Body image satisfaction, distress and resilience in women with breast cancer surgery: a within group study

Objectives: To explore the relationship among body shape satisfaction, distress and resilience in women with breast surgery and to explore the predictors of resilience in women with breast surgery

Methodology: The study was conducted in Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore and Inmol Cancer Hospital, Lahore. The current research was carried out by using within-subject research design. Sample comprised of 100 indoor patients admitted for general surgery. Age range of the sample was from 40 to 65 years. Body Image Satisfaction Scale [Cash, 2000], was used for assessing body image satisfaction , Depression, Anxiety, Stress Scale [Lovibond and Lovibond, 1995] for measuring distress and Hiew's State-Trait Resilience Checklist [2000] was used to measure resilience of the research participants

Results: In pre assessment, the mean scores of body image satisfaction were higher than post assessment. Similarly, scores were higher on distress and resilience on pre-testing as compared to post-testing. Scores on body image satisfaction and resilience in women with lumpectomy were higher than women with mastectomy

Conclusion: There were significant differences on body image satisfaction, distress and resilience in pre and post assessment of women with breast cancer surgery

practice of self-medication among Pakistani university students

Self-medication refers to the selection and use of medicines without prescription by an individuals' personal responsibility as a cure of self-identified disease. Although its rationale, type and extent may different from culture to culture, it is globally prevalent practice. In Pakistan no research is available on the use of self-medication among university students. The existing study was conducted to investigate the frequency and percentages of branded medicines used by university students, reasons and rationale behind self-medication. It was a survey research design and descriptive statistics were collected regarding the use of self- medication. Hence, a sample of 300 students was employed between the age range of 16-25 years [M = 20.23, SD = 2. 76]. The respondents filled a questionnaire regarding socio-economic and demographic variables, use of self-medication, and medication knowledge. Information was obtained on the conditions treated with medication, the medications used, and attitude towards self-medication. Results indicated mostly used type of self-medication was allopathic [f= 230, 77%]. Headache was found to be more frequently prevalent disease. Most frequently used medicine was Disprin [M = 49.68, SD = 15. 14] as a cure of headaches and other body pains. Financial problems [f = 90, 30%] left over drugs [f= 46, 15%] and easy accessibility [p=38, 12.7%] were found to be the strongest factors in using self-medication. Moreover significant differences appeared in the use of type of medicines between boys and girls. The study concluded that self-medication is widely used practice among university students in Pakistan

Depression, anxiety, stress and their effect upon the self-efficacy in dengue patients

Objective: To explore the correction of self-efticacy with depression, anxiety and stress in dengue patients

Methodology: For this purpose a sample of 200 dengue patients [men = 132, women = 68] was employed from two different hospitals of Lahore by using purposive sampling technique of collect data. In order to measure self-efficacy of dengue patients General Self Efficacy Scale, and Depression, Anxiety and Stress Scale [DASS] was used to assess depression, anxiety and stress of dengue patients. Correlation and simple regression statistical techniques were used for data analyses

Results: Results depicted that self-efficacy has significant negative relationship with depression [r = -.42, p< .01], anxiety [r = -.49, p< .01] and stress [r = -.42, p< .01] in dengue patients. Regression coefficients of depression [3 = -.32], anxiety [p = -.24] stress [P = -.14] and overall combine effect of DASS [P = -.45] have negatively predicted self-efficacy of dengue patients

Conclusion: Self-efficacy has negative correlation with depression, anxiety and stress in dengue patients. Self-efficacy cannot be obtained in the presence of depression, anxiety and stress. These negative states [DASS] weaken self-efficacy of an individual

Hypertension; does psychological state of an individual cause to develop?

