Lady Willingdon Hospital Lahore Research Articles

Association between Vitamin D Deficiency and Preeclampsia among Pregnant Females during First Trimester

One of issue during pregnancy among women is vitamin D insufficiency and studies have shown a dose–response relationship between development of preeclampsia and maternal vitamin D levels. Objective: To determine any association between vitamin D insufficiency in blood during the first trimester of pregnancy and development of preeclampsia. Methods: It was a Case Control study conducted in Department of Obstetrics and Gynecology, Lady Willingdon Hospital Lahore, from September 2019 to August, 2020. 150 women fulfilling selection criteria were enrolled from OPD of Lady Willingdon Hospital, Lahore. Informed consent was taken. Demographic variables e.g. age, gestational age, parity and BMI were recorded. Then females were divided in two groups i.e. cases with preeclampsia and controls without preeclampsia. Then medical record was obtained and vitamin D level during first trimester was noted. If vitamin D <20ng/dl, then vitamin D deficiency was labeled (as per operational definition). Data were entered and analyzed in SPSS version 20.0. Frequency and percentages were calculated for qualitative variables. Results: Mean age was 28.01±3.43 years. Mean gestational age was estimated as 32.84±4.75 weeks in cases and 32.24±3.55 in controls, Vitamin D deficiency in blood during the first trimester of pregnancy and development of preeclampsia shows that 90.67% in cases and 82.67% in controls had vitamin D deficiency with odds ratio of 2.03. Conclusions: We concluded that there is an association between vitamin D deficiency in blood during the first trimester of pregnancy and development of preeclampsia.

Evaluation of Applications of Intrauterine Progesterone Versus Oral Progesterone in the Treatment of Dysfunctional Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a common gynecological problem that affects the women of all ages. It is defined as any irregular or excessive bleeding from the uterus that is not related to the woman’s normal menstrual cycle. It can be caused by a many of underlying factors such as hormonal imbalance, fibroids, polyps or endometriosis. Study design: It is a randomized controlled study conducted at Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Lady Willingdon Hospital Lahore for the duration of six months from June 2022 to November 2022. Material and Methods: The study was carried out for two groups. Intrauterine group included the patients that received intrauterine dose of progesterone and oral group patients had progesterone orally. The study was approved by the review board committee of the hospital. The use of pads for both groups was studied and it was found that oral group used the most pads 18.7 and 12.9 before and after the study respectively. Results: Duration of bleeding was examined. The patients in intrauterine group stated about bleeding for 7.8 days before the study and 5.9 days after the study. In case of oral group participants, they bled for 8.9 days before the study and 6.7 days after the study. Standard deviation and p value was calculated and results were statistically significant. Conclusion: The investigation of oral and intrauterine progesterone for patients suffering from dysfunctional uterine bleeding was studied and it was found that the rate of bleeding was more in case of oral group. Keywords: Intrauterine progesterone and oral progesterone.

Correlation of Sonographic Findings and Histopathological Examination of Hysterectomy Specimens in Perimenopausal Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a frequent prenatal problem that affects the women of all ages. AUB is the condition in which vaginal bleeding occur in the absence of pregnancy. The most common and easily available imaging procedure is the ultrasonography. Our study aimed to investigate the correlation between sonographic findings and histopathological examination of hysterectomy specimens in perimenopausal women with AUB. Study design: It is a cross-sectional study conducted at Lady Willingdon Hospital Lahore and Divisional Headquarters Teaching Hospital Mirpur, Azad Kashmir for the duration of six months from July 2022 to December 2022. Material and Methods: This study on hysteroscopy was carried out on 50 patients suffering from uterine bleeding and having a biopsy. All the patients selected in the given study were according to the inclusion criteria, while those patients were excluded that do not fulfill the inclusion criteria. Most of the patients included in this study had ages between 31 to 41 years. The study was approved by the review and ethical board committee of the hospital. Results: Most patients having this ultrasonography had fibroid and bulky uterus. Only a few had Adenomyosis and thick endometrium. Neglectable patients had an endometrial polyp and malignancy issues. The sensitivity value for the normal endometrium used as a control was at an acceptable range and it was used as the control for the further evaluation of other attributes. Conclusion: For the diagnosis of abnormal uterine bleeding, hysteroscopy is an excellent diagnostic tool and it is highly efficient for the estimation of pathological issues of the endometrium wall. Keywords: Abnormal uterine bleeding, sonography and histopathological examination.

Immediate Postpartum and Post Abortion Long Acting Reversible Contraception in Referral Level Facility

Background: Despite the advances in the contraceptive technologies, still the unintended pregnancies are adding to the global health issues. The placement of a contraceptive device, such as an intrauterine device (IUD) or contraceptive implant, immediately after childbirth is termed as long-acting reversible contraceptives LARC. Study design: It is a retrospective study conducted at Lady Willingdon Hospital Lahore and Divisional Headquarters Teaching Hospital Mirpur, Azad Kashmir for the duration of six months from April 2022 to September 2022. Material and Methods: The study was approved by the health and ethical board committee of the hospital. The study was conducted on 102 patients that visited tertiary care center during a course of six months. The age of women ranged from 18 to more than 36 years. There were 51 women who belonged to age group 18-24 years, 32 were in the 25-35 year range and 49 were older than 35 years. Results: Standard deviation and p value was calculated and results were statistically significant. There were 8 women who were nulliparous, primipara women were 31 and 58 were multipara. There were 5 women that were included in the grand multipara group. There were 42 women that belonged to urban area and 60 lived in rural area. Most of the women 52 had primary level of education, however 24 had higher secondary level of education and 56 were working women. Conclusion: The acceptance rate was only 9% in the vaginal birth patients. The use of LARC could be an easy and cost effective contraceptive way. Keywords: Intrauterine device and family planning services.

Contributing Factors for Placenta Accreta in Patients Presenting in a Tertiary Care Hospital

Objective: determine the frequency of contributing factors for placenta accreta in patients presenting in a tertiary care hospital Methodology: The study was conducted on all the pregnant patients diagnosed with placenta preavia on ultrasound that were admitted through emergency and outpatient department of Lady Willingdon Hospital Lahore. A total of 180 patients fulfilling the inclusion/exclusion criteria coming to the Emergency Department were recruited in study. Contributing risk factors i.e. placenta previa, number of previous caesarean sections, and Dilatation & Curettage were recorded by the researcher herself on a pre-designed proforma attached. Data was collected and analyzed by single researcher to overcome the bias. Results: In our study, out of 180 cases, 73.33%(n=132) were between 20-30 years of age while 26.67%(n=48) had >30 years of age, mean+sd was calcualted as 27.89+4.14 years, 73.33%(n=132) were between 20-30 years of age while 26.67%(n=48) had >30 years of age, mean+sd was calcualted as 27.89+4.14 years, contributing factors of placenta accreta shows that 87.22%(n=157) had placenta previa, 51.67%(n=93) had <2preivous cesarean section, 48.33%(n=87) had 3 previous cesarean section and 27.22%(n=49) had D&C. Conclusion: We concluded that Placenta previa is a leading contributing factor followed by 2 and 3 cesarean sections and D&C for placenta accreta. Keywords: Placenta accreta, contributing factors, placenta previa, previous cesarean section, dialatation & curettage

Comparison of Oral Magnesium Supplements with Placebo for Pregnancy-Induced Leg Cramps

Background: Magnesium deficiency results in different types of complications in the pregnant females in pre and post delivery phase. This study is planned to check the impact of magnesium supplementation in terms of reduced leg cramps. Objective: To compare the effectiveness of oral magnesium supplements versus placebo for pregnancy-induced leg cramps. Study Design: Randomized control trial Place and Duration of Study: Department of Obstetrics & Gynecology Department Unit 1, Lady Willingdon Hospital Lahore from 25th March 2017 to 30th September 2017. Methodology: Two hundred pregnant women were enrolled. All patients were divided in two groups and each group comprised 100 patients. Group A received magnesium bisglycinate chelate (300 mg per day) and group B received placebo. All patients of both groups were followed for effectiveness. At the end of the 4th week, a detailed history was taken from patients about entirely free from leg cramps i.e. effectiveness. Results: The mean age was 28.29±5.76 years. Gestational age was 27.74±5.25 weeks. The body mass index was >30 in 141 (70%). Majority of the females 57 (28.5%) have parity 3 while 55 (27.5%) were having parity 2. Overall efficacy was 71 (35.5%) and it was not noted in 129 (64.5%). It was found that efficacy of magnesium was in 45 (45%) and in placebo group 26 (26%) and this difference was statistically significant (p<0.05). Conclusion: Magnesium therapy appears to be effective in the treatment of pregnant induced leg cramps in the general population, but may have a small effect in pregnant women. Key Word: Leg cramps, Pregnancy, Magnesium therapy

Impact of burnout among surgeons and residents at a Tertiary Care Hospital of Pakistan.

Objectives: To determine frequency and impact of burnout among surgeons and residents of different specialties at a tertiary care hospital in Punjab, Pakistan, over a period of 6 months. Study Design: Observational Cross-sectional study. Setting: Departments of General Surgery and Ophthalmology, Mayo Hospital Lahore and the Department of Gynecology, Lady Willingdon Hospital Lahore. Period: September to November 2019. Material & Methods: Out of 150 invited participants, 124 responded to the questionnaire. Grades of burnout were determined according to the American Public Welfare Association (APWA) inventory. Data analysis was performed using SPSS 26.0, with qualitative statistics determined as frequency and percentages, and quantitative correlations among variables determined by application of chi-square test with p-value ≤ 0.05 as significant. Results: Out of 124 participants, 48.3% were female while the rest were male, mostly in the age group of 26-30 years (75%). Majority (50.8%) belonging to General Surgery; 32.3% were from Gynecology and Obstetrics and 16.9% were from Ophthalmology. Most of the participants (81.4%) were residents, with majority (51.6%) working 60-80 hours per week. There was high rate of burnout, with 46.3% of females and 32.8% of males reporting early burnout, and 36.6% of females along with 25% of males reporting advanced burnout. General surgeons and gynecologists were more prone to advanced burnout, while eye surgeons and residents had an increased propensity towards developing burnout. Conclusion: There is a high rate of burnout among surgical residents and consultants, attributable to increased working hours, less pay, and decreased job satisfaction. Measures should be taken to curb this trend, both for patient safety as well as for personal and mental health improvement of surgeons.

Conceiving After Management of Infertility Without Assistance in a Low-Income Area

Getting pregnant after infertility management is a more challenging situation in some under equipped sub-Saharan setting. To highlight the determinants of conception without Assisted Reproductive technology (ART) in a low-income area. The current study concerned 2958 patients who sought care for infertility in the Mayo Hospital , Lady Willingdon Hospital Lahore and Khyber Teaching Hospital, from January 2018 to December 2018. For them, any technique of ART was used. Age of patients ranged from 18 to 49 with average of 33.2 ± 5.6 years old. After treatment, 249 (9%) patients conceived (clinical pregnancy). Most of the patients who conceived were less than 36 years, without history of illegal abortions et who suffered from genital infections. The treatments closely associated with conception were antibiotics (73%), hydrotubation (12%) ovulation inductors (11%) and gynecologic surgery (4%). In that setting, ART is a must. Very few infertility problems, apart from infection and its consequences, can get solution Keywords : Conceiving, Infertility Management, Low Income Area, ART, Tubal Infertility DOI : 10.7176/JMPB/60-05 Publication date :October 31 st 2019

English

Background: The most common congenital malformations are Neural tubedefects (NTDs) occurring in 0.6 per 1,000 live births in the United States, and almost 4000pregnancies are recorded of babies with neural tube defects, among them anencephalyand Spina bifida are the most common and their annual incidence is 2,500 to 3,000 births inthe United States. The etiology of NTDs is still an enigma, however, in the past few decadesvaluable advances has been made in understanding the causation and measures to preventNTDs and many risk factors are indentified which are associated with it. Objectives: This studywas designed to determine the risk factors and their association with neural tube defects. StudyDesign: Case control study. Place and Duration of Study: This study was conducted at unit111 Lady Willingdon Hospital Lahore and duration was one year from 1.1.2016 to 31.12.2016.Methodology: A total of 120 mothers were included in the study, of which 30 were having ofbabies delivered with NTDs, matched with 90 mothers delivered babies without NTDs (Threecontrols for each NTD case). Informations were collected on special Performa, data was analyzedon SPSS version 20. Results: Majority of the patients in both groups were found between 31-40 years of age, 43.33 %( n13) in patients with NTD group and 56.67 %( n51) in controls whileonly 16.67% (n5) in NTD and 17.78 % (n16) were found between 21-30 years. The mean agewas recorded as 33.06+1.21 and 32.12+ 0.89 respectively. Regarding parity, 23.33% (n7) werefound between P1-2, 26.67% (n11) were P2-3 while 40% (n12) with Parity >4 in the NTD group,while 21.11% (n19) were p1-2, 37.77% (n 34) with P 3-4 and 41.12% (n37) were P >4 in controlgroup. 86.67% (n 26) were found with poor economic status and 13.33% (n4) were found withrich status in NTDs, while 18.89% (n17) were found with poor and 81.11% (n73) with rich statusin control group. Distribution of fetuses according to their gender revealed that 20% (n6) weremales, and 80% (n24) were females in NTDs while 47.77 %( n43) were found males and 52.23%(n47) were females in controls. Regarding family history 80% (n24) with positive history of NTDsin patients of NTD group and 20% (n6) with no history while 4.44% (n4) had positive history and95.56% (n86) had no familial history of NTD in control cases. About previous history of NTDs,93.33% (n28) were found with positive previous history of NTDs and only 6.67% (n2)with noprevious history of NTDs in NTD group, while only 5.56% (n5) were found with positive previoushistory of NTDs and 94.44%(n85) with no previous history in controls. Conclusions: Poor socioeconomic status, family history and previous history of a baby with Neural tube defects are themajor risk factors.

