Caesarean sections carry the risk of urinary bladder injury due to formation of adhesions obscuring pelvic planes. Visualizing bladder during retro-fill (cystoinflation) makes it recognizable as it rises into the abdomen taking a tense rounded contour. We conducted a prospective randomized controlled trial to find out whether improved identification of bladder margins by cystoinflation could decrease bladder injury rate and blood loss without causing urological complications. This study included 214 healthy women with previous operative deliveries undergoing elective caesarean section and found to have dense pelvic adhesions. The subjects were randomly allocated into cystoinflation and control groups. Adhesiolysis was performed using bladder retro-fill with 300 cc saline in cystoinflation group, and without retro-fill in control. The bladder injury rate was significantly lower in cystoinflation group compared to control (2.8% vs 20.6%, P < .0001) with lesser blood loss in cystoinflation group (585.33 cc vs 797.10 cc, P < .0001). Mean operative time was similar in both groups. Urinary tract infection and micturition problems occurred more frequently in control group than cystoinflation group (16.8% vs 1.9%, P = .001 and .47 ± 1.63% vs 077 ± .633%, P = .021 respectively) with fistula in one subject compared to none in cystoinflation group. In this study, cystoinflation was effective to significantly reduce bladder injury rate and blood loss. This technique may also prove useful in the fields of surgery, urology and urogynecology.
<p>Unexplained infertility is a major gynecological problem with complex etiolgy. Partial tubal blockage with inflammatory reaction and thick mucus plugs in fallopian tubes and cervix is one of the likely causes in such cases. This study is based on the hypothesis that women having unexplained infertility could be helped by transcervical flushing of fluid through the fallopian tubes which would remove reversible blocking factors and help in achieving pregnancy.</p><p><strong>Objective:</strong><strong>Â Â </strong>To compare the outcome of hydrotubation<br /> in unexplained infertility in clomiphene citrate stimulated cycles with control group (no Hydrotubation).</p><p><strong>Setting:</strong><strong>Â Â </strong>Infertility Centre of a Public Sector Hospital.</p><p><strong>Study Design:</strong><strong>Â Â </strong>A two years Prospective randomized controlled trial from Jan 2014 to Dec 2015.</p><p><strong>Method:</strong><strong>Â Â </strong>128 women participated in the study. Participants were divided into study and control group with 64 members in each group. Ovulation induction was done with clomiphene citrate in all the participants and confirmed by ovulation detection strips and follicular tracking on Ultrasonography. 50 cc cocktail of inject-ion (inj.) kanamycin 1 gm, inj. hydrocortisone and normal saline was injected transcervically in study group for three consecutive days from the next day after end of menstruation. No hydrotubation was done in control group. Main outcome measures were number of conceptions within next 3 cycles and complications of hydrotubation.</p><p><strong>Results:</strong><strong>Â Â </strong>In hydrotubation group, 20 women conceived. Out of these, 14 women conceived in the same cycle in which hydrotubation was done while 6 pregnancies occurred in subsequent cycle. 4 pregnancies occurred in the control group. Complications of hydrotubation were mild abdominal pain (59 women), vomiting (49 women) and Per vaginum bleeding (18 women). There were significantly more pregnancies in women who experienced right shoulder tip pain after the procedure.</p><p><strong>Conclusion:</strong><strong>Â Â </strong>In women with unexplained infertility, tubal hydration can increase conception rate and decrease the time to achieve pregnancy.</p><p>Â </p>
Pakistan Medical Commission (PMC) database indicates that there are 184 medical and dental undergraduate institutes registered to provide medical and dental education in the country. Of these, sixty-six colleges are in public sector and 118 colleges are operated by private sector.1 Abundance of private insti- tutes implies that medical education has now trans- formed into a lucrative industry. A political turmoil in regulating medical education by peak medical regula- ting body, Pakistan Medical Commission, which now possibly be renamed back as “Pakistan medical and Dental Council” has already created a chaos in the minds of medical educationists to how our young medical professional be trained and how these ‘products of medical factories’ will save lives, minimize disease burden and how do they practice ethically and professionally.
