Vaginal discharge during pregnancy and associated adverse maternal and perinatal outcomes.

OBJECTIVES: To observe the effects of vaginal discharge during pregnancy on maternal and fetal outcomes. METHODS: This observational study was undertaken form June 2018 to 31 May 2019 period in the Department of Obstetrics and Gynaecology at Liaquat University of Medical and Health Sciences hospital Jamshoro Unit IV. Data were collected from a convenience sample of 85 pregnant women. All the pregnant women with vaginal discharge were included in the study, while the women with bleeding and other medical disorders during pregnancy were excluded. Data was analyzed. RESULTS: Women's mean age as 27.4 (±4.7) years and most were 28-35 weeks pregnant (n=29, 34%) and primigravida (n=35, 41%). Seventy six women (89%) presented with vaginal discharge while nine women (11%) reported no vaginal discharge. Of those with vaginal discharge,53 women (69.7%) had vaginal infections: bacterial vaginosis (n=21, 39.6%), vaginal candidiasis (n=17, 32.1%) and vaginal trichomoniasis (n=15, 28.3%). Pathological vaginal discharge (PVD) was associated with vaginal irritation (n=30, p<0.0001), vaginal pain (n=50, p<0.0001), fever (n=12, p=0.015), uterine contractions (n=31, p<0.0001), premature membrane rupture (n=29, p<0.0001), abortion (n=13, p=0.009), pre-term delivery (n=24, p<0.0001) and post-partum endometritis (n=19, p=0.0006). PVD was associated with neonatal outcomes i.e. low birth weight (n=24, p<0.0001), low Apgar score at birth (n=22, p=0.0001), neonatal respiratory distress syndrome (n=21, p=0.0002), neonatal intensive care hospitalisation (n=20, p=0.002) and early neonatal death (n=16, p=0.003). CONCLUSION: Pathological vaginal discharge (PVD) during pregnancy is more frequent and is associated with adverse maternal and perinatal outcomes.

Infertility and weight reduction: influence and outcome.

OBJECTIVE: To assess the effect of weight reduction in obese infertile women on conception rate spontaneously as well as with ovulation induction and pregnancy outcome. STUDY DESIGN: Observational experimental study. PLACE AND DURATION OF STUDY: Different private clinics at Mirpurkhas, Thana Bola Khan and Hyderabad, Sindh, Pakistan, from March 2008 to February 2011. METHODOLOGY: Infertile women who were obese with the body mass index (BMI) > 30 kg/ m2 and failed to conceive within 2 - 5 years after taking treatment of infertility for many cycles were inducted. These women underwent life style change program related to exercise and diet for 6 months and in the next 6 months they were observed for spontaneous conception. Those women who failed to conceive were prescribed ovulation induction (clomifene citrate) for the next 6 months and were observed for conception. After conception, they visited regularly during antenatal period till delivery. The data was collected and analyzed on SPSS version 17. RESULTS: The mean decrease in the body index observed was 9.6 ± 1.23 kg/m2, spontaneous conception rate was (n = 35, 41.17%) and miscarriage rate was (n = 9, 16.66%). CONCLUSION: Weight reduction leads to high spontaneous conception rate as well as with ovulation induction therapy and improves the pregnancy outcome.

Obstetrical trauma to the genital tract following vaginal delivery.

OBJECTIVE: To determine the frequency, types and complications of genital tract trauma during child birth. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Unit I, Liaquat University of Medical and Health Sciences, Jamshoro, from June 2006 to May 2010. METHODOLOGY: All women who sustained genital tract trauma during delivery at the study centre and those referred from periphery with the same condition within 40 days of delivery were enrolled in the study. Exclusion criteria were women who sustained genital tract injury with caesarean section and genital tract trauma due to accident. Studied variables included age of women, parity, place of labour, type of trauma received and its immediate complications. The data was expressed in terms of descriptive statistics. RESULTS: Out of a total 9216 cases admitted in maternity ward during the study period, 467 cases (5.06%) had sustained genital tract trauma. The most frequent obstetrical trauma seen in primiparous referral cases were vaginal tears in 16 cases (25.39%) and perineal tears in 12 cases (19.04%). Multiparous women were 196 (41.97%) and cervical tears were the most frequent obstetrical trauma in them (n=52, 26.53%). Grand multiparous women were 208 having cervical tears (44.4%) and uterine rupture in 77 cases (37.01%) each. Most frequent early morbidities were postpartum haemorrhage (n= 352, 75.37%), hypovolemic shock (n= 220, 47.10%) and infection (n=158, 33.83%). The mortality rate was 16.05%. CONCLUSION: Genital tract trauma is a common complication of vaginal birth mostly seen in grand multipara, leading to haemorrhage, shock and infection.

Risk factors in early pregnancy complications.

OBJECTIVE: To determine the underlying risk factors in early pregnancy complications and outcome. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Obstetrics and Gynaecology Unit-IV, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2007 to June 2008. METHODOLOGY: All the women with first trimester pregnancy with different complications were included in this study while those women with uneventful first trimester were excluded. The inducted women were registered on pre-designed proforma. Studied variables including demographic details, gestational period, type of complications, risk factors, treatment and outcome. The data was expressed in terms of mean and percentages with a confidence interval of 95%. Analysis was done on SPSS version 14. RESULTS: Out of a 204 total admissions, 115 (56.37%) patients had different early pregnancy complications. Their mean age was 29.4+6.8 years. Commonest complications found were abortion in 88 (76.52%) cases. The underlying risk factors found in abortion were antiphospholipid syndrome in 5 (5.68%) cases, Diabetes mellitus in 8 (9.09%) cases, hypertension in 16 (18.18%) cases, and polycystic ovarian syndrome and infection in 11 (12.5%) cases each. Most of the cases 69 (60%) were treated by minor surgical procedures, and 22 (19.13%) cases responded with conservative medical therapy. Outcome were anaemia in 92 (79.3%) cases, psychological upset in 72 (62.1%), infection in 55 (44%) cases and coagulopathy in 9 (7.8%) cases. CONCLUSION: Abortion was found as the most frequent early pregnancy complication and the most frequent underlying risk factor was hypertension. Outcome included anaemia, psychological upset and infection.