We report 2 cases of complete uterine prolapse and bilateral severe hydronephrosis. Although vaginal hysterectomy corrected the obstruction the development of post-obstruction atrophy was associated with hypertension and moderate renal failure. Early diagnosis and correction are required to prevent these sequelae.
Introduction: Peripheral infarcts on maternal side are relatively common and are not thought to be clinically significant. However those that occupy more than 5% of the placental mass or are more than 3cm in diameter in size are associated with perinatal mortality and morbidity. Objectives: To determine the frequency of placental infracts and its different severity grades among women with severe placental abruption. Study Design: Cross sectional descriptive study. Setting: Department of Obstetrics & Gynaecology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. Period: January 2016 to July 2016. Material and Methods: Patients admitted in hypovolemic shock or intrauterine fetal death was considered as severe abruption. Placenta of the subject was collected from labour room of the wards and was fixed in 10% formalin. Gross examination of placenta performed and then the section of placenta was stained with hematoxylin & eosin stain. The consultant pathologist reviewed the slides. All the data was recorded on predesigned Performa and analyzed through SPSS version 11.0. Results: Among 124 cases, majority of women (41.93%) were in the age group 30-40 years and presented at gestation age more than 37 weeks. 21.77% of patients were having placental infarcts of less than 3 cm and 18.54% of cases were having placental infarcts of more than 3 cm. 79.03% of babies born alive, 41.12% were preterm and stillbirth was a finding in 20.96% of cases. Overall frequency of placenta infarcts in patients was 40.32%. Conclusion: Placental infarcts were seen in about 40.32% placentae of women with placental abruption. Association between placental infarcts and preterm babies and stillbirths was also significant.
Objective: The purpose of this study is to assess the effectiveness of manual vacuum aspiration vs standard evacuation and curettage in the case of early pregnancy loss: HMC hospital, Peshawar, gynecologic and obstetrics department Study Design: A Single-center study Duration and place of study: From January 1st, 2017, to January 30th, 2020, the study was carried out in the gynecological and obstetrics unit B of the HMC hospital, Peshawar. Patient Methodology: One thousand and sixty-three (603) patients were studied. According to the inclusion criteria, all patients who experienced an early miscarriage (18-42 years old) were recruited for the research. The lottery approach was used to split the patients into two groups. Those in Group A who had been treated by MVA Group B were individuals who had traditional surgical evacuation and curettage. Age and BMI were obtained after obtaining written consent from the patient. The patient's entire blood picture, blood group, hepatitis serology, and coagulation profile were analyzed as part of a baseline assessment. Ultrasound and the starting day of the last menstrual cycle were used to determine gestational age. Two hours before the surgery, misoprostol 400mcg was used to ripen the cervical lining. Aseptic procedures were followed during the process. Ultrasound was used to verify that both methods had successfully evacuated the uterus. Results Group A had a mean age of 27 years, while Group B had a mean age of 29 years, both with a standard deviation of 7.55 years in Group A. Approximately 40% of the patients in Group A were mono para, and 60% of the patients in Group B were multipara. Forty-two percent of patients in Group B were first-time paras, whereas 58 percent of patients in Group B were second-time paras. In Group A, 40% of the patients were first-time mothers, whereas 60% were multiple mothers. There were 42 percent primi gravida and 58 percent multi gravida in Group B. Aspiration using manual vacuum and conventional evacuation and curettage were equally successful for 92% and 82% percent of patients, respectively. Keywords: Early Pregnancy Loss, M .V. A, Conventional Evacuation And Curettage
To determine diagnostic accuracy of spot urine protein to creatinine ratio (PCR) for estimation of significant proteinuria in patients of preeclampsia based on 24-hour urine protein. METHODS: This cross-sectional validation study was conducted at Gynae B unit, Lady Reading Hospital, Peshawar from July 2014 to December 2014. Out of 253 patients, 222 women were finally enrolled as per inclusion and exclusion criteria by using non-probability convenient sampling technique. After taking proper history and calculating period of gestation, blood pressure was measured using standard sphygmomanometer while urinary protein by urine dipsticks. Following standard protocol, urine was collected for 24 hours followed by spot midstream urine. Samples were analyzed for urine protein and creatinine. 24 hours urinary protein level ≥300 mg/day and spot urine PCR was ≥3 mg/mmol was considered significant proteinuria. SPSS v 16.0 was used a statistical instrument. RESULTS: Out of 222 patients with preeclampsia, 24-hours urinary protein level estimation was ≥300 mg/day in 179 (80.6%) cases and <300 mg/day in 43 (19.4%) cases. Spot urine PCR was ≥3 mg/mmol in 175 (78.8%) cases and <3 mg/mmol in 47 (21.2%) cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of spot urine PCR against 24-hours urinary protein level estimation was 95.5%, 90.6%, 97.7% 82.9% and 94.5% respectively. CONCLUSION: In our study, spot urinary protein/ creatinine ratio shows a high sensitivity, specificity, PPV, and NPV (at a cut off value >0.3 mg/mmol). This test can be regarded as a reliable investigation among pre-eclamptic patients.
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