Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: From12-May-2017 to 11-May-2018. Material & Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m2. Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications.
Objective: To determine the association of meconium stained amniotic fluid with puerperal pyrexia. Study Design: Cohort Study. Setting: Department of Obstetrics & Gynecology, Nishtar Hospital, Multan. Period: 1st January 2018 to 31st December 2018. Material & Methods: A total of 66 women with singleton pregnancy, gestational age 37-40 weeks of any parity undergoing elective caesarean section were eligible for study. Patients with rupture of membranes (≥18 hours), preterm delivery and postdate pregnancy were excluded. During elective caesarean section, after rupture of membranes, women were divided in two equal groups. Thirty three patients with meconium stained liquor group (MSAF) and 33 patients with clear liquor group. Puerperal pyrexia was defined as temperature of ³ 38°C on any two occasions was reported during first ten days postpartum excluding first 24 hours. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p £ 0.05 as significant. Results: Age range in this study was from 15 to 45 years with mean age 15 to 45 years with mean of 29.5± 2.5 years in MSAF group while 28.5 ± 3.5 years in clear liqour group. Mean gestational age was 39.1±1.0 weeks in MSAF group while 38.5±1.10 weeks. Puerperal pyrexia was seen in 45.5% patients in MSAF group as compare to 10% in clear liqour group (p=0.005). Conclusion: There is strong correlation between meconium stained amniotic fluid and postpartum febrile illness.
Objective: Determine the duration and post-operative complications of surgery in patients who underwent rectus sheath sling for correction of vault prolapse. We started doing this novel technique and found it very safe with least side effects so wanted to study it. Study Design: Experimental study. Setting: Nishtar Hospital Multan Pakistan. Period: July 2016 to June 2018. Material & Methods: Patients were applied autologous sling of rectus sheath at Nishtar Hospital Multan and were followed for 2 years. Patients with diabetes mellitus and any other chronic disease were excluded. Patients who had previous surgery for vault prolapse were also excluded from the study. Data were recorded and analyzed using IBM-SPSS version 23.0, percentages are given for previous surgery duration (how long before the previous surgery was done), duration of current surgery, post-operative fever, post -operative urinary tract infection(UTI), duration of stay in the hospital after surgery, parenteral analgesia requirement. Parameters were tested using Pearson Chi Square test with type of previous surgery. Results: The total number of patients in the study were 19.The mean age of the patients was 59.7 years (SD = ±9.7) and mean weight was 59.4kg (SD = ±12.5). The duration of surgery was less than 1 hour in 84 % of patients. Same percentage had less than 36 hours requirement of post- operative parenteral analgesia and thus less than 2 days of post-operative stay in hospital. Postoperatively 31.6 % had fever, 26.3% had Urinary tract infection. On 2 years follow-up of this surgery, no patient had any recurrence of vault prolapse and 85.7% showed no coital difficulty. Conclusion: This surgical procedure is a simple, time saving method with less complications and is best suited for low resource countries like Pakistan.
Objective: To detect the resistant pattern of uropathogens and find the association of different factors with the resistance in the Poonch District of Azad Kashmir. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Shaikh Khalifa Bin Zayed Hospital, Rawalakot, from Mar to Aug 2019. Methodology: Patients having signs and symptoms of urinary tract infection and growth of bacteria on urine culture were included in the study. The antimicrobial susceptibility of the isolates was determined by using the standard, modified Kirby Buer disc diffusion method. Zone sizes were interpreted following Clinical Laboratory Standards Institute (CLSI) 2019 guidelines. Results: 68 culture-positive patients were included in the study, 45 (66%) patients were female. There was a previous history of urinary tract infection in 44 (64.7%) patients, and 52 (76.5%) gave a history of antibiotic use in the last three months. E. coli was the commonest organism isolated, followed by Klebsiella, Proteus and Pseudomonas. All patients were resistant to at least one antibiotic, 48 (72%) isolates were multi-drug resistant. Uropathogens showed the highest resistance to Ampicillin in 67 (98.5%) patients and the lowest resistance to Piperacillin/Tazobactam 2 (3%) patients only. Resistance was significantly higher in patients having a history of recurrent urinary tract infection (p=0.028) and the use of antibiotics in the last three months (p<0.001). Conclusion: Resistance to antimicrobial agents is increasing in community-acquired urinary tract infections. Resistance is significantly higher in patients having a history of recurrent urinary tract infection and the use of antibiotics in the..........
Objective: To determine the frequency of anemia and its causative risk factors in patients attending the gynecology outpatient department of Nishtar Medical University and Hospital. Study Design: Cross sectional study. Setting: Gynecology Outpatient Department attendees of Nishtar Medical University and Hospital. Period: 1st September to 31st December 2019. Material & Methods: Total 361 females between 19-49 years of age were enrolled and included those patients who consented to be tested for blood hemoglobin estimation. Their brief history was taken after proper consent according to predesigned proforma to rule out the risk factors. Patients with chronic kidney disease, chronic lung diseases and liver diseases were excluded. Blood test was done by obtaining the blood sample by finger prick method. Hemoglobin analysis was performed by portable Hemocueanalyser. Frequency of anemia, severity of anemia and their stratification was performed against the risk factors like age, educational status, socioeconomic status, status of pregnancy, parity and contraception were obtained to rule the causative factors. Anemia was defined per standard criteria as hemoglobin less than 11gm/dl. Results: Majority of patients 65% were between 19-35 years of age and 34% were 36-49years of age. Frequency of pregnant patients and non-pregnant patients was 63.4% and 36.6%. Frequency of anemia was 56.8%, mean hemoglobin 10.48±1.18 with mild, moderate and severe anemia were 36.8%, 17.2% and 2.8%. Majority of females 82.9%, never went to school and had primary education, 71.70% belong to very poor and poor socioeconomic status, 79.02% were multipara and 81.95% never and infrequently practiced the contraceptive methods. Conclusion: Frequency of anemia is very high in females presenting to tertiary care hospital being more common in younger age group. Frequent pregnancies, poor socioeconomic status and low level of educational attainment were the major determinants of anemia in females.
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