ABSTRACT
To study knowledge, attitudes and practices oft he patients of induced abortion. Descriptive analytical study. This study was conducted from July 2004 to March 2005 in the department of obstetrics and gynecology, Islamic International Medical College, Railway General Hospital, Rawalpindi and Federal Government Services Hospital, Islamabad. The patients who were admitted in the Obstetrics and Gynecology with a history of induced abortion were included in the study. A special questionnaire was designed to explore the reasons which compelled them to undergo this illegal and dangerous procedure rather than using some contraception before. The patients were interviewed by a single post graduate trainee on a pre- designed Performa. The data collected was entered on SPSS- 10 and analyzed. The results were shown in percent. Most of the abortions [66%] were done by dais at their homes, while 28% terminations were done by doctors at their clinics. Majority of the patients [90% and 60% and respectively] were aware of not only the religious and legal implications of abortion but also knew that it could cause great harm to their health, including the fact that it could be fatal. Majority of women [74%] were not using any contraceptive measure for no specific reason.ln majority of patients [92%] it was an unwanted or unintended pregnancy which was terminated. Only 14% of patients showed reservations in using some contraceptive measure like religious position, husband's disapproval or fear of side effects. The problem of induced abortion is not merely a medical problem to be resolved through medical means. Rather it falls into the social norms of people. The physician is supposed to understand the deep seated psychological inhibitions and motives which lead the patient to have [or not have] abortion
ABSTRACT
To correlate colposcopic findings with the results of cervical biopsy and to prove colposcopy as a valuable screening tool for the diagnosis of premalignant and malignant cervical pathologies. A quasi experimental study Study was conducted from January 2008 to April 2010 in the Department of Obstetrics and Gynecology, Railway Hospital Rawalpindi. The study population included three hundred women who attended the outpatient department of Railway hospital over a period of two years. All these symptomatic women between the ages of 30-60 years were recruited with one or more of the complaints of post coital bleeding, intermenstral bleeding, postmenopausal bleeding, recurrent vaginal discharge or abnormal Pap smear. The recruited women were examined by speculum, followed by pap-smears. Out of 300 women Pap smear of 200 women was abnormal and showed inflammatory lesions at three consecutive times. These ladies were booked for colposcopy. However, any other women whose reports showed dyskaryotic changes were immediately booked for colposcopy. Biopsies from abnormal areas were taken and sent for histopathology. The reports of cervical biopsy were then analyzed. Out of 300 women recruited, 200 showed positive Pap smear. 108[54%] symptomatic women showed normal epithelium, while 92 women [46%] had abnormal transformation zone changes. Cervical biopsy reports of 92 women with abnormal colposcopic findings, showed up chronic cervicites in 60 cases, miscellaneous cervical pathologies in 10 cases, no dysplasia in 10 cases and cervical carcinoma was diagnosed in 12 cases. The study concluded that colposcopy followed by cervical biopsy proved to be a valuable screening tool for the diagnosis of premalignant and malignant cervical pathologies
ABSTRACT
To determine association of risk factors with hepatitis B surface antigen positivity in pregnant women. Case control study. Two years from 2004 to 2006 at Agha Khan University Hospital. A total of 210 subjects including 35 cases and 175 controls were enrolled into study. A detailed history from study subjects was recorded on a performa during antenatal visits. Univariate and multivariate analysis was done using SPSS package. A significant association was observed for the history of at least four injections for minor illnesses in past one year [adjusted odds ratio [AOR] = 5.5; 95% confidence interval [CI]: 1.6, 18.1] and history of blood transfusion [AOR= 6.025; 95% CI: 2.1, 17.1], with HBsAg status of pregnant women. We recommend interventions to improve injection safety and to discourage unnecessary therapeutic injections. There is also urgent need for strict enforcement of regulations for safe blood transfusion. Further research is required to estimate proportion and to evaluate reasons for unnecessary injections in women of reproductive age
ABSTRACT
To determine the effect of Phloroglucinol Trimethylether vs Placebo on the duration of 1 stage of labour in term pregnancies. Quasi experimental study. Obs/Gynae wards IIMC, Railway hospital, Rawalpindi from June 2011 to May 2012. A double blind randomized placebo controlled trial was conducted on 131 patients in active phase of uncomplicated labour. The patients were randomized into two groups by simple random technique. After evaluation, patients were divided into group A and B. Neither the patients nor the doctor knew about the injection of phloroglucinol or distilled water. Sixty five patients in group a received Phloroglucinol Trimethylether 40 mg [4 ml] intravenous and 66 patients in group B received distilled water as placebo at 4 cm cervical dilatation. Dose was repeated after 60 minutes. Maximum 3 doses were given. Progress of labour was plotted on partogram. Any adverse effects of the drug on mother and fetus were noted. Student't-test was applied for statistical analysis. Out of 131 labouring patients, 61 patients from group A and 61 patients from group B were included in analysis. During 