Hypertension is a condition of the person in which blood pressure is chronically high. Hypertension is a leading factor to damage health and turn out many chronic conditions in human body[1]. To study the relationship of hypertension with psychological states of anger, stress and anxiety and do they predict hypertension? A co relational study. Outdoor hypertensive patients [N = 200, men = 110, women = 90] between ages 30-65, and control group [N = 170, men = 90, women = 80], matched with age, gender and monthly income were taken from the public hospitals. STAXI [Spielberger, 1988] and DASS [Lovibond and Lovibond, 1995] were used for data collection. Descriptive statistics, chi-square, logistic regression analyses were used. Significant positive correlation of hypertension with anger, stress and anxiety was found. Anger-control, anger-in, stress and anxiety emerged as strongest predictors of hypertension

trauma of sexual harassment and its mental health consequences among nurses

To determine the prevalence of sexual harassment in nurses and to observe its correlation with negative mental health [depression, anxiety and stress]. Further to examine the role of sexual harassment as a predictor of negative mental health in nurses and to explore the differences in the experience of sexual harassment, depression, anxiety and stress between junior and senior nurses. Cross-sectional descriptive study. Public Sector Hospitals in Lahore, from December 2011 to March 2012. A sample of 200 nurses with age range 23 to 46 years was obtained. Assessment tools used in the study were Sexual Harassment Experience Questionnaire [SHEQ] by Kamal, and Depression, Anxiety and Stress Scale [DASS] by Lovibond and Lovibond. Mean age of the nurses was 29.80 +/- 7.10 years. Among these 63% were married and 37% unmarried. The mean working experience of nurses was 13.7 +/- 3. 52 years and their mean monthly income was 27820 +/- 13687.32 rupees. Their working hours ranged from 8 to 16 hours [M = 8.32, SD = 2.12]. The mean prevalence of sexual harassment was 71.66 +/- 19.01. A significant positive correlation of sexual harassment with depression, anxiety, stress and combined effect of them [DASS] was found. Multiple regression analysis showed sexual harassment as significant predictor of depression [[beta] = 0.47, p < .001], anxiety [[beta] = 0.43, p < .001] and stress [[beta] = 0.45, p < .001] in nurses. Sexual harassment was found to be a predictor of negative mental health in the form of depression, anxiety and stress in nurses of public hospitals

Rejection sensitivity, shyness and body mass index: determinants of self-worth among obese adolescents

Background: Research has established the negative impacts of obesity upon the adolescents especially in the form of peer rejection and bullying behaviors. Shyness is a natural response of obese adolescents which adversely affects their self-worth

Objectives: To observe the relationship of obesity with rejection sensitivity, shyness and self-worth of obese adolescents and to explore the differences of rejection sensitivity, shyness and self-worth among obese and non-obese adolescents

Study design, settings and duration: This cross-sectional study was carried out in private schools of Lahore from August 2013 to January 2014

Subjects and Methods: In this study, both boys and girls were taken as participants and a sample of 200 adolescents [obese = 100, non-obese = 100] was recruited from private schools. Demographic information form, Rejection sensitivity scale, Shyness scale and Contingencies of self-worth scale were used for data collection. Correlation and regression analyses were used to analyze the data

Results: Obesity was significantly associated with rejection-sensitivity and shyness in obese adolescents and had negative relationship with self-worth. Obese boys scored high on obesity and self-worth as compared to obese girls, whereas, obese girls scored high on feelings of rejection sensitivity and shyness than obese boys. Similarly obese adolescents scored high on rejection sensitivity and shyness than non-obese; however non-obese adolescents scored high on self-worth than obese adolescents

Conclusion: Obese adolescent experience more rejection sensitivity and shyness while had less self-worth as compared to non-obese adolescents of their age

Policy message: Public awareness may be increased regarding the problems, obese adolescents face in the society. They should be accepted, and rewarded for their positive behaviors; especially their weight reduction efforts should be appreciated by the society. Penalizing approaches by their parents, teachers or other family members targeting to their body shape should be avoided

Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

To compare the management outcome of induction of labor with expectant management in patients with term pre labor mpture of membranes [PROM]. Randomized controlled trial. This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25[th] July 2010 to 25[th] January 2012. A total of 384 patients were selected for this study, which were divided into two groups by lottery methoid. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma, The mean duration between PROM to onset of active labor in group A was significantly less [8.4 +/- 2.3 hours] as compared to group B in which it was [9.6 +/- 2.1 hours] [p = 0.000]. The mean duration between PROM to delivery in group A was significantly less in group A [17.4 +/- 20] versus group B [22.2 +/- 2.0 hours] [p = 0.0000]. The spontaneous vaginal delivery [SVD] rate was considerably higher [p=0.056] in group A in which 161 [83.8%] patients delivered by SVD and 31 [16.1%] patients by LSCS. In group B, 146 [76.0%] patients delivered by SVD and 46 [23.9%] patients by LSCS. In group A, 8 [4.1%] patients developed chorioamnionitis and 13 [6.7%] patients in group B [p = 0.262]. In group A there were 178 [92.7%] neonates with APGAR score of > 5 at 1 minute in contrast to 173 [90.1%] in group B with [p = 0.363]. Similarly in group A at 5 minutes, there were 178 [92.7%] neonates with APGAR score of >7 and 173 [90.1%] in group B [p = 0.460]. There were 9 [4.6%] cases of neonatal sepsis in group A, in comparison with 12 [6.2%] patients in group B [p = 0.501]. The mean duration of labor in induced patients was less as compared to patients with expectant management

Hypertension; coping strategies used by people

The literature review portrays a reasonable picture of the role of certain coping strategies in developing hypertension. Present research based on self-regulation theory explored correlation of coping strategies of stress with hypertension. Cross sectional research design. Shaikh Zayed Hospital, Services Hospital, Ganga Ram Hospital, Lahore. June 2010 to June 2011. Sample [N = 400] outdoor hypertensive males [N = 100] and hypertensive females [N = 100] between ages 30-60, and their age matched healthy controls [N= 200, 100 males, 100 females] were taken from 3 hospitals. Brief COPE scale was used to measure coping strategies. Chi-square and logistic regression analysis were carried out. Significant positive correlation of hypertension with active coping, substance use, instrumental support, positive refraining, acceptance, and self-blame was found and active coping, acceptance, instrumental social support and self-blame coping strategies appeared as significant predictors of hypertension

effect of metformin on endometrial hyperplasia in patients with polycystic ovarian syndrome [PCOS]

To study the effect of metformin therapy in patients with poly cystic ovarian syndrome having irregular heavy menstrual cycle and thickened endometrium [hyperplasia] on transvaginal ultrasound. Quasi - experimental study. The study was conducted in Military Hospital Rawalpindi, department of gynae / obs unit-1 from January 2009 - June 2010. A total of 100 patients in the age group of 40-47 years who reported to gynae OPD with irregular heavy menstrual cycles with or without clinical features of hyperandrogenism were selected and informed consent was taken. Transvaginal ultrasound [TVS] was performed on them by the same operator and those who had polycystic ovaries [enlarged ovaries with > 8-9 follicles peripherally enlarged] and endometrial thickness > 12 mm in the follicular phase of the cycle were selected. Total 100 patients were included in the study, but 10 patients were dropped out. Metformin was started after explaining the purpose of the study initially in low dose [500-1000 mg/day] and was adjusted to 1500 mg/day over next 4-6 weeks. Patients with abnormal liver or renal functions and those already taking hormonal therapy or on tamoxifen were excluded from the study. The endometrial thickness was assessed on monthly follow up visits and final findings were recorded and presented at the end of one year. Of 90 patients, mean age of patients was 43.25 years [SD = 1.91], mean pretreatment endometrial thickness was 20.25 mm [SD= 4.85] mean and post treatment endometrial thickness was 16,38mm [5D = 4.72], There was a significant reduction in endometrial thickness after treatment with metformin. Metformin therapy [1500 mg/day] significantly reduces endometrial thickness [hyperplasia] in patients with PCOS

