ABSTRACT
BACKGROUND: Spinal anaesthesia causes hypotension that is countered through various methods. Phenylephrine is a vasoconstrictor and haemocoel increases the intravascular vascular volume; both have an effect in preventing this hypotension; but their comparison has not been done in local setting. METHODS: Randomized control trial was conducted in month of June, 2017 at Ayub Teaching Hospital, Abbottabad. Block randomization with sealed envelopes was employed. Sample size was set at 90. Two equal groups were formed; Group A received 500 ml of haemocoel before spinal anaesthesia administration and Group B received 300µg of phenylephrine in 100ml infusion over 3 minutes.. RESULTS: An average drop of 8.2 mmHg, 9.7 mmHg and 3.1 mmHg in MAP was observed in Group A participants at 5 minutes, 10 minutes and 15 minutes respectively after spinal anaesthesia. In Group B, an average drop of 1.2mmHg was observed in first 5 minutes. MAP did not change significantly from this value throughout the monitoring period. There was a drop of 1.2 mmHg at 5 minutes in group B. After this, no further drop in blood pressure was observed. CONCLUSIONS: Phenylephrine infusion is better than haemocoel preload in preventing hypotension due to spinal anaesthesia.
Subject(s)
Anesthesia, Spinal/adverse effects , Cesarean Section , Hypotension/prevention & control , Phenylephrine/administration & dosage , Vasoconstrictor Agents/administration & dosage , Adult , Anesthesia, Obstetrical/adverse effects , Arterial Pressure/drug effects , Colloids , Female , Humans , Hypotension/etiology , Infusions, Intravenous , PregnancyABSTRACT
BACKGROUND: Uterine rupture, an obstetrical emergency though rare but still has grave implications. Uterine rupture is the occurrence of breach in the wall of uterus. Complete rupture involves complete disruption of uterine wall resulting in spillage of uterine contents into the abdominal cavity whereas an incomplete rupture has intact peritoneum or serosa. The most commonly reported risk factor in developed countries is previous caesarean section whereas in developing countries neglected and obstructed labour are more frequently reported predisposing factors. METHODS: This was a cross sectional descriptive study which was carried out for a period of 2 years from January 2015 to December 2016 in Gynae "A" unit of Ayub Teaching Hospital Abbottabad. RESULTS: In our study frequency of uterine rupture was 0.63%. Previous scar dehiscence was the most common risk factor for uterine rupture. Maternal mortality was 4% out of total 52 ruptured uterus, while 94.2% was perinatal mortality. CONCLUSION: Although uterine rupture can be prevented but its frequency is still high. Therefore, proper antenatal care, health education, utilisation of health facilities is needed to reduce adverse outcome associated with this avoidable condition..
Subject(s)
Cesarean Section/adverse effects , Cicatrix/etiology , Uterine Rupture/epidemiology , Adult , Cross-Sectional Studies , Female , Humans , Maternal Mortality , Pakistan/epidemiology , Pregnancy , Risk Factors , Uterine Rupture/mortality , Young AdultABSTRACT
BACKGROUND: Ectopic pregnancy is the leading cause of pregnancy related deaths in the first trimester. The aim of this study was to evaluate the frequency of risk factors, clinical presentation, diagnostic methods and site of ectopic pregnancy. METHODS: This descriptive cross sectional study was conducted in Gynaecology and Obstetrical Unit-A of Ayub Teaching Hospital Abbottabad from 1st October 2013 to 31st October 2015. All women diagnosed with ectopic pregnancy were included in the study. A predesigned proforma was used to record the details about demographic features, risk factors, clinical features at presentation, diagnostic methods and site of ectopic pregnancy. RESULTS: Out of total 6675 patients admitted during the study period, 45 cases of ectopic pregnancy were diagnosed with frequency of ectopic pregnancy to be 0.65%. Mean age of the patients was 28.98±5.525. Majority of patients were primigravida14 (31.3%), 9 (20.0%) gravida 2, 5 (11.1%) gravida 3, 4 (8.8%) gravida 4, 7 (15.5%) gravida 5, 6 (13.3%) found grand multi out of total 45 ectopic pregnancies, 45% of the patients had no identifiable risk factors, however history of infertility 20 (22.22%), history of Pelvic inflammatory disease (PID) 10 (22.22%), previous ectopic 2 (4.44%) and previous abdominal pelvic surgery 3 (6.67%) were identified as common risk factors of 45 ectopic pregnancies. Out of total 45 sufferers 23 (51.11%) were clinically diagnosed, 20 (44.44%) through abdominal ultrasound and 2 (4.44%) through transvaginal ultrasound. The most frequent clinical presentation was amenorrhea 30 (66.67%) followed by abdominal pain 28 (62.22%), irregular vaginal bleeding 18 (40.00%), asymptomatic patients with routine ultrasound 18 (40.0%) and 10 (22.22%) presented in shock. Twenty-eight (62.2%) of the ectopic pregnancies were found in right sided fallopian tube and 17(37.8%) were found in left sided fallopian tube. The commonest site of ectopic pregnancy was ampulla 29 (64.44%) followed by 11 (24.44%) Isthmus, 4 (8.89%) fimbrial end and 1 (2.22%) were rudimentary horn of uterus out of total 45 ectopic pregnancies. Evidence of 32 (71.1%) patients with ruptured ectopic was recorded. Thirteen (28.9%) were unruptured ectopic. CONCLUSIONS: Amenorrhea and abdominal pain are the most consistent features of ectopic pregnancy.
