effect of modes of delivery on infants' feeding practices

Breast feeding has a great impact on the infant morbidity and mortality. According to Pakistan Demographic and Health survey [PDHS] infant mortality rate is 78 deaths per 1,000 live births. World Health Organization recommends that exclusive breast feeding for six months can decrease infant mortality rate by one-third. The objective of the study was to find out how the mode of delivery had impact on the practice of breast feeding. Data were collected for 2500 consecutive patients during a period of two years, and it was seen that maternal initiative to breast feed was low and problems with lactation were much more in cases delivering their babies via cesarean sections than those delivering theirs by normal delivery. Vaginal and cesarean section deliveries took place in 54% and 46% of the case, respectively. Thirty percent of the women studied felt that they had no problems regarding breastfeeding, but 70% of them had some sort of problems with breastfeeding their babies. When the women were matched for the mode of delivery, 58% of women who had breastfeeding problems belonged to the cesarean delivery group and 42% of complaining mothers were from women with normal delivery. The relative risk of having problems with breastfeeding for women subjected to cesarean was 1.38 and the odds ratio was 0.61. The findings of the present study indicate that more in depth counseling sessions are required for women undergoing operative delivery to improve breast feeding among them

Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding

We compared endometrial sampling by pipelle endometrial curette with Conventional dilatation and curettage [D and C] in patients with abnormal uterine bleeding. Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D and C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D and C as the gold standard. An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D and C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value [100%, 98% and 100%, respectively] for hyperplasia with atypia, and low sensitivity [57%] and positive predictive value [57%], but high specificity [97%] and negative predictive value [97%] for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D and C report. Difficult endotracheal intubation was encountered in two cases of D and C. No other complications of the procedure were observed. The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy

Neoadjuvant chemotherapy in stage IV ovarian malignancy

A 57 years old woman was diagnosed to have stage IV ovarian malignancy on the basis of ascitic fluid cytology, tumor marker and imaging. Neoadjuvant chemotherapy was administered before surgery. Four months after surgery no evidence of malignancy was found on laparotomy and histopathology. She is under surveillance for any signs of recurrence