Objective: To find out the frequency of secondary postpartum haemorrhage (pph) as well as its causes and management in women presenting in a tertiary care hospital Methods: It was a descriptive case series study conducted from 1st January 2016 to 31st December 2016 at the Department of Gynaecology and Obstetrics, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. All the patients presenting with secondary postpartum haemorrhage in the specified time period were included in the study. The patient's age, parity, booking status, mode of delivery, place of delivery, cause of secondary postpartum haemorrhage and management done was noted on a predesigned proforma. Results: The average age of the women was 30.62 ± 4.37 years. Postpartum haemorrhage was ob- served in 130 patients, out of these 27 patients had secondary postpartum haemorrhage with a fre- quency of 20.67%. Majority of the women with secondary pph were multiparous 17 (62.96%) with 21 (77.77%) being delivered vaginally compared to 6 (22.22%) who had caesarean section. Most of the women 16 (59.25%) presented with secondary pph around 10-14 days post-delivery. Retained placen- tal pieces was identified as the commonest cause in 19 (70.37%) women, antibiotics was given to all the patients, evacuation done in 19 (70.37%) cases, 2 (7.40%) women had obstetrical hysterectomy and 1 (3.70%) woman had repair of uterus while 5 (18.51%) cases were managed conservatively. No maternal death was recorded. Conclusion: Secondary postpartum haemorrhage though less common but is found to be associated with significant maternal morbidity which require timely diagnosis and management so as to prevent life threatening complications.
Objective: To determine the frequency of gestational trophoblastic diseases and gestational tropho- blastic neoplasm, its risk factors and prognosis. Methods: This was a descriptive, cross-sectional study conducted at Civil Hospital, Karachi from March 2015 to September 2015. All cases of gestational trophoblastic disease after necessary inves- tigations like tumour marker b-hCG, ultrasound with classical picture of "bunch of grapes" or "snow storm" pattern and X-ray chest (for lung metastases) under went suction evacuation. In all cases specimen was sent for histopathology to confirm gestational trophoblastic disease. After primary treat- ment, cases were followed with b-hCG till complete remission was achieved. During follow-up, cases were labelled as gestational trophoblastic neoplasm on the basis of International Federation of Gyne- cology and Obstetrics (FIGO) criteria. After risk scoring on World Health Organization (WHO) criteria, chemotherapy was given. Results: Out of 497 pregnant ladies, 40 were cases of gestational trophoblastic disease (8.05%). Frequency/obstetric case was 1.7% and frequency/delivery was 2.1%. Out of 40 cases 13 (32.5%) were cases of gestational trophoblastic neoplasm. Out of 13 cases of gestational trophoblastic neo- plasm 9 (69.23%) were labelled as low-risk and 4 (30.76%) as high-risk cases. All cases achieved complete remission. One case of high-risk group expired. Conclusion: All women with gestational trophoblastic disease must be followed as per recommenda- tion with serum b human chorionic gonadotropin measurement until the levels are undetectable, for early diagnosis and optimum treatment of gestational trophoblastic neoplasm.
Objective: To view current clinicopathological pattern of gynecological malignancies at a tertiary care hospital in Karachi. Methods: This is a retrospective research performed in the department of obstetrics and gynecology unit 1 from January 2020 to December 2021. All cases of gynecological malignancies irrespective of age, race and cast were included for study. Around 164 cases with clinical or radiological diagnosis of malignancy were admitted for gynecological malignancy work up. Out of them 42 were confirmed on histopathology of biopsy or resected specimen. Patients with gestational trophoblastic disease and metastatic malignancies from another primary site were excluded. Data of these confirmed 42 cases fulfilling exclusion and inclusion criteria was included for study. Relevant data on pre-designed Performa was tabulated and histopathology according to WHO histological classification system. Results: Out of 164 cases of suspected gynecological malignancy 42 histopathological confirmed cases were selected for study. Frequency of gynecological malignancies out of 885 gynecological ad- mission is 4.7%. Ovarian cancers were commonest gynecological malignancy (54.7%), followed by cervical cancer (19.04%), uterine cancer (16.66%), and vulvar /vaginal cancers (9.5%). In ovarian can- cers epithelial cancers were (86.9%) and (13.04%) were non-epithelial. In epithelial (65%) serous, (15%) mucinous and (20%) were other less common types. In non-epithelial were dysgerminoma (66.66%) and (33.33) sex cord stromal cancers. In cervical (100%) were squamous cell carcinoma. In uterine (85.7%) were adenocarcinoma and (14.28%) were leiomyosarcoma. In vaginal cancers (50%) squamous cell carcinoma and (50%) was melanoma. In vulvar cancers all (100%) were squamous cell carcinoma. Conclusion: Ovarian cancer is commonest gynecological malignancy in our study. Common age group, parity, clinical presentation and histopathology is comparable with studies. Majority of cases came late in advanced stage of disease.