Depression, anxiety, stress and demographic determinants of hypertension disease

Research evidence supports the relationship of psychological and demographic factors with hypertension and these variables are strongest predictors of hypertension which are scarcely studied in Pakistan. The present study was carried out to explore the correlation of depression, anxiety, stress and demographic factors with hypertension. We used correlation research design and a sample of [N = 237], hypertensive patients [N = 137] and their age matched healthy controls [N = 100] was taken from hospitals. Depression, Anxiety and Stress Scale [DASS] [Lovibond and Lovibond, 1995] was used to assess depression, anxiety and stress. Results indicated significant positive correlation between depression [x[2][MH] = 104.18, p < 0.001], anxiety [x[2][MH] = 78.48, p < 0.001], stress [x[2][MH] = 110.95, p < 0.001] and overall negative states [x[2][MH] = 97.43, p < 0.001] with hypertension. Depression [OR = 1.44, p < 0.01], anxiety [OR = 1. 76, p < 0.01] stress [OR = 1.37, p < 0.01], job and dependents, working hours and weight turned out as predictors of hypertension. Hypertension has significant positive relationship with depression, anxiety, stress and with demographic variables. The findings of the present study will contribute in the existing knowledge of health professionals to enhance public awareness regarding the harmful outcomes of depression, anxiety and stress upon human health

Pattern of severe acute maternal morbidity at CMH Quetta

To determine the pattern of severe acute maternal morbidity [SAMM] at Combined Military Hospital Quetta. Descriptive Study. Department of Gynae Obs, Combined Military Hospital Quetta from March 07 to Sept 08. One hundred admitted patients of severe acute maternal morbidity [SAMM] were identified through random sampling procedure. Thorough history, examination and laboratory investigation were considered to identify the pattern of SAMM that is; severe hemorrhage, hypertension, sepsis, pulmonary embolism, uterine rupture, inversion, ruptured ectopic pregnancy etc and to recognize patient features common in cases of SAMM like maternal age, parity, socio-economic/ educational status and level of antenatal care. Out of 100 patients of SAMM, 52% had severe obstetrical hemorrhage, 32% had hypertension, 10% had both severe pre-eclampsia and massive obstetrical hemorrhage, 4% had ruptured Ectopic pregnancies, 1% had septic induced abortion and 1[1%] had puerperal sepsis. These complications were greater in booked multi-gravidas of 20 to 40 years, para 3 to 5, under matric and with less than Rs.10,000/month income. Massive Hemorrhage and uncontrolled hypertension are the major contributors of severe acute maternal morbidity. SAMM is more prevalent in women of 20 to 30 years [reproductive age], parity 3-5, under metric and with monthly income of less than Rs.10,000.

Outcome of laproscopies for subfertility military and combined military hospitals Rawalpindi

The purpose of the study was to determine the common causes of subfertility among patients reporting to Military and Combined Military Hospital [Rawalpindi] by means of diagnostic laparoscopy in a selected group and to compare our findings with other international data. Descriptive study. It was a conducted in two sister hospitals of Army; Military and Combined Military Hospital [Rawalpindi] from September 2010 to August 2011. A total of 120 women with primary, secondary or unexplained subfertility were carefully selected by purposive sampling according to inclusion and exclusion criteria of the study design. The patients were subjected to diagnostic laparoscopy and pathologic causes documented accordingly. Outcome measures were based on tubal, uterine and ovarian pathology. Results were recorded and then compared with international data. Out of a total of 120 sub fertile women who underwent diagnostic laparoscopy, 82.5% had revealed pathologic abnormalities and 17.5% were with normal pelvic findings. Among the patients with abnormal pelvic findings PID with tubal occlusion was found in 40% of the patients, simple ovarian cysts in 30% of the patients and 12.5% had endometriosis. Primary subfertility was present in 53.3% of patients and 46.7% of patients had secondary subfertility. Maximum number of patients [58.3%] were in age group of 20-25 years and maximum number of patients [59.2%] had duration of infertility of more than 5 years. The laparoscopic procedures are less invasive, more convenient and more precise for the diagnosis of subfertility. Indeed diagnostic pelviscopy is the standard means of diagnosing the tubal pathology, peritoneal factors, endometriosis and intraabdominal causes of infertility. Not only does this help in identification of unsuspected pelvic pathology but also contributes to decision making of infertility treatment. Therefore, because of its potential diagnostic as well as therapeutic benefits, all patients with subfertility should undergo pelviscopy

