Emergency contraception: knowledge, attitude and practices among doctors of a tertiary care hospital

In Pakistan maternal mortality rate [MMR] is very high and more than one in five women die from pregnancy related causes; solution to this is to have low fertility rate. The emergency contraceptives [ECs] can be used to prevent unwanted pregnancies. The aim of this study was to assess the knowledge, attitude and practice about ECs among doctors. Institution-based crosssectional descriptive study on knowledge, attitude and practice of ECs was conducted at Rawal Hospital from Feb to May, 2012. Data was collected using structured questionnaire and analysed using SPSS-16. Fifty-seven percent of the respondents were >30 years of age, 94% were Muslim, 81% were married and 51% were women. Ninety-seven percent had heard of ECs before, only 17% knew Intra-uterine contraceptive device [IUCD] a method of EC. Sixty-one percent responded that IUCD should be removed if patient gets pregnant [p=0.007] and according to 31% ECs were not abortifacient [p=0.045]. Regarding attitude, 55.5% of the participants supported its use [p=0.027] and agreed to its easy accessibility [p=0.004]. Thirty-eight percent responded an increased dose of birth control pills as a form of EC [p=0.008], while 40% did not agree that ECs are effective when taken before intercourse [p=0.011]. Knowledge and practice of ECs is very low among doctors but a positive attitude is there. Evidence-based knowledge to family physicians regarding emergency contraception is strongly recommended to reduce the chances of MMR

Etiology of primary amenorrhoea: a study of 50 cases

Amenorrhoea is one of the commonest reasons for referral of female patients to a gynaecology clinic. It is subdivided into primary and secondary. The etiology of primary amenorrhoea is complex. The aim of this study was to determine the etiological factors of primary amenorrhoea and to find out the mean age at first presentation. Descriptive Study. This Study was conducted in the department of Obstetrics and Gynaecology Foundation University Medical College Fauji Foundation Hospital Rawalpindi, from 1[st] January 2005 to 31[st] December 2007. 50 girls who reported to gynae outpatient department with the complaint of primary amenorrhoea were included in the study after informed consent. Detailed history, clinical examination and investigations [transabdominal ultrasonography, hormonal profile including serum FSH, LH and prolactin, karyotyping] were recorded in proformas for analysis. A total of 50 girls reported to gynae OPD with complaints of primary amenorrhoea over a period of 24 months with the mean age of 18.5 years at initial presentation. Almost half of the girls [48%] with normal secondary sexual characteristics had anatomical defects, rokitansky;s syndrome being the commonest, while those with absent secondary sexual characteristics had constitutional delay as the commonest cause. Mean age at first presentation is late. Anatomical causes are the commonest. Turner's syndrome is relatively uncommon in our patients

Chorionic villus sampling: a safe tool for prenatal diagnosis of genetic disorders

To determine the safety and efficacy of chorionic villus sampling [CVS] for early prenatal diagnosis of genetic disorders. Descriptive study. Department of Obstetrics and Gynecology, Foundation University Medical College, Rawalpindi, from December 2002 to April 2006.Subjects who had high risk factors like personal or family history of genetic disorders were referred to us for CVS after 10 gestational weeks. Under local anaesthesia and ultrasound guidance [USG] guidance a special chorion biopsy double needle [outer guide and inner aspiration needle] was introduced through anterior abdominal wall into placenta to obtain specimen from chorionic villi. Women were observed for 1-2 hours to notice any immediate complications like uterine cramps and vaginal bleeding. Follow up was done till end of pregnancy to know the outcome. Specimen obtained was sent to laboratory for DNA analysis to diagnose beta-thalassaemia in 234 patients and for karyotyping to diagnose Down's syndrome in 17 patients. Of 252 CVS performed, sample was successfully obtained in 99.6% of cases and only one procedure failed. Most common indication was beta -thalassaemia [93.0%]. The immediate complications were uterine cramps in 41 [16.3%], vaginal bleeding in one [0.8%] and amniotic cavity puncture in six [2.4%] subjects. Noteworthy was the fact that miscarriage rate was quite low [2.4%]. At follow up no evidence of incorrect sampling was reported. Of 234 specimens for DNA analysis, 23.5% were homozygous for beta-thalassaemia, to whom termination of pregnancy [TOP] was offered to prevent birth of an abnormal baby. CVS is a safe and effective method for early prenatal diagnosis of genetic disorders. Its use can help in early detection and prevention of birth of babies with lethal genetic disorders

Obstetric trauma is the commonest cause of urogenital fistulae

To determine incidence of different types of urogenital fistulae, their frequency and success rate of different methods of repair. This descriptive study was conducted at Armed Forces Institute of Urology and Department of Obstetrics and Gynecology, Military Hospital Rawalpindi from January 1997 to January 1998. A total of 44 patients were included in the study. Diagnosis was made by taking comprehensive history, detailed examination and appropriate investigations. Data regarding aetiological and risk factors was gathered. The incidence was 0.26%. Obstetric trauma, mostly prolonged and obstructed labour, was responsible for 53.3% cases and 40% were result of surgical trauma and miscellaneous causes. Forty percent of fistulae were vesico vaginal and same number was simple in type. Nearly 55% were repaired by abdominal route and 75% were successful in 1[st] attempt. Obstetric trauma was the commonest cause of urogenital fistulae. Majority were repaired by abdominal route and 75% were successful in first attempt. Improvement in maternity care in rural areas, easy approach to specialist care and better training of staff in instrumental deliveries may help to decrease the incidence of these fistule

comparison of efficacy and safety of vaginal misoprostol and dinoprostone for labour induction