Objective: To compare the outcome of early blood transfusion i.e. within 6hrs. (hours) of admission VS late blood transfusion (after 6 hrs.) in puerperal septic shock patients with anemia. Study design: A prospective quasiexperimental controlled trial in ICU(intensive care unit) of lady Willingdon hospital, a tertiary care hospital of Obstetrics and gynecology from Aug2013 to July 2016. Population: Patients admitted with septic shock and anemia during puerperium in ICU . Methods: 74 patients were included in the study by purposive sampling technique. Exclusion criteria were an irreversible shock, chronic lung, and heart disease or those requiring surgical intervention. Surviving sepsis campaign guidelines were followed for the management of these patients. Effect of blood transfusion on the recovery of these subjects was studied. The study group consisted of 43 patients in which blood was transfused within 6hrs. of admission. Control group had 31 patients in whom blood could not be transfused within this period. The demographic features and outcome of both groups were recorded and entered on spss20 statistical package. Results: The time of recovery from hypotension, tachycardia, pulmonary edema, ventilator and cardiac support was significantly shorter in the study group compared to the control. A lesser number of blood transfusions was required to treat anemia in the study group. Maternal mortality was less in the study group (23.25%) as compared to control group (48.39%) with an odds ratio of decrease in maternal mortality of 0.323(.119-.877). Conclusion: Early blood transfusion shortens the time of recovery and decreases maternal mortality and morbidity in puerperal septic shock patients with anemia.
Coronavirus disease-2019, or Covid-19, was first reported in Wuhan, China, at the end of December 2019 as viral pneumonia. The causative agent, the Novel Coronavirus severe acute respiratory syndrome (SARS) CoV-2, spread rapidly across the world to cause a considerable death toll. On March 11, 2020, the World Health Organisation declared Covid-19 a pandemic. For a little over a year, the coronavirus has been around. Pregnancy is an immunodeficient state predisposing women to an increased risk of respiratory viral infections. The risk is even higher in pregnant women who already have underlying health problems due to growing age, such as diabetes, hypertension, cardiac or respiratory diseases. The exact treatment of Covid-19 is still unknown. This narrative review was planned to summarise the current information on pathophysiology, diagnosis and effects of Covid-19 in pregnancy for better treatment plans. Key Words: Coronavirus, Pneumonia, Pandemic, Pregnant women. Continuous...
BackgroundUrinary Incontinence (involuntary loss of urine) is a highly prevalent problem among women with profound effects on their quality of life. Patients tend to conceal their problems and avoid seeking medical help, which results in their prolonged illness and psychological depression. Only a few researchers have focused on finding out the characteristics of incontinent women with prolonged treatment denial. These women's shared features can serve as predictors of treatment delay; screening the incontinent patients for these predictors can point out the susceptible women with delayed help-seeking behaviour who need in-depth counselling and support for their treatment. This cross-sectional study was designed to investigate the predictors of treatment delays of urinary Incontinence among Pakistani women.Methods We performed this survey at Lady Willingdon Hospital outdoor from july1to Dec 31, 2019. We randomly selected one-hundred and six women with urinary incontinence from the gynaecology outdoor to fill the study Performa(sample size calculated with Raosoft, sample size calculator, Inc 2004). The Performa included risk factors of incontinence: demographic features, psychosocial effects of incontinence, the logic behind treatment delay, and the Incontinence Questionnaire UI-short form for incontinence characteristics. We evaluated predictors by analyzing shared risk factors of treatment delay by regression analysis (IBM SPSS statistics 20; SPSS Inc., Chicago, IL, USA). ResultsThe mean age of participants was 56.11±11.24years (30-77years). Treatment delay ranged from 1-30years; about half of the participants (48.1%) reported >3-year delay. The shared risk factors of treatment-delay were elderly age (OR=1.163; CI:1.075-1.259), embarrassment (OR = 8.15;CI:2.117-31.382), lower subjective severity of symptoms (OR=.316;CI:133-.978) and stress incontinence (OR=8.09;CI:1.87-35).ConclusionIn this cross-sectional survey of urinary incontinent women, elderly age, embarrassment, lower subjective severity of symptoms, and stress incontinence were predictors of treatment-delay among Pakistani women. Trial registrationThis study had ethical approval from King Edward Medical University and registered retrospectively at Clinical trials.gov with reg #NCT04470700 on 13-07-2020.
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