Histological Pattern Of Endometrial Samples In Postmenopausal Women With Abnormal Uterine Bleeding.

BACKGROUND: Abnormal uterine bleeding is one of the most common clinical problems in gynaecological practice and is an indicator of various underlying disorders. An endometrial biopsy should be done in all women over 35 years with AUB to rule out endometrial cancer or pre-malignant lesion and to initiate treatment. However, wide range of histological patterns on endometrial biopsy offer a diagnostic challenge to practicing pathologists. The objective of this study was to determine histological patterns of endometrium in postmenopausal women with abnormal uterine bleeding. METHODS: This cross-sectional study was conducted in the department of obstetrics and gynaecology, Benazir Bhutto Shaheed women and children teaching hospital, Abbottabad from 15/11/2014 to 14/05/2015. This study involved 110 postmenopausal women presenting with abnormal uterine bleeding. A written informed consent was obtained from every patient. RESULTS: The mean age of the patients was 61.60±6.17 years and the mean duration of AUB was 5.20±2.80 years. Most of the patients were para 6 (28.2%) and para 5 (28.2%) followed by para 4 (18.2%) and para 3 (17.3%) while only 8.2% were para 1. The most common histological pattern observed was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%). When stratified the data, there was no significant difference of histological patterns across various age groups (p=.673), duration of AUB (p=.064) and parity (p=.242). CONCLUSIONS: The most common histological pattern observed in postmenopausal women with AUB was complex hyperplasia without atypia (30.9%) followed by atrophic endometrium (24.5%), simple hyperplasia (23.6%), malignancy (12.7%), complex hyperplasia with atypia (4.5%) and benign endometrial polyp (3.6%).

Out Come Of Trial Of Scar In Patients With Previous Caesarean Section.

BACKGROUND: Patients who had one caesarean section were previously not given a trial of scar due to fear of increased morbidity. However, recently there has been a trend to give a trial of labour to patients with a previous caesarean section for a non-recurrent cause. Medical evidence indicates that 60-80% of women can achieve vaginal delivery after a previous lower segment caesarean section. Proper selection of patients for trial of scar and vigilant monitoring during labour will achieve successful maternal and perinatal outcome. The objective of our study is to establish the fact that vaginal delivery after one caesarean section has a high success rate in patients with previous one caesarean section for non-recurrent cause. METHODS: The study was conducted in Ayub Teaching Abbottabad, Gynae-B Unit. All labouring patients, during the study period of five years, with previous one caesarean section and between 37 weeks to 41 weeks of gestation for a non-recurrent cause were included in the study. Data was recorded on special pro forma designed for the purpose. Patients who had previous classical caesarean section, more than one caesarean section, and previous caesarean section with severe wound infection, transverse lie and placenta previa in present pregnancy were excluded. Foetal macrosomia (wt>4 kg) and severe IUGR with compromised blood flow on Doppler in present pregnancy were also not considered suitable for the study. Patients who had any absolute contraindication for vaginal delivery were also excluded. RESULTS: There were 12505 deliveries during the study period. Total vaginal deliveries were 8790 and total caesarean sections were 3715. Caesarean section rate was 29.7%. Out of these 8790 patients, 764 patients were given a trial of scar and 535 patients delivered successfully vaginally (70%). Women who presented with spontaneous onset of labour were more likely to deliver vaginally (74.8%) as compared to induction group (27.1%). CONCLUSIONS: Trial of vaginal birth after caesarean (VBAC) in selected cases has great importance in the present era of the rising rate of primary caesarean section.

Ectopic pregnancy management in Ayub Teaching Hospital Abbottabad: a ten year survey.

BACKGROUND: Ectopic pregnancy is a common life-threatening emergency in the developing world. It is a cause of maternal morbidity and mortality in the first trimester and these mortalities can be reduced if it is properly managed. The objective of this study was to assess the variable clinical presentations and outcome of treatment of ectopic pregnancy in Ayub Teaching Hospital Abbottabad. METHODS: Two hundred and fifty-five patients with ectopic pregnancy managed in Ayub Teaching Hospital over period of 10 years, were included in the study. The clinical presentation, diagnostic modalities and out come of treatment were recorded and analysed. RESULTS: Out of 255 patients 43 (16.86%) had un-ruptured tubal pregnancy, 183 (71.76%) had ruptured ectopic pregnancy and 22 (8.62%) had chronic ectopic pregnancy. At laparotomy, salpingectomy was done in 229 (89.80%) patients, salpingo-ophrectomy in 2 patients (0.78%), linear salpingostomy in 15 (5.88%) patients. Medical treatment was given to 5 patients and 8 patients were treated conservatively. There was no maternal mortality. CONCLUSION: In spite of various recent advances in the management of ectopic pregnancy, conventional surgical treatment by laparotomy is still the most widely used modality of treatment in our institution. With appropriate and prompt management, maternal mortality due to ectopic pregnancy can be prevented.

