Association of Peripartum Cardiomyopathy with Pre-eclampsia and Maternal Outcome

Objective: To determine the Prevalence of Pre-eclampsia in women with peripartum cardiomyopathy (PPCM) and to compare the maternal outcome in cases of PPCM who develop pre-eclampsia with those cases who are normotensive.      Study design: This is a prospective observational study. Setting: Study carried out at department of Gynecology and Obstetrics, Liaquat university hospital Hyderabad from 20th February 2019 to 19th February 2020. Materials and methods:  This prospective observational study was conducted in department of Gynecology and Obstetrics and department of Cardiology Liaquat University Hospital Hyderabad. Inclusion criteria were patients admitted with a diagnosis of peripartum cardiomyopathy diagnosed clinically and confirmed by echocardiography. Exclusion criteria were cases with multiple pregnancies, smokers, those with chronic hypertension and chronic renal disease or diabetes. We assessed patients for pre-eclampsia. Outcome measures studied were serious maternal complications like Pulmonary oedema, Cardiogenic shock, intensive care unit admission, and death. Results:  During one year study period, there were 71 cases of peripartum cardiomyopathy. The mean age of patients was 29.77±6.8 years. Pre-eclampsia was seen in 62% cases of Peripartum cardiomyopathy. Mean ejection fraction was 33.24±6.49. In patients of PPCM, serious maternal complications including cardiogenic shock 11(15.5%) cases, intensive care unit admission 10(14.1%) cases, pulmonary oedema 35(49.3%) cases and prolonged hospitalization 58(81.7%) cases.  Conclusion: We conclude that pre-eclampsia has high prevalence in patients with PPCM. Both when combined, significantly increase the chances of serious maternal complications including death.

Analysis of uterine rupture at university teaching hospital Pakistan

OBJECTIVE

To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan.

METHODS

This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences (LUMHS) for a period of one year from January 1st to December 31st 2012. Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package.

RESULTS

The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 (44.26%) with mean age of 30.36 years. and parity group 2-3 (57.37%) with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43(70.49%), injudicious use of oxytocin 33(54.09%), obstructed labour 15 (24.59%) and multiparty 18 (29.50%). Repair of uterus was performed in 47(77.04%) cases. Maternal case fatality was 5(8.19%), while foetal wastage was 51 (83.60%).

CONCLUSION

This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication.

Pattern of presentation of cervical carcinoma at Nuclear Institute of Medicine and Radiotherapy, Pakistan

OBJECTIVE

To find the pattern of presentation of cervical carcinoma as seen at Nuclear Institute of Medicine and Radiotherapy, Pakistan.

METHODOLOGY

This retrospective descriptive study was conducted at the Nuclear Institute of Medicine and Radiotherapy (NIMRA) for a period of one year from January 1(st) to December 31(st), 2009. The clinical records of all patients diagnosed with carcinoma of the cervix were reviewed with regard to sociodemographic and reproductive parameters. Frequency of cervix and stage of disease at time of presentation were recorded. The data was collected on pre-designed proforma and analysed using SPSS Version 16 statistical package. Results : There were a total of 56 cases (33.53%) of carcinoma of cervix who presented at NIMRA during the study period. The mean age was 51 years. Irregular vaginal bleeding, foul smelling vaginal discharge and post coital bleeding were the most common symptoms. Squamous cell carcinoma corresponds to 52 (92.85%) and adeno carcinoma to 4 (7.14%) cases. Only 8(14.28%) cases were in Stage I, while 20(35.71%), 22(39.28%) were in Stages II and Stage III respectively whilst 6(10.71%) cases were in advanced stage (1V).

CONCLUSION

Squamous cell carcinoma accounted for 92.85% of cases with mean age of 51 years, most patients 74.98% presented in stage II, III and IV. Diagnosis at advanced stage needs implementation of large scale educational and screening programme on national level to saves the lives of Pakistani women.

Gestational trophoblastic disease

BACKGROUND

Molar pregnancy represents a significant burden of disease on the spectrum of Gestational Trophoblastic Disease (GTD). The incidence appears to be quite high in South Asia. The objective of this study was to determine the frequency of GTD, and clinical presentation, management and outcome of patients with molar pregnancy.

METHODS

This retrospective, descriptive study was conducted at Nuclear Institute of Medicine and Radiotherapy (NIMRA), Jamshoro from 1st Jan to 31st Dec 2009. All patients diagnosed and registered as GTD were included in the study. The clinical records of all molar patients were reviewed regarding presentation, treatment, and follow-up.

