OB DEPARTMENT Research Articles

Social Demographic Characteristics of Fistula Patients at Fistula Center of Rangpur Medical College Hospital, Rangpur, Bangladesh

Introduction: Fistulas are abnormal connection between two body parts that is not supposed to be there. Differenc types of fistulas can occur among both male and female, but obstetric fistulas are more common among women. Because of the physical, psychological, and social repercussions of urine leakage, people with Vesicovaginal Fistula become severely incapacitated. These fistulas are typically caused by hindered labor and trauma. The most prevalent kind of fistula is vesicovaginal fistula, which is a serious condition that can bring physical, emotional, and social issues for both the afflicted and their family. Fistulas are more common in underdeveloped nations. The study's goal was to look at the socio-demographic features of fistula patients in a specific area. Aim of the study: The aim of the study was to observe the social demographic characteristics of fistula patients of Rangpur region. Methods: This prospective descriptive study was conducted at the Department of Obs and Gynae, Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 2 years, from September 2006 to September 2008. A total of 50 patients were selected for the present study following the inclusion and exclusion criteria. Result: 60% of the patients were between the age of 21-30 years, and 38% were between 31-40 years. 62% of the precent study participants had low socio-economic status. 72% of the women were of smaller stature (≤145 cm). 84% of the patients had vesicovaginal fistula, 12% had mixed type of fistulas. 24% had associated complications. Successful outcome was observed in 84% of cases. Conclusion: The study showed that obstetric fistula is more common among the women of lower social economic class with low availability of medical facilities. Women of small stature are at higher risk of fistulas, and among the different types of fistulas, vesicovaginal fistulas are the most common.

Pipelle Endometrial Sampling Versus Conventional Dilatation & Curettage in Patients With Abnormal Uterine Bleeding

Aim: To assess the efficacy of endometrial sampling using Pipelle compared with Conventional dilatation & curettage in women with bleeding from the uterus that is heavier/longer than usual or that occurs at an irregular time. Place and duration of study: Department of Obs & Gynae, Aviceena Medical College/Hospital from June 2020 to June 2021. Methodology: This comparative study was carried out in 57 women with abnormal uterine bleeding. Endometrial sampling was done by Pipelle without cervical dilatation followed by dilatation & curettage. Histopathology results were compared. Histopathological evaluation of the samples obtained by Dilatation & curettage was considered gold standard. Results: All endometrial tissue samples (100%) collected by dilatation & curettage while 98% obtained by the Pipelle sampler were acceptable for histopathology. Histopathological investigation of 57 samples acquired through dilatation & curettage confirmed proliferative and Secretory changes, Endometrial Hyperplasia, Endometritis in 15,13, 19, and 4 subjects while Endometrial Polyps and Malignant change in 2 and 4 specimens respectively. Conclusion: Pipelle endometrial sampling is an efficient outpatient procedure thus avoiding hazards of general anesthesia with a great precision for evaluating benign and malignant endometrial pathology. Keywords: Abnormal Uterine Bleeding , Endometrial biopsy, Dilatation & curettage, Pipelle sampler

Association between Hypertensive Disorders in Pregnancy and Postpartum Mental Health

Aim: To determine the relation between prevalence of Postpartum Depression and varying degrees of severity of Hypertensive Disorders in Pregnancy. Study design: A cross sectional study . Place & duration of study: Department of Obs. & Gynae, Avicenna Hospital, Lahore from June 2020 to December 2021. Methodology: A total of 220 women with and without hypertensive disorders of pregnancy (110 in each group) delivered during this period were enrolled in the study. A survey in the post partum period from second to sixth week postpartum was carried out. It was done according to the Edinburgh Postnatal Depression Scale (EPDS) to assess the effect of severity of Hypertensive disorders of pregnancy to develop new-onset postpartum depression. Results: 220 women were enrolled in the study. Among them Forty five women showed sign and symptoms of post partum depression. On the other hand 175 had no manifestation of depression according to the scale. The prevalence of PPD was 27 % (30/110) in women with hypertensive disorders, being twice the value in normotensive subjects (13.6%). The risk of Post partum depression surged with the aggressiveness of hypertensive disease in pregnancy. Conclusion: Preeclampsia has an independent association with Post partum depression. The risk of Post partum depressive disorder seemed to increase with the rising severity of hypertension in pregnancy. Therefore support and additional preventive strategies should be planned for women with Preeclampsia to reduce the likelihood of Post partum deterioration of mental health. Keywords: Hypertensive disorders in Pregnancy, Preeclampsia , Postpartum Depression.

