Factors for inaccessibility of antenatal care by women in Sindh

Antenatal care is important for pregnant women. By good antenatal care many complications of pregnancy can be prevented and lives can be saved. This study was carried out to find out the reasons of not utilising antenatal care, knowledge about dangerous signs and symptoms of pregnancy, and diet in women receiving and not receiving antenatal care. This descriptive study was conducted at Department of Obstetrics and Gynaecology, Liaquat University Hospital, Hyderabad Pakistan from February 2007 to October 2007. A total of 134 women who came for delivery were included in the study. Out of these, 71 women had received antenatal care while 63 did not receive antenatal care. After taking informed consent, women were interviewed regarding demographic data, reason of not utilising antenatal care, knowledge about diet and dangerous signs and symptoms of pregnancy. Twenty-eight [44.44%] women did not receive antenatal care because the facility was far away from home, 10 [15.87%] said that transport was not available. Tetanus toxoid coverage was higher among women who received antenatal care [p<0.0001]. Women who received antenatal care were more aware of the dangerous signs and symptoms of pregnancy than women who did not receive antenatal care. Most common reason of not utilising antenatal care was that facility was far away from there home. Women who received antenatal care were not anaemic and had received tetnus toxoid vaccination. They knew more about diet and dangerous sign and symptoms of pregnancy than women who had not received antenatal care

Awareness of women regarding analgesia during Labour

Delivery pain is one of the most severe pains that women experience during their life so a change can affect all dimensions of pregnant women and her family life. Aim of this study was to assess the women's knowledge of pain relief during labour, and their beliefs, fears, and misconceptions regarding epidural analgesia. It was descriptive study conducted in Obstetric and Gynaecology OPD of Liaquat University of Medical and Health Sciences, Hyderabad from September 2007 to January 2008. Women were selected randomly. All pregnant females who had delivered previously were interviewed. Primigravida were excluded from study. Information was collected on self-made questionnaire after an informed consent. Information was collected on computer software programme of SPSS 11.frequencies and percentages were calculated to express the results. Total 131 women were included in this study. Out of these 65, [49.6%] had no education while 41 [31.2%] had primary education. Majority of women [82, 62.5%] had knowledge about injections while few [12, 9.1%] women had knowledge about epidural analgesia. Seventy-nine [60.3%] had chosen the injections as preferred method during next labour. Regarding attitude towards labour pains, 61 [46.5%] feels that labour pains as severe pain. Regarding epidural analgesia 4 [3%] women thought that epidural analgesia will lead to weakness of limbs and 3 [2.2%] women thought that it will cause permanent backache. There was poor general awareness of women about the role of epidural analgesia in labour leading to a low patient demand for such services. Most of the women had gained knowledge regarding pain relief from past experience or from friends and relatives

Postpartum hemorrhage: an experience at tertiary care hospital

To determine the frequency, causes and various treatment methods used in for postpartum hemorrhage [PPH] our setup. Descriptive study. This study was conducted in the Department of Obstetrics and Gynecology Unit 1, Liaquat University of Medical and Health Sciences Hyderabad, from June 2007 to April 2008. All women admitted with or developed PPH in hospital after delivery or cesarean section were included. Patients with history of bleeding disorders and those on heparin/warfarin were excluded. Results were analyzed through computer software program SPSS version 11 and percentages were used to describe the data. Total number of obstetric admissions during the study period was 1231. Out of these 118 [9.5%] patients developed PPH. Out of these 118 patients, 98[83%] patients had primary PPH while 20[16.9%] patients had secondary PPH. Seventy five [63.5%] patients were unbooked while 43[36.4%] were booked. Regarding causes of PPH, most common cause was uterine atony in 76[64.4%] cases, followed by perineal and vaginal tears in 41[34.7%] patients and prolonged labor in 29[24.5%]. Uterine massage was done in 76[64.4%] patients, B-Lynch sutures were applied in 6[5%] cases and hysterectomy done in 4[3.3%] patients. Majority of patients developed primary PPH and the commonest cause was uterine atony. PPH was commonly seen in unbooked patients, induced/ augmented labor and grand multiparous women

