Urinary fibrin(-ogen) degradation products in pregnancy associated hypertension

The relationship between the urinary fibrin(-ogen) degradation products (FOP) and high blood pressure and other features like proteinuria and oedema were studied in 42 cases of pregnancy associated hypertension (PAH) and/or pre- eclampsia (PE). Urinary FOP were detected in 64.3 per cent of cases. All cases with systolic blood pressure> 180 mmHg and/or diastolic blood pressure> 100 mmHg showed FOP in urine in various concentrations. In 91 per cent of cases with protenuria more than 2+ urinary FOP was also detected. In some cases with no proteinuria FOP was found. There was no definite relationship between severity of oedema and urinary FOP level. When a patient is under treatment and responding well to that treatment urinary FOP level also becomes reduced or undetectable.

Role of amniotic fluid index assessment in postdate pregnancy

The objective was to determine the significance of amniotic fluid volume with regard to pegnancy outcome in postdate pregnancy with the amniotic fluid index (AFI) assessment and to define the optimal cut-off level where adverse pregnancy outcome can occur. Ninety-eight pregnant women under 35 years of age with over 40 weeks' completed gestational age and no other complications admitted to Central Women's Hospital during the study period of 6 months beginning in April 1994 were selected for AFI assessment by using real time linear array B-scan. Pregnancy outcomes were correlated with AFI in cases of delivery within 3 days of AFI assessment. analysis revealed an inverse relationship between AFI and incidence of adverse pregnancy outcome and the optimal cut-off point was AFI 8.0 cm with sensitivity, specificity, positive and negative predictive value of 72.8 per cent, 71 per cent, 42 per cent and 90 per cent respectively for adverse fetal outcome. In conclusion, amniotic fluid volume assessment was an effective method in predicting adverse pregnancy outcome and AFI of 8.0 cm was shown statistically to be an appropriate cut-off level to identify the fetus at risk.

Serum fibrin (-ogen) degradation products (FDP) in toxaemia of pregnancy

The relationship between the levels of FDP in the serum, blood pressure and the severity of other features of toxaemia of pregnancy were studied in 42 patients with pregnancy-associated hypertension and/or pre-eclampsia (PE). Serum FDP levels were found to be elevated in 88 per cent of cases but not related to the severity of the clinical manifestations of toxaemia in pregnancy. It was elevated in cases with normal systolic blood pressure as well as in cases with no proteinuria. Subsequent serum FDP concentrations fell to normal along with the treatment in all cases. Serum FDP determination was suggested to include in investigation of severe cases of PE as a sensitive index for the diagnosis as well as for the assessment of response to treatment.

Screening for and utilization of contraceptive methods among clients at family planning clinic of Central Women's Hospital, Yangon

One thousand one hundred and thirty two clients attending the family planning clinic of Central Women's Hospital, Yangon during a 16-months period, begining in May 1995 were screened according to a set of eligibility criteria, counselled on suitable method(s) among the 4 methods, viz. combined oral contraceptive pills (COC). depot-medroxyprogesterone acetate (DMPA), intra-uterine contraceptive device (IUCD) and condoms, and offered the method of informed choice. Among the clients, 904 (79.85 per cent) were fit for COC. Of these, 9.4 per cent chose COCs whereas 58.9 per cent chose DMPA, Of these, 55.33 per cent chose DMPAs, whereas 30.69 per cent chose IUCDs, 9.1 per cent COCs and 4.9 per cent condoms. Of these 44 clients who were unfit for DMPA, 59.1 per cent had been past users. Likewise, 942 (83.2 per cent) were fit for IUCD. Of these, 36.2 per cent chose IUCDs, whereas 50.8 per cent chose DMPAs, 7.6 per cent COCs and 5.3 per cent condoms. Of those 190 who were unfit for IUCK, 1.6 per cent had been past users. Those who were unfit were reassessed to fulfil the wishes of users. In all, DMPA was the most utilized method (54.2 per cent), followed by IUCD (31.3 per cent), COC (9.0 per cent) and condoms (5.5 per cent). The utilization of IUCK was increased 6 times higher than that in 1990 before provision of contraceptive services by public sector. Tthe creation of such services in the country will definitely improve the optimum contraceptive mix required for a family planning programme.

Acceptability of condoms among family planning clinic attenders in Waybagi, North Okkalapa

A hundred currently married women of 20-49 years were interviewed to assess the knowledge, attitude and practice of male condoms among family planning clinic attenders of Waybagi in North Okkalapa Township and to identify their acceptance and perception towards male condoms. The majority of wives were 30 to 34 years ole and primary school level whereas the majority of husbands were between 35 to 39 years of age, educated up to high school level. Most wives (75 per cent) were dependents whereas majority of husbands (38 per cent) were semi-skilled workers. although 75 per cent have heard of condoms only 36 per cent had actually seen one. Most knew that condoms were meant for contraception (86.7 per cent). Sixty-eight per cent knew condoms could prevent transmission of sexually transmissible diseases; 8 per cent thought condoms were meant for extra-marital sex; 77.3 per cent knew that condoms were meant for single use only. Over half thought condom is important for family planning and prevention of STD, less than half thought it was good for sexual relationship, that every adult male should use it, that it was good for male use, and that it would not create any problem between husband and wife. as regards statements with negative view, more than half disagreed with statements that condoms could disturb sexual relationship and that it could not be used for monogamous marriage. Overall, the respondents seemed to regard condoms positively rather than negatively. Only 5 per cent had ever used condoms out of which only one liked it whereas one disliked it due to condom rupture. None were currently using condoms. It indicated that proper counselling and appropriate training is essential to promote condom acceptability.