study of gestational trophoblastic disease

To study the frequency, type of mole and follow-up of patients of gestational trophoblastic disease. Descriptive study. Military Hospital Rawalpindi [Tertiary Care hospital] from Jan 2001 to Dec 2006. Ninety patients both primigravida and multigravida were recruited by convenience sampling. They did not have any associated disease. The frequency regarding age, parity, blood group and antecedent pregnancy was calculated. They were managed initially by suction curettage and later either expectantly or actively. Type of mole was confirmed by histopathology report. Follow-up of these patients was done by clinical symptoms, beta-hCG level, x-ray chest and ultrasound abdomen and pelvis. GTD included 31.11% patients aged <40 years and 68.88% patients aged >40 years. 55.55% of patients had blood group O and only 33.33% patient with other blood groups. In 64.44% patients previous pregnancy was miscarriage while only 6.66% patients had term pregnancy before. 77.77% patients presented with vaginal bleeding, while cough, gastro-intestinal symptoms and hemorrhage 65.55% patients within 6 months while 34.44% patients had persistently raised serum beta- hCG level. Histopathological reports of 80% patient revealed complete mole while 20% patients had partial mole. Frequency of malignancy was found mostly in patients of complete mole. Chemotherapy was given to 38.88% patients among them 24.44% treated with single agent and 14.44% patients were given multi-drug therapy. GTD is more common in multigravida than primigravida. High frequency was observed in extremes of reproductive life and with blood group O. Irregular vaginal bleeding is the most common clinical feature. The frequency of complete mole is more than partial mole

randomized comparision of foley catheter insertion versus frostaglandin E[2] vaginal pessary for induction of labour in post date pregnancy

To see the safety and efficacy of cervical Foley catheter insertion in post date pregnancy, for induction of labour, as compared to prostaglandin E[2] vaginal pessary. A comparative, cohort study. The study was conducted in the department of obst / Gynae MH Rawalpindi from Sep 2003 to Sep 2004. There were hundred subjects in each group including both primigravidas and multigravdas upto para 3 with singleton pregnancy, postdates 6-10 days, age 20-30 years, Bishop score 3-6 with adequate pelvis. Sampling technique was convenient, non probability. In primigravidas improvement in Bishop Score after 06 hours was similar in both Group A [Foley catheter] [32%] and Group B [Prostin E[2]] [30%]. While in multigravidas improvement in Bishop Score was more in foley catheter in Group A [36%] as compared to Group B [24%]. The induction delivery interval was 12 hours in 69% cases of Group A and 67% cases of Group B [p< .001]. In Group A 80% patients were delivered by spontaneous vaginal delivery, 9% were delivered by lower segment ceasarian section [LSCS]. Where as in Group B 76% patients were delivered by spontaneous vaginal delivery, 11% were delivered by lower segment ceasarian section [LSCS]. There were 4 cases of non progress of labour, 4 cases of fetal distress, 2 cases of meconium aspiration and 1 case of uterine hyperfunction in Group A. However there were 5 cases of fetal distress, 3 cases of meconium aspiration, 3 cases of uterine hyperfunction and 1 case of uterine rupture in Group B. A good cervical preparation was achieved with Foley catheter by mechanical effect of the distended balloon and by release of endogenous PGE[2] comparable to extra amniotic PGE[2]. The readily available Foley catheter was inexpensive and there were no maternal systemic side effects