Eclampsia; frequency and morbidity

The purpose of our study was to find the outcome, frequency, maternal morbidity and perinatal outcome due to eclampsia in our set up. Descriptive study. This study was conducted in the department of obstetrics and gynae from 1st January 2007 to 1st January 2008 in Gynecology and obstetric department: unit 1 of Liaquat University hospital Hyderabad. Total 39 patients who had eclampsia were included in this study while other obstetric patients who had no eclampsia were excluded from the study After an informed consent information was recorded on predesigned proforma regarding maternal age, parity, duration of pregnancy, B.P at admission mode of delivery maternal morbidity and perinatal outcome. Results were analyzed through computer software programme SPSS version 11 and percentages were used to describe the data. Total 1415 deliveries were conducted during the study period. Out of these 39 patients had eclampsia. So the frequency of eclampsia was 2.7% Majority of patients i.e. 15 [38.4%] were less than 20 years. Out of 39 patients 32 [82.0%] patients were primigravida while 4 [10.2%] were multigravida and 3 [7.6%] patients were grandmultigravida. Majority of the patients i.e. 28 [71.7%] were unbooked. 18 [46.1%] patients had fit during antenatal period 14 [35.8%] patients had fit in postpartum period one case with eclampsia was received on 6th postnatal day. Serious maternal morbidity was pulmonary edema seen in 6 [15.3%] HELLP Syndrome in 3 [7.6%] and acute renal failure in 4 [10.2%] patients. Regarding perinatal outcome 28 [71.7%] babies were born alive out of these 11 [39.2%] were died in early neonatal period 8 [20.5%] babies born, were still birth while 3 [7.6%] were macerated IUD. In our study majority of patients who developed eclampsia were young and primigravida Major maternal morbidity was pulmonary edema chest infection and acute renal failure. Perinatal mortality was also high

Laparoscopic evaluation of chronic pelvic pain: experience at a public sector university hospital

To evaluate laparoscopically the causes of chronic pelvic pain in our set-up, so that appropriate treatment could be offered to these patients and unnecessary hospital visits and repeated use of antibiotics are avoided. A descriptive study. Obstetrics and gynecology outpatient department [OPD] of Liaquat University Hospital Hyderabad, Sindh - Pakistan from 1[st] October 2006 to 31[st] March 2007. This study was based on sample of convenience and conducted on women who attended OPD. A total of 4301 patients attended the OPD. Among them, 271 patients attended the OPD because of chronic pelvic pain. They were thoroughly interviewed and investigated. Those patients who did not respond to symptomatic treatment were advised laparoscopy. Thirty-three patients who fulfilled the inclusion criteria and gave consent were selected for laparoscopy. Informed consent was taken and detailed history, thorough examination and necessary investigations were carried out. Patients with serious heart or lung disease, peritonitis, intestinal obstruction, abdominal operations and malignancy were excluded. Diagnostic laparoscopy was carried out under general anesthesia and operative findings were noted on a proforma. Data were analyzed through software programme SPSS version 11.0. Of these 33 patients, majority 17[51.52%] belonged to 31-41 years of age group and were multiparous patients [57.58%]. Seventeen [51.52%] patients had dull, deep pelvic pain with occasional sharp episodes. Only 03[9.1%] patients with acute pain required hospitalization. Eleven [33.33%] patients complained of subfertility, 7[21.21%] had dysmenorrhea while 05[15.15%] had dysfunctional bleeding. Only 04[12.12%] patients complained of backache low down in the lumbosacral region. No any sign was present in 7[21.21%] patients. Uterus was bulky in 11[33.33%]patients. Adnexal masses were felt in 06[18.18%] patients while 05[15.15%] had nodularity in pouch of Douglas. Regarding laparoscopic findings, 11[33.33%] patients had chronic pelvic inflammatory disease. Varying degree of endometriosis was seen in 09[27.27%] patients. In 04[12.12%] patients, no abnormality was detected. This study emphasizes the importance of laparoscopy in evaluating the cause of chronic pelvic pain. This procedure shall be considered an essential investigation in the management of such patients so that repeated and unnecessary use of antibiotics and other drugs could be avoided