Hepatitis C in haemorrhagic obstetrical emergencies.

OBJECTIVE: To determine the maternal health and fetal outcome in hepatitis C with obstetrical haemorrhagic emergencies. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology Unit-I, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, Sindh, from January 2009 to December 2010. METHODOLOGY: All the women admitted during the study period with different obstetrical haemorrhagic emergencies were included. On virology screening, hepatitis C screening was done on all. The women with non-haemorrhagic obstetrical emergencies were excluded. Studied variables included demographic characteristics, the nature of obstetrical emergency, haemorrhagic conditions and maternal and fetal morbidity and mortality. The data was analyzed on SPSS version 20. RESULTS: More frequent obstetrical haemorrhagic emergencies were observed with hepatitis C positive in comparison with hepatitis C negative cases including post-partum haemorrhage in 292 (80.88%) and ante-partum haemorrhage in 69 (19.11%) cases. Associated morbidities seen were disseminated intravascular coagulation in 43 (11.91%) and shock in 29 (8.03%) cases with hepatitis C positive. Fetal still birth rate was 37 (10.24%) in hepatitis C positive cases. CONCLUSION: Frequency of maternal morbidity and mortality and perinatal mortality was high in obstetrical haemorrhagic emergencies with hepatitis C positive cases.

Diagnostic laparoscopic findings in chronic pelvic pain.

OBJECTIVE: To assess the cause of pain on diagnostic laparoscopy in women with chronic pelvic pain and equivocal clinical and ultrasound examination. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Red Crescent General Hospital, Hyderabad, Sindh, from January 2007 to December 2009. METHODOLOGY: All the women presenting with chronic pelvic pain for more than 6 months duration, without any obvious pathological findings on clinical as well as on ultrasound examination were recruited. Women with chronic pelvic pain and having pelvic pathological lesions detected on clinical and/or ultrasound examination were excluded. Clinical, ultrasound, and laparoscopic data was collected and analyzed on SPSS version 14. The results were described as frequency, proportion, compared by chi-square test with significance at p < 0.05. RESULTS: Highest frequency of chronic pelvic pain was observed in women aged between 26 - 35 years (62.4%), 53 out of 85 women. Most of these women were married (90.6%) and nulliparous (47.1%). Pain was reported as dull and sharp by 35 women (41.2%), infertility (n = 46, 54.1%) and dyspareunia (n = 45, 52.9%) were the commonest co-existent complaints. On laparoscopic examination, pathological lesions were detected in 65, tuberculosis in 17 (20%) endometriosis in 11 women (12.9%), pelvic inflammatory diseases and pelvic adhesion in 8 (9.4%) women each and ovarian cyst in 6 women (7.1%). CONCLUSION: Positive laparoscopic yield was high in women with pelvic pain. Pelvic tuberculosis was the most common pathology detected followed by endometriosis, pelvic inflammatory disease and adhesions.

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.

Subjective pain perceptions during labour and its management.

OBJECTIVE: To investigate women's own labour pain perception, experiences and satisfaction with health care providers at a referral hospital of Sindh. METHODS: A descriptive study conducted on 400 labouring women at Obstetrics and Gynaecology Department Unit-II and IV Liaquat University Hospital Hyderabad/Jamshoro from January 2006 to July 2006. Four hundred full term labouring women in first stage of labour were included in the study. All the women with associated medical problems were excluded. Two questionnaires were completed containing demographic details, antenatal record, mode of onset of labour, labour duration, ambulation, use of various pharmacological agents and women's personal experiences regarding pain perception and future family planning. Data was collected and analyzed on simple percentage basis. RESULTS: This study shows an acceptable birth experience in 136 (34%) cases, while 264 (66%) patients found it an exhausting painful experience. Common factors which favour good experience included lower socioeconomic class 67 (57.98%), rural population (54.68%), multiparous women (68.08%), prior knowledge of labour pains (69.31%), spontaneous labour (86.89%), use of pharmacological agents (76.04%) and co-operative staff attitude (89.27%). Those who found labour pains an acceptable process, 87.5% had a positive attitude for future child bearing. CONCLUSION: Childbirth can be a good experience with effective antenatal counseling. A highly professional attitude and tender loving care is the key to a pain free labour.