Osteoporosis in women

Objective: To find out the frequency of osteopenia and osteoporosis and to evaluate their etiological factors in women

Study design: Cross sectional study

Place and Duration of Study: Department of Obstetrics and Gynecology Fatima Hospital Baqai Medical University, in October 2014

Methodology: Females visiting the outpatient department were randomly selected. These were offered bone mineral density [BMD] test and calcaneal ultrasound. Variables assessed were marital status, parity, lactation status, dietary habits, covering body / using hijab [veil], profession etc. Data was entered and analyzed using SPSS version 15. Chi square test and Fisher Exact test were applied. Results were considered significant if p value was < 0.05

Results: One hundred and thirty two women were evaluated in the study. Mean age of woman was 34.27 + 9.04 year. Osteopenia was detected in 71 [53.8%] women while 20 [15.2%] were in the category of osteoporosis. Significant association was found between anemia and bone density while no significant association was found between working status of women and bone density. Lactation and veil also played important role in BMD scores

Conclusions: Osteopenia was common in pre-menopausal period. The frequency of osteoporosis was found to be less than osteopenia

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

Beneficial effect of cervical cerclage in preventing pregnancy loss

To find out results of cervical cerclage in patients with cervical incompetence [CI] for preventing pregnancy loss. Observational case series. Fatima Hospital Baqai Medical University Karachi, from January 2010 to December 2011. Patients with previous history of mid-trimester pregnancy loss, previous early preterm deliveries and cervical length < 2.5cms were included. McDonald cervical cerclage was placed around the cervix between 13-24weeks of gestation with silk no.2 after excluding intra-uterine infection, gross fetal anomaly and placental abruption. Cerclage was removed at 37 week of gestation. The patients and neonates were followed till one week post delivery. A total of 33 patients were included. Pregnancy prolongation with delivery at term occurred in 87.8% [through vaginal delivery in 87.7% and via cesarean section in four -12% cases]. Preterm delivery [9%], miscarriage [3%], live born babies [93.9%], fetal survival rate [87.8%], peri-natal death[6%], per-operative complications [12%], post-operative complications [18%] were other findings. Birth weight more than 2500gms was noted in 54.5%. Cervical cerclage has beneficial role in properly selected patients with sonographically short and incompetent cervix

Paraurehthrial abcess

Paraurehthral abcess in female is a rare lesion. The patient was a 25 years old female who had history of something coming out of vagina with perineal heaviness. She had history of off and on foul smelling copious vaginal discharge

On vaginal examination a 6 x 6cm mass around the anterior lip of cervix was seen with excessive foul smelling vaginal discharge. Ultrasound showed a hypoechoic cyctic mass near cervical region. Incision and drainage of abcess was done and about 300ml of pus drained followed by marsupilization. Histopathology revealed section of vaginal wall with subepithelial infilration of neutrophils and lymphocytes. No. evidence of malignancy was seen

Screening for postpartum depression in ; recently delivered mothers

To identify the risk factors for postpartum depression and compare the rate and severity in abdominal versus vaginally delivered women at Fatima Hospital at Baqai Medical University using Edinburgh Postnatal Depression Sale [EPDS]. It was a cross sectional comparative study conducted from 1[st] December 2007 to 28[th] February 2009. At Fatima Hospital total 393 women were interviewed using translated questionnaire of EPDS at 6-8 weeks postnatal, when they came for their post-delivery checkup in OPD. Women of all parities and age groups, who consented for the interview, were included in the study. Women who delivered stillborn, malformed and preterm babies were excluded. Additionally, women with complicated deliveries e.g. instrumental deliveries, extended episiotomies and with PPH were also excluded. Women were studied in two groups. Group-1 consisted of 195[47.3%] vaginally delivered women and group-2 consisted of 198[50.4%] abdominally delivered women. For convenience of patients EPDS was translated into Urdu. Statistical analysis was done by using SPSS version 15. Score of >12 out of 30-point scale was used to diagnose postpartum depression while score of >15 indicated severe postpartum depression. According to this criteria, over all 15% of women had confirmed PPD; while 22/195 [11.3%] vaginally delivered women and 35/198[17.8%] women delivered by caesarean section were found to have PPD. Risk of postpartum depression was higher in the women delivered by caesarean section compared to vaginally delivered women [p-value of 0.004]. Both groups had the same chance of severity of symptoms. By using EPDS criteria our study identified that 15% of delivered women at Fatima Hospital at Baqai Medical University had sign and symptoms of postpartum depression. Risk of post partum depression increased with traumatic birth experience, while the risk of severe postpartum depression was independent of mode of delivery