Association of maternal hypertension with placental abruption.

BACKGROUND: Placental abruption is one of the leading causes of maternal mortality and morbidity. Many causes predispose an expecting mother to placental abruption, such as trauma, previous history, smoking, ethnicity and hypertension. The present study concentrated on maternal hypertension as a cause of abruption. METHODS: All subjects of this comparative study underwent a complete obstetrical clinical workup comprising history, general physical examination, abdominal and pelvic examination, and relevant investigations. The maternal condition was assessed and managed according to established labour ward protocols, which included both pharmacological and surgical intervention. Patients were allotted various subgroups for detailed data analysis and comparative analysis. RESULTS: A total of 50 cases and 50 controls for placental abruption were studied during the study period. Both groups were compared based on parity, gestational age, proteinurea, haemoglobin, and hypertension. Mean systolic blood pressure (SBP) of cases in this study was 155 +/- 7.8 mmHg versus mean SBP for controls was 120 +/-14 mmHg. Mean diastolic blood pressure (DBP) of the cases was 104 +/- 6.6 mmHg compared to controls where mean DBP was 71 +/-11 mmHg. Among the controls, 45 (90%) had blood pressures in the normal range. There was statistically significant differences between cases and controls with respect to hypertension (p < 0.01). CONCLUSION: Placental abruption is strongly associated with maternal hypertension.

Maternal mortality: a ten year review in a tertiary care setup.

BACKGROUND: Maternal mortality ratio of a country is indicative of its health and development status. Information on maternal mortality is required to determine this status and to set priorities for policy making and programmatic and operation research strategies. This study was conducted to determine the causes of maternal mortality in a tertiary care hospital. METHODS: This study was conducted in Department of Obstetrics & Gynaecology B Unit, Ayub Medical College, Abbottabad, from January 2002 to January 2012. Data of all the pregnant patients admitted to Obs/Gyn Unit 'B' Labour Room were retrospectively collected and reviewed for the causes of direct maternal deaths. RESULTS: There were 21,120 deliveries during the study period. Out of these, there were 163 maternal deaths. The maternal mortality ratio was calculated as 772 per 100,000 live births. Direct maternal deaths constituted 143 (87.7%) and indirect deaths were responsible for 20 (12.3%) deaths. Haemorrhage was the leading cause of maternal death and was responsible for 43.55% of maternal deaths, while eclampsia was observed in 26.99% of maternal deaths. In 6.13% of patients rupture uterus was the cause of maternal death. CONCLUSION: Maternal mortality in our part of the world is high and most of the causes of maternal death remain haemorrhage and eclampsia. Haemorrhage which is the leading cause of maternal death is both predictable and preventable, if proper peripartum care is provided, maternal mortality can be reduced.

A ten year review of emergency peripartum hysterectomy in a tertiary care hospital.

BACKGROUND: Emergency peripartum hysterectomy (EPH) is a life saving procedure considered in cases of severe haemorrhage unresponsive to medical and conservative surgical procedures. The aim of present study was to review the frequency, indications, maternal morbidity and mortality associated with emergency peripartum hysterectomy in a tertiary care hospital in a developing country. METHODS: This was a cross sectional study in which data was retrospectively collected from January 2000 to December 2010. Main outcome measures were maternal morbidity and mortality associated with EPH. RESULTS: The incidence of EPH was 10.52/1000 deliveries. The main causes of EPH were rupture uterus 76 (34.86%), atonic uterus 65 (29.81%), placenta accreta 19 (8.71%), placenta previa 17 (7.7%), and placental abruption 36 (16.5%). Mostly subtotal hysterectomy was the preferred method done in 196 (89.9%) of cases, while total abdominal hysterectomy was done only in 22 (10.09%) of cases. The over all complication rate was 81.2% which included both minor and major complications like hypovolemic shock 180 (82.5%), febrile morbidity 108 (49.5%), wound infection 40 (18.3%), bladder injury 6 (2.75%), and thrombophlebitis 22 (10.09%). The maternal mortality in present review was (10.5%). CONCLUSION: Frequency of EPH was found to be high in this study. Obstetricians must be skilled in it particularly in developing countries where the main indication of hysterectomy is rupture uterus.