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

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

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

Management and obstetric outcome of ovarian hyperstimulation syndrome

To describe the management and obstetric outcome, in terms of take home baby rate, of Ovarian Hyperstimulation Syndrome [OHSS]. Case series. Baqai University Hospital, Nazimabad and Baqai Institute of Reproduction and Developmental Sciences, from January 1998 to December 2002. All patients undergoing in vitro fertilization and intracytoplasmic sperm injection from 5th January 1998 till 12th December 2002 were selected for the study. The infertile couple were interviewed, after informed consent, examined and investigated. Ovulation induction agents were prescribed to the female, if all the investigations were normal. In vitro fertilization was reserved for blocked fallopian tubes, endometriosis and abnormal semen parameters. Intracytoplasmic sperm injection was indicated for cases with few normal sperms. All the patients, who had developed mild ovarian hyperstimulation syndrome were excluded from the study. The patients who had developed moderate and severe ovarian hyperstimulation syndrome were included in the study. Out of 30 patients who developed OHSS, 23 had moderate OHSS, 7 patients had developed severe OHSS. Polycystic ovaries were present in 21 cases. Clinical pregnancy rate in the study was 40% and the take home baby rate was 21.7%. Patients with polycystic ovarian disease were identified as the main reason for subfertility and were identified as the main reason for adverse foetal outcome. A remarkable pregnancy rate was achieved, but the take home baby rate was comparatively low. But even then, the results were comparable in terms of take home baby rate to the results reported in international literature