Medicine and Health Sciences Commons^™

Critical Appraisal Of Endometriosis Management For Pain And Subfertility, N F. Zuberi, J H. Rizvi

Department of Obstetrics & Gynaecology

Objective: To critically appraise current best available management of pain and subfertility ascribable to endometriosis.
Methods: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis.
Discussion: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of …

Breast Diseases: A Histopathological Analysis Of 3279 Cases At A Tertiary Care Center In Pakistan, M. S. Siddiqui, Naila Kayani, Shahid Pervez, S. A. Aziz, S. Muzaffar, Z. Setna, M. Israr, S. H. Hasan, M. S. Gill

Department of Pathology and Laboratory Medicine

Objective: To know the frequency of breast diseases in Pakistani females.

Methods: A retrospective analysis of 3279 breast specimens received over a period of 4 years (1 993-1996) at the department of pathology, the Aga Khan University Hospital.

Results: Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or >2 cms. in 93% of cases and 40% of …

Increased Risk Of Cervical Canal Infections With Intracervical Foley Catheter, S Siddiqui, Nf Zuberi, Afia Zafar, Rn Qureshi

Department of Obstetrics & Gynaecology

OBJECTIVE: To evaluate the effect of intracervical Foley catheter insertion, for the induction of labor, on cervical canal infection.
DESIGN: A prospective interventional study with paired analysis.
PLACE AND DURATION OF STUDY: The study was conducted in the department of Obstetrics and Gynecology at the Aga Khan University, Karachi, between June 1 and August 31, 2002.
SUBJECTS AND METHODS: In 45 women undergoing cervical ripening with intracervical Foley catheter for the induction of labour at term, cervical swabs were taken for culture and sensitivity before its insertion and again after its spontaneous expulsion or removal.
RESULTS: Intracervical …

Comparative Study--Efficacy, Safety And Compliance Of Intravenous Iron Sucrose And Intramuscular Iron Sorbitol In Iron Deficiency Anemia Of Pregnancy, A Wali, A Mushtaq, Nilofer

Department of Obstetrics & Gynaecology

Objective: (1) To determine an alternative iron supplementation with better efficacy, compliance & safety in treatment of iron deficiency anemia during pregnancy, (2) to reduce blood transfusion during pregnancy, labor and puerperium.
Material and Method: A prospective comparative study. A total number of 60 pregnant women with the gestational age of 12 - 34 weeks were included in the study who were suffering from iron deficiency anemia. They were divided in 3 groups (A, B and C). Group A (n15) received intravenous iron sucrose according to recommended dose containing 500 mg of iron sucrose for storage, in group B (n=20) …

Histiocytosis X Of The Vulva, R M. Rizvi, C Nasreen, N Jafri

Department of Obstetrics & Gynaecology

No abstract provided.

Epidermal Growth Factor Receptor (Egfr) As A Prognostic Marker: An Immunohistochemical Study On 315 Consecutive Breast Carcinoma Patients, S. A. Aziz, Shahid Pervez, N. Kayani, M. H. Rahbar, S. Khan

Department of Pathology and Laboratory Medicine

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI).

Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling.

Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant …

Infected Endometrioma With Ascites And Bilateral Pleural Effusion, T Naru, N Chaudhury

Department of Obstetrics & Gynaecology

No abstract provided.

Maternal Deaths In A Developing Country: A Study From The Aga Khan University Hospital, Karachi, Pakistan 1988-1999, R N. Qureshi, S Jaleel, R Hamid, S F. Lakha

Department of Obstetrics & Gynaecology

Objective: The maternal deaths occurring over a twelve-year period (1988-1999) in a tertiary referral center were reviewed. The purpose of the study was to assess the causes of these maternal deaths.
Setting: The Aga Khan University Hospital (AKUH) Karachi, Pakistan.
Methods: The medical records of maternal deaths were reviewed. These were women who had either registered for delivery at the hospital; or were referred from another hospital or from home, when an emergency developed. They were either admitted to the Medicine, Surgery and the Obstetrics and Gynaecology Departments at the hospital.Results: A total of 81 maternal deaths were identified, of …

Female Genital Tuberculosis Revisted, R N. Qureshi, S Samad, R Hamid, S F. Lakha

Department of Obstetrics & Gynaecology

Objective: To assess the clinical presentation of genital tuberculosis and to study various modes of diagnosis and treatment.SETTING: The Aga Khan University Hospital (AKUH), Karachi.
Method: A retrospective case review of all index female cases of genital tuberculosis, admitted to AKUH over twelve years of period.
Result: A total of 40 cases of genital tuberculosis were reported during this time period. Majority of cases were between 25-45 years. The commonest presenting symptoms were infertility (42.5%) and abdominal pain (42%). Others included fever, ascites, irregular vaginal bleeding, oligomenorrhea, chest pain and pain in the flanks. Main mode of treatment was antituberculous …

Dna Ploidy Analysis Of Borderline Epithelial Ovarian Tumours, Saba Lodhi, Sabeen Najam, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective: Borderline epithelial ovarian tumors not uncommonly pose a great difficulty to surgical pathologists as morphologically they may show very similar features as those of malignant epithelial tumors except invasion. However it is important to separate these from their invasive counterparts because of their superior prognosis. Recently, attention has been focussed on the prognostic value of flow cytometric analysis of DNA ploidy in borderline epithelial ovarian tumors. The purpose of this study is to investigate whether flow cytometric analysis of cellular DNA content acts as a useful adjunct to the histopathological diagnosis of borderline malignancy.

Materials and Methods: Fifteen histologically …

Uterine Atony At A Tertiary Care Hospital In Pakistan: A Risk Factor Analysis, S H. Feerasta, A Motiei, S Motiwala, N F. Zuberi

Department of Obstetrics & Gynaecology

Objectives: To identify risk factors for uterine atony following assisted or unassisted vaginal delivery.
Design: This hospital based case control study was done at The Aga Khan University Karachi, Pakistan. Cases were defined as all women with uterine atony within 24 hours of an assisted or unassisted vaginal delivery. Controls were based on women with normal assisted or unassisted vaginal delivery without uterine atony. Data abstracted form the medical records; adjusted odds ratios were estimated by multiple logistic regression.
Results: Factors having a significant association with uterine atony were gestational diabetes mellitus (odds ratio 7.6, 95% CI 6.9-9.0, p = …

The Effect Of Grandmultiparity On Pregnancy Related Complications: The Aga Khan University Experience, S Munim, M H. Rahbar, M Rizvi, N Mushtaq

Department of Obstetrics & Gynaecology

Background: Grandmultiparity has been associated with complications for both mother and the fetus.Objective: To evaluate if grandmultiparity is a risk factor in the presence of adequate antenatal care.
Setting: A tertiary care teaching hospital.
Methods: It was a retrospective study conducted in the department of Obstetrics & Gynecology at The Aga Khan University Hospital in Karachi. During this period 9253 women were delivered, out of these 143 booked grandmultiparas (GMP) served as cases. The outcome of these women was compared with 430 non-grandmultiparas (NGMP). Logistic regression model was used to adjust for potential confounders.
Results: Grandmultiparas had almost three times …

Effect Of Prepregnancy Body Mass Index And Gestational Weight Gain On Birth Weight, S S. Merchant, I A. Momin, A A. Sewani, N F. Zuberi

Department of Obstetrics & Gynaecology

Objective: Nutritional status of women has been considered an important prognostic indicator of birth outcome. The study aims to show the effect of various prepregnancy Body Mass Index (BMI) categories and corresponding gestational weight gain on newborn birth weight.
Methods: Two hundred women were included in the study. These women had regular antenatal visits and later delivered at The Aga Khan University Hospital (AKUH) between the period January 1, 1996 to December 31, 1997.
Results: For women with prepregnancy BMI < 19., mean birth weight of newborns was lower for those gaining < 12.5 kg than those gaining > 12.5 kg (P < 0.001). Women who started their pregnancy with BMI 19.8-26 and gained weight above expected range gave birth to high birth weight babies (P = 0.009). Gestational weight gain did not have a significant association with birth weight for women having prepregnancy BMI > 26.
Conclusion: Efforts should be made to attain adequate prepregnancy weight to reduce the likelihood of low …

A Comparison Of Severe Pre-Eclampsia/Eclampsia In Patients With And Without Hellp Syndrome, N F. Zuberi, K Arif, F M. Khan, J A. Pal

Department of Obstetrics & Gynaecology

Background: The relationship of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome with maternal and perinatal health and its presentation in Pakistani population is not known.
Purpose: To determine the mode of presentation along with maternal and perinatal outcome of patients with HELLP syndrome.
Methods: Case records of patients with severe hypertension in pregnancy who delivered between January 1, 1989 and December 31, 1994 at The Aga Khan University Hospital, Karachi. Out of 120 cases of severe pre-eclampsia/eclampsia, there were 36 cases of HELLP syndrome (Group-A). These were then compared with cases without HELLP syndrome (Group B) for their …

Effects Of First And Second Trimester Vaginal Bleeding On Pregnancy Outcome, S A. Karim, I Bakhtawar, A T. Butta, M Jalil

Department of Obstetrics & Gynaecology

The effects of vaginal bleeding during first and second trimester on pregnancy outcomes was assessed in a hospital-based population of 268 non-diabetic women. The group of non-bleeders comprised 173 females whereas, there were 71 females with first and 24 with second trimester bleeding. Fetal loss (abortion) occurred in 34% of first trimester and 25% of second trimester bleeders. Low birth weight and preterm delivery were significantly associated with second trimester haemorrhage. The results suggest that first and second trimester vaginal bleeding correlates with adverse infant outcomes.

Diagnostic Evaluation Of Fine Needle Aspiration Cytology In The Management Of Palpable Breast Lesions, S. H. Shah, Naila Kayani, S. H. Hasan, I. N. Soomro, Shahid Pervez, A. S. Hussainy

Department of Pathology and Laboratory Medicine

A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. …

Prevalence And Severity Of Viral Hepatitis In Pakistani Pregnant Women: A Five Year Hospital Based Study, A B. Aziz, S Hamid, S Iqbal, W Islam, S A. Karim

Department of Obstetrics & Gynaecology

A hospital based observational study was carried out on pregnant women presenting with either acute hepatitis or fulminant hepatic failure (FHF), during the past years. Of 53 patients, 20 (38%) developed FHF.Non-A, Non-B was the commonest cause (62%) followed by hepatitis B in 17% and hepatitis A in 4% cases. Eight women expired (case fatality rate 15%) with a high maternal mortality (62%) caused by NANB hepatitis. Perinatal mortality was 30%. Poor prognostic factors identified were lack of antenatal care, severity of jaundice, history of somnolence, gastrointestinal bleeding and a high grade of encephalopathy.

Hereditary Ovarian Cancer Syndromes In Three Pakistani Families, A B. Aziz, M Sabih, I A. Malik

Department of Obstetrics & Gynaecology

No abstract provided.

Risk Of Uterine Rupture After The Partographic 'Alert' Line Is Crossed--An Additional Dimension In The Quest Towards Safe Motherhood In Labour Following Caesarean Section, K S. Khan, A Rizvi, J H. Rizvi

Department of Obstetrics & Gynaecology

To determine if prolonged active phase of labour is associated with increased risk of uterine scar rupture in labour following previous lower segment caesarean section, a retrospective cohort study (1988-91) was done to analyse active phase partographs of 236 patients undergoing trial of labour following caesarean section, 7 (3%) of whom had scar rupture. After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate "alert". A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of "alert" line), B (0-1 h after "alert" …

Audit Changes Clinical Practice! Impact On Rate Of Justification Of Hysterectomy Indication, Khalid S. Khan, J H. Rizvi

Department of Obstetrics & Gynaecology

After performing a baseline audit in 1986-89, an ongoing quality assurance process was initiated in January, 1990 and all hysterectomies performed over the next 2 year period were analyzed. Hysterectomy indications were divided into two groups: one in which the uterine specimen was expected to show pathology and another in which no pathology was expected. The hysterectomy was considered justified in the former if the pathology report verified the indication or showed a significant alternate pathology. In the latter, validation criteria showing documentation of certain prerequisite diagnostic procedures performed before reverting to hysterectomy, were used to ascertain justification. The overall …

Are Non-Diabetic Women With Abnormal Glucose Screening Test At Increased Risk Of Pre-Eclampsia, Macrosomia And Caesarian Birth?, Khalid S. Khan, Firasat A. Hashmi, J H. Rizvi

Department of Obstetrics & Gynaecology

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks, In 482 cases the GCT was abnormal (plasma glucose value was >140 mg% 2 hours after 75g glucose challenge). Of these, 292 had one or more abnormal critical …

Malakoplakia Of The Uterus, H Shaikh, P E. Khan, N Faridi

Department of Pathology and Laboratory Medicine

No abstract provided.

Laparoscopic Appraisal Of Infertility And Pelvic Pain In Pakistani Women: A 5 Years Audit, R Hamid, K S. Khan, T Mubeen, J A. Razzak

Department of Obstetrics & Gynaecology

Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women …

Bacteriuria And Pregnancy Outcome: A Prospective Hospital-Based Study In Pakistani Women, R N. Qureshi, Khalid S. Khan, Omar Darr, Nasir Khattak, Bader J. Farooqui, J H. Rizvi

Department of Obstetrics & Gynaecology

The prevalence of bacteriuria in Pakistani women and its association with complications of pregnancy was studied. Out of 1579 women, 77 had bacteriuria (4.8%). There was no association of age, gravidity, parity, haemoglobin, pre-eclampsia, mode of delivery, gestational age at delivery, preterm delivery and low birth-weight with presence of bacteriuria. With detection and treatment the pregnancy outcome of women with bacteriuria in pregnancy was the same as that of those without.

Aggressive Angiomyxoma Of Vulva, Farrukh Aijaz, Shahid Pervez, Shehnaz Wasti, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

No abstract provided.

Platelets And Leucocyte Counts In Pregnancy, Saadiya Aziz Karim, Javaid H. Rizvi, Iffat Rizwana, Mohammad Khurshid, Sadiqua N. Jafarey

Department of Obstetrics & Gynaecology

A study involving the obstetric clinic population of 3 major teaching hospitals of Karachi has been conducted to define changes in leucocyte and platelet counts as pregnancy progresses. 573 “normal” pregnant women - 183 in the first trimester, 195 in the second trimester and 194 in the third trimester were included in this analysis. We have found leucocytosis to be a feature of normal pregnancy; the change is subsequent to a progressive increase in granulocytes. Platelet counts were found to decrease slightly as pregnancy progresses

A Clinicopathological Analysis Of Ovarian Tumours, M Saeed, K Khawaja, I Rizwana, Iffat Rizwana, J Rizvi, Imtiaz Malik, A Khan

Department of Obstetrics & Gynaecology

We performed a retrospective analysis of patients with ovarian tumors who were admitted to the Aga Khan University Hospital from January 1985 to December 1989. Sixty one cases were reviewed. Mean age of the whole group was 44 years. Majority of the patients presented with abdominal pain and distention. Most frequent physical finding was a palpable mass on pelvic or abdominal examination. Overall these patients had a higher incidence of breast cancer than expected in the general population. Two-thirds of the tumors were malignant. Comparison of the patients with malignancy against those with benign tumors failed to show any correlation …

Gestational Diabetes In A Developing Country, Experience Of Screening At The Aga Khan University Medical Centre, Karachi, Khalid S. Khan, J H. Rizvi, R N. Qureshi, R Mazhar

Department of Obstetrics & Gynaecology

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than …

Gestational Diabetes In A Developing Country, Experience Of Screening At The Aga Khan University Medical Centre, Karachi, Khalid S. Khan, Javaid H. Rizvi,, Rahat Qureshi, Rauf Mazhar

Department of Obstetrics & Gynaecology

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga khan University Medical Centre were subjected to a 75g glucose challenge followed 2hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at < 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at < 28 weeks gestation. The glucose challenge test was abnormal (2hr plasma glucose> 1 40mg%) in 8.6% of the screened population. Follow-up oral glucose tolerance test on these patients revealed a prevalence of 3.2% of gestationat diabetes and 1.9% of impaired glucose tolerance test based on the modified …

Serum Cholesterol In Neonates And Their Mothers. A Pilot Study, S.H. Badruddin, R. Lalani, Mohammad Khurshid, A. Molla, R. Qureshi, M.A. Khan

Department of Medicine

Reports from the Aga Khan University indicate that 58% of 400 school children studied had undesirably high serum cholesterol levels. The present study was undertaken to determine whether the high cholesterol levels are present at birth and to determine the relationship between cord blood, maternal blood cholesterol and maternal diet. Cord blood from 58 neonates and fasting venous blood form 45 mothers were analyzed for total serum cholesterol. Mothers were interviewed regarding their usual diet during pregnancy. Mean cord blood cholesterol was 56.90 mg/dl (range 26 to 123 mg/dI). Mean maternal blood cholesterol was 232.4mg/dl (range 141-382 mg/dl). Mean maternal …