beta-lynch suture for the management of postpartum haemorrhage: an experience at Peoples Medical College Hospital

To report our clinical experience of the effectiveness and safety of applying beta-lynch suture for the management of primary postpartum haemorrhage. An observational, cross-sectional study. This study was conducted at the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from 1[st] January 2009 to 30 [th] June 2010. All the patients of primary postpartum haemorrhage in whom compression and conventional ecobolic had failed to achieve uterine contraction and haemostasis were subjected to beta-lynch suture. beta-lynch suture technique was applied in 33 patients, in 22 patients after vaginal delivery and in 11 patients at the time of cesarean section. This technique was successful in 31 [93.94%] patients and failed in only 2 [6.1%]. Patients who were proceeded to hysterectomy, none of the patient had infection. beta-lynch suture compresses and envelopes the uterus and manages massive life threatening postpartum haemorrhage successfully. It is effective, simple and fertility conserving procedure

Early pregnancy complications and risk factors

To determine the underlying risk factors in early pregnancy complication and outcome. Case series study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2010 to December 2010. all the women with first trimester pregnancy with different complications were included in this study, while those women with uneventful first trimester were excluded. The included women were registered on pre-designed proforma studied variable including demographic details, gestational period, type of complication, risk factor treatment and outcome. The data was examined in terms of mean and percentage with a confidence interval of 95%. Analysis was done on SPSS version 10. out of 661 total early pregnancy admissions, 309 [46-74%] patients had different early pregnancy of complication. Their mean age was 29.22 +/- 6.22 years. Commonest complications found were abortion in 206 [66.66%] cases. The underlying risk factors found in miscarriage were antiphospholipid syndrome in 8 [3.88%] cases, diabetes mellitus in 35 [16.99%] cases. Hypertension in 50 [24.27%] cases, PCOS in 15 [7.28%] cases and infection in 10 [4.85%] cases. 60 [61.22%] cases were treated by minor surgical procedures and 38 [38.77%] cases treated with conservative medical therapy. Outcome were anaemia in 245 [79.28%] cases, psychological upset in 189 [61.16%], infection in 131 [42.39%] and coagulopathy in 17 [5.50%] cases. Miscarriage was found as the most frequent early pregnancy complication and the most frequent risk factor was hypertension. Outcome included anaemia, psychological upset and infection

Maternal factors associated with low birth weight babies

To determine the maternal factors associated with low birth weight babies in women age of 15-35 years. Case control study. This study was carried out in the department of gynecology and obstetrics, Isra University Hospital [IUH] Hyderabad, Sindh from 02-05-2009 to 02-11-2009. Total 200 women were included in the study.100 as cases and 100 as control. Mothers aged 15-35 years, who deliver live or dead singleton baby through vaginal delivery or cesarean section after 37 week of gestation were included in the study while others who have delivered newborn with congenital abnormalities, had multiple pregnancy or known chronic illness [hypertension, tuberculosis, diabetes mellitus] were excluded from the study. The mean +/- SD of maternal age [years] in cases was26.40 +/- 4.77 and controls was 26.23 +/- 4.36 with P-value 0.739. The mean +/- SD of maternal weight [Kg] in cases was 53.13 +/- 8.93 and in controls was 64.97 +/- 13.72 with P-value < 0.001. Maternal history of smoking and anemia had significant association with low birth weight with P-Value of 0.005 and <0.001 respectively. It was concluded from our study that malnutrition, anemia, short stature like under weight and height are important risk factors for low birth weight

First trimester termination of pregnancy -role of sublingual misoprostol

The objective of this study was to evaluate the efficacy acceptability and dose of misoprostol sublingually in the management first trimester pregnancy failure. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from 01.01.2010 to 31.12.2010. A total 150 patients with the diagnosis of missed and incomplete miscarriage upto 13 weeks gestation. All eligible women who consented were counseled and given detail information protocol. A total of 150 patients with missed miscarriage 119 [79.33%] and incomplete miscarriage 31 [20.66%].The mean age group 28.34 years ,mean parity 4.79 and mean gestational age 8.61 weeks. Efficacy was 92%, 127 [84.66%] had complete miscarriage by the end of 7 days with 2 doses of misoprostol 600ug sublingually 3 hours apart. 23 [15.33%] require 3rd dose of misoprostol and 11 [7.33%] underwent surgical evacuation. Patients satisfaction was 94% [141 patients]. Misoprostol prove with benefit of efficacy, safety and acceptability in first trimester pregnancy failure. In low resources countries achieve infection haemorrhage and uterine damage can for two commonly reported on consequences of post surgical care. Misoprostol treatment can prove to be a rewarding step towards reducing morbidity and mortality

Pregnancy outcome at maternal age 40 and older

Objective: the objective of this study was to compare pregnancy outcome of women aged 40 and above with those of 20- 30 year

Study design: cross-sectional and comparative study

Setting: department of obstetricsand Gynecology Peoples University of Medical and Health Sciences Nawabshah

Duration: from 1st July 2011 to 31st Dec 2011

Material and method: consecutive 100 cases of women aged 40 and above and 100 cases of women aged between 20-30 years were included in the study, and labeled as group A and B respectively. All patients were under gone general and physical examination and routine laboratories tests. The biological effects of age on the pregnancy outcome were observed, and results were tabulated

