Late antenatal booking, Its barrier and maternal complications

Objective: To determine the prevalence of late booking, its barrier and complications in women attending antenatal clinics of Isra University Hospital [IUH] -Hyderabad

Study Design: A Descriptive study

Place and Duration: Study conducted at Isra University Hospital, Hyderabad [IUH] from 1[st] January 2012 to 30[th] June 2012

Methodology: Total 931 women were interviewed who came for antenatal checkup however women who had antenatal checkup before 24[th] weeks were excluded. 641 women who booked after 24[th] weeks of gestation were included in the study reasons for late antenatal booking and maternal complications were explored

Results: Prevalence of late antenatal booking was 71 %. Women who had no past obstetrical complications and those who lived far away from health care facilities came late for booking [76.6%]. Most commonly identified maternal complications were anemia, Hypertension and diabetes 20.90 %, 28.54%, 31.21% respectively

Conclusion: Attendance of late booking is still high in our rural communities Women who booked late usually suffered from medical complications like anemia, hypertension, Diabetes and intrauterine fetal death

Women perception and awareness about genitourinary fistula

OBJECTIVE: To determine the knowledge of women about different causes of urogenital fistula and their attitude about fistula prevention

STUDY DESIGN: A Descriptive qualitative KAP study

STUDY SETTING: This Study was done in Obstetrics and Gynecology ward of Isra University Hospital Hyderabad [IUH] from January 2011 to December 2013

METHODOLOGY: By using non-probability purposive sampling technique, women who were admitted in GU-11 with genitourinary fistula were included in this study while women who have urinary incontinence, other than fistula were excluded. Women were asked about their awareness for cause of fistula formation, its preventive measures, source of knowledge, information regarding willingness to accept caesarean section as a primary mode of delivery after successful fistula repair, all information were recorded on questionnaire and data analyzed by using SPSS 16

RESULT: One hundred and ten women were included in this study, 57 % women were illiterate imposing great challenge towards genitourinary fistula. Out of these 110 women 59 [53.6%] were having obstetrical fistula and 43 [39%] were having iatrogenic fistula. About 38.2% women were well aware about their problem while12 women [10.9 %] perceived it as a curse of God and 9 [8.18%] of women has knowledge about iatrogenic injury to bladder. After successful repair 31.8% preferred tertiary care hospital delivery however 20.9% did not want future conception

CONCLUSION: There is a high association of illiteracy with genitourinary fistula. Women must be educated about the cause of fistula and its prevention. There is a need to create awareness among women about hospital delivery, and to take well directive efforts to increased skill among junior doctors involved in pelvic surgeries

Reliability of biparietal diameter [Bpd] measurement for assessment of gestational age: at tertiary care hospital

Objectives: To find out correlation between biparietal diameter and gestational age and its correspondence with LMP [Last Menstrual Period] and to determine the ultrasonographic criteria of BPD [Biparietal Diameter] measurement at different gestational ages of normal singleton pregnancy

Study design: A descriptive study

Place and duration: The study was conducted at Radiological department of Liaquat University of Medical and Health Sciences and Isra University Hospital Hyderabad from July 2005 to December 2005

Methodology: Pregnant women [n=100] with different gravidity and gestational age, carrying singleton fetus were examined by transabdominal scan using standard Curvilinear probes 3.5 M. Biparietal diameters at different gestational age were recorded and its accuracy was assessed

Results: Out of 100 women 76% correspond with LMP and gestational age by measuring BPD in second trimester as compare to third trimester where only 62% corresponded

Conclusion: It can be concluded from the study that there is good correlation of BPD measurement by ultrasonography and gestational age. It is a reliable tool especially in those women where LMP is not known or doubtful, for assessing gestational age especially during earlier 2nd trimester of pregnancy than during late 2nd trimester and 3rd trimester of pregnancy

