Pre labour Rupture of Membranes at Term: Expectant Management vs Induction of labour

Objective: To determine the best approach to PROM at term. Study design: A randomized control trail. Place and duration of study: Obstetrics and Gynecology department of nishtar hospital from may 2017 to march 2018. Methodology: 100 women with PROM at term were selected. After consent, they were randomly assigned to expectant or induced group. Expectant group was managed conservatively while in the patients of the induced group induction of labour was done. All the data was entered on already designed Performa. Collected data was analyzed by SPSS software. Results: the duration between PROM to delivery was significantly reduced with a p value of <0.001 in induced group compared to the expectant group. Moreover, the difference of maternal morbidity and LSCS between induced and expectant group is not statistically significant. The difference observed in the neonatal outcomes was statistically significant showing higher rates of morbidity (asphyxia and sepsis) in the expectant group compared to the induced group. Conclusion:   induction of labour is the best approach towards the PROM at term compared to conservative management because of remarkable decrease in PROM to delivery interval and neonatal morbidity without significant rise of LSCS and maternal morbidity. Moreover, it gives the additional advantage of maternal satisfaction and decrease hospital stay time. Keywords: Pre Labour, Membranes Rupture, Induction

Comparison between bipolar diathermy and silk ligation technique during tonsillectomy

Objective: to compare the use of bipolar diathermy and silk ligation in tonsillectomy with respect to operative time and post op hemorrhage, in our setting. Study design: randomized controlled trail. Place and duration of study: nishtar hospital, multan from May 2016 to May 2018.  Methodology: After consent, 234 patients of chronic tonsillitis of 5 to 35 year of age were selected as per inclusion and exclusion criteria. They were randomly divided in to two groups by using lottery method. In group A, tonsillectomy was done and suture ligation was applied for hemostasis. In group B, tonsillectomy was done and bipolar diathermy was used for hemostasis. Data was entered and analyzed by using SPSS software. Results: In our study, mean age was 13.84 + 5.83 years. Majority of patients 55.13% were between 5-15 years of age. Out of 234 patients, 71.37% were male and 28.63% were females. The mean operative time in group A was 29.45 + 9.71 minutes and in group B was 16.37 + 4.38 minutes with p-value <0.0001. Secondary hemorrhage was seen in 2.56% patients in group A (suture ligation group) and 10.56% patients in group B (Bipolar diathermy group) with p-value of 0.016. Conclusion: bipolar diathermy method of hemostasis in tonsillectomy is fast but associated with statistically increase risk of secondary hemorrhage compared to silk ligation. Keywords: tonsillectomy, silk ligation, bipolar diathermy, operative interval, secondary hemorrhage

Management of Iatrogenic Facial Nerve Palsy and Labyrinthine Fistula in Mastoid Surgery

A 6-year review of complications of mastoid surgery between June 1995 and June 2001 revealed five cases with serious iatrogenic complications from mastoid surgery, of which four were facial nerve palsy and two were labyrinthine fistula. One of these patients had concomitant facial nerve palsy and labyrinthine fistula. There were two cases of complete facial nerve palsy (House Brackmann grade VI) and two cases of incomplete palsy (House Brackmann grades IV and V). The second genu was the site of injury in three of the four cases. Of the four cases with facial nerve palsy, two patients had full recovery (House Brackmann grade I), one recovered only to House Brackmann grade III, and one was lost to follow-up. Both patients with labyrinthine fistula had postoperative vertigo and profound sensorineural hearing loss. The site of iatrogenic fenestration was the lateral semicircular canal in both cases