Breast feeding; factors involved in avoidance

To study the causative factors responsible for avoidance of Breast Feeding in post-partum women attending the post-natal OPD in MH Rawalpindi. Comparative cross sectional study. Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from all the Pakistan dealing with other ranks of Pak Army. Nine months [From 01.01.2007 to 1.10.2007]. Study was done on 1000 patients at post-natal Gynae OPD. Patients were divided into two groups of 500 each. Those patients who were exclusively breast feeding their babies were included in group-II while group-I included those patients who were not breast feeding their babies at all. Patients demographic data was entered on questionnaire and factors involved were interpreted. The most important causative factor responsible for avoidance of breast feeding in group-I were noted down. The mothers in group-II were enquired about that problem. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. The study showed that as compared to group-II causative factors involved in avoidance of breast feeding in group-I were pain at operated site 148, working women 38, Sick baby 26,Cracked nipples and mastitis 59, Breast abscess 4, Social Myths 58, Multiple Births 2, Inverted Nipples 5 and failure of proper counseling 160. Most of the factors responsible for avoidance of breast feeding are preventable and treatable. General population should be educated regarding the benefits of breast feeding in the mother and baby. Thus reducing mortality rate in woman and infants

Efficacy of lng-ius in menorrhagia

To determine the therapeutic efficacy of levonorgestrel releasing intra uterine system in achieving a reduction in heavy menstrual bleeding in patients of idiopathic menorrhagia. Quasi experimental study. At out patient department of Gynecology and Obstetrics, Military Hospital Rawalpindi, from October 2005 to June 2008. Fifty patients who fit in the inclusion criteria were recruited by purposive non probability convenience technique. Insertion of LNG-IUS was done on the fifth day of the menstrual cycle. Menstrual blood loss and Hb level was assessed before the insertion and at three monthly intervals after the insertion for one year for the evaluation of the efficacy of the treatment and recorded on a Performa. Amount of menstrual blood loss was estimated subjectively as mild, moderate and severe. Hb level was measured at intervals. Menstrual blood loss and change in Hb levels before and after insertion were analyzed by the 'Chi-square test' using SPSS version 10.0. The results of this study showed a significant improvement in the amount of menstrual blood loss and a subsequent rise in the Hb levels after insertion of LNG-IUS in the patients of idiopathic menorrhagia. The LNG-IUS reduced bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. It has the potential to replace hysterectomy as treatment of choice in selected patients

Complications of raised BMI in pregnancy

To study the effects of raised BMI on maternal and fetal well being. Randomized Control Trial prospective study. Gynae/Obs department Military Hospital Rawalpindi. January 2006 to June 2007. 200 primiparas with raised BMI [25 or more] were booked in first trimester. Patients were followed up with regular antenatal check-up and routine investigations of pregnancy. Patients found to be anaemic were further investigated and anaemia corrected. Another group of 200 primiparas was also booked with normal BMI [18.5 TO 24.9] in first trimester. Complications encountered during pregnancy were recorded in both groups. Mode of delivery and fetal outcome were also recorded. The relative frequency of pregnancy induced hypertension, gestational diabetes, sleep apnoea, urinary infection, preterm labour and intrauterine deaths were compared in both groups. Obstetric complications were also recorded. The frequency of asymptomatic bacteriuria, sleep apnoea, pregnancy induced hypertension, induction of labour, instrumental delivery, caesarean section and post partum hemorrhage was found to be significantly increased in group-I [raised BMI]. Pregnancies in obese women are considerably at higher risk for pregnancy and labour complications, It is advisable to achieve normal BMI before conception

Transvaginal sonography; its specificity and sensitivity in abnormal uterine bleeding

[1] To evaluate predictive values of non-invasive transvaginal sonography in abnormal uterine bleeding. [2] Correlate results of transvaginal sonography with hysteroscopy and biopsy in abnormal uterine bleeding. Descriptive study. [Validity study for TVS]. Gyny/Obs Deptt, Military Hospital Rawalpindi. One year - from January 2006 to December 2006. Women of any age presenting with abnormal uterine bleeding. Total number of cases included were two hundred. Patients were evaluated in OPD by taking detailed gynaecological history. Clinical examination was carried out to find any local source of bleeding from genital tract. Pap smear was taken at that time. Transvaginal ultrasound was performed in OPD basis. The results were noted on a pre-designed proforma. Routine investigations were performed on outpatient basis at the time of patient selection which included complete blood picture, urine analysis, random blood sugar, renal function tests and hepatitis B and C screening. Then the patients were admitted for hysteroscopy and histopathology. Hysteroscopic findings were noted on the proforma. Later histopathology report was also entered into proforma. Hysteroscopy and biopsy were considered gold standard in our study. Thus the procedure was considered 100% accurate and sensitivity, specificity, PPV and NPV for TVS were calculated. It was found that at less than 14 mm endometrial thickness no serious pathology was found. Sensitivity, specificity, negative predictive value and positive predictive value for TVS was found as follows; 1. For endometrial hyperplasia 100%, 93%, 100%, 79% respectively. 2. For endometrial polyp 100%, 97%, 100%, 25% respectively. 3. For carcinoma 100%, 99%, 100%, 33% respectively. 4. For proliferative endometrium 79%,100%, 78% and 100%. 5. For secretary phase endometrium 100%, 96%. 100%, 79% respectively. 6. For sub mucus fibroid 100%, 98%, 100%, 60% respectively. Difference between values of hysteroscopy and TVS is not very significant so TVS should be used as 1st line investigation. At less than 14mm endometrial thickness no major pathology is detected

