Women's perception towards menopause

To determine knowledge and attitude towards menopause among women aged 40 - 60 year presenting with gynecological complaints. Descriptive cross sectional survey. Obstetrics and Gynaecology Unit III, Civil Hospital Karachi from February 2009 to January 2010. Two-hundred premenopausal and postmenopausal women of 40 - 60 year of age were recruited in the study. They were interviewed after informed consent to obtain information about knowledge and attitude towards menopause. Data entered and analyzed by SPSS version 10. Descriptive statistics like frequencies, percentage proportions were calculated to present all categorical variables. The mean age of the participants was 46.8 year, 54.5% were premenopausal and 45.5% postmenopausal, out of them 10% had surgical menopause. 99% were married and 98.5% multiparous and grand multiparous. Only 22% were educated. 94% had heard about menopause, only 30% knew about symptoms, consequences [22%] and treatment of menopause [11%] especially hormone replacement therapy [HRT - 2%]. Ageing and natural transition were considered the common reasons of menopause. Only 21.5% had negative attitude towards menopause due to reason of somatic problems, loss of fertility and feminity. 58.5% considered treatment for menopause unnecessary. Majority of women knew about menopause but lacked knowledge because of limited source of information, education and cultural taboos

Maternal morbidity in emergency versus elective caesarean section at tertiary care hospital

In the past 30 years the rate of caesarean section [C/S] has steadily increased from 5% to more than 20% for many avoidable and unavoidable indications. The objective of this study was to compare maternal morbidity and determine its cause in elective and emergency caesarean section. It was a cross-sectional comparative study conducted in Civil Hospital Karachi at Obs/Gyn Unit III. All mothers admitted through OPD or emergency during the study period, of any age or parity undergoing C/S were recruited in the study. Patients having previous myomectomy, hysterotomy or classical C/S were excluded from the study. Patients undergoing emergency C/S were placed in group A, and those delivered by elective C/S were included in group B. Study variables were general and obstetric parameters and complications observed intra-operatively. Any postoperative complications were recorded from recovery room till patient was discharged from the ward. There were 50 patients in each group. In group A, 11 [22%] were booked and 33 [66%] were referred cases. In group B, 48 [96%] were booked. The mean age in both groups was 28 years. In both groups, multigravida compared to primigravida were 78% vs 22% in group A, and 92% vs 8% in group B. Indication for C/S was previous C/S in 10 [20%] patients in group A, and 39 [78%] patients in group B, placenta previa, chorioamionitis, obstructed labour [6, 12% each]; pregnancy induced hypertension and eclampsia in 5 [10%] cases in group A only. Intra-operative complications in group A were 48 [96%] vs 15 [30%] in group B [p=0.000]. Postoperative morbidity in group A was 50 [100%] and 26 [52%] in group B [p=0.000]. Intra-operative complication was haemorrhage in 46 [92%] cases in group A and 11 [22%] in group B. Anaesthetic complications were 40 [80%]; prolonged intubation 25 [50%], aspiration of gastric contents 8 [16%], and difficult intubation 7 [14%] in group A. Ten [20%] cases had anaesthetic complications in group B. Commonest postoperative complication in both groups was anaemia in 41 [82%] and 11 [22%] cases respectively. Maternal morbidity is significantly higher in emergency C/S. Haemorrhage is a frequent complication in C/S, emergency or elective.

Trends and determinants of caesarean section

To analyze different indications and frequency of caesarean section [CS] so as to provide recommendations for reduction of caesarean section rate. Descriptive case series. Obstetrics and Gynaecology Unit III, Civil Hospital and Dow University of Health Sciences Karachi, from January 2009 to December 2009. All patients who underwent CS either booked, unbooked or referred were included in the study. The data was collected and analyzed for socio-demographic parameters and indications of CS. Patients with ruptured uterus on laparotomy were excluded. Data was analyzed on SPSS 11; percentages and mean were calculated. During one year study period 778 CS were performed. The rate of CS was 27.94%. Emergency CS was performed on 85.86% and elective caesarean section on 14.14% patients. Among them 71.34% were non-booked and referred cases. The commonest indication was repeat CS [n 367 - 47.17%], followed by labour dystocia [n 78 - 10.01%], breech presentation [n 77 -9.8%], foetal distress [FD n 72 - 9.2%], cephalo-pelvic disproportion [CPD n 71 - 9.1%], hypertensive disorders of pregnancy [PID n 49 - 6.2%] and antepartum haemorrhage [APH n39 - 5.0%]. The rate of caesarean section was high. The majority of the cases were non-booked and referred patients, who mostly underwent emergency CS. The commonest indication was repeat CS