ROLE OF GENITAL TUBERCULOSIS IN SUB-FERTILE WOMEN

OBJECTIVE: To evaluate role of Acid fast bacilli culture (AFB) in sub-fertile women undergoing laparoscopy and dye test with endometrial biopsy. METHODS:  This cross-sectional study was conducted from 1st January 2020 to 30th April 2021, on 108 cases of subfertility, enrolled through non-probability consecutive sampling technique, for diagnostic laparoscopy & dye test with endometrial biopsy for AFB culture. We included all women of reproductive age with ≥2 years of subfertility, normal menstrual history, hormonal assay and normal male-factor. All women with comorbidities, women having contraindications for anaesthesia & couple with male-factor subfertility were excluded. Data analysis was done by SPSS version-20.      RESULTS: Seventy-two (66.7%) women had primary and 36 (33.3%) had secondary subfertility. Duration of subfertility was >5 years in 63 (58.3%) cases. Ninety-seven (89.8%) patients had bilateral patent tubes. Majority of patients (n=46/108; 42.6%) were aging 32-38 years. Endometrial biopsy of 22 (20.4%) cases were positive for AFB culture. Out of AFB-positive cases, 17 (77.3%) had primary and 5 (22.7%) had secondary sub-fertility. All AFB-positive cases had patent tubes (unilateral n=5/22; bilateral n=17/22). Common laparoscopic findings were tortuous tubes (n=30; 27.8%) and clumped end fimbrial (n=24, 22.2%). CONCLUSION: In our study, endometrial sampling of 20.4% cases were positive for AFB culture. Although female genital tuberculosis constitutes a small proportion of extra-pulmonary tuberculosis, but it has an immense effect on fertility. Thus without challenging the superiority of laparoscopy, AFB culture could be considered a judicious part of subfertility workup in low resource countries carrying high burden of disease

Efficacy of Uterovaginal Packing Versus Uterine Balloon Tamponade to Control Postpartum Hemorrhage Due to Uterine Atony

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group

Study of Postdatism with Respect to Fetomaternal Outcome at A Tertiary Care Hospital

OBJECTIVES This study aims to know our setup’s fetomaternal pregnancy complications that extend beyond 40 weeks of gestation. METHODOLOGY This is a prospective cross-sectional study of 390 patients with uncomplicated postdated pregnancies fulfilling the inclusion and exclusion criteria admitted to the department of Obstetrics and Gynecology (both in spontaneous labour and induced patient) at Hayatabad Medical Complex, a tertiary care hospital in Peshawar, KPK from July 2020 to June 2021.RESULTS Out of 390 patients, a majority (72.30 %) were in the age group of 20 – 35 years. Most of them (50.51%) presented at gestation 40+1 – 40+6 weeks. The majority (57.69%) were multigravida, and most (93.07%) were un-booked. Most delivered vaginally (80.51%), and 19.48% had C/section (including both emergency and elective). The most common indication for C/section was fetal distress (44.73%), followed by C/section on demand (18.42%). The majority>90% had Apgar score greater than seven at 5 minutes which was gestation dependent. Overall perinatal mortality was 4.07% which was also gestation dependent ranging from 0.5% at 40+1 – 40+6 weeks to 2.30% at and beyond 42 weeks of gestation. Neonatal morbidity in the form of Birth asphyxia, Meconium Aspiration Syndrome (MAS), Shoulder Dystocia and NICU admission also showed an increasing tendency with increasing gestation beyond 40 weeks. Maternal morbidity in the form of PPH, perineal tears 3°/4° and endometritis also showed a similar increasing trend with increasing gestation beyond 40 weeks. CONCLUSION Pregnancy continuing beyond 40 weeks has a definite risk to the fetus.

Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear

Efficacy of Manual Vacuum Aspiration Vs Conventional Evacuation and Curettage

OBJECTIVES: To evaluate the safety and efficacy of Manual Vacuum Aspiration (MVA) compared to Conventional Evacuation and Curettage (E & C) in managing first-trimester miscarriage. METHODOLOGY: A total of 160 patients were enrolled in this comparative study. Patients were categorized into two groups (Group A undergoing MVA) and (Group B undergoing E&C). Each group had 80 cases randomly selected. Stable patients with miscarriages ­< 12 wks of gestation and no comorbid were included in the study. Data was recorded on pre-designed proforma, and analysis was done by SPSS Software. RESULTS: Efficacy of MVA was 97.5% and 92.5% in E&C, with a 7.5% vs 30% complication rate in MVA and E&C Group, respectively. The mean duration of the procedure was 9 minutes in the MVA group versus 18.8 minutes in the E&C group. The hospital stay was 14.2 hours vs 20.3 hours in MVA and E&C Group. 16.25% vs 46.25% of women in MVA vs E&C Group reported post-op pain. 93.75% of women were satisfied with MVA, whereas only 50% of women were satisfied with E&C. 81.25% 91.25% required Anesthesia/Analgesia in MVA and E&C Group, respectively. CONCLUSION: MVA is a more effective and rapidly performing outpatient procedure with a lower complication rate. In this study efficacy of MVA is 97.5% compared to the E&C group, i.e., 92%. Its safety, cost-effectiveness and efficacy advocate its extended use as an alternative to the conventional surgical method of miscarriag

