Frequency of different types of domestic violence in antenatal patients

To determine the frequency of different types of domestic violence in antenatal patients. A cross-sectional hospital-based study was done at Obstetrics and Gynaecology Department, Lady Reading Hospital from April 2010 to March 2011. Patients received in antenatal clinic were enrolled. Informed consent was taken from the participants meeting the inclusion criteria. The tool used to measure abuse was derived from the Abuse Assessment Screen. A total of 129 of pregnant women participated in this study. The respondents were young [average age 31 years]. One hundred thirteen [87.6%] had length of marriage more than one year. Ninety six [74.4%] were multipara and Sixty six [51.2%] were in third trimester. Among them 53.5% were abused [any type] in marital lifetime and 39.5% experienced physical violence last year. Forty six [35.7%] respondents were abused physically during pregnancy. Verbal violence was 51.9%, followed by emotional violence 46.50%, economic violence 33.3%, and 20.40% had nonconsensual sex [sexual violence]. Husband was involved directly in 38.0% cases, while in-laws in 20.2% cases. Violence during pregnancy was associated with marital life-time violence and physical violence during last year [p < 0.05]. Domestic violence during pregnancy is a common problem and highlights the need for interventions by health professionals

Frequency of postpartum haemorrhage in maternal mortality in a tertiary care hospital

To determine the frequency of postpartum haemorrhage as a cause in maternal mortality during a period of seven years in a tertiary care hospital. This descriptive study was conducted in Gynae A unit of Department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar. Data was collected from maternal mortality records retrospectively from 1[st] January 2003 to 31[st] December 2009. All patients who died in the hospital with a diagnosis of postpartum haemorrhage as the primary cause of death were included in the study. A total of 302 maternal deaths were recorded during the study duration. Out of these 302, 74 were due to Post-partum Haemorrhage which constituted 24.5% of maternal deaths. The mean age of the sample was 29.69 +/- 7.10. Uterine atony was the cause of death in 45.9% [n=34], rupture uterus in 32% [n=24], genital tract tears in 14.86% [n=ll] and retained placenta in 6.75% [n=5] of the cases of Postpartum Haemorrhage. Subtotal abdominal hysterectomy was performed in 51.35% [n=38]; repair of tears and removal of placenta in 6. 75% [n=5] each; Subtotal abdominal hysterectomy with internal iliac If gat ion was performed in 5.4% [n=4] cases while only internal iliac ligation and B Lynch suture was applied in 1.35% [n=l] each. The remaining 20 cases expired before they could be prepared for it. Postpartum Haemorrhage was found to be leading cause of maternal mortality making up to one quarter of total deaths in 7 years. Uterine atony and ruptured uterus were the major causes of Postpartum Haemorrahge. Subtotal abdominal hysterectomy was the major procedure performed

audit of change in rate and indications of caesaren section in a tertiary care hospital of Peshawar

To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively. This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study. During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 [59.81%], followed by grandmultigravida n=93 [21.98%] while n=77 [18.20%] were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680 [47.61%] but it was followed by primigravidas n=480 [33.61%] and least n=268 [18.76%] in grandmultigravidas During 1996, the commonest indications in order of frequency were dystocia n=120 [31.20%], previous caesarean section n=71 [16.78%], placenta praevia n=56 [13.23%] and fetal distress n=48 [11.34%] respectively while during 2006, they were dystocia 310 [21.70%], fetal distress n=197 [13.79%], previous caesarean section = 191 [13.37%] and breech presentation n=180 [12.60%] respectively A significant increase [14.84%] in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006

Maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term

To find out the maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term. This study was conducted at Lady Reading Hospital, Peshawar from 1st July 2000 to 30th June 2001 on patients presenting with singleton term breech. Multiple pregnancy and preterm breech were excluded. Information regarding,age, address, parity, gestational age, physical and vaginal examination, ultrasound findings, mode of delivery, any specific procedures performed including external cephalic version [ECV] was collected. Demographic variables and obstetrical outcome were observed in diagnosed and undiagnosed breech cases.Diagnosed breech cases were diagnosed antenatally and proper management plan decided, while undiagnosed breech cases were unbooked who came to hospital for 1st time in labour. Out of 203 cases, 163 [80.29%] patients presented with undiagnosed breech and 40[19.71%] had been diagnosed in antenatal clinic. Out of 163 undiagnosed cases, 137 [84.1%] had successful vaginal breech delivery [VBD], 22 [13.5%] cases had caesarean section [CS], three [1.8%] had subtotal hysterectomy for rupture uterus and 1 [0.6%] with successful ECV had normal vaginal delivery [NVD]. Among 40 diagnosed cases, 8[20%] had successful VBD, 22 [55%] had CS and 10 [25%] had successful ECV followed by NVD. There was no statistical significant difference in short term neonatal outcome, neonatal morbidity and mortality among both groups. Maternal morbidity was lower in vaginally delivered undiagnosed breech cases than in those delivered by caesarean section.In diagnosed group maternal morbidity was the same regardless of mode of delivery. Good prenatal care is essential to reduce undiagnosed breech cases at term. ECVreduces the incidence of Breech Presentation at delivery. In selected cases VBD is a safe option

