Effectiveness of reflective exercises for obstetrics and gynaecological residents

To evaluate the effectiveness of reflective exercises in obstetrics and gynaecology [OB/GY] residents for the improvement in certain identified skills. Experimental study. Gynaecology Unit III, Services Institute of Medical Sciences / Services Hospital, Lahore, from September 2009 to August 2010. Twenty-four residents from all 4 years of residency program were included in the study after their informed consent. The competencies identified were surgical skills, professionalism, communication skills and critical appraisal skills. The reflective exercises evaluation was done on questionnaire designed for this purpose. The results showed that the residents initially had underdeveloped ability to engage into purposeful reflective exercises, which improved with practice and showed encouraging results. Reflective exercises particularly helped in improvement of surgical skills as opposed to other identified competencies. Regular engagement of postgraduate trainees in reflective exercises in a purposeful manner has encouraging results in terms of improvement in surgical, communication, critical appraisal skills and has a role in boosting professionalism among residents. However, a longitudinal multicentre study can give better insight regarding the effectiveness of this practice

Primary postparyum haemorrhage prevention by misoprostol and oxytocin

Objective: to determine the efficacy of rectal misoprostol combined with intravenous oxytocin for prevention of primary postpartum haemorrhage

Material and Methods: a total of 600 cases were included in this study. Patients were given 600mcg rectal misoprostol and intravenous oxytocin at the delivery of anterior shoulder of baby. These patients were followed in 24 hours for postpartum haemorrhage

Results: mean age of the patients was 27 .1 +/-4.9 years. Mean gestational age was found to be 37.2+/-5.8 weeks. According to parity distribution, primigravida were 220 [37%], gravida 2-4 were 312 [52%] and gravida 5-6 were 68 [11 %]. Majority of the patients i.e. 554 [92.3%] had blood loss < 500 ml and 46 patients [7.3%] had blood loss> 500 ml. rectal misoprostol with intravenous oxytocin was effective in 554 patients [92.3%]

Conclusions: rectal misoprostol combined with intravenous oxytocin is effective in the prevention of primary postpartum haemorrhage

Prediction model for determining important factors of success of external cephalic version

The External cephalic version [ECV] is a skill as well as an art that could be easily acquired. It has become a valuable option in the management of breech foetus at term. Aims of this study were to determining those factors that were significantly associated with success of external cephalic version [ECV] procedure. This prospective interventional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, Services Hospital, Lahore, Pakistan from July 2007 to December 2009. Total of 56 patients who had undergone ECV was analysed descriptively and analytically. Univariate and multivariate data analysis was performed. Pre-procedural factors [gravidity, gestational age, amniotic fluid index, placental location, type of breech, maternal obesity, foetal weight], and factors associated with the procedure itself [abdominal wall musculature tone, uterine tone, maternal anxiety, maternal threshold for pain, engagement of breech, number of attempts] were assessed. Thirty-three patients were successfully converted to vertex presentation. In multivariate analysis, placenta, type of breach, station of breach and number of attempts [

Perinatal Mortality

The aim of study was to assess perinatal mortality rate in mentioned period and to know the probable cause of the perinatal mortality. Place and Period: The study conducted at Gynae Unit III Lady Willingdon Hospital Lahore from January 2001 to December 2002. All the perinatal mortality occurring during the study period. Data collection done on designed performa. Patients detailed history, management and the probable cause of the perinatal mortality recorded. At the end of the study data was compiled. Total number of births in the mentioned period was 7665. The number of perinatal death was 625. The perinatal mortality rate was 82/1000. In the study 560 [90%] cases were unbooked while 115 [10%] casers were booked. Four hundred and thirty [69%] were neonatal deaths while 195[31%] cases were stillborn. Most of the patients belong to low socioeconomic group. Regarding the occupation 438 [70%] patients were housewives. Four hundred and sixty four [74%] patients were uneducated. One seventy [27%], 200 patients [32%] were multigravida and 255 [40.8%] patients were gr and multigravida. The major cause of perinatal mortality was prematurity in 325 [52%], asphyxia neonatorum in 100 [16%] cases, meconium aspiration in 30%] cases and congenital malformations in 40[6.8%] cases. Most of the causes of perinatal mortality are avoidable. By providing the proper antenatal care, developing the proper referral system in indicated cases and better pediatric training can reduce the perinatal mortality