Peripartum cardiomyopathy: Frequency and predictors and indicators of clinical outcome.

OBJECTIVE: To determine frequency and prognostic factors of peripartum cardiomyopathy. METHODS: The prospective cohort study was conducted from April 2012 to September 2013 at Civil Hospital, Karachi. Cases were collected in the first year, and were then followed up for six months. On clinical and transthoracic 2-D M Mode echocardiography, cases of prepartum peripartum cardiomyopathy were detected. After necessary lab tests, cardiac opinion and treatment, pregnancy was terminated using caesarean section. At complete clinical recovery, the subjects were discharged to be followed up in cardiac and gynaecology clinics with current echocardiograph at 3rd and 6th month. SPSS 15 was used for data analysis. RESULTS: Out of 5742 deliveries, 22(0.38%) were cases of prepartum peripartum cardiomyopathy; the frequency being 3.8/1000 births. At 6-month follow-up, 14 (63.63%) cases recovered and 6(27.3%) did not. Two (9%) cases expired on 2nd and 16th day of delivery. On baseline or diagnostic echo, left ventricular ejection fraction and fractional shortening were statistically significant predictors of clinical outcome (p<0.05 each). Ejection fraction and fractional shortening were strong predictors of clinical outcome (p<0.05 each).During follow-up, left ventricular ejection fraction, fractional shortening, left ventricular internal dimension at diastole, and left ventricular internal dimension at systole (LVISd) were statistically significant indicators of clinical outcome (p<0.05 each). CONCLUSIONS: Baseline and follow-up echo was the best tool for prognosis. Baseline left ventricular ejection fraction and fractional shortening were significant predictors of clinical outcome.

Sideropaenic anaemia: Impact on perinatal outcome at tertiary care hospital.

OBJECTIVE: To determine association between sideropaenic anaemia among women and adverse perinatal outcome. METHODS: This prospective cohort study was conducted at Civil Hospital a tertiary care hospital in Karachi, from February to August 2011, and comprised pregnant women. The participants were divided into two equal groups: those who had sideropaenic anaemia were in Group A, and those without it were in Group B. Data was collected by random choice (lottery) method. SPSS 13 was used for data analysis. RESULTS: Of the 234 women, there were 117(50%) in each group. Besides, there were 130(55.5%) women aged 26-30 years, 62(26.5%) 21-25 years and 42(18%) 31-35 years. There were 78(66.7%) cases of preterm births in Group A compared to 23(19.7%) in Group B. Low birth weight was witnessed in 43(36.8%) cases in Group A and in 20(17.1%) cases in Group B. There were 8(6.8%) perinatal mortalities in Group A and 2(1.7%) in Group B. In Group A, 38(32.5%) cases showed Appearance, Pulse, Grimace, Activity, Respiration score <5 at 1 minute compared to 16(13.7%) cases in the other group. Similarly, the score <7 at 5 minutes was recorded in 25(21.4%) deliveries in Group A and 12(10.3%) in Group B. CONCLUSIONS: Sideropaenic anaemia was found to be an important risk factor for adverse perinatal outcome.

Frequency and impact of hypertensive disorders of pregnancy.

BACKGROUND: Hypertensive disorders are one of a major cause of maternal mortality and morbidity especially in developing countries. This cross sectional descriptive study was carried out to determine frequency of hypertensive disorders of pregnancy and its impact on maternal and perinatal outcome. METHODS: Records of 150 pregnant hypertensive ladies presenting at gynaecology Unit-1 of Civil Hospital Karachi from January to December 2010 was reviewed for demographic profile, mode of delivery, maternal and perinatal outcome. Statistical analysis was performed by SPSS-15. RESULTS: Total deliveries during study period were 2702. Out of 2702 deliveries 150 (5.5%) mothers were hypertensive. Out of 150 hypertensive cases 30% were cases of gestational hypertension, 58% were cases of toxaemia of pregnancy and 12% were cases of chronic hypertension. Maternal age, gravida, parity was lowest in toxaemia of pregnancy group. Commonest maternal complication was eclampsia (32%). There were 6 (4%) maternal deaths. Caesarean section was mode of delivery in 54% cases. CONCLUSION: Hypertensive disorders of pregnancy are an important cause of maternal and perinatal mortality and morbidity.

Maternal and neonatal adverse outcome at repeat cesarean delivery versus repeat vaginal delivery.

OBJECTIVE: To determine selected maternal and neonatal adverse outcomes at repeat cesarean delivery compared with repeat vaginal delivery. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Lyari General Hospital, Karachi, from January 2005 to December 2008. METHODOLOGY: Healthy pregnant women at 28-42 weeks of second singleton pregnancy were selected for study. Those with previous cesarean birth was labelled the exposed group and those with previous vaginal birth were considered the control group. Maternal and neonatal morbidity's attributable to the previous cesarean section was estimated. Potential confounders like persistent medical disorders, previous adverse outcome and trial of scar cases was excluded. Results were presented in frequency and percentage. Effects of outcomes were calculated as odds ratio with 95% confidence interval. SPSS-16 was used for statistical data analysis. RESULTS: A total of 195 mothers at repeat cesarean delivery were compared with 1486 mothers at repeat vaginal delivery. Mothers with previous cesarean birth were at high risk of peripartum hysterectomy and placenta accrete followed by placenta praevia [OR 7.6 (95% CI=0.48-122.8), 7.6 (0.48-122.8) and 2.5 (0.68-9.6) respectively]. Very preterm birth [OR=3.86, 95% CI 1.15-12.97)] was the most significant neonatal adverse outcome. CONCLUSION: Cesarean section in first pregnancy conferred an additional risk in the second pregnancy even after exclusion of known complications of trial of scar. These should be part of overall clinical assessment at the time of first cesarean section.

Benign tumours of the vulva.

OBJECTIVE: To present clinicopathological analysis of benign tumours of the vulva. DESIGN: A case series. PLACE AND DURATION OF STUDY: The study was carried out in two phases at JPMC, Karachi from October 1995 to April 1997 and at Usman Memorial Hospital from 1st February 2003 to 30th July 2003. PATIENTS AND METHODS: Thirty cases of benign tumours of vulva were studied during 2 years research period. Detailed history along with complete local and general physical examination followed by all necessary pre-operative investigations were carried out. Excision surgery was the treatment of choice in majority of cases while marsupialization was done for Bartholin's cyst. Histopathology of tumours specimen was also collected. RESULTS: A total of 30 cases were studied. Twenty-two were cystic and 8 were solid tumours. Aggressive angiomyxoma was 10% of solid tumours and Bartholin's cyst was 46.6% of cystic tumours. Most of the patients were multipara and between 21-30 years of age. The main site of tumour was labium majus. Excision surgery for all cases and marsupialization for Bartholin's cyst was treatment of choice. CONCLUSION: Aggressive angiomyxoma is the commonest solid benign vulval tumour. It should be considered in the differential diagnosis of vulval mass in women of reproductive age.