Frequency of Neonatal Hypocalcemia among Diabetic Mothers

Objective: To determine the frequency of neonatal hypocalcemia among mothers presented with glucose impairment. Subject and Method: This was a cross-sectional study and was done at department of OBS and Gynaecology of PNS SHIFA Karachi. Study was conducted during six months from December 2010 to June 2011. This study comprised all the known diabetes mothers aged more than 18 years presented at PNS SHIFA Hospital and underwent child birth of either mode of delivery and parity. Females were monitored until they gave birth. A 5ml blood sample was taken from each mother to assess the current value of fasting blood sugar levels. To assess the neonatal calcium level 2cc blood samples were obtained under aseptic conditions after 24 hours of the births and the serum calcium level below 7mg/ dl was considered as hypocalcemia. All the data was collected via self-made study proforma. SPSS version 26 was used the purpose of data analysis. Results: Total 150 diabetes mothers were studied. The average maternal age was 30.23±3.55 years and gestational ag was 37.11±3.22 weeks. Most of the females were multiparous 54.0% and majority of the cases underwent c-sections 93(62.0%). Neonatal hypocalcemia was 20.7% Frequency of the newborn hypocalcemia was higher in age group of 21-30 years (p-0.082), while it was also insignificant according to gestational age (p-0. 172). Conclusion: According to the study's findings, the newborn hypocalcemia was observed to be the 20.7% in diabetes mothers. According to maternal age, it was determined to be statistically significant. Key words: Pregnancy, diabetes, neonatal calcium level

Antimicrobial Sensitivity and Resistance Pattern in Surgical Site Infections following Gynaecological and Obstetrical Operations

Background: Surgical Site Infections (SSIs) are one of the common problem in obstetrical and gynaecological operations. It is related to the increasing cost, morbidity and mortality. Objectives of this study were, find out the rate of surgical site infection, frequencies of various pathogens causing SSIs and their antibiotic sensitivity and resistance pattern in gynaecological and obstetrical operations in the Department of Obs & Gynae Chittagong Medical College, Chattogram.
 Materials and methods: This hospital based prospective longitudinal study was carried from January 2021 to July 2021 in the Department of Gynaecology and Obstetrics, Chittagong Medical College, Chattogram, Bangladesh. After operation, patients’ surgical wounds were inspected first on 5-7 th day and there after weekly up to 30 postoperative- day. If there had any features of wound infection, pus or discharge would have been collected from the wound. A total 100 pus or discharge were collected from the wound after obtaining written informed consent and according to the inclusion and exclusion criteria. Samples were processed following the standard laboratory technique.The isolates were identified by colony morphology, Gram’s staining and biochemical test according to standard laboratory test methods.
 Results: In this study most of the surgical site infections were caused by gram negative organisms (90%). Pseudomonas aeruginosa (36%) was the commonest organism responsible for SSIs. Staphylococcus species were responsible for SSIs in 6% of cases. In case of gram negative bacteria Amikacin and Imipenem were sensitive to about 89% and 91% microorganisms. While in case of gram positive organisms it were about 78% and 89%. Commonly used antibiotics in our set up included Ceftriaxone, Cefixime, Ciprofloxacin and Cefuroxime were sensitive in gram positiveorganisms 45%, 33%, 33% and 33% respectively. Butin case of gram negative organisms it were 76%, 63%, 79%, and 66%.
 Conclusion: Surgical site infections are the reflection of quality of hospital services. Once it was thought that the organisms responsible for the SSIs were derived from normal bacterial flora of the skin. But in last few years, it has been shown that the gram negative organisms are the main pathogens responsible for SSIs. Most of them are derived from the hospital environment.So the strict surgical ritual has come to mainstay in the management of the patients instead of being used antibiotics irrationally, which not only increases the chance of resistance to the micro-organisms but also glooming our future.
 JCMCTA 2021 ; 32 (2) : 115-121