Huge ovarian cyst

A 24 year old female presented with complaint of abdominal distension, difficulty in breathing and restlessness. Ultra-sonographic examination revealed that there was a huge cystic collection with internal debris, multiple septation involving whole abdomen and pelvis, originating from left ovary. Her laparotomy was done; a huge ovarian cyst of about 25x30 cm was removed. Post-operative recovery was smooth. Histopathological examination revealed that it was mucinous cyst adenoma. The purpose of this case presentation to report one of the huge ovarian cysts from our Centre and to highlight the diagnostic finding

Arrest of preterm labour by nitroglycerine patch

Preterm labour and delivery before 37 weeks of gestation is a major cause of perinatal morbidity and mortality. To delay preterm delivery, we need a tocolytic agent which is uterospecific with few fetomaternal side effects and which can significantly improve perinatal outcome. Since long the search for such a tocolytic agent that is effective and safe for both the mother and fetus has been frustrating. Recently attention has focused on the use of Nitroglycerine, a nitric oxide donor in the treatment of preterm labour as it has a uterine smooth muscle relaxant properties. This study was conducted to assess the effectiveness of nitroglycerine patches in the treatment of preterm labour. Quasi - Experimental study was conducted in Obstetrics and Gynaecology Department of Abbasi Shaheed Hospital in Karachi. Duration of study was from March2005 to March2006. Women in preterm labour with alive singleton pregnancy, uterine contractions of at least 1 in 10 minutes, intact membranes and cervical dilatation of no more than 2 cm were recruited. Women with premature rupture of membranes, ante partum hemorrhage, hypotension, and chorioamnionitis were excluded from the study. Those women who fulfilled inclusion criteria were included in the study. History and examination were done at the time of admission and baseline observations were made. Nitroglycerine patch delivering 10mg/24 hours was applied on abdominal skin and if needed another 10mg patch applied after 1 hour. After 24 hours previous patches replaced with a new patch for next 24 hours. During treatment two doses of Inj. Dexamethasone were given for fetal lung maturity. Efficacy of transdermal patches were measured in terms of cessation of uterine contractions, cervical dilatation of not more than 2 cms, allowing prolongation of pregnancy for at least 48 hours without significant maternal side effect like headache, nausea, tachycardia and hypotension. Data was analyzed on SPSS version 10.0. 60 patients were enrolled in the study. Mean maternal age was 24.60 +/- 2.25 and mean parity was found to be 1.96 +/- 1.96. Out of them 47 [78.3%] had cessation of uterine contractions for more than 48 hours where as 13 [21.6%] failed to stop contracting. Progressive cervical dilatation of more than 2 cms was found in 29 [48.3%] in less than 48 hours, where as in 31 [51.6%] cervical dilatation remained same after 48 hours. Pregnancy was prolonged for more than 48 hours in 40 [66.6%] patients and 20 [33.3%] delivered in less than 48 hours P = 0.0098. Headache was present in 17[28.3%], nausea 7 [11.6%], tachycardia 8 [13.3%] and hypotension in 3[5%] patients. Transdermal Nitroglycerine Patches were effective tocolytic agents allowing prolongation of pregnancy for at least 48 hours

Term pregnancy with uterovaginal prolapse and severe anemia

Cases of uterovaginal prolapse common in high parity societies. Cases concurrent with pregnancy are rare, but can present with its complication and require specific advice and management

Risk factors in relation with uterine rupture

To determine the risk factors in relation with uterine rupture in patients coming to Abbasi Shaheed Hospital. Case Control Study. The department of Gynecology and obstetric Abbasi Shaheed Hospital Karachi from January 2001 - December 2002. All cases of ruptured uterus who were either admitted with or who developed this complication in the hospital were included in the study. These cases were compared with their control i.e. women who delivered normal at Abbasi Shaheed Hospital in the same period and did not develop rupture uterus; matched by same age parity socioeconomic status and area of residence. The cases were further divided in two groups, those with previously scarred uterus [n=20] and those with unscarred uterus [n=23]. Risk factors associated with uterine rupture included injudicious use of oxytocin by traditional birth attendants [TBAs] or unskilled persons [88%] no antenatal care [79%] or late referral by TBAs or Dais [58%] and obstructed labour [25.5%]. All cases referred by Dais had crossed the partographic alert line. In unscarred group oxytocin used injudiciously in all cases with no antenatal care [ANC] at all and late referral by Dais in 78% cases. Injudicious use of oxytocin and late referral by TBAs [Dais] and lack of Ante Natal Care are the significant risk factors for uterine rupture

Frequency of prenatal depression in second and third trimesters of pregnancy in Karachi: a hospital based study

Objective: To determine the frequency of depression and its relationship with some demographic variables in pregnant women presenting in the second and third trimester at a tertiary care hospital in Karachi, Pakistan

Design: A descriptive study

Setting: Departments of Psychiatry and Gynecology/Obstetrics, Abbasi Shaheed Hospital, Karachi, Sindh- Pakistan, from July 2003 to October 2003

Methods: Seventy-five females in second and third trimester of pregnancy were interviewed in out patients department. Questionnaire was based on Edinburgh postnatal depression scale. Main outcome measure was to find out the number of pregnant depressed females

Results: Pregnant females had twenty-six to thirty-six weeks of pregnancy. Twenty-six females [34.6%] were found to have clinically significant depression according to Edinburgh postnatal depression scale. Most of the cases were found between 22 and 36 weeks of pregnancy. The average age of presentation was 26 years. Six, out of 26 [23%] depressed females were primigravida. More so, other cases which were having depression were mostly in their second or third confinements [ten cases out of twenty-six i.e. 38%]

Conclusion: Prenatal depression is an important clinical entity and shall be screened during second and third trimesters of pregnancy. The more severe cases should be offered treatment with either psychotherapy or medications to avoid future complications

Association of bacterial vaginosis with preterm delivery

Preterm delivery is the leading cause of infant morbidity and mortality. Preterm labor and premature rupture of membranes and low birth weight have been associated with either specific maternal genital tract infections or an altered microflora in pregnancy. Bacterial vaginosis is one of the implicating factors for preterm labor and preterm delivery. Objective of the study is to study the frequency of Bacterial vaginosis in preterm labor. By identifying and observing the frequency of Bacterial vaginosis as a causative factor in preterm labor, we can reduce its frequency by taking certain measures and indirectly we would be able to overcome the problem of infant mortality and morbidity due to prematurity. Observational study. Fifty patients.Obstetric and Gynecology department unit II of Abbasi Shaheed Hospital and Karachi Medical and Dental College Karachi, From Jan 2003 to Jan 2004. Patients included were presented with established labor after 24[th] weeks and before 37[th] weeks of gestations. Patients with singleton pregnancy were with or without rupture of membranes. Patients excluded were multiple pregnancies, current pregnancy with sepsis, cervical incompetence, and antepartum bleeding. Patients presented with chorioamnionitis, diabetes, mellitus, hypertension, cardiac disease, renal disease and urinary tract infection were also excluded. Patients presented with effective uterine contractions after 24[th] weeks and before 37[th] weeks of gestation were admitted. Full history and examination were recorded on a given proforma. Full base line investigations, including complete blood picture, random blood sugar, and urine detailed report, blood group and Rh factor were done. High vaginal swab was taken and sent for culture/sensitivity and microscopy for clue cells. Vaginal pH was determined by using Nitrazine paper and change in color of Nitrazine paper was recorded. Whiff test was performed by taking some secretion by disposable syringe on glass slide and fishy odor was observed after adding a drop of KOH on slide. Amsel's criteria were applied to all cases preterm labor and results was analyzed on SPSS 10. Results were based on Amsel's criteria. Fifty patients were enrolled in this study. Out of fifty patients only 2[4%] patients fulfilled all four criteria, while 29[58%] patients fulfilled three criteria, 4[8%] patients fulfilled 2 criteria and 15[13%] patients fulfilled 1 criterion. Hence Bacterial vaginosis was found in 35[70%] patients. Bacterial vaginosis was associated with majority of patients presented with preterm labor and responsible for perinatal morbidity and morbidity

Family planning awareness in local population of district central Karachi

According to WHO estimated population of Pakistan in the year 2003 was 149.1 million with a projected population of 249.7 million in 2025 and total fertility rate of 4.8 showing failure to achieve our family planning strategies. The aim of this study was to investigate family planning awareness in local population of district central, Karachi as this is most thickly populated and biggest district of Karachi facing the problems of overcrowding due to population explosion. This questionnaire based study was conducted at family planning center affiliated with Abbasi Shaheed Hospital involving 100 women of reproductive age group. Majority of women of reproductive age group were found to attend family planning center of those most were literate. Main sources of information were television, relatives and neighbours. Majority knew about different contraceptives, injections, intra uterine device and tubal ligation. Most of families and husbands [again from educated families] have favoured attitude towards family planning. Improving literacy level, involving husband and families in discussion and giving them clear information may further improve local trends of contraception

Ovarian tumours: a five years retrospective study at Abbasi Shaheed Hospital, Karachi

The purpose of this study was to determine the pattern, presentation and management of patients with ovarian tumors.Retrospective study carried out from Sept. 1999 to August 2004. Department of Gynaecology and Obstetrics [Unit II] at Karachi Medical and Dental College and Abbasi Shaheed Hospital, Karachi.Sixty three patients with Ovarian Carcinoma.The epidemiology, presentation and the outcome of manangenient was noted Out of the 63 patients seen during the study period, .fifty [79.36%] had benign and 13[20.63%] malignant ovarian tumours. Most [39-47.61%] women were <40 years of age and the majority[61.90%] of them were married. Ovarian malignancy was found more in patients who were unmarried and nulliparious. The common presenting complaints were abdominal pain [57.14%], GI upsets [47.61%] and an abdominal mass [31.74%]. Out of the 20 cases that presented with masses, 11 [55%] were solid and malignant looking. Thirty two [50.79%] patients underwent unilateral oophrectomy / tumerectomy, 22 [34.92%] total abdominal hysterectomy with bilateral salpingo-oophrectomy, 7 [11.11%] total abdominal hysterectomy with conservation of one ovary and one debulking, while in one case which was inoperable, only biopsies were taken.All the patients with ovarian tumours presented late with symptoms. This was either due to the lack of specific symptoms or delayed referral by the primary care centers. Proper evaluation and attention to minor symptoms like lower abdominal pain, GI upsets, symptoms of mass effect [urinary frequency, constipation, palpable mass, pelvic pressure] by the primary care clinicians can lead to early diagnosis

Uncommon presentation of endometroid carcinoma of ovary

We report here two cases of endometroid carcinoma ovary. One was of an 18 years old girl and another was of a 40 years old lady. Both patients complained of lower abdominal pain, distension, scanty menses and constipation. Histopathological examination revealed endometroid carcinoma of ovary. Total abdominal hysterectomy and bilateral salpingo oophorectomy was done in both patients and were put on chemotherapy. [<0.05] to reduce 50% contraction of the uterus produced by oxytocin

Maternal and perinatal outcome in HELLP syndrome at Abbasi Shaheed Hospital

The Objective of this study was to determine the maternal and perinatal outcome in HELLP syndrome and to reflect the importance of early diagnosis of HELLP syndrome in eclampsia and preclampsia. A case control study was designed; where retrospective review of 15 cases of confirmed HELLP syndrome from January 1997 to January 2002 was undertaken at Gynae /Obstetrics Unit II, Abbasi Shaheed Hospital and thirteen controls were selected of eclampsia with no evidence of HELLP. Maternal and neonatal complications were recorded and resolution of laboratory indices was measured. Seventy five% of the women were delivered within 24 hours of diagnosis; out of this, 83.73% were delivered by caesarean section. There were 73.3% pre-term deliveries and 75% of the babies were admitted to the neonatal intensive care unit [NICU]. The peri-natal mortality was 46.66% while the maternal mortality was 20%. The mean interval of resolution of laboratory indices to within normal ranges was twelve [7-35] days. The neonatal morbidity was high and was closely related to the period of gestation at delivery

Effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section

To evaluate the effects of leaving the parietal and visceral peritoneum open at lower segment caesarean section. A non- randomized controlled trial. Materials and Of the 50 evaluable subjects, 25 had parietal and visceral peritoneum left open whereas 25 were closed. Analgesia requirements assessed by visual and verbal scale, oral analgesia used after 24 hours postoperatively for four days and postoperative satisfaction assessed verbally, shorter surgical time length of postoperative hospital stay, reestablishment of intestinal motility were the main out come measures. Pain at 24 hours was similar in both groups but in subsequent days the non-closure group had decreased maternal pain and had a tendency to require less postoperative analgesics [1500 mg/day Vs 750 mg/day, P = 0.03], shorter hospital stay and early reestablishment of intestinal motility. Non-closure of both visceral and parietal peritoneum at the caesarean section produces a significant reduction in the postoperative use of analgesia and shorter hospital stay postoperatively