Emerging Trends in Peripartum Hysterectomy; A High Alert in Obstetrics

Introduction: The high incidence of lower segment caesarean section (LSCS) leading to morbidly adherent placenta and making it a leading cause of peripartum hysterectomy.Objective: Peripartum hysterectomy is one of the major obstetrical procedures that need to be performed electively/emergency in patients having morbidly adherent placenta (MAP) for the sake of the patient’s life. Need to conduct this study arises because we want to highlight the increasing rate of peripartum hysterectomy secondary to MAP, the emerging trend of increased LSCS in our socio-demographic strata, and its effects on maternal morbidity and mortality.Materials and Methods: This was a retrospective study which was carried out in the Department of Obstetrics and Gynaecology Unit II, Holy Family Hospital, Rawalpindi. All patients who underwent peripartum hysterectomy were included in the study. Data was collected from record files and labor room registers in accordance with ethical guidelines.Results: Out of 11,440 deliveries in one year, 60 patients underwent peripartum hysterectomy with an incidence of 5.2 per 1000 deliveries. The majority of patients (87%) fell in the age group of 25-33 years. 4(6.6%) patients undergone peripartum hysterectomy for postpartum hemorrhage (PPH) due to uterine atony, 3(5%) due to the ruptured uterus, and 53(88%) due to MAP. All patients who had undergone a peripartum hysterectomy due to MAP were previously scarred for LSCS (100%). 5% with previous 1 LSCS, 31% with previous 2 LSCS, 44% with previous 3 LSCS and 18% with previous 4 LSCS.Conclusion: The high incidence of peripartum hysterectomies in young patients secondary to MAP highlights the need for critical review and audit of indications of primary LSCS and repeat LSCS. It also highlights the need for expertise at the time of surgery to decrease the rate of maternal morbidity and mortality

Association between Irregular Labour Pains and Meconium in Low Risk Pregnancies

Background Meconium stained amniotic fluid (MSAF) is a frequent occurrence seen by health care providers in obstetric and neonatal practice. MSAF is a predictor of adverse perinatal outcome even in low risk pregnancies, so MSAF can be taken as independent marker of fetal distress. MSAF was associated with higher rate of caesarean delivery, meconium aspiration syndrome, hospital admission and perinatal mortality. Objective The objective of this study is to determine the frequency of MSAF in low risk pregnancies presenting with irregular labour pains between 37 to 40 weeks of gestation. Material and Methods This was a Descriptive case series conducted in Gynae / Obs Unit II, Holy Family Hospital, Rawalpindi from December 2020 to May 2021. All patients registered in the labour room of Obs/Gynae Unit-II between 37 to 40 weeks were evaluated for the occurrence of irregular labour pains, with the help of history and clinical examination. Presence of meconium stained amniotic fluid in low risk pregnancies presenting with irregular labour pains was noted. A cutoff value of 12 hours for irregular labour pains was taken and after that elective amniotomy was done to see the colour of liquor and delivery was planned accordingly. Informed written consent was taken from all patients before enrollment in study. All relevant information was recorded on specified proforma. Results Out of 120 low risk pregnant women those presenting with irregular labour pains, meconium was found positive in 77 (64.2%) pregnant women. Out of which majority 45 (37.5%) was 26-30 years old. The mean age of the pregnant women was 28.05 years those fall in the category of low risk pregnancies with irregular labour pains and the standard deviation was 4.354. Among 36 (30.0%) pregnant women who were 19-25 years old, meconium was found positive in 21 (17.5%) pregnant women. Among 45 (37.5%) pregnant women who were 26-30 years old, meconium was found positive in 32 (26.7%) pregnant women. Likewise among 39 (32.5%) pregnant women who were 31-38 years old, meconium was found positive in 24 (20.0%) pregnant women.   Conclusion  Meconium-stained amniotic fluid was prevalent among majority of the women (64.2%) those presented with irregular labour pains and categorized as low risk. Mean age of the women was 28.05 years. MSAF was found positive among all three age groups but it was more prevalence in age group 26-30 years

Comparison of efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia

INTRODUCTION: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly. OBJECTIVE: To compare the efficacy and safety of intramuscular magnesium sulphate with low dose intravenous regimen in treatment of eclampsia STUDY SETTING: The study was conducted at Gynecology and Obstetrics Department unit II, Holy Family Hospital, Rawalpindi, from June 20, 2020 to December 20, 2020. Study design was Randomized Controlled Trial. SUBJECTS & METHODS: Patients were randomly distributed into two groups, group-A (IM Group) and group-B (IV Group). Group-A patients received a loading dose of 4 gm IV MgSO4 over 5-10 minutes+10 gm MgSO4 deep intra-muscular injection (5 gm in each buttock) and a maintenance dose of 5 gm MgSO4 deep intramuscular injection in alternate buttock every 4 hourly. Group-B patients received MgSO4 4 gm slow IV over 5-10 minutes as loading dose and 1 gm MgSO4 per hour as continuous intravenous maintenance infusion. Clinical response to therapy for both drugs was calculated in terms of efficacy and safety. All the data were entered & analyzed by using SPSS v25.0. Both the groups were compared in terms of efficacy and safety by using Chi-Square test. A p-value less than 0.05  was taken as significant. RESULTS: A total of 160 patients with eclampsia were enrolled for this study. Patients were divided into two groups i.e. Group-A (IM MgSO4) and Group-B (IV MgSO4). In group-A, there were 45(56.3%) in 18-30 years age group and 35(43.8%) in 31-40 years age group, while in group-B, there were 48(60.0%) in 18-30 years age group and 32(40.0%) in 31-40 years age group. In IM MgSO4 group, prevention from recurrence of seizure was noted in 74(92.5%) and 78(97.5%) in IV MgSO4 group, which is statistically insignificant with a p-value of 0.147. CONCLUSION: Both IM and IV regimen are equally effective in controlling the recurrence of convulsions. IM Magnesium Sulphate is associated with a higher incidence of toxicity as evidenced by significantly higher incidence of loss of knee jerk reflex. Both IM and IV regimen are equally effective but IM Magnesium Sulphate is associated with a higher incidence of toxicity. KEY WORDS: Eclampsia, Intramuscular MgSO4, Intravenous MgSO4