The Effect of Pregnancy-Induced Hypertension on Uteroplacental Vasculature Hemodynamic Changes and Pregnancy Outcome

Background: Among the various complications of pregnancy, pregnancy-induced hypertension is found to be the most common which may affect maternal and fetal outcome. Pregnancy induced hypertension can cause growth retardation of fetus.
 Aim and Objective: This study aims to assess hemodynamic variations in uteroplacental circulation in pregnancy-induced hypertension and its effect on fetal outcome.
 Materials and Methods: The study was carried out at tertiary care hospital of nawab shah for the period of 06 months at Department of Radiology in association with Department of Gyne and Obs. Total 106 participants were selected for the study and all females were pregnant with 1st or 2nd trimester gestational record and medical history was taken from all participants and co-morbidities was also evaluated. Blood pressure was checked from all participants from their right arm in lying position and Ultrasound test was repeated as per requirement through color Doppler ultrasound machine and Data was analyzed by using statistical software SPSS. 24.00 version.
 Results: After collection of research data from all participants, the entire data was assembled for the analysis. Participants were divided into various age groups as 26 were in 18-21yeras, 34 in 22-25years, 21 in 26-29years and only 07 were from 34-37years. 26 participants were belongs to 1st trimester, 34 among 2nd trimester and 21 in third trimester. PI was also noted with three different readings 32 in Umbilical artery, 21 in middle cerebral artery and 37 in uterine artery. RI was also noted among different arteries 41 in umbilical, 36 in middle cerebral and 39 in uterine arteries. S/D was also noted, 33 in umbilical artery, 49 in middle cerebral artery and 30 in uterine arteries.
 Conclusion: Pregnancy-induced hypertension causes hemodynamic variations in uteroplacental vasculature which may be responsible for causing impaired fetal growth in some cases.

To Determine the Frequency of Endometriosis in Sub-Fertile Women Undergoing Laparoscopy

It is a cross sectional study conducted in department of obs and gynae civil hospital karachi from 1 january 2016 to 30 june 2016 . There were 96 women were selected in this study .
 Results The average age of the women was 27.44+_3.69 years . frequency of endometriosis in subfertile women undergoing laparoscopy was found in 32(33.33%) women.

Peripartum Hysterectomy

Objective: To find out the frequency, indication & its associated morbidity in our setup. Study design: Prospective cross-sectional observational study for the period one year (from June 2003 —May 2004) carried out in the Department of Obs/ Gynae, Lahore General Hospital Lahore. Results: During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery & 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases (46.15%). Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6(23.07%) of cases. In 19.2% (5) of cases abnormal placentation was the cause. In 2(7.6%) of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 (38.46%) & total hysterectomy was performed in 16 (61.53%) cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3(11.53%) cases, fever, chest infection & wound infection were common morbidity. Anemia was found in almost every case. Intra & post-operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Conclusion: Despite its morbidity & mortality emergency Obstetric hysterectomy remains an essential life-saving tool Uterine atony, uterine rupture & abnormal placentation were mast common indications, reflecting under-utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty & delayed referral all contribute to morbidity & mortality associated with emergency Obstetric hysterectomy.

EVALUATION METABOLIC SYNDROME IN POLYCYSTIC OVARIAN SYNDROME IN REPRODUCTIVE AGE GROUP WOMEN

Background: The disorder can be morphological (polycystic ovaries) or predominantly biochemical (hyperandrogenemia). Hyperandrogenism, a clinical hallmark of PCOS, can cause inhibition of follicular development, microcysts in the ovaries, anovulation, and menstrual changes
 Objectives: To study the risk factors for developing metabolic syndrome in PCOS.
 Material and Methods: This is Prospective study, total 100 patients, department of obs and Gynae, women of reproductive agegroup (15-45yrs) attending OPD at Darbhanga medical college and Hospital Laheriasarai, Bihar. Conclusion: This study helps in recognition of this high-risk group and aid in the enforcement of preventive strategies including therapeutic lifestyle modificationsand risk factor management. This will have a promising impact on women’s health and will prevent or delay the outset of varyingcardiometabolic complications in PCOS.
 Keywords: PCOS, metabolic syndrome

Frequency of Cervical Cancer in Women Attending Gynae OPD with Complaint of Abnormal Vaginal Bleeding

Aim: Frequency of cervical cancer in women of reproductive age presenting with abnormal vaginal bleeding. Methodology: Descriptive cross sectional study, done at Department of Obs &Gynae, JPMC, Karachi Duration of study: Six months from 01-11-2014 to 30-04-2015 Total 73 patients of age 18-45 years, having history of abnormal vaginal bleeding > 3 menstrual cycles were selected. Pregnant woman, abortion within last 6 months, age >45 years, fibroid/ tumors/ polyps, PID, gonorrhea, or Chlamydia patients were excluded. Chi-square was used as test of significance with a P value <0.05 taken as significant. Results: Mean ± SD age was 38.12 ± 4.33 years. Mean ± SD parity was 2.21 ± 1.67 children (Range: 0-5). Mean ± SD duration of presenting symptoms was 7.45 ± 2.81 months (Range 3-11). About one fifth of patients (i.e. 19.2%) were of age between 18-25 years. a vast majority (i-e; 43.8%) were in 26-35 years age category while remaining (36.99%) patients were of age between 36-45 years. 12.3% women had no children, 35.6% had 1-2 children, 28.8% had 3-4 children while remaining 23.3% women had 5 children. 12 out of 73 (16.4%) women had cervical cancer confirmed through biopsy and histopathology of cervical tissue. Age was significant (P value = 0.003) while parity & duration of presenting symptoms were non-significant (P values = 0.110 & 0.405 respectively). Conclusion: The study found that almost every 6th women with abnormal vaginal bleeding is suffering from cervical cancer. Younger age women and those having lesser parity are less prone to this condition. Keywords: Abnormal vaginal bleeding, Cervical cancer, Postcoital bleeding

Comparison of Vitamin D Level among Vaccinated and Non Vaccinated Pregnant Women with Covid-19

Objective: The aim of this study is to compare the vitamin D level among vaccinated and non-vaccinated pregnant women with COVID-19. Study Design: Observational/comparative study Place and Duration: The study was conducted at the department of Gynae and Obs Quaid-e-Azam International Hospital, Islamabad and Qazi Hussain Ahmad Medical Complex, Nowshera for Duration of six months from October 2020 to March 2021. Methods: Total 120pregnant women had coronavirus disease were presented. Informed written consent was taken for details demographics age, gestational age, parity and body mass index. 18-45years was the women ages. Patients were categorized into 2-groups. Group I had 60 vaccinated patients and in group II 60 non-vaccinated pregnant women. Blood sample of all the patients were taken for the level of serum 25-hydroxy vitaminD3 [25 (OH) D3]. Vitamin D deficiency was calculated and compared among both groups. Sufficient serum vitamin D level was considered >30ng/ml. SPSS 23.0 version was used to analyze complete data. Results: In group I age was 28.4±8.55 years with mean BMI 24.08±1.18 kg/m2 and in group II age was 27.41±6.37 years with mean body mass index 23.12±4.42 kg/m2. Mean gestation age in group I was 33.12±9.42 weeks and in group II mean gestational age was 34.07±5.63 weeks. Mean parity in group I was 3.88±7.27 and in group II 4.01±4.14 was mean parity. We found 28 (46.7%) primigravida cases in I-group and 30 (50%) primigravida females in II-group. In group I 51(85%) patients had vitamin D deficiency and in group II 54 (90%) had deficiency of vitamin D. Among 51 deficient women of group I, number of severe deficiency (<10ng/ml) women were 8 (13.3%), deficiency (10-20ng/ml) were 13 (21.7%) and not-sufficient (20-30ng/ml) were 30 (50%) and in group II prevalence of severity (<10ng/ml) patients were 10 (16.7%), deficient cases (10-20ng/ml) were 15 (25%) and not-sufficient cases (20-30ng/ml) were 29 (48.3%). Deficient vitamin D serum levels were 15.01±1.22 in group I and 14.34±4.12 in group II. Conclusion: In this study we concluded that prevalence of vitamin D deficiency was highly among pregnant women and most probably in non-vaccinated pregnant patients but did not find any significantly difference among both groups. Keywords: Pregnancy, COVID-19, Vitamin D, Vaccination

