Factors associated with timely initiation of breastfeeding among mothers in JPMC

Objective: Study the frequency of common factors Associated with timely initiation of breastfeeding

Study design: Descriptive Cross sectional

Duration and place of study: this study was conducted at, Jinnah postgraduate Medical center Karachi unit-I from 19 May to 18 November 2015

Material and Methods: A total of 108 mother infant pairs were selected by Non probability consecutive sampling technique, meeting our inclusion criteria. Informed consent was taken after explaining the pros and cons, purpose and procedure of the study. The common factors associated with timely initiation of breastfeeding like age of the mother, gestational age, parity, educational status, working status of the mother, mode of delivery, birth weight of the baby and gender of the baby were evaluated through face to face interview of the mothers

Results: In our study mothers found to be 26.1 years old. Mean birth interval found to be 3.1years. Mean birth weight of the babies was 2.86 kg. Mean gestational age of the Patients was 38.1weeks. Most of the babies were female 63[58%] other were male 45[42%].Out of 108 patients, 40[37%] received Primary education, 27 [25%] were graduated, 18[17%] were Illiterate, 13[12%] secondary and 10[9%] were Intermediate. Thirty eight [35.2%] belonged to middle class, 56[51.9%] to upper middle class and only 14[13%] to higher class. Fifty eight [53.7%] women were multipara and 76[70.3%] were employed; And Mostly 66 [61%] delivered through C-Section

Conclusion: According to this study the main conclusion of Common factors associated to timely initiation of breastfeeding were age of mothers[74.07%] more than 20years , parity 2 or more[ 61.1%], educational level secondary and above [50.9%], house wives [32.9%], male sex of infant [41.6%] and Vaginal mode of delivery [38.8%]

Foeto-maternal outcome of abruptio placentae at a tertiary care hospital

Objective: To determine the frequency, risk factors and, maternal and perinatal outcome in women presenting with abruptio placentae at a tertiary care hospital

Methodology: This observational, descriptive study was conducted in the Department of Obstetrics and Gynecology Unit I, Jinnah Postgraduate Medical Centre [JPMC], Karachi from January 2011 to December 2013. All pregnant women with gestational age 28 weeks or greater, having retro-placental clots on ultrasound and/or painful vaginal bleeding were included by using nonprobability purposive sampling technique

Results:There were 24,591 obstetric admissions during the study period, and 21,669 of them delivered. Of these 489 were diagnosed as abruptio placentae, making it a condition with a frequency of 1.98% of obstetric admissions and 2.25% of deliveries. 394 of the 489 cases [80.6%] were un-booked. Majority of them [252, 51.5%] were grand multipara with mean parity of 4.8 +/- 3.3. 330 [61.4%] were older than 30 years [36.1+/- 12.6 years]. 392 [80.2%] delivered vaginally and the rest 97 [19.8%] were delivered by Caesarean section. Hypertension and pre-eclampsia were collectively seen in 124 [25.2%], anaemia in 77 [15.7%], smoking in 39 [7.9%] and trauma in 8 [1.6%] patients. Noteworthy maternal complications were postpartum haemorrhage [PPH] in 70 [14.3%], postpartum anemia in 55 [11.2%], disseminated intravascular coagulation in 13 [2.65%] and renal failure in 2 [0.4%] patients. Maternal death occurred in 17 [3.5%] women. Still birth occurred in 194 [39.7%] patients. Perinatal Mortality was 68.7%

Conclusion: Abruptio placenta has a significantly increased risk of maternal and perinatal mortality. Risk factors include multiparity, hypertension, pre-eclampsia, anaemia and smoking

Emergency obstetric hysterectomy

Objective: To evaluate the frequency of emergency obstetric hysterectomy, and to find out its indications and accompanying maternal and perinatal morbidity and mortality

Methodology: This cross sectional study was undertaken at Obstetrics and Gynaecology department of Unit-I, Jinnah Postgraduate Medical Centre, Karachi from 1st January 2015 to 31st December 2016. Those patients who had emergency obstetric hysterectomy at JPMC during this period were included in the study. Their parity, booking status, age, indication and, the type of surgery undertaken was recorded. Maternal and fetal morbidity and mortality were also determined. Data was analyzed using SPSS 20

