Safety of caesarean myomectomy

Uterine fibroids are the most common type of tumours in women arising from uterine myometrium and less commonly from cervix. Objective of the study was to check the safety of caesarean myomectomy. Patients attending Gynaecology-B Unit of Ayub Teaching Hospital having pregnancy with fibroid and undergoing myomectomy along with caesarean section [CS] were included in this prospective study during Jan 2010-Dec 2011. Intra-operative and postoperative maternal morbidity in terms of blood loss, operative time and length of hospital stay was compared to matched pregnant woman with caesarean section alone. Out of 6,000 antenatal mothers registered during the study period myoma was detected in 96 [1.6%] cases. Mean age of mother having myoma was 28 years, 70% were primigravida, and mean haemoglobin was 10.56 gm%. Size of myoma was 12 Cm in 30% cases 5 Cm in 23% and more than 1 myoma in 60% cases. There was no significant difference in intra-operative haemorrhage and length of hospital state in comparison matched women with CS although operating time was double than later. None required caesarean hysterectomy. Myomectomy can be safely performed in majority of carefully selected patients with myomas without any serious life threatening complications.

Effectiveness and safety of vaginal misoprostol for induction of labour in unfavourable cervix in 3[rd] Trimester

The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasiexperimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery. This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness [delivery within 24-hours] and safety [uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity]. Secondary outcome measures included neonatal outcome. Out of 946 cases, successful vaginal deliveries were achieved in 843 [89.1%] cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 [12%] patients. Caesarean Section had to be done in 103 [10.8%] cases. The indications for Caesarean Section were foetal distress in 42 [40%], occipito-posterior position in 8 [7.7%], abruptioplacentae 2 [1.9%], cord around the neck 9 [7%], uterine hyperstimulation 6 [5.8%] and failure to progress in 20 [19%] cases. Admission to NICU was 28 [3.3%] and Neonatal deaths were 5 [0.5%]. Postpartum Haemorrhage [PPH] was observed in 22 [2.3%] patients. There was no case of rupture uterus. Vaginal Misoprostol appears to be safe and effective for cervical ripening in third Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory

Maternal and neonatal outcome of ventouse delivery at Ayub teaching hospital, Abbottabad during the year 2005 to 2006

To study the maternal and neonatal outcome of assisted vaginal delivery with vacuum extractor [ventouse]. This prospective study conducted in the department of obstetrics and gynaecology. Unit A, Ayub Teaching Hospital, Abbottabd included hundred consecutive cases of successful ventouse deliveries from May 2005 to April 2006. There were minimum [16%] maternal and neonatal complications during this study. As no serious maternal and neonatal morbidity noted during the study period, vacuum extractor should be the instrument of first choice for instrumental vaginal delivery

Combined abdominal hysterectomy, cholecystectomy and appendicectomy: a study of 25 cases in Abbottabad

Gallstone disease is common in women. Many patients undergoing abdominal ultrasound for gynaecological diseases are found to have gallstones. This study was done to see the results of combined abdominal hysterectomy, mini-cholecystectomy and appendicectomy in a set up lacking facilities of laparoscopic surgery. This prospective study was conducted in Ayub Teaching Hospital, Iltaf Hospital and Shahina Jamil Trust Hospital of Abbottabad from August 1998 to July 2004. All patients undergoing combined abdominal hysterectomy and mini-cholecystectomy were exclusively studied with reference to following variables. Age, Weight, Parity, Co-morbid conditions, peri-operative and post-operative complications, blood transfusion, hospital stay and mean extra time for mini-cholecystectomy and appendicectomy after abdominal hysterectomy. There were 25 patients in the study group. The ages ranged from 35-50 years. Mean weight was 65 Kg. There were no operative complications. Mild postoperative complications occurred in 7[28%] patients. Mean extra time for cholecystectomy was 25 minutes. Mean hospital stay was 9 days. In selected women, combined abdominal hysterectomy, cholecystectomy and appendicectomy is a safe, feasible and cost effective procedure