Perceptions of insufficient breast milk: a comparison of depressed and non-depressed lactating mothers

Objective: The objective of the current study was to compare the perceptions of depressed and non-depressed lactating mothers regarding breast feeding

Study Design: Cross-sectional comparative study

Place and Durations of Study: Bolan Medical Complex Hospital Quetta from March 2010 to March 2011

Material and Methods: All mothers who fulfilled the inclusion criteria were screened with self-reporting questionnaire and Edinburgh post natal depression scale by trained female researchers. A detailed proforma was used to obtain information on demographic, pattern of breast feeding, antenatal information variables. The perception of insufficient milk [PIM] questionnaire was also applied

Results: In this study the majority of the mothers booked for antenatal care 84% but only one third 26% had proper information about breast feeding both in depressed and non-depressed mothers. Most of the mothers were multigravida 73% and about 27% were primgravida. Depressed mothers were 41% who scored >12 on EPDS, while 59% were non-depressed who scored >12 on EPDS. Depressed group 18 [42%] scored less than 30 while non-depressed group 8 [13.5%] scored less than 30

Conclusion: The view of insufficient milk has a significant and control atmosphere in the interruption of breast milk in the postnatal depressive lactating mothers

Vesico vaginal fistula repair with wide bore tube for urinary drainage

Objective: To assess the efficacy of wide bore tube in vesicovaginal fistula repair for urinary drainage

Study Design: Observational / descriptive / cross sectional study

Place and Duration of Study: This study was carried out in the Department of Gynae and Obs at Medical College/District Headquarter Hospital Mirpur Azad Kashmir from May 2009 to July 2012

Materials and Methods: All the patients were evaluated with history, physical examination and required labs

Cystoscopy was done in all patients before surgery. Repair was done in two layers. Bladder was drained with 20fr open end drain for first 72 hours, which was replaced with Foley catheter

Results: Total 28 patients with mean age 31 years [18-49 yrs], twenty three [82.1%] patients were having primary fistula while five [17.9%] had undergone surgical repair before

Location of fistulas were trigonal in 20 [71.4%] patients, supra trigonal 6 [21.4%] patients and 2 [7.1%] were involving the urethra. Twenty one [75%] patients were managed through vaginal route which include both trigonal and supra trigonal fistulas, remaining 7 [25%] repairs were done through the abdominal route. In twenty seven [96.4%] patients the repair was successful on removal of catheter

Conclusion: Approach for repair of VVF depends upon the preference and experience of surgeon. Success rate can be improved by following basic principles and good urinary drainage with drain

Uterine rupture; four years experience on seventy four cases in secondary care hospital

To determine frequency and to identify social, demographic and obstetrical causes of rupture uterus in Bagh Azad Jamu Kashmir and to define appropriate recommendations for its prevention and effective management. A descriptive case series study. DHQ Hospital Bagh at AJK. 1[st] September 2008 to 30[th] September 2012 was done. Data was entered on pre-design preform included age, parity, booked or un-booked cases, time delay to reach hospital and etiological factors. Incidence of rupture uterus is 1:185 deliveries. Mostly occurred in grand multipara and injudious use of syntocinon and neglected labor are most common cause. Skilled birth attendant, free transportation and avoidance of undue use of syntocinon in peripheral health center are key element for better maternal outcome

