Pregnancy loss rate following amniocentesis

Objective: To determine pregnancy loss rate following amniocentesis in a mainstream urban healthcare centre.Methods: We analysed cases of all pregnant women who underwent Amniocentesis at the Foetal Medicine Unit of Aga Khan University Hospital, Karachi, during 2001 to 2010. Cases of unknown pregnancy outcome were excluded, and after the process of consent, the final study population was 228 patients. Two operators performed the procedure using 22 G needle.Results: The mean age of women in the study was 32 +/- 6 years. The commonest indication of the procedure was a previous baby with Down\u27s Syndrome. Majority 197 (86.6%) cases had a normal karyotype. Down\u27s syndrome was 14 (6.1%). Regarding the outcome of pregnancies, it was normal in 173 (77.3%) cases while 2 (0.8%) intrauterine deaths were reported, one of which was within two weeks of the procedure. The number of pregnancy termination was 27 (11.7%). There was one miscarriage which means the pregnancy loss rate in the study population was 0.4%.Conclusion: In order to have good quality control, healthcare audits are essential on both short-term and long-term basis

Frequency of urinary incontinence with pelvic organ prolapse and associated factors.

 Introduction : To determine the frequency of common types of urinary incontinence (UI) in women with pelvic organ prolapse (POP) attending Uro-gynaecology clinics at Aga Khan Hospital Karachi. METHODS: A total of 85 women attending the Uro-gynaecology clinics with symptoms of pelvic organ prolapse were included in a cross sectional survey  RESULTS: Out of 85 women presented with pelvic organ prolapse, 61(71.7%) were aged above 50 years and 24(28.4%)  below 50 year of age . The frequency of SUI was reported by 46(54.1%) women, 16(18.8%) women presented with UUI and 23(27.1%) with MUI. Large majority of women were postmenopausal(69%) ,  multiparous(71%), , and obese with a BMI >25 (69.4%). Thirty nine (46%) women had III grade of POP and 46( 54%) had SUI. Grade of POP was significantly associated with UI (SUI). Grade II POP was associated statistically significant  with SUI [Adjusted Odd Ratio (AOR) 0.04; 95% CI: 0.004, 0.418; P value: 0.007].The other factors like age ,parity and BMI were not found to be statistically significant in association with UI.CONCLUSION: Pelvic organ prolapse and urinary and incontinence are significant problems in developing countries .Both of these conditions badly impact quality of life of women .In our study only SUI was found to be significantly associated with increasing grades of POP

Comparison of foeto-maternal outcome in pregnant women with hepatitis E - A review of 12 years.

Objective: To compare adverse maternal and foetal outcome in pregnant women with hepatitis E immunoglobulin M reactive versus non-reactive.Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of pregnant patients at any gestational age with clinical and biochemical evidence of hepatitis E from January 2002 and December 2014. . Maternal and perinatal outcome of the subjects were analysed. SPSS 20 was used for data analysis.Results: Out of the 200 subjects, 168(84 %) were hepatitis E immunoglobulin M reactive and 32(16%) were non-reactive. The overall mean age was 26.7±4.5 years. Also, 12(7%) patients in the immunoglobulin M reactive group were admitted to intensive care unit compared to no one from the non-reactive group. Similarly fulminant hepatic failure was seen in 12(7.1%) patients in the immunoglobulin M reactive group compared to no one in the other group. Post-partum haemorrhage was more frequent in the immunoglobulin M reactive group compared to the non-reactive group. There were 5(3%) maternal deaths in the reactive group compared to no death in the other group.Moreover, 34(20.2%) neonates of the immunoglobulin M reactive group needed neonatal intensive care unit admission compared to none in the non-reactive group. There were 4(2.4%) neonatal deaths in the reactive group.Conclusion: Participants in the immunoglobulin M reactive group had a higher percentage of adverse foeto-maternal outcomes compared to the non-reactive group

Phytochemicals and bioactivities of Syzygium filiforme var. filiforme

Syzygium filiforme var. filiforme is a plant variety from dicotyledonous plant family (Myrtaceae). Phytochemical studies on S. filiforme var. filiforme stem bark have successfully isolated and characterized arjunolic acid (1), alphitolic acid (2), betulinic acid (3), ursolic acid (4), ursolic acid 3-methyl ester (5), β-sitosterol (6) and stigmasterol (7). The inhibitory activities against free radical, starch, and bacteria for major compounds were tested by using DPPH, α-glucosidase and minimum inhibitory and bacterial concentration assays, respectively. No promising antioxidant activity was shown on tested samples except methanolic crude extract. For antidiabetic activity, methanolic and dichloromethane crude extracts displayed potent activity compared to 1-deoxynojirimycin. Minimum inhibitory concentration (MIC) and minimum bacterial concentration (MBC) assays for antibacterial activity were evaluated on Escherichia coli, Staphylococcus aureus, and Bacillus subtilis. All crude extracts and major compounds displayed weak and no promising activities for MIC method, respectively. Meanwhile, for MBC method, hexane crude extract and compound 1 showed inhibition against B. subtilis

Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery – The AIMS (Antibiotics in Miscarriage Surgery) trial: study protocol for a randomized controlled trial