Introduction: The cesarean delivery (CD) rate has increased significantly over recent decades. It is estimated that almost a third of women have delivered by CD worldwide. In most countries, the caesarean section rate (CSR) has exceeded the level of 10–15% recommended by the World Health Organization (WHO). In different areas of Pakistan current CSR was 16–20%, approximately. Objective: To determine the frequency of successful vaginal birth after previous cesarean section (VBAC) and factors associated with failed VBAC and fetomaternal outcome after trial of labour after cesarean section (TOLAC) in pregnant women. Study Design: This descriptive cross sectional study was conducted in the department of Obstetrics & Gynaecology of Civil Hospital Karachi for the duration of six months from July, 2020 to January, 2021. Subjects and Method: The pregnant women who had a prior cesarean delivery and the intension to desire a TOLAC at the prenatal visit at 36 weeks were recruited according to inclusion and exclusion criteria. Trail of labor was assessed of all women and the outcome of successful VBAC after attempted TOLAC was noted and associated factors. Results: Total numbers of patients included in study were 142. Out of which 97 (68.3%) had successful vaginal delivery after previous C-section and 45 (31.6%) were failed VBAC. Regarding the Factors associated with Successful VBAC in pregnant women, 83 (85.5%) had normal BMI, 94 (96.9%) had Gestational age b/w 37th to 40 weeks, 93 (95.8%) were booked cases, 51 (52.5%) were working women, 87 (89.6%) had h/o of VBAC, 81 (83.5%) had Interval time from previous CS > 18 months and 96 (98.9%) had normal birth weight Conclusion: Majority of the cases of previous CS done can be delivered safely by the vaginal route, without any major 3 complication to the mother and the newborn, in an institution having facilities for emergency CSs. Keywords: Trial of labor, vaginal birth after cesarean section, induction of labor.
Introduction: The cesarean delivery (CD) rate has increased significantly over recent decades. It is estimated that almost a third of women have delivered by CD worldwide. In most countries, the caesarean section rate (CSR) has exceeded the level of 10–15% recommended by the World Health Organization (WHO). In different areas of Pakistan current CSR was 16–20%, approximately. Objective: To determine the frequency of successful vaginal birth after previous cesarean section (VBAC) and factors associated with failed VBAC and fetomaternal outcome after trial of labour after cesarean section (TOLAC) in pregnant women. Study Design: This descriptive cross sectional study was conducted in the department of Obstetrics & Gynaecology of Civil Hospital Karachi for the duration of six months from July, 2020 to January, 2021. Subjects and Method: The pregnant women who had a prior cesarean delivery and the intension to desire a TOLAC at the prenatal visit at 36 weeks were recruited according to inclusion and exclusion criteria. Trail of labor was assessed of all women and the outcome of successful VBAC after attempted TOLAC was noted and associated factors. Results: Total numbers of patients included in study were 142. Out of which 97 (68.3%) had successful vaginal delivery after previous C-section and 45 (31.6%) were failed VBAC. Regarding the Factors associated with Successful VBAC in pregnant women, 83 (85.5%) had normal BMI, 94 (96.9%) had Gestational age b/w 37th to 40 weeks, 93 (95.8%) were booked cases, 51 (52.5%) were working women, 87 (89.6%) had h/o of VBAC, 81 (83.5%) had Interval time from previous CS > 18 months and 96 (98.9%) had normal birth weight Conclusion: Majority of the cases of previous CS done can be delivered safely by the vaginal route, without any major 3 complication to the mother and the newborn, in an institution having facilities for emergency CSs. Keywords: Trial of labor, vaginal birth after cesarean section, induction of labor.
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