Hyperinsulinemia and its association with polycystic ovarian syndrome

To determine the variable clinical presentation of Poly cystic ovarian Syndrome [PCOS] and its association with Hyperinsulinaemia in young adolescent girls. A descriptive study was conducted for one year from February 2009-2010 at Isra University Hospital Hyderabad [IUH]. 136 adolescent girls who came in OPD with suspected features of polycystic ovarian syndrome were recruited. Biochemical test, ultrasound of pelvis and test to determine hyperinsulinemia were done .woman having preexisting ovarian pathology were excluded. All results were analyzed on statistical software SPSS version 16. Frequencies and percentages were calculated. Result: Insulin resistance significantly increased [43.4%] in girls who have shown the features of PCOS. Weight gain observed in 69 [50.7% - Obese] and 40[29.4%- very obese] of girls respectively. Different types of menstrual irregularities such as oligomenorrhea 50[36.8%], secondary amenorrhea 28 [20.6%] primary amenorrhea 5 [3.7%] were observed. 53[39.0%] adolescent girls had normal cycle but evidence of PCO on ultrasound. Infertility was found in 32 [23.5%] of participant followed by hirsutism and acne in 59 [43.4%] 45 [33.1%] of woman respectively. There is significant association of PCOS with hyperinsulinemia. Hyperinsulinemia if persist can lead to metabolic syndrome with its serious sequelae .Steps should be taken for early recognition of PCOS in young woman

An unrecognized complication of un safe abortion

We report a case of a 30-year old female who presented with uterine perforation with macerated fetus in the abdominal cavity with severe sepsis after an attempted unsafe abortion

Ovarian ectopic pregnancy: a rare condition

Pregnancy of extra-uterine origin can be a serious condition that demands early diagnosis and prompt treatment to save life of the women. Apart from tubal ectopic, ovarian ectopic pregnancy is the second common but rare type of extra-uterine pregnancy. A patient who has been using long term injectable contraception presented with 8 weeks amenorrhea followed by irregular bleeding per vaginum. Spiegelberg criteria were fulfilled. Laparotomy and histopathology confirmed ovarian ectopic pregnancy.

Women's preferences for place of delivery: a study at tertiary care hospital

Objective: To determine the preference for choice of birth place among pregnant women attending antenatal clinics at tertiary care Hospital. To find out the barriers which make their choices

Study Design: Prospective descriptive study

Place and Duration: This study was done in the Department of Obstetrics and Gynecology Isra University Hospital from January 2010 to July 2010

Methodology: In this study pregnant women [n = 912] attending antenatal clinics, were interviewed to collect data regarding socio demographic profile. Women views about their preferences for home delivery and hospital confinement were assessed. The data was recorded on structured questionnaires analyzed by SPSS version 16 and presented as frequencies and percentages

Results: It was observed that 553 [60.63%] of study participant preferred hospital birth. The main reasons for choosing hospital delivery were safety and good care 260 [47% of the women], better hygiene 138 [25%] and because of medical advice and services 70 [12 %]. About 359 [39. 36 %] were liked home birth reason were social support and privacy and good care at home 141 [40%] low cost 135 [38%] new born care being taken at home 44 [12.25] and local hygiene 17 [4 %] respectively

Conclusion: Majority of our study participant were preferred hospital birth because of provision of good care and safety. Social pressure were common in those who delivered at home so women preference should be acknowledged

Frequency and impact of premenstrual syndrome on quality of life

This study was conducted to determine the frequency and impact of premenstrual syndrome [PMS] on quality of life in women of reproductive age [15-49 years], and to determine if frequency estimates varied with menstrual flow. This cross-sectional study was carried out on 500 women of reproductive age currently menstruating, non-pregnant including women attending gynaecology outpatient department and female students of Isra University Hyderabad, from 1 -July-09 to 31 -December-09. Demographic data, and premenstrual Symptoms were recorded through interview and filling of predesigned questionnaire after taking verbal informed consent, and later analyzed on SPSS 11 for descriptive statistics and comparison of proportions using chi-squire test of Independence. This study shows very high frequency 81.25% of Premenstrual syndrome among women of reproductive age. The most frequent symptoms were reported Backache 446[89.2%] and fatigue in 446[89.2%] out of 500 women. Significant difference of weight gain, lower work or college performance, cramps, skin disorders, fatigue, mood swings, depression and tension were found in premenstrual and menstrual phases among study participants. Premenstrual syndrome is a common problem, have an adverse impact on a woman's quality of life and productivity

Diagnostic accuracy of transvaginal scan in the diagnosis of ectopic pregnancy

Objective: To determine the value of transvaginal sonography in the evaluation of women with suspected ectopic pregnancy [EP], a life-threatening condition in early pregnancy

