ABSTRACT
@#The incidence of unintended pregnancy and unsafe abortion are significantly high due to the lack of knowledge and negative attitude towards contraception and it can be prevented by effective and appropriate contraceptive knowledge and usage. Considering the future role of medical students as family planning educator as well as counsellors, it is not only important to determine their knowledge, attitude and perception towards contraception but also should be updated for improvement on the quality of future healthcare professionals on contraceptive knowledge which may lead to the reduction in the number of unintended pregnancy with improving maternal morbidity and mortality. This was a cross sectional study using self-reported questionnaires survey that consists of four sections as socio-demographic characteristics information, knowledge towards contraception, attitude towards contraception, and perception of education and training in sexual and reproductive health among medical student. Questions were, distributed among medical students in Faculty of Medicine and Health Sciences and analyzed. The response rate was 100%. and most of the respondents in this study were Malay (64·4%), female (68·3%), single (98·6%) and live in urban area (69·1%). Most of their parents had tertiary education level (father educational level, 63·3%; mother educational level, 50·0%). 56·1% of the respondents had poor level of knowledge and 59.2% of them had negative attitude towards contraception. Regarding the perception on contraception, most of the respondents thought that they did not have sufficient clinical practice (50·4%) though adequate training (57·6%) in counselling the patients for family planning service during their clinical posting. There was a significant association between gender, place of birth, ethnicity, marital status, father educational status and level of knowledge. There were a higher percentage of respondents who had poor knowledge and negative attitude towards contraception. Assessing the knowledge and attitude of medical students on contraception and their relationship with socio-demographic characteristics and socio-economic factors plays a leading role in public health projects which are aimed to combat maternal mortality through reducing unintended pregnancies. To change the attitude towards contraception and further increase the level of knowledge of contraception among medical students, collaborated health education and similar studies among health workers are highly recommended.
ABSTRACT
Early pregnancy losses occur in 10-20% of all pregnancies. Surgical evacuation has always been the mainstay of management of miscarriages. The main aim of this study was to understand the success rate of expectant management of miscarriage with regards to gestational sac size and period of gestation. The secondary outcome was to measure the satisfaction level and the rate of pregnancy after 6 month of expectant management. Patients diagnosed with missed miscarriages were requested to choose between expectant or surgical management. Those decided for expectant management on “wait and watch” approach were assessed weekly up to 5 completed weeks until complete miscarriage was achieved spontaneously. Surgical evacuation was performed if medically indicated or requested by the patients at any time or at the end of fifth week if complete miscarriage was not achieved. Out of 212 cases, 75 (35.4%) opted for expectant management. Complete miscarriage was achieved in 85.3% of subjects by the end of fifth weeks respectively. Mean of Gestational sac size and period of gestation was not found to influence the success rate of complete spontaneous miscarriage in the expectant management. No morbidity was recorded during the five weeks of the study period. Mean satisfaction score was 9.7±8.3. Pregnancy occurred in 47% of patients within 6 months follow up. The Receiver operation characteristic (ROC) curve analysis suggested the end of second week as the cut off for surgical intervention. This study revealed that expectant management of missed miscarriage is a reliable management of missed miscarriage within the first two weeks.