A Two-Year Analysis Of Uterine Rupture In Pregnancy.

BACKGROUND: Uterine rupture, an obstetrical emergency though rare but still has grave implications. Uterine rupture is the occurrence of breach in the wall of uterus. Complete rupture involves complete disruption of uterine wall resulting in spillage of uterine contents into the abdominal cavity whereas an incomplete rupture has intact peritoneum or serosa. The most commonly reported risk factor in developed countries is previous caesarean section whereas in developing countries neglected and obstructed labour are more frequently reported predisposing factors. METHODS: This was a cross sectional descriptive study which was carried out for a period of 2 years from January 2015 to December 2016 in Gynae "A" unit of Ayub Teaching Hospital Abbottabad. RESULTS: In our study frequency of uterine rupture was 0.63%. Previous scar dehiscence was the most common risk factor for uterine rupture. Maternal mortality was 4% out of total 52 ruptured uterus, while 94.2% was perinatal mortality. CONCLUSION: Although uterine rupture can be prevented but its frequency is still high. Therefore, proper antenatal care, health education, utilisation of health facilities is needed to reduce adverse outcome associated with this avoidable condition..

Analysis Of Two Years Cases Of Ectopic Pregnancy.

BACKGROUND: Ectopic pregnancy is the leading cause of pregnancy related deaths in the first trimester. The aim of this study was to evaluate the frequency of risk factors, clinical presentation, diagnostic methods and site of ectopic pregnancy. METHODS: This descriptive cross sectional study was conducted in Gynaecology and Obstetrical Unit-A of Ayub Teaching Hospital Abbottabad from 1st October 2013 to 31st October 2015. All women diagnosed with ectopic pregnancy were included in the study. A predesigned proforma was used to record the details about demographic features, risk factors, clinical features at presentation, diagnostic methods and site of ectopic pregnancy. RESULTS: Out of total 6675 patients admitted during the study period, 45 cases of ectopic pregnancy were diagnosed with frequency of ectopic pregnancy to be 0.65%. Mean age of the patients was 28.98±5.525. Majority of patients were primigravida14 (31.3%), 9 (20.0%) gravida 2, 5 (11.1%) gravida 3, 4 (8.8%) gravida 4, 7 (15.5%) gravida 5, 6 (13.3%) found grand multi out of total 45 ectopic pregnancies, 45% of the patients had no identifiable risk factors, however history of infertility 20 (22.22%), history of Pelvic inflammatory disease (PID) 10 (22.22%), previous ectopic 2 (4.44%) and previous abdominal pelvic surgery 3 (6.67%) were identified as common risk factors of 45 ectopic pregnancies. Out of total 45 sufferers 23 (51.11%) were clinically diagnosed, 20 (44.44%) through abdominal ultrasound and 2 (4.44%) through transvaginal ultrasound. The most frequent clinical presentation was amenorrhea 30 (66.67%) followed by abdominal pain 28 (62.22%), irregular vaginal bleeding 18 (40.00%), asymptomatic patients with routine ultrasound 18 (40.0%) and 10 (22.22%) presented in shock. Twenty-eight (62.2%) of the ectopic pregnancies were found in right sided fallopian tube and 17(37.8%) were found in left sided fallopian tube. The commonest site of ectopic pregnancy was ampulla 29 (64.44%) followed by 11 (24.44%) Isthmus, 4 (8.89%) fimbrial end and 1 (2.22%) were rudimentary horn of uterus out of total 45 ectopic pregnancies. Evidence of 32 (71.1%) patients with ruptured ectopic was recorded. Thirteen (28.9%) were unruptured ectopic. CONCLUSIONS: Amenorrhea and abdominal pain are the most consistent features of ectopic pregnancy.

Assessment of pregnancy outcome in primigravida: comparison between booked and un-booked patients.

BACKGROUND: Primigravida (PG), defined as a woman who conceives for the first time, is in a high-risk group. Objective of this study was to evaluate the pregnancy outcome in booked and un-booked primigravida. METHODS: This was a hospital based comparative study conducted in Women and Children Hospital Abbottabad from May 1998 to November 1999. A total of 322 patients were included in the study. Inclusion criteria was all primigravida, both booked as well as un-booked patients. Evaluation was done by taking detailed history, clinical examination and relevant investigations. Antenatal, intrapartum and postnatal complications were noted in the mothers. Perinatal morbidity and mortality was assessed in both the groups. RESULTS: Out of 322 cases, 52 patients were booked and 270 patients were un-booked. Majority of un-booked patients belonged to the rural areas and were from lower socioeconomic group, between the age group of 15-35 years. The rate of instrumental deliveries was high (87.5%) in un-booked patients as compared to booked patients (12.5%). Caesarean section rate in un-booked patients was higher (76.5%) as compared to booked patients (23.5%). Twenty-three (20%) patients of un-booked group presented in emergency mainly with obstructed labour. Twenty-two (19.8%) patients had pregnancy induced hypertension, while foetuses of 48 (43.2%) patients developed foetal distress. Antipartum haemorrhage was present in 12 (10.8%) patients, while prolonged labour with foetal distress was noted in 26 (23.4%) patients in un-booked group. Postpartum haemorrhage and puerperal pyrexia was more common in un-booked patients (7.7% and 18.6% respectively). Perinatal mortality was high in un-booked patients (19.5%) as compared to booked patients. CONCLUSION: Primigravida are high-risk patients. Comprehensive antenatal care should be provided in this group of patients to have better maternal and foetal outcome.