Prevalence of domestic violence among women seeking abortion

To determine the prevalence of domestic violence in women seeking abortion. This cross-sectional study was conducted in outpatient department of Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar, family planning Centre, Marie Stoop's society Peshawar and a private clinic from April 2012 to March 2013. Approval was taken from the ethical committee of the hospital before starting the study. A Proforma made and women seeking induced abortion that volunteered to answer the questions were included in the study. Confidentiality was maintained to avoid potential retaliation from disclosure. Domestic violence was reported by 40 [38.9%] women out of 105 women seeking induced abortion, who were interviewed consecutively. Majority of them were in stable relationship being married for more than a year [n=38, 95%]. Physical and sexual violence both were reported by 10 [25%] women each while all three types of violence i.e., verbal; physical; and sexual, were reported by 16 [40%] women. Domestic violence was reported more in spouses with lower educational status [n=22, 55%]. Violence by intimate partner was reported in 23 [57.5%] and by other family members in 7 [17.5%] cases. More than one third of the women of the sample were faced with the problem of domestic violence. Level of education was inversely related to domestic violence as it was reported more in spouses with lower educational status

Maternal morbidity associated with emergency versus elective caesarean section

To compare maternal morbidity in elective versus emergency caesarean section in a tertiary care teaching hospital. This comparative study was conducted at Department of Gynecology and Obstetrics, Lady Reading Hospital Peshawar, Pakistan, from July 2006 to June 2007. A total of 100 patients, 50 in emergency and 50 in elective caesarean section group through convenient sampling were included in the study. The sample size was calculated as 100 by keeping 8% prevalence of caesarean section in Pakistan and using WHO software for sample size estimation. The complications were compared in both groups using a semi structured proforma. The comparison was done by using Chi-square test and p-value

Trends in maternal mortality in tertiary care hospital in Peshawar - Pakistan

To report a 9 year review of maternal mortality ratio in the largest tertiary care hospital in Peshawar, Pakistan. Medical records of 371 maternal deaths were retrospectively reviewed to determine the trends and likely cause of each death over the study period. There were a total of 371 maternal deaths, while 36,460 deliveries were conducted over the 9 year period. The maternal mortality ratio [MMR] was 1017/100,000 live births. The highest MMR of 2015 / 100,000 was observed in 2001 and lowest was 759 / 100,000 in 2009. Hemorrhage consistently remained the leading cause accounting for 38.89% of maternal deaths followed by Eclampsia, Suspected cases of pulmonary embolism and sepsis, each contributing 27%, 9.7% and 7% respectively. 45% of deaths were noted in older women [30y]. Multiparas accounted for more deaths. Lack of seeking antenatal care was observed to be major determinant of maternal mortality. The fall in MMR has been very slow. It still remains very high with hemorrhage being the main contributing cause. Improvement in the quality of skilled maternity care, community education on the need to avail antenatal care, provision of family planning services, among other factors, can drastically curtail the preventable causes of maternal deaths and reduce MMR

Levenorgestrel Intra utrine system [LNG IUS] in menorrhagia: a three years followup study

To find the role of Levenorgestrel Intra uterine system [LNG IUS] in menorrhagia in women over period of three years. This descriptive study was conducted in private setup and Gynaecology A unit, Lady Reading Hospital, Peshawar over a period of three years i.e., June 2004 to June 2007. The study population consisted of 60 women. All these women presented with heavy menstrual flow, having no contraindication for the device and consenting to Levonorgestrel Intra Uterine System after counseling. Those having organic cause for menorrhagia were excluded. Women were followed up at 6 week, 6 month and 12 month. The mean age of the sample was 35.98 +/- 7.66 years. In the sample, multipara were 86.66% [n=52] and nulliparous were 13.33% [n=8]; married were 91.66% [n=55] and unmarried were 8.33% [n=5]. The indication for the device were menorrhagia in 75% [n=45] cases; women having intrauterine contraceptive device previously and currently having menorrhagia in 16.6%[n=10] cases; and others 8.33%[n=5] cases [women who are unfit for general anesthesia or having other co-morbidity i.e., asthma, uncontrolled diabetes]. The acceptance rate was 80% [n=48] and discontinuation rate was 20% [n=12]. In these 12 cases, expulsion of device, pelvic inflammatory disease and no improvement in the condition was seen in cases, expulsion of device, pelvic inflammatory disease and no improvement in the condition was seen in 10%[n=6], 3.3%[n=2] and 6.6%[n=4] respectively. At follow up 3.3% [n=8] women had irregular period while 73.3% [n=44] were amenrroheic and 13.33% [n=8] women had regular period at the end of one year. Levonorgestrel IUS is one of the effective treatment modality which can be used for menorrhagia with reasonable efficacy

