Adult granulosa cell tumor: a small mass producing troublesome morbidity to a woman

Granulosa cell tumors are sex-cord stromal tumor ofovary, a rare neoplasmaccounting for approximately 3-5% of all ovarian malignancies. Hormone producing tumor, a total of 95% of all GCTs are adult type and of large size. A majority of women present with abdominal mass and diagnosis made on histopathology. While small size symptoms producing Granulosa cell tumors are rare and it's a rare virilizing tumor of adolescents. Adult Granulosa cell tumor is a clinically and molecularly unique subtype of ovarian cancer. The present case study reports on a case of a small size Granulosa cell tumor producing postmenopausal bleeding in 56-year-old woman

Cornual ectopic pregnancy: a threat to the life of mother

Cornual [interstitial] ectopic pregnancy, an uncommon variant of ectopic pregnancy often poses a diagnostic and therapeutic challenge with a significant risk of rupturing and bleeding. Early diagnosis and treatment of interstitial ectopic pregnancy is very crucial, as they carry a very high risk of morbidity associated with the rupture. If they continue without diagnosis, a life-threatening situation may occur even when surgical intervention with laparotomy is performed. We present a case who reported with lower abdominal pain and 2 months amenorrhea. The patient was diagnosed with a cornual ectopic pregnancy and managed timely

Neonatal outcome with instrumental vaginal delivery: a study at PNS Shifa

To evaluate neonatal outcome in terms of Apgar score after forceps and ventouse delivery in pregnant ladies indicated to have instrumental deliveries. Randomized control trial. This study was conducted at Labor ward of department of obstetrics and gynecology, PNS SHIFA Karachi, between Dec 2007 to Mar 2008. The target population were all pregnant subjects who visited labor room for delivery. Out of these patients, subjects who were indicated an assisted vaginal delivery for necessary management of labor were formally requested to participate in the study after various exclusions. Instrumentation was done in only those patients with singleton term pregnancy with cephalic presentation and vertex at + 1 to +3 stations. Patients with an indication for assisted vaginal delivery [n=105], were randomized for ventouse [n=53] and forceps delivery [n=52]. Instruments used were Wrigley's outlet forceps and vacuum extractor [V.E] with silicone cups. Data was recorded on specially designed Proforma. Post delivery neonatal outcome in terms of Apgar score at one minute and five minutes were compared between two modalities. The subjects undergoing forceps delivery had a significantly higher Apgar score [8.36 +/- 1.27] at 1 minute in comparison to those subjected to vacuum delivery [7.53 +/- 1.56]. The differences in Apgar score at 5-minutes [forceps delivery: 9.136 + 1.01 vs vacuum delivery 9.00 + 1.19], were not statistically significant. Outlet forceps assisted vaginal deliveries had better neonatal outcome in terms of Apgar score in comparison to ventouse

effect of hyoscine butylbromide on 1st stage of labour in term pregnancy

To determine the effect of hyoscoine butylbromide in shortening active phase of 1st stage of labour without adverse effects in mother and fetus. Randomized, double-blinded placebo controlled trail. Labour ward of PNS SHIFA hospital for duration of 06 months from 1st Jan 2008 to 30 June 2008. One hundred pregnant women both primigravida and multigravida in active phase of spontaneous labour [an active phase is defined as 3 cm or more cervical dilatation with regular uterine contraction] were included in the study. Either drug or placebo was given intravenously once the women entered active labour. Progress of labour was plotted on partogram student 't' test was applied for comparison for two groups. The duration of 1st stage of labour was main outcome. Secondary outcome measures included duration of second and third stages of labour, blood loss at delivery, and apgar score in neonates between the two groups. In patient receiving hyocscine butylbromid the active phase of 1st stage of labour was 194.8 +/- 87.3 mins as compared to placebo group where active phase 1st stage of labour was 282.3 +/- 92.3. There was significant difference in duration of active phase 1st stage in both groups of [87.5 mins], there was no significant change in duration of second and third stage of labour, no difference in blood loss, and apgar score in both groups. Hyoscine butybromide is effective significantly in reducing duration of 1st stage of labour in primigravida and multigravida with term pregnancy and it is not associated with any adverse out come in mother or neonate

Beta-thalassemia- institution based analysis of ethnic and geographic distribution, effect of consanguinity and safety of chorionic villus sampling as a diagnostic, tool for pre-natal diagnosis in selected patients

To study the ethnic and geographic distribution of Beta-thalassemia amongst the patients included and to study the effect of consanguinity in promoting this disease. Also, to establish the safety of CVS when used as a pre-natal diagnostic tool in aiding the early diagnosis of Beta-thalassemia in selected patients. Descriptive Study. PNS Shifa Karachi, from Jan 2008 to Dec 2008. A total of 223 women out of 240 that were referred from all over Sindh to PNS Shifa Hospital Karachi for susceptible gene mutations participated in the study. The standard procedure that was used in this study was trans-abdominal aspiration of chorionic villi through suction needle. The samples were then sent for further analysis to the Pathology Department at PNS Shifa Hospital Karachi. In our study population Beta-thalassemia was most prevalent in Sindhi 107 [48%] followed by Punjabi 46 [21%], 27 [12%] Pathan, and 43 [19%] Balochi. Out of 223 women, 95 were of thalassemia trait, while 85 were of thalassemia major. Fifty five percent of thalassemia trait and 56% of thalassemia major fetus parents were first cousins. The rate of pregnancy loss after performing CVS was 2.0% with no complications reported. It is concluded that highest percentage of thalassemia is in first cousins and sindhi origin families are mostly affected. However CVS is a safe and effective tool for prenatal diagnosis and subsequent counseling in selected couples

Efficacy of intramyometrial prostaglandin in the management of primary postpartum hemorrhage due to uterine atony in the multipara after failure on convential therapy

To determine the success rate of postgardin [PG] F[2] alpha in a primary post partum Hemorrhage [PPH] due to uterine along in multipara. Quasi-experimental study. Department of Obstetrics and Gynecology in PNS Shifa Karachi Pakistan, from 1st June 2004 to 30th May 2005. During this one year 126 cases of multipara had primary post partum hemorrhage. Inclusion criteria was multipara who developed PPH due to uterine atony and who did not respond to any other non surgical treatment modalities. Medical diseases were not considered in exclusion criteria. Primary gravida and those with secondary PPH were excluded. Out of these 26 patients had not responded by conventional methods. 250 micro g of PG F[2] alpha was administered intra-myonemetrially. Syntocinon drip was stopped before and ergometrine was not given along this. The patients without uterine atony were managed according to the cause. In this study 26[100%] received PGF[2] alpha out of which 22 [84.6%] patients responded successfully. Two patients required second dose. It was repeated at 15-90 minute interval maximum three doses were tried. The four patients [15.38%] who failed to response, two patients had chorioamionitis, one patient had placenta praevia. One patient had no uterine response possibly due to delayed use of drug and excessive blood loss. PGF[2] alpha is a safe drug which can reduce the rate of surgical procedures in cases uterine atony