Burden of advance stage gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy Jamshoro Sindh

Objectives: In Pakistan gynaecological cancers are among the leading causes of women's morbidity and mortality posing huge financial burden on families, communities and state. Due to lack of national cancer registry exact facts and figures are unknown therefore this study was planned to find out prevalence, age, site and stage of presentation of gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy [NIMRA], Jamshoro

Methods: A retrospective, cross sectional study was conducted from 1[st] January 2011 to 31[st] December 2011 at NIMRA Jamshoro. All cases of genital tract cancers were evaluated, required data was entered on predesigned performa and results were analyzed manually

Results: Out of 2401 total registered cancer cases, 231 [9.6%] patients were suffering from gynaecological cancer making it third most common cancer. Ovary was commonest site followed by cervix and uterus. More than 60% cases presented in advanced stage, mostly during 4[th] and 5[th] decade of life

Conclusion: Gynecological cancer was among top three cancers at one of the busiest public sector cancer institute in Sindh province and significant number presented in advance stage making treatment difficult and expensive. There is urgent need for development and implementation of an effective health policy regarding cancer prevention and treatment

Adverse fetomaternal outcome among pregnant overweight women

To compare the adverse fetometernal out come in overweight and normal weight pregnant women. This comparative cohort study was conducted from 1[st] October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI [25 - 29.9 Kg/m[2]] were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. The age range was between 30 to 45 years with mean age of 30 +/- 4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia [27% versus 9% in controls], PIH [24% versus 8% in controls], gestational diabetes mellitus [22% versus 5% in controls], prolonged labour [4% versus 6% in controls], Caesarean section [44% versus 16% in controls], Wound infection [3% versus 2% in controls] and Postpartum Hemorrhage [5% versus 2% in controls]. P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth [13% versus 2%], Early neonatal death [11% versus 1%], shoulder dystocia [5% versus 1%] and NICU admission [47% versus 10%]. Results were statistically significant except shoulder dystocia. We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome

Prevalence, instigating factors and help seeking behavior of physical domestic violence among married women of Hyderabad, Sindh

Domestic violence against women is highly prevalent but under reported issue having social, legal, health and economic implications. It needs to be identified and addressed in order to decrease the sufferings of women. Our objective was to find out prevalence, instigating factors and help seeking behavior of physical domestic violence against married women. A total of 378 married women who were attending Department of Obstetrics and Gynaecology, Liaquat University Hospital from January 1, 2013 to March 31, 2013 for different obstetrical and gynaecological problems were randomly selected and interviewed. After informed consent, required information was collected on predesigned performa including demographic details, prevalence, instigating factors, help seeking behavior for physical domestic violence. About 31%[120] of women reported lifetime physical domestic violence. Husbands and in-laws were perpetrators in 70% [84] and 30% [36] cases respectively. Wives being disobedient and making arguments were the most common instigating factors for violence followed by husband's drug addiction, extra marital relationship and infertility. It was severe enough to require medical care in 24%[29] cases. Only 2% [2] women sought social and legal aid. Domestic violence was quite common among married women, however help seeking was minimal. There is need to identify and address this menace effectively

Seroprevalence and risk factors for hepatitis C virus [HCV] infection in pregnant women attending public sector tertiary care hospital in Hyderabad Sindh

Background and Objectives: Pakistan is among the countries having high prevalence of HCV infection in the population but there is dearth of proper epidemiological data regarding acquisition of HCV infection in the pregnant population. Our objective was to determine the seroprevalence of HCV antibodies in healthy pregnant women and to assess the potential risk factors for HCV infection in HCV positive subjects and in the control group

Methodology: This cross sectional and comparative study was conducted from 1[st] January to 31[st] December 2010 in the Department of Obstetrics/Gynaecology Unit-I, Liaquat University Hospital Hyderabad. Sera were collected from all admitted pregnant women and tested for HCV anti bodies using Elisa kits [Abbott, USA]. Data were analyzed using SPSS version 16.0 statistical package

Results: The seroprevalence of HCV among pregnant population was found to be 4.7%. HCV positive women were more likely to have a history of blood transfusion [OR 1.99, 95% CI 1.26- 3.12], History of therapeutic injection use [OR 2.46, 95% CI 1.43-4.26], history of surgery [OR 1.72, 95% CI 1.12-2.66] and history of sharing household products [OR 1.81, 95% CI 1.14-2.87]

Conclusion: HCV seropositive pregnant women were more likely to have a history of blood transfusion, therapeutic injection use, surgery and sharing household items

Impact of training on general practitioner's knowledge, attitude and practices regarding emergency contraception in Hyderabad

Objectives: To elaborate the impact of family planning training on general practitioners' knowledge, attitude and practices regarding emergency contraception

Methods: A cross sectional survey involving 270 general practitioners was conducted in Hyderabad from 1[st] Oct to 31[st] Dec 2010. Participants were divided into two groups on the basis of attending family planning training course after graduation and were interviewed face to face. Data was noted on questionnaire asking their knowledge, attitude and practices regarding emergency contraception. Data was analyzed on SPSS version 11. Student t-test was applied to compare the proportions among two groups

Results: Out of 270 general practitioners, male and female participants were 132 [48.9%] and 138 [51.1%] respectively. Mean experience as private general practitioner was 7.48 +/- 7.6 years. One third of the participants 84 [31.1%] have attended five days training course on family planning in the past, while 186 [69.9%] did not have any training. Source of training was government institutes 46[17%] and non government organization in 38 [14.1%] cases. Significant positive difference was noted on emergency contraception knowledge, attitude and use in group who attended family planning training

Conclusion: Educational intervention has a positive impact on health care provider's knowledge, attitude and practices of emergency contraception

Met and unmet need of family planning and associated factors in a remote rural area of Sindh, Pakistan

To determine the met and unmet need of family planning among married women of Taluka Golarchi, District Badin, Sindh, Pakistan. Secondary objective was to assess the knowledge and practices of modern contraceptive methods and associated factors. It is a cross sectional community based survey done from 1[st] May to 31[st] May 2008 in Taluka Golarchi, District Badin, Sindh, Pakistan. A structured questionnaire was used to interview 300 eligible women of reproductive age. Stratified cluster sampling was done to collect information on met and unmet need of family planning, knowledge and practice of modern contraceptive methods and associated factors. Nearly two third of respondents were housewives and illiterate. Most of them 71% [213] were multiparous having more than four children. Current contraceptive practice was 42%, out of which 39% were using modern methods of contraception. Oral contraceptive pills were commonly used method. Unmet need of Family planning was 19%. Lady Health Workers were the prime source of knowledge and provision of family planning methods. Husbands' co-operation and approval is influential factor for modern contraceptive use. Fear of side effects is the main hurdle for non use of modern contraceptive methods. Modern methods of contraception are gaining popularity in rural Sindh. In addition to sustained lady health worker programme, involvement of males should be incorporated in future family planning initiatives

Severe acute maternal morbidity [SAMM] in postpartum period requiring tertiary hospital care

Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% [125/3292 obstetrical admissions]. The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage [PPH] [50%], preeclampsia and eclampsia [30%] and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% [34] and maternal mortality rate was 4.8%. PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high

Hyperhomocysteinemia in Pakistani women suffering from uexplained subfertility

Hyperhomocysteinemia [hhcy] has been considered as a risk factor for several obstetrical complications such as early pregnancy loss, pre-eclampsia and IUGR. Recently is association with infertility has been underscored in IVF failure; however limited information is available about the relationship of hhcy and subfertility. To find out the association between unexplained subfertility and hhcy in Pakistani women. This observational study was conducted in Department of Obstetrics and Gynaecolocy, Liaquat University Hospital Hyderabad from 1[st] April 2008 to 31[st] March 2009. Study group consisted of all those women who were subfertile for more then one year, have body mass index less than 25, regular menstrual cycle, normal pelvic examination findings and no past history of pelvic inflammatory disease. Exclusion criteria was male factor subfertility, endocrine and ovulatory dysfunction and tubal blockage. Evaluation was done by semen analysis, pelvic ultrasound scan, hysterosalpingography and hormonal assays. Fasting serum levels of homocysteine were determined using a fluorescence polarization immunoassay. In total, 61 subjects were enrolled in the study including 49 subfertile women and 12 healthy women. Among subfertile women, 39 [80%] were suffering from primary subfertility while 10 [20%] were complaining of secondary subfertility. Majority of the subjects were young, house wives and residents of Hyderabad city. Mean serum fasting homocysteine levels were significantly higher in women suffering from unexplained subfertility as compared to controls [12.8 +/- 5.1 versus 9.7 +/- 1.7, p-value=0.04]. Hyperhomocysteinemia was observed in women suffering from unexplained subfertility. However large scale clinical studies are required to confirm the association

Perinatal mortality and related obstetric risk factors at a tertiary care hospital of Hyderabad

Objective: To determine perinatal mortality rate and its related obstetric risk factors in our setup. Design: Observational study. Setting: Department of Obstetrics and Gynaecology [Unit-I], Liaquat University Hospital Hyderabad, from January to December 2006

Patients and Methods: All perinatal deaths including stillbirths [SBs] and early neonatal deaths [ENNDs] within 0-7 days of birth after 24 weeks of gestation were studied during the study period, while Pregnancies <24 weeks of gestation were excluded from the study. The relevant information was collected through a pre-designed proforma which contained variables including maternal demographics, obstetric risk factors and other details

Results: A total number of 2224 deliveries were analysed for perinatal mortality. Out of these, there were 224 perinatal deaths giving a PNMR of 100.7/1000 births. There were 196 SBs and 28 ENNDs. Among these, 88% women were unbooked. Commonest risk factors was antepartum haemorrhage [27.67%], followed by hypertensive disorders of pregnancy [23.21%] and mechanical factors affecting labour [14.28%]. Congenital abnormalities were found in 9.8% of PNDs while maternal medical disorders were seen in 6.25% cases. In 3.5% cases, chorioamnionitis/ neonatal septicaemia was the underlying cause and multiple pregnancies were seen in only 02 [0.89%] cases. However, in 32 [14.28%] cases, no cause was found

Conclusion: The high perinatal mortality rate in present study is comparable to the figures from other institutions. Main reason being lack of antenatal and pre-pregnancy care where from almost all obstetric risk factors can be picked up and treated / prevented