Study Objective: The objective of this study is to describe the maternal and perinatal outcome of conservative managementin PPROM. Design: Descriptive prospective study. Period: One year from August 2006 to August 2007. Setting: Maternal and child health(MCH) Centre PIMS Islamabad. Material and Methods: 50 patients between 28-36 weeks of gestation presenting with PPROM. Results:The mean age was 27+5.1 years, 14(28%) were having gestational age between 28to 32 weeks and 36 (72%) were between 33 to 36weeks of gestation. 34 (68.0%) of the mothers had no history of abortions while 10 (20.0%) had 1-2 abortions and 6 (12.0%) had 3 ormore abortions. Sixteen (32.0%) women had previous PRROM while 10 (20.0%) had previous history of preterm labor. Inversecorrelation was observed between latency period and gestational age. Among 14(28%) women with gestational ages between 28 to 32weeks 10 delivered within 48 hours and 4 after 48 hours. Among 36(72%) women with gestational ages between 33-36 weeks 31(62%)delivered in less than 48 hours and 5 (10 %) women delivered after 48 hours.14(28%) of the 50 babies were admitted in NICU withsepticemia, 7(14.0%) with RDS, hypoglycemia in 2(4.0%) and necrotizing enterocolitis in 3(6.0%). 3 neonates died from septicemia and2 from RDS. On first follow-up 34.0% mothers had infections and 8.0% had post-partum hemorrhage. Conclusions: Expectantmanagement till 36 weeks is a suitable option as gestational age at delivery and birth weight both affect neonatal survival and offer time toadminister corticosteroids to allow foetal lung maturity. Foetal deaths occurred due to septicaemia and RDS with direction co-relationshipwith low birth weight.
Objective: To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Study Design: Observational analytical study. Period: June 2009 to June 2010. Methods: In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in our study, 74% (2/3 rd) patients were less than 30 years of age and 26% (1/3rd ) were between 30 – 40 yrs of age. Primary infertility was seen also in 2/3rd of patients (73% ) and secondary infertility in remaining 1/3rd (27%) of patients. Polycystic ovary (PCO) was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown (unexplained infertility). on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day (12.41 day) of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8 % of patients refused further treatment and 4 % did not report back. Conclusions: Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients.
background: Labor can be induced through a myriad of ways. The aim of this study was to compare the effectiveness of the intracervical Foley balloon catheter and intra vaginal 3 mg prostaglandin E2 tablet(s) in preinduction cervical ripening at term. Methods: Prospective analytic study of a cohort of 280 women selected through non probability sampling admitted in Obstetrics units, in two private hospitals one at Rawalpindi and the other at Mirpur (Azad Kashmir), from January 2009 to March 2010. All women were randomized to receive an intracervical Foley catheter or prostaglandin E2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. Results: There were no differences in mean Bishop Scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean ± S.D.) after ripening were 6.6±0.81 and 6.7±0.86 for the Foley catheter and prostaglandin groups, respectively (P=0.54). The prostaglandin group showed a statistically shorter induction to delivery time compared with the Foley catheter (16.5±2.2 and 20.51±3.89 h, respectively (P<0.01). Both the groups showed no statistically significant difference between the occurrences of spontaneous vaginal delivery. Labor was established in 72% cases of cervical Foley group. On the other hand induction occurred in 76% cases in prostaglandin group. There was no statistical difference between the need of oxytocin infusion for labor augmentation between the two groups and fetal distress was equally frequent in both the groups. Conclusions: Foley catheter was as effective as Prostaglandin E-2 at term for induction of labor with additional advantage of being cheaper, readily available and had no systemic side effects.
Objective: To evaluate the therapeutic benefit of low dose heparin in cerebral venous thrombosis, occurring during period ofperpeurum. Study design: Descriptive study. Setting: Department of Medicine DHQ Hospital Mirpur (Department of Obs/Gynae DHQ HospitalMirpur(AK). Period: January 2010 to November 2011. Method: This study was carried on 100 patients with history of postpartum cerebralvenous thrombosis. Out of which 48 on heparin and 52 formed the control group. The ages of all patients were between 20 to 30 years.Parameter recorded included history. Blood pressure.,the diagnosis was supported by cranial computed tomography. The secondary causeswere ruled out on the basis of history and physical examination. The data and results were analyzed in SPSS. Results: Out of 48 patients inheparin group 30 with non-heamorrhage lesion and 18 with haemorrhagic infarction). 52 in control group. 34 non-haemorriagic lesion and 18with haemorragic infarct .in non-haemorrhagic CVT, there is no death in heparin group as compared to 5 deaths in control group. In patients withhaemorriagic lesions, there were 5 deaths in heparin group as compared to 7 deaths in the control group. Heparin faed better than the controlgroup, both in patients with haemorrhagic as well as non-haemorrhagic lesions. Conclusions: Low molecular weight (LMWH) at low doses issafe and effective for both non-haemorrhage and haemorrhgic infarct of postpartum cvt with regard to recovery and outcome as compared tocontrol group.
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