Risk Factors Leading to Meconium Aspiration Syndrome in Meconium-Stained Amniotic Fluid

OBJECTIVES This study aimed to find out the risk factors leading to meconium aspiration syndrome in patients having meconium-stained amniotic fluid. METHODOLOGY This comparative study was conducted in the department of Obstetrics and Gynaecology at Hayatabad Medical Complex from January 2022- June 2022. All patients admitted to the labour ward with the diagnosis of meconium-stained liquor (MSL) were included in the study through a convenient sampling technique. Patients were divided into two groups, group 1 having only meconium-stained amniotic fluid (MSAF) without meconium aspiration syndrome while group 2 having babies with the diagnosis of meconium aspiration syndrome (MAS). Both groups were compared for different risk factors for the development of MAS. Differences in the risk factors between the two groups were analyzed using Pearson’s correlation with a p-value of <0.05 considered significant. SPSS vs 20 was used for statistical analysis. RESULTS 84 patients were included in the study, i.e., 61 in group 1 and 23 in group 2. The mean age of the patients was 25± 3.45. The frequency of meconium-stained amniotic fluid was 3.83%. Meconium aspiration syndrome developed in 23 babies out of 84 MSAF deliveries (27.38%). Low APGAR score (< 0.00), patients handled outside the hospital (<0.001) and prolonged second stage (0.003) were significant risk factors for the development of MAS. CONCLUSION In the prolonged second stage, patients handled outside the hospital by unauthorized personnel and low APGAR score at birth were statistically significant risk factors for developing meconium aspiration syndrome

Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR)

Covid-19 Positive Antenatal Patients in Obstetrics and Gynea Unit, Peshawar

OBJECTIVES: The study aimed to determine the frequency of COVID-19 positive antenatal patients admitted in Obstetrics & Gynecology unit Hayatabad Medical Complex Peshawar with the concerns that pregnant women may be more susceptible to COVID-19 as they may be more vulnerable to respiratory infection. METHODOLOGY: This was a descriptive cross-sectional study conducted at Obstetrics & Gynecology units Hayatabad Medical Complex Peshawar from May 12th, 2020, to November 29th, 2020, screening and testing of patients admitted for childbirth was in HMC. Screening consisted of questions related to travel, contacts, and symptoms of COVID-19. All patients without a prior diagnosis of COVID-19 underwent SARS-CoV-2 polymerase chain reaction (PCR) testing of nasopharyngeal swabs, with rapid testing available. Patients scheduled for cesarean birth were screened and tested at preoperative visits RESULTS:  One hundred eighty-two patients presenting for antenatal visits were screened; 6.5% (12 out of 182) were previously diagnosed with COVID-19. The remaining 170 patients were tested at admission, and 17.6% (30 out of 170) tested positive for SARS-CoV-2. Twenty-two of the 30 who tested positive for SARS-CoV-2 (73.3%) were asymptomatic. The overall prevalence of positive test results among asymptomatic patients was 14.1% (22 out of 156). The prevalence of positive test results among asymptomatic patients increased from 1.29% (2 out of 155). CONCLUSION: The evidence on this novel infection is changing almost daily, although it will likely be many months before, we can determine the true impact it will have on both maternal and fetal well‐being. In the interim, our primary responsibility is to ensure all women have access to safe maternity services. KEYWORDS: Asymptomatic, COVID-19 Positive, Antenatal Patients, Obstetrics & Gynecology, Infectio

Risk factors associated with microalbuminuria in children and adolescents with diabetes in Bangladesh

Introduction: Diabetic nephropathy is leading cause of morbidity and mortality of type 1 diabetes mellitus (DM). Microalbuminuria is the first clinical sign of nephropathy. Methods: This was a cross-section study with longitudinal evaluation of urinary albumin xcretion in 199 children with type 1 diabetes attending CDiC Clinic in BIRDEM over a period of two years. The aim of the study was to assess the frequency of microalbuminuria and to determine other risk factors. We collected blood and early morning spot urinary sample and analyzed for HbA1c by Clover A1c and urinary microalbumin by a DCA analyzer. Children had urinary microalbumin 30-300 mg/L on at least two occasions were categorized as having persistent microalbuminuria. Demographic and clinical data were recorded including age at onset of diabetes, age during registration, gender and duration of diabetes which were compared between patients without microalbuminuria and with microalbuminuria. Result: Microalbuminuria developed in forty nine children and adolescents (25%). Among them 24% were Type 1, 27% were with Fibrocalculous pancreatic diabetes (FCPD) and 68% were Type 2 diabetes. Median HbA1c was higher 10.8 [9.4-12.4] vs 9.5 [8.0-11.2] (P.006) in adolescents with microalbuminuria. On logistic regression univariate analysis independent predictors of microalbuminuria were older age, systolic blood pressure, BMI SDS and mean HbA1c which remained significant in multivariate analysis as predictors of microalbuminuria. Conclusion: We found high prevalence of microalbuminuria which was associated with higher age, systolic blood pressure, BMI SDS and HbA1c

Lipid profile in relation to glycemic control in Type 1 diabetes children and adolescents in Bangladesh

Introduction: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. Methods: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10–18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study.Results: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2–21.4] vs. 19.5 [17.3–21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9–15.2] vs. 10.6 [7.9–12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4–11.8] vs. 7.9 [9.3–10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). Conclusion: More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents