Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Ensuring Patient Safety: Burkholderia Cepacia Infections Spread via Ultrasound Gel and Probes

Sat, 06 Apr 2024 07:28:57 -0400

Effectiveness of Oral PGE1 versus Intracervical PGE2 in Induction of Labor

TAHSEEN FATIMA,, FAHMIDA JABEEN, BUSHRA MUKHTAR — Sat, 06 Apr 2024 07:07:58 -0400

Background: Induction of labor is a common obstetric intervention used to initiate or augment
labor in pregnant women for various indications. Two commonly used agents for induction of
labor are oral prostaglandin E1 (PGE1) and intracervical prostaglandin E2 (PGE2). Both have
been shown to be effective in inducing labor, however, there are some differences in their use,
efficacy, and safety profiles.
Objective: To determine the effectiveness of oral PGE1 versus intracervical PGE2 in terms of
induction of labor, mode of delivery and feto-maternal outcomes.
Subjects and Methods
Setting: Department of gynecology and obstetrics of Bahawal Victoria Hospital, Bahawalpur
Study design: Comparative study
Duration of study: Six months from April 2022 to September 2022
Inclusion criteria: All the pregnant women at or beyond 37 weeks of gestation, with a singleton
pregnancy and a live fetus, clinically favorable cervix, determined by Bishop score of 6 or less,
who are not currently in active labor, and have not received any other cervical ripening or
induction agents in the 24 hours prior to study enrollment and who are able to attend the hospital
for follow-up and monitoring during the induction process were included.
Methods: After taking informed consent, all the study subjects as per the randomization were
divided into two groups: one group receiving oral PGE1 and the other group receiving
intracervical PGE2. Administration of the allocated induction agent according to a pre-
determined protocol, as 25-mcg oral misoprostol every 4-hourly interval or 3 applications of
intracervical PGE2 at a 6-hour interval for effective cervical ripening. Oxytocin augmentation
was used once the cervical ripening was successful. Outcomes was evaluated in terms of time to
onset of active labor, duration of labor, mode of delivery and feto-maternal complications. All
the information was collected via study proforma and SPSS version 26 was used for the data
analysis.
Results: A total of 80 women were comparatively studied; their overall mean age was
31.23+4.22 years and mean gestational age was 38.12+1.33 weeks. Average time duration
cervical ripening interval was 8.11±2.51 hours in oral PGE1 group and 9.32±3.44 hours in
intracervical PGE2 group (>0.05). However average duration of interval was statistically
insignificant according to parity and maternal complications (p=.0.05).
Conclusion: Both oral PGE1 and intracervical PGE2 are effective in inducing labor, with
similar success rates and similar maternal and fetal outcomes. However, oral PGE1 appears to
have a faster onset of action and a shorter duration of labor compared to intracervical PGE2.
Additionally, oral PGE1 is associated with a lower risk of hyperstimulation of the uterus and a
lower risk of fetal distress compared to intracervical PGE2. Although oral PGE1 to be associated

with a higher incidence of maternal side effects such as nausea, vomiting, and diarrhea, which
can be a concern for some women.
Key words: Induction of labour, prostaglandin, cervical ripening, complications

Prevalence of Urinary Incontinence in Patients Presenting with Other Complaints in Urology and Gynecology Clinics

Sat, 06 Apr 2024 02:54:27 -0400

patients attending urology and gynecology clinics for unrelated reasons.

Methods: Patients attending the urology and gynecology OPDs at a private medical center were approached and were offered an interview regarding urinary incontinence over a period from March 2022 to April 2023 . Patients who consented to participating in the study were given a questionnaire to fill ICIQ-SF questionnaire. Their data was recorded and analyzed in SPSS 24.

Results: The prevalence of urinary incontinence in our study cohort of 290 patients was 25.17%. The prevalence of urinary incontinence in males was 16.8% and 29.63% in females. Urban residents belonging to upper middle socio-economic bracket had a higher prevalence of urinary incontinence (p<0.05). Retirees had a higher prevalence of urinary incontinence (p<0.05). Comorbids such as diabetes and hypertension were found to be significantly associated with an increased prevalence of urinary incontinence (p<0.05).

Conclusion: Unreported urinary incontinence is much more common than is anticipated. In the light of lack of data regarding its true prevalence, physicians should screen their patients for urinary incontinence to detect this problem as soon as possible.

Keywords: Urinary Incontinence, Urge Incontinence, Stress Incontinence, Mixed Incontinence, Diabetes, Hypertension, BPH, Prostatectomy.

High Contribution of Male Partners to Infertility Issues

Sat, 06 Apr 2024 03:19:24 -0400

Objective: The objective of the study was to investigate the male factors, their clinical pattern and association with infertility issues.

Materials and Method: This is a descriptive unblended, retrospective study of 1393 infertility cases presented to our gynecology infertility clinic from 2017-2020. We assessed semen analysis of all patients presenting to our clinic for pattern of infertility and incidence.

Results:The age of the male patients ranged from 19 years to 64 years with a mean of 33.62±6.08 years. The mean values of volume of the semen was 3.01±0.83, total sperm count was 48.11±30.89 millions/ml and mean sperm motility in semen sample (%age) was noted to be 47.47±18.82. Total sperm motility less than 40 percent (asthenozoopsermic) was observed in 37.3% patients, and Asthenozoospermia was the leading cause of infertility, attributing to 37.3% of the patient’s. Quite a large number 15.4% of the patients had oligospermia followed by 3.1% patients who had Azoospermia.

Conclusion: According to the results male infertility was high among couples reporting infertility in our area. Our study shows clear attribution to a greater number of male factor to the infertility issues having asthenozoospermia as the commonest finding observed.

Keywords. Male Infertility, Male factor, Semen Analysis

The Effect of Phloroglucinol in Shortening Active Labor in Primigravidas at Term

Sat, 06 Apr 2024 03:32:48 -0400

Objectives: To evaluate the difference in the average length of the active phase of labor between patients who received phloroglucinol and those who received a placebo.

Methodology: A randomized controlled trial was conducted in Holy Family Hospital, Gynae Unit 1, Rawalpindi. 60 primigravidas at term, ranging in age from twenty to thirty-five, who were in the active first stage of labor and had a singleton pregnancy were randomly assigned to two groups A and B. Group A received phloroglucinol 40mg repeated after one hour at cervical dilatation of between 4cm to 6cm. While the Group B received a placebo 10mL of normal saline. Patients were monitored for vital signs and fetal heart rate, and the progress of labor was plotted on a standard WHO partogram. Maternal outcomes were measured in terms of the average duration of labor in both groups and any untoward reaction of the drug under study by the attending obstetrician.

Results: In our study, the mean age was calculated as 27.97 + 4.25 years in Group A and 26.10 + 3.92 years in Group B, mean gestational age was calculated as 39.13 + 0.97 weeks in Group A and 39.37 + 0.96 weeks in Group B. The mean BMI of the patients was recorded as 28.47 + 2.76 in Group A and 28.37 + 2.52 in Group B. Duration of labor was recorded as 205.06 + 4.64 in Group A and 309.33 + 5.71 minutes in Group B.

Conclusion: We concluded that the mean duration of active labor is significantly shorter in patients receiving phloroglucinol when compared to those receiving a placebo.

Comparison of the Frequency of Failed Induction of Labor in Obese Versus Non-Obese Women with Post-Date Pregnancy

Sat, 06 Apr 2024 04:02:35 -0400

Abstract : The objective of this study was to compare the frequency of failed induction of labor in obese and non-obese women with post-date pregnancies.

Materials and Methods: This prospective coho took place at the Department of Obstetrics and Gynecology in the District Headquarter (DHQ) Hospital Rawalpindi, spanning from January 2020 to December 2020. This study involved 128 pregnant women aged between 18-35 years, presenting with post-date pregnancy (≥42 weeks of gestation), who were categorised as cases (BMI ≥30 Kg/m²) and controls (BMI <30 Kg/m²). The outcome variable was the failure of labor induction, labeled as such if the woman failed to deliver vaginally within 24 hours of induction or if the trial was terminated due to fetal distress. The frequency of failed induction was compared between obese and non-obese women, and relative risk were estimated.

Results: The mean age of the patients was 25.65±3.56 years, while the mean gestational age was 43.27±0.99 weeks. The Bishop score ranged from 1 to 7 with a mean of 3.95±1.90.65 (50.8%) women had a Bishop Score ≤3. Induction of labor failed in 58 (45.3%) women with post-date pregnancy. The frequency of induction failure was significantly higher among obese women compared to non-obese women (59.4% vs. 31.3%; p-value=0.001; 95% CI RR=1.90).

Conclusion: In the present study, maternal obesity was associated with increased risk of induction failure in pregnant women with post-date pregnancy.

Correlation of Placental Thickness with Gestational Age in Normal Singleton pregnancies using Transabdominal Ultrasound

Sat, 06 Apr 2024 04:14:31 -0400

Objectives: To determine correlation of gestational age with placental thickness in normal singleton pregnancies using transabdominal ultrasound.

Study Design: Cross-sectional study.

Place and Duration of Study: 20th September 2021 to 19th March 2022.

