Maternal and Fetal Risks Associated with Teenage and Adult Pregnancy

Background: To compare the fetal and maternal complications between teenage and adult mothers. Methods: This comparative study included 200 teenage pregnant patients (15 – 19 years) and 200 adult pregnant patients(20-28 years). The fetal and maternal complications in both age group were compared. Results: Anaemia was more frequent in teenagers (30% vs 18%). Preterm delivery occurred in 28% of cases as compared to 12% in adult group. Spontaneous Vertex Delivery (SVD) was the mode of delivery in 73% of teenage group as compared to 65% of cases in adult group. Caesarean section was done in 10% of patients in teenage group as compared to 20% cases in adults while the rate of instrumental delivery was 8% vs 10%. Pregnancy Induced Hypertension occurred in 12% of teenagers group as compared to 5% in adult group . Eclampsia occurred in 8 patients of teenage group as compared to 3 patients of adult group. Diabetes was seen in 2% versus 12% in teenage and adult group, respectively. Low Apgar was noted in 12% of babies born to teenage age mothers as compared to 5% in adult group. Low birth weight babies were born more in teenage group as compared to adult group ( 20% vs 10%) Neonatal death occurred in 20 babies of teenage group as compared to 8 babies in adult group. Conclusion:Teenage mothers generally encounter more problems during pregnancy and child birth than older women. There is an increased risk of complications such as premature labour, anaemia and small for gestational age babie

Comparison of analgesic efficacy of diclofenac suppository with intramuscular diclofenac sodium in post-operative pain relief after cesarean delivery in the first 24 hours

Background About 80% of the patients experience enough post-operative pain to require analgesia. Adequate pain relief  is needed after caesarean section to assist ambulation , mother / baby bonding & above all, a  pleasant experience of being a mother. Different analgesics with  various routes of administrations are available for pain relief which include opioids and NSAIDS. Opiods are known for their undesireable side effects . Diclofenac sodium is an NSAID & acts via blocking prostaglandin production. The WHO recommends diclofenac as a first line drug in pain relief. It  is available in various preparations which include injections, tablets and suppositories. We  compared the mean pain experienced by the women after use of diclofenac suppositories and intramuscular diclofenac sodium after elective cesarean section in first 24 hours. Methodology This RCT was done in  the department of Obstetrics and Gynecology, --removed for blind review---from 1st March 2018 till 30th August 2018. Total of 100  antenatal women already planned for elective caesarean section ,who fulfilled inclusion criteria were selected after taking  informed consent & ethical approval by employing non probability consecutive sampling . The age , parity ,gestational age, weight  ,BMI & ASA status of all women was documented. 50 women were randomly assigned to the each group A & B. Group A was given 75 mg intramuscular diclofenac injection  immediately & then 8 hrly for the first 24 hrs after caesarean section while group B was given  100 mg rectal diclofenac suppository immediately & then  after 12 hrs  post caesarean for the first 24 hrs. if needed ,50 mg tramadol I/V was given to the women as rescue analgesia, Visual analogue pain  (VAS) score was used to assess the pain intensity of post operative  women after 24 hrs of caesarean and poltted  in the proforma. The number  of women needing rescue analgesia  in each group was also documented. & compared between the two groups. RESULTS:             Data was analyzed on the SPSS version 23.  In group A; mean age was 26.34 years with STD of 3.69. Mean gestational age was 37.82 weeks with STD of 1.79. In group B; mean age was 25.3 years with STD of 3.47. Mean gestational age was 37.70 weeks with STD of 1.59. In group A; mean weight was 84.62 kgs with STD of 5.76 and mean BMI was 32.18 with STD of 3.16. In group B; mean weight was 84.84 kgs with STD of 7.27 and mean BMI was 31.13 with STD of 3.57. In group A (intramuscular diclofenic injection group) the mean score of pain was 3.72 with STD of 0.57.  In group B (Diclofenic Suppository Group) the mean score of pain was 1.84 with STD of 0.68. P-value was significant. 26 women (52%) in group A (I/M diclofenac group) and 20 women (40%) in group B (rectal diclofenac suppository group) needed rescue analgesia with I/V Tramadol .P value was not significant.     CONCLUSION:             Dicolofenac is an effective post caesarean analgesic . Rectal route of diclofenac  is more effective than the intramuscular route as post caesarean analgesia . Almost less than half number of post caesarean women needed rescue analgesia after using diclofenac suppository

Feto-maternal Outcome of Reverse Breech Extraction versus Dis-impaction of Fetal Head in Caesarean Section for Obstructed Labour

Objectives: Obstructed labour is an obstetrical emergency with adverse feto-maternal consequences and caesarean delivery in such cases requires skillful handling of impacted fetal head. Objective of our study was to guide clinician about caesarean technique that facilitates the delivery with least complications for mother and baby. Methods: It was a randomized clinical trial with non-probability consecutive sampling conducted at –removed for blind review---from 1st july 2018 – 30th june 2020. Patients who underwent emergency cesarean section were randomized to undergo either push technique for delivery of impacted fetal head (Group A) or reverse breech extraction method (Group B) via lottery method. The data of 60 patients who fulfilled the inclusion criteria was analyzed using SPSS version 19. Maternal outcome measured were extension of uterine incision, blood transfusion, postpartum pyrexia, wound infection, postpartum hemorrhage and length of hospital stay. Fetal outcome measured were 5 minutes Apgar score, birth weight and NICU admission. Results: The results of our study showed statistically significant difference between extension of uterine incision(p-value=0.015), blood transfusion during surgery (p-value=0.021) and postpartum hemorrhage (p-value=0.020) in two groups with pull technique associated with less traumatic extension of uterine incision, less intraoperative transfusion and less PPH than push technique of fetal delivery. Length of hospital stay was also significantly less in reverse breech extraction group(p-value=0.001).More patients had postpartum pyrexia, wound infection, low 5-min Apgar score and NICU admissions in cephalic delivery group but results were not statistically significant. Conclusion: The results of our study recommend reverse breech extraction technique to be a safe alternative to conventional vaginal pushing of fetal head especially regarding maternal outcomes during caesarean section of patients with obstructed labour for fetal delivery. Key words: Obstructed labour, impacted fetal head, reverse breech extraction, caesarean sectio

