Frequency of backache in pregnancy women attending antenatal clinic

To determine the frequency of backache and assess the efficacy of various treatment modalities used for the management of backache in pregnancy.Descriptive study. Outpatient department of obstetric services, Jinnah Hospital, Lahore. Patients coming to the antenatal clinic during February 2004 were asked about history of backache. A total of 918 women with complete data were recruited. Four hundred and thirty-two [47.05%] reported one or more significant episodes of back pain during their pregnancy. Of these 96 [22.22%] noted ongoing back pain at the time they became pregnant leaving a true incidence rate of [36.60%]. Twenty-one patients [4.86%] were less than 20 years, 407 [94.21%] were in between 20-40 years of age and 4 [0.92%] were above 40 years. Eighteen patients [4.16%] were less than 50kg, 345 [79.86%] had weight in between 50-70 kg and 69 [15.97%] were more than 70kg. Seventy-eight patients [18.05%] were primigravidas, 292 [67.59%] were multigravidas and 62 [14.35%] were grand multigravidas. Ninety-six patients [22.22%] had backache before pregnancy and 336 [77.77%] had it during pregnancy. No treatment was taken in 23 patients [5.32%], rest in 297 [68.75%], analgesic in 106 [24.52%] and massage by 6 [1.38%] patients. Subjective relief was up to 50.0% with rest, 75.0% with analgesics and up to 50.0% with massage. Backache is quite common in pregnancy. About one quarter of all pregnant women experience backache. About half of the patients took treatment mainly in the form of rest and analgesia. Chiroptic practice is also common in pregnancy and it gives some relief as well

study of babies born after intracytoplasmic sperm injection

With the advent of ART [assisted reproduction techniques] the face of fertility for humans has changed. Couples previously unable to have children of their own now have a practical option to aid in pursuit of their fertility. With growing numbers of IVF [in vitro fertilization] and ICSI [intra cytoplasmic sperm injection] pregnancies, concerns regarding normality of these babies along with apprehension about their long term health are also mounting. This study was conducted to assess the growth and development of babies conceived by ICSI at the time of birth at the age of one month and subsequently at twelve months. To assess growth and developmental outcome of ICSI babies up to one year in comparison with babies born by spontaneous conception. A prospective cohort study. Twenty eight ICSI babies. All patients who underwent ICSI with a successful outcome from 15-10-2001 till 31-12-2004 were included. The outcome of pregnancy and gestational age were noted. The resulting neonates were evaluated critically at birth, 4 weeks and one year with regard to growth and development. The results were compared with age-matched controls and conclusions drawn. Growth parameters: weight, length and head circumference. Comparison of weight, length and head circumference between the observed mean and the mean of normal population at various ages for both boys and girls separately revealed that most of the babies had weight, length and head circumference within normal ranges. After correction for gestational age, all the pre-term babies caught up growth within the first year of life. ICSI babies do not have an adverse outcome with regards to their growth. However long term follow up is necessary to properly assess the developmental outcome. This needs to be confirmed by multicenter studies

Backache in pregnancy

This study was performed to determine the frequency of backache, its causes and to assess the efficacy of various treatment modalities used for the management of backache in pregnancy. The location of the study was outpatient department of obstetric services, Jinnah Hospital, Lahore. Patients attended to the antenatal OPD during February 2004 were asked about history of backache. A further information was obtained from patients who had history of backache. A total 918 ladies with complete data were recruited. Four hundred and thirty-two [47.05%] reported one or more significant episodes of back pain during their pregnancy. Of these 96 [22.22%] noted ongoing back pain at the time they became pregnant leaving, 1 true incidence rate of 36.60%. Twenty-one patients [4.86%] were less than 20 years, 407 [94.21%] were in between 20-40 years of age and 4 [0.92%] were above 40 years. Eighteen patients [4.16%] were less than 50kg, 345 [79.86%] had weight in between 50-70 kg and 69 [15.97%] were more than 70kg. Seven ty-eight patients [18.05%] were primigravida, 292 [67.59%] were multigravida and 62 [14.35%] were grand multigravida. Three hundred and twenty-nine patients [76.15%] were delivered vaginally, 5 [1.15%] had instrumental deliveries and 98 [22.68%] had lower segment caesarean section. In the later group, spinal anesthesia was given in 60 [61.22%], general anesthesia in 34 [34.69%] and epidural anesthesia in 4 patients [4.08%]. Ninety-six patients [22.22%] had backache before pregnancy and 336 [77.77%] had it during pregnancy. No treatment was taken in 23 patients [5.32%], rest in 297 [68.75%], analgesics in 106 [24.52%] and massage in 6 [1.38%] patients. Subjective relief was up to 50.0% with rest, 75.0% with analgesics and up to 50.0% with massage. Backache was found to be common in pregnancy. About one quarter of all pregnant women experience backache. The most common cause of backache in pregnancy is odd posture, heavy work and weight lifting. About half of the patients took treatment mainly in the form o f rest and analgesia. Chiroptic practice is also common in pregnancy and it gives some relief as well. Although, backache is so common in pregnancy still none of the patients had any concept about posture and exercise. It is advised that patients should be given special advice regarding posture and exercises