NEURAL TUBE DEFECTS (NTDS);

Background: The most common congenital malformations are Neural tubedefects (NTDs) occurring in 0.6 per 1,000 live births in the United States, and almost 4000pregnancies are recorded of babies with neural tube defects, among them anencephalyand Spina bifida are the most common and their annual incidence is 2,500 to 3,000 births inthe United States. The etiology of NTDs is still an enigma, however, in the past few decadesvaluable advances has been made in understanding the causation and measures to preventNTDs and many risk factors are indentified which are associated with it. Objectives: This studywas designed to determine the risk factors and their association with neural tube defects. StudyDesign: Case control study. Place and Duration of Study: This study was conducted at unit111 Lady Willingdon Hospital Lahore and duration was one year from 1.1.2016 to 31.12.2016.Methodology: A total of 120 mothers were included in the study, of which 30 were having ofbabies delivered with NTDs, matched with 90 mothers delivered babies without NTDs (Threecontrols for each NTD case). Informations were collected on special Performa, data was analyzedon SPSS version 20. Results: Majority of the patients in both groups were found between 31-40 years of age, 43.33 %( n13) in patients with NTD group and 56.67 %( n51) in controls whileonly 16.67% (n5) in NTD and 17.78 % (n16) were found between 21-30 years. The mean agewas recorded as 33.06+1.21 and 32.12+ 0.89 respectively. Regarding parity, 23.33% (n7) werefound between P1-2, 26.67% (n11) were P2-3 while 40% (n12) with Parity >4 in the NTD group,while 21.11% (n19) were p1-2, 37.77% (n 34) with P 3-4 and 41.12% (n37) were P >4 in controlgroup. 86.67% (n 26) were found with poor economic status and 13.33% (n4) were found withrich status in NTDs, while 18.89% (n17) were found with poor and 81.11% (n73) with rich statusin control group. Distribution of fetuses according to their gender revealed that 20% (n6) weremales, and 80% (n24) were females in NTDs while 47.77 %( n43) were found males and 52.23%(n47) were females in controls. Regarding family history 80% (n24) with positive history of NTDsin patients of NTD group and 20% (n6) with no history while 4.44% (n4) had positive history and95.56% (n86) had no familial history of NTD in control cases. About previous history of NTDs,93.33% (n28) were found with positive previous history of NTDs and only 6.67% (n2)with noprevious history of NTDs in NTD group, while only 5.56% (n5) were found with positive previoushistory of NTDs and 94.44%(n85) with no previous history in controls. Conclusions: Poor socioeconomic status, family history and previous history of a baby with Neural tube defects are themajor risk factors.

Effectiveness of Utero-Vaginal Packing in Management of Postpartum Hemorrhage

<p>A major cause of maternal mortality and morbidity in developing world is postpartum hemorrhage (PPH). Different management options have been in use including use of oxytocins, prostaglandins, surgical exploration of genital tract, ligation or angiographic embolization of uterine/internal iliac arteries and hysterectomy. A simple and effective measure is to control bleeding with uterovaginal packing which is easy and quick to perform and saves the patient need of major surgical procedures.</p><p><strong>Objective:</strong><strong> </strong>To determine effectiveness of uterovaginal packing in control of postpartum hemorrhage, its safety and complications associated with it.</p><p><strong>Place and Duration of Study:</strong><strong> </strong>This study was carried out in Gynae unit 1 of Lady Willingdon Hospital Lahore from January 2014 – June 2015.</p><p><strong>Patients and Methods:</strong><strong> </strong>It was a prospective interventional study. The patients presenting with postpartum hemorrhage after vaginal or abdominal delivery who did not respond to medical management were included in the study. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding. Data was analyzed by SPSS version 11.</p><p><strong>Results:</strong><strong> </strong>99 patients who presented with PPH were included in study.49.5% were between age of 31 – 40 years, 38.4% were between 21– 30 years. 8.1% of patients were P1-2, 52.5% were P3-5 and 39.4% were P6 and above. 76.7% had hemorrhage after vaginal delivery and 23.3% after lower segment caesarean section. Uterineatony was the most common cause of postpartum hemorrhage, seen in 78.78% of cases, 9.09% had placenta previa, 8.08% presented with abruption placenta and 4.04% had coagulopathy. Regarding complications 7 women had to undergo hysterectomy, fever occurred in 14.14%, 8.08% had wound infection and 2 patients died of Disseminated Intravascular Coagulation (DIC). Procedure was successful in 90.9% of cases.</p><p><strong>Conclusion: </strong>Utero-vaginal packing effectively controls postpartum hemorrhage with fewer complications and its role in emergency obstetric scan not be denied.</p>

Treatment Outcome of Adherent Placenta: An Experience at Tertiary Care Hospital

<p><strong>Objective:</strong><strong> </strong>The objective of this study was to see treatment outcome of morbidly adherent Placenta.</p><p><strong>Methodology: </strong>This descriptive case series was carried out in Obstetrics and Gynae Unit-2 Lady Willingdon Hospital Lahore from January 2013 to December 2014. In this period 127 females between 20 to 45 years with any parity were enrolled in this study. All the patients were diagnosed for Placenta Accreta, Increta and Percreta by color flow Doppler. Operative delivery was carried out in all. Cesarean Hysterectomy with or without Placental separation, conservative measures (uterine artery ligation, tamponade and hemostatic sutures) and Internal iliac ligation were used. The outcome measures recorded were total blood loss, neonatal birth weight, mean gestational age at delivery, neonatal Apgar score, intra and postoperative complications and maternal mortality. Non-probability, sampling technique was used. The results were analyzed using SPSS version 20.</p><p> </p><p><strong>Results:</strong><strong> </strong>The mean age of subjects in this study was 26.77 ± 3.17 years. Gestational age at diagnosis and at surgery was 34.83 ± 1.94 weeks and 36.19 ± 1.557 weeks respectively. According to previous history of cesarean section, 60 (47.3%) had 1 previous C-section, 38 (29.9%) had 2 previous C-section and rest of 29 (22.9%) had ≥ 3 C-section. The diagnosis was made on Doppler Ultrasonography (USG) and the patients had surgery under emergency as well as elective conditions. We found that 96 (75.5%) females had Accreta, 27 (21.26%) had Increta and only 4 (3.15%) females had Percreta. Placental separation was done in 63 (49.6%) followed by Cesarean Hysterectomy were done in 36 (57%), and conservative measures like tamponade, haemostatic sutures in Placental bed and Uterine artery ligation in the rest i.e. 27 (43%). Non-separation of Placenta followed by direct Cesarean Hysterectomy was done in 64 (50.3%), and Internal iliac ligation was done in 30 (23%). During surgery the average blood loss was 2.97 ± 1.36 L. According to neonatal outcome Apgar score at 5 minutes was 5.69 ± 1.446 and weight of new baby was 2.85±0.30 kg. According to final outcome 83 (65.35%) females were successfully discharged, 29 (22.83%) had bladder rupture occurred in 29 (22.83%) while maternal mortality occurred in 15 (11.81%) only.</p><p><strong>Conclusion:</strong><strong> </strong>An increasing number of patients with morbidly adherent Placenta is coming up along with the rising incidence of C-Section. The key to the management of this condition is prompt diagnosis and referral to well-equipped hospitals having multidisciplinary input. Conservative measures with uterine sparing are worth trying in selected cases.</p>

Effect of episiotomy on perineal lacerations in spontaneous vertex deliveries

Objectives: To evaluate the effects of episiotomy on the frequency of perineal lacerations. Design: Cross-Sectional analytical study. Place & duration of study: Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. Patients & methods: 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 (48.63%) of these women. There were 1095(37.53%) primiparae and 1823 (62.47%) multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 (9.2%) perineal tears were sustained by these women during vaginal delivery . Episiotomy was associated with 151 (10.6%) perineal tears compared to 116(7.7%) without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Conclusion: Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications.

