audit of caesarean sections carried out in a tertiary care maternity unit

A study was carried out to determine the caesarean section rate and to analyse the indications thereof to control the growing CSR and associated complications. The prevalence of C -section during the study period was about 24%. Major indications included dystocia [25%], repeat C-Section [24%], fetal distress [15%] and breech presentation [11%]. Statistically significant changing trends in the indications of caesarean sections were observed; dystocia and fetal distress being the commonest causes during the first half and repeat C-Section in the later half of the study period. Specific characteristics of our obstetric population, flaws in the areas of antenatal surveillance and effective working of the referral chain and departmental polices regarding dealing with commonest indications of C-sections have been identified as major causes of high CSR

Standard and utility of lectures: views and opinions of undergraduate medical students

A survey study was carried out to determine the views of our undergraduate medical students regarding the quality and usefulness of the lectures attended by them so that feedback obtained could be used to make the lectures more effective and beneficial mode of instruction in undergraduate medical education. The study involved final year students of Fatima Jinnah Medical College For Women, Lahore. A self administered questionnaire was prepared containing the questions regarding various aspects of the content, organization and mode of delivery of the presented lectures. About 72% students said that lectures should be upgraded to ensure their utility. A significant percentage of the participants found pitfalls in the content and presentation of the lectures delivered to them. According to 67% to 77% respondents, lectures were not prepared in a clearly understandable pattern and the lecturers were more interested in dictating their notes rather than explaining or discussing the subject. Very little effort was demonstrated as far as active learning process was concerned. Main objective of the lecturing session seemed just to fulfil the University requirement as voiced by 86% students. Consideration should be given to the feed back obtained and follow-up studies should be carried out so that effective lecturing skills could be developed and practiced

Occurrence of lower urinary tract symptoms during pregnancy and their significance

A study was carried out between September 1997 and August 1998 to determine the frequency of occurrence of lower urinary tract symptoms in pregnant women and to establish their significance in relation to infection through bacteriological examination. About 47 percent did complain of having single or multiple lower urinary symptoms. There were 41 percent nulliparous and 59 percent multiparous women and in 52 percent cases gestational age was > 31 weeks. The most commonly encountered problem was abnormal voiding patterns found in 84 percent of participants, followed by irritative manifestation 47 percent, urinary incontinence 37 percent and voiding difficulties 10 percent. Significant pyuria [> 6 pus cells per high power field] was found in 19 percent cases and bacterial growth was demonstrated in 8 percent of women. The cases with positive bacterial growth mostly had the problems of increased diurnal frequency and/or nocturia, dysuria and urgency. Prevalence of hypertensive disorders of pregnancy was found to be significantly higher among these cases as compared to the cases who had no bacteriological evidence of cystitis

Lecture as a mode of instruction in undergraduate medical education

OBJECTIVE: This study was carried out to determine the place of lecture as a mode of instruction in undergraduate medical education by examining the views of the students about some selected aspects of the lecturing sessions and their ability to recall the varying percentages of the content of the delivered lecture after a specified period of time. METHODS: An observational cross sectional study was carried out in which the final year students of Fatima Jinnah Medical College for Women, Lahore belonging to sessions 1995-1996 and 1996-1997 participated. The study comprised of two parts; first was administration of a questionnaire containing the questions regarding students' opinions about the lectures attended, duration of lecturing sessions and comparison between lecture and clinical classes. The second part consisted of two surprise tests examining the ability of the students to recall the subject taught in a particular lecture after one week and one month intervals. According to 74% students lecturing sessions were not beneficial. Only 12% students remained attentive throughout the lecture their reason being ineffective and boring presentations and 55% participants wanted the existing duration of the lecture period to be halved. Clinical sessions were considered to be superior by 79% respondents. About 34% to 35% students could recall more than 50% of the content of the delivered lecture after one week and 20% were able to do so after one month. Consideration should be given to the feedback received and follow up studies should be carried out so that appropriate changes in the curriculum could be induced in order to ensure the effectiveness of the lecture and to avoid wastage of resources and time and to justify the place of lecture as a mode of instruction in undergraduate medical education

community based knowledge, attitudes and practice [KAP] study on the non or improper utilization of maternity services by Pakistani mothers