Results: A total of 14,157 deliveries were carried out during the study period. Out of them, 32 hysterectomies were undertaken due to obstetric indications [0.22%]. The most common indication was ruptured uterus in 20 [62.5%]. The most common complication was infection [40.6%]. Five patients could not survive after the surgery [15.6%] and perinatal deaths were 19 [59.3%]

Conclusion: Obstetric hysterectomy needs to be done in emergency cases where life of the patient can not be saved otherwise. However, clear judgement, highly professional surgical technique and optimal time for the surgery can decrease mortality and morbidity in such cases

Frequency of stillbirths in a tertiary care hospital of Karachi

Background and Objective: Pakistan accounts for the highest stillbirth rate in the world. Therefore, this observational study was planned to determine the prevalence of stillbirths and its associated demographic characteristics in the given context. Hence our objective included: To determine the frequency of stillbirths with reference to parity and gestational age in a tertiary care public hospital, Karachi. To determine the socio-demographic characteristics of families with stillbirths

Methods: All pregnant mothers who delivered stillbirth babies at Gynaecology and Obstetrics ward of Jinnah Postgraduate Medical Center, Karachi a tertiary care facility were prospectively enrolled from October 2012 to September 2013. Deliveries occurred before 28 weeks of gestational age were excluded. Gestational age was confirmed from hospital record and attending physicians. Data was collected on predesigned proforma and analyzed using descriptive statistics

Results: Among 7708 registered deliveries, 137 were stillbirths. A total of 84 mothers were primiparous and 12% of mothers were below 20 years at the time of delivery. Majority of stillbirths were macerated type [80.3%] and 20% were fresh stillbirth. About 55% of still births occurred between 33-37 weeks and 20% between 28-32 weeks. Almost 80%[109] of stillbirths were low birth weight and only 20%[28] were normal birth weight

Conclusion: This study shows that stillbirths are more common in primiparous mothers in a given context. Conducting awareness sessions with special focus on antenatal and obstetrical care of primiparous may be helpful to reduce still births

Frequency and outcome of hepatitis C virus infection in pregnant women at tertiary care hospital

Objective:-To determine the frequency of Hepatitis C virus infection and maternal and fetal outcome in pregnant women with Hepatitis C virus infection

Materials and Methods:This descriptive case series study was conducted in the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Center, Karachi for a period of six months from 17-02-2015 to 18-08-2015. A total of 202 pregnant women of any parity and gestational age after 24 weeks were selected in this study. After taking history and examination, 5ml of blood was drawn from the peripheral vein from each patient and serum was tested for the presence of Anti-HCV antibodies in all patients using a third generation ELIZA test in diagnostic laboratory. All data was collected in pre-approved proforma

Results: The frequency of hepatitis C virus infection in pregnant women was observed in 15.35% [31/202] cases. The average age of the patients was 27.35±4.66 years. The most common obstetrical complication in women with hepatitis C virus infection was jaundice 77.4% [24/31] followed by preterm delivery 35.5% [11/31], LBW 32.3% [10/31], placenta previa 25.8% [8/31], premature birth 19.4% [6/31], intra uterine death 19.4% [6/31], hepatic encephlopathy 9.7% [3/31] and maternal death 9.7% [3/31]. Rate of jaundice, preterm birth, premature birth, intra uterine death and low birth weight was also significantly high in those pregnant women who were HCV positive.

Conclusion: HCV positivity may be a surrogate marker for increased risk of poor pregnancy outcomes and the HCV-positive pregnant population may require greater clinical vigilance in this regard

Preterm deliveries in women presenting with threatened abortion

Objective: To determine the frequency of preterm deliveries in women presenting with threatened abortion at tertiary care hospital

Study design: Cross sectional study

Place and duration of study: Department of Obstetrics and Gynaecology Unit I, Jinnah Postgraduate Medical Center [JPMC] Karachi, from October 2014 to March 2015

Methodology: Women between 18 year to 45 year of age diagnosed as cases of threatened abortion, were consecutively selected. Patients with non-obstetric causes of bleeding such as cervicitis, vaginitis, cystitis, trauma, significant cervical dilation, ectopic pregnancy, multiple gestations etc were excluded from the study. The variables assessed were maternal age, gestational age and parity. Preterm delivery and obstetrical factors were expressed as frequency and percentages. Stratification of age, gestational age, parity and obstetrical factors was done. Chi square test was applied to the data and p <0.05 was taken as significant

