Feto-maternal outcome; comparison while using epidural analgesia versus parenteral opioid derivatives in labour

To compare the effects of epidural analgesia and parenteral nalbuphine in labouring women with term pregnancies on feto-maternal outcome. Randomized controlled trial. It was carried out in the Labour Room, Nishtar Hospital, Multan From June 2009 to December 2009. A total of 60 patients were included in the study. Patients were divided into two groups, having 30 patients in each group. In group-A, pain control was much better and satisfactory [VAS=00-1], duration of labour was slightly prolonged and instrumental delivery was more common. Low Apgar score and birth asphyxia were seen in group-B. No baby developed RDS in both groups. Feto-maternal outcome is much better in women having epidural analgesia with bupivacaine as compared to women having intramascular nalbuphine

role of laparoscopic ovarian surgery in women with polycystic ovarian syndrome

To determine the efficacy of laparoscopic ovarian surgery [LOS] in women with polycystic ovarian syndrome in terms of ovulation induction, conception rate and regulation of menstrual cycle. The study was carried out in the Department of Gynaecology, Nishtar Hospital, Multan from March 2007 to February 2009. A total of 200 patients fulfilling the inclusion criteria were enrolled. LH/FSH ratio and ultrasound pelvis was done in all women. Presence of eight or more follicles in one or both ovaries was the cutoff number for the positive ultrasound. Patients with other causes of infertility were excluded from the study. Laparoscopic ovarian drilling [LOD] was done in all patients. In this study 100% patients [n=200]were infertile due to PCOS. 70% women had menstrual irregularity, 30% had hirstuism, 35% had weight gain. Raised LH/FSH ratio was observed in 52% of patients while ultrasound features were seen in 81% of women. After LOD regulation of menstrual cycle was seen in 70% of patients, ovulation was observed in 75% while 55%of patients conceived after laparoscopic ovarian drilling. Laparoscopic ovarian drilling is the preferred second line for induction of ovulation after clomifene citrate resistance/failure

role of metformin therapy in women with polycystic ovarian syndrome

To determine the efficacy of metformin therapy in women with PCOS in terms of ovulation induction and pregnancy. The study was carried out in Outpatient department Gynaecology Unit-1, Nishtar Hospital, Multan from January 2007 to March 2008. A total of 285 patients fulfilling the inclusion criteria [oligo/hypomenohorea, infertility, weight gain, hyperandrogenism] were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in one or both ovaries was the cut off number for positive ultrasound. Patients with other causes of infertility were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were evaluated for response to metformin therapy. At the start of the study, 78% women had menstrual irregularity, 54% had primary and 46% had secondary, ultrasound features were found in 94% patients, hirstism in 70% and weight gain was found in 64% of patients. After six months of metformin therapy, ovulation was observed in 66% of women while 52% of patients conceived on metformin, therapy alone. Metformin alone was an effective treatment for PCOS in terms of ovulation induction and pregnancy

Fetomaternal outcome of cases referred to Nishtar Hospital, Multan

To determine feto-maternal outcome and to identify factors associated with adverse obstetric outcome. This descriptive case series study was conducted in the Department of Obstetrics and Gynecology Unit lit. Nishtar Hospital, Multan. During the period from 18[th] July 2007 to 17[th] January 2008. One hundred patients who were admitted through emergency after a trial of labour by traditional birth attendants [TBAs], lady health visitors [LHVs] or doctors at home or private clinics were managed and followed in the department of gynecology and obstetrics Unit-II. Mean age of the patients was 27.28 +/- 5.13 years. Fever was the most common complication found in 69[69%] patients. Antepartum hemorrhage occurred in 22 [22%] cases. Postpartum hemorrhage complicated 46 [46%] pregnancies leading, to shock in 51 [51%] patients. Oligohydramnios was observed in 35 [35%] patients and uterine rupture in 5[5%] cases. There were 3 [3%] maternal deaths. Low Apgar score was observed in 36 [36%] patients. Meconium staining was common in 34 [34%] cases and 34 [34%] patients needed for hospitalization. Fetal growth restriction was found in 23 [23%] patients. There were 23 [23%] fetal deaths. Postpartum hemorrhage led to maternal and fetal complications in majority of the patients which was not handled

Placenta previa; a study to determine responsible factors

To determine the factors suspected to be associated with placenta praevia. It was a case control analytical study. Department of Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. This study was conducted from 13th August 2004 to 12th February 2005. 50 cases of placenta praevia was selected on the basis of ultrasonography from out patients, emergency and indoor patients. 250 controls were taken [50 for each variable i.e. age, parity, previous history of caesarean section, smoking and previous history of placenta previa] and were divided into 5 groups after matching. The study revealed that placenta praevia was more prevalent in elderly patients [72%], grand multiparas [68%] in patient with history of previous caesarean deliveries [52%] and in patients who smoked [30%] but this study did not identify previous history of placenta praevia [44%] as a risk factor for subsequent pregnancies. It was concluded that maternal and fetal mortality can be reduced by identifying high risk patients [in whom any of above mentioned risk factors were present] and educating them for care about next pregnancy