Aims: Teenage pregnancy has globally recognized as high risk pregnancy. Under grown pelvic bones at delivery pose greater risk of obstructed labour in such young girls resulting in poor feto-maternal outcome. Objective of this study was to determine the frequency of obstructed labor in teenage pregnancy and to know fetomaternal outcome. Methods: This Cross Sectional Observational study was conducted at department of Obstetrics and Gynecology unit I and II, Shaikh Zyed Women Hospital Chandka Medical College, Shaheed Mohtarma Benazir Bhutto Medical University Larkana Sindh Pakistan from 1st January 2010 to 31st December 2010. 468 women admitted with obstructed labour of all age groups, out of these which 257 patients were teenage mothers. Patients selected after fulfilling selection criteria. Obstructed labour in teenage patients wasdiagnosed on the basis of history of prolonged labour and clinical presentation. Demographical characteristics noted. Mode of the delivery and fetomaternal outcome was observed. Statistical analysis was performed using SPSS. 12 version. Results: Total deliveries in both units during study period were 9000. Among them 468(5.2%) patients found to have obstructed labour. Out of these 257(2.85% of total) patients were teenagers.. 82% (210) teengers were non booked and admitted in emergency while only 18 %(47) came through OPD having a single visit. Mean age was 16±2 years and parity was 2±1.5.Mode of delivery was LSCS in 84% (214) ,assisted vaginal delivery in 12% (32) and 4% (11)had spontaneous delivery with episiotomy. Cephalopelvic disproportion remained the commonest reason of obstruction (66%). 1.94% (5) of patients died of septicemia .PPH seen in 41% (105),1.1% (3) had scar dehiscence due to prolonged trial by untrained birth attendant.1.94% (5) patients developed vesicovaginal fistula later on. Perinatal mortality was around 54.6% (142) while 44.75 % (115) babies born alive. Conclusions: Adolescent pregnant women not only face pregnancy related problem but also they are prone to have obstructed labour due to their developing pelvic bones. Obstructed labour is one of the most common and preventable causes of maternal and perinatal deaths and disabilities. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 37-40 DOI: http://dx.doi.org/10.3126/njog.v7i1.8834
Objective: To evaluate the outcome of Vesico-vaginal Fistulae (VVF) repair by abdominal and vaginal route. Design: Interventional / clinical trial. Setting: Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Period: Feb; 2005 to Nov; 2010. Patients/Methods: After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae (VVF) were selected for repair. All patients had under gone examination those anesthesia (EUA) and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Results: Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years (ranged from 22 to 45 years). The main cause of vesico-vaginal fistulae was obstetrical in 28(87.5%) and iatrogenic gynecological (hysterectomy) in 04 (12.5%) patients. No major difficulty was experienced except in 01(0.83%) case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes (range 80 to 125 minutes) & 145 minutes (range 110 to 175 minutes) in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 (33.33%) and 13 (93%) patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups (P< 0.05). Postoperative complications like wound infection occurred in 01(7.15%) of group- 1 and haematuria was present for few days in o4 (22.22%) and 05(35.5%) in group-1 and group-2 respectively. The mean hospital stay was 07 (range 5-10) days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15(83.33%) and in all 14 (100%) cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups (P=NS). All the patients were followed up regularly except 03 (16.5%) and 05 (35.5%) patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 (11.1%) patients of group-I, where as small capacity bladder and stone formation was observed in 02(14.3%) of group-11 cases. Conclusions: Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended.
Objective: To observe the results of syndromic management in women living in IDPs camps complaining of chronic vaginal discharge. Design: Descriptive study. Setting: Medical Camps at Larkana set by Chandka Medical College Hospital for Internally Displaced Persons (IDPs) due to floods. Period: 1st September 2010 to 31st December 2010. Material and Methods: Total 200 symptomatic patients aged from 20 to 50 years suffering from chronic vaginal discharge having history of more than 6 months duration were included in the study. Asymptomatic as well as pregnant women and patients with abnormal cervix and having abnormal growth on cervix were excluded from the study. A detailed history and examination (including speculum and vaginal) was done and a proforma was filled. All these patients were given empirical treatment recommended by WHO as syndromic management consisting of stat doses of antifungal along with antibiotics, where no laboratory tests are required before treatment. Results: Next to vaginal discharge which was main symptom in all patients, the other symptoms like dusparunia, dysuria, itching ,lower abdomen pain and low backache was reported 9%, 16%, 20%, 24% and 31% respectively. Also 8% patients reported post coital bleeding. All patients were married and the mean age of the patients was 28+0.2 years and 15% of them were over 40 years. Mean parity was 4±1.Vaginal infection improved in 65% of the patients excellently with a first line single course of antibiotic and percentage raised up to 88% with second course. 19(9.5%) patients couldn’t be followed as they left that camp and 5(2.5%) patients who did not improve with two courses of antibiotics had big cervical erosions, referred to nearby tertiary care hospital for further management. Conclusions: IDPs live in poor conditions in camps without basic facilities and where it is difficult to perform bedside tests like microscopy, Potassium Hydroxide, wet mount films and tests for Sexually transmitted diseases like Chlamydia and gonorrhea are not available, syndromic management there is a rational way of treating cases of chronic vaginal discharge to get quicker response in such desperate women.
Since independence in sub-Saharan Africa, decentralization of psychiatric services has been accepted as a policy, but it has resulted so far only in developing small units attached to the provincial hospitals. Because of the shortage of qualified psychiatrists, the latter are invariably staffed by locally trained psychiatric or sometimes general nurses. With one or two exceptions most of the mental hospitals were built in the colonial times and they often resemble penal institutions and are geared mainly to offering custodial care.
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