Social determinants of induced abortion: A qualitative study

The purpose of the study was to explore the community perceptions of the socio-economic, socio-cultural and socio-psychological determinants of women with induced abortion. Qualitative data was obtained by means of focus group discussions with induced abortion patients admitted to Gynaecological Ward of the North Okkalapa General Hospital. Future sub-grouping of patients with respect to parity and contraceptive usage was done. Content analysis of focus group discussion revealed the following data. Regarding family formation, the best age at first union was 20 years, the desired number of children was two to three and the ideal birth interval two to three years. With respect to family planning, they felt that most pregnancies were unplanned. They were aware of traditional and modern contraceptive methods but most were uncertain of correct methods of usage. Information regarding contraception was obtained mainly from lay persons.

Utilization of gynaecologic beds at the Central Women's Hospital (1990)

A one year situational analysis of utilization of gynaecological beds at the Central Women's Hospital (Unit II) is presented. The pattern of admission, details of treatment, duration of hospital stay and bed occupancy were determined. There were 667 admissions of which 564 were elective admissions and 103 were emergencies, of all admissions, 84.1 percent were operated on. Of the abdominal operations, hysterectomy (135) was the most common operation followed by female sterilization (120). Anterior and posterior colporrhaphy (56) was the commonest vaginal operation performed. The mean hospital stay for cases of female sterilization, myoma uterms, ovarian tumour and uterovaginal prolapse was 7 days, 26 days, 22 days and 19 days respectively while the mean waiting time was 5 days, 14 days, 14 days and 11 days respectively. Recommendations whereby the waiting time and the hospital stay and indirectly the bed occupancy can be reduced are presented. It is hoped that quality medical care can be rendered by optimal use of existing resources.

The Cost of Abortion

The cost of abortion in 20 patients with unsafe abortion were compared with 40 patients each of spontaneous abortion and spontaneous vaginal delivery. The mean duration of hospital stay was 1.95 days, 2.8 days and 12.9 days-while antibiotic usage was 52, 82 and 100 percent respectively in normal deliveries, spontaneous abortions and unsafe abortions. Intravenous infusions and blood transfusions were used in 80 percent and 35 percent of unsafe abortion patients. Evacuation of the uterus was performed in 82 percent if spontaneous abortion patients and 35 percent with unsafe abortion while 40 percent of the latter required operative drainage of pus. The cost of unsafe abortion was calculated as expenditure before admission and costs and loss of income during hospitalization. The average total costs bome by patients with unsafe abortion was Kyats 2480/-. Hospital costs for unsafe abortion at Kyats 1431/- were twice as much as the comparison groups.

Clinical, ultrasonic and pathologic analysis of ovarian tumours at the Central Women Hospital (A prospective study)

During an 18 month period from 1st January 1988 t0 30th June, 1989- 90 cases diagnosed as ovarian tumours were admitted to Unit 11, Central Women Hospital. Pre-operative data collection on clinical features and ultrasonic findings were made. Following laparotomy, operative findings and histopathologic diagnosis were noted. 87 cases had a laparotomy. Out of 82 cases of ovarian tumours, 21 were malignant (25.6 per cent) and 61 (74.4 per cent) benign. The clinical and ultrasonic diagnotic accuracy of ovarian tumours were 87.35 per cent and 91.18 per cent. There was no statistical difference between the two methods in diagnosing ovarian tumours (p>0.05). The accuracy of differentiating malignant from benign ovarian tumours clinically, by ultrasound or by laparotomy using gross findings and histopathology as the definitive diagnosis was also calculated and there was no significant difference (p>0.05). The sensitivity, specificity, predictive values for positive and negative teste were calculated in differentiating benign from malignant ovarian tumours. It was found that clinical diagnosis had the highest sensitivity rate (73.68 per cent) whereas operative findings had the highest specificity rate (96.72 per cent).

Abnormal cervical lesions detected at a Colposcopy Clinic

A coloposcopy clinic was established in February 1988. An analysis of 300 cases seen at this clinic (over a 20 month period) is presented. The procedure consisted of taking a history, taking a cervical smear, perfoming colposcopy and colposcopy directed biopsy in the majority of cases (260 cases 86.67 per cent). The cases were referred for clinically suspicious cervices, abnormal bleeding per vaginam, abnormal cervical smears or self referral for check-up. The age of the patients ranged from 16 to 74 years, with the majority in the 35-44 age group (137 patients 45.67 per cent). The parity was from nulliparous to parity 14+2.37 of the patients were menopausal. Colposcopy could be satisfactorily performed in 286 patients. Most of the cases seen were colposcopically and histologically normal. Pathological lesions detected were squamous metaplasia (15), cervical intra epithelial neoplasis (14), coexistent cervical carcinoma and cervical intra-epithelial neoplasia (2) and inflammatory lesions (79).

Severe pre-eclampsia at the Central Women's Hospital

A study on hypertensive diseases in pregnancy was carried out at the Central Women's Hospital between December 1985 and November 1986. The patients were interviewed, examined and followed up according to a prepared proforma. There were 119 cases of severe pre-eclampsia, 58 cases of pre-eclampsia, 61 cases of gestational hypertension and 21 cases of eclampsia. Among the cases of severe pre-eclampsia, the majority40.3 per cent were in the 25 to 34 age group, 38.6 per cent were promigravidae. Most of them were house-wives. The majority were of low educational status. Regarding their income, 75 patients (71.3 per cent) had a family income of less than five hundred kyats. There was a higher rate of intervention, the caesarean section rate being 21 per cent. Regarding the risk of association between fetal complications and maternal socio-biological parameters, multigravidae or those from a lower income group had intra-uterine fetal death more often (p < 0.5). Mothers from a lower educational status were higher risk groups for delivery of low birth babies. (p < 0.5).