Objective: To study efficacy of Magnesium Sulphate in reducing maternal morbidity and mortality in patients presenting with eclampsia. Study Design: Prospective observational study. Place and Duration of Study: Gynae/Obs Department, Combined Military Hospital Bannu, from Jan 2018 Sep 2019. Methodology: A total of 134 patients fulfilling inclusion criteria were included in the study. Patient management was multidisciplinary. Convulsions were controlled by 4gram magnesium sulphate intravenously over 20 minutes as a loading dose, followed by 1gram per hour of maintenance infusion. Blood pressure was controlled with injection Labetalol 10 milligram followed by injection Hydralazine repeated after every 20 minutes till the blood pressure was controlled. Results: A total of 134 patients had eclampsia constituting 6.8% of obstetric admissions. Case fatality was 14 (10.4%) while 120 (89.55%) of the cases responded well to treatment and survived the event. Mean age of patients was 22 years. Thirty patients 22.4% were booked and 104 patients 77.6% were un-booked. Mostly patients 122 (91%) came from rural area and only 12 (9%) were from urban areas with booked pregnancies having regular antenatal visits. One hundred and twenty six (94%) patients with eclampsia presented in antenatal period and only 8 (6%) presented in post natal period. Mode of delivery was cesarean section in 87 (64.9%) and 47 (35.1%) delivered vaginally. Frequency of patient requiring ventilator support, acute renal failure,disseminated intravascular coagulation, adult respiratory distress syndrome, HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome was 11 (8.2%), 46 (34.3%), 43 (32.1%), 35 (26.1%), 7 (5.2%) respectively..........

Objective: To emphasize the importance of antenatal diagnosis of the morbidly adherent placenta, employ management options accordingly and their impact on the patient’s outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Okara Pakistan, Jan 2018 to Aug 2020. Methodology: One hundred and twenty-four patients were enrolled in the study. Diagnosed morbidly adherent placenta was made through trans-abdominal ultrasound, and a Doppler study in selected cases of posterior placenta previa magnetic resonance imaging (MRI) was performed. The surgical approach was either a high transverse placenta sparing or a classical incision on the uterus. After delivery of baby, conservative management included resection of part of uterus with adherent placenta followed by reconstruction of the lower uterine segment, segmental resection of myometrial tissue and hemostatic sutures, and over sewing of placental bed. The requirement of blood transfusion, intensive care unit stay, post-operative recovery, and day of discharge, along with all demographic and surgical details, was noted. Results: In 87(70%) patients, high transverse or placental sparing incision was made to assess the baby. Over sewing of the placental bed was done in 37(29.8%) patients, and myometrial segment resection was done in 57(46%) patients. An obstetrical hysterectomy was carried out in 30 patients. Blood transfusion of > 4 units RCCs was required in 92(74%) patients. 16% the patients required intensive care management. Conclusion: Antenatal diagnosis of morbidly adherent placenta through useful imaging modality allowed for a planned surgical approach and minimized......

Objective: To study the impact of isolated oligohydramnios at term on mode of delivery and perinatal outcome. Study Design: Prospective comparative study. Place and Duration of Study: Combined Military Hospital Okara, from Aug 2019 to Aug 2020. Methodology: A total of 250 patients were recruited in the study. They were divided in 2 groups. In group A there was 123 patients, with isolated oligohydramnias at term, amniotic fluid index of ≤5cm, while in group B 127 patients, with normal liquor volume were included through lottery method. Demographic parameters, Intrauterine fetal demise, mode of delivery, perinatal out comes like meconium stained amniotic fluid, low birth weight, APGAR score at 1 and 5 minutes, of two groups were compared. Results: A total of 57 (46.3%) patients in group A delivered through cesarean section and 27 (21.3%) in group B. Meconium staining of liquor was in 56 (45.5%) in group A versus 13 (10.2%) in group B. As compared to group B the patients in group A lower birth weight babies 2.6 ± 0.34 kg versus 3.0 ± 0.33 kg were delivered. Mortality in group A, intrauterine fetal demise was 4 (3.3%) and still birth was 2.3%. There were no perinatal mortality in controlled group B. Conclusion: Isolated oligohydramnias at term is not associated with adverse perinatal outcome. Umbilical cord compression, potential utero-placental insuffiency and increased incidence of meconium stained liquor possibly explains the increased perinatal morbidity. The delivery should be routinely advocated as in otherwise uncomplicated pregnancy with appropriately grown fetus.