Usefullness of 100 microgram misoprostol in term gravid patients regarding Labour, fetal and maternal outcome

To determine the effect of 100 microgram misoprostol for induction of labour in term gravid patients regarding, labour, fetal, and maternal outcome. Descriptive study was carried out in the Gyne [A] Unit of PGMI/Lady Reading Hospital Peshawar, from June 2005 to February 2006. A total of 100 admitted patients were selected for the study in whom 100 microgram Misoprostol was administered orally. Labour was induced in selected patients and post delivery complications were recorded. The age range of patients was from 15-39 years. Out of 100 gravid patients, primigravida were 63%. In 83% of patients pre-induction cervical scoring was <4 while 4-7 in 17% patients. Indications for induction of labour were; raised blood pressure 40%, post dates 35%, intrauterine fetal death 11%, LU.G.R.10% and diabetes mellitus 4% cases. Misoprostol 100 microgram was given as one dose to 37% women, 2 doses to 44% women, 3 doses to 13% women, while 4 doses were given to 6% women. Normal vaginal delivery was done in 68% cases. Instrumental delivery was done in 30% cases, while cesarean section was done in 2% cases due to fetal distress. Majority of patients [69%] delivered within 24 hours. Stay in the hospital was 2 days in 42%, 3-4days in 48%, and 5-6 days in 10% of cases. Maternal complications included nausea/vomiting in 61% cases and postpartum hemorrhage in 1%. Fetal low APGAR score was observed in 6% cases. Oral misoprostol is an attractive alternative for induction of labour in patients with full term pregnancy

Role of transvaginal sonography in investigating the causes of menorrhagia

To determine the role of transvaginal sonography [TVS] in finding the causes of menorrhagia in patients with no obvious pathology on bimanual examination. This study was conducted in the department of Obstetric and Gynaecology ["A" Unit], Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over a period of one year from 01.11.2003 to 31.10 2004. Married women having menorrhagia with no pelvic mass on bimanual examination underwent TVS in private setup. Unmarried patient, patient with pubertal menorrhagia or postmenopausal patients on hormonal replacement therapy were excluded form the study. After taking detailed history they were thoroughly examined and investigated. Total of 65 cases underwent TVS for menorrhagia. The most common age group was 36-50 year. The commonest cause of menorrhagia on TVS was submucus fibroid of uterus in 38.5% cases [n=25] followed by adenomyosis in 27.9% [n=18] cases, endometrial hyperplasia in 13.07% [n=15], endometrial, polyp in 9.23% [6 cases] and forgotten IUCD in 1.53% [n=1]. TVS is an effective diagnostic tool for finding a cause for abnormal uterine bleeding before proceeding for any operative procedure

Maternal and foetal complications in neglected transverse lie

To see the frequency of foetal and maternal complications of neglected transverse lie at a tertiary care hospital. This prospective study was conducted at Gynae B Unit Department of Gynaecology and Obstetrics Lady Reading Hospital Peshawar, Pakistan, from 1st January I997, to 31st December I997. Eighty-seven Patients presenting with neglected transverse lie were included in this study. Detail information regarding name, age, address, parity, past history, physical, abdominal and vaginal examination findings, general management and specific managements like internal podalic version, caesarean section, foetal complications and maternal complications of neglected transverse lie were entered into a predesigned proforma for the purpose. The maternal complications in order of frequency were dehydration 86.5% [n=77], pyrexia 41.37% [n=36], wound sepsis 31.03% [n=27], antepartum haemorrhage [APH] 16.09% [n=14] and postpartum haemorrhage [PPH] 14.94% [n=13] and maternal death 1.14% [n=1]. The foetal complications of neglected transverse lie were fresh stillbirth 55.17% [n=48], prematurity 14.94% [n=13], alive with poor Apgar score 10.34% [n=9], macerated stillbirth 8.04% [n=7], neonatal death 3.44% [n=3], post mature and alive 2.29% [n=2] and congenital malformation 2.29% [n=2]. Emergency lower segment caesarean section was done in 58 [66.7%] cases, while internal podalic version followed by breech extraction was done in 21 [24.1%] cases. Neglected transverse lie is associated with various maternal and foetal complications. Prenatal examinations are essential to reduce the unfortunate complications of transverse lie