Frequency and risk profiles associated with antenatal anxiety and depression in middle socioeconomic women

Objective: To determine the frequency of antenatal anxiety and depression and its risk profile including demographic, psychosocial and obstetric risk factors, in middle socioeconomic women

Methods: A cross-sectional study was carried out at two private hospital centres of Karachi, over a period of five months from October 2016 to March 2017. A questionnaire [age, education, parity, socioeconomic status, employment] and the Hospital Anxiety and Depression Scale [HADS] were the tools used to gather required information from pregnant women. Data collected was entered in SPSS 16 software. Descriptive statistics were used to calculate frequency and mean values. Logistic regression both binary and multinomial was performed to identify significant predictors of anxiety and depression

Results: Our study showed that out of 520 pregnant women, 130 [25%] women had anxiety, whereas 220 [42.3%] had depression. The mean age of women was 26.9 +/- 4.198 years. The range being from 18 years to 35 years. Significant risk factors among anxiety group were: working woman; 30.8% [p-value=0.000, OR=0.286], domestic violence; 84.6% [p-value=0.000, OR=2.8], difficult relationship with in-laws; 84.6% [p-value=0.000, OR=12.375], sleep disturbance; 76.9% [p-value=0.000, OR=9.667], primigravida; 23% [p-value=0.000, OR=2.576] and unplanned pregnancy; 23.1% [pvalue= 0.029, OR=0.511]. Significant risk factors among women with depression were: working woman; 31.8% [pvalue= 0.000,OR=0.286], domestic violence; 68.2% [p-value=0.000, OR=3.571], difficult relationship with in-laws; 22.7% [p-value=0.000, OR=4.8], sleep disturbance; 54.5% [p-value=0.008, OR=2.0], primigravida; 45.5% [p-value=0.000, OR=17.246] and unplanned pregnancy; 18.2% [p-value=0.000, OR=3.0]. Other factors that were found to be significant in the depression group only were: unsatisfactory relationship with husband; 22.7% [p-value=0.000, OR=4.118], stressful life event in previous year; 45.5% [p-value=0.000, OR=2.167], and tertiary education; 68.2% [p-value=0.002, OR=0.916]

Conclusion: Psychosocial and demographic factors such as working woman, domestic violence, and difficult relationship with in-laws and sleep disturbance had a significant association with antenatal anxiety and depression. Obstetric risk factors were primigravida and unplanned pregnancy. Significant association with depression was unsatisfactory relationship with husband, stressful life event in a previous year and tertiary education

Frequency of pelvic pain and bleeding per vaginum in first trimester of pregnancy in a tertiary care hospital of Karachi

Objective: The objective of this study was to determine the frequency of pelvic pain and per vaginal bleeding, in the first trimester of pregnancy

Methods: A total of 150 pregnant women 18 to 35 years in first trimester were recruited in this crosssectional study, conducted from July 2015 to July 2016. Non-probability sampling technique was used to collect the data. The collected information from patients were entered in pre-designed proforma after taking informed consent. Data was analysed by using SPSS version 20

Results: The average age of the patients was 26.33 +/- 4.23 [range 18-35] years. Frequency of pelvic pain and per vaginal bleeding in first trimester of pregnancy was observed in 29.33% [44/150] and 12% [18/150] respectively. Stratification analysis was performed and it was observed that rate of pelvic pain and per vaginal bleeding was not statistically significant among different age groups. Rate of pelvic pain was significantly high in women with primigravida as compare to multigravida [p=0.003]

Conclusion: We found in our sample a significant number of women experiencing pelvic pain and vaginal bleeding in first trimester of their pregnancy. The practitioner must employ sound clinical and diagnostic skills in the management of the patient as early pregnancy complications can cause significant distress for some women and their partners

Umbilical cord blood pH in intrapartum hypoxia

To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia. Descriptive analytical study. Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012. All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures [healthy, NICU admission or neonatal death], color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed. A total of 204 newborns were evaluated. The mean pH level was found to be significantly different [p=0.007] in two groups. The pH value 7.25 had significant association [p < 0.001] with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor [MSL] also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSL had pH > 7.25. Majority [63.6%] cases needed caesarean section as compared to 31.4% controls. There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive

Stillbirth; frequency and correlates in severe acute maternal morbidity [SAMM] and maternal death at tertiary health care centre

Pakistan stands second in the world s rating of highest stillbirth rate. This gives an emergency call to authorities involved in maternity health care of Pakistan to take serious and quick steps to address the problem. Retrospective observational study at tertiary health care centre to see frequency and risk factors for stillbirth in cases of severe acute maternal morbidity [SAMM] and maternal death over period from January 2008 till Jan 2010. High stillbirth rate 438 /1000 was found in the study group as compared to still birth rate of 74 /1000 in rest of the deliveries during the same period. Data analysis by using multivariate regression for variables after adjusting for co variable showed significant association [p value < .05] with still births of following factors grand multipara [adjusted OR 1.887 Cl 1.156-3.081] primigravida [adjusted OR 1.623 Cl -1.023-2.573] low education [adjusted OR 19.378 Cl- 2.586-145.208] lack of standard antenatal [care Non booked [adjusted OR 10.101 Cl 3.847-26.518] referred cases [OR 5.879 Cl 2.166-15.954]] preterm deliveries [adjusted OR 2.994 Cl 1.512-5.931] and vaginal deliveries 1.986 [Cl 1.351-2.920] whereas uterine rupture [adjusted OR 4.003 Cl 1.647-9.729] prepartum haemorrhage [adjusted OR 3.617 Cl 1.756-7.451] and hypertension [adjusted OR 3.298 Cl 2.040- 5.330]were significant obstetric risk factors. Audit of SAMM and maternal death with emphasis on risk factors of still birth would help to find strategies to reduce preventable causes of stillbirth .This would be important relatively quick contribution to efforts of achieving MDG 4

Polycystic ovarian syndrome; acne is common presentation in women in relation to menstrual irregularity a study from hospital in Karachi

Polycystic ovarian syndrome is a common disease among the women in reproductive age group and more common in South Asian women. Clinical presentations include menstrual disorders, subfertility, obesity,hirsutism, acne vulgaris and acanthosis. The objective of study was to investigate co relation between acne and polycystic ovaries and its relation to menstrual irregularity. A total of 56women were enrolled in the study from Outpatient Department of Obs and Gynae and Dermatology, Dow University Hosptial, Ojha campus by convenient sampling. It was cross sectional study, conducted from July 2012 to November 2012.Verbal consent was taken. Sociodemographic information,Anthropometric measurement [height, weight, BMI] and acne severity with affected area, menstrual irregularities were administered on pre designed questionnaire.Pelvic ultrasound for polycystic ovaries and serum LH, FSH in follicular phase of menstrual cycle [2nd day] advised from Dow Radiology and Dow Lab respectively. A total of56 patients of PCOS were enrolled during five month period. The mean age of patient was 21.1 +/- SD 0.994. Frequency of acne was 32 [57.1%].The mean BMI was 19.66 +/- SD 4.54. Face was the commonest area involved in 24 [42.9%], menstrual irregularity was found in 50 [89.4%] women. There was no statistically significant relation seen between acne and oligomenorrhea. [X2 = 0.55, P = 0.45]. It was also determined that there was no co relation seen between the acne and serum testosterone level calculated by independent sample t test.[P = 0.17] but statistically significant association seen between severity of acne and serum LH/FSH ratio, [ttest =3.28, p= 0.004] Acne was found in 32 [57.1%] women with PCOS. The study results revealed a significant association seen between severity of acne and serum LH/FSH ratio. Relation between acne and serum testosterone level was statistically insignificant

Use of bilateral internal iliac artery ligation for controlling severe obstetric haemorrhage

To study the role of bilateral internal iliac artery ligation [BIAL] in arresting intractable postpartum haemorrhage. This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding [failure rate 16.66%]. While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity

Maternal outcome in cases of vaginal deliveries after one Cesarean section

To evaluate maternal morbidity and mortality in cases of vaginal deliveries after one prior cesarean section. To reduce repeat cesarean rate in selective cases. To construct guide line for trial of cesarean scar. Descriptive prospective study. Department of obstetrics and Gynecology Unit 1 Civil hospital Karachi. Duration of Study: Two years study from 1st October 2005 to 30th September 2007. During two years period women with previous one cesarean delivery due to non recurrent cause were selected. Excluded cases underwent elective cesarean sections. Women with no medical disorder having singleton term pregnancy, vertex presentation and adequate pelvis were enrolled for trial of labour. All the women were allowed to go into spontaneous labour. No augmentation of labour was done. Careful monitoring was done during labour. During two years period One hundred and eighty eight women presented with previous one cesarean section for nonrecurrent cause .Out of one hundred and eighty eight women seventy eight decided to have elective cesarean section for some obstetric reason. One hundred and ten women were selected for study, Out of these One hundred and ten women thirty four [30.9%] ended in emergency cesarean section [Non progress of labour, 41.17%, fetal distress 29.41%, impending rapture 17.64%. where as seventy six [69.09%] women had successful vaginal deliveries. Of sventy six women delivering vaginally twenty [26.31%] women had instrumental vaginal deliveries and fifty two [73.68%] women had spontaneous vaginal deliveries. There was no maternal mortality. No case of uterine rapture occurred. Partial scar dehiscence was found in 2.6% cases. Postpartum hemorrhage occurred in 5.2%cases due to atonic uterus. Duration of hospital stay was 2-3 days following vaginal deliveries where as it was 7-8 days following cesarean section. With well defined protocol, trial of labor after one prior cesarean delivery is safe and most often successful and reduces the rate of repeat cesarean section