Septic/unsafe abortion: a preventable tragedy.

BACKGROUND: Unsafe abortion is one of the greatest neglected problems of health care in developing countries like Pakistan. In countries where abortions are restricted women have to resort to clandestine interventions to have an unwanted pregnancy terminated. The study was conducted to find out the prevalence of septic induced abortion and the associated morbidity and mortality and to highlight the measures to reduce it. METHODS: This cross-sectional descriptive study was carried out in Obs/Gyn B Unit, Ayub Teaching Hospital, Abbottabad from January 2007 to December 2011. During this period all the patients presenting with pyrexia lower abdominal pain, vaginal bleeding, acute abdomen, septic or hypovolaemic shock after undergoing some sort of intervention for abortion outside the hospital were included. After thorough history, examination and detailed investigations including high vaginal and endocervical swabs for culture and sensitivity and pelvic ultrasound supportive management was given followed by antibiotics, surgical evacuation of uterus/ major laparotomy in collaboration with surgeon as required. Patients with DIC or multiple system involvement were managed in High Dependency Unit (HDU) by multidisciplinary team. RESULTS: During the study period out of a total 6,906 admissions 968 presented with spontaneous abortion. There were 110 cases (11.36%) of unsafe abortion, 56.4% presented with vaginal discharge, 34.5% with vaginal bleeding, 21.8% with acute abdomen, while 18.9% in shock and 6.8% with DIC. Forty-nine percent patients used termination as a method of contraception. Mortality rate was 16.36%, leading cause being septicaemia. CONCLUSION: Death and severe morbidity from unsafe abortions and its complications is avoidable through health education, effective contraception, early informed recognition and management of the problem once it occurs.

Foetomaternal outcome in patients with or without premature rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes is responsible for one third of all preterm births and is associated with significant maternal, foetal and neonatal risks. The objectives were to compare the foeto-maternal outcome in patient with and without preterm premature rupture of membranes. METHOD: This prospective comparative study was conducted in Gynae-C Unit of Ayub Teaching Hospital from Sep 2005 to Mar 2006. Total 170 cases were recruited in the study out of which 85 had Preterm Premature Rupture of Membranes (PPROM), and 85 had preterm labour without PROM. Patients' data were recorded on a performa. Maternal outcome was measured on the basis of presence of fever and mode of delivery. Foetal outcome was measured on the basis of weight of the baby, and presence of infection (fever), APGAR score and neonatal death. Analysis was performed using SPSS-10. RESULTS: The primary data arranged in groups was divided into PPROM and no-PPROM groups. The PPROM was found to be frequent in younger age group between 15-25 years while no-PPROM was common among the age group between 26-35 years (p = 0.002). Lower socioeconomic class and history of previous one or more preterm delivery was significantly associated with PPROM (p = 0.001). Maternal fever was also significant in the PPROM group (p = 0.01). Low birth weight was statistically significant in the PPROM group. Majority of the babies born to mother were either extremely low birth weight or low birth weight, i.e., between 1-25 kg (p = 0.005). Low APGAR score at the time of delivery (p = 0.01) and foetal infection (p = 0.002) between the PROM and no-PPROM group was found to be statistically significant Neo-natal deaths was also higher in the PPROM group as compared to no PPROM group (11 verses 2) (p = 0.009). CONCLUSION: In our study premature rupture of membrane had increased neonatal morbidity and mortality as compared to preterm birth. Strategies should be developed for its prevention.

Pregnancy with fibroids and its and its obstetric complication.

BACKGROUND: Pregnancy along with a fibroid is a high risk pregnancy which may lead to complication with unequal gravity. Objective of this study was to assess the prevalence and obstetric complications of fibroids during pregnancy, this cross-sectional study was carried out in the Department of Gynaecology, Unit 'C', Ayub Teaching Hospital Abbottabad. METHOD: Data of all patients who presented with fibroid during pregnancy during two years, i.e., from Jan 2006 to Dec 2007 was recorded on a proforma and analysed using SPPS-12. RESULTS: Thirty patients were diagnosed to have fibroids during pregnancy out of 3468 deliveries, thus prevalence was 0.865% in our hospital. The age of 50% cases was from 20 to 30 years, and 30 to 35 Year (27%). Twenty-one (70%) belonged to low socioeconomic status. Ninety percent patients reached up to term pregnancy between 37 to 40 weeks. Fibroids were found less common in patients in their first pregnancy (8, 23.66%). Twenty-one (70%) patients were delivered by caesarean section, and in 1 (3.33%) patient hysterotomy was performed. Failure to progress and foetal distress was the commonest indication for caesarean section (8, 38.09%) followed by breech presentation (4, 19.04%), cord prolapse (3, 14.28%) and fibroids in the lower segment (2, 9.52%). Anaemia was the commonest complication (20, 66.66%) followed by postpartum haemorrhage (PPH) (10, 33.33%). Breech presentation was the commonest malpresentation (4, 13.33%) associated with fibroids during pregnancy. Premature rupture of membranes and cord prolapse was seen in 3 (10%) patients each. Four (13.33%) patients underwent abdominal hysterectomy. Intra uterine growth restriction IUGR was seen in 2 patients (6.66%), 2 patients ended up with abortions, 1 patient had a spontaneous pregnancy loss and the other underwent hysterotomy due to low lying placenta and heavy bleeding per vaginum. Compound presentation, neglected transverse lie, stuck head of breech, placenta increta, retained placenta, low lying placenta, were the other complications occurring in one patient each. One patient died during anaesthesia. Neonatal outcome was encouraging as 20 (67%) babies were of average birth weight and only 4 (13.33%) babies had low APGAR score and needed NICU admission. Perinatal mortality was 37/1000 live births. CONCLUSION: Pregnancy with fibroids leads to increase in caesarean section rate due to dysfunctional labour and malpresentation. There is also increased incidence of post partum haemorrhage along with associated complication of anaemia, anaesthesia and surgery.