Survey of patient awareness and beliefs regarding emergency contraception

To investigate patient's knowledge and beliefs regarding emergency contraception and its use. Cross-sectional descriptive study. A six months cross-sectional descriptive study, from 1[st] July 2009 till 31[st] December 2009 carried out at Shifa international Hospital [SIH] and Shifa community health centre [SFCHC] Islamabad. All married women of reproductive age coming to SIH or SFCHC clinics after informed consent were interviewed regarding their knowledge of emergency contraception. A total of 770 women were interviewed, but the data was completed for 759 women. 131 women [17.3%] had knowledge about emergency contraception but only 79 [10.4%] had actually used this method for contraception. There is a very low awareness level regarding emergency contraception among women of developing countries even in the urban population

effect of modes of delivery on infants' feeding practices

Breast feeding has a great impact on the infant morbidity and mortality. According to Pakistan Demographic and Health survey [PDHS] infant mortality rate is 78 deaths per 1,000 live births. World Health Organization recommends that exclusive breast feeding for six months can decrease infant mortality rate by one-third. The objective of the study was to find out how the mode of delivery had impact on the practice of breast feeding. Data were collected for 2500 consecutive patients during a period of two years, and it was seen that maternal initiative to breast feed was low and problems with lactation were much more in cases delivering their babies via cesarean sections than those delivering theirs by normal delivery. Vaginal and cesarean section deliveries took place in 54% and 46% of the case, respectively. Thirty percent of the women studied felt that they had no problems regarding breastfeeding, but 70% of them had some sort of problems with breastfeeding their babies. When the women were matched for the mode of delivery, 58% of women who had breastfeeding problems belonged to the cesarean delivery group and 42% of complaining mothers were from women with normal delivery. The relative risk of having problems with breastfeeding for women subjected to cesarean was 1.38 and the odds ratio was 0.61. The findings of the present study indicate that more in depth counseling sessions are required for women undergoing operative delivery to improve breast feeding among them

Validity of hysteroscopy and histopathology in patients with menstrual irregularity

Abnormalities in menstrual cycle is the most common presenting symptom in Gynaecology out-patient. Dilatation and curettage has been the diagnostic investigation of choice for decades in such cases. With the advent of new more valid and safe methods, it has been replaced by hysteroscopy as gold standard. The objective of this study was to know the sensitivity and specificity of hysteroscopy in patients presenting with menstrual irregularity. Validity study was conducted over 269 cases for a period of two years at Maternal and child health centre, Pakistan Institute of Medical Sciences, Islamabad. Inclusion criteria were age >/= 35 years and abnormal uterine bleeding. Patient with positive pregnancy test, recent cervicitis, vaginitis, endometritis, pelvic infection were excluded. Hysteroscopy and curettage was performed after taking informed consent, mostly on outpatient basis. A predesigned Performa was used for a detailed record of hysteroscopic findings, which were later compared with histopathology report. Data was analysed using MS Excel, and Cross Tabulation was done using Epi-info. Sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy was calculated against histopathology, the gold standard. Sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy was calculated against histopathology after excluding 46 [17.1%] cases of uterine fibroid that were diagnosed only at hysteroscopy. Hysteroscopy has shown highest sensitivity for retained products of conception and adenocarcinoma [100%] while a specificity of 90% and above for all hysteroscopic findings. Seventy eight percent of the procedures were performed on outpatient basis, 95% under intravenous sedation and 95% with no operative complication. Hysteroscopy should be used as an adjunct procedure to curettage as it is a better tool for diagnosis of intracavity lesions, with a high sensitivity and specificity for endometrial carcinoma

Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding

We compared endometrial sampling by pipelle endometrial curette with Conventional dilatation and curettage [D and C] in patients with abnormal uterine bleeding. Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D and C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D and C as the gold standard. An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D and C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value [100%, 98% and 100%, respectively] for hyperplasia with atypia, and low sensitivity [57%] and positive predictive value [57%], but high specificity [97%] and negative predictive value [97%] for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D and C report. Difficult endotracheal intubation was encountered in two cases of D and C. No other complications of the procedure were observed. The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy