Clinical audit of foetomaternal outcome in pregnancies with fibroid uterus

Leiomyoma, myoma, leiomyoma or fibroids are synonymous terms. They may be present in as many as 1 in 5 women over age 35 years. If pregnancy is associated with fibroids, it leads to multiple complications. Objectives of this study were to evaluate the maternal and foetal outcome in women having pregnancy with fibroids in uterus and the complications associated with fibroids during the pregnancy. This descriptive study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital Abbottabad from March 2009 to March 2010. Data were collected on performa regarding demographic variables, obstetrical history, mode of delivery, maternal outcome, maternal complications, and foetal outcome. Mean and standard deviation was calculated for age, period of gestation, and obstetrical history. Frequency and percentages was calculated for booking status, maternal outcome, maternal complications and foetal outcome. Thirty patients were included in this study who had pregnancy with fibroid. Normal delivery was achieved in 14 [46.66%] patients. Eight [26.67%] patients had caesarean section and eight [26.67%] had miscarriages. Seven [23.33%] patients had no complications while 8 [26.67%] had miscarriages, 8 [26.67%] had postpartum haemorrhage, 10 [33.33%] had preterm delivery, and 3 patients had ante-partum haemorrhage. Two [10%] patients had premature rupture off membranes and 1 patient [3.33%] had pain abdomen and technical difficulty during caesarean section. There were 12 [40%] healthy babies. Five [16.67%] babies delivered with morbidity but recovered. There were 4 [13.33%] intrauterine deaths and one early neonatal death. Fibroid in pregnancy, especially multiple intramural fibroids and fibroids larger than 10 Cm, cause miscarriage and preterm labour.

Assessment of iron deficiency in pregnant women by determining iron status

Background: Pregnant women constitute a high risk group for iron deficiency. Maternal iron deficiency and particularly iron deficiency anaemia may be associated with detrimental effects on maternal and infant function and particularly with a higher risk of preterm delivery and delivery of low birth weight neonates. Objective of this study was to assess and compare the iron status of normal healthy non-pregnant women with that of pregnant women of Hazara Division. Methods: This study was conducted at Faculty of Health Sciences, Hazara University, and Ayub Medical College, Abbottabad from 1st March to 31st August 2006. Altogether 120 women, 90 pregnant at various stages of pregnancy and 30 non-pregnant women as control group were included in this study by convenience sampling. Their iron status was assessed by determination of haemoglobin [Hb], Serum ferritin, Serum-iron, Total Iron Binding Capacity [TIBC], Unsaturated Iron Binding Capacity [UIBC], and Percentage saturation of transferrin. Data generated on these variables were subjected to ANOVA and correlation analysis. Results: The salient finding of this study is a significant decrease in Hb, Serum ferritin, Serum iron, percentage saturation of transferrin and a significant increase in values of TIBC and a pronounced increase in UIBC in 2nd and 3rd trimester compared to 1st trimester in iron deficient pregnant women. The mean values of Hb, SF, and Fe/TIBC% were significantly lower in the cases than in the control and significantly higher values of TIBC and UIBC were observed in the cases compared to controls. Significant correlations were observed for TIBC, UIBC and Fe/TIBC% against serum iron in different trimesters of pregnancy. Conclusion: A high percentage of the pregnant women are iron deficient due to factors such as high parity, poor dietary habits and socioeconomic status

Vaginoplasty by using amnion graft in patients of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser Syndrome

Vaginal agenesis is congenital anomaly of the female genital tract and may occur as isolated developmental defect or as part of a complex of anomalies. The aim of this study was to determine the effectiveness of vaginoplasty by using amnion as graft in the creation of neovagina for patients with Mayor-Rokitansky-Kuster-Hauser Syndrome. This is a retrospective study of 28 cases of vaginal agenesis associated with Mayor-Rokitansky-Kuster-Hauser Syndrome, over the period of 20 years, in which vaginoplasty was done by modified McIndoe procedure by using amnion as graft. Vaginoplasty using amnion graft was successfully performed in all except one case in which rectum got opened and procedure was abandoned after the repair of rectum. The functional results were quite satisfactory. Except one case none had any significant peri-operative complication. Post surgical results were acceptable to the patients sexually and aesthetically. Although new techniques of vaginoplasty have evolved over the years using laparoscopic approach and by use of different materials as graft, vaginoplasty with amnion graft is still a safe and effective procedure to treat patients of vaginal agenesis. The technique is simple and safe and provides a satisfactory and functional vagina in majority of the patients

Maternal morbidity and mortality due to primary PPH-experience at Ayub Teaching Hospital Abbottabad

Postpartum Haemorrhage [PPH] remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation [DIG], blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit 'B', Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18[th] April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 [58%] cases, followed by cervical, vaginal and perineal tears in 12 [24%] cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal [haemostatic] hysterectomy was performed in 10 [20%] cases. Maternal morbidity was detected in 31 [62%] of cases; the major morbidities were DIC in 3 [6%] cases, Acute renal failure in 3 [6%] patients and shock in 2 [9.9%] cases and anaemia in 20 [90.1%] cases. The study concludes that the frequency of primary PPH in this setting is in keeping with globally cited frequencies. Other findings such as causes of primary PPH and maternal morbidity data also agree with most national and international studies on this topic

Abruptio placentae and its complications at Ayub teaching hospital Abbottabad

Abruptio placentae remains a major cause of perinatal morbidity and mortality globally, though of most serious concern in the developing world. As most known causes of abruptio placentae are either preventable or treatable, an increased frequency of the condition remains a source of medical concern. The present study was undertaken at the Department of Obstetrics and Gynaecology, Unit B, of the Ayub Teaching Hospital, Abbottabad, Pakistan, from July 2003 to June 2004. Patients of abruptio placentae were selected from all cases of 28 weeks or greater gestation, presenting with ante partum haemorrhage during the study period. Patients underwent a complete obstetrical clinical workup including history, general physical examination, abdominal and pelvic examination. Relevant investigations such as laboratory tests and imaging were performed. Patients were managed according to maternal and fetal condition. Any maternal and/or fetal complications were noted and recorded. All data were collected on predesigned proformas and analyzed by computer. A total of 53 cases of abruptio placentae were recorded out of 1194 cases [4.4%] admitted for delivery during the study period, giving a rate of 44 cases of abruptio placentae per 1000 deliveries. Induction of labour was required in 27 [50.9%] cases, while caesarean section was performed in 16 [30.2%] cases. Major complications were intra uterine fetal demise [31/53, 58.5%], fetal distress [8/22 live births, 36.4%] and post partum haemorrhage, which occurred in 10 [18.9%] cases. A higher than expected frequency of abruptio placentae exists in our setting and the consequences of abruptio placentae for neonatal mortality outcome are alarmingly high. The majority of patients presented with intra uterine death so that any management protocol directed at abruptio placentae or its consequences is of little help in preventing perinatal mortality

Use of Foley's catheter and prostaglandin F-2 alpha in second trimester termination of pregnancy

Termination of pregnancy [TOP] in the second trimester is associated with three to five times higher risk of maternal morbidity and mortality than termination during first trimester. The main concern of obstetrician is to provide the most effective and safest regimen which combines the shortest expulsion interval with least side effects. This study was undertaken to compare the use of Foley's catheter with extra-amniotic instillation of PGF2 alpha for second trimester TOP so that a choice of the safer and cost-effective method could be available. The study was conducted in Department of Obstetrics and Gynecology Unit 'B' at Ayub Teaching Hospital Abbottabad between August 2003 and July 2004. Sixty patients recommended for TOP [missed abortion or anencephalic fetus confirmed on ultrasonography] were randomly allocated into two groups. In group 'A', Foley's catheter alone was used while in group 'B' extra amniotic instillation of Prostaglandin F-2 alpha [PGF2 alpha] was done via a Foley's catheter. After expulsion of catheters in both cases oxytocin infusion containing 30 units were started till the expulsion of fetus, placenta and membranes. The mean induction to expulsion time and the mean induction to delivery time for both groups were noted as well as total cost of treatment. Difference in time interval with regard to induction to expulsion time of catheter and induction to delivery time between the two groups was significant being 3 hours and 5 hours respectively less in group 'B' [p < 0.001]; however only 25% of patients in group 'B' had a significant short induction to delivery time as compared to group 'A'. The difference in costs of treatment between the groups was also significant [p < 0.001]. Use of PGF 2 alpha is preferred, though for poor patients Foley's catheter may be used, but only in a tertiary care setting