Role of Modified Biophysical Profile in Prediction of Fetal Asphyxia

Objective    To determine the diagnostic accuracy of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar Score as gold standard.       Patients and Methods After written informed consent from patients, 235 patients with high risk pregnancies admitted to obstetric ward unit 2 Holy Family Hospital were enrolled in study. BPP was done by modified method in high risk patient at > 36 week gestation. Amniotic fluid index was calculated by measuring 4 quadrant vertical pockets and if sum of 4 pockets was< 5 it was considered as abnormal. Total score in MBPP is 4.Out of which 2 score for CTG and 2 score of AFI. These patients were followed till delivery and newborn will be assessed at the time of delivery for fetal asphyxia. Fetal asphyxia was assessed on the basis of Apgar score at 5 min after birth. All patients delivering beyond 7 days of MBPP was excluded from the study. Results Mean age (years) in our study was 27.11+1.47 whereas mean parity was 2+1.06 with ranges from nulliparous to para four. The sensitivity, specificity, positive predicative value and negative predicative value of Modified Biophysical Profile (MBPP) in determining fetal asphyxia in high risk pregnancies keeping actual birth asphyxia on Apgar score as gold standard was 95.02%, 71.43%, 98.13% and 47.62% respectively. Conclusion MBPP was found to have high sensitivity and positive predictive value in predicting fetal asphyxia as assessed by Apgar score at birth. Key words:             Modified Biophysical profile, Perinatal outcome, High risk pregnancies, Non stress tes

Frequency of pregnancy induced hypertension and its association with elevated serum beta human chorionic gonadotropin levels during mid trimester of pregnancy

Objective: To determine the frequency of PIH amongst elevated beta-hCG levels and non-elevated beta-hCG in the mid-trimester of pregnancy. Materials and Methods: It was Descriptive case series conducted for six months (02-12-2019 to 02-06-2020) in OPD of Gynae Unit-II, Holy Family Hospital, Rawalpindi. A total of one hundred and twenty-two (n=122) normotensive pregnant females at 13-20 weeks gestational age and 18-35 years of maternal age were selected in this study after informed consent from every patient. The frequency of PIH in patients with elevated serum beta-hCG was measured. Data were analyzed using SPSS version 20. Effect modifiers were controlled by stratification. A p-value of ≤ 0.05 was considered significant. Results: Mean beta-hCG levels in the total study population were found to be 7305.09±3900.64 IU/mL. Median b-hCG levels in our study population were noted as 6936.15 IU/mL. Pregnancy-induced hypertension was found positive in 16 (13.1%) patients. Raised beta-hCG levels were present in 10 (8.2%) patients. The frequency of PIH in raised beta-HCG levels was found in 7/10 (70%) of patients. We found a statistically significant (p-value ≤ 0.05) difference in the frequency of PIH among patients with elevated and not-elevated beta-hCG levels. Conclusion: It is evident from my study that patients with raised levels of serum β-hCG during mid-trimester pregnancy are at increased risk to develop hypertensive disorders of pregnancy. We further elaborated that there is a statistically significant difference in various effect modifiers such as maternal age, gestational age, residential status, and BMI  for developing  PIH among patients with elevated and non-elevated beta-hCG levels

Phragmites karka as a Biosorbent for the Removal of Mercury Metal Ions from Aqueous Solution: Effect of Modification

Batch scale studies for the adsorption potential of novel biosorbent Phragmites karka (Trin), in its natural and treated forms, were performed for removal of mercury ions from aqueous solution. The study was carried out at different parameters to obtain optimum conditions of pH, biosorbent dose, agitation speed, time of contact, temperature, and initial metal ion concentration. To analyze the suitability of the process and maximum amount of metal uptake, Dubinin-Radushkevich (D-R) model, Freundlich isotherm, and Langmuir isotherm were applied. The values of max for natural and treated biosorbents were found at 1.79 and 2.27 mg/g, respectively. The optimum values of contact time and agitation speed were found at 50 min and 150 rpm for natural biosorbent whereas 40 min and 100 rpm for treated biosorbent, respectively. The optimum biosorption capacities were observed at pH 4 and temperature 313 K for both natural P. karka and treated P. karka. values indicate that comparatively treated P. karka was more feasible for mercury adsorption compared to natural P. karka. Both pseudo-first-order and pseudo-second-order kinetic models were applied and it was found that data fit best to the pseudo-second-order kinetic model. Thermodynamic studies indicate that adsorption process was spontaneous, feasible, and endothermic