Incidence, management, and outcome of molar pregnancies at a tertiary care hospital in quetta, pakistan.

Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. The incidence appears to be higher in women from South Asia. The purpose of our prospective study was to determine the incidence, presentation, and outcomes of all molar pregnancies at our institution. During the study period, there were a total of 16,625 patients admitted to our department; out of whom 85 patients were diagnosed with a molar pregnancy. Vaginal bleeding was the commonest symptom (94.2%); theca lutein cysts were noted in 39% of the cases. Suction, dilatation, and curettage were noted to be the preferred method in almost all cases; hysterectomy was done in 12 (14.1%) patients. Single-agent chemotherapy was employed in high-risk patients and was well tolerated. Mean followup for these patients was 5.7 months (range 1-24 months). None of these patients developed persistent trophoblastic disease, invasive mole, or choriocarcinoma during the follow-up period.

Experience of emergency peripartum hysterectomies at a tertiary care hospital in quetta, pakistan.

Emergency peripartum hysterectomy (EPH) is associated with significant morbidity and mortality worldwide. The purpose of our paper was to determine the incidence, morbidity, and mortality of EPH done at our institution; the largest tertiary care government hospital in the city of Quetta, Pakistan. During the study period there were 12,642 deliveries, out of which 46 women had undergone an EPH, translating into an incidence of ∼4 per 1,000 births. Disturbingly, 82.6% of these patients had received no antenatal care prior to their presentation. There were 4 (8.7%) maternal deaths and 31 (67.4%) perinatal deaths. The commonest indication noted was uterine rupture in 21 (45.7%) cases. Lack of antenatal care is indeed a modifiable factor that needs to be addressed to help reduce maternal and fetal morbidity/mortality not only from emergency hysterectomies but also from all other preventable causes.

Quintuplets born to a woman without fertility treatment in Pakistan.

OBJECTIVE: To report a case of quintuplets born to a woman without fertility treatment along with a discussion on the incidence and management of related cases. DESIGN: Case report. SETTING: Bolan Medical College, Quetta, Pakistan. PATIENT(S): The quintuplets and their mother. INTERVENTION(S): Perinatal care. MAIN OUTCOME MEASURE(S): Perinatal morbidity and mortality in multiple gestation. RESULTS AND CONCLUSIONS: Quintuplets are a rare occurrence. This is even rarer if they are born to a woman without fertility treatment. The survival of the infants is even rarer. We here report a case of a woman who presented in her third trimester of gestation and gave birth to five babies through normal delivery; all of them are alive and doing well along with the mother of the babies. The learning points and issues for discussion in this case are fourfold. We present, first, an account of surviving quintuplets and their occurrence; second, the medical issues involved in the management and care of such cases; third, the psychologic and social consequences involved in these scenarios; and, finally, the plight and difficulties faced by a woman from a poor socioeconomic background along with the dilemma faced by a practicing clinician in a developing country.

Vaginitis and sexually transmitted infections in a hospital based study.

OBJECTIVE: To determine the frequency of Sexually transmitted infections (STIs) in immigrant population versus the local population, comparing the symptomatic patients against the asymptomatic women as controls. METHODS: A cross-sectional comparative study was conducted in Gynaecology Clinic of Unit 1, Bolan Medical Complex Hospital, Quetta. The study duration was six months from 1st April, 2004 to 31st October, 2004, examining 500 women. World Health Organization (WHO) recommended questionnaire was answered and High Vaginal Swab (HVS) was taken from posterior fornix of patient's vagina. Gram staining was done by the Pathology Department of the same hospital and description was based on Nugent's score and modified Spiegel's criteria. Blood was analyzed for human immunodeficiency virus (HIV) and hepatitis-B surface antigen (HBsAg) by immunochromatography. Analysis of results was done by Chi square test, screening test validity and incidence testing. RESULTS: Women with vaginal discharge had higher incidence of STI (84%) than without it (38%). Refugees and women with grand multiparity made the high risk groups of targeted testing (P < 0.001). The commonest notifiable infections, in this study were vaginitis (33.48%), bacterial vaginosis (30.7%), candidiasis (10%), trichomoniasis (7.2%), gonorrhea (1.35%) and 1 case each of lymphogranuloma venereum and chancroid, and 3 carrier states of HbsAg were detected. No case of syphilis or HIV/AIDS, or genital herpes was found. CONCLUSION: This study will serve as a marker for the tip of an iceberg of STI in Balochistan, needing targeted testing in high risk groups.

Perinatal mortality rate in relation to gender.

OBJECTIVE: To calculate the gross and gender adjusted perinatal mortality rate (PMR) and determine the association between gender and susceptibility towards perinatal death. DESIGN: A cross-sectional hospital-based study conducted at Gynae Unit-I of Bolan Medical Complex Hospital, Quetta from 1st January to 31st December, 2002. PATIENTS AND METHODS: The study included the total births and perinatal deaths over one year period. The cause of death was ascertained through specifically-designed questionnaires and external autopsy. PMR was defined as the number of fetal deaths from 28 weeks of gestations to early neonatal deaths within 7 days after birth. Birth weight of >1000 grams or 35 cms crown-heel length was considered in lieu of unknown gestational age. Multiple pregnancies and stillbirths occurring at home were excluded. Extended Wiggles Worth classification was used to study the etiology of perinatal death separately. RESULTS: The PMR was calculated to be 113 per 1000 births. Stillbirth rate was 103 per 1000 total births; out of these, 56.5% were intrapartum and 43.3% antepartum. Male stillbirths were 89.24% in intrapartum and 62.5% in antepartum (df=1,X2=16, p < 0.001). Out of 16 early neonatal deaths, 11 were male infants. Aberdeen classification revealed obstetric causes of PMR as antepartum haemorrhage (34 cases;76% males), malpresentations (28 cases; 57% males), and congenital anomalies (26 cases; 80% males), after adjusting for maternal age and parity. CONCLUSION: This study shows fetal gender as statistically significant risk factor and it will pave the way for future community-based studies to confirm such an association, after adjusting for other co-variables.