Methodology: Total 150 patients who presented to our radiology department for obstetric ultrasound with accurate LMP, viable singleton pregnancy confirmed on ultrasound were selected. Placental thickness and gestational age recorded ultrasonographically after taking detailed history from antenatal women. The procedure was carried out with 3.5 MHz convex array curvilinear transducer through trans abdominal grey scale ultrasound technique. The procedure was performed on Apllio 300, 500 and LogiQ S8 ultrasound machines by principal investigator in ultrasound rooms.

Results:

Mean placental thickness was 29.64 ± 4.51 mm and mean gestational age was 30.56 ± 4.67 weeks. Correlation of gestational age with placental thickness in normal singleton pregnancies using transabdominal ultrasound is 0.932 with p-value of 0.0001.

Conclusion:

This study concluded that there is a strong correlation of gestational age with placental thickness in normal singleton pregnancies using transabdominal ultrasound.

Keywords: gestational age, placental thickness, correlation.

Diagnostic Accuracy of Magnetic Resonance Imaging in Detecting Parametrial Invasion in Cervical Cancer Patients, Taking Histopathology as the Gold Standard

Sat, 06 Apr 2024 06:21:24 -0400

Objectives: Evaluating the diagnostic accuracy of magnetic resonance imaging using histopathology as the gold standard to identify parametrial invasion in patients with cervical cancer.

Methodology: Between March 7, 2019, and September 8, 2019, a cross-sectional validation study was carried out at the Department of Radiology, Lahore General Hospital. 136 female patients with cervical cancer, ages 25 to 65, were included in the study. After a biopsy and an initial MRI, all participants had reports from the biopsy
compared to the MRI results to determine the accuracy of parametrial invasion based on
MRI studies.

Results: Sixty true positives and eight false positives were identified among the 136 patients with parametrial invasion in cervical cancer based on MRI results. Seven false negatives and sixty-one true negatives were found in MRI-negative patients. A significant difference was found by statistical analysis (p=0.0001). With 89.55% sensitivity, 88.41% specificity, 88.24% positive predictive value, 89.71% negative predictive value, and
88.97% diagnostic accuracy when compared to histopathology, which is the gold standard, MRI performed admirably.

Conclusion: MRI can accurately diagnose cervical cancer patients by identifying parametrial invasion with high sensitivity.

Frequency of Robson Ten Group Classification System Among Patients Coming for Caesarean Section

Sat, 06 Apr 2024 00:00:00 -0400

Objective: The Robson Ten Group Classification System (RTCGS) is a structured method and good tool that has been used for monitoring CS rates. Present study was planned to determine frequency of Robson Ten Group Classification System among patients coming for CS.
Methodology: This retrospective study was conducted at Department of Obstetrics and Gynecology, Fauji Foundation Hospital, Rawalpindi from June 2023 to December 2023. A total of nine hundred and forty five women with age between 18-35 years and gestational age >28 weeks admitted for both elective and emergency caesarean section were enrolled in the study.
Results: Our results showed that the group making the largest contribution to the CS rate (50.5%, n=477/945) was Robson group V (women with at least one previous CS and a term, singleton, cephalic-presenting pregnancy) followed by Robson group II (induced labor or Caesarean section before labor) (20.8%, n=197/945).

Conclusions: Robson group V (women who had one past CS and a term, singleton, cephalic-presenting pregnancy) was most frequent group in this study followed by Robson group II (induced labor or Caesarean section before labor)

KEY WORDS: Cesarean delivery, Robson Classification, Induced labor

Rate of and indications for caesarean sections at Federal Government Polyclinic Islamabad

Sat, 06 Apr 2024 07:57:00 -0400

Objective: To determine the rate of CS among pregnant women admitted to the hospital and to document the indications for CS among them.

Methods: This descriptive observation study was carried out at the Department of Obstetrics and Gynecology, Federal Government Polyclinic (FGPC), Islamabad over a period of one year. Non-probability consecutive sampling technique was employed. All pregnant women who were admitted in the hospital for childbirth were included in the study. Non-consenting patients were excluded. Robson's ten group classification system (RTGCS) was employed to categorize the women undergoing CS.

Results: Out of 3489 deliveries there were 1855 CSs with CS rate of 53.16%. Majority of the CS (n=1445; 77.89%) were emergency whereas only 22.10% (n=410) CS were elective. Majority of the CS (n=1411; 76.06%) were instituted among women with previous scars whereas 444(23.93%) were performed in primigravida.

The highest frequency of CS was observed among women of Robson’s group-5 (n=965; 52.02%), followed next by women in Robson’s group-2 (n=276; 14.87%), and those in Robson’s group-1 (n=182; 9.81%).

Conclusion: The rate of CS was 53.16%. Majority of the CS were performed among women with previous CS. Robust efforts should be made to improve the standards of obstetric care at the level of the primary healthcare facilities. This will help to reduce not only primary CS but more importantly the alarmingly high secondary CS in the Robson’s group-5 women.

Effectiveness of the Combined Therapy of intra-vaginal Misoprostol and intra-Cervical Foley Catheter for Second Trimester Pregnancy Termination – A comparative study

Nosheena Shabbir, Saima Saeed, Zubina Adnan, Maryam Zubair, Shazia Nayyar — Mon, 01 Apr 2024 00:00:00 -0400

The objective of this study is to compare the success of combined Foley’s catheter with vaginal misoprostol versus vaginal misoprostol only for second trimester termination of pregnancy.
Methods: This Randomized Controlled Trial was conducted in Department of Gynaecology and Obstetrics, Combined Military Hospital, Muzaffarabad. A total of 210 (105 in each group) women of age from 18 to 45 years undergoing 2nd trimester termination of
pregnancy. In Group A, women were administered 400µg misoprostol intra-vaginally along with inserting intra-cervical Foley’s catheter (number 16 FrCh) inflated with 50 ml normal saline. Then 400 µg misoprostol (maximum 5 doses) were repeated four hourly
until termination of pregnancy. In Group B, misoprostol tablet (400µg) four hourly intra- vaginally (max 5 doses) was given until termination. All the women were followed up till expulsion of fetus.
Results: In this study, success (in terms of complete expulsion of fetus within 24 hours of treatment) was seen in 95 (90.48%) women in group A (combined Foley’s catheter with vaginal misoprostol) and 79 (75.24%) women in group B (vaginal misoprostol only) with p-value of 0.0034.

Conclusion: This study concluded that success of combined Foley’s catheter with vaginal misoprostol for second trimester termination of pregnancy is better as compared to vaginal misoprostol.

Pre-pregnancy risk factors for miscarriages: A prevalence study

Thu, 18 Apr 2024 02:53:10 -0400

Background: Risk factors for a normal first-trimester transition to a long-term pregnancy are well established. The common risk factors include increasing maternal age, pre-pregnancy body mass index, and low level of serum progesterone. Recently, lifestyle factors such as caffeine intake, exercise, stress, exposure to smoking, and alcohol consumption have been implicated as risk factors.

Objective: To determine the frequency of different maternal pre-pregnancy modifiable risk factors for miscarriages.

Methods: A cross-sectional descriptive study was done at the Department of Obstetrics and Gynecology, Benazir Bhutto Hospital, Rawalpindi from October 2022 to April 2023. Total 234 women were presented with miscarriage and 18 to 40 years of age were included. Various pre-pregnancy modifiable risk factors (drinking coffee/tea No. of cups/day, obesity, smoking, short inter-pregnancy interval, iron deficiency anemia, genital infections, hyperthyroidism and hypothyroidism) were studied.

Results: The patient’s mean age was 27.72±4.29 years. 65.4% patients were between the age of 18 to 30 years. The frequency of different maternal pre-pregnancy modifiable risk factors for miscarriages were as follows; drinking coffee ≥ 5 cups/day was 64.9%, obese 45.3%, smoking 29.9%, short interpregnancy interval 33.8%, iron deficiency anemia 38.5%, genital infections 22.2%, hyperthyroidism 15.4% and hypothyroidism was 9.4%.

Conclusion: This study concluded that there is significant impact of modifiable pre-pregnancy risk factors on the high incidence of miscarriages.

Role of Phloroglucinol in Reducing Duration of Active First Stage of Labour

Fariha Saleem, Talat Parveen , Zainab Malik, Khiaynat Sarwar Hashmi — Tue, 09 Apr 2024 00:00:00 -0400

Objective: Prolonged labor is a concern associated with increased maternal and neonatal mortality and morbidity. Factors contributing to its occurrence are multifaceted, including maternal age, labor induction, membrane rupture, early hospital admission, epidural use, and maternal stress hormones. Antispasmodics administered during labor hold promise for expediting cervical dilation. We conducted a randomized controlled study to compare the effectiveness of phloroglucinol in reducing the duration of the active first stage of labor

Methodology: This randomized controlled trial was carried out during six months from December 2018 and June 2019 at Department of Obstetrics & Gynaecology at Bahawal Victoria Hospital, Bahawalpur. Patients with singleton pregnancies in the active first stage of labor, without complications, aged between 18 and 40 years and within the term range of 37 to 42 weeks of gestation were included. Group A received intravenous phloroglucinol 40mg (4ml), while Group B received an intravenous placebo (4ml) at the start of the trial. Following the initial dose, another administration was given after 30 minutes, and both the patient and observer remained unaware of the injection's contents. Subsequently, labor progression was carefully monitored. All collected data were entered into SPSS version 26.