analysis of direct causes of maternal mortality

This study was conducted to analyze the direct causes of maternal mortality during a period of seven years in a tertiary care hospital of NWFP. This retrospective, analytic study was conducted from 1998-2004, and included all the pregnant patients including miscarriage and ectopic pregnancies, presenting during this period to Gynae B Unit, Lady Reading Hospital Peshawar. The records of maternal deaths were reviewed from 19982004 retrospectively and causes of direct deaths were analyzed. Deaths in non-pregnant patients and indirect deaths in pregnant patients were excluded. Total number of live births during the time period was 23720 and total number of maternal. deaths was 311. The maternal mortality ratio [MMR] was calculated as 1311/100,000 live births. Out of 311 maternal deaths, 268 [86.2%] had direct causes and 43 [13.8%] had indirect causes of maternal mortality. Hemorrhage was responsible for 42.16% [113/268] of maternal deaths, followed by hypertensive disorders in 24.63% [66/268], ruptured uterus in 10.45% [28/268], septicemia in 9.7% [26/268], thromboembolism in 7.8% [21/268] and unsafe abortion in 3.4% [9/268] cases. The study shows a very high MMR as compared to national figures. The leading cause of direct maternal death was hemorrhage, followed by pregnancy induced hypertension, ruptured uterus and septicemia. These conditions can be prevented by good antenatal, intranatal and postnatal care

Perinatal and maternal outcome in retained second twin

To evaluate the perinatal and maternal outcome related to retained second twin. This study was carried out in Gynae 'B' Unit, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2004 to December 2005. Patients presenting to the labour ward after having delivered the first twin at home and with retention of the second twin in-utero with time interval of more than 30 minutes after the delivery of the first twin were included in the study. A total number of 25 patients presented with retained second twin during the above mentioned time period. Malpresentation in 14 patients [56%] and uterine inertia in 7 patients [28%] were found to be the commonest reasons causing retention of second twin, while malpresentation and uterine inertia together was seen in 4 patients [16%]. The perinatal mortality was 76% [n=19/25]. Maternal morbidity like fever was seen in 12 patients [48%] while post partum hemorrhage occurred in six patients [24 N. Blood transfusion was required in 17 patients [68%]. In post partum period breast engorgement requiring treatment with bromocriptine was seen in 5 patients [20 N]. Retained second twin is associated with a hlgh perinatal mortality rate and also causes increased morbidity in mothers. Thus, patients with twin gestation should be referred earlier to a center equipped to handle such a high-risk pregnancy and its associated problems at birth

Magnesium sulphate in the prophylaxis and treatment of eclampsia

Magnesium Sulphate is considered to be the agent of choice for the control of eclamptic seizures in pregnant women. Our objectives were to determine frequency of eclampsia and pre-eclampsia in our unit and to determine the effect of initial loading dose of magnesium sulphate on maternal and fetal outcome. This study was carried out in Department of Gynaecology at Lady Reading Hospital, Peshawar. In the year 2000 only 133 patients received magnesium sulphate out of 228 cases of eclampsia and pre eclampsia due to the problems with the continuous supply of the drug. This included 53 cases of eclampsia and 80 cases of pre-eclampsia. Information regarding the dosage of magnesium sulphate labor out cone, maternal and fetal outcome, side effects and complications of therapy were evaluated from hospital case records. The magnesium sulphate regimen consisted of 4 gm loading dose as 20% solution intravenously over 10-15 minutes followed immediately by 5 gm into each buttock. Dose of 5gm intramuscularly was repeated only if the patient developed convulsions. Eclampsia and pre-eclampsia occurred in I in 25.5 and 1 in 34.4 deliveries respectively. Majority of patients received the initial loading dose of magnesium sulphate, but in 2 patients's dose had to be repeated. In two patients of pregnancy induced hypertension convulsions occurred soon after delivery unheralded by any signs and symptoms of impending eclampsia. Perinatal mortality was 19 [35.8%] and 16 [20%] in eclampsia and pre-eclampsia respectively. High perinatal mortality was attributed to prematurity as only 16.98% of eclampsia and 57.5% of Pre eclampsia were more than 37 weeks. One patient of sever pre-eclampsia developed postpartum hemorrhage and acute renal failure, but she recovered while another one developed sudden postpartum collapse immediately after delivery and died due to cerebrovascular accident. 8 patients of eclampsia died despite intensive management. All of them were referred from periphery with history of multiple fits and were brought in a serious state. Frequency of eclampsia and pre-eclampsia is high in this region with high perinatal and maternal morbidity and mortality. Magnesium sulphate is an effective drug to prevent and control seizures. It is easy to administer and subsequent nursing is easy. Seizures usually terminate after the initial loading dose of magnesium sulphate

Fallopian tube prolapse after abdominal hysterctomy

A 38 year old lady who had total abdominal hysterectomy, for chronic pelvic pain, presented with profuse vaginal discharge per vaginum along with a cystic pelvic mass of 10 week size. There was a polypoidal fleshy growth present in the vault. It was diagnosed to be a fallopian tube on histopathology. Patient was treated with bilateral salpingo-ophorectomy through an open laparotomy