Male participation in birth spacing

A cross-sectional, descriptive, community-based survey using pre-tested pre-formed questionnaire was carried out on 100 randomly selected husbands of 1000 currently married women of age 15-49 years residing in rural area of Taikkyi Township where 24.2 percent of the married women were current users of contraceptives. Major portion (89 percent) had heard of contraception and 85 percent knew one or more method(s) of spacing birth. Only 1 percent knew what safe period meant although 75.3 percent claimed to have knowledge of the method. The majority desired three children per family. As regards attitudinal responses, 80 percent thought contraception should be the wife's responsibility, 72 percent thought it should be theirs, 23 percent thought contraception should begin at the start of married life, 71 percent preferred male method, 51 percent agreed that contraception should not be practiced, 48 percent disliked methods requiring medical examination and 78 percent thought contraception should be used during lactation. As for effect on health, 70 percent considered it good for the child. Contraception was negatively reviewed by some as to be against religion (22 percent), against culture (18 percent) and against nature (17 percent).

Objective assessment of meconium content in amniotic fluid

In the first part, a sample set of meconium and amniotic fluid solutions with concentrations of 15 percent, 10 percent, 7.5 percent, 5 percent, 3 percent and 1.5 percent was prepared by mixing fresh meconium with clear amniotic fluid. After centrifugation, meconiumcrit values were measured similar to haematocrit measurement. A graph was constructed from meconium concentration and respective meconiumcrit values. A linear relationship was found. In the second part meconiumcrit readings were measured from meconium-stained amniotic fluid obtained from women in labour. fetal and neonatal morbidity were increased significantly in cases where meconium level reached >10 percent. The cut-off level requiring tracheal intubation was found to be 15 percent. High meconiumcrit levels could alert the obstetrician to the possibility of neonatal morbidity and the need for intensive resuscitative measures.

Operative management of vaginal agenesis

Vaginal agenesis is said to occur once in 4,000 to 5,000 women. In the absence of functioning endometrial tissue, the most common complaint is primary amenorrhea. With a functioning uterus, pain and mass in lower abdomen due to haematometra are the usual features. In this study, operative management of 5 cases of vaginal agenesis fulfilling full reproductive objective in 4 cases was described and presentation would be carried out with the help of slides taken throughout the operative procedures.

Prescribing practices on contraception among general practitioners and basic health services staff in Taikkyi Township

Sixty-eight health service providers including 14 Medical Doctors (7 Full-time General Practitioners (GPs) and 7 Government Medical Officers), 4 Health Assistants (HAs), 11 Public Health Supervisors (PHS I & II), 5 Lady Health Visitors (LHVs) and 34 Midwives (MWS) practising in Taikkyi Township, were interviewed using a self administered structured questionnaire, to assess their level of knowledge and prescribing practices for contraception. All of the service providers with the exception of some PHS have prescribed some form of contraception during their practice. Among the contraceptives stated to be most prescribed by them, oral contraceptives came first with 94 percent, followed by injections with 92 percent, rhythm method in 37 percent, intra-uterine device in 30 percent, female sterilization in 21 percent, and condoms were prescribed only by 16 percent of them. The real and perceived side effects experienced with various methods are also discussed. The findings suggest that health care providers need to be trained or given refresher courses on contraceptive technology and proper counselling and use of the available methods, appropriate choice of methods suitable for the individual, the real and perceived side effects from various methods and their management. Development of appropriate health education and counselling package for use in birth spacing programmes is also indicated.

Carcinoma Vulva (Five Years Analysis)

A 5 years study (1989-1993) of cases of Carcinoma vulva admitted to Central Women's Hospital was carried out to find (a) the clinico-epidemiologic features and (b) the association between clinical staging (FIGO) with the histological evidence of lymph node involvement. Objective (a) was achieved with preformed questionnaire and Objective (b) from clinical and pathological assessments. Out of 32 cases of Ca vulva, the modal age group on the study was 50 to 59 years and modal parity 7. Seven cases had medical disease and one had prior history of carcinoma cervix. The presenting features were growth or ulcer, pruritis vulva, leukoplakia, white discharge. Two cases were recurrent growths. According to FIGO staging, 3 belonged to stage (2), 21 to stage (3) and 8 to stage (4). There were no nodal desease in stage (2) cases. Stage (3) cases had 4.76 percent superficial nodal disease and no deep nodal disease. Stage (4) had 75 percent superficial and 25 percent deep nodal disease in 100 percent cases. Regarding histological spread in cases with palpable nodes, the positive predictive values were 25.9 percent with superficial inguinal enlargement, 40 percent with gland of Cloquet enlargement and O with external iliac node enlargement.