Frequency, risk factors and complications in pregnancies associated with placenta praevia

To evaluate the frequency of placenta praevia, risk factors, and complications, both maternal and fetal associated with placenta praevia. Cross-sectional and analytical study. Study was conducted in Department of Obstetrics and Gynaecology, Unit-1, Ghulam Muhammad Maher Medical College Hospital Sukkur from April 2010 to March 2012. In this study 75 cases of pregnancy beyond 24 weeks of gestation complicated by placenta praevia were included. Total number of deliveries was 5041 and patients presented with placenta praevia were 75. Patients with placenta praevia were 75 giving an incidence of 1.5%. Among 75 cases 67 cases were non-booked, 71 cases came in emergency, out of which 8 were referred cases. The gestational age at the time of admission was < 37 weeks in 57% of cases. The maximum number of patients 28 [37%] were between 30-40 years and above, while 44 [58.7%] women were multiparous, 41 [54.7%] cases had at least one or more gynaecol / obstet procedure before the presnt pregnancy. Incidence of placenta praevia was significantly high in patients with previous caesarean section [6%] than overall incidence of%. Regarding complication 7%] cases ended up in caesarean hysterectomy due to postpartum haemorrhage and morbid adherent placenta. Intra operative haemorrhage was found in 11 [14.7%] cases and 2-4 units of bloodlransfusion were required in 52 [69%] of cases. Pre-maturity was found commonest cause of perinatal mortality about 87%. The improvement in social, nutritional and educational status of women, provision of antenatal care and ultrasonography can help in diagnosing and in decreasing the complication rate. One should anticipate placenta praevia in all patients with previous caesarean section and ultrasound scan should be used for its diagnosis specially for placental localization in patients with history of previous caesarean section

experience of trans-abdominal repair of vesico-vaginal and uretero-vaginal fistulae

To assess the success rate of trans-abdominal repair of vesico-Vaginal fistula. This prospective descriptive study was conducted in the Departments of Surgery, Gynaecology and Urology, Ghulam Mohammad Mahar Medical College Hospital, Sukkur, Pakistan from August 2009 to July 2012. A total 27 patients of vesicovaginal fistula [VVF] and Uretero-Vaginal fistulae were included in the study. All patients had supra-trigonal multiple or single VVF were repaired by the abdominal approach. The outcome of the procedure and post-operative complications were recorded. Thirteen patients had single Supra-trigonal, three had multiple VVF. Three had vesico-Uterine and four had uretero-vaginal fistulae. All were operated by abdominal approach successfully. Pelvic surgery [abdominal hystrectomy /LSCS] was the major cause of VVF, accounting for 66.66 %[18 Patients], while in remaining 33.33% [9 patients] the obstructed and prolonged labor were the cause. All fistulae healed successfully with minor leaking in 2 [7.4%] patients which settled spontaneously. One patient developed post-operative adhesions [small bowel obstruction] and was explored and adhesiolysis was done. Three [11.11%] patients developed post-operative wound infection and healed by dressing. Trans abdominal is an excellent approach for supra-trigonal, vesico-uterine and uretero-vaginal types of fistulae

How early is early laparoscopic cholecystectomy in acute cholecystitis?

The efficacy and timing of early laparoscopic cholecystectomy for acute cholecystitis has been a subject of debate for years. Prospective comparative study, done at Ghulam Muhammad Mahar Medical College and Hira Medical Center, Sukkur, from July 2007 to June 2010. All patients undergoing Laparoscopic cholecystectomy for acute cholecystitis were included in the study. They were admitted through emergency with acute cholecystitis. Patients were divided into two groups according to the timing of surgery from the onset of symptoms. Group I included 205 patients who presented with acute cholecystitis within 48-72 hours of onset of symptoms and their surgery was done within 48-72 hours of presentation. Group II included 95 patients who presented after 72 hours of onset of symptoms and their surgery was done after 72 hours to one week of presentation. Clinical data was recorded and routine investigations along with ultrasound abdomen were carried out. The procedure performed, and its complications and success rate noted and compared between the two groups. The study included 300 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy within 48 to 72 hours of onset of symptoms in Group I and after 72 hours to 1 week in Group II. Among 300 patients there were 90[30%] males and 210[70%] females. The age of patients ranged from 20 to 70 years with a mean of 45 years. There were no open conversion in group I while 4.2% had to be opened in group II, the median operative time was 65 minutes in group I and 90 minutes in group II, postoperative hospitalization was 1 day in group I and 3.5 days in group II and total hospital stay was 2 days in group I and 4.5 days in group II. Intra-operative and postoperative complications were less in group I as compared to group II. Early laparoscopic cholecystectomy within 48-72 hours of onset of symptoms results in lower conversion rate, shorter operative time and reduced hospitalization. All patients with acute cholecystitis should be operated within 48-72 hours of the symptoms