Insertion of intrauterine contraceptive device at caesarean section

To determine the safety [infection, conception rate and perforation] of intrauterine contraceptive device [IUCD, Multiload Cu 375] insertion at caesarean section and compare their postoperative period [in term of pain, amount of bleeding and expulsion rate] of women who had caesarean section without IUCD insertion and to women who had IUCD inserted as an interval procedure. A case control study. Jinnah Postgraduate Medical Centre, Karachi, from November 2006 to October 2007. Group 1 [cases] were 50 women who had IUCD inserted at caesarean section. Groups 2 and 3 were controls, group 2 consisted of 50 matched women who had a caesarean section without IUCD insertion and group 3 consisting of 50 women who had IUCD inserted as an interval procedure. Degree of pain was assessed by doses of analgesics needed and amount of bleeding by the soaked pads, which were observed by doctor. Infection and expulsion was observed in immediate postoperative period during admission and at follow-up visits at 6 weeks and 6 months and conception was also checked. Analysis of variance was undertaken to compare characteristics at baseline on SPSS version 13. Data were analyzed using univariate methods, two-tailed t-test for continuous variables and chi-square test or Fisher's exact test as appropriate for dichotomous variables. Hospital stay of group 1 was 3.48 days as compared to 3.46 in group 2 [p=0.93]. Wound was infected in 10% women in group 1 and 2% in group 2 [F-test=0.10]; lochia was heavy in 4% in group 1 and 0% in group 2 [F-test=0.25]. Thread was visible in 92% in group1 and 96% in group 3 [p=0.50]. Eighty two percent women were willing to continue with IUCD in group 1 and 86% in group 3 after 6 months. Women undergoing caesarean section, who are desirous of, and suitable for using this method, should be given the option of IUCD insertion at the same time

Oral versus vaginal misoprostol for induction of labour at term

To compare the safety and efficacy of misoprostol through oral and vaginal routes for induction of labor at term. Cross-sectional comparative study. Department of Gynecology and Obstetrics, Ward-9, Jinnah Postgraduate Medical Centre Karachi, from October 2004 to March 2005. Two hundred term patients meeting inclusion criteria for induction of labour were selected using non-probability convenient sampling technique. They were allocated to two groups to receive misoprostol 50 micrograms [micro g] either by vaginal or oral routes. The dose was repeated at an interval of 4 hours till Bishop score improved or need arose for intervention. Results were analyzed through software SPSS version 10.0. Mean induction-delivery [I-D] interval were similar in both groups; vaginal [9.09 +/- 3.4 hours] and oral [9.81 +/- 4.43 hours p=0.33]. Oxytocin augmentation and analgesia requirement were also not statistically significant [p=0.5]. Only one patient had uterine hyper stimulation in the vaginal group. There was no significant difference between the groups with regard to caesarean section rate, maternal complications like post partum haemorrhage [PPH] and neonatal outcome. Oral misoprostol has the potential to induce labour as safely and effectively as its vaginal analogue

Female surgical sterilization at a tertiary care hospital in Karachi

Tubal ligation for sterilization is one of the common methods of contraception practiced by women in developing countries like Pakistan. This study was undertaken to study characteristics of couples undergoing surgical sterilization, and to identify ways of improving utilization of contraceptive services. Material and methods: Details of 1148 women who underwent tubal ligation at the reproductive health center Jinnah Postgraduate Medical Center Karachi from January to December 2002 were recorded on a special proforma. The woman's age, duration of marriage, number of living children and the couple's educational status were recorded. Contraceptive use and duration, and associated medical conditions were documented. Data was entered in SPSS, frequency tables, means and standard deviations were obtained and comparative evaluation undertaken using non parametric methods, as indicated. Out of the 4210 initial clients, 1163 [27.62%] underwent surgical sterilization. This included 1148 [98.69%] tubal ligations and 15 [1.31%] vasectomies. Of these, 608 [52.96%] were carried out in the immediate puerperium. The mean age of women was 33.1 +/- 3.55 years, they had been married for 14.84 +/- 4.22 years and 44.34% had already had 6 or more children. Tubal ligation performed after careful selection and counseling, by experienced personnel under local anaesthesia is a safe procedure with very few complications. However older women with no history of contraception, who have already had 6 or more children, seem to avail it. Promotion of temporary contraceptives for birth spacing among younger couples is more likely to improve maternal and newborn health in addition to limiting the family size