Anemia; moderate to severe during pregnancy

Moderate to severe anemia during pregnancy is associated with increased maternal and fetal morbidity and mortality. Therefore moderate to severe maternal anemia is a high risk group and it is imperative that all cases of anemia should be identified and treated to ensure adequate hemoglobin level before labour. Different countries have shown considerable variations in the prevalence of moderate to severe anemia during pregnancy. To determine the frequency of moderate to severe anemia during pregnancy and its association with socio-demographic and obstetric characteristics. Cross sectional descriptive study. This study was conducted from 1st October 2011 to 31st March 2012, in the obstetrics and gynaecology department of Sir Syed Hospital, a tertiary care hospital in Karachi. Methodology: The patients attending the antenatal OPD between the gestational age of 20 to 41weeks who were moderate to severely anemic [according to WHO criteria based on Hb level] were selected for the study. A self-designed proforma was then utilized to obtain relevant information. This proforma covered sociodemographic as well as patient's obstetric characteristics. The frequency of anemia was found to be 42% [633/1507].Patients with moderate to severe anemia after 20 weeks till 41 weeks were 323. Patients with moderate anemia were 268/323 [83%], while 55/323 [17%] women had severe anemia. Majority of women with moderate anemia were multiparous between 26-32 years of age and presented between 35-41 weeks gestation. Majority of women with severe anemia were primigravidas between 18-25 years and presented in late third trimester. Our study revealed multiparity, illiteracy, poverty and late antenatal booking as the factors responsible for the severity of anemia during pregnancy. Therefore, anemia should be recognized as a serious public health problem. The adverse effects of anemia can be avoided by counseling on birth spacing and early antenatal booking

Knowledge, attitude and practice of parous women regarding contraception

To determine the frequency of knowledge, attitude and practice regarding contraception of parous women. A cross-sectional survey. The Out-patient Department of Obstetrics and Gynaecology, Sir Syed Hospital, Karachi, from October 2008 to March 2009. A self-maintained structured questionnaire was used to interview 100 parous women, who had practiced contraception. This questionnaire covered socio-demographic characteristics of women as well as knowledge of different contraceptive methods. Attitude towards contraception, religious beliefs, myths and misconceptions were also assessed. It also covered decision-making and involvement of other family members in the choice of contraceptive methods. Results of knowledge, attitude and practice were presented in terms of frequencies and percentages. Exclusion criteria were primigravida, nullipara and sub-fertile women and those who had never used any contraceptive method. Majority of women were Muslim [88%] and educated housewives [78%] while 55% belonged to lower middle class. Majority of the women [70%] received information from a health professional. Male condom was used by 57%; 43% used injectables, 33% used oral contraceptive pills, 28% practiced withdrawl and 30% used intrauterine contraceptive device. Majority of the women [78%] were self-motivated and 67% considered family planning as their own responsibility. Majority [65%] believed that contraception is not permitted in religion and 57% of women discontinued contraception because of side effects. This study highlights good knowledge and positive attitude of women regarding contraception

Perinatal outcome in high risk pregnancies

To determine the perinatal outcome of high risk pregnancies, in terms of perinatal mortality, Apgar score, birth weight and neonatal complications in first week after birth. Cohort study. Obstetric Department of Sir Syed Trust Hospital, Karachi, from January to December 2007. All antenatal patients attending the Outpatient Department were interviewed, after informed consent. Those who fulfilled the required criteria were grouped in 2 categories; high risk [group A cases] and low risk [group B control] pregnancies according to the risk factors identified in the history. All singleton pregnancies from 28th weeks of gestation till delivery were included in the study. All pregnant women, who had multiple pregnancies or congenital malformations were excluded. Patients were followed till delivery and neonatal outcome was assessed in both the groups. Outcome measures were recorded. There were a total of 282 patients studied. The number of patients in group A were 162 and in group B, 120. Anaemia 98 [60.49%], pregnancy induced hypertension 24 [14.8%] and preterm labour 26 [16%] were identified as the major risk factors in group A. There were 12 [7.40%] stillbirths and 5 [3.08%] early neonatal deaths in group A, while there was 1 [0.84%] stillbirth and no neonatal death in group B [p=0.004, RR=1.72]. There were 58 [35.80%] neonates with low birth weight in group A, while the same were only 4 [3.33%] in group B, which was statistically significant [p=0.001, RR=1.98]. Poor Apgar score of

Effect of domestic violence on pregnancy outcome

To determine the causes and type of domestic violence endured by pregnant women and their effect on pregnancy, in terms of maternal and neonatal outcome. Cohort study. The study was conducted in Sir Syed Trust Hospital, Karachi, from March 2007 to February 2008. All the antenatal patients were screened for domestic violence, using a self-made questionnaire and abuse assessment screen. All the pregnant patients, who had language barrier or those who declined to be interviewed were excluded. All the pregnant patients with positive response, according to the abuse assessment screen were included in the group A, while every 4th patient with negative response was taken as control. SPSS 10 was used for statistical analysis. Logistic regression analysis was performed to determine the effect of domestic violence on delivery outcome. Relative risk was also calculated. Statistical significance was taken at p 0.05. Four hundred and ten [n=410] antenatal patients were interviewed. The factors associated with domestic violence included addiction in 32 [39%], allegedly aggressive nature of husband in 21 [25.6%] and unemployment of husband in 6 [7.31%] cases [p=0.001]. Fifty two per cent women had been victims to more than one form of violence. Antenatal complications were not observed in a statistically significant number in either group. Depression was identified in 25.60% of group A and in 3.65% of group B [p=0.001; RR=2.01; 95%CI=1.58-2.56]. Various factors leading to domestic violence were identified among the husbands of women subjected to violence during pregnancy. The differences between the two groups, with regard to neonatal outcome [except depression], did not reach statistical significance. However, depression was significantly higher in the women enduring violence

Frequency of hepatitis C in obstertric cases

To compare the frequency of antihepatitis C virus [HCV] after single blood transfusion, multiple blood transfusion and in non-transfused obstetric cases. Design: A comparative descriptive study. Place and Duration of Study: The Department of Obstetric and Gynaecology, Jinnah Postgraduate Medical Centre, during the period of one-year from January 2002 to December 2002. Patients and Patients included in the study after single transfusion were 38, after multiple transfusion 39, and controls 120. History of patients regarding all the relevant information and clinical examination were recorded on a specially-designed and coded proforma. Anti-HCV was detected by Roche HCV EIA 2nd generation kit method in all cases and controls. Descriptive statistics and frequency of anti HCV in each group was calculated using SPSS version 10. Frequency of anti-HCV among patients with single blood transfusion was 13.2% [5], with multiple transfusion was 15.4% [6] and 6.6% [8] in non-transfused subjects. Anti-HCV frequency after one pint blood was almost same [13.2%] as after multiple transfusion [15.4%]. This positively provided a firm argument for the necessity of a nationwide blood donor screening for anti-HCV by most sensitive immunoassay. Equally important was the need for clear cut indication for single blood transfusion