Broad Ligament Haematoma Following Normal Vaginal Delivery.

A 37-year-old, patient presented in emergency with history of normal vaginal delivery followed by development of abdominal distention, vomiting, constipation for last 3 days. She was para 4 and had normal vaginal delivery by traditional birth attendant at peripheral hospital 3 days back. Imaging study revealed a heterogeneous complex mass, ascites, pleural effusion, air fluid levels with dilatation gut loops. Based upon pelvic examination by senior gynaecologist in combination with ultrasound; a clinical diagnosis of broad ligament haematoma was made. However, vomiting and abdominal distention raised suspicion of intestinal obstruction. Due to worsening abdominal distention exploratory laparotomy was carried out. It was pseudo colonic obstruction and caecostomy was done. Timely intervention by multidisciplinary approach saved patient life with minimal morbidity.

Comparison of prostaglandin E2 gel, prostaglandin E2 pessary and extra-amniotic saline infusion with oxytocin for induction of labour.

BACKGROUND: Induction of labour is the intentional initiation of cervical ripening and uterine contraction for the purpose of accomplishing delivery, prior to onset of spontaneous parturition. This study was conducted to compare maternal and neonatal outcome in women induced with Prostaglandin E2 gel, Prostaglandin E2 pessary and extra-amniotic saline infusion with oxytocin at Bishops score < 5. METHODS: It was a quasi-experimental which was conducted at the Department of Gynaecology and Obstetrics Unit-I, Mother and Child Health Care Centre, Pakistan Institute of Medical Sciences, Islamabad during one year of time. Eighty cases in each group (prostaglandin gel, prostaglandinE2 pessary and extra-amniotic saline infusion with oxytocin) were collected. Systematic sampling was done. First woman admitted was induced with prostaglandin gel, the second one with prostaglandin pessary and the third was induced with extra amniotic saline infusion and oxytocin. RESULTS: The most common indication for induction was post dates followed by PIH. The induction labour interval was less in EASI with oxytocin group (5.18 +/- 3.4) hours, as compared to prostaglandin pessary (8.81 +/- 5.60) hours and prostaglandin gel (8.32 +/- 5.18) hours. Induction delivery interval in EASI with oxytocin was (10 +/- 5.6) hours as compared to prostaglandin pessary (14 +/- 6.3) hours and prostaglandin gel (13 +/- 7.1) hours. This difference was statistically significant. The primigravidas had longer duration of labour than multigravidas. Induction labour interval in primigravidas was (8.2 +/- 5.1) hours while in multigravidas it was (6.7 +/- 5.02) hours. Induction delivery interval was also more in primigravidas (13.6 +/- 6.80) hours as compared to multigravidas (11.4 +/- 6.20) hours. Vaginal delivery rate was 89.2% while the caesarean section rate was 10.4%. The most common indication for caesarean section was foetal distress. There was no significant difference in perinatal morbidity and mortality in the three groups. CONCLUSION: EASI with oxytocin is a better method of induction than prostaglandin E2 gel and pessary. Moreover it is more economical in our country.

Frequency of fibroid uterus in multipara women in a tertiary care centre in Rawalpindi.

BACKGROUND: At least 20% of all women and 40% of women over the age of 40 years have uterine leiomyomas. They distort the overlying endometrium and can become extruded or pedunculated (fibroid polyp) in the endometrial canal. The diagnosis of myomas is usually based upon the finding of an enlarged, mobile uterus with an irregular contour on bimanual examination or an incidental finding on transabdominal sonography. The objective of this study was to study the frequency of fibroid uterus in multipara women as observed by physical examination and ultrasonography. METHODS: During this descriptive study period all the patients reporting Fauji Foundation Hospital with menstrual irregularity partly and fulfilling the inclusion criteria were included. RESULTS: Out of 140 patients with fibroid uterus presenting to gynaecology department 108 (77.14%) were multiparous while 32 (22.86%) were primiparous. The mean parity was 5. The mean maternal age came to be 46 years. Most common presenting complaint of patients with uterine leiomyoma in this study was menstrual irregularity with menorrhagia in 42 (38.9%), metrorrhagia in 28 (25.9%), polymenorrhagia in 8 (7.4%) patients. The other presenting complaint was abdominal mass which was seen in 25 (23.1%). CONCLUSION: Multiparous patients were found to have fibroids more frequently than nulliparous in their perimenopausal years, which shows their characteristic slow growth rate. The most common manifestation was menorrhagia.

Endometrial pathology by endometrial curettage in menorrhagia in premenopausal age group.

BACKGROUND: Menorrhagia is objectively defined as blood loss greater than 80 ml or menstrual period lasting longer than 7 days. Dysfunctional uterine bleeding is responsible for 80% cases of Menorrhagia. Objective of this study was to find out the endometrial pathology and usefulness of hysterocopic directed endomentrial sampling in patient having menorrhagia in premenopausal age group. METHODS: This prospective descriptive study was conducted at Unit 1 of the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital Rawalpindi, Pakistan from January to December 2007. During the study period, 100 patients with menorrhagia in age group 35-50 years were selected after fulfilling the inclusion criteria. These patients were selected from Gynaecology out patient department. After detailed history, examination and ultra sonography, they were admitted and hysteroscopic directed endometrial sampling was done endometrial samples were sent for histopathology to find out the endometrial pathology. RESULTS: The selected patients of my study with menorrhagia were scattered over all premenopusal age groups > 35 years. It was observed that 67 patient were above the age of 40 years. The analysis of histopathology reports of endometrial curettage revealed proliferative endomentrium in 33%, cystic hyperplasia's in 25% and carcinoma endometrium in one case. Cystichyperplasia and proliferative endometrium were found in menorrhagic women over 40 years of age. Adenoicarcinoma was found in a single premenopausal women of 48 years. CONCLUSION: All patients having menorrhagia above 40 years should be screened for any endometrial pathology. Accurate analysis of endometrial sampling is the key to effective therapy and optimal out come.

Postmenopausal bleeding: causes and risk of genital tract malignancy.

BACKGROUND: Postmenopausal bleeding (PMB) is bleeding occurring after 6-12 months of amenorrhea in a woman of age where the menopause can be expected. Objectives of this study were to ascertain various causes and prevalence of genital organ malignancy in patients presenting with postmenopausal bleeding. METHODS: A prospective observational study carried out in the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital, Rawalpindi comprising of 167 consecutive cases presenting with postmenopausal bleeding one year after menopause. Women having undergone hysterectomy and bilateral salpingo-oophorectomy, receiving radiotherapy or chemotherapy, suffered trauma to the genital tract, having coagulation disorder or on anticoagulant or hormone replacement therapy were excluded. Detailed history was obtained and a thorough clinical examination was conducted. Data were entered into hospital computer database (Medix) system. Mean +/- SD were calculated for age, percentage was calculated for types of histopathological findings. RESULTS: The commonest cause of PMB was atrophic endometritis and vaginitis 33 (21.2%). Overall incidence of various genital tract malignancies was 25 (16.0%). CONCLUSION: The overall incidence of genital tract malignancies in patients presenting with PMB is high (16.0%), therefore, it needs to be taken seriously and requires prompt and thorough investigations.