100 primigravidae, 58 had high foetal head. A discernable cause was found in the 39 [67.2%] patients. Cephalopelvic disproportion [20.7%] and foetal ma! position [17.2%] were the leading cause of high foetal head Lower segment Caesarian section [50%] was the management of choice in half of the patients with high foetal head. Cephalopelvic disproportion and foetal malposition were the major cause of high foetal head in this study and lower segment Caesarean section was the mode of delivery in only 50% of these high risk subjects

Frequency and types of anemia in an antenatal clinic in the third trimester of pregnancy

To determine the frequency and the types of anemia in a specific sample of patients reporting to Combined Military Hospital, Rawalpindi. Design and A descriptive study with retrospective data was conducted in outdoor patients department of Combined Military Hospital, Rawalpindi by screening/testing haemoglobin and haematocrit in the third trimester of pregnancy. Five hundred patients that reported to outdoor patient department of Combined Military Hospital, Rawalpindi from July 2002 to January 2003, were selected for study according to the inclusion and exclusion criteria by convenience sampling. Study was carried out on automated electronic cell counters and chemical analyzers. Any abnormal results in routine investigations were followed up. Inclusion criteria was educated women with at least a high school degree in their third trimester with age ranging between 20 to 30 years, gravidity between 1 to 3 and birth spacing of at least 2 years. The significant out come of the study was that iron deficiency anemia exists substantially in this socioeconomic group [educated middle class]. Out of the total 500 cases, 241 [48.2%] were found to be anemic, according to the severity was 39.8% mild, 7.6% moderate and 0.8% severe anemia. The mean + SD haemoglobin was 10.3 +/- 0.3 g/dL for mild, 8.9 +/- 0.41 g/dL for moderate and 6.8 +/- 0.22 g/dL for severe anemia. Seventeen patients out of the original sample were lost to follow up. The major categories of anemia to effect the study sample were iron deficiency anemia and beta thalassaemia trait. The percentages obtained were 41.6% and 4.8% respectively. Iron deficiency is quite frequent during third trimester of pregnancy is our study population. A comprehensive research in our country is needed on how to improve existing iron supplementation programs and the overall health care and nutritional status of women before they enter their reproductive years

Comparison of maternal and infant outcome between vacuum extraction and forceps deliveries

To analyze the instrumental deliveries carried out at the Gynae Department during the year 1996 and compare the outcome of ventouse and forceps deliveries. Retrospective case notes review of all instrumental deliveries; carried out during the year 1996. Three hundred and four instrumental deliveries; of which 258 were ventouse and 46 were forceps deliveries; were assisted. Seventy percent of forceps deliveries were carried out in primigravida as compared to 49% of ventouse deliveries. Fetal distress was the indications in 81.4% of ventouse deliveries as compared to 76% forceps deliveries [p<0.05]. Prolonged 2nd stages of labor were indications in 6[13%] of forceps and 16[6.2%] of ventouse deliveries. Consultants and senior Gynecologists were more likely to use forceps while registrars use ventouse as their preferred instrument for delivery. Attempted ventouse delivery was successful in 91.4% as compared to 95.7% in forceps [p<0.05]. Extension of an episiotomy was more likely to occur with ventouse than forceps deliveries while 3rd degree perineal tears occurred more with forceps deliveries. Babies who had attempted ventouse deliveries have lower apgar score at one minute than attempted forceps. No babies required admission to neonatal intensive care unit. There was only one stillbirth in the ventouse delivery group due to intrapartum asphyxia and true knot in the umbilical cord. Forceps is more likely to be used in the primigravids and prolonged 2nd stage of labor and less likely to fail. Ventouse is more likely to be used by registrars. Extension of an episiotomy and low apgar score at one minute is more likely to occur with ventouse deliveries

Comparison of intraoperative haemorrhage by blunt versus sharp exapansion of the uterine incision at caesarean section

