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[en] Ectopic pregnancy (EP) is a major problem in obstetrics as there is evidence of increasing incidence throughout the world. It is an important cause of maternal morbidity and mortality. In Pakistan, the care seeking behaviour among female is limited that makes female vulnerable to die due to complication of ectopic pregnancy. The aim of this study is to determine the frequency of tubal rupture in ectopic pregnancy in Pakistani patients. Method: In this cross-sectional study data pertaining to age, gestational age, parity and duration of presenting symptoms were collected and analysed. Result: 80 patients were diagnosed to have ectopic pregnancy. The frequency of tubal rupture was 91.25%. It is encountered significantly more often in women with age of 26 years. More tubal rupture is found in patient with low parity, in which the frequency of tubal rupture is up to 100% and decrease up to 78.6% with increasing parity up to four. Furthermore, it is noted that increase in gestational age from 8 weeks to 10 weeks caused an increase in frequency of tubal rupture from 80 to 100% respectively. It is also noted that earlier the patient presents the lesser is the frequency of tubal rupture, as compared to late presentation beyond 3-4 days which make frequency up to 95%. Conclusion: Tubal rupture is still common cause of maternal morbidity and mortality, and is still a major challenge in gynaecological practice. Creating awareness amongst midwives and GPs regarding early diagnosis can contribute to decrease the mortality, morbidity and fertility loss related to EP. (author)
[en] The authors reviewed the reports of 4/3 abnormal hysterosalpingographies from 1,200 medical records of patients at the sterility and infertility out-patient clinic of the School of Medical Sciences of the State University of Campinas (Unicamp), from July, 1974 to December, 1981. The objective was to evaluate the incidence and main alterations diagnosed by hysterosalpingography. The most frequent findings were tuboperitoneal factors in 91% of the examinations, uterine cavity abnormalities in 17.4% and cervical factor in 6.3% of the cases. The examinations showed a great incident of tuboperitoneal abnormalities as cause of sterility from lower social classes. (author)
[pt]Foram revisados 1.200 prontuarios de pacientes atendidos no setor de esterilidade conjugal da Faculdade de Ciencias Medicas da Universidade de Campinas (FCM-Unicamp) com queixa de esterilidade, no periodo de julho de 1974 a dezembro de 1981 de onde foram analisados os laudos de 473 histerossalpingografias (HSG) com resultados anormais, para avaliar incidencia e alteracoes mais frequentes. As principais alteracoes encontradas foram: fatores tuboperitoneais em 91% dos exames, alteracoes de cavidade uterina em 17,4% e cervicais em 6,3% dos exames. Os exames mostraram a grande incidencia de alteracoes tuboperitoneais como causa de esterilidade conjugal em um servico universitario que atende a uma populacao predominantemente de baixa renda. (autor)
[en] To correlate transvaginal sonographic findings with histopathology in diffuse uterine adenomyosis. We prospectively analyzed the transvaginal sonographic findings of 15 patients undergoing hysterectomy for adenomyosis. Diffuse adenomyosis was diagnosed when an abnormal echotexture (heterogenous echogenicity, decreased echogenicity, increased echogenicity, cystic lesion) was present in myometrium of enlarged uterus. We evaluate the size of the uterus, abnormal echotexture in myometrium and anterior and posterior myometrial wall thickness'. Transvaginal sonographic findings of diffuse adenomyosis are enlarged uterus (n=15), heterogenous and increased echogenicity in myometrium (n=10), heterogenous echogenicity in myometrium (n=4), heterogenous and increased echogenicity with cystic lesion lesion in myometrium (n=1). The posterior myometrial wall is equal to anterior wall (n=7), thicker than anterior wall (n=4), thinner than anterior wall (n=4). The histopathologic findings including ectopic endometrial gland (n=14), muscular hypertrophy (n=15), myoma (n=4). Diffuse adenomyosis was confirmed except one case that proved myoma. Transvaginal sonographic findings of enlarged uterus with heterogenous and increased echotexture in myometrium of adenomyosis is correlated with ectopic endometrial gland with secondary muscular hypertrophy.
[en] Purpose/Objective: To compare one and two intracavitary brachytherapy with low dose rate in the management of stage IIB cervix cancer through a prospective and randomized trial. Materials and Methods: From September 1989 to December 1992, 81 patients with stage IIB cervix cancer were randomized in two arms according to the number of intracavitary brachytherapy insertion to be realized. Of these, 34 were treated by two intracavitary insertions (group A) and 47 by one insertion (group B). The external beam radiotherapy (EBRT) was realized through a Cobalt unit at whole pelvis with total dose of 40Gy in 20 fractions of 2,0Gy, in box arrangement, followed by parametrial complementation of 10Gy. The brachytherapy was realized right after the end of EBRT. The patients from group A were underwent to two insertions of 25Gy, calculated at point A, defined by the Manchester system. The interval between each insertions was 2 weeks. The patients from group B were underwent to one insertion of 40 Gy at point A. The average dose rate was 60cGy per hour at point A. Results: With the follow up ranging from 36 to 75 months and medium of 55 months, the disease free survival of the patients from group A was not statistically different of those from group B, 70,6% and 72,3% respectively (p=0,711). Local recurrence occurred in four patients from group A (11,7%) and in eight from group B (17%). Distant metastasis occurred in one patient from group A (2,9%) and in two from group B (4,2%). Three patients from group A (8,8%) and three from group B (6,4%) were lost to follow up and considered as dead. The causes of death among patients from group A were progression of local disease in four, distant metastasis in one, complicated diabetes mellitus in one and actinic intestinal complications in other one. The cause of deaths among patients from group B were progression of local disease in eight and distant metastasis in two. The grade I and II rectal complications rate was 5,9% and 6,3% at groups A and B respectively. Grade III rectal complications occurred in 8,8% of the patients from group A and in 0% from group B. Grade I genitourinary complications occurred in 8,8% of the patients from group A and in 2,1% from group B. The table of complications and survival curves will be shown during the poster session. Conclusions: These series suggest that there is no difference in disease free survival in the management of stage IIB cervix cancer treated by one or two intracavitary brachytherapy applications. The higher incidence of grade III rectal complication among patients from group A can be probably due to the higher total dose delivered at point A
[en] H.S.G. has been proven to be an important diagnostic method in clinical gynecology for under 50 yrs. It is valuable in the investigation of the uterine and tubal factors of female infertility. Hysterosalpingograms of 81 patients with infertility were analyzed and following brief results were obtained. Ratio between primary and secondary infertility was 3 : 5, secondary infertility was more frequent. 2. Age distribution was more frequent under 30 years of age than over 30 years of age. 3. Abnormal uterine findings was only seen in 18 cases, abnormal tubal finding was only seen in 25 cases and combined uterine and tubal abnormalities were seen in 14 cases. 4. Abnormal uterine findings were malposition (12 cases), filling defect (5), spastic uterus (5), irregular contour (3), arcuate uterus (3), didelphia (1), in order of frequency. 5. Abnormal tubal findings were hydrosalpinx (21 cases), occlusion (19), intravasation (6), beaded appearance (3), and diverticula (2), in order of frequency. 6. Negative finding in both uterus tube was seen in 23 cases. 7. In 2 cases, pregnancy after the H.S.G. examination was confirmed.