Prescribing in pregnancy

Objective: To assess the prescribing patterns and clinical practices in the use of pharmaceutical agents in pregnancy

Study Design: Observational, Cross-sectional study

Study Period: March 2002 to March 2003

Setting: Study was conducted at antenatal clinic, Jinnah Hospital, Lahore

Materials and Methods: 250 patients from antenatal clinic were interviewed to collect information regarding age, parity, gestational age, any medication, its indication, route, duration and prescriber during current pregnancy on a pre-designed proforma

Sampling Method: Patients were enrolled in this study on first come and enroll basis

Results: Most of the women [90%] visiting the antenatal clinic were in the age group 21-30years. 94% of the women were taking medications and the prescriptions included haematenics [88%], folic acid [61%], calcium supplements [63%], antibiotics [22%], anti-fungals [19%], antiemetics [8%] and laxatives [6%]. 6% of women were not taking any medication. Commonest prescribers were general practitioners [46%]. Rest of the prescribers were medical officers at antenatal clinic [28%], LHVs/nurses [11%] and specialists [9%]. Self-medication was seen in 6%. 47% of the women taking self-medications were among the educated group [Matric and above] and 53% of the women were among the uneducated group [P < 0.001]. 28% took treatment from general practitioners and lady health visitors without any certain diagnosis, on symptomatic grounds

Conclusion: The use of drugs in pregnancy is substantial and varied. Information on the use of drugs during pregnancy is scarce and anecdotal. Careful consideration of the benefits to the mother and risks to the fetus is required, when prescribing drugs during pregnancy. All prescriptions or drugs recommended in pregnancy must have solid evidence derived from current literature

Hysterectomy: the patient`s perspective

Objectives: Importance of information provision by the gynaecologist and its effects on women`s decision making about hysterectomy

Design of Study: Structured questionnaire and interview

Setting: Department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore

Materials and Methods: A questionnaire was given to 50 women who had undergone hysterectomy for benign menstrual problems and information was collected. Main Outcome Measures: Women`s experience and satisfaction, with the communication and information provision by the doctor about her disease before hysterectomy. To assess the influence of that counseling on the decision-making process of hysterectomy

Results: Most of the women undergoing hysterectomy were between the age group of 40 - 45yrs [40%]. Most common indication for hysterectomy was dysfunctional uterine bleeding [55%]. 32% women reported optimal satisfaction with decision made. 57 highlighted sub-optimal aspects of decision-making process. 37% complained of deficiency in communication skills of doctors and 63%, stated that information provided were incomplete [P<.001]. 11% had residual doubts about the appropriateness of hysterectomy

Conclusion: The efforts are required to ensure that women are adequately informed and involved in decision about gynecological treatment

Sacrocolpopexy in management of vaginal vault prolapse

Aims and Objectives: To review the efficacy of Sacrocolpopexy in the management of vaginal vault prolapsed

Study Design: Interventional study

Setting and Population: Department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. Women with vaginal vault prolapse after hysterectomy.

