Gynecology Unit Research Articles

Preoperative Imaging in Patients with Deep Infiltrating Endometriosis: An Important Aid in Predicting Depth of Infiltration in Rectosigmoid Disease

To determine the diagnostic accuracy of specialist-performed transvaginal ultrasound (TVUS) and pelvic magnetic resonance imaging (MRI) modalities in predicting depth of deep infiltrating endometriosis (DIE) of the rectosigmoid by comparison with histologic specimens obtained at surgery. A retrospective analysis, which met the Standards for Reporting of Diagnostic Accuracy Studies (2015) guidelines for a diagnostic accuracy study. Tertiary teaching hospital. A total of 194 cases who underwent preoperative discussion at the gynecologic endosurgery unit multidisciplinary meeting between January 2012 and December 2019 were eligible for inclusion. Retrospective assessment of the accuracy of TVUS and MRI in predicting histologic depth of rectosigmoid DIE after operative management. Al total of 135 surgeries were performed for DIE; 20 underwent a rectal shave, 14 had a disc/wedge resection, 38 an anterior/segmental resection, and 63 had no rectosigmoid surgery. Of the 52 patients with full-thickness rectal wall excision, all patients had at least one imaging modality available for review; 42 (81%) had both. At least one imaging modality was in agreement with histologic depth in 48 cases (92%) (sensitivity, 94%; specificity, 50%; positive predictive value [PPV], 97.9%; negative predictive value [NPV], 25.0%; area under the receiver operating curve, 0.720; 95% confidence interval, 0.229-1.000). When TVUS was assessed in isolation, the test remained sensitive for any rectal wall involvement (sensitivity, 93.6%; specificity, 50.0%; PPV, 97.8%; NPV, 25.0%; area under the receiver operating curve, 0.718; 95% confidence interval, 0.227-1.000). When only MRI was assessed, the test demonstrated both high sensitivity and specificity for rectal wall disease (sensitivity, 86.4%; specificity, 100%; PPV, 100%; NPV, 14.2). Specialist-performed TVUS and MRI are accurate in predicting depth of disease in rectosigmoid endometriosis. These modalities were similar in their diagnostic performance at assessing depth of rectal wall involvement, and their use is justified in the preoperative planning of these gynecologic surgeries.

The relationship between time of delivery and composite outcomes in women who sent to the intermediate intensive care unit after delivery

The relationship between time of delivery and composite outcomes in women who sent to the intermediate intensive care unit after delivery Abstract Objective: In this study, we evaluated the effects of delivery time on maternal-fetal outcomes by evaluating patients who were taken to the gynecological intermediate intensive care unit according to their delivery hours. Material and Methods: This study cohort included 292 women aged 18-45 years, whom we followed up in the postpartum gynecological intermediate intensive care unit. We divided the patients into three groups according to the time they gave birth. Those who gave birth between 08:00-16.00 formed group1, those who gave birth between 16:00-24:00 group2, and those who gave birth between 24:00-08:00 formed group 3. We compared all collected data between groups. Result: Hysterectomy (45(36%)) and blood transfusion (35(28%)) rates in the first group were higher than the other groups (p <0.001). Drain placement rates were higher in group 3 (48 (84.2%), p<0.001). No other operative approach and complications were significantly different between the three groups. Conclusion: Regarding maternal-fetal outcomes and surgical complications, making the delivery outside of working hours or after 24:00 may not have a negative effect.

Presenting a conceptual model for designing hospital architecture with a patient-centered approach based on the patient's lived experience of sense of place in the therapeutic space.

BACKGROUND:In recent years, among managers and designers of health-care spaces, there has been a growing tendency to move toward hospital design by combining patient perceptions and expectations of the physical environment of the care area. The main idea of this study was to present a conceptual model of hospital architecture in our country with a patient-centered approach based on some factors that were affecting the sense of place. This model determined the architectural features of treatment spaces from a patient's lived experience that could have a positive mental effect on patients as well. The main question of the research was how to adapt the objective perception to the patient's mental perception to create a sense of place in the hospital space?MATERIALS AND METHODS:This research was qualitative with a phenomenological approach, conducted between July and December 2020. Purposeful sampling consisted of 23 patients, 13 males in the male surgery unit and 10 females in the gynecology unit, who were interviewed in-depth. They were hospitalized for at least 3 days in two hospitals (Dr. Pirooz in Lahijan and Ghaem in Rasht). The data were analyzed by the Colaizzi method.RESULTS:The results consisted of 530 primary codes, 57 subthemes, and 7 main themes. The main themes were hospital location, access to hospital, hospital identity, hospital dependency, hospital attachment, human interactions in the hospital, and hospital evaluation.CONCLUSION:The hospital form guided the patient, and the hospital function directed and obviated the patient's needs. The healing environment and human interactions with it caused the patient to be satisfied with the hospital environment.