Social factors involved in women avoiding early antenatal booking in aemy setup

To study the factors involved in women avoiding early antenatal booking coming to Military Hospital Rawalpindi. Comparative cross sectional study. Place and duration: Dept of Gynae and Obstetrics, Military Hospital, Rawalpindi. Tertiary care centre from whole of the Pakistan dealing with other ranks of Pak Army, from July to December 2006. Study was done on 1000 patients at maternity OPD. Patients were divided into two groups of 500 each. Those patients who had early antenatal booking and took regular advice during pregnancy were included in group-I. While group-II included those patients who were late in antenatal booking or remained unbooked till delivery or presented with complications in 3rd trimester for the 1st time. Patients demographic data was entered on questionnaire and factors involved were interpreted. Data was analyzed by using computer software programme SPSS version 11. Chi square test was used to see the significance of difference between group-I and group-II and results were considered significant if P value is less than 0.05. The study showed that as compared to booked patients factors involved in late booking of pregnant women were fear of invasive treatment [C-Section, Episiotomy] [40%], dai system [26%], education less than middle [19%], not living with husband [18%], far distance from hospital [14%], financial restraints [10%]and self medication [05%], [P value < 0.05]. Anemia was significantly lower among women utilizing antenatal care early [3.8%], as compared to those who were late at booking [17.8%], [P value < 0.05]. Similarly preterm labour was also statistically significant, with lower rate in group utilizing antenatal care early [1%] as compared to the other group [8.2%] [p value < 0.05]. Conclusion: Women of reproductive age need to recognize the importance of receiving early antenatal care in the army setup. Factors such as fear of invasive treatment, more faith in dai system, husband being away, living at far distance from hospital were hindering in early booking. Similarly lower socio-economic status and literacy rate of women also delays early utilization of this facility. By early booking, we can reduce the number of patients reporting with complications especially anemia and preterm labour and thus reducing the need of hospital admission and cost on many expensive medicines

Vacuum extraction and forceps deliveries; comparison of maternal and neonatal complications

To compare the maternal and neonatal complications after instrumental deliveries. Prospective study. At MH Rawalpindi. Six months from April 15,2006 to October 14,2006. Total 96 instrumental deliveries were carried out; of which 46 were ventouse and 50 were forceps deliveries. 58% of forceps deliveries were carried out in nulliparous and 42% in mulitparous patients as compared to 61% of ventouse deliveries in nulliparous and 39% in multiparous patients. Fetal distress was indication in 68% of forceps deliveries and 61% ventouse deliveries. Prolong second stage [>1 hr] was the second commonest indication i.e., in 18% of forceps deliveries and 13% of ventouse deliveries. Success rate was 90% in ventouse and 97% in forceps deliveries. Extension of episiotomy was more likely to occur with ventouse deliveries and third degree perineal tear occurred more with forceps deliveries. 14 babies were admitted to NICU and 90% of them were due to meconium staining. There was only one intrapartum death in the ventouse delivery group and that was due to intrapartum asphyxia. Forceps are more likely to be used in primigravidas and less likely to fail. Most common indication of instrumental deliveries is fetal distress followed by prolonged second stage. Cephalhaematoma and jaundice are more common in ventouse deliveries. Extension of episiotomy and low apgar score at one minute is more likely to occur with ventouse deliveries where as third degree perineal tear and subconjuctival haemorrhage are more likely to occur in forceps deliveries

Post partum haemorrhage prophylaxis; Comparison of the efficacy of misoprostol and ergometrine in cesarean delivery

Post partum hemorrhage [PPH] is defined as the loss of greater than 500ml of blood from the genital tract in the first 24 hours following delivery. PPH occurs in 2-11% of all deliveries. To compare the efficacy of misoprostol and ergometrine for the prophylaxis of Post Partum Haemorrhage. Prospective study. Gynaecology and Obstetrics Department Military Hospital Rawalpindi. From 01 July 2006 to 31 Dec 2006. A total of 200 patients were recruited in the study, they were divided in two groups, group - I [n- 100] included those patients who were administered ergometrine intravenously at the time of delivery of head for the prophylaxis of post partum haemorrhage, Group - 2 [n-100] included those patients who were administered Misoprostol 800 microgram per rectally just before the start of cesarean section for the same purpose. Blood loss was calculated objectively by squeezing the soaked pads and quantifying the amount of clots in a kidney tray of standard size to be equal to 500ml. In group I [n-100] 15 patients had mild PPH blood loss > 500ml, out of them 03 had severe PPH requiring bimanual message and 02 patients required blood transfusion, in group II[n-100]. 08 patients had PPH, blood loss > 500 ml, out of them 01 patient required uterine message and none required blood transfusion. Chi-square test was applied to compare the efficacy of the two groups, P > 0.05 showed no significant difference in the efficacy of the two groups but the side effects were obviously less in the Misoprostol group. No patient in group II had GI symptoms while 36 patient in group I had retching and, vomiting and 03 patients had raised B.P after the administration of ergometrine. Misoprostol administered per rectally has equal efficacy to ergometrine given intravenously for the prophylaxis of post partum haemorrhage but the side effect profile and patient tolerability is better with Misoprostol