Results: During the study period 105 women were diagnosed as cases with threatened abortion. The mean maternal age was 26.53 +/- 6.36 year. Mean gestational age was 29.92 +/- 3 weeks while mean parity was 2.30 +/- 1.18 [range: 1 to 5 children]. Frequency of preterm delivery among patients of threatened abortion was 17.14% [n =18]. Age was high significant [p = 0.001] effect modifier which decreased more than half from 20.83% in 18-25 year of age to 9.09% in 36-45 year of age. There was no significant difference with variation of gestational age and parity. With any obstetrical condition [pre-eclampsia, eclampsia, HELLP syndrome and placental abruption] much higher frequency of preterm delivery was noted as compared to having none [p = 0.000]

Conclusion: The frequency of preterm delivery in patients of threatened abortion was more common in younger age and primigravida

Letrazole for ovulation induction in clomiphene resistant women with polycystic ovarian syndrome

Objective: To determine the frequency of successful ovulation induction with letrozole in infertile women with polycystic ovarian [PCO] syndrome who were resistant to clomiphene citrate

Study design: Descriptive case series

Place and duration of study: Department of Gynaecology and Obstetrics ward-8, Jinnah Postgraduate Medical Center Karachi, from September 2009 to March, 2010

Methodology: Women between 20-40 year of age with history of PCO and primary infertility of at least one year duration who failed induction on clomiphene citrate for at least 2 months, were included in the study. After taking informed consent and counseling letrozole was given in a dose of 2.5 mg daily from day 3-7 of menstrual period. Patients were monitored by transvaginal ultrasound scan [TVS]. The mean follicular diameter was noted on day 10, 12, 14, and 16. This was followed by HCG injection 10000 IU and serial monitoring of the follicles till 18mm size reached

Results: Sixty seven patients were selected. Mean age was 27.6 +/- 3.3 year and mean duration of infertility was 4.3 +/- 1.6 year. Fifteen [22.4%] of patients had infertility for 4 years, 13 [19.4%] had for 5 years and 12 [17.9%] for 6 years. Ovulation was successfully induced in 33 [49.3%] women

Conclusion: Letrozole can be used as a second line agent when there is resistance to clomiphene citrate, a first-line treatment, for induction of ovulation in women with polycystic ovarian syndrome

Maternal and perinatal outcome of preeclampsia and eclampsia treated with magnesium sulphate

Objective: to determine the maternal and perinatal outcome of pre-eclampsia and eclampsia treated with magnesium sulphate

Study design: interventional study

Place and Duration of study: department of Obstetrics and Gynecology Unit-I, Jinnah Postgraduate Medical Centre Karachi, from May 2012 to April 2014

Methodology: all patients admitted with pre-eclampsia and eclampsia were included. After taking detailed history and clinical examination they were treated with magnesium sulphate [MgSO[4]]. Patients were monitored for recurrent fits, side effects of MgSO[4], and causes of discontinuation of treatment. Maternal outcome in terms of mode of delivery, number of maternal deaths and perinatal outcome in terms of perinatal death and APGAR scores were recorded

Results: the study was conducted on 50 pre-eclamptic patients [Group-I] and 100 eclamptic patients [Group II]. Mean age of patient in group-I was 26.94 +/- 5.5 year and in Group-II 24.32 +/- 5.8 year. High frequency of eclampsia [n=61, 61%] was found in antepartum cases. Majority of patients [n=79, 52.6%] were primigravidae in both the groups. In group-II five patients had recurrence of fits. There were seven maternal deaths due to eclampsia but none of the deaths was attributed to magnesium sulphate therapy. Overall perinatal mortality was 30.7% [n=46]

Conclusions: recurrence of seizure was seen in only 5% eclamptic women and none in those with severe pre-eclampsia. Magnesium sulphate was found effective in treatment as well prophylaxis of eclampsia

