Comparative Effectiveness of Teaching Obstetrics and Gynaecological Procedural Skills on Patients versus Models: A randomized trial.

Objective: To compare the effectiveness of learning procedural skills on patients versus mannequins and models

Methods: Seventy four interns from two consecutive batches at the Department of Obstetrics and Gynaecolgy Unit-I at Jinnah Postgraduate Medical Center Karachi participated in the study between April and September 2014. Five basic skills; taking a cervical [Pap] smear, intrauterine contraceptive device insertion, manual vacuum aspiration, making/ suturing an episiotomy and active management of the third stage of labour were identified. Interns were randomly allocated to two training groups [Group-1 and 2 of thirty eight and thirty six trainees respectively], with Group-I received training on the five procedural skills on models and mannequins for four weeks while Group-II trained on patients initially. After an evaluation at four weeks the groups crossed over with a final evaluation at eight weeks. The evaluation was through identical objective structured assessment of technical skills on models and mannequins for both groups with standard checklists

Results: There was no significant difference in skills between the two groups at the four weeks assessment. However at the end of training, Group-1 trainees performed significantly better than Group 2 with higher overall tests scores [86.7 +/- 2.7 versus 80.4 +/- 4.8, p <0.001]. This difference was more marked in skills of intrauterine contraceptive device insertion, making and suturing an episiotomy and active management of third stage of labour

Conclusion: Our findings suggest that simulations using models and mannequins for developing procedural skills can be readily incorporated in training programs with potential benefits for teaching infrequently performed or more difficult procedures. Our data suggest potential benefits of initiation of trainings on simulations and mannequins followed by human subject exposure

Frequency and treatment of methicillin resistant staphylococcus aureus in obstetric and gynaecological sepsis

To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in such infections. Observational study. Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen [Ampicillin, Metronidazole and Gentamicin] was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. Staphylococcus aureus was the most frequent organism isolated in 34% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, [17] 77% was associated with puerperal sepsis and rest [5] 23% was associated with post-operative wound infection. It showed best sensitivity to vancomycin. Staphylococcus aureus and E.coli were common agent of postoperative infections and puerperal sepsis

Comparing effects of spinal versus general anesthesia in patients undergoing emergency cesarean sections: an obstetrician's view

Objective: to compare the maternal and neonatal effects of spinal versus general anesthesia in terms of quality of analgesia, muscle relaxation, blood loss during surgery, postoperative analgesia requirement and apgar score

Study design: comparative study

Place and duration: department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, from July 2004 till June 2005

Patients and methods: total 250 patients were included in the study. Informed consent was obtained. Spinal anesthesia [SA] was given to 100 patients and General anesthesia [GA] to 150 patients. Maternal effects were observed in terms of quality of analgesia, muscle relaxation, blood loss and postoperative analgesia requirement. Neonates were assessed by Apgar score. Results were analyzed through SPSS version 10.0

Results: in the Spinal group, quality of analgesia and muscle relaxation was excellent [CI=95%]. Blood loss and amount of blood transfusion was significantly less [p=0.001] in the spinal group. Apgar score at 1 minute was better in the spinal group but the difference at 5 minutes was insignificant. Postoperative analgesia requirement was also significantly less [p-value <0.001]. There was one mortality due to Total Spinal block

Conclusion: there remains no doubt that spinal anesthesia, whenever medically feasible, is superior to general anesthesia in emergency cesarean sections

Magnesium sulphate prophylaxis in pre-eclampsia

To determine the efficacy of magnesium sulphate in the management of preeclampsia. Ward 8, Department of Obstetrics and Gynaecology, Jinnah Post Graduate Medical Center [JPMC] Karachi, from January 2004 to December 2004. A study was done using non random purposive sampling. Study population consisted of 100 pre-eclamptic women. All women with severe pre-eclampsia and impending eclampsia were recruited in the study with blood pressure more than 140/100 mm Hg, proteinuria + + on dipstick or signs and symptoms of impending eclampsia like epigastric pain, nausea, vomiting, headache associated with sever hypertension. Fifty patients had magnesium sulpahte prophylaxis and 50 [control group] without any anticonvulsant. Before giving magnesium sulphate, the clinician checked that knee and other tendon reflexes were present, respiratory rate was normal [more than 16 breaths per minute] and urine output more than 100 ml in last four hours or greater than 25 ml in last four hours. The average age of patients with magnesium sulphate prophylaxis was 28.06 +/- 5.5 years and for controls, it was 27.88 +/- 5.46 years. A significant reduction in the rate of eclampsia in women assigned to magnesium sulphate 2% versus 12% [p<0.05, OR 0.15] was noted. However there was no significant reduction in the rate of abruptio placentae in either group, 6% versus 8% [p>0.5]. The rate of caesarean section was lower in women given magnesium prophylaxis 6% versus 17% [p=0.01]. There was no significant difference inperinatal outcome in either group, 41% live births in study versus 38% amongst controls [p=0. 91]. No maternal death was observed in either group. Magnesium sulphate minimizes the risk of eclampsia and decreases the morbidity and mortality related to eclampsia but at the same time it does not prevent the progression of pre-eclampsia and therefore maternal and fetal surveillance should be continued irrespective of magnesium sulphate prophylaxis

Scioc ultural determinants of induced abortion

To determine the frequency of induced abortion and identify the role of sociocultural factors contributing to termination of pregnancy and associated morbidity and mortality in hospital setting. Design: Prospective observational study. Place and Duration of Study: The study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi from January 1999 to June 2001. Subjects and The patients who were admitted for induced abortion were interviewed in privacy. On condition of anonymity they were asked about the age, parity, family setup and relationships, with particular emphasis on sociocultural reasons and factors contributing to induction of abortion. Details of status of abortionist and methods used for termination of pregnancy, the resulting complications and their severity were recorded. Out of total admissions, 57[2.35%] gave history of induced abortion. All women belonged to low socioeconomic class and 59.6% of them were illiterate. Forty-three [75.5%] of these women had never practiced contraception. Twenty-four [42%] were grandmultiparae and did not want more children. In 29 women [50.9%] the decision for abortion had been supported by the husband. In 25 women [43.8%] abortion was carried out by Daiyan [traditional midwives]. Serious complications like uterine perforation with or without bowel injury were encountered in 25 [43.8%] of these women. During the study period illegally induced abortion accounted for 6 [10.5%] maternal deaths. Prevalence of poverty, illiteracy, grand multiparity and non-practice of contraception are strong determinants of induced abortion