Background: The estimated annual global burden of miscarriage is 33 million out of 210 million pregnancies. Many women undergoing miscarriage have surgery to remove pregnancy tissues, resulting in miscarriage surgery being one of the most common operations performed in hospitals in low-income countries. Infection is a serious consequence and can result in serious illness and death. In low-income settings, the infection rate following miscarriage surgery has been reported to be high. Good quality evidence on the use of prophylactic antibiotics for surgical miscarriage management is not available. Given that miscarriage surgery is common, and infective complications are frequent and serious, prophylactic antibiotics may offer a simple and affordable intervention to improve outcomes.Methods: Eligible patients will be approached once the diagnosis of miscarriage has been made according to local practice. Once informed consent has been given, participants will be randomly allocated using a secure internet facility (1:1 ratio) to a single dose of oral doxycycline (400 mg) and metronidazole (400 mg) or placebo. Allocation will be concealed to both the patient and the healthcare providers. A total of 3400 women will be randomised, 1700 in each arm. The medication will be given approximately 2 hours before surgery, which will be provided according to local practice. The primary outcome is pelvic infection 2 weeks after surgery. Women will be invited to the hospital for a clinical assessment at 2 weeks. Secondary outcomes include overall antibiotic use, individual components of the primary outcome, death, hospital admission, unplanned consultations, blood transfusion, vomiting, diarrhoea, adverse events, anaphylaxis and allergy, duration of clinical symptoms, and days before return to usual activities. An economic evaluation will be performed to determine if prophylactic antibioticsare cost-effective.Discussion: This trial will assess whether a single dose of doxycycline (400 mg) and metronidazole (400 mg) taken orally 2 hours before miscarriage surgery can reduce the incidence of pelvic infection in women up to 2 weeks after miscarriage surgery

A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery.

BACKGROUND: Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries. METHODS: We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one of these features and the clinically identified need to administer antibiotics. The definition of pelvic infection was changed before the unblinding of the data; the original strict definition was two or more of the clinical features, without reference to the administration of antibiotics. RESULTS: We enrolled 3412 patients in Malawi, Pakistan, Tanzania, and Uganda. A total of 1705 patients were assigned to receive antibiotics and 1707 to receive placebo. The risk of pelvic infection was 4.1% (68 of 1676 pregnancies) in the antibiotics group and 5.3% (90 of 1684 pregnancies) in the placebo group (risk ratio, 0.77; 95% confidence interval [CI], 0.56 to 1.04; P = 0.09). Pelvic infection according to original strict criteria was diagnosed in 1.5% (26 of 1700 pregnancies) and 2.6% (44 of 1704 pregnancies), respectively (risk ratio, 0.60; 95% CI, 0.37 to 0.96). There were no significant between-group differences in adverse events. CONCLUSIONS: Antibiotic prophylaxis before miscarriage surgery did not result in a significantly lower risk of pelvic infection, as defined by pragmatic broad criteria, than placebo. (Funded by the Medical Research Council and others; AIMS Current Controlled Trials number, ISRCTN97143849.)

Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery - The AIMS (Antibiotics in Miscarriage Surgery) trial: study protocol for a randomized controlled trial

Follow-up card. (DOCX 605 kb

Maternal and fetal outcome in cardiac patients: A cross-sectional study at tertiary care setting

Background: The presence of cardiac diseases in pregnancy is a high-risk condition and poses a threat to both mother and child. This study aimed to determine maternal and fetal pregnancies in women with cardiac disease at a tertiary care hospital.Methodology: This was aretrospective study conducted in theDepartment of Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, from January 2013 to December 2015. All pregnant women with cardiac diseases were enrolled in the study. Mean (SD) was used for continuous variables, while percentages were calculated for categorical variables. Chi-square test was applied to compare the maternal and fetal outcome with the severity of functional class. A p-value of less than 0.05 was considered significant.Results: The average maternal age was 29.8 ± 5.2 years. Rheumatic heart disease was present in 47% and congenital heart disease in 28.8% of pregnant women. Almost 80% of women belonged to NYHA functional class I and II. Overall maternal complications were GDM, Preeclampsia, pulmonary edema, PPH, CCF, Arrhythmias, Cardiogenic and septic shock. GDM, preeclampsia, pulmonary edema mainly occurred in congenital heart disease patients. Perinatal outcomes included 93.2% live births, 3% neonatal, and 3% intrauterine deaths. Significant associations were found between pulmonary edema, use of Digoxin & Diuretics, and NYHA functional class.Conclusion: The current study indicates that cardiac diseases are associated with adverse maternal and fetal outcomes. These women require aggressive monitoring and time management. Therefore, such patients should be regularly followed and counseled

Methyl (E)-3,5-dimethoxy-2-{[2-(4-methoxybenzoyl)hydrazin-1-ylidene]methyl}benzoate

In the title compound, C19H20N2O6, the azomethine [C=N = 1.269 (2) Å] double bond adopts an E conformation and the dihedral angle between the planes of the benzene rings is 17.41 (11)°. In the crystal, inversion dimers linked by pairs of N—H...O hydrogen bonds generate R22(16) loops. The dimers are connected by C—H...O and C—H...N hydrogen bonds, forming sheets lying parallel to (100)