Result: the mean age for case group was 41.56 +/- 2.06 and that for control group 25 +/- 2 years. Among the maternal complication of increased maternal age were abortion in early half and preterm labor in second half of pregnancy [10%] and [12%] respectively. Hypertension [14%] and Diabetes [9%] were more common than in younger age group. Risk of fetal malformation [11%] was also three fold more than younger group [2%]. Increased rate of c- section [6%] was seen more with advanced maternal age with high parity

Conclusion: the advanced maternal age is candidate with high risk of maternal and perinatal morbidity andmortality. Appropriate management can be formulated to ensure better maternal and fetal outcome during pregnancy

Female genital tract-reproductive performance with its variable anomalies

To observe the different presentation and reproductive performance of women with congenital anomalies detected by ultrasound, hysterosalpingography and on laparotomy. Prospective observational study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Hospital Nawabshah from January 2004 to December 2009. All the women with congenital anomalies of genital tract detected clinically, by ultrasound and hysterosalpingography, attended the outpatient department or presented with a complication and operated; and or those who were incidentally diagnosed during cesarean section or on laparotomy were included in this study. 48 patients with different mullerian duct anomalies were detected during the study period. Their age varied from 15 to 40 years. Mullerian agenesis with absent vagina was found in 6 cases, transverse vaginal septum was found in an other 6 patients. These patients presented with primary amenorrhoea, haematometra and haematocolpos. Imperforated hymen was found in 10 patients. They also present with a primary amenorrhoea, mass in lower abdomen and cyclical pain, few patients presented with acute retention of urine. Longitudinal vaginal septum was found in 3 cases. They presented with dyspareunia and difficult labour. Bicornuate uterus was found in 9 cases. They presented with maipresentations, recurrent abortion and preterm labour. Unicornuate uterus was found in 3 cases. Who were presented with ectopic pregnancy. Uterus dideiphys was found in 3 cases, 5 patients had arcuate uterus, 3 patients presented with congenital second degree uterovaginal prolapse. Uterine abnormalities are not uncommon, although not all the types of uterine anomalies can affect the fertility but most of the time they have bad impact on fertility. Early diagnosis and treatment of these conditions may improve the fertility prospectus and also prevents various obstetrical complications

Polycystic ovarian syndrome: response to metformin therapy

To determine the response of polycystic ovarian syndrome [PCOS] to metformin therapy. This study was conducted from January 2006 to December 2007 at Peoples Medical College Hospital Nawabshah. All the patients presenting with infertility, menstrual irregularity and increase body mass index [BMI] were included. Diagnosis was confirmed by clinical presentation and ultrasound finding. Patients diagnosed with PCOS were given metformin for six months, the clomiphene was added for three months if the patients did not conceive. Later metformin alone was continued and patients were re-evaluated after one year. Total 63 patients, mean age of PCO was 24.49 +/- 4.87 years and married were 52 [82.53%] cases, 44 [69.83%] cases were present with menstrual irregularity, 31-74% were overweight, 6.34% obese. 52 cases with infertility in which 39 [74.98%] cases had conceived. Metformin significantly increase ovulation and conception rate

Eclampsia: still a dreadful situation

To study the prevalence of eclampsia, its related maternal morbidity, mortality and perinatal outcome. Observational Study. This study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College Nawabshah from 1st January 2009 to 31st December 2009. All the patients admitted with eclampsia were included in this study and they were analyzed according to their age, parity, duration of gestation, timing of convulsions, mode of delivery, complications and feto-maternal outcome. 107 patients of eclampsia presented during the study period, giving a frequency of 2.43%. Mean age group involved was 15-24 years [47.7%] and 25 - 34 years [44.9%] while 7.5% were > 35 years. Majority of the patients belong to 15-24 years age group and found to be statistically significant [p-0.000]. Primi gravida [65%] were highly effected population. 57% [62] patients had fits in antenatal period while 9.3% [10] patients had intrapartum and 32% [35] patients had postpartum fits. Vaginal was the commonest mode of delivery 49 [45.5%]. Assisted vaginal delivery in 21 [19.6%], while cesarean section was performed in 37 [34.6%] patients. 39 [36.44%] maternal deaths occurred during study period, while 7 materanl deaths were attributed to eclampsia. Regarding the neonatal outcome, 64.5% [69] were born alive, 20.6% [22] were IUD and 15% [16] were dead during neonatal period mostly due to prematurity [75.7%].Eclampsia is a big challenge in obstetrics, it can lead to very high maternal and perinatal mortality and morbidity. It is a 3rd commonest cause of maternal death in developing countries. Community health education coupled with availability of emergency obstetric and neonatal care service at doorstep would reduce the incidence of eclampsia and its associated morbidity and mortality in Pakistan

study of vesicovaginal fistulae repair at gynaecological surgical camp at peoples medical college hospital Nawabshah

To evaluate the predisposing factors for vesicovaginal fistulae [VVF], route of fistula repair and outcome of surgery. Total 21 patients of VVF were admitted. 15 - 24 October 2002 Department of Obstetrics of Obstetrics and Gynaecology at PMCH Nawabshah, Sindh Out of 2I VVF, 14 of them were due to obstetrical trauma, 5 occurred due to gynaecological surgery and 2 were congenital. 18 cases were repaired vaginally and 2 were repaired with abdominal approach. One case was not repaired due to impacted bladder stone. Success repair was in 18 cases and 2 were failed. The success rate was 90%. The key for success was adequate tissue mobilization, division of scar tissue and good postoperative care