Does Interval between Breastfeedıng and Heel Lance Affect the Perception of Pain in Newborns?

To investigate whether the duration between breastfeeding and heel lance has an effect on babies' pain perception. A randomised trial. Obstetrics & Gynecology Unit, Yenimahalle Training and Research Hospital, Ankara, Turkey between August 2019 and February 2020. Healthy term newborns who were scheduled for a heel lance blood collection for newborn screening were included in the study. Healthy term babies were randomised into three groups, according to their heel lance time. The procedure was performed immediately after breastfeeding (group 1), one hour after breastfeeding (group 2), and two hours after breastfeeding (group 3). The magnitude of pain was measured by the neonatal pain, agitation and sedation scale (N-PASS) one minute before intervention, at the time of intervention, and at 1, 2 and 5 minutes after the intervention. Total crying times of the babies was recorded as well. Ninety-one babies were included in the study. The pain scores during heel lance and one and two minutes after heel lance were significantly higher in group 3 than in group 1 and group 2. Total crying time of the babies in group 3 was also significantly longer than the total crying time of the babies in group 1 and group 2. However, there was no significant difference between group 1 and 2 in terms of pain scores. The duration between breastfeeding and heel lance may influence the perception of pain in newborns. Keeping this period short, may reduce the perception of pain. Key Words: Breastfeeding, Breast milk, Newborn, Pain.

IS THERE A RELATIONSHIP BETWEEN COMPLICATIONS OF EARLY PREGNANCY AND BIOMETEOROLOGICAL FORECAST?

The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12th week of gestation with biometeorological conditions while assuming a greater number of incidents with an unfavorable biometeorological forecast. We performed a retrospective observational study using medical data of a single medical center of Department of Gynecology and Obstetrics, Sveti Duh University Hospital and meteorological data from the Croatian Meteorological and Hydrometeorological Service in Zagreb. We tracked the number of visits to the gynecology and obstetrics emergency unit on a daily basis during 2017. Days with five or more visits were selected and underwent further analysis, during which the number of miscarriages and symptomatic ectopic pregnancies was noted. The information from the biometeorological forecast was then extracted and added to the database. Our results did not show a statistically significant difference between the groups determined by biometeorological forecast in the number of spontaneous abortions or ectopic pregnancy. Also, statistically significant results did not follow the expected trend of the increasing number of complications related to worse biometeorological forecast, or vice versa, a decreased number of complications with better forecast. Our single-center retrospective analysis of emergency unit visits related to weather conditions did not show a connection between the complications of early pregnancy and biometeorological conditions. However, different results could emerge in future studies. Considering the large and high-quality database collected for this study, efforts in researching the connection between other gynecologic pathologies and weather conditions will be feasible.

Could Surgery Improve Survival in Patients with Advanced Endometrial Cancer?

Background: Patients with endometrial cancer are mostly diagnosed at an early stage. But unfortunately 10% to 15% of endometrial cancer patients will present with advanced-stage disease, and hence poorer prognosis. When disease is primarily intraperitoneal, cytoreduction to reduced to no visible disease remaining. Aim: Of the work is to detect the survival rate benefits of primary surgery in patients with advanced endometrial cancer at gynecologic oncology unit in El Shatby Maternity University Hospital. Methods and Materials: Retrospective study was conducted on 102 patients diagnosed to have advanced endometrial cancer FIGO (stage III/IV) in a duration of 4 years between 2016 and 2020 and had undergone cytoreductive surgery. The patients were further subdivided into two groups: group 1 who underwent optimal cytoreduction with residual disease less than or equal 1 cm visible lesion, and group 2 who had residual disease more than 1 cm visible lesion and they were followed to check the survival benefits. Results: The mean of disease free survival in group: 1) patients was 2 years which was significantly longer than those in group; 2) those who had residual disease > 1 cm, p I endometrial cancer had significantly longer (DFS) than those diagnosed to have type II endometrial cancer, p = 0.046. Conclusion: Primary complete cytoreductive (upfront) surgery when possible has a favorable impact on overall survival in patients with advanced endometrial cancer.

