Medicine and Health Sciences Commons^™

Maternal And Fetal Outcome In Renal Transplant Recipients, Wajeeha Syed, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To determine maternal and fetal outcome in renal transplant recipients.
Methodology: Retrospective analysis of the antenatal patients with renal transplant
was done between January 1st 2005 till December 31st 2015 and maternal
and fetal outcomes were determined. Data was entered and analyzed in SPSS
version 20.
Results: 08 pregnancies in 07 women who had undergone renal transplant
were included in this study. The mean age at the time of transplantation was
25.29 ±5.5 years (16-32 years). 25% cases had gestational diabetes mellitus,
75% had anemia and 50% had urinary tract infection. The mean birth weight
of babies was 2210 …

"The Co-Authors Of Pregnancy": Leveraging Men's Sense Of Responsibility And Other Factors For Male Involvement In Antenatal Services In Kinshasa, Drc, Michelle M. Gill, John Ditekemena, Aimé Loando, Vicky Ilunga, Marleen Temmerman, Franck Fwamba

Department of Obstetrics & Gynaecology

Background: Despite efforts to improve male involvement (MI), few male partners typically attend antenatal care (ANC). MI in ANC and interventions to prevent mother-to-child HIV transmission have been demonstrated to be beneficial for the HIV-positive mother and her child. This study aimed to explore factors influencing partner attendance and highlight interventions with potential to improve MI within a Congolese context.
Methods: This was an exploratory, qualitative study conducted in two urban and two semi-urban catchment areas of Kinshasa, DRC in June–September 2016. Two women-only and two men-only focus group discussions (FGDs) were held; participants were recruited from ANC clinics and …

Referral Pattern Of Emergencies In Obstetrics: Implications For Defining Scope Of Services And Policy, Rahat Najam Qureshi, Rozina Sikandar Sultanali, Zahra Hoodbhoy, Raffat Bano, Nigar Jabeen

Department of Obstetrics & Gynaecology

Objective: To analyse referral pattern of high-risk obstetric cases from secondary to tertiary care hospitals and to assess their maternal and neonatal outcomes.

Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised all referred obstetric cases from secondary-level hospitals to tertiary-level care within and outside the Hospital between January 2011 and December 2014. Day and time of referral, reason for referral as well as maternal and neonatal outcomes were collected. SPSS 19 was used for data analysis.

Results: Of the 634 obstetric referrals, 279(44%) patients were referred to the study site, while 355(56%) …

Obstetric Patients In Intensive Care Unit: Perspective From A Teaching Hospital In Pakistan, Rahat Qureshi, Sheikh Irfan Ahmed, Amir Raza, Ayesha Khurshid, Uzma Chishti

Department of Obstetrics & Gynaecology

Objective: Review of obstetric cases admitted to the intensive care unit.
Design: Ten year retrospective review of individual patients' medical records.
Participants: Records of obstetric patients admitted from 2005-2014.
Setting: Aga Khan University Hospital Karachi.
Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay …

Comparative Effects Of Ballooning Intracervical Catheter And Prostaglandin Pessary On Cervical Ripening, Raheela Baloch, Qamarunissa Muhabat, Fakhrunissa Waheed, Waqarunissa Ahmed

Department of Obstetrics & Gynaecology

Labor is induced to stimulate the uterine contraction in effort to have vaginal birth. Induction may be advocated to reduce fetal or neonatal morbidity and mortality. Indication of labor needs to be considered when risk and benefits analysis indicates that delivering the baby is safe option for mother or both rather than continuing the pregnancy and when there are no clear indications for caesarean section and no contraindication for vaginal delivery.

True Knot Of Umbilical Cord: Case Report And Review Of Literat, Momna Khan, Sana Zahiruddin, Maria Iftikhar

Department of Obstetrics & Gynaecology

True knot of umbilical cord (TKUC) is a rare abnormality. When it becomes tight, it may lead to the obstruction of the foetal circulation and intrauterine death (IUD). We present two cases of TKUC managed at The Aga Khan University Hospital with two extreme outcomes. A 22 years old primigravida was diagnosed with unexplained intrauterine foetal demise at 28th week gestation. She delivered vaginally after induction and tight TKUC was identified as a cause of IUD. The second patient delivered an alive healthy male baby vaginally who was found to have a lose TKUC.

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

Fallopian Tube Cyst: A Rare Complication Of Tubal Sterilization, Sana Zahiruddin, Momna Khan, Maria Iftikhar

Department of Obstetrics & Gynaecology

Tubal sterilization is one of the most commonly employed permanent method of contraception, although it is considered very safe, rarely a cyst may develop in the fallopian tube after sterilization which may undergo torsion resulting in patient presenting with acute abdomen. We are presenting a case of a middle aged women presenting to emergency room with severe lower abdominal pain, she had past history of tubal ligation done 12 years back. Pelvic ultrasound showed right sided ovarian cyst, emergency laparotomy was performed for suspected torsion of ovarian cyst, which revealed normal ovary, however a right sided fallopian tube cyst was …

Clinical Presentation Of Ovarian Tumors, Qamarunissa Muhabat, Fakharunissa Waheed, Waqar Unissa, Nigar Jabeen

Department of Obstetrics & Gynaecology

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

Comparison Of Risk Factors And Survival Of Type 1 And Type Ii Endometrial Cancers, Tahira Y. Malik, Uzma Chishti, Aliya Aziz, Irfan Sheikh

Department of Obstetrics & Gynaecology

Objective: To compare risk factors and progression free survival of type 1 & 2 endometrial cancers.
Methods: A retrospective analysis of 149 patients with early stage endometrial carcinoma treated between 1997 and 2012 in Aga Khan University Hospital, Karachi was performed.
Results: A total of 149 patients were analyzed. Type I tumors accounted for 92% of cases in the study while 8% were type II tumors. The mean age, BMI, parity, co-morbidities (hypertension & Diabetes), family history and history of polycystic disease were comparable in both groups. Overall better survival (113 Vs 24 months) was observed for type I endometrial …

Anticipated And Unanticipated Complications Of Severe Dengue In A Primigravida, Madiha Hashmi, Ghulam Zainab, Farah Khan

Department of Obstetrics & Gynaecology

As the incidence of dengue is rising among adults more cases of dengue fever are being reported during pregnancy. Physiological changes of pregnancy mask the pathognomonic features of severe dengue such as increased hematocrit, thrombocytopenia, and leukopenia and a high index of suspicion are required in endemic areas. Massive hemorrhage may complicate operative deliveries in unsuspected patients. World Health Organization recommends that all patients with severe dengue should be admitted to a hospital with access to intensive care facilities and blood transfusion. We present the successful management of hemorrhage and unanticipated complications of severe dengue in a young primigravida admitted …

Impact Of Self Regulation Skills On Students Academic Grades, Abeer Kathawala, Shelina Bhamani

Department of Obstetrics & Gynaecology

This research aimed to explore if self-regulation skills had any effect on the academic outcomes of young children in private schools of Karachi, Pakistan. Quantitative research method was used to determine the impact of self-regulation upon the academic outcome of young children by utilizing Early School Self-Regulation Scale-Care Giver Version (Bhamani, 2012).The sample size consisted of randomly chosen 210 children, studying in grades 1 and 2 from seven different private schools in Karachi. The results of the research show that selfregulation skills had a significant impact on the academic outcome of young children in private schools of Karachi, b = …

Comparing Neonatal Respiratory Morbidity In Neonates Delivered At Term By Elective Caesarean Section With And Without Dexamethasone: Retrospective Cohort Study, Anita Dileep, Neelofur Babar Khan, Sana Sadiq Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the effect of dexamethasone on neonatal respiratory morbidity in babies delivered by early term elective lower segment Caesarean section. Method: The retrospective cohort study was conducted at a secondary level hospital in Karachi. It reviewed the medical record of pregnant women and their babies who were delivered by elective lower segment Caesarean section between January 1 and June 30, 2013, at 37-38+6 weeks of pregnancy. The women were divided into exposed group (Group A) who received prophylactic dexamethasone, and non-exposed group (Group B) who did not receive dexamethasone Neonatal respiratory morbidity was compared between the two groups. …

Financing Early Childhood Education: An Investment Into The Future, Shelina Bhamani

Department of Obstetrics & Gynaecology

No abstract provided.

Is Risk Malignancy Index A Useful Tool For Predicting Malignant Ovarian Masses In Developing Countries?, Aliya Aziz, Nida Najmi

Department of Obstetrics & Gynaecology

Introduction: Risk of Malignancy Index (RMI) is widely studied for prediction of malignant pelvic masses in Western population. However, little is known regarding its implication in the developing countries. The objective of this study is to determine how accurately the RMI can predict the malignant pelvic masses.

Materials and Methods: The study is a retrospective review of patients attending the gynecological clinic between January 2004 and December 2008 with adnexal masses. Information on demographic characteristics, ultrasound findings, menopausal status, CA125, and histopathology was collected. RMI score for each patient in the study group was calculated.

Results: The study …

Predictors Of Vaccination Card Retention In Children 12-59 Months Old In Karachi, Pakistan, Sana Sadiq Sheikh, Syed Asad Ali

Department of Obstetrics & Gynaecology

Objective: To determine the factors associated with retaining the vaccination card among care takers of 12-59 months old children in Karachi, Pakistan.
Methods: This was an analytical cross-sectional study in Karachi. Households were randomly selected throughout a multistage cluster sampling technique. Data was collected for 504 children of 12- 59 months of age. Questionnaire was administered to caretakers to gather information regarding the children's vaccination status, socio-demographic characteristics and reviewing their vaccination cards. Statistical analysis was done by SPSS 19 using logistic regression.
Results: Among 462 vaccinated children, caretakers of 33% provided vaccination cards. Odds of card retention decrease if …

Gender Differences In Self-Esteem In Young Adolescents Of Karachi, Shelina Bhamani, Sabeen Jamil, Falak Zehra Mohsin

Department of Obstetrics & Gynaecology

The purpose of this research was to explore the self-esteem trends in adolescents of Karachi, Pakistan with regard to gender differences. The insights from previous literature helped to form the hypothesis that there will be a significant gender difference on the self-esteem of adolescents variable. There were a total 224 (96 male and 126 female) adolescents chosen for this study and the Multidimensional Self-Esteem Scale: a 36 item and a 3 Likert response scale was adapted for this study with the consent of the author. The data analysis revealed that there is a significant gender difference on the variable of …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …

Validation Of Verbal Autopsy Tool For Ascertaining The Causes Of Stillbirth, Sidrah Nausheen, Sajid B. Soofi, Kamran Sadiq, Atif Habib, Ali Turab, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Zulfiqar A. Bhutta, Zahid Memon, Rajiv Bahl, M. Imran Khan, Shireen Bhutta

Department of Obstetrics & Gynaecology

Objective: To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.
Methods: All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death …

Wilson’S Disease In Pregnancy: Case Series And Review Of Literature, Ayesha Malik, Ali Khawaja, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Background: Wilson’s disease is a rare, autosomal recessive inherited disorder characterized by impaired liver metabolism of copper leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson’s disease has been shown to cause subfertility and even in cases where pregnancy occurs, it often results in spontaneous miscarriage.

Case presentations: We present four cases of successful pregnancy outcomes in three patients diagnosed with Wilson’s disease along with the literature review. All the patients were managed with zinc sulphate without any postnatal complications.

Conclusion: Patients with Wilson’s disease receiving regular treatment who remain asymptomatic …

Gastroschisis, Raffat Bano, Akhtar Amin Memon, Ammara Mushtaq

Department of Obstetrics & Gynaecology

We report a case of gastroschisis which was not diagnosed antenatally and was delivered through lower segment caesarean section due to non-reassuring cardiotocograph and small for gestational age fetus in a 21-year old mother. It was associated with oligohydramnios and partial extension of wrist joint in the neonate. After delivery, baby was referred to tertiary care for specialized care by paediatric surgeon and neonatologist where he had silo reduction and surgical repair. Postnatally, the baby is in healthy condition till now.

Frequent Hypomethylation Of Ptgs2 Gene Promoter In Human Term Placenta, Nuruddin Mohammad, Ahmed Yaqinuddin, Fatima Kakal, Lumaan Sheikh, Rahat Qureshi, Mehreen Soman

Department of Obstetrics & Gynaecology

Background: Gene expression profiles of several tumor suppressor genes are regulated by the methylation and demethylation of their promoters. Here, we aim to identify and quantify the methylation status of four tumor suppressor genes from placentas at term and compare them with the maternal white-blood-cells.

Methods: In order to achieve this objective, DNA enriched from twenty placentas at term and maternal white blood cells was bisulfite-converted and amplified using quantitative real-time methyl-light polymerase chain reaction for the four-genes studied (RASSF1A, APC, RAR-beta, and PTGS2).

Results: Among the four genes examined, RASSF1A, APC and RAR-beta promoter regions were hypermethylated in all …

A Review Of Comparison Of Complications Of Vaginal Hysterectomy With And Without Concomitant Surgery For Sui: A 5 Years’ Experience At A Tertiary Care Hospital Of Pakistan, Raheela Mohsin Rizvi, Munnazza Akhtar, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH …

Rational Use Of Antibiotics--A Quality Improvement Initiative In Hospital Setting, Sidrah Nausheen, Rabia Hammad, Ambreen Khan

Department of Obstetrics & Gynaecology

Objectives: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaeocology.
Methods: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13.
Results: Therapeutic antibiotic use was rationalized, reducing the use …

Silent Uterine Rupture Of Scarred Uterus--An Unusual Presentation As Amniocele, Aisha Syed Wali, Tahira Naru

Department of Obstetrics & Gynaecology

Obstetricians should be aware of the possibility of silent rupture of scarred uterus. Ultrasound has an important role in the diagnosis of silent uterine rupture. A case of silent uterine rupture with foetal demise, that remained undiagnosed for many weeks, is described.

Assessment Of Experimental Animal Model For Training Obstetric Anal Sphincter Injury Techniques, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The Multiparous Goat Pelvic Model was used to train obstetricians and residents for perineal and anal sphincter anatomy and techniques of repair of Obstetric Anal Sphincter Injuries (OASIs). The purpose of this study was to assess the similarity of this model with human anatomy and the usefulness of goat model for training obstetricians for perineal tears. Six workshops were conducted between June 2009 and December 2010. A total of 90 participants, including 64(70.3%) residents and 26(28.5%) consultants in Obstetrics and Gynaecology, attended hands-on training workshops using experimental goat pelvic model for the repair of perineal tears. Among the consultants, 23 …

Association Of Gestational Weight Gain And Pre-Pregnancy Body Mass Index With Adverse Pregnancy Outcome, Shama Munim, Humaira Maheen

Department of Obstetrics & Gynaecology

Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007.
Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight (LBW), preterm delivery, large for gestational age …

Each Day Outdoor Play!Exchange-Early Childhood Leaders, Shelina Bhamani

Department of Obstetrics & Gynaecology

No abstract provided.

Pregnancy Loss Rate Following Amniocentesis, Shama Munim, Humera Ismail

Department of Obstetrics & Gynaecology

Objective: To determine pregnancy loss rate following amniocentesis in a mainstream urban healthcare centre.
Methods: We analysed cases of all pregnant women who underwent Amniocentesis at the Foetal Medicine Unit of Aga Khan University Hospital, Karachi, during 2001 to 2010. Cases of unknown pregnancy outcome were excluded, and after the process of consent, the final study population was 228 patients. Two operators performed the procedure using 22 G needle.
Results: The mean age of women in the study was 32 +/- 6 years. The commonest indication of the procedure was a previous baby with Down's Syndrome. Majority 197 (86.6%) cases …

Spontaneous Bilateral Tubal Pregnancy, Aisha Syed Wali, Rozilla Sadia Khan

Department of Obstetrics & Gynaecology

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described.