Methods and Main-outcome measures: Abdominal Sacrocolpopexy using proline mesh. Follow-up in these patients were carried out at one week, four weeks, six months, and one year

Results: Sacrocolpopexy was carried out in ten patients for vaginal vault prolapse after vaginal [6] and abdominal hysterectomy [4]. The mean age was 49.8 years. Parity was between P3 - P6 [Mean parity 4.3]. Mean operation time was 79.3 minutes. Estimated blood loss was less than 200m1. No intra-operative or post-operative complications occurred in any case

Conclusion: Abdominal sacrocolpopexy is effective and safe in the treatment of vaginal vault prolapse. This procedure has high success rate in correcting prolapse without a time dependent decrease in efficacy

Eclampsia

To review and critically evaluate the incidence, epidemiology, clinical pattern, management and complications of eclampsia. Design: Study of patients presenting with convulsions in pregnancy or pregnant women who developed convulsions while admitted with a systolic blood pressure [BP] of 140mm Hg or more, or diastolic blood pressure of 90mmHg or more, or both. Department of Obstetrics and Gynaecology, Postgraduate Medical Institute, Services Hospital, Lahore during the period 1.9.95 to 31.8.96. Nineteen [19] pregnant women with obstetric complications. Incidence, clinical features, management and complications of eclampsia. The incidence of eclampsia in our study was 0.75% of all deliveries. None of the patients had any antenatal check up in that pregnancy. Mean age of the patients was 22.95 +/- 4.12 years and the mean parity 1.2 +/- 1.08. The mean gestational age at the time of developing eclampsia was 33.8 +/- 4.43 weeks. Thirteen [68.42%] patients had antepartum fits while the rest had postpartum fits. The mean fit admission interval was 7.21 +/- 9.77 hours and the mean admission delivery interval was 15.87 +/- 13.91 hours making a mean fit delivery interval of 23.08 +/- 20.82 hours. The mean systolic blood pressure was 155 +/- 10 mmHg and the diastolic was 112.5 +/- 9.57. Dependent oedema was seen in78.94% while proteinuria was seen in 89.48% of the patients. The consciousness level was altered in 78.94% of the patients. Intravenous diazepam and a methyldopa were employed as the primary anticonvulsant and antihypertensive respectively in all the patients with 42.1% receiving nifedipine sublingually as an adjuvant to a methyldopa. The labour was spontaneous in 57.89% while the rest required induction. None of the patients underwent abdominal delivery straight away. Caesarean section was however, finally the mode of delivery in 26.31% of the patients. There was only one mortality [5.26%] which resulted from development of acute pulmonary oedema making a maternal mortality rate of 5260 per 100,000 pregnancies. Five patients [26.31%] presented with fetal demise in utero while one [5.26%] perinatal death occurred within twenty-four hours of birth making a perinatal mortality rate of 315.7 per 1000 births. The booking status [100% unbooked] of these patients suggests a need for better antenatal services to ensure prevention rather than cure of eclampsia. The mean fit admission interval of more than seven hours denotes a need for strengthening the primary health services for early recognition of problems and rapid transfer, if required

Heart disease during pregnancy a study of 54 cases

To review and critically evaluate the prevalence, epidemiology, clinical pattern, diagnosis, management, complications and outcome in our set-up. Design: A study of 54 cases of cardiac disease during the two year period of 1994 and 1995. Setting: Department of Obstetrics and Gynaecology Postgraduate Medical Institute, Services Hospital Lahore. Patients: Fifty four obstetrical cases with cardiac disease admitted in the ward. Main outcome measures: Prevalence, clinical features, diagnosis, management and complications. During this period five thousand six hundred and ninety nine [5699] patients delivered giving the prevalence of cardiac disease 0.95%. Mostly the cases were 26-30 years primigravidae, in class I and II of rheumatic heart disease and only in few cases the class aggravated. Prophylactic antibiotics were given to all cases, half were digitalized, three quarters required diuretics and heparin, one had infective endocarditis and none underwent cardiac surgery. No other complication occurred. Three quarters reached term and delivered vaginally and only few had caesarean sections, preterm delivery and spontaneous or therapeutic abortion. Only 7.4% had post partum complications. Contraception by barrier method or sterilisation was advised. Mostly healthy babies were delivered, three still births and two neonatal deaths occurred, Co-operation of the Obstetrician, Cardiologist, Anaesthetist and Neonatologist can achieve good results regarding fetal outcome in the management of heart disease during pregnancy