Fetomaternal Outcome in Antepartum Hemorrhage; A Cross Sectional Study at Feto-Tertiary Care Hospital of Sindh, Pakistan

Introduction: Antepartum hemorrhage is the bleeding from the genital tract following the completion of 28 weeks of pregnancy till full term. It is an obstetrical emergency and a leading cause of maternal and perinatal death and morbidity. Objectives: This study was conducted to determine the frequency of maternal and fetal complications in women with antepartum hemorrhage. Methods: It was a cross sectional study held at the Department of Gynecology and Obstetrics unit IV, Liaquat University of Medical and Health Sciences, Jamshoro between 2017 and 2019. This study enrolled 158 women with a history of antepartum hemorrhage using non- probability consecutive sampling. The fetal and maternal outcomes of the patients were recorded. Maternal outcomes were assessed according to age, gravidity and gestational week. Data was analyzed in SPSS 20. Results: The average age of the women was 25.77±4.15 years. Anemia was the most common maternal outcome 102(64.6%) followed by disseminated intravascular coagulation (DIC) 24(15.2%), shock 12(7.6%), postpartum hemorrhage (PPH) 11(7%) and maternal mortality 5 (3.1%). Preterm birth and low APGAR score were the most frequently fetal outcomes that were observed in 69 (43.7%) and 50 (31.6%) cases, respectively. There was significant association of DIC with gravidity and gestational age. Anemia was significantly associated with gestational age more frequently among mothers with <37 weeks of gestational age. Conclusion: In conclusion, anemia was the most frequently encountered complication of antepartum hemorrhage, followed by DIC and shock. Multigravidity was a significant etiological factor in antepartum hemorrhage.

Masturbation Injury Following Intravaginal Introduction of a Candlestick: A Case Report

Masturbation, a common sexual behaviour, may result in life-threatening injuries. Here the authors present a case of 40 years old female patient, P2L2 who presented to the Gynaecological Emergency unit, on account of a three-hour history of bleeding per vagina following candlestick masturbation which resulted in a 4 cm right lateral vaginal fornix laceration and accompanying hypovolemic shock. She was separated from her husband for a period of 2 years. She underwent examination under anaesthesia and repair of vaginal laceration. Postoperatively, she had one unit of blood transfused and was discharged for home on haematinics, broad spectrum antibiotics and analgesics. Counselling on marital stress and sexual distress was provided, while encouraging the use of adult sex toys in favour of improvised ones when necessary.

ASSESSMENT OF INTERNS’ TRAINING IN THE TEACHING HOSPITALS OF BAGHDAD MEDICAL CITY COMPLEX

The aim: The aim of this study is to assess the training of medical interns in Baghdad Medical City Complex. Materials and methods: A cross-sectional observational study was conducted in the Medical City Complex, Baghdad. The study targeted all the medical interns who finished year one of internship. A questionnaire form was designed for data collection. A questionnaire form was done according to the Medical Interns’ Guideline adopted by the Minister of Health in 2015. Results: A total of 60 interns filled the questionnaire, their mean age is 27.07 years (SD = 2.04), male respondents constituted 48.3%. Twenty-seven respondents (45%) were from Baghdad Medical College. More than half (58%) of them were singles. The mean pre-internship score was 69.32 (SD = 6.6). About half of the interns (29, 48.3%) have a future interest in surgery. Average preparedness for the internship was reported in 45% of interns. Half of the interns had prior ideas about the internship through variable means. A larger percentage of interns reported average/poor quality of training in different aspects of medical internships. Accepted quality of training (above average and excellent) and average one were reported respectively by 19 (31.7%) and 31(51.7%) of interns in general surgery, followed by the internal medicine branch. Thirty-one (51.7%) interns were moderately prepared for their future medical careers. Surgeons and general physicians gained better opinions (above average and excellent) from the interns (17, 28.3%, and 13, 21.6%) respectively. Conclusion: There was a deficiency in the preparedness of newly graduated doctors for the internship. But they reported an average skill performance in major medical branches, and some related laboratory and medical procedures, there was a defect in dealing with emergency cases. The Supervision of interns was below average in gynecology and obstetrics units and was good in other branches. The medical school training was poor to help interns in dealing with deaths and legal medicine cases. More than 50% of trainees were prepared for the future medical branches of interest.

Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case-control study in Ghana.

Background:Postpartum preeclampsia has been implicated in increasing hospital re-admissions, maternal morbidity, and mortality worldwide. The knowledge of the risk factors of postpartum preeclampsia would be helpful in formulating strategies to aid in the prevention, early diagnosis, and timely treatment of this disorder. Thus, this study aimed to identify the risk factors associated with the development of new-onset postpartum preeclampsia and persistent postpartum preeclampsia in the Ghanaian setting.Methods:This case–control study was conducted at the Obstetrics and Gynecology units of Komfo Anokye Teaching Hospital and the Kumasi Regional Hospital, both located in the Ashanti Region of Ghana. A total of 65 postpartum preeclamptic women (33 new-onset postpartum preeclampsia and 32 persistent postpartum preeclampsia) and 65 normotensive postpartum mothers were recruited from 48 h to 6 weeks post-delivery. Questionnaires were administered to assess the socio-demographic, lifestyle, obstetric characteristics, and past medical history of the study participants.Results:Physical inactivity (p < 0.0001), infrequent antenatal visits (p < 0.0001), analgesic use (p < 0.0001), and cesarean delivery (p = 0.021) were significantly associated with both the new-onset postpartum preeclampsia and persistent postpartum preeclampsia. Contraceptive use was significantly associated with the development of new-onset postpartum preeclampsia (p < 0.0001) while women with low-birthweight babies are also at high risk of developing persistent postpartum preeclampsia (p < 0.0001).Conclusion:Physical inactivity, infrequent antenatal visits, analgesic use, contraceptive use, and cesarean delivery are major predisposing risk factors for the development of postpartum preeclampsia. Screening using these risk factors, close monitoring and follow-up observation of women after delivery would be beneficial in identifying and managing postpartum preeclampsia.

Prevalence and correlates of hypothyroidism in pregnancy: a cross-sectional study at Bouget General Hospital, Ivory Coast.

Introductionseveral adverse pregnancy outcomes have been reported in gestations with associated hypothyroidism. The prevalence of hypothyroidism has not been frequently reported in Black Africans. This study sorts to report the prevalence and associated factors of hypothyroidism in Black African pregnant women.Methodsthis was a hospital-based cross-sectional study, including all pregnant women attending the gynecologic unit of Bouget General Hospital Abidjan. Serum thyroid-stimulating hormone and T4 were obtained from all participants and analyzed using a fluorescent Immunochemistry assay. Data were analyzed using R version 4.05. Univariable and multivariable logistic regression was used to assess factors associated with hypothyroidism and statistical significance considered as p < 0.05.Resultsoverall there were 693 participants, mean age of 28.1(SD 6.4) years with an average gestational age of 24.1 (SD 8) weeks, and a majority of study participants were in the second trimester of gestation. The prevalence of hypothyroidism was 12.1% (n = 84) (10.8% subclinical hypothyroidism and 1.3% clinical hypothyroidism) whereas 1.9% (n = 13) had hyperthyroidism. In addition, patients with reported type 1 diabetes mellitus had an increased risk of hypothyroidism (aOR: 12.6, 95% CI 1.9-100.8; p ≤ 0.01).Conclusionthis study revealed a high prevalence of hypothyroidism, though mostly in the subclinical form. Further research is warranted to confirm these findings which may have implications on early screening of hypothyroidism in black African women.

