Morbidity from episiotomy.

OBJECTIVE: To assess the morbidity from episiotomy. METHODS: The prospective randomised control study was conducted at the Military Hospital Rawalpindi's Gynaecology & Obstetrics Department from January 2006 to April 2008. It comprised 100 patients who were given a mediolateral episiotomy at the crowning of the foetal head (group 1). Another group of 100 patients were delivered without an episiotomy (group 2). Postpartum morbidity was compared in the two groups. Morbidity included perineal damage by tears, subjective assessment of pain at perineum, dyspareunia after puerperium, feeling of pressure puerperium, incontinence and objective assessment of prolapse after puerperium. RESULTS: Morbidity including perineal damage by tears, pain at perineum and dyspareunia, was much more in group I as compared to the group II. There was no significant difference in feeling of pressure perineum, subjective feeling of urinary and flatus incontinence or objective assessment of prolapse of vagina and uterus. CONCLUSION: There are no significant advantages of episiotomy. In fact, it leads to morbidity which is otherwise avoidable in deliveries that are episiotomy-free.

Frequency of Subclinical Hypothyroidism Among Pregnant Women: A Retrospective Chart Review.

Background Subclinical hypothyroidism is a common endocrine disorder during pregnancy, associated with adverse maternal and fetal outcomes. This study aimed to evaluate the frequency of subclinical hypothyroidism among pregnant women who presented to our hospital between 2020 and 2022. Methods A retrospective chart review was conducted on 589 pregnant women using convenience sampling. Only women who underwent thyroid function testing and had no known thyroid disease were included. Data on age, weight status, history of miscarriage, history of infertility, menstrual cycle regularity, thyroid function, and symptoms of thyroid diseases were collected. Descriptive statistics were used to analyze the data. Results The mean age of the participants was 24.8 ± 3.7 years. Among the participants, 270 (45.9%) had a normal weight, 199 (33.8%) were overweight, and 120 (20.4%) were obese. A history of miscarriage was reported by 69 women (11.7%) while 37 women (6.3%) had a history of infertility. The menstrual cycle was regular in 499 women (84.7%) and irregular in 90 women (15.3%). The results showed that 517 (87.7%) women were euthyroid, 47 (7.9%) had hypothyroidism, and 25 (4.2%) had hyperthyroidism. Of the 47 patients with hypothyroidism, 32 (68.08%) had subclinical hypothyroidism and 15 (31.91%) had overt hypothyroidism. Conclusion This study highlights the frequency of subclinical hypothyroidism among pregnant women. The findings underscore the importance of thyroid function testing during pregnancy.

Colouterine fistula with a foreign body.

Foreign bodies in vagina are known to have been inserted by the patient herself or by some other person; as an aid to masturbation, sexual intercourse or sexual assault. The two most common items retained in adult females are tampons and burst condoms. Since long, vaginal deliveries and Obstetric and Gynaecological interventions have been associated with vesicovaginal and rectovaginal fistulae. We present a case of a 24 years old Pakistani woman with a colouterine fistula. Although vesicouterine fistulae have rarely been reported previously, world-literature has only a few documented cases of colouterine fistula.

Bacterial vaginosis.

OBJECTIVE: To estimate the frequency of bacterial vaginosis in women with preterm labour. METHODS: Descriptive cross sectional study carried out in department of Obstetrics and Gynaecology, Military Hospital and Army Medical College Laboratory, Rawalpindi. Non-probability convenience sampling was used and the study was completed in 12 months (from 1st January 2007 - 1st January 2008). Hundred patients in preterm labour were included in the study. An objective diagnosis of the type of discharge was made. The vaginal pH of the discharge was measured. Samples for bacterial culture were obtained. A wet smear of the vaginal secretions was made and examined under the microscope for clue cells followed by Whiff test. All information was recorded on a specially designed proforma and the frequency of patients with bacterial vaginosis was estimated. RESULTS: A diagnosis of bacterial vaginosis was made in 21% of the patients by the Amsels criteria. However, culture report suggested bacterial vaginosis in 18% of cases with most of the cases (56%) having normal flora. Overall, incidence of infection was 44% in patients with preterm labour. CONCLUSION: The frequency of bacterial vaginosis in our study was found to be 21% in preterm labour

Comparison of suture material and technique of closure of subcutaneous fat and skin in caesarean section.

BACKGROUND: A large number of women undergo caesarean section throughout the world. These women pass through a period of post operative pain and a morbidity period. These women translate into a substantial portion of population and hence there is a load on the financial resources of healthcare system. Use of the appropriate technique to approximate the wound after caesarean section would not only avoid financial load but also help in early recovery of the patient. AIM: The aim of this study is to compare the effects of alternative techniques for closure of subcutaneous fat and skin on maternal health and use of healthcare resources in caesarean section. MATERIALS AND METHODS: Patients undergoing Caesarean section were divided in two groups of one thousand patients each. Patients with hematological disorders or a malignancy, diabetes, septicemia or chorioamnionitis were excluded from the study. In all the patients, after stitching the uterus, the rectus sheath was stitched with thread vicryl No.1 (synthetic absorbable braided sutures with polyglycolic acid, polycaprolactone and calcium stearate coating), using a round body needle. Then the patients were divided into two groups. In group I, vicryl No.1 thread used in stitching of the rectus sheath was continued into the skin with application of subcuticular stitches, after securing the edges with a knot. In group II, after stitching the rectus sheath with vicryl No. 1, the thread was cut and interrupted sutures were applied in subcutaneous fat with thread vicryl No. 2. Skin was stitched with subcuticular stitches using proline 2, a non-absorbable propylene suture. The two groups of patients were observed for the duration of surgery, post-operative pain in stitches, patient satisfaction about removal of stitches, evidence of wound infection or seroma, and cosmetic results. RESULTS: It was noted that the duration of surgery in group I was on average 7.5 minutes less as compared to the duration in group II. Patients in group I were more satisfied with the results of the surgery and were relieved to know that their stitches did not need to be removed. CONCLUSION: Although no difference was found in the rates of wound infection and formation of scar tissue between the group I and group II, the duration of surgery was less and the patients were more satisfied in group I.

Thyroidology over the ages.

Thyroidolody, the study of the thyroid gland, is considered to be a relatively new field of endocrinology. However, references to the thyroid gland and its diseases can be seen in the literature of ancient Greek, Indian and Egyptian medicine. Goiter has always been a disease of immense interest of the general population due to its widespread prevalence. It is one of the most common medical problems portrayed in ancient paintings. Owing to the lack of awareness and poor nutritious habits of the people in that era, diseases such as iodine deficiency goiter were common. Physicians, healers and philosophers had been attempting time and again until the 19(th) century to come up with explanations of the thyroid gland and provide a reasonable basis of its diseases. Although the discovery of thyroid gland, its structure, function and diseases has been accredited to modern scientists who presented their work mostly in the 19(th) and 20(th) century, it is of significance to note that much of what we discovered in the 19(th) and 20(th) century had already been known centuries ago. This review attempts to explain the knowledge of thyroid gland, its function and diseases as held by the people in the previous centuries; and how this knowledge evolved over the years to become what it is today.

Evaluating trial of scar in patients with a history of caesarean section.

AIMS: To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar. PATIENTS AND METHODS: The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose. RESULTS: The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes) included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required) with syntocinon infusion. 60 patients were induced with prostaglandin E(2) vaginal tablet. CONCLUSION: This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.