Reliability Of Transvaginal Ultrasound Measured Endometrial Thickness In Diagnosis Of Endometrial Cancer In Postmenopausal Women

Abstract Objective: Dilatation and curettage have been replaced by ultrasound measurement of uterine endometrial thickness (ET) especially by Transvaginal ultrasound (TVS) as a first step in the workup of women with postmenopausal bleeding for many years. Still, there is no unanimity for endometrial thickness cut-off value to define abnormality. We used an endometrial thickness of 4mm as a cut-off value in this study. Methods: This cross-sectional validation study included 120 patients who presented with postmenopausal bleeding in OPD of POF hospital from 01-12-2017 to 1-06-2018.TVS measured endometrial thickness ≥4mm was assumed positive for malignancy and ˂ 4 mm was taken negative for malignancy. The TVS findings of patients were compared with the histopathology report of endometrial sampling, which was performed in OPD by manual vacuum aspirator (MVA). Histopathology report was taken as a reference standard to confirm or refute the diagnosis of transvaginal ultrasound. Results: On TVS, 54 patients had ≥ 4mm endometrial thickness (taken positive for malignancy) while 66 patients had <4 mm endometrial thickness (taken negative for malignancy). Histopathology of the endometrium (reference standard) revealed that 47 (39.17%) patients had malignancy and 73(60.83%) patients did not have malignancy. The reliability of transvaginal ultrasound (TVS) using 4mm cut-off point ET in detecting endometrial malignancy in patients presenting with uterine bleeding after menopause, keeping histopathological findings as a reference standard showed 89.36% sensitivity, 83.56%, specificity, 92.42% negative predictive value and 77.78% positive predictive value & 85.83% accuracy rate. Conclusion: We concluded that there was a low probability of endometrial malignancy in women with ˂ 4 mm transvaginal ultrasound (TVS)measured endometrial thickness (ET).TVS  may replace invasive endometrial sampling in cases of postmenopausal bleeding with ˂ 4mm ET

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score <7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score<7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

The Fetomaternal Outcome of Induction of Labour in Idiopathic Oligohydramnios

Objective: To assess fetomaternal outcome of induction of labour in patients with idiopathic oligohydramnios at ANTH to reduce the morbidity associated with increased cesarean section rate and deliver alive healthy babies. Methodology: This quasi experimental study was conducted in the department of Obstetrics & Gynecology, Alsuffah hospital Rawalpindi and Akbar Niazi Teaching Hospital, Islamabad, over a period of six months from June to Dec 2022. A detailed history was taken followed by a thorough general physical examination and obstetric examination. Routine investigations were performed along with obstetrical ultrasonography. CTG was performed and after ensuring a reactive trace along with no contraindication to vaginal delivery; were offered option of induction of labour after informed consent on predesigned consent form with tab. prostin E2 3mg maximum of two doses with 6 hours apart via vaginal route as per induction of labour protocol at 37 weeks or beyond and were followed-up in OPD till postnatal follow up after 1 week. Results: The mean age of the patients was 26.85 ± 0.46 years. Majority 30 (41.1%) of the patients had parity of 3 or more and most 31 (42.47%) of the females in the study were given induction of labor at 39 weeks’ gestation followed by 27 (36.99%) were given IOL at 38 weeks. The mean value of the amniotic fluid index was 4.35 ± 1.84. Main bulk 34 (46.58%) of the females delivered with cesarean section and most common indication for cesarean section Pathological CTG in 15 (20.55%) patients. Mean birth weight was recorded to be 3.25 ± 0.86 kg and about one third of the babies, 24 (32.88%) babies required admission in NICU. A large number 31 (42.47%) of the children had low APGAR score (< 7) at 5 minutes. Conclusions: The development of foetal distress, meconium-stained liquor, caesarean delivery rates, NICU admission rates, and low birth weight are all linked to pregnancies with isolated oligohydramnios

New bioactive triaryl triglyceride esters: Synthesis, characterization and biological activities

Four new bioactive aryl triester derivatives of glycerol and benzoic acids were synthesized. The synthetic compounds were studied for their antimicrobial and urease inhibition activities. Esterification was carried out by using carbonyldiimidazole to enhance the acyl elimination addition reaction with benzoic acid derivatives. The structure of triglycerides were studied by EI-MS, 1H, 13C-NMR, FT-IR and elemental analysis. All synthetic compounds showed urease inhibition activity with highest value of IC50 value 22.4 ± 0.45 μM which is nearest to standard thiourea IC50 value (21.6 ± 0.12 μM).  Except compound (3d), all other compounds exhibited antimicrobial activity against Streptococcus pneumoniae, Staphylococcus epidermidis, Bacillus pumilus, Escherichia coli, Pseudomonas aeruginosa and Candida albican. Video Clip of Methodology: 7 min 59 sec   Full Screen   Alternate