[en] Unicomuate uterus with rudimentary horn is a rare type of uterine malformation associated with obstetrical complications. Rupture of pregnant rudimentary horn is the usual presentation resulting in severe haemoperitoneum with increased maternal morbidity, and at times, mortality. A case of ruptured rudimentary horn pregnancy in a 24-year-old, second gravida, is reported. Exploratory laparotomy revealed a ruptured rudimentary horn pregnancy of 14 weeks gestation with haemoperitoneum. Excision of the rudimentary horn was done and an uneventful recovery followed. (author)
[en] Background: There is a trend of rising caesarean section rate over the past decade affecting the economy of the country. This continually rising caesarean section rate is of increasing concern to the health professionals and the public This study was designed to assess the indications and trends of caesarean sections done over a five year period from 2007 to 2011. Methods: This was a retrospective observational study done over a five year period in the department of Obstetrics and Gynaecology Fatima Memorial Hospital Lahore from 2007 to 2011. Results: Total no of deliveries from 2007 to 2011 were 30741 out of which caesarean sections performed were 13820.The caesarean birth rate increased from 41% to-48%. The indications varied a little in case of mal-presentation and eclampsia. APH and IUGR has risen a little from (from 2.56% to 2.6% and 1.83% to 2.34% respectively). But proportion of repeat caesarean section increased by 25.99% to 31.45% and that of presumed fetal distress increased from 8% to 15% respectively. Recently the indication of maternal choice is emerging with incidence of 0.8% in our study. The proportion has fallen in prolonged labour due to cervical dystocia from 17% to 14% and in obstructed labour from 4.6% to 3%. Conclusion: Individualization of every case, meticulous clinical examination, use of intrapartum fetomaternal survellience along with regular use of partograrm would limit the practice of undue caesarean sections. (author)
[en] The purpose of this study is to investigate the effect of developed product on skin and reproductive system of animal due to irradiation via in vivo test, and finally acquire fundamental data for evaluation of protective materials on degenerative damages. <1st year> - Evaluate the effect of candidate materials on UV-induced skin damages · Test the effect of candidate materials to protect the skin from photodamage, the gross and microscopic changes in the skin of hairless mice and materials-treated mice exposed chronically to UV <2nd year> - Evaluate the effect of developed product (HemoHIM) on radiation-induced reproductive system (female) damages - Evaluate the effect of developed product (HemoHIM) on chemical-induced reproductive system (female) damages <3rd year> - Evaluate the effect of developed product (HemoHIM) on radiation-induced reproductive system (male) damages - Evaluate the effect of developed product (HemoHIM) on chemical-induced reproductive system (male) damages
[en] To characterize the sonohysterographic (SH) findings of endometrial hyperplasia and cancer and to determine the role of SH in differentiating endometrial cancer from hyperplasia. The clinical, pathologic and SH findings of 38 patients with histologically confirmed endometrial hyperplasia (n=21), atypical hyperplasia 9n=6), and cancer (n=11) were reviewed retrospectively. We evaluate the presence and morphologic characteristics 9 surface contour ehcogenicity, echotexture) of endometrial thickening and mass, obliteration of endometrial cavity, and disruption of endometrial-myometrial interface on SH. SH findings of endometrial hyperplasia were endometrial thickening in 17 cases (81%), mass in 8 cases (38%), and regular surface of endometrium and mass in 16 (76%) and 6 cases (75%) respectively. Obliteration of endometrial cavity was seen only in 3 cases (14%) of endometrial hyperplasia and 1 case (17%) of atypical hyperplasia and disruption of endometrial-myometrial interface was not seen. Endometrial cancer showed endometrial thickening in 6 cases (55%), mass in 7 cases (64%), irregular surface of endometrium and mass in 10 (91%) and 7 cases (100%) respectively, obliteration of endometrial cavity in 10 cases(91%), and disruption of endometrial-myometrial interface in 4 of 8 cases with myometrial invasion. Using endometrial thickening or mass with irregular surface and obliteration of endometrial cavity as the positive findings for SH diagnosis of endometrial cancer, we observed sensitivity of 90.9%, specificity of 85.2%, and accuracy of 86.8%. The demonstration of the irregular surface with endometrial thickening or mass and obliteration of endometrial cavity through SH were suggestive of endometrial cancer.