Background: Cesarean section (CS) has become a frequent practice in the recent years while this increase has been seen in developing as well as developed countries. The aim of current study was to determine the frequency of lower segment cesarean section (LSCS) along with indications of LSCS in multiparous women with previous normal deliveries. Methods: This was a cross sectional study, done at the Department of Gynaecology & Obstetrics, Nishtar Hospital, Multan, from 20th July 2018 to 20th January 2019. A total of 222 pregnant women with live singleton pregnancy at term with gestational age between 37 to 41weeks and multipara with no previous LSCS were included in the study. The decision to undertake LSCS if indicated was made in every case after complete assessment. Data was collected for frequency of LSCS and its indications in shape of fetal distress, antepartum hemorrhage and malpresentation. Results: Mean age was 32.720±1.96 years, mean height 1.551±0.11 meters and mean BMI was 27.855±3.14 Kg/m2. Most women were 31-35 years (90.5%) of age and 2-4 parity (89.2%). Primary caesearen section was seen in 43 patients (19.4%). Indications for primary caesarean section were malpresentation 27.9%, fetal distress 41.9% and antepartum hemorrhage 30.2%. Conclusion: The frequency of LSCS in multiparous women with previous normal deliveries was noted to be 19.4%. Fetal distress turned out to be commonest indication for primary caesarean followed by antepartum hemorrhage and malpresentation.
Objectives: To determine the failure of DHS (dynamic hip screw) in terms of lag screw cutout. Study Design: Hospital Based Cross Sectional study. Setting: BVH and Civil Hospital Bahawalpur. Period: From 2013 to 2018. Material & Methods: 273 patients of both genders with age more than 50 years having stable intertrochanteric fractures were included in this study. With the help of C arm, the best possible anatomical reduction and rigid internal fixation was done with 135 degree DHS. Lag screw position and TAD determined on first postoperative day on radiographs (Anteroposterior & Lateral). Failure of fixation was determined on the radiographs during follow up. Lag screw cut-out was the projection of the screw from the femoral head by more than 1mm. Results: The mean age of the patients was 68.6 years (50-88). There were 132 (51.1 %) males and 126 (48.8%) females. Overall lag screw cutout rate was 11.2%. 21(30.8%) had screw cutout while 47 (69.1%) healed successfully among 68 patients with TAD ≥ 25mm. On the other hand 8(4.2%) had screw cutout while 182 (95.7%) healed successfully among 190 patients with TAD < 25mm. Middle middle and inferior middle position had highest success rate (˃ 92%) while inferior posterior position had highest cutout rate (36.2%). Among different age categories high failure rate (17.8%) seen in patients more than 70 years. Conclusion: The incidence of lag screw cutout is 11.2 % and risk of cutout can be minimized by placing lag screw in middle middle or inferior middle position and keeping the TAD < 25mm. More attention during follow up should be paid to patients with age ˃ 70 years.
Objectives: To compare the outcome in terms of carrying angle with medial versus lateral approach in the treatment of these fractures among children. Study Design: Randomized Clinical trial. Setting: Department of Orthopaedic Surgery Civil Hospital Bahawalpur and Nishtar Hospital Multan. Period: From June 2018 to September 2019. Material & Methods: A total of 154 children of both genders, aged 2-14 years having supracondylar humeral fracture of type II and III, with duration of fracture within 7 days, were enrolled. Patients were divided in two groups (77 in each group), group A and group B. Group A was managed by open reduction internal fixation (ORIF) with cross K-wire through medial approach and group B underwent lateral approach. Results: Out of 154 cases, 102 (66.2%) were boys and 52 (33.8%) were girls. Overall, mean age was noted to be 7.98 ± 2.23 years. Obesity was present in 16 (10.4%) cases. Mean duration of fracture was noted to be 4.21 ± 1.34 days while 106 (68.8%) had duration less than 5 days. There were 119 (77.3%) cases with history of fall and 35 (22.7%) had history of road traffic accidents (RTA). Sixty one (39.6 %) cases were classified as Gartland type II fractures while remaining 93 (60.4 %) were type III fractures. Excellent outcome with carrying angle 0–5o in group A was noted to be 67 (87 %) while that of group B was 54 (70.1%) (p = 0.011). Conclusion: Medial approach for the treatment of pediatric SHF was noted to be superior in terms of postoperative carrying angle having satisfactory outcome in comparison with the lateral approach.
Objective: To determine the frequency of perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) in pregnant diabetic women with low and high plasma glucose levels between 36-40 weeks. Study Design: Cross-sectional study. Setting: Department of Obstetrics & Gynaecology, DHQ Hospital, Lodhran. Period: 2017 to 2019. Material & Methods: Total 285 diabetic women of age 25-40 years with singleton pregnancy of gestational age 36-40 weeks were selected. Patients with multiple pregnancies, GDM, renal disease and hypertension were excluded. Plasma glucose levels (fasting & 2 hour post-prandial) measured and mean values (fasting + postprandial/2) calculated. The mean values falling between 100-139 mg/dl were taken as low plasma glucose level where as ≥140 mg/dl noted as high plasma glucose level. The perinatal outcomes (macrosomia, large for gestational age, birth asphyxia) were assessed at the time of delivery. Results: Mean age was 29.44 ± 6.01 years. Mean plasma glucose levels were 109.77 ± 6.81 mg/dl. Perinatal outcome i.e. macrosomia, large for gestational age infants and birth asphyxia was found in 7.72%, 27.37% and 22.81% respectively. In this study that pregnant women with mean plasma glucose of 100-139 mg/dl showed frequency of macrosomia by 3.59%, large for gestational age 16.17% and birth asphyxia 14.35% while women with mean plasma glucose of ≥140 mg/dl showed frequency of macrosomia by 13.56%, large for gestational Age 43.22% and birth asphyxia 34.75%. Conclusion: Pregnant diabetic women with high plasma glucose levels have significantly high percentage of large for gestational age, birth asphyxia and macrosomia as compared to diabetic mothers with low plasma blood glucose levels. Consider diabetic mothers at risk and implement efficacious treatment in order to reduce the perinatal complications.
Background: Percutaneous pining among children with displaced supracondylar fracture of the humerus, may offer additional benefits to patients in terms of outcome. Objective: To determine the union of fracture and range of motion at elbow, in supracondylar fracture, among children, with closed reduction and percutaneous pinning. th th Methodology: A cross-sectional study was conducted, from 19 December 2016 to 19 May 2018, at Ortho Unit 2, Nishtar Hospital, Multan, patients of both sex, having supracondylar fracture (Gartland type II and III) diagnosed st radiographically, and presenting within 1 week of injury, were included, and patients with a history of previous surgery or trauma over the arm, compound fracture and neurovascular compromise, were excluded. All patients were operated for the fracture (closed reduction and pinning under image intensifier). The patients were discharged the next day after the procedure. The follow up completed at 6 weeks postoperatively by Flynn's criteria. Results: Out of 254, 202 (79.5%) patients were fulfilling the satisfactory level of outcome, 52 (20.5%) patient showed an unsatisfactory level of outcome according to operational definition In this study, 96 (37.8%) males and 106 (41.2%) females patients shows satisfactory outcome whereas 23 (9.1%) males and 29 (11.4%) females patients showed unsatisfactory level of outcome (p= 0.04). Out of 254 patients 59 (23.2%) showed excellent, 94 (37%) good, 49 (19.3%) fair and 52 (20.4%) poor outcome based on Flynn's criteria. Conclusion: From our study, the percutaneous pinning of displaced supracondylar fracture of humerus among children under image intensifier is the effective method of treatment in our study setting.
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