Abdominal techniques for surgical management of vaginal vault prolapse

To evaluate and compare the short and long term safety and effectiveness of different abdominal techniques for surgical management of vaginal vault prolapse. Observational Cross sectional study. Department of Obstetrics and Gynaecology Unit II, Bahawal Victoria Hospital, Bahawalpur, from January 2001 to December 2008. A total of 80 cases were divided into four Groups [20 patients in each]. In Group A, patients were managed by sacrocolpolexy with polypropylene [Prolene mesh, Group B had sacrocolpopexy with autologous rectus sheath, Group C underwent high uterosacral ligament suspension and Group D had vault suspension with an autologous fascial sling of rectus shealth.. All cases were analyzed regarding their complaints, clinical examination, investigations and follow up. No recurrence occurred in group A, as compared to 10%, 20% and 15% in Group B, C and D respectively. No patient from Group A reported with incisional hernia as compared to 10%, 5% and 10% in Group B, C and D. Operative time was less in Group A as compared to Group B but longer as compared to Group D and almost same as in Group C. The complaint of low persistent backache remained same in Group A and B [30%] as compared to 35% in Group C and D. Least blood loss was observed in Group A. Sacrocolpopexy is gold standard procedure for treatment of vault prolapse. If it is performed with prolene mesh best results are expected

[PROM], active management at term with oral misoprostol

To assess and compare the number of subjects in both groups [Study and comparison], who went into active labour within 24 hours and to compare the various complications [maternal and fetal] in both groups. Quasi experimental. Convenience sampling. A total of 100 pregnant women presenting with history of leaking amniotic fluid at term [>/= 37 wks] to labour ward of obstetrics and Gynaecology unit, Bahawal Victoria Hospital, Bahawalpur were included in the study. The pregnant women fulfilling the inclusion criteria were enrolled as our study subjects. Rupture of membranes was confirmed by nitrazine test.The patients were randomized into two groups [50 women in study and 50 in comparison group]. In study group, 50 [Ligm of misoprostol was given orally after initial assessment of mother and fetus. The dose was repeated 4 hourly, if there was no uterine activity. The number of patients going into active labour and delivering within 24 hours were noted. Different complications [maternal and fetal] faced during all procedure were also recorded and managed. In comparison group, patients were managed were also recorded and managed. In comparison group, patients were managed conservatively for 24 hours. Like in study group, number of patients gong into active labour and delivering with in 24 hours were noted. Different maternal and fetal complications occurring in this group were also recorded and managed. A total of 100 Pregnant women were included in the study. The sample size [100 patients with PROM at term] was completed in 5 months. During that period over all 1105 deliveries were conducted, so the incidence of PROM at term in the study was 9.4%. It was observed in the study group, that all the patients [100%] went into active labour and 96% were delivered within 24 hours of PROM. While in comparison group 72% patients went into active labour and only 62% were delivered within 24 hours of PROM. The results showed that in study group 36 patients went into active labour with only one dose of oral misoprostol, 9 patients required 2 doses and 5 patients required 3 doses of oral misoprostol for going into active labour. When maternal complications were compared in both groups, 92% patients in study group had no complication while only 8% patients had to face different complications. In comparison group 86% had no complication and in 14% patients different complications occurred. Regarding fetal complications 4% fetus/neonates had to face different complications in each group. In current study there was no significant difference in the mode of delivery between the two groups. It was concluded that active management of pre labour rupture of membrances at term with oral misoprostol is a better option than the expectant management. Oral misoprostol in dose of 50 jugm is an effective agent for cervical ripening and induction of labour in PROM at term as significantly high percentage of patients delivered within 24 hours with no increase in maternal and fetal complications

Labour Induction With Randomized Comparison Of Oral And Intravaginal Misoprostol In Post Date Multigravida Women

The efficacy and safety of oral versus vaginal misoprostol for elective induction of labor in post date multigravida with an unfavourable cervix was compared over a period of one year in the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Eightyeight multigravida post date women were divided into two groups and given 50 mg misoprostol orally and 50 mg intravaginally, respectively. The induction to onset of significant uterine contractions and delivery intervals were lower in the first group (7.8 h vs. 8.9 h) when compared to (10.4 h vs. 12 h). The first group had a higher rate of Caesarean section (7% vs. 4%; p>0.05), uterine hyperstimulation (9% vs. 5%; p>0.05), uterine tachysystole (23% vs. 14%; p>0.05) and neonatal admissions to intensive care unit (12% vs. 4%; p>0.05) when compared to second group. Fifty mg oral misoprostol has the potential to induce labor as safely and effectively as the intravaginal route.