Incidence and Clinical Presentation of Polycystic Ovarian Syndrome in a Tertiary Care Hospital

Aim: To determine Incidence of Polycystic Ovarian Syndrome and its clinical presentation in a tertiary care Hospital. Study Design: A Cross sectional study. Place and duration of study: The study was conducted in the Department of Obs. & Gynae, Avicenna Medical College and Hospital, Lahore for a period of six months, January 2020 to June 2020. Methodology: A total of 753 patients attending the gynecological outpatient department were included in the study. Among these the women presenting with clinical picture of menstrual irregularities weight gain, hirsutism and subfertility were evaluated for diagnosis of PCOS. Radiological findings by pelvic U/S were confirmed. Results: 169 women out of 753 patients were found to have PCOS. The incidence was thus 22.44%. Maximum number of women were overweight, BMI (25-29.9Kg/m2). 113(66.86%) presented with oligomennorrea followed by hirsutism and amenorrhea. 57.1% of married women with PCOD had subfertility. Conclusion: Polycystic ovarian Syndrome is common in our population. It is more frequently seen in unmarried obese women. Menstrual irregularity is the most common clinical presentation. Ultrasound criteria is a valuable tool to diagnose the Polycystic Ovarian Disease. Keywords: Polycystic 0varian Syndrome, oligomenorrhoea, amenorrhoea, hirsutism, obesity

Effect of Micronutrient Supplements on Female Fertility

Introduction: Over the last few decades, fertility has declined globally to unprecedented low levels. Objective: Main goal was to determine whether the micronutrient supplements have any impact on female fertility. Method: This prospective observational study was conducted at the Department of Gynae and Obs, Dhaka Medical College Hospital, Dhaka, Bangladesh. Total 142 patients were enrolled in the study, during July 2019 to June 2020. Analysis of different variables were done according to standard statistical tool Spss and calculations were done using scientific calculators & using MS-excel program in computer. The present study was conducted after receiving approval from the Medical and Health Research Ethics Committee (MHREC). Result: For vitamins C and E, mean nutritional intake surpassed the estimated average requirement (EAR). There were no variations in antioxidant consumption across the groups. In multivariable models, women with a body mass index (BMI) of R25 kg/m2 had shorter TTP when they took vitamin B6 from dietary supplements. Vitamin C from dietary supplements was also linked to a shorter TTP among women with a BMI of less than 25 kg/m2. Conclusion: Women with a BMI of 25 kg/m2 had a shorter TTP when their vitamin C intake increased, while women with a BMIR of 25 kg/m2 had a shorter TTP when their vitamin B6 intake increased.

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.Material & Methods: The present study was conducted in department of Gyane and Obs. department of J. L. N. Medical College, Ajmer. In this study 200 cases were included during period of July 2020 to December 2020. Patients undergoing Caesarean section were divided in two groups of one thousand patients each. 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. Results: In our study post CS complications were found in 14% of cases with wound infection has been the most common complication occurring in 6.5% of cases studied. Other complication included were wound seroma (4%), wound dehiscence (2%), wound haematoma (2%), and suture sinuses (0%).Conclusion: On the basis of this study, it was concluded that inspite of using best closure technique and keeping in mind the patient related factors complication arising after C.S. are frequent and most commonly associated with non closure of fat.

Impact of body mass index (BMI) and physical activities among menopausal women

Background: The impact of body mass index (BMI) and physical activity on menopausal symptoms is still unclear. The relationship between menopausal symptoms with physical activity and BMI may differ depending on the specific symptom and socio-demographic factors may have impact on the symptoms.
 Objectives: It was aimed to determine most common presenting symptoms as per MRS scale, and to assess physical activity status as per IPAQ scale. Also to assess the impact of physical activity and BMI on common menopausal symptoms in addition to socio-demographic characteristics of the respondents in particular.
 Methods: This was a descriptive cross-sectional study among menopausal women age between 45-60 years attended at Outpatient Department (OPD) of Obs & Gynae in three randomly selected tertiary care hospital of the country during November 2017 to April 2018. The data were generated as per Menopause Rating Scale (MRS) and by International Physical Activity Questionnaire (IPAQ) and by calculation of Body Mass Index (BMI).
 Results: About 70.0% respondents were within 45-54 years of age group, 28.0% respondents were illiterate and 78.0% were housewife. Overweight was to be found almost 30.0% within 50-54 years age group. Respondent’s somato-vegetative menopausal symptoms like hot flashes, heart discomfort and sleeping problems were found mild to moderate among 53.0-67.0% respondents mostly. Psychological and urogenital menopausal symptoms were found mild to moderate among 52-62.0% and 45-53.0% respondents respectively. The irritability and heart discomfort were found significantly associated with age. Moreover, joint and muscular discomfort, hot flushes, sweating and heart discomfort were also found significantly associated with BMI (p<.05).
 Conclusion: Findings of the study will help planners and policy makers in developing one stop comprehensive services as appropriate in minimizing symptoms without medications and will also help minimizing burden of symptoms among menopausal women towards a comfortable end stage life line towards menopause specific quality of life (MENQOL).
 Bangladesh Med Res Counc Bull 2020; 46(2): 109-114

Fetomaternal outcome after physical Domestic Violence during pregnancy.

Pregnancy by itself imposes great physical and psychological pressures on a woman and consequently, coupled with other stressors such as violence, can have adverse effects on the fetus and mother. Objectives: To identify the association of physical domestic violence with unfavorable feto maternal outcome. Study Design: Observational Cross Sectional Review. Setting: Department of Obstetrics and Gynaecology Unit 4 at Liaquat University Hospital Hyderabad. Period: Six months from June 2017 to December 2017. Material & Methods: All pregnant females admitted in department of OBS and Gynae for various obstetrical and gynaecological problems because of bodily domestic violence. Results: Overall 196 pregnant females were selected in review, mean age was 26.32±4.36 yrs. On assessment of maternal outcome females were presented as; preterm labor in 34.2% females, Antepartum hemorrhage in 25.5%. On fetal outcome Miscarriage in 31.1%, intrauterine mortality (IUD) in 15.3%, Stimulated miscarriage in 12.8%, intrauterine growth retardation (IUGR) in 12.8%, Neonatal mortality (NND) in 9.2% & Neonatal intensive care unit (NICU) admission was seen in 18.9% cases. It was found that the age, socio-economic status, maternal education, occupational status, education of husband, addiction of husband, parity, physical and psychological forms of violence, marriage duration, were significantly associated with maternal and fetal outcome (p value < 0.05) due to bodily domestic violent behavior. Conclusion: We concluded that domestic violence during the course of pregnancy has been identified as being a significant factor affecting health of mother and fetus.

INDUCTION OF LABOUR;

Background: Increased risk for the baby and higher perinatal mortality are related to birth after 42 weeks. To find out whether a delivery occurs within a span of 24 hours, assessment of cervix through Transvaginal ultrasonography (TVS) and Bishop’s Score are two methods. Objectives: To find out the accuracy of transvaginal ultrasound and Bishop’s Score for cervical length assessment to know the success of induction of labor in primigravidas at term. Setting: Department of Obs and Gynae of Civil Hospital, Bahawalpur. Study Design: Cross sectional study. Period: Nov 1st 2016 to April 30th 2017. Material and Methods: Total 220 females were included through non probability, purposive sampling. Females underwent vaginal examination and Bishop Score was noted and case was labeled as positive or negative. TVS and cervical length was measured and case was labeled as positive or negative. After that, PGE1 50 ug was used and females were waited for labor to be started and normal delivery occurrence. Data was entered and analyzed using SPSS version 16.0. Results: The mean bishop score of females after induction was 6.78±2.66. There were 171 (78%) females who had bishop score >5 while 49 (22%) had bishop score <5. The mean cervical length of females after induction was 26.40±3.69mm. There were 154 (70%) females who had cervical length <27mm while 66 (30%) had cervical length >27mm. The mean induction to delivery interval was 23.01±4.66hours. There were 130 (59%) females who delivered within a period of 24 hours while 90 (41%) delivered after 24 hours. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of Bishop score were 31%, 84%, 64%, 57% and 62% respectively. The calculated specificity, sensitivity, positive predictive value, negative predictive value along with diagnostic accuracy of cervical length were 59%, 90%, 76%, 80% and 77% respectively. Conclusion: Cervical length assessment on TVS had more accuracy than bishop score in primigravidas presenting at term for induction of labor helping avoidance of post-term pregnancy.

