Depression; prevalence and predicators among Pakistani infertile women

Infertility is very stressful event and is proven to associate with depression, anxiety, sexual dysfunction loneliness, sadness and impaired couple's relationship

Objectives: To determine the frequency of depression in infertile females and to determine the various risk factors associated with infertility and depression

Study Design: Prospective cross sectional study

Setting: Department of Obstetrics and Gynecology of Ziauddin University Karachi

Period: January to June 2014

Methodology: Infertile women were interviewed and the diagnosis and severity of depression was assessed together with the effects of different predicators such as age, duration of infertility, employment educational and socioeconomical status using PHQ- 9 scale scoring

Results: This study showed that 199 [58%] of the infertile women suffered from depression. There was a statistically significant association with socio economical status while no significant association was detected with age of women, duration of infertility and educational status

Conclusion: We found a high prevalence of depression among infertile women. Depression was more among women belonging to higher socioeconomic class

Maternal and perinatal outcome in threatened miscarriage in first trimester

Objective: To see the consequences of first trimester threatened miscarriage on maternal and fetal outcomes

Study design: A prospective case-control study

Place and duration: Study conducted at Ziauddin University and Hospitals Karachi from 1st January 2012 to 31st January 2013

Methodology: 100 females attending the Antenatal clinic with threatened miscarriage who matched the selection criteria were included as cases.106 women without any history of threatened miscarriage were selected as controls. These patients were then followed to evaluate complications in later pregnancy

Results: Women with threatened miscarriage were more prone to be delivering prematurely, experience pre labour premature rupture of membranes and to deliver babies with intrauterinegrowth restriction as compared to those women without any bleeding. Women with first trimester threatened miscarriage had a statistically significant higher likelihood of Antepartum haemorrhage [18%] as compared to controls [4.6%] and were found to be significantly associated with Pregnancy induced hypertension and preeclampsia. Regarding fetal outcomes it was found that higher rates of perinatal mortality were found in females with 1[st] trimester bleeding and more babies with congenital anomalies were born to these women

Conclusion: Threatened miscarriage during first trimester of pregnancy is a predictor of increased incidence of adverse maternal and fetal outcomes

Trial of labor; success in women with previous caesarean section

To determine the frequency and types of vaginal delivery in women with previous one caesarean section and to observe the effect of women age on success of vaginal birth. A descriptive study was carried out in the department of obstetrics and gynecology, Ziauddin University Hospital Kemari campus Karachi from January 2011 to January 2013. 200 patients with previous one caesarean section for a non recurrent cause were included in the study after fulfilling the inclusion and exclusion criteria. The women selected were evaluated and counseled for trial of labor. The frequency and mode of vaginal delivery was recorded in cases of successful trial of labor and caesarean section was performed in case of failed trial of labor. Successful vaginal delivery was achieved in 67% of the patients and repeat emergency caesarean section was carried out in 33% of the patients. Leading indication for repeat caesarean section was failure to progress, fetal distress and scar tenderness. No maternal and fetal complication occurred. We also observed that patients of less than 30 years were more likely to have a successful vaginal delivery [82%] as compared to patients older than 30 years [18%]. The trial of labor should be encouraged with vigilant monitoring in patients with previous one Caesarean section and is a safe and successful option if carefully selected and monitored

Urinary incontinence three months after delivery; prevalence and risk factors

The objective of this study was to investigate prevalence of urinary incontinence at 3 months postpartum and to study how continence status during pregnancy and different factors influence urinary incontinence at 3 months postpartum in primiparous women. Pregnant women attending routine antenatal clinic at Ziauddin hospital and Kharader general hospital Karachi were recruited to this study. Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester. Incontinence was re-assessed three months postpartum. Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence. Urinary incontinence was reported in 15 women [10.6%] out of 141 women, mode of delivery, onset of labor weight of the baby, episiotomy, and the length of the second stage of labor, were not predictive of urinary incontinence after delivery. Adjusted RR for incontinence after spontaneous vaginal delivery compared with elective caesarean section was 2.200 [95% CI .6-7.28] among women who were continent during pregnancy. Urinary incontinence was prevalent 3 months postpartum. The association between incontinence postpartum mode of delivery, onset of labor, perineal trauma and weight of baby was not statistically significant

Ectopic partial mole; presence on the serosal surface of uterus

A case of Partial Hydatidiform Mole presented at the serosal surface of uterus in primiparous women treated with removal of the lesion. The patient required Systemic methotrexate therapy to treat the possible remnants of the molar pregnancy

Pemphigus vulgaris during pregnancy - a case report

Pemphigus vulgaris [PV] is an uncommon immune-mediated bullous dermatosis which is very rare during pregnancy. Its management during pregnancy is a challenge and sometimes very difficult. Only few cases have been reported in literature so far. The disease may be associated with adverse fetal outcomes such as prematurity and fetal death. The neonate can develop transient skin lesions. We present a case of a patient who conceived during the active phase of PV required high doses of corticosteroids and delivered a preterm appropriate for gestation age newborn

Breast feeding; factors causing early termination

To identify the factors, causing the early termination of breast feeding i.e. from birth to six months of age. A cross sectional study. Outpatient Department of Ziauddin Medical University, Kemari Campus, Karachi. June 2008 to December. 2008. A structured questionnaire was put to mothers of children up to two years of age attending the outpatient department of pediatrics. Significant associations existed between the early termination of breast feeding and family income, family structure [nuclear vs. extended], mode of delivery, delayed in initiation of breast feeding early weaning and antenatal counseling with a p-value of <0.05. Provision of adequate prenatal counseling, early initiation, proper economical and environmental support, backup and encouragement are key factors associated with prolonged breast feeding among women