Female surgical sterilization at a tertiary care hospital in Karachi

Tubal ligation for sterilization is one of the common methods of contraception practiced by women in developing countries like Pakistan. This study was undertaken to study characteristics of couples undergoing surgical sterilization, and to identify ways of improving utilization of contraceptive services. Material and methods: Details of 1148 women who underwent tubal ligation at the reproductive health center Jinnah Postgraduate Medical Center Karachi from January to December 2002 were recorded on a special proforma. The woman's age, duration of marriage, number of living children and the couple's educational status were recorded. Contraceptive use and duration, and associated medical conditions were documented. Data was entered in SPSS, frequency tables, means and standard deviations were obtained and comparative evaluation undertaken using non parametric methods, as indicated. Out of the 4210 initial clients, 1163 [27.62%] underwent surgical sterilization. This included 1148 [98.69%] tubal ligations and 15 [1.31%] vasectomies. Of these, 608 [52.96%] were carried out in the immediate puerperium. The mean age of women was 33.1 +/- 3.55 years, they had been married for 14.84 +/- 4.22 years and 44.34% had already had 6 or more children. Tubal ligation performed after careful selection and counseling, by experienced personnel under local anaesthesia is a safe procedure with very few complications. However older women with no history of contraception, who have already had 6 or more children, seem to avail it. Promotion of temporary contraceptives for birth spacing among younger couples is more likely to improve maternal and newborn health in addition to limiting the family size

Obstetrics hysterectomy-five years experience at Jinnah postgraduate medical centre, Karachi

During the five years period [1st] January 1988 to 31st December 1992], 106 hysterectomies were performed for obstetric indications in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre [JPMC], Karachi. The frequency was 1 in 331 deliveries [total 35.172 deliveries]. In all except one hysterectomy was performed as a life saving measure. The major indications were rupture uterus in 61 [58%] cases and severe postpartum haemorrhage due to uterine atony in 18 [17%]. Other indications included haemorrhage due to placenta praevia in 11 [10%], placenta accreta 7 [7%] and abruptio placentae 5 [5%], severe infection 2 [2%] and broad ligament haematoma following caesarean section 1 [1%]. There were 10 [9%] maternal deaths all due to severity of the conditions necessitating hysterectomy. Obstetric hysterectomy can save many lives but requires proper judgement and skill. Senior resident staff in obstetric units in the developing countries should be trained for it

Evaluation of the role of craniotomy in developing countries

A review of 32 cases of craniotomy performed at the Jinnah Postgraduate Medical Centre Karachi, over a period of 6 years from January, 1984 to December, 1989 is presented. Total number of deliveries during this period were 37,682. Frequency of craniotomy was 0.08% i.e., 1 in 1177 deliveries. Of these 32 craniotomies, 28 were done on non-deformed dead fetus, 16 because of obstructed labour, 7 in cases of after coming head of breech and 5 in failure to progress in second stage of labour. Four cases were of live hydrocephalic fetus in whom cephalocentesis was done followed by craniotomy due to failure to progress in labour. Maternal morbidity was 12.5% with no maternal death. We conclude that it is safe and quicker than caesarean section in selected cases. Though unpleasant to perform, is of great relief to the patient and her family

Rupture of the uterus in full-term pregnancy

Of 48,519 deliveries conducted at Jinnah Postgraduate Medical Centre [JPMC] over 7 years [January, 1986 to December, 1992], 257 were of ruptured uterus, giving a rate of one in 189 deliveries. Main cause of rupture was obstructed labour. Maternal mortality was 3.9% and foetal mortality 88% in cases admitted with uterine rupture and 17.6% in rupture occurring within the hospital

Culdocentesis in diagnosis of disturbed ectopic pregnancy still a useful procedure in developing countries

Over a period of 5 years culdocentesis was carried out in 156 cases of suspected ectopic pregnancy using needle aspiration through the pouch of Douglas. The result was positive in 134 cases, with 131 being true positive and 3 false positive. In 22 cases the result was negative, 6 of which were false negative. It is concluded that culdocentesis is an effective method of diagnosing disturbed ectopic pregnancy

Perinatal mortality in Jinnah postgraduate medical centre, Karachi

During the one year period from 1 st January to 31 st December, 1989, there were 6,826 deliveries and 695 perinatal deaths, of these 553 were still-born and 142 were neonatal deaths [died within 7 days of birth]. The perinatal mortality rate was 101.8 per thousand total births. The still-birth rate was 81 per thousand total births. Of the perinatal deaths, 7.9% occurred in booked and 92.1% in non-booked cases. The commonest cause of death was antepartum haemorrhage [APH], 24.2% followed by mechanical which accounted for 23.6% deaths. Abruptio placentae was the leading cause among all still-births and low-birth weight [LBW] in all neonatal deaths