Effectiveness of per rectal misoprostol versus intramuscular oxytocin for prevention of primary postpartum haemorrhage

Objective: To compare the effectiveness of per rectal misoprostol over oxytocin in primary postpartum haemorrhage [PPH]

Study Design: Randomised controlled trial study

Place and Duration of Study: Gynaecology and Obstetrics Department, Unit IV, Bolan Medical Complex Hospital, Quetta, from September 2013 to February 2014

Methodology: Emergency obstetric patients receiving per rectal misoprostol [800 micro gm] were named as group 'A' and those receiving 10 units oxytocin intramuscularly were labelled as group 'B'. The patients were followed within 24 hours of spontaneous vaginal deliveries. Pads soaked were used to assess the amount of blood loss

Results: A total of 1,678 patients were included in the study. The mean age of patients in group-A was 29.11 years while the mean age of patients in group-B was 29.16 years. One hundred and twenty-three [14.66%] patients in group-A and 120 [14.31%] patients in group-B had PPH. Among the total 1,678 patients, 243 [14.49%] had postpartum haemorrhage among whom 24 [9.88%] had major haemorrhage with a blood loss >/=1000 mL. Among the sub-group [839 patients] administered misoprostol had 123 [14.66%] patients with blood loss greater than 500 mL and the rest 716 patients [85.34%] had blood loss less than 500 mL. The sub-group administered oxytocin have 120 [14.31%] out of 839 patients with postpartum haemorrhage while 719 [85.69%] had blood loss less than 500 mL

Conclusion: Active management of 3rd stage of labour with per rectal misoprostol administration was as effective as intramuscular oxytocin. Both were equally effective to reduce PPH and the subsequent need for surgical interventions

Gynaecological malignancies frequency and outcome at a tertiary care hospital

To determine the frequency of different Gynecological Malignancies and outcome following primary treatment. Cross sectional Descriptive Study. In a tertiary care hospital; Bolan Medical Complex Hospital Quetta Baluchistan from Feb 2006 to Nov 2009. All the women presenting with genital tract cancer during the study period were included. Their age, parity, mode of presentation, anatomic area involved, and investigations performed were noted. Stage of disease [according to FIGO staging], surgical procedures performed, and operative finding were recorded. Specimens were subjected to histopathological examination. Post operative chemo or radiotherapy was given according to stage and histopathology reports. Patients were followed up by telephonic appointments for growth recurrence, disease free interval and mortality. Follow up records were also obtained from Oncology Department and CINAR [Cancer Institute of Nuclear Medicine and Radiotherapy] Hospital Quetta. Amongst the 93 cases of gynecological cancer ovarian cancer was the commonest [45%], cervical and uterine cancers were equal in frequency [17.2%], and Choriocarcinoma was seen in [9.3%] cases while vaginal cancer was rarest [1.83%]. Epithelial ovarian tumors were the commonest [71%] and 67% patients presented in stage III and IV. During the median follow up period of 25 months 44% patients are alive without recurrence. 27% lost to follow up, 18% developed recurrence, 11% died with disease, 50% cancer deaths were due to ovarian cancer. Ovarian cancer is the commonest genital tract cancer and accounted for half of all genital tract cancer deaths. Early diagnosis and treatment can improve prognosis. Well established screening program and public awareness is important for early diagnosis and to decrease mortality

Frequency of perinatal mortality at Bolan medical complex hospital Quetta

To determine the extent and feto maternal factors contributing to perinatal Mortality. A prospective review study. This study was Gynecological and Neonatal Intensive care units of BMCH, Quetta from January 2006 to December 2011 A prospective review of all still births from 24 weeks of pregnancy and on words and neonatal deaths within first seven days of life either in obstetric ward or neonatal nursery was done. The details of each mother and new born were recorded on standardized proforma. The perinatal mortality rate was 99/1000during last 6 years, 102/1000 in 2006, 97/1000 in 2011 Most common maternal cause for perinatal morality was hypertensive disorders of pregnancy 26%, then antepartum hemorrhage 23.8%, birth asphyxia 23%, Congenital anomaly contributed 5.3%, unexplained 7% of all. Perinatal mortality is a major health problem caused by poor maternal health, lack of antenatal visits, multiparity, prematurity and infections of both mother and new born. Antenatal care, birth spacing, proper referral and standardized management during labour and in nursery can reduce the perinatal mortality

Pap smear; outcomes of cervical screening

Objective: To detect and manage Pre-cancerous cervical change in order to prevent invasive cancer in a symptomatic sexually active women of reproductive age group. Study design: An observational study

Place and Duration of Study: Study was conducted in Gynae unit 11 of Bolan Medical College Complex Quetta from June 2002 to May 2004

Patients and Methods: 370 women visiting either Gynae OPD or antenatal clinic were included in study. Positive smears were followed by biopsy and histopathology

Results: 198 [53.51%] smears were reported to be normal, 126 [34%] inflammatory, 20 [5.40%] borderline, mild dyskaryosis was seen in 6 [1.62%] moderate in 5 [1.35%] and severe dyskaryosis in 3 [0.81%]. 14 smears were considered inadequate because of blood stained specimen or due to other artifacts. Patients with mild dyskaryosis were advised to come for follow up and to repeat smear after three months.8 [2.16%] patients with moderate to severe dyskaryosis had punch biopsy. Histopathology revealed CIN-II in four cases of moderate dyskaryosis and CIN-III in one case of severe dyskaryosis. Two patients with moderate dyskaryosis were managed by local destructive procedure with electrocautry. While two patients with CIN-II and three patients with severe dyskaryosis had total abdominal hysterectomy due to continuous pain lower abdominal and excessive vaginal discharge

Conclusion: Cervical cancer screening by pap smear is a simple and effective method of detecting pre malignant lesions. If it is done routinely in asymptomatic patients at regular intervals, it may help to decrease the incidence of the invasive cancer

Maternal mortality: a four year review

Over a four-year period [from January 1991 to December 1994] 20.317 patients were delivered at the Civil Hosptial, Quetta. During this period 128 maternal deaths occurred giving a maternal mortality rate of 630.01/100.000 births. These maternal deaths were reviewed retrospectively. The aim was to find out the incidence and causes of maternal deaths at the Civil Hospital, Quetta and to compare the results with other studies. The classic triad of haemorrhage, sepsis and hypertensive disorders was the major cause of death. Grand multiparity, poverty and illiteracy were common risk factors, which can be overcome to some extent by the use of effective contraception, motivation for antenatal check up and by safe home or hospital delivery