Objective: To compare the effectiveness of two types of haemostatic sutures to secure bleeding in thinned out caesarean section scars. Study Design: Comparative Interventional Study. Setting: CMH Okara, Pakistan. Period: September 2019 to September 2021. Material & Methods: Patients were divided in four categories. Category I was previous one scar patients while category II was previous two scars patients. Similarly, categories III and IV were previous three and four scar patients respectively. In each category hemostasis was secured either by purse string suture or transverse mattress sutures. Hemostasis whether achieved with difficultly or without difficulty was assessed and time utilized was also calculated. Results: In patients with previous one caesarean section 3 out of 15 (20%) had haemostatic difficulty with both purse string suture and horizontal mattress suture. In patients with previous two caesarean sections the number was 5 (33.33%) and 6 (40%) in both purse string and horizontal mattress suture respectively. In patients with previous three caesarean sections there were 7 (46.66%) women who had difficulty in haemostasis in both group I and II. The average time to achieve the procedure in group I (purse string suture) was 3.25 minutes while it was 7.5 minutes in group II (Horizontal mattress sutures). There was two times difference in time consumption between two groups. Conclusion: Purse string suture is more effective, convenient and quicker to apply as compared to transverse mattress sutures for haemostasis in thinned caesarean section scars.
Objective: To determine the symptoms, demographic parameters and health profile of post-menopausal women and factors related to the deranged health profile. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Gynecology and Obstetrics, Pak Emirates Military Hospital Rawalpindi Pakistan, from Jun 2019 to Aug 2021. Methodology: Five hundred post-menopausal women were included in this study via convenience sampling. Menopause was confirmed based on clinical and laboratory information. A consultant Gynecologist inquired about details of clinical symptoms and demographic profile. Relationship of age, body mass index, use of hormonal replacement therapy and living with husband was assessed with the presence of deranged health profile among the post-menopausal women participating in this study. Results: Out of 500 post-menopausal women studied in the given period, 323 (64.6%) had at least one clinical symptom of a deranged health profile, while 177 (35.4%) did not report any such symptom. The mean age of the study participants was 58.47 ± 4.561 years. Hot flushes 200 (40%) were the most commonly reported symptoms, followed by urinary tract infections 121 (24.2%) and palpitations 121 (24.2%). After applying the statistical analysis, high body mass index and not using hormonal replacement therapy emerged as factors associated with deranged health profiles in the study participants (p-value <0.001). Conclusion: Most of the women had at least one clinical symptom after menopause. Hot flushes, urinary tract infections and palpitations were commonly reported symptoms. Patients with high body mass index and no hormonal replacement therapy were more likely to have a........
Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta.Study Design: Quasi-experimental study.Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020.Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required. Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases. Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity.
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