The Potential Role of Uterine Retroversion in Pelvic Pain Symptoms and Caesarean Delivery

Aim: Uterin Retroversion is a common status in the women population and assumed to be related with pelvic pain symptoms. The aim of this study is to investigate whether uterine retroversion is associated with pelvic pain symptoms and is a reason for cesarean delivery.Method: One hundred thirty-three premenopausal women admitted in a Tertiary Education and Research Hospital, Department of Gynecology unit for pregestational counseling were evaluated for pelvic pain symptoms with a self-administrated questionnaire. Uterine position was assessed by pelvic examination and transvaginal ultrasound. Sixty-one women had a retroverted uterus (group1), and seventy-two had an anteverted or intermediate uterus (group2). Dyspareunia, dysmenorrhea, weight, Body Mass Index (BMI), cyclic pain, ovulation pain, premenstrual pain and mode of delivery were compared between the Retroverted group and the Anteverted or intermediate group. After successful conception and pregnancy survey, mode of delivery was also compared.Results: Dyspareunia, dysmenorrhea, weight, BMI, cyclic pain, ovulation pain, premenstrual pain, patients’ sexual activities restrictment due to dyspareunia, patients medical treatment requirement for dysmenorrhea, and mode of delivery was statistically significant between two groups. (p&amp;lt;0.05). However, PMS (premenstrual syndrome), height, gravid and parity were similar (p&amp;gt;0.05).Conclusion: Uterine retroversion is associated with a higher prevalence of cesarean rate, pelvic pain and visual analogue scale for dyspareunia and dysmenorrhea in a population of unselected women.

To Determine the Frequency of Preterm Births in Abruptio Placentae in a Tertiary Care Hospital, in Urban City of Pakistan

Introduction: Abruption placenta is a serious condition in which a normally sited placenta detaches its attachment from the uterine wall, after 20 weeks of gestation and before the delivery. Abruptio placentae is associated with various complications. In this study, we will focus on frequency of preterm birth in patients with abruptio placentae. Material and Methods: This cross-sectional study was conducted at the department of Obstetrics and Gynecology Unit – I, Civil Hospital Karachi and Dow University of Health Sciences from January 2021 to December 2021. Three hundred and eighty four (384) patients with confirmed diagnosis of abruptio placentae were followed till delivery of their babies. Results: 154 (40.1%) participants had preterm delivery. Preterm delivery was significantly higher in participants with parity more than 3 (p value &lt; 0.0001). There was no difference in frequency of preterm based on age and status Conclusion: Preterm deliveries are very prevalent in pregnant women presenting with abruptio placentae. Booked participants who are at risk of abruptio placentae should be monitored more closely and they should be made aware of the possible complication of preterm delivery associated with abruptio placentae. Keywords: Abruptio placentae, preterm delivery, premature delivery, tertiary care, Pakistan

Case Report on Cervical Dysplasias

Introduction: Cervical dysplasia is a precancerous disorder in which abnormal cell growth occurs on the cervix's surface lining or endocervical canal, which connects the uterus and the vaginal canal. Cervical intraepithelial neoplasia is another name for it (CIN). Clinical finding:-Abdominal pain, weight loss, fever (Temperature – 101oF).&#x0D; Diagnostic Evaluation: Blood test: HB- 10.8 gm%, Total RBC count- 4.15 millions/cu mm, RDW –13.1%, Total WBC count-6100 /cu mm, Total platelets- 2.381ACS/MM3.&#x0D; Cytopathology Examination: Cervical cytology Smear shows only scattered superficial and intermediated squamous cell with few neutrophils. Colposcopy Examination: Moderated dysplasia, chronic cervicitis. Colposcopy finings- cervical erosion seen on post lip,-Mosaic pattern of blood vessels seen on green filter, Aceto white areas seen at 7o’clock position, Less iodine uptake at 7o’ clock and 12o’clock positions, aceto white areas reduced as compared to previous colposcopy.&#x0D; Therapeutic Intervention: Vaginal hysterectomy lateral Sphincterotomy I/V/O Cervical Dysplasia Inj. Gentamacine 80 mg iv 12 hrly, Inj. Ctax 1 gm IV 12hrly, Inj. Pan 40 mg iv 12 hrly, Inj Metro 100 ml /8 hrs, Inj. Neomal 100 ml Iv 12 hrly, Inj Pause 8 hrly, zonac suppository TDS, Tab-Gabapentin 300 mg HS, Glucose powder, protein powder 2tbsp BD with milk.&#x0D; Outcomes: After treatment the patient shows improvement. Her abdominal pain and fever were relived and the surgery precancerous cells are removed, Patient condition was improved.&#x0D; Conclusion: My patient was hospitalized to AVBRH gynecology unit with abdominal pain, fever, weight loss. After receivingproper therapy, her condition has improved.