Causes of postmenopausal bleeding in our population

Objective: To evaluate common causes of postmenopausal bleeding in our population. Study design: Observational Analytical study. Settings: Department of Obstetrics & Gynaecology unit II Lady Willingdon Hospital Lahore from June 2000 to May 2002. Materials & methods: Hysteroscopically directed endometrial biopsies were taken from 100 cases of postmenopausal bleeding and were sent for histopathology. The data was collected with the help of Performa which was filled for every patient. Results: In our part of world, Atrophic Endometrium is the commonest cause of Postmenopausal Bleeding (PMB). Next common being Endometrial Hyperplasias. Out of malignant causes, Carcinoma Cervix is the commonest. Conclusion: Postmenopausal bleeding (PMB) should be taken seriously; no matter how less the bleeding is and malignant causes should be ruled out.

Assessment of tubal patency in infertile women: can HyCoSy be performed in place of Hysterosalpingography?

Objective: To determine the advantages and accuracy of hysterosalpingo-contrastsonography (HyCoSy) in the assessment of tubal patency with regards to conventional hysterosalpingography (HSG). Study design : Interventional study. Setting: The study was conducted at Lady Willingdon Hospital Lahore. Study Period: One year, from November 2003 to October 2004. Patients and methods: Thirty infertile women were examined with hysterosalpingo-contrastsonography (HyCoSy) using air and saline as contrast medium. The results were compared with those obtained from conventional hysterosalpingography.(HSG). Results: Altogether 30 patients were included in the study. They were examined with both HyCoSy and conventional hysterosalpingography (HSG) and the results were calculated. Of the patients investigated by salpingo -contrastsonography, 22 were found to have patent tubes whereas 8 were having blocked tubes. Unilaterality or bilaterality could not be detected by this method. Bilateral tubal patency was found by hysterosalpingography in 22 cases. Unilateral tubal patency was found in 5 cases. Bilateral tubal occlusion was detected in 3 cases using either technique .Sensitivity and specificity of HyCoSy was 90.9% and 89.4% respectively. Positive predictive value was 83.3% and negative predictive value was 55.55%. Conclusion: The outcome of the study shows that HyCoSy with the combination of air and saline is cost effective, reliable and safe method and can replace conventional hystero salpingography as base line investigation of infertility on out patient basis.

Vesico vaginal fistula: prevention is possible

A prospective study was conducted at Lady Willingdon hospital Lahore from Jan,2002 to Dec, 2004. During the mentioned period 22 patients were admitted with the diagnosis of urinary tract fistula. Among these most of the patients (i.e, 45%) were young belonging to age group 20-30 years. According to the causes 72 % were due to obstetrical causes, 23% due to surgical causes and 5 % were due to malignant. Regarding to the location of the fistula 14% were juxtauretheral,28% low vaginal, 35% mid vaginal,09% high vaginal and 14% were vault fistulae.Out of 22 patients first surgical repair failure occurred in four patients.

Primary post partum hemorrhage after vaginal birth: an analysis of risk factors

Objective: - To analyze the risk factors for primary post partum Haemorrhage. Settings: - Gynae/Obstetrics-Unit I Lady Willingdon Hospital Lahore. Study Design: - Observational Analytical study. Duration: - One year Ist January 2005 to 31 December 2005. Materials/Methods:-It was an observational analytical study in which the data about patients was collected with the help of proformas. Conclusion:- Uterine atony due to various underlying risk factors is the major cause of post partum Haemorrhage. If these factors are identified and treated accordingly then a lot of mothers can be saved.

Clomiphene citrate for ovulation induction in patients with polycystic ovarian syndrome

Objective: To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Design: Observational study. Place and duration of study: Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Intervention: Clomiphene citrate (50-150mg) was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Main outcome measures: Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Results: Forty-six patients (54.76%) ovulated in six cycles while twenty-seven (32.14%) remained anovulatory. Sixteen women (34.79%) conceived during the study period. Out of which ten women (62.5%) miscarried. Endometerial thickness did not differ (P>.50) between the conceived and non-conceived group but echogenic grade A pattern (75%) was observed during the conceived cycles (P<. 001). Conclusion: Clomiphene citrate (CC) is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome.

TUBAL STERILIZATION REVERSAL: IS THERE ANY ROLE IN THIS MODERN ERA OF ART?

AbstractObjectives:To determine the clinical pregnancy rate and to evaluate the factors affecting pregnancy rate following tubal recanalization.Study Design:Descriptive case series.Sampling Technique:Consecutive sampling.Setting / Duration of Study:The study was conduc-ted at Lady Willingdon Hospital Lahore, from January 2010 to March 2014.Methodology:Fifty nine women were included who underwent tubal re-anastomosis at Lady Willingdon Hospital Lahore.Inclusion Criteria:Patients undergone tubal ligation, no other female cause of infertility, normal semen ana-lysis.Surgical Procedure:Patients underwent tubal re-anastomosis through laparotomy. 4-quadrant suture technique was used.Data Analysis:Data was collected and entered into SPSS version 20. Descriptive statistics were computed and differences between groups were assessed through Chi square test where it was required. P-value < 0.05 was taken as statistically significant.Results:Out of 59 patients we could follow only 55 patients for clinical pregnancy as rest of 4 were lost for follow-up. Pregnancy rate, intrauterine ongoing pregnancy, miscarriage and ectopic pregnancy were the main outcome measures. Over all pregnancy rate was 34.5% (19/55), intrauterine pregnancy rate was 84.2% (16/19), term viable pregnancy was 68.8% (11/16). Spontaneous abortions were 31.3% (5/16) and ectopic pregnancy rate was 15.8% (3/19).Conclusions:The important prognostic factors for the success of tubal recanalization are age of the patient, sterilization/reversal interval, site of sterilization, method used for sterilization and length of the tube after reanastomosis. The technique is feasible, simple and less time consuming with good intrauterine pregnancy rate. Key Words:Tubal reanastomosis, Tubal recanalization, Pregnancy rate, Tubal sterilization.

Comparative Study of Metformin Versus Clomiphine Citrate for Ovulation Induction in Polycystic Ovary Syndrome at Lady Willingdon Hospital Lahore

Background: Metformin has given quite encouraging results in a number of patients improving overall ova-rian health and inducing pregnancies. Objective: The Purpose of this study was t o compare the effectiveness of combined treatment regimen Met-formin and Clomiphene citrate with Clomiphene cit-rate alone for ovulation induction. Methodology: This randomized controlled trial was conducted over a period of 2 years from Jan. 2008 to Jan 2010. This study includes prospective analysis of PCOS subjects, who were treated in Gynaecological unit II of Lady Willingdon Hospital Lahore. Two hun-dred subjects were recruited and then divided rando-mly into two groups, A and B. Group A, included one hundred patients (50%) who were treated with clomi-phine citrate only while Group B, included one hun-dred patients who were treated with Metformin and clomiphine citrate both. The collected data was ente-red into SPSS version 17 and were analysed accordin-gly applying descriptive statistics e.g. mean, frequency and analytical e.g. t-test and Chi Square. Results: Mean age at presentation of group-A was 26.52 ± 0.23 which when compared with that of gro-up – B 26.17 ± 0.25 did not differ statistically (P-Value = 0.306 – in significant). Similarly age at mena-rche of group A (CC) 12.82 ± 0.08 did not show statis-tical difference when compared with that of group – B (CC + met) 13.04 ± 0.11 (P-Value = 0.123 – insignifi-cant) or > 0.05. As for as duration of infertility was concerned it was 5.28 ± 0.27 yrs for group – A and 4.99 ± 0.20 years, for group – B. Overall, 125 (62.5%) women ovulated, out of which 46 (36.8%) were from Group – A while 79 (63.2) were from Group – B). Conclusion: Metformin may be a therapeutic option for PCOS based on improvement in laboratory and clinical parameters. Our results also establish guide-lines for metformin treatment with special implication on non-obese patients. It should be recommended for being effective as well as ecnomical. Key words: Polycystic ovary, Metformin and Clomi-phene citrate.