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

Comparison of fetal birth weight between anaemic and non anaemic pregnant women

The objective was to compare the fetal birth weight between anaemic and non anaemic pregnant women. This cross sectional, comparative study was conducted with a total of 200 pregnant women, 100 anaemic and 100 non anaemic, delivering in the labour ward of Abbasi Shaheed Hospital of Gynae unit 1. Study duration was one year from October 2005-September 2006. Pregnant women with singleton, term and gravidity up to 5 were included while twin, grand multi para, intrauterine growth retardation [IUGR], preterm and women with co-morbids were excluded. Data was recorded on a special form. Maternal blood was drawn for haemoglobin estimation and fetal birth weight was recorded after delivery. Results were analyzed by using SPSS 10 on computer. The mean fetal birth weight in anaemic pregnant women was 2338 +/- 266 gm and in non anaemic pregnant women it was 3081 +/- 307 gms with p-value 0.000. Out of 100 anaemic pregnant women 25% were mild, 65% were moderate and only 10% were severely anaemic. The mean birth weight of moderately anaemic was 2184 +/- 89 gms and of severely anaemic women was 1990 +/- 73 gms with p = 0.000. This study shows that anaemic pregnant women who have haemoglobin level of less than 11 gms/dl deliver low birth weight babies as compared to non anaemic pregnant women who have haemoglobin levels greater than or equal to 11 gms/dl

Prevalence and clinical profile of insulin resistance in young women of poly cystic ovary syndrome: a study from Pakistan

Objective: The aim was to estimate the prevalence of Insulin Resistance [IR] in Poly Cystic Ovary Syndrome [PCOS] and analyze its clinical parameters

Methodology: This observational study was conducted at Dow University Hospital during June 2011 till May 2012. Patients of PCOS were selected, an anthropometric measurement, examination and fasting blood test for sugar [FBS] and insulin was performed. Data was collected on pre designed questionnaire, was analyzed by SPSS version 16

Results: Forty-six cases of PCOS were included in the study. Prevalence of IR was 34.78%. Mean age of patients was 23.72 +/- 4.37 years. Waist Hip Ratio [WHR] was raised in 42 [91.30%], acanthosis was found in 26[56.50%], impaired FBS was seen in 9 [19.6%] and raised fasting insulin in 16 [34.8%] patients. There was significant association between acanthosis and WHR [0.044] and between acanthosis and FBS [0.008]. Correlation studies between parameters showed a significant correlation between Waist and Hips [0.93], similarly Waist and WHR showed positive correlation [0.59], at p < 0.01. Significant positive correlation was also found between waist and FBS [0.32] and FBS and WHR [0.378]

Conclusion: Acanthosis nigrican, raised WHR and FBS are significant parameters for insulin resistance in cases of Poly Cystic Ovary Syndrome [PCOS]

Premenstrual syndrome: a comparative study of working women vs housewives in Karachi

To compare the frequency of premenstrual syndrome [PMS] in working women and house wives and its relationship with associated factors. A comparative cross sectional study having qualitative characteristics, was conducted in Karachi form August 2002 to August 2003. Working women in the study were from Abbasi Shaheed Hospital and-house wives from Federal B Area Karachi. Hundred women were included aged between 20-40 years belonging to two groups of 50 each. The first group comprised of working women from a hospital, ranging from highly educated doctors to janitors. The other group comprised of non-working housewives of middle and low income group. In both groups exclusions were made for those who had irregular menstrual cycle, on contraceptive pills, desiring pregnancy, were lactating or had known major psychiatric or medical disorders. Results were compiled after three consecutive menstrual cycles using questionnaire. The results indicated that PMS is significantly higher in working women than housewives [50% vs 30%]. Statistical analysis showed that it is more commonly present in the age range of 26-35 years, in single women or women with low parity and the well educated. Irritability, depression and loss of interest are most frequent complaints in working women. General malaise, abdominal cramps and dysmenorrhoea are more common in house wives. Working women show greater tendency to use analgesics. PMS was more common in working women compared to housewives. There is a need to identify women with PMS and to establish an intervention that would help to alleviate the symptoms so that their work performance remains unaltered

Factors related to blood transfusion in placenta previa

To determine the frequency of blood transfusions in cases of placenta previa and to assess the factors influencing such a need. Descriptive case series. Department of Obstetrics and Gynecology, Civil Hospital Karachi, from January 2009 to December 2010. Clinical records of 88 cases of placenta previa were retrieved. Ten cases of placenta previa with multiple gestation, adherent placentae, placental abruption, maternal death on arrival and incomplete records were excluded. Seventy-eight cases were selected for the study. Structured proforma was used to collect information about transfusion of blood and blood products and the factors affecting need for transfusion. The mean age of the patients was 28.37+4.74 year; parity was between 2 to 4 in 34[44%] patients and 26 [34%] of the total cases were booked. A total of 177 [mean 2.3] transfusions were received by 59 [76.6%] patients. Seventy-five [97.6%] patients had anemia including 8[10.4%] cases of severe type. Patients aged below 25 or above 34 year, of un-booked status and parity below 2 or above 4, received more transfusions. Complete placenta previa, severity of anemia and signs of shock were significant determinants for transfusion. Majority of blood transfusions were given during the delivery or cesarean section. Pregnant woman with major placenta previa who presented with hemorrhage and already anemic, needed more replacement of blood