Disseminated intravascular coagulation in obstetric patients at combine Military Hospital Quetta

To describe the frequency of disseminated intravascular coagulation [DIG] as a complication in obstetric patients. Descriptive study. This study was carried out between April 2006 to August 2007 at the department of obstetrics and gynecology, Combined Military Hospital Quetta. All pregnant subjects who presented at the out-patient department, CMH Quetta for delivery or related complaints were considered for inclusion into the study. After various exclusions, a total of 1939 patients were included in our study. They were consented, and evaluated with detailed history and clinical examination for the presence of DIC. In suspected patients DIC screening was ones's, including fibrinogen levels, prothrombin time, partial thromboplastin time, platelet and fibrin degradation products. These patients were regularly followed up during the course of the disease till their discharge or otherwise. Out of 1939 subjects 15 [0.77%] subjects developed disseminated intravascular coagulation. Out of these 15 subjects, 10 [66.7%] subjects were having no booking record. 10 [66.7%] subjects developing DIC were multi-gravida, while 5 [33.3%] were primary gravida. The major complications leading to DIC in our subjects were abruption 4 [26.7%], intrauterine death 4 [26.7%] and sepsis 4 [26.7%].13 [86.7%] ladies were finally discharged without complications, while 1 [6.7%] subject developed acute renal failure and 1 [6.7%] subjects died. Disseminated intravascular coagulation is a grave complication of obstetrical population, which increases the maternal mortality and morbidity

Compilications of grand multiparity

To find out different maternal and fatal complications associated with grand multiparity. A descriptive study. The maternity ward of obstetrics and gynaecology department, Military Hospital Rawalpindi from Jan 2003 to Dec 2003. The study was carried out in Maternity ward, obstetric and gynaecology department, Military Hospital Rawalpindi, a tertiary care hospital. It included 100 cases of grandmultipara women. All antenatal patients admitted in Maternity ward, Military Hospital Rawalpindi who had five or more viable pregnancies were included in the study. A detailed history was taken with thorough physical examination and necessary investigations were carried out. For this purpose a proforma was made covering all aspects of the study. Most of the patients included in our study were ranging in age between 30-40 years. 20% were booked cases, 58% belonged to poor socioeconomic class, about 83% were with term pregnancy, 15% with preterm labour. Intrauterine death 7%. Eclampsia was seen in 4% of patients preeclampsia 9%, 5% diabetic, 45% anemic, 4% presented with obstructed labour. Malpresentation 16%, placenta praevia 5%, placental abruptio 8%. Ruptured uterus 2%, caesarean-rate 23%. Vaginal delivery ratio of 58%, retained placenta 2%. Postpartum haemorrhage 9%. Low birth weight [LBW] babies were 15%, intra uterine growth retardation [IUGR]. Macrosomia birth was 10% and 67% had apgar score of 8-10. It is concluded that grandmultipara is a still major obstetric hazard which needs active intervention by improving literay rate, health care, facilities provision of safe and effective contraception and reproductive health status

Frequency of polycystic ovarian syndrome [PCOS] Among obese diabetic and non diabetic females with clinical features of: hyperandrogenism