Results: The mean duration of the first stage of labor in the phloroglucinol group was 230.20 ± 52.96 minutes, while in the placebo group, it was 345.30 ± 50.57 minutes (p<0.0001). These findings align with previous studies demonstrating the efficacy of phloroglucinol in reducing the duration of labor. Notably, shorter labor durations were not associated with adverse maternal or neonatal outcomes.

Conclusion: Phloroglucinol observed as an effective treatment option for reducing the duration of the active first stage of labor.

The Migration of IUCD into the Bladder with Stone Formation (2 Case Reports)

Summera Aslam Aslam — Sat, 06 Apr 2024 07:20:01 -0400

Background:

An IUCD is the most effective and reversible method of contraception worldwide. One of the most serious complications is uterine perforation and migration of the IUCD.

Case Presentation:

Case I: A 40 years old female presented with severe LUTS and suprapubic pain. She had history of IUCD placement about 10 years ago. She was diagnosed as a case of migrated IUCD into the bladder with stone formation. She was managed endoscopically with the help of stone punch and foreign body forceps for IUCD removal

Case II: A 37 years old female was referred from Gynae department to Urology department with the complaint of frequency, disuria and lower abdominal pain. There was history of IUCD (Copper T) placement 4 years ago. She was also diagnosed as a case of migrated IUCD into the bladder with stone formation on one limb of IUCD. This patient was also managed endoscopically with the help of stone punch and foreign body forceps.

Ovarian Dysgerminomas: Role Of Imaging In Correct Diagnosis

Benazir Gul , Naseebullah Tareen, Palwasha Gul , Pari Gul, Khanda Gul — Mon, 01 Apr 2024 00:00:00 -0400

Ovarian dysgerminomas (OD) are rare ovarian germ cell tumors that usually affects young patients usually in 2nd and 3rd decades of life. Lower quadrant pain, adnexal mass and abdominal distension are common presentation of these tumours. Laboratory values such as beta human chorionic gonadotropin (beta-hCG) and lactate dehydrogenase may be elevated (LDH). Imaging such as ultrasound, CT and MRI can predict OD owing to its solid nature, internal calcifications and vascularized nature. Radiologically large solid lobulated adnexal mass with elevated LDH levels in young females strongly suggest an ovarian dysgerminoma as a probable diagnosis. OD will respond well to fertility sparing surgery and will be monitored by imaging and LDH levels. We report two cases of ovarian dysgerminoma and role of imaging in correct diagnosis of these uncommon tumors.

Tuberculosis of Breast - Case Report

Kanza Farrukh, Muhammad Raheem, Fahad Akhtar, S H Waqar — Mon, 01 Apr 2024 00:00:00 -0400

Tuberculosis of breast is rarely found, especially as primary presentation. The diagnosis can be difficult because the disease may mimic breast carcinoma, pyogenic abscess, and other granulomatous diseases. We present a case report of breast tuberculosis that was initially considered as breast carcinoma due to its typical presentation.

Behind the mystery, “rare” until that happens to you. A unique presentation; hard to suspect

Mon, 01 Apr 2024 00:00:00 -0400

This report investigates into the complexities of heterotopic pregnancy, a rare and potentially life-threatening condition characterized by simultaneous intrauterine and extra-uterine pregnancies. Diagnosis is challenging, requiring a vigilant approach, particularly in cases with risk factors or acute symptoms. The incidence of this condition has increased with the use of assisted reproductive techniques (ART), and delayed diagnosis can result in greater health risks.

In a specific case, a 33-year-old Asian woman presented with abdominal pain during her 17-week intrauterine pregnancy, which later escalated with heavy bleeding. Suspecting heterotopic pregnancy, the medical team performed an emergency laparotomy to successfully manage the situation.

Discussion highlights the diagnostic complexities of heterotopic pregnancy, often masquerading as an ectopic pregnancy. Beta-hCG levels can be misleading, making transvaginal ultrasound a critical diagnostic tool. The report emphasizes the role of ART and other risk factors in the condition's rising prevalence, while underscoring the importance of preserving the intrauterine pregnancy during management.

In conclusion, clinicians must maintain a heightened awareness of heterotopic pregnancy in patients with abdominal pain, especially when presenting symptoms resemble ectopic pregnancy. Timely diagnosis and appropriate management are essential for better patient outcomes, and routine screening to rule out extrauterine gestation is imperative.