This survey was conducted to figure out the reasons and barriers being responsible for the non or under utilization of the existing facilities by the pregnant women and to propose solutions based on the analysis of the results obtained. For the stated purpose women residing in a slum area of Lahore were interviewed to examine their knowledge, attitudes, belief and practices related to pregnancy and delivery associated complications and towards maternity establishments. Of the 930 married women who were in active phase of reproductive life, 450 were selected randomly for interviewing. Responses of 432 were included for final analysis. About90% respondents were aware of the existence of nearby maternity services but 58% regarded them useless. Of the 432 interviewed, 53% had no knowledge of pregnancy related complications and attributed all mishaps to superstitious beliefs. About 73% women did not know or understand the importance of antenatal care. Home delivery by dais in squatting position in the presence of relatives was considered to be on ideal situation by 79% respondents. Resentment towards institutional births was shown due to lack of privacy, overwhelming hospital atmosphere, fear of operative delivery and lying position during birth. Most of the women were unaware of postpartum complications. Conclusions: From the responses obtained, causes of inadequate and improper utilization of available and accessible services were formulated and solutions proposed accordingly

Acute puerperal uterine inversion a rare but life threatening complication of the third stage of labour.

To find out the causes of acute puerperal inversion in the study population so that appropriate preventive measures could be planned. This presentation is based on two studies conducted at two teaching maternity units in Lahore. Duration of the first study was from July 1985 to December 1990 and second one extended from January 1991 to June 1996. Demographic data, details of index labour and placental delivery were collected. An effort was made to determine the cause of inversion. Ten cases of acute uterine inversion were seen among 34293 deliveries during the said period, prevalence was prevalence was 1 in 3429 deliveries. Parity of the parturients ranged from 2-6. Haemorrhage and shock were the commonest presenting features. Six women were delivered by the TBAs. Injudicious traction on the umbilical cord in the presence of a lax uterus was probably the most likely underlying cause. Complete uterine inversion occurred in 6 patients. Nine cases were managed by manual reduction and one required surgical intervention. Three had hysterectomy due to uncontrolled bleeding due to uterine atony after correction. Proper education and training regarding placental delivery must be imparted to the care providers engaged at different levels in maternity healthcare system so as to avoid this fatal but preventable obstetric emergency

Assciation. between previous caesarean section and occurrence of placenta praevia and pathological placental adherence

A 5-year retrospective study was carried out at Sir Ganga Ram Hospital, Lahore, to determine the relationship between previous uterine scars and the incidence of placenta praevia and pathological placental adherence. A total of 21.808 deliveries occurred in the said period and 341 were diagnosed as cases of placenta praevia during Caesarean section, giving an incidence of 1.56%. The incidence of placenta praevia in parturients with unscarred uteri was 1.25% as compared to 5.74% in cases with scarred uteri. The risk of placenta praevia increased in direct proportion to the number of previous uterine incisions. With one previous scar the incidence was 2.60% which went up to 27.27% in cases with 4 or more previous Caesarean sections. The incidences of pathological placental adherence in patients with unscarred uteri and placenta praevia was 3.54% and it escalated to 28.74% in cases with placenta praevia and scarred uterus

Rupture of previously scarred uterus: a preventable catastrophy

A study was carried out on 50 cases of rupture of a previously scarred uterus to determine causative factors and to discuss preventive aspects. Rupture occurred more frequently in 33 [66%] cases who had had Caesarean section previously for cephalopelvic disproportion and/or failure to progress. Thirty-six [72%] Caesarean sections had been done at non-teaching institutions. Some intra-or post-operative problems were encountered in 28 [56%] patients during previous surgery. In 22 [44%] cases labour was well established at the time of presentation and 16 [32%] patients came with a classical clinical picture rupture. Evidence of outside interference was documented in 39 [78%] cases. Preventive measures emphasized are to perform Caesarean section only it genuinely indicated and to impart essential health education to the scarred obstetric population regarding management of subsequent pregnancies. It is also important that personnel engaged in the maternal health care system must be trained adequately so that they can properly handle patients with previous scars