study of gestational trophoblastic disease

To study the frequency, type of mole and follow-up of patients of gestational trophoblastic disease. Descriptive study. Military Hospital Rawalpindi [Tertiary Care hospital] from Jan 2001 to Dec 2006. Ninety patients both primigravida and multigravida were recruited by convenience sampling. They did not have any associated disease. The frequency regarding age, parity, blood group and antecedent pregnancy was calculated. They were managed initially by suction curettage and later either expectantly or actively. Type of mole was confirmed by histopathology report. Follow-up of these patients was done by clinical symptoms, beta-hCG level, x-ray chest and ultrasound abdomen and pelvis. GTD included 31.11% patients aged <40 years and 68.88% patients aged >40 years. 55.55% of patients had blood group O and only 33.33% patient with other blood groups. In 64.44% patients previous pregnancy was miscarriage while only 6.66% patients had term pregnancy before. 77.77% patients presented with vaginal bleeding, while cough, gastro-intestinal symptoms and hemorrhage 65.55% patients within 6 months while 34.44% patients had persistently raised serum beta- hCG level. Histopathological reports of 80% patient revealed complete mole while 20% patients had partial mole. Frequency of malignancy was found mostly in patients of complete mole. Chemotherapy was given to 38.88% patients among them 24.44% treated with single agent and 14.44% patients were given multi-drug therapy. GTD is more common in multigravida than primigravida. High frequency was observed in extremes of reproductive life and with blood group O. Irregular vaginal bleeding is the most common clinical feature. The frequency of complete mole is more than partial mole

Social factors involved in women avoiding early antenatal booking in aemy setup

To study the factors involved in women avoiding early antenatal booking coming to Military Hospital Rawalpindi. Comparative cross sectional study. Place and duration: Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from whole of the Pakistan dealing with other ranks of Pak Army, from July to December 2006. Study was done on 1000 patients at maternity OPD. Patients were divided into two groups of 500 each. Those patients who had early antenatal booking and took regular advice during pregnancy were included in group-I. While group-II included those patients who were late in antenatal booking or remained unbooked till delivery or presented with complications in 3rd trimester for the 1st time. Patients demographic data was entered on questionnaire and factors involved were interpreted. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. The study showed that as compared to booked patients factors involved in late booking of pregnant women were fear of invasive treatment [C-Section, Episiotomy] [40%], dai system [26%], education less than middle [19%], not living with husband [18%], far distance from hospital [14%], financial restraints [10%]and self medication [05%], [P value < 0.05]. Anemia was significantly lower among women utilizing antenatal care early [3.8%], as compared to those who were late at booking [17.8%], [P value < 0.05]. Similarly preterm labour was also statistically significant, with lower rate in group utilizing antenatal care early [1%] as compared to the other group [8.2%] [p value < 0.05]. Conclusion: Women of reproductive age need to recognize the importance of receiving early antenatal care in the army setup. Factors such as fear of invasive treatment, more faith in dai system, husband being away, living at far distance from hospital were hindering in early booking. Similarly lower socio-economic status and literacy rate of women also delays early utilization of this facility. By early booking, we can reduce the number of patients reporting with complications especially anemia and preterm labour and thus reducing the need of hospital admission and cost on many expensive medicines