RESULTS

There were a total of 167 patients presenting with different female genital tract neoplasia at NIMRA during the study period, including 39 (29.35%) cases of GTD. Hydatidiform mole was seen in 33 (84.61%) patients. Complete mole in 31 (79.48%), partial mole in 2 (5.12%) patients, invasive mole in 1 (2.56%) patient, and choriocarcinoma in 5 (12.82%) patients. The mean age of the patients was 27 +/- 9.8 years. The highest incidence was found in nulliparous and para 1. Thirty-two patients had suction evacuation and 1 patient underwent hysterectomy. Patients received chemotherapy, 17 (54.54%) patients followed protocol for 3-6 months.

CONCLUSION

Frequency of molar pregnancy was high, more common in low-parous, poor socioeconomic class women, and usually presented late.

Risk factors and clinical outcome of placental abruption: a retrospective analysis

OBJECTIVE

To determine frequency, obstetrical risk factors and the subsequent feto-maternal outcome in women suffering from placental abruption.

METHODS

A retrospective case series study was carried out in the Department of Obstetrics and Gynaecology Unit One, Liaquat University Hospital Hyderabad, Pakistan from 1st January 2006 to 31st December 2006. All women with the diagnosis of placental abruption having more than 24 weeks gestation were included in the study.

RESULTS

Of the 2224 delivered women 106 (4.7%) had placental abruption. All of the 106 women were unbooked, with 67 (63%) in the age group 20-35 years, 68 (64%) belonged to rural areas. 98 (92%) patients were multiparous and 57 (54%) were preterm. The commonest medical disorders observed were anaemia in 84 (79%), Diabetes Mellitus in 8 (8%) and gestational hypertension in 8 (8%) patients. There were five maternal deaths, showing case fatality rate of 5%. The foetal prognosis was characterized by low birth weight seen in 74 (70%), low apgar score in 30 (28%) and high still birth rate in 54 (51%), constituting perinatal mortality rate of 25.62/1000 deliveries.

CONCLUSION

Abruptio placentae is associated with adverse maternal and foetal outcome. Multiparity, un-booked status, rural residence and maternal anaemia are important risk factors.

Role of serum leptin level as a marker of severity of pre eclampsia

BACKGROUND

To explore the possibility of serum leptin being a marker of severity of pre-eclampsia, so that risk of imminent eclampsia and eclampsia can be reduced.

METHODS

This observational study was conducted at a private hospital of Hyderabad from 31st July to 1st December 2007. Forty primipara with same age, body mass indices and gestational age were included in this study. Twenty women had raised blood pressure in third trimester of pregnancy and 20 women with a normal blood pressure in third trimester of pregnancy. The exclusion criteria included history of diabetes, twin pregnancy, chronic hypertension, liver or renal disease. After counselling and affordability of laboratory testing their blood sample was taken for serum leptin, uric acid, serum creatinine and urine for albumin. The serum leptin level was measured by radio-immunoassay (RIA) kits. All data was filled in a pre-designed proforma after taking detailed history and examination. Statistical analysis was performed on SPSS. Student's t-test was applied where applicable.

RESULTS

Mean systolic and diastolic blood pressure between pre-eclamptic and control group showed a marked difference (p < 0.001) ranging from 149.50 +/- 3.44 and 104.40 +/- 3.03 as compared to control 107 +/- 1.56 and 74.50 +/- 1.49 respectively, similarly proteinuria was present in 20 (100%) cases of pre-eclampsia and 07 (35%) of normotensive women. Mean serum leptin level was significantly high in pre-eclampstic (79.380 +/- 3.287), when compared with a control group (27.825 +/- 1.050). Mean serum uric acid in pre-eclamptic (5.040 +/- 0.147) showed significant changes than control (3.600 +/- 0.141), while serum creatinine level was insignificant in both groups. It has been observed that Mean +/- SEM value of serum leptin level was much higher in severe pre-eclamptics (76.418 +/- 5.056) than in women with mild pre-eclampsia (40.856 +/- 2.807). All the parameters correlated positively and significantly with increased blood pressure.

CONCLUSION

Elevated plasma leptin concentration appears to be a marker of pre-eclampsia independently or along with other parameters of pre-eclampsia could be used to reduce the severity of pre-eclampsia thus avoiding risk effects of pre-eclampsia to mother and foetus. This study still needs more research work to prove our results.