A Case Report On: Incomplete Abortion with Chronic Hypertension

Introduction: Abortion is a distressing experience that affects the mother in a variety of ways by influencing on emotional status that can finally result in psychological disorders such as depression [1]. An incomplete abortion occurs when the products of conception are lost in the first 20 weeks of pregnancy. Moderate to severe vaginal bleeding, as well as lower abdomen and/or pelvic pain, are common symptoms of incomplete abortion [2]. Substantial evidence indicates that women with a history of spontaneous abortion have a greater risk of non-communicable diseases, including hypertension, cardiovascular diseases, and type 2 diabetes [3]. In low and middle-income nations, abortion is one of the most common causes of maternal death [4]. In general, incomplete abortions are unavoidable, with chromosomal abnormalities accounting for 50% of all occurrences. Age, maternal disorders (diabetes, hypertension, renal disease, thyroid issue, polycystic ovarian syndrome, lupus, thrombophilia), under or overweight, aberrant uterus, teratogen exposure (drug, alcohol, caffeine, radiation), and infections are all changeable etiologies and risk factors (human immunodeficiency virus, sexually transmitted infections, Listeria monocytogenes) [2].&#x0D; Case Presentation: A 30-year-old woman's case study with 15 weeks pregnant admitted in the obstetric and gynecological unit on the date 11 June 2021 with complaints of amenorrhea since 4 months, bleeding per vaginam, passage of clots, blurring of vision, pain in abdomen, breathlessness and her blood pressure was noted as 140/100mm of Hg. Interventions: Generally, the patient with abortion and raised blood pressure is hospitalized and care is provided in the obstetric and gynecological unit or ward. The goals during this phase are saving a life of mother, maintaining and restoring hemodynamic stability and preventing the spread of infection or correcting the complication.&#x0D; Outcomes: During the period of five days treatment, the client was having raised blood pressure but significantly the client’s health was improved with further treatment and management .After a hospital stay of five days the markable progress was seen further before returning to the home. Discussion: Although the patient reacted well to treatment, more interventions and health education could be used in the future to help the patient to achieve the better health results.

Female Sexual Dysfunction in a Third Level Health Facility, Southern Nigeria

Background: Observation during our gynaecology consultations does not tend to agree with reviews in literature suggesting high prevalence of sexual dysfunction. With this background, we decided to subject this general observation to scientific scrutiny to determine the proportion of our patients that actually have sexual dysfunction; and thepredisposing risk factors.&#x0D; Objective: To determine the prevalence and risk factors associated with sexual dysfunction in females attending the gynaecology clinic of the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt.&#x0D; Methods: This was a prospective cross-sectional questionnaire based study of 72 females of reproductive age group attending the outpatient gynaecological unit of UPTH. They were interviewed using the Female Sexual Dysfunction Index (FSFI). A total FSFI score of less than 26.5 was indicative of sexual dysfunction. The data were collated and entered into SPSS version23 statistical software which was also used for analysis. A p-value of &lt; 0.05 was considered significant.&#x0D; Results: The prevalence of sexual dysfunction in females was 61.1% using the FSFI of less than 26.50. The most common type of sexual dysfunction among the respondents was desire disorders (66.7%) followed by disorders of orgasm (62.5%), lubrication (56.9%), arousal (43.1%) and pain (40.3%). Advanced age, higher education, parity and female genital cutting were found to be associated with sexual dysfunction.&#x0D; Conclusion: The findings in this study showed that a significant number of women in our centre are affected with sexual dysfunction.

Association of Thyroid Dysfunction and Pregnancy Outcomes

Background: Hypothyroidism in pregnancy results in serious consequences for both mother and fetus. Pregnant women are prone to thyroid dysfunction due to physiological changes taking place in body. This study is undertaken to see the effect of thyroid dysfunction on pregnancy outcomes. Methodology: A prospective observational study was done. Study was conducted in a private gynecological and obstetric unit. A sample size of 200 women in selected institute with singleton pregnancy was recruited. Pregnant women with chronic disabilities and previously known thyroid disorders were excluded. Data was analyzed using SPSS version 23.0 and binary logistic regression analysis was done. Ethical rules were followed throughout the study and consent taken from all participants. Results: Out of 200, 23 participants were positive for thyroid disorder. Thyroid dysfunctions are responsible for causing multiple complications in pregnancy for mother and fetus. Findings suggest a signification association of thyroid dysfunction and feto-maternal consequences (p-value &lt;0.005). Conclusion: Subclinical hypothyroidism is a common finding during pregnancy. It is compulsory to detect and treat thyroid dysfunction early in pregnancy so that adverse outcomes could be avoided. There is a need for timely screening of thyroid profile in suspected pregnancies. keywords: TSH, FT3, FT4, Pregnancy, Outcomes.

Viewing the image? Ultrasound examination during abortion preparations, ethical challenges.

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination.

Outcome of Pregnancies Associated with Fibroids

Objectives: To evaluate the behaviour of uterine leiomyoma, their frequency and impact on the course of pregnancy Design: It was a descriptive study. Setting: Gynaecology and Obstetric Unit, Hayatabad Medical Complex, PGMI, Peshawar. Subjects: All the patients presenting to antenatal clinic or emergency having a pregnancy associated with fibroids from 1st July 2001 to 30th June 2002. Subject and Methods: Women diagnosed with leiomyoma during pregnancy were evaluated clinically and the findings were confirmed by ultrasound. Detection of leiomyoma during caesarean section also made the patient eligible for the study. In all there were 76 patients in the study. The size of leiomyoma, the type of leiomyoma, their effect on pregnancy outcome and complications were noted. Patients obstetric, and fertility history was recorded on a questionnaire. The concerned doctors were required to fill a performa regarding the outcome and complications the delivery of such patients. Data Analysis: After data collection, the data was analyzed using various statistical tests like percentage, relative risk (R.R), ods ratio (O.R), mean, standard deviation (S.D) confidence interval (C.I), using software SPSS version 8.0 and Epi-Info 6. Main Outcome Measures: The main outcome measures were noted down as the frequency of spontaneous pregnancy loss, vaginal delivery or the caesarean section. Results: Out of 76 patients (1.9%), 16 underwent spontaneous pregnancy loss (21 %, O.R 1.16. R.R 1.13, P 0.59), 31 had vaginal delivery (40.8%, O.R 0.21, R.R 0.62, P 0.0000) and 29 had caesarean section (38.2%. O.R 4.71, R.R 2.91, P 0.0000). The frequency of complicated deliveries was 73.3%. The different complications occurring were antepartum haemorrhage, acute abdomen, laparotomy, preterm labour, dysfunctional labour, retained placenta and retained products of conception. Conclusion: Although abortions, preterm delivery, dysfunctional labour and cesarean sections were common, the neonatal outcome in viable pregnancies was fairly good in women with uterine leiomyomas. Because of increased risk of complications all the patients with leiomyomas having pregnancy should be considered as high-risk cases.

Effect of COVID -19 pandemic on still births.

Introduction: The COVID-19 pandemic is testing the strength of the strongest medical management in the globe. In developing countries, this contagious disease is quickly spreading in the midst of various endemic medical conditions like HIV, tuberculosis, jungle fever, lack of healthy sustenance, and incessant episodes of rampant contaminations. This happens especially in a setting of frail healthcare systems which may scarcely adapt to the previously mentioned existing medical challenges.&#x0D; Purpose: The objective of this research is to examine the impacts of pandemic of COVID-19 on the stillbirth rates.&#x0D; Methodology: Study was conducted at department of obstetrics and gynecology Unit Gynae C Lady Reading Hospital Peshawar from 1st January 2019 to 31st August 2020. This comparative cross sectional study was carried out at using non probability consecutive sampling technique.&#x0D; Findings: A large number of patients admitted with the diagnosis of stillbirth during 2019 and 2020 were multiparas 57% and 62% respectively. Booking status was 64% during 2019 and dropped to 52% in pandemic year 2020.Percentages of stillbirth due to abruption, placenta previa, gestational diabetes mellitus(GDM), type II diabetes, malpresentation, intrauterine growth restriction (IUGR),obstructed labor, eclampsia, postdates and unknown causes in 2019 and 2020 have been given in the table.&#x0D;