Design: Adescriptive study

Place and Duration: The study was conducted in the radiology department of Liaquat University of Medical and Health Sciences from February to August 2005

Patients and Methods: A total of 7155 consecutive women presented to the radiology department during study period. Among them, 100 women were enrolled for study by non-probability convenience sampling. These patients underwent pelvic ultrasound examination. Both transabdominal and transvaginal scans were performed simultaneously in the patients. Serum beta hCG levels of all patients were greater than 1500iu/ml

Results: Ultrasound correctly identified EP in 34 patients. Transvaginal sonography [TVS] demonstrated EP in 24 patients while transabdominal scan [TAS] identified EP in 9 patients. Ultrasound diagnosis included adnexal mass in 16 patients, ecogenic ring in 10 patients, extrauterine gestational sac in 4 patients, live embryo in one patient, and intrauterine fluid in 21 patients

Conclusion: Timely diagnosis of EP with the help of TVS and serum beta hCG is the modality of choice and plays a vital role in the decreasing mortality rate caused by this complication of pregnancy

Effect of non-smoked chewable tobacco on placental morphology

Objective: To evaluate and compare the morphological changes occurring in the placentae of mothers who chewed tobacco and the normal placentae of non-tobacco users

Methodology: This case-control study was conducted at the Departments of Anatomy and Gynecology and Obstetrics at Isra University from June 2006 to June 2007. Sixty full-term placentae from chewing tobacco users [Group A], and non-tobacco using [Group B] subjects were divided into groups of 30 placentae. The features evaluated included shape, site of attachment of umbilical cord, weight, and central and peripheral thickness

Results: The mean weights were: Group A, 444.56 +/- 112 gm; and Group B, 437.8 +/- 61.94. The mean diameters of the placentae were: Group A, 17.50 +/- 1.8 cm; Group B, 17.94 +/-/-1.2 cm. The difference in the numbers of cotyledons seen in both groups was highly significant [p < 0.001]: in Group A, the mean number was 16.33 +/- 2.39 compared with Group B, 13.81 +/-1.36. The central thickness was 1.94 +/- 0.59 cm in Group A and 2.49 +/- 0.47 cm in Group B. The mean peripheral thickness of the placentae in Group A was 1.75 +/- 0.41 cm which is similar to that of Group B, 1.74 +/- 0.44cm

Conclusion: The non-smoked chewing form of tobacco produces significant changes in placental morphology, which may affect the outcome of the pregnancy; however, the changes are less significant than those seen in the placentae of smokers

Attitudes towards menstruation among young women

To determine knowledge and different attitudes towards menstruation among young women. A descriptive study was carried out at Isra University Hyderabad and villages around the Isra University Hospital, from 1st April 2005 to 31st March 2006. Five hundred women from villages around Isra University Hospital and students of Isra University Hyderabad were selected by non-probability sampling who were of menstruating age irrespective of their marital and literacy status. Women with menstrual irregularities or any other gynecological or psychological problem were excluded. All information was recorded on a questionnaire Performa and analyzed on SPSS version 15.0. Out of 500 participants, 438 [87.6%] regarded menstruation as a natural process; whereas, 62 [12.4%] perceived it as a disease and curse from God. Out of 500, 415 [83%] of the participants responded that the menstruation process is good for health; however, 85 [17%] felt this process not healthy for themselves. Ignorance, false perceptions and unsafe practices regarding menstruation are not uncommon among young women, hence the importance of health education particularly of women living in rural areas. Then they will be better prepared emotionally to experience menstruation and will have less negative reactions

Torsion of fimbrial cyst

A case of fimbrial cyst torsion is presented in an 18-year-old virgin female. She presented with severe left lower abdominal pain. Ultrasound scan was suggestive of an ovarian cyst. On laparotomy, a large 22 x 22cm twisted leftfimbrial cyst was found and a left salpingectomy was performed. Although torsion of fimbrial cyst is rare, it should be considered in the diagnosis of acute abdomen in females

Silent uterine rupture at 24 weeks in twin gestation

Scar dehiscence is a preventable condition. If recognized earlier, the lives of the woman and child may be saved. We present a case of twin pregnancy with a previous lower segment caesarean section. The uterus ruptured at 24 weeks of gestation without uterine contraction