To determine the frequency of Polycystic Ovarian Syndrome in obese diabetic and non-diabetic females with clinical features of hyperandrogenism and to find if type 2 diabetes is a risk factor for developing polycystic ovarian syndrome. A cross-sectional comparative study. The study was done in Gynaecology and obstetric unit of Military Hospital Rawalpindi from June 2004 to April 2005. Eighty four obese females were enrolled and counseled about the procedure Body Mass Index [BMI] age and clinical features of hyperandrogenism, were recorded. Informed consent was taken, their relevant information was documented on the data collection sheets. These females were divided in two groups, 46 patients who had type 2 diabetes mellitus were enrolled in group 1 [n=46], 38 patients with normal fasting plasma glucose were enrolled in group 2 [n=38] as controls. Transvaginal scan was done on females of both groups to record the findings of Polycystic Ovarian Syndrome [PCOS]. Eighty four women were included for the study, all had BMI > 28, out of 46 patients who were enrolled in group-1; 32 [69%] [95% C1:59.2-78.8] had polycystic ovaries on transvaginal scan [table], while in control group, 38 women who were enrolled 23; [61%] [95% CI: 50.7 - 71.3] had polycystic ovaries. The frequency of PCOS was slightly higher in diabetics compared to the non diabetics 70% vs 61% respectively. The statistical analysis by chi-square test revealed a statistically insignificant relationship [p>0.05]. There was no statistically significant difference between the frequency of PCOS among diabetics and non-diabetics and this does not support the view that type 2 diabetes could be a risk factor for PCOS

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

Comparison of parenteral iron sucrose and low molecular weight iron dextran in treatment of iron deficiency anaemia of pregnancy at Military Hospital Rawalpindi

To evaluate the effect of two forms of iron therapy for treatment of moderate to severe iron deficiency anaemia. Quasi experimental comparative study. Department of Obstetrics and Gynaecology, Military Hospital, Army Medical College, Rawalpindi. July2004 to June 2005. All pregnant women with confirmed iron deficiency anaemia [IDA] at 26-36 weeks gestation were included in the study. Hemoglobin level [Hb] was between 6 and 10 gm/dl. Patients with history of blood loss, allergy to parenteral iron, hemoglobinopathy, parasitic infections and haematuria were excluded. After detailed history and examination baseline hematological parameters like Hb, MCV, MCHC and serum ferritin were assessed. After informed consent patients were divided into two groups [A and B] for Iron Sucrose complex or Low Molecular Weight [LMW] iron dextran therapy respectively constituting 50 patients in each group. Intravenous infusion [after test dose] was administered by calculating the dose by the standard formula. Post treatment hemoglobin and serum ferritin was checked after one month of therapy and results tabulated. In Group A pretreatment Hb was 8.02 +/- 1.08g/dl which improved to 10.95 +/- 0.41g/dl at the end of treatment whereas serum ferritin level increased from 8.84 +/- 0.86 to 12.41 +/- 0.396ug/l while in Group B pretreatment hemoglobin was 8.13 +/- 1.9g/dl which improved to 11.14 +/- 0. 428g/dl whereas serum ferritin level increased from 8.67 +/- 0.77ug/l to 12.24 +/- 1.78ug/l. Lesser side effects were noted in Group B patients. Both parenteral iron therapies are highly and rapidly effective and have equal compliance but LMW Iron dextran is more effective, due to lesser side effects and good compliance

Term prelabor rupture of membranes: management and outcome

To review the management of term prelabour rupture of membranes and its outcome. Interventional and descriptive. Military Hospital Rawalpindi from 10th June 2002 to 9th March 2003. 110 patients including both primigravidas and multigravidas with singleton pregnancy having term prelabour rupture of membranes were recruited by convenience sampling. They did not have any other complicating factor. They were managed according to their Bishop's score either expectantly or actively by inducing them. 64.54% of patients went into spontaneous labour within 24 hours and only 35.45% required active intervention. Deliveries by the vaginal route were 89.2% with 61% normal and 28.20% instrumental. Cesarean section rate was 10.90%, higher in those induced and primigravidas as compared to the expectantly managed and multigravidas. Chorioamnionitis was seen in 5.45% cases, 3.6% developed postpartum fever, 1.8% wound infection with no case of endometritis or neonatal mortality. 43.64% neonates were put on antibiotics but significant infection was seen in 5[4.54]% cases. Both active and expectant management are equally effective with a significant percentage delivering vaginally. However the cesarean rate was higher among the actively managed