This study compared increased intraoperative blood loss in lower segment caeserean section between blunt versus sharp extension of uterine incision. This comparative analytical study was carried out in Gynaecology and Obstetrics department of Combined Military Hospital Rawalpindi from November 2002 to April 2003. The study comprised of 100 patients who were to undergo lower segment caesarean section out of which 50 patients were allotted in each of the two groups by non-probability convenience sampling. The selection criteria were full term pregnant women with single fetus. The maternal demographics of age, parity, body mass index, pre- operative haaematocrit were similar between the two groups. In the blunt group, the estimated blood loss was 805.80ml+376.95 as compared to 750.40ml+247.97 in the sharp group. It was more in the blunt group but the difference was not significant. There was no cervical tear in the sharp group as compared to four tears [8%] in the blunt group. In conclusion, both methods are comparable regarding amount of intraoperative haemorrhage. The sharp method confers some protection against cervical tears in cases of advanced labour and repeat caesarean section as compared to blunt met

Abnormal glucose screening test followed by normal glucose tolerance test and pregnancy outcome

The present study was conducted explore the pregnancy outcome of patients with abnormal glucose screening test followed by normal glucose tolerance test. In Combined Military Hospital [CMH], Rawalpindi, a study was made to compare the complication of pregnancy, infant weight, placental weight and neonatal morbidity in women with and without abnormal glucose screening test, it was performed between July 1998 and June 2000. Hundred postnatal files from each group were analyzed. The Chi square test, and test for comparison of proportion were the statistical test used. Although women with abnormal glucose screening test were older, there was no evidence in this study that increasing parity is a risk factor for abnormal glucose screening test. Candidiasis and polyhydramnios was significantly more frequent in the group with abnormal glucose screening test. The women with abnormal screening test were at higher risk for elective cesarean section, whereas the number of emergency cesarean section and instrumental deliveries was not significantly different. The mean birth weight of infants in the abnormal glucose screening test group was higher and also, macrosomia was significant more frequent in this group. The mean weight of placenta from women with abnormal glucose screening test was higher than that of placenta from women with normal glucose screening test. The results of this study are consistent with the previous reports that even minor abnormalities of glucose metabolism without gestational diabetes are a significant risk factor for fetal overgrowth and its attendant problems

Short and long term complications of abdominal and vaginal hysterectomy for benign disease

The present study was conducted to ascribe to the indications of short, intermediate and long term complications for total abdominal versus vaginal hysterectomy in women with benign pelvic disease. This study was carried out at Gynecology Department, CMH Peshawar. Chart review was conducted from 1993 to 1997, for all patients who had hysterectomy for benign disease. We compared indications for short, intermediate and long term complications of total abdominal versus vaginal hysterectomy. A total of 108 patients who had hysterectomy were available for analysis. Group I consisted of patients who had total abdominal hysterectomy [n=82], group 2 consisted of patients who had vaginal hysterectomy [n=26]. The principal indication for the vaginal hysterectomy was uterine prolapse 18%, which occurred in women >45 years old. While, the most common indications for the total abdominal hysterectomy were menstrual disorders and uterine fibroids 56%, which occurred in women >45 years old. The overall complication rates were 51.2% and 23.1%, in women who underwent total abdominal hysterectomy and vaginal hysterectomy p=0.01. odds ratio=3.5] Twelve patients [14.6%] required 2nd intervention or rehospitalization, or both, in total abdominal hysterectomy group. While none were required in the hysterectomy group. Febrile morbidity formed the major category of the postoperative complications in our study, total incidence was 27.8% [30/108]. No statistically significant differences were noted between the total abdominal hysterectomy [30.1%[25/ 82] and the vaginal hysterectomy group [19.2% [5/26], [p=0.3]], nor for women who received antibiotic prophylaxis [25.5% [14/55]] and women who did not [28.3% [15/53], [p=0.7]]. Vaginal hysterectomy is associated with less intraoperative, intermediate and late complication rates than total abdominal hysterectomy. No significant differences in postoperative febrile morbidity, but significantly shorter hospital stay was found among women who under went vaginal hysterectomy