To prove the efficacy of misoprostol for labour induction, to ascertain its safety and to determine the frequency of complications of the vaginal use. An interventional comparative study. April 2004 to March 2005. Fauji Foundation Hospital, Rawalpindi. The study was conducted for induction of labour at term by using two different kinds of labour induction agents [Dinoprostone and Misoprostol]. A total of 112 women were included in this study. With the vaginal use of these two drugs, data regarding obstetrical, fetal and neonatal outcomes was collected and analyzed. The mean induction to delivery interval was lesser in misoprostol group as compared to dinoprostone group [11.14 +/- 3.47 hrs versus 15.05 +/- 5.21hrs, p-value: <0.01]. Cesarean section rate was higher in dinoprostone group as compared to misoprostol group [30.35% vs 21.42%,]. Tachysystole and hyper stimulation were experienced more frequently in misoprostol group but was statistically insignificant [p-value: > 0.05]. The Apgar score of neonates in both groups was comparable at one minute [6.96 +/- 1.40 vs 7.18 +/- 1.08, and at 5 minutes [8.48 +/- 0.83 vs 8.66 +/- 0.64] Both misoprostol and dinoprostone appear to be effective agents for labour induction, but misoprostol has shorter induction to delivery interval, requires less oxytocin and has comparable neonatal outcomes

Vaginal misoprostol -the revolutionary starter switch in induction of Labour

To assess the role of vaginal misoprostol in cervical ripening in term pregnancies with minimum effective dose, and evaluating any side effects or complications in the mothers and fetuses in comparison with a placebo group. Experimental study. This study was conducted at Heavy Industries Taxila [HIT] hospital, Taxila, from July 2002 to May 2004. Cervical ripening was done in term pregnancies in 307 women with vaginally placed misoprostol. All subjects were monitored closely in labour using partograms. Fetal heart rate monitoring was done by intermittent auscultation using sonic aid / fetoscope. Control group consisted of 103 women. They were given no treatment. The subjects were randomly selected. Cervical ripening occurred in 99% of the 307 women in the experimental group. Induction-delivery time reduced significantly. Uterine hyperstimulation was not observed in any case. There was no marked difference in instrumental vaginal delivery in either group. Caesarean section rate was significantly reduced in the experimental group. 92.5% delivered vaginally while 7.5% underwent caesarean section. In the control group, 87.12% women delivered vaginally while 12.88% delivered by caesarean section. There were no significant side effects or complications in subjects or fetuses. The results prove that it is the safest and the most effective labour inducing agent to date. The dose in which it was used in the stud, is the optimum dose for its use vaginally. It achieved maximum results with minimal side effects in the mother and the fetus. Low cost, easy availability, stability at room temperature and excellent results give it an advantage over other induction agents

Perinatal outcome in pregnancy induced hypertensive mothers

Hypertensive disorders are common complications of pregnancy and they may have devastating consequences for both the mother and the fetus. The study was carried out to investigate the perinatal outcome in babies born to pregnancy induced hypertensive mothers and to formulate the means, which improve the outcome in such pregnancies. A total of 500 expectant mothers were included in the study and were followed till delivery. Neonates were examined immediately after birth and were followed for one week to record the outcome. The commonest maternal complication was eclampsia in 30 mothers; abruptio placentae occurred in 26 women,13 developed features of HELLP syndrome, and 16 developed congestive cardiac failure. Two mothers died, one with features of HELLP syndrome and the other with pulmonary edema and C.C.F. The incidence of preterm delivery was 61%, while 54% babies were low birth weight, 42% babies were shifted to neonatal unit for intensive care. The commonest illness was respiratory distress syndrome in very low birth weight premature babies and it is also the commonest cause of perinatal death. The overall perinatal mortality in this study was 13% and maternal mortality was 0.4%

Frequency of endometrial tuberculosis in female infertility

To determine the frequency of endometrial tuberculosis in infertility patients. Design: An observational analytical study. Place and Duration of Study: Military Hospital Rawalpindi and Armed Forces Institute of Pathology, Rawalpindi from August 1998 to April 1999. Subjects and Endometrial biopsies were taken from 50 cases of infertility and subjected to culture on BACTEC 460 TB instrument. Tuberculous endometritis was found in 10% [n=5] of cases. It was concluded that endometrial tuberculosis is not an infrequent cause of infertility in our setup

Prevalance of sexually transmitted diseases among a selected group of Pakistani women

Sexually transmitted diseases or sexually transmissible infections are terms used interchangeably and remains a subject of great interest. Venereal diseases among females are a double-edged sword with an additional risk of transplacental and perinatal spread. The subject remains neglected in Pakistan, while disaster like Hepatitis B and HIV infections are at our doorsteps arleady. Just to take an initiative we attempted to asess prevalence of STD's among a selected group of Pakistani women. A strictly confidential interview including sexual history was followed by examination and laboratory screening. Overall prevalence was not high with one woman having a past history of Syphilis. l patient was culture positive for Chlamydia Trachomatis, 2% were serologically positive for Hepatitis B surface antigen while 22% were positive for Trichomonas Vaginalis. None was found psoitive for HIV. This small study cannot be representative of the whole society, similar studies have to be designed at wider scales for the calcualtion of the exact risk we are exposed. Only then definite prevention and control strategies can be defined to suit our local population

Prenatal diagnosis of B-thalassaemia by chorionic villus sampling

Chorionic villus sampling was performed in 124 cases for prenatal diagnosis of beta-thalassaemia over a period of two and a half years. All samples were taken during the late first and early second trimester of pregnancy by transabdominal route using either biopsy forceps or by suction with the help of double needle technique. Twenty six foetuses were found homozygous for beta-thalassaemia