Women’s decision versus couples’ decision on using postpartum intra-uterine contraceptives

Background: In conservative societies of low- and middle-income countries, the decision-making process is heavily influenced by male partners.

Aims: To assess the male partner's influence on female partner's ultimate decision regarding uptake of postpartum intrauterine contraceptive device (PPIUCD)

Methods: This was a prospective, analytical study conducted at Abbasi Shaheed Hospital, Karachi, Pakistan, from 1 March 2016 to 30 August 2016. The study included 566 pregnant women who were counselled regarding postpartum contraception (PPC) and asked to choose their preferred method. The choice was noted before and after discussion with their spouse. Discordance was assessed using McNemar's test for paired samples, taking P

Results: Among those counselled, 470 (83.03%) showed willingness to accept PPC. Out of these, 142 (30.2%) chose PPIUCD initially. After discussion with their spouse, only 82 (17.4%) accepted PPIUCD. The discordance between original decision of the woman and final decision to accept PPIUCD was statistically significant (P < 0.001).

Conclusions: The discordance between original decision and final decision shows considerable influence by males on uptake of PPIUCD

Occult form of premature ovarian insufficiency in women with infertility and oligomenorrhea as assessed by poor ovarian response criteria

Background: The purpose of this study was to evaluate the ability of poor ovarian response criteria to classify women presenting with infertility and oligomenorrhea as having "occult" premature ovarian insufficiency

Methods: This was a cross sectional study conducted at Aziz Medical Center, Karachi, Pakistan from 1[st] August 2015 to 31[st] July 2016. Women with infertility and oligomenorrhea were included. All eligible women underwent day 2 FSH level and an early follicular phase transvaginal ultrasound to assess the antral follicular count [AFC]. All women then underwent the confirmatory test, of Anti- Mullerian Hormone [AMH] level. The main outcome measure was assignment to occult premature ovarian insufficiency [POI] after screening that used the criteria set out in fertility guideline for predicting the likely ovarian response to gonadotrophin stimulation. Another measure was to compare the sensitivity and specificity of the two index criteria, of FSH and AFC, relative to the emerging reference standard, of the AMH criterion

Results: The three criteria together classified 59 [34.91%] women as occult POI in those with oligomenorrhea. The sensitivity, specificity, negative predictive value and positive predictive value of FSH relative to AMH for these women were 77.8%, 95.7%, 90.2% and 89.4%, respectively whereas the same values of AFC relative to AMH were 92.6%, 99.1 %, 96.6% and 98%, respectively

Conclusion: Women with menstrual irregularity and infertility are at a higher risk for satisfying criteria of poor ovarian response irrespective of age. A policy incorporating these surrogate markers can be used to screen these women for occult premature ovarian insufficiency

Antenatal counselling on breastfeeding- Is adequate counselling being provided?

Objective: To study the effect of antenatal counselling on breastfeeding practices. Methods: This study was conducted at Abbasi Shaheed hospital Karachi. All primigravidas from June 2014 to December 2014 were recruited. The study was a cross-sectional survey and non-probability purposive sampling was done. Among these 432 primigravida mothers, 324 who had a minimum of three antenatal visits were included in the study. These 324 mothers were administered a pre-tested semi-structured questionnaire on breastfeeding. The awareness among mothers [both "counselled" and "not counselled"] regarding health information pertaining to breastfeeding was assessed. The content of counselling sessions was discussed with women who received counselling to ensure whether the counselling received was adequate. Results: Of the booked mothers, 21.91% had received some antenatal counselling about breastfeeding while 78.09% had not received any such counselling. Awareness related to breastfeeding among mothers who received counselling was better than those who were not counselled. Conclusion: Antenatal counselling given to first time mothers in not sufficient and needs to be improved. Antenatal visits provide an opportunity to counsel about breastfeeding, which should not be missed

Three consecutive vaginal deliveries after three caesarean section

Caesarean section involves the delivery of the fetus through a direct incision in the abdominal wall and the uterus. Women with scarred uterus are considered at risk of uterine rupture during subsequent pregnancies and labour. Although trial of labour is usually given to patients having past history of previous one lower segment caesarean section [LSCS] due to non recurrent cause with a considerable success rate but most obstetricians opt an elective LSCS in women having past history of two or more LSCS. We report a case of three consecutive successful vaginal deliveries with an intact scar in a woman having history of previous 3 LSCS

Use of compression sutures to decrease blood loss in myomectomy

To evaluate the haemostatic efficacy of compression sutures in open myomectomy. This observational study was carried out in Abbasi Shaheed Hospital from February 2012 to October 2013. Twenty six women with uterine fibroids undergoing open myomectomy were included in the study. Uterine size was equivalent to 16-20 weeks size. Compression sutures were applied in 13 cases [group A] to control bleeding during myomectomy. In another 13 patients, controls, [group B] compression sutures were not applied. Outcome measures were operative time, blood loss, transfusion, intraoperative and postoperative complications, and length of hospitalization. The average blood loss during surgery was 250 +/- 75 ml for group A and 600 +/- 120 ml for the control group B. Postoperative blood loss was 75 +/- 15 ml for the group A and 250 +/- 75 ml for the control group B. Length of the postoperative hospital stay was 3 +/- 1 days for group A and 4 +/- 1.5 for the control group B [p<0.05]. Compression Sutures are effective in reducing blood loss in patients undergoing myomectomy

Histopathological profile of cases of oophorectomy: a report from 1997-2007

Objective: this study was carried out to describe the findings of histopathological profile of series of ovarian tumors removed on oophorectomy during ten-year period in Karachi

Material and methods: it was a descriptive study of 316 oophorectomy specimen observed during last 10 years. Data were entered on SPSS 11 and results were analyzed regarding distribution of cysts in relation to age, size and complications

Results: the mean +/- SD age of the women undergone oophorectomy was 28.3 +/- 8.46. Complications were reported in 28.7% of the cysts and more commonly found in younger age groups. Corpus luteum was found to be the most frequent histopathology in all cases [22.87%] while follicular cysts were seen in 50% of the bilateral presentations

Conclusion: most of the cysts removed on oophorectomy were benign in nature and despite of larger sized cysts in young women, malignancy was happened to be twice more common in middle age group. Hence, in younger age group, conservative management is recommended even for large sized cysts

Assessment of knowledge and practice regarding HIV/aids and its magnitude among truck drivers

It is estimated that 70,000 to 80,000 persons, or 0.1 percent of the adult population in Pakistan, are infected with the HIV virus, according to UNAIDS. Only 1,972 HIV cases and 231 AIDS cases had been reported to the government's National AIDS Control Program. Under reporting is attributable to social stigma, ill-developed surveillance, lack of screening and as well as lack of knowledge among the population and practitioners. Our country is highly vulnerable to an escalating epidemic due to a number of prevalent risk factors. To assess the knowledge, attitude and practice of truck drivers regarding AIDS and to calculate the magnitude of AIDS among truck drivers. It was a descriptive study, carried out as KAP survey of truck drivers. The truck drivers were interviewed at the truck agency "adda" or midway driver's hotels "charpai hotel" at eight different sites during December 2004 to January 2005. A total of 129 truck drivers were conveniently selected and information was obtained. There 104 in Lahore and 25 in Hyderabad were interviewed. Out of total subjects, 104 respondents [interviewed at Lahore] were tested for HIV antibodies by ELISA / CAPILLUS technique. The drivers were aged 19-56 years, 74% of the drivers were married with families and engaged in driving job for a mean duration of 13 years. Eighty nine [74.4%] of drivers were aware of AIDS and 61% admitted having multiple heterosexual partners, including prostitutes, and 5% admitted to have regular homosexual sexual encounters. Thirty two percent knew most of the correct sources of HIV spread. It was found that 9% of promiscuous drivers used condoms regularly, none admitted taking IV drugs, 35% reported histories of either urethral discharge or genital ulcers, and none of the 104 men tested were found to be infected with HIV. The truck drivers were adequately familiarized with AIDS but the knowledge regarding spread of disease through sexual transmission was found to be poor. No single subject was tested positive for HIV in this study. Although, literacy was found to be significantly associated with awareness of AIDS but attitude and practices were found to be unaffected

Occurrence of post natal depression and its determinants: as reported at Abbasi Shaheed hospital

This study was conducted in order to assess the magnitude of the postnatal depression [PND] at Abbasi Shaheed hospital during 2004-2006 and also to explore the causes of PND A total of 600 subjects were selected through convenient sampling frame at Gyne unit I during postnatal follow up and their mental health was assessed by using Edinburg scale of postnatal depression. The females were contacted at 3 weeks, 8 weeks and 12 weeks of delivery. Most of them were interviewed and examined in the Gynae OPD and some non complaints were contacted on telephone. There were 21 variables in the ESPND and a score of 13 or more was taken as a cut off for established post natal depression. The diagnosed cases of depression were referred to psychiatry department for further advice and treatment. It was found that 11% of the female had postnatal depression during 12 weeks of observation and majority of the participants 64% were of 20-25 years old. The causes among the cases [n=67] found to be overlapping but in 63% it was related to the repeated birth of female child, in 37% of the cases it was previous depressive illness while in 52% unplanned pregnancy was claimed to be the cause. Souse related problem was seen in 32% of the cases. Post Natal Depression was found to be a significant problem among women reporting at government teaching hospital. Repeated birth of female child and unplanned pregnancy were the significant causes in all cases. But due to limitations of the study design Used in this study, it was difficult to relate one single cause to the outcome and subsequent research using analytical design would be preferred