Detection of antisperm antibodies in patients with unexplained infertility

Objective: To detect Antisperm antibodies in Patient’s with unexplained infertility. Method: This study was undertaken in 50 patient of unexplained infertility who were admitted in the indoor ward and those attending outpatient Department of obs and Gynae of M.L.N Medical College, Prayagraj. fifty couples with no organic cause for infertility were selected for this study.25.58% of couples with primary unexplained infertility showed positive ASA while only 14.42% of couples with secondary unexplained infertility showed positive results.No correlation was present between the presence of ASA and duration of infertility,socio economic status and ethnic group. Result: Antisperm antibody has a high predictive value for the patient with unexplained infertility. Presence of antisperm antibody was a more accurate predictor of Unexplained infertility than other historical risk factors. The serological test is rapid and non-invasive, and our data suggests that it would be useful in investigation of infertility. Conclusion: Antisperm antibody is a Sensitive, specific, easy, non-invasive and reliable test for diagnosis of Unexplained infertility

FETO-MATERNAL OUTCOME

Background: Trial of labour is a clinical test to assess the adequacy of pelvis andability of fetus and mother to withstand labour. If progressive changes in dilation and station donot occur, a cesarean delivery is performed. Objective: Feto-maternal outcome after trial oflabour in women with gestational age b/w 37 to 42 weeks. Study Design: Cross sectional study.Setting: Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. Duration ofStudy: One year from 01-02-2009 to 31-01-2010. Subjects and Methods: 100 pregnant women,with gestational age between 37-42 weeks, who underwent trial of labour at labour ward,Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included inthe study. Detailed history and examination including abdominal and pelvic examination as wellas Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation andCTG. Partogram was maintained to observe the progress of labour. Those who progressed withtrial either delivered normally or with the help of instruments and those who did not progress weredelivered by C-section. After delivery, mothers were watched for any postpartum complicationand condition of neonates was assessed by APGAR score. Results: Out of 100 women includedin this study 58% delivered vaginally, 31 % delivered by cesarean section and 11 % hadinstrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% hadspontaneous labour. 77.0% babies had apgar score > 5(7.1±0.72), 16% < 5(3.68±2.18) and 6%were still birth. 81% mothers had no complication during or after delivery, whereas 19 developedcomplications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterinerupture and one retained placenta. There was no statistically significant difference (P=0.42)when mode of delivery was compared with the trial of labour. However augmentation of labourwas associated with increased rate of maternal complications when maternal outcome wascompared with the type of labour (P=0.03). Conclusions: Trial of labour in carefully selectedwomen with high probability to deliver their babies vaginally decreases the rate of LSCS, therebyreducing the maternal morbidity and mortality associated with it. However augmentation oflabour is associated with increased rate of maternal complications as compared to spontaneousor induced labour.

OUTCOME OF PREGNANCIES WITH PREVIOUS LOWER SEGMENT CESAREAN SECTION

Objectives: To find out safe mode of delivery for patients with previous lowersegment Cesarean Section. Study Design: Descriptive analytical study. Setting: Departmentof Obs and Gynae, Civil Hospital, Bahawalpur. Period: From June 2017 to November 2017.Material and Methods: 200 women with previous lower segment Cesarean section. Womenscheduled for trial of scar were closely observed for evidence of either maternal or fetal distress.Results: Out of 200 patients, 54 (27%) delivered vaginally. Most common indication for repeatCesarean was previous Cesarean followed by CPD & Fetal distress. Conclusion: Properlyselected cases of previous one Cesarean section, the chances of having a successful vaginaldelivery could be as high as 63%.