Effect of obesity and its outcome among pregnant women

To identify and assess the effect of obesity on pregnancy and its outcome and to compare it with non obese pregnant women. It is a cross sectional study conducted at Ziauddin Hospital Kemari Campus and Kharader General Hospital Karachi from June 2009 to June 2010. Four hundred twelve women with normal and raised BMI [25 or more] were booked in first trimester. Patients were followed up with regular antenatal check-up and routine investigations of pregnancy. Complications encountered during pregnancy were recorded in both groups. The relative frequency of pregnancy induced hypertension, gestational diabetes, induction of labor was compared in both groups. Mode of delivery and fetal weight were also recorded. The frequency of pregnancy induced hypertension, diabetes mellitus, and Caesarean section and increased fetal weight were found to be higher in women who are obese in comparison to women who are non obese. Pregnancies in obese women are considerably at higher risk for pregnancy and labor complications. It is advisable to achieve normal BMI before conception

Caesarean section; surgical technique

To determine what surgical techniques are used by obstetricians in Pakistan for caesarean section operations and to compare it with the recommendation, proposal and guidelines of Royal College of Obstetrician and Gynecologist [RCOG] and Cochrane Reviews. A questionnaire was set up regarding surgical technique used during caesarean section and one hundred obstetricians were part of study. Hospitals in two large cities of Pakistan i.e. Karachi and Rawalpindi were requested to fill them. Jan 2009 to June 2009. Substantial and remarkable and difference noted in the practice of caesarean section among the obstetricians. Certain practices and procedures performed by our obstetrician are same as proved to be beneficial and valuable based on evidence and recommended by the RCOG and Cochrane Data on pregnancy. We observed that our obstetricians follow different surgical techniques for performing caesarean section. Some of the techniques follow recommendations by RCOG and provide to effective and beneficial by cochrane data

Endometriosis in a caesarean section scar

Scar or incisional endometriosis is a rare condition and often difficult to diagnose. The symptoms are non specific and often confused with other pathologies. Rarely endometriosis occurs in an abdominal wall scar after a caesarean delivery. A case of 37 year old woman is presented who developed endometriosis at the caesarean section scar done four years back. A clinical diagnose of endometriosis was made. The mass was removed completely and histopathology of the surgical specimen revealed endometriosis

Broad ligament haematoma following a vaginal delivery in primigravida

Broad ligament haematoma is a rare complication of a normal vaginal delivery. We report a 24 year old patient who developed this complication and was managed successfully

Spontaneous resolution of non-immune hydrops fetalis

A case report of hydrops fetatis characterized by ascites and scalp edema of unknown etiology is described. The hydrops developed at 24 weeks and resolved completely without treatment resulting in a live born infant at term

Prevalence of hepatitis B infection in pregnant women in a tertiary care hospital

The purpose of this study was to determine the prevalence of hepatitis B among pregnant women, and to study acceptance and compliance of hepatitis B screening program during the five year period. A five year, descriptive cross sectional study of screening for hepatitis B infection of routine prenatal laboratory testing during antenatal registration. Compliance with the programme was evaluated by checking delivery and laboratory records of the hospital. Study Period January 1 2002 to December 31, 2006. Kharadar General Hospital [KGH] Karachi. During the last five years 34, 918 women registered for antenatal care at KGH. Out of these 25, 482 women accepted to be screened for hepatitis B virus. A total of 401 women were found to be hepatitis B surface antigen positive. The overall prevalence was 1.57% during this period. We found a rising trend in the acceptance of the hepatitis B screening among pregnant women coming for antenatal care from 42% in 2002 to 96% in the year 2006. [p value <0.001]. We also observed an overall decrease in the prevalence of seropositive cases observed, probably due to the administration of hepatitis B vaccination in the postpartum period. Prevalence of seropositivity of hepatitis B was 1.57% among pregnant women at KGH. Secondly, there was a higher trend in acceptance of hepatitis B screening among pregnant women during the antenatal period

Prevalence of bacterial vaginosis in pregnant women and efficacy of rapid diagnostic tests in its diagnosis

The purpose of this study was to determine the prevalence of bacterial vaginosis among pregnant women on the basis of clinical and laboratory findings and compare the efficacy of rapid diagnostic tests, namely a vaginal pH > 4.5, positive amine test and presence of clue cells. An observational study. Study period Form 1st Mar 2006 to 30th Apr. 2006. Ziauddin University and Hospitals, Karachi. One hundred and thirty pregnant women were included in this study, attending antenatal clinic, irrespective of duration of their pregnancies, with the history of homogenous white vaginal discharge. Diagnosis was based on increased level of vaginal pH [>4.5], positive amine test and presence of clue cells on cytology of vaginal discharge. Overall prevalence of bacterial vaginosis among the study group was found to be 55.38% [72 patients]. The level of vaginal pH was greater than 4.5 in fifty one patients [70.83%], amine test was positive in forty six patients [63.88%] and clue cells were demonstrated in 72 patients [100%]. The presence of clue cells is the most sensitive amongst the rapid diagnostic tests. A vaginal pH of more than 4.5, positive amine test and presence of clue cells [Amsel's criteria], proved to be reliable diagnostic tests for bacterial vaginosis