Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded. Results: During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04). Conclusion: PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome. (
Aim: To evaluate the factors behind primary and secondary infertility in females through diagnostic laparoscopy. Study design: Cross sectional study Place and duration: This study was conducted at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020 Methodology: The present study is a cross sectional study conducted at at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020. A total of 115 females were included in the study and they all underwent diagnostic laparoscopy after setting strict inclusion criteria. Data was recorded on proforma and analyzed on IBM SPSS version 22. Primary and secondary infertility frequency was calculated and analyzed. Result: A total of 115 infertile women were considered in the study and results were recorded after performing diagnostic laparoscopy on all of the participants. Total 74 (64.35%) had primary infertility and 41 (35.65%) reported secondary infertility. Total 19 (25.67%) participants of primary infertility and 5 (12.19%) participants with secondary infertility showed no abnormality. The most common abnormality found was tubal blockage in 17 (22.97%) women of primary infertility and 13 (31.70%) women of secondary infertility. Total 11 (14.86%) patients of primary infertility were diagnosed with polycystic ovaries (PCO). PCO was absent in patients with secondary infertility. Total 9 (12.16%) cases of primary infertility and 5 (12.19%) cases of secondary infertility were diagnosed with Endometriosis. Total 2 (2.7%) cases of primary infertility and 7 (17.07%) participants with secondary infertility presented with Pelvic Inflammatory disease (PID). A total of 6 (8.10%) cases having primary infertility were observed with periovarian adhesions and Peritubal adhesions, whereas, 9 (21.95%) cases of secondary infertility were seen with these issues. Conclusion: Tubal occlusion, periovarian adhesions, peritubular adhesions, and endometriosis were the most common factors behind infertility in both primary and secondary infertility. Ovarian cyst and polycystic ovarian disease were only present in patients with primary infertility. Keywords: Diagnostic Laparoscopy, Primary infertility tubal occlusion, Secondary infertility
Objective: To evaluate the effect of structured counselling on women's choice of obstetrical anaesthesia for elective caesarean section. Methods: This was a cross-sectional comparative survey conducted at department of gynaecology (unit II), Abbasi Shaheed Hospital, Karachi, from 1st January, 2017 to 30th June, 2017. The study included 250 pregnant women at term ( ³37 weeks) with a prior caesarean section, planned for elective caesarean having no contraindications to spinal or general anaesthesia. Excluded from the study were women with obstetric emergencies like antepartum haemorrhage, cord prolapse, eclampsia, disseminated intravascular coagula- tion, vertebral column deformities, foetal distress and obstructed labour. They were asked about the technique of anaesthesia they would prefer for their caesarean section. The women then received structured counselling and the choice was assessed again. Chi-square statistic was applied to assess the association between both choices taking p-value of £ 0.05 as statistically significant. Data were analysed using the SPSS software program, version 15.0 (IBM, Armonk, USA). Results: Out of 250 women recruited, before counselling 116 (46.4%) chose general anaesthesia, 94 (37.6%) women chose spinal anaesthesia whereas 40 (16%) had no particular preference. After receiving structured counselling 68 (27.2%) women chose general, 170 (68%) women opted for spinal and 12 (4.8%) women still remained undecided. The effect of structured counselling was assessed by cross-tabulating pre- counselling choice and post-counselling choice. The Chi-square test statistic was significant at p < 0.001 showing a significant association of structured counselling on the choice of anaesthesia. Conclusion: Women's choice is significantly altered by the counselling. Majority of women's beliefs are shaped by past experience and the information they receive. Significant improvement can be expected in near future if more consistent information is provided. Consistency can be ensured by use of patient informa- tion leaflets.
Objective: To assess the utility of Robson's ten group classification system (RTGCS) as an auditing tool for cae- sarean section rates. Methods: The present study was conducted by collecting data retrospectively from hospital records of Gynaecology and Obstetrics Unit 3, Abbasi Shaheed Hospital for the years 2013 and 2016. The rates of both years were com- pared in terms of RTGCS. After the initial audit in 2013, a three point strategy was implemented and the audit cycle repeated. Results: During the year 2013, 1986 women delivered in the hospital, 610 underwent caesarean section. The cae- sarean rate for the year was 30.7%. In the year 2016, 1560 women delivered at the unit, out of which, 412 births were by caesarean section. After the implementation of the three point strategy, which was formulated in the light of RTGCS, the caesarean rate was 26.4% in the year 2016. Conclusion: The adoption of RTGCS is the first step to analyse the obstetric practice in a standardised manner.
Aim: To determine the prevalence of anemia in rural pregnant patients and its relationship with education and birth spacing. Study Design: Cross sectional study Place and duration: This study was conducted at Abbasi Shaheed Hospital Karachi, Pakistan from August 2019 to August 2020 Methodology: Total 450 pregnant ladies visited the OBS/Gyne department at Abbasi Shaheed Hospital Karachi, Pakistan for a check-up, treatment, and follow-u were included. The percentage of hemoglobin was used to determine the diagnosis of anemia. The SPSS program version 21.0 was used to analyze the data. The Chi-Square test was used to look into the association between the variables. Result: Out of 450 subjects, we found that 291 pregnant ladies were anemic. We found that 64.66 % of the population suffers from anemia. 43.98 % (n=128) of the cases had mild, 30.92 % (n=90) had moderate, and 25.08 % (n=73) had severe anemia. Total 13.74% (n=40) females were under 20 years of age. Women aged 20 to 25 years old made up 52.92 % (n=154). It has been discovered that there is a link between age and the severity of anemia. (P0.001) (X2=25.68). The degree of anemia in pregnant women is linked to their educational level and the spacing of their births. (P<0.001) Conclusion: Anemia is common among pregnant women visiting Abbasi Shaheed Hospital Karachi, Pakistan. Low birth spacing and a lack of education are also linked to severity of anemia. Keywords: Anemia, Pregnancy, Birth Spacing, Pakistan
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