1[st] stage of labour 61 cases[100%] received 1 injection, whereas 11 cases [18.0%] were given 2 injections and 3 cases [4.91%] received 3 injections during the 1[st] stage of labour in group A and in group B 61 patients [100%] received 1 injection, 52 patients [85.2%] were given 2 injection and 37 cases [60.6%] were received 3 injection. The average duration of observed active phase of 1[st] stage of labour was shortened by almost two hours in patients receiving Phloroglucinol. The mean duration of 2[nd] stage of labour in group A was 25.16 mins and 34.52 mins in group B. Phloroglucinol definitely has a therapeutic role to play in obstetrics with its strong antispasmodic effect. In the presence of good and regular uterine contractions, it shortens the duration of labour, is non toxic to both mother and fetus and it also decreases the severity of labour pain
ABSTRACT
Mentoring implies a 2-way relationship between the mentor and the mentee. A successful partnership can lead to the professional development of both individuals. Although the significance of mentoring programs has been realized in the developing countries, its role in the holistic development of our students is still not given its due importance. There are important questions to be answered; who should be a mentor? What are the qualities students look for in an ideal mentor? These gaps in research are especially significant in our part of the world, where robust mentoring systems have yet to be established. To compare the perceptions of our faculty and students regarding the qualities of an ideal mentor as measured by Ideal Mentor Scale [IMS]. Cross-sectional study. At Pakistan Railway Hospital, Rawalpindi, Pakistan during July 2013 to August 2013. Seventy participants [faculty members:26, students:44] participated in the survey using the [Ideal Mentor Scale] [Gail Rose, The University of Iowa, 1999] to identify the relative importance of integrity, guidance and relationship in a potential mentor using a 5-point rating scale. Integrity [average sum of means: 58] was considered to be the most important attribute of an ideal mentor followed by guidance [40] and relationship [35] by all the participants [undergraduate: postgraduate: faculty member]. However, in the scale of relationship the undergraduate students gave higher score than the postgraduates and faculty members [3.8: 3.5: 3.3]. Successful mentoring most importantly requires a mentor who can be emulated as a role model due to his/her principled behavior and integrity
ABSTRACT
To compare the efficacy and safety of misoprostol with a Foley's catheter and oxytocin for induction of laborator beyond term. Quasi experimental study. This study was carried out in the Department of Obstetrics and Gynaecology, Railway Hospital Rawalpindi from January 2008 December 2008. Hundred patients requiring induction of labor at or beyond term with bishop less than 5 were randomized by lottery method to receive oral misoprostol or a cervical Foley's plus oxytocin. Patients in the misoprostol group [Group A] received 50 microgram misoprostol at6 hourly interval fora maximum of 4 doses or until an adequate contraction pattern developed. Those in the Foley's group [Group B] had a Foley's catheter inserted in the cervix. Whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 milliunits/min. The mean induction delivery interval is 9.8 hours in group A while in Group B the mean induction delivery interval was 17 hours. Although all patients delivered in both groups within 24 hours but the mean induction delivery interval was prolonged in Foley's group as compared to misoprostol group. The neonatal outcome was comparable in both the groups. Oral misoprostol at the dose 50 microgram is better than Foley's group for induction of labor at term
ABSTRACT
To assess the effectiveness of ECV in singleton breech presentation at term and to determine its effect on maternal, delivery and perinatal outcomes in women to whom the procedure was offered. Aquasi experimental study. The study was carried out in the Department of Obstetrics and Gynaecology, Railway hospital, Rawalpindi, fromAugust2006 to December2008. Eligible women, presenting with uncomplicated breech, between 37-41 weeks gestation, underwent ECV on day care basis. Fifteen minutes before the procedure, injection salbutamol 0.5 mg was administered. Cases with contraindication to ECV or salbutamol injection were excluded from the study. Success rate of ECV [in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound] along with maternal, delivery and perinatal outcomes were assessed. Maternal and fetal demographic characteristics were also recorded as secondary outcome measures. For statistical analysis, SPSS version 10 was used and Chi-square test applied with a p<0.05 taken as significant. Of the 42 ECV procedures, 25 [59.5%] were successful. None of the patient suffered from serious maternal complications. Seven [16.7%] parturients complained of severe palpitations and 4 [9.5%] of marked discomfort during the procedure. Reversible fetal bradycardia was seen in 1 [2.4%] patient. Reversion to a non cephalic presentation occurred in two cases. Vaginal delivery was carried out in 21 patients out of the 25 who successfully underwent external cephalic version while all the patients with failed ECV underwent caesarean delivery. The 5 minute Apgar score was more than 8 in all except one baby. Adverse maternal and fetal outcomes of breech presentation at term are rare and there was no increased risk of complications after external cephalic version. Findings provide important data to quantify the frequency of adverse outcomes that will help facilitate informed decision-making and ensure optimal management of breech presentation