Son preference in Pakistan: M Myth or reality

Objective: To analyze desire for sons/daughters among ladies of Peshawar, Pakistan, with a view to rule out son preference and to study impact of various demographic characteristics on the subject

Methods: Cross-sectional descriptive study conducted at Combined Military Hospital, Peshawar, from August 2015 - January 2016; sampling technique was random/probability/non-purposive. Self-designed questionnaire was utilized; carrying questions pertinent to desire for sons/daughters during marital life, and demographic details. Data analyzed via descriptive analysis [SPSS-21], expressed as frequencies/ percentages and mean +/- standard deviation [minimum/maximum]

Sons and daughters desired [dependent variables] were cross-tabulated with independent variables

Results: Response rate was 63.25% [n-506]

Data revealed following: Sons desired 3.05 +/- 2.061[1/12]; Daughters desired 1.15 +/- 0.767[0/4]; 6.1%[n-31] and 0.6%[n-3] desired infinite number of sons and daughters respectively, 18.2%[n-92] did not desire to have even one daughter, while 2.2%[n-11] considered it immaterial to have daughters or sons

There was a significant relation between sons desired and client's education [p<0.001], husband's education [p<0.001] and socioeconomic class [p<0.001]. There was no significant impact of religion [p-0.142] on desire for sons. Impact of independent variables on daughters desired was similar but less pronounced

Conclusion: There was candid son preference among the respondents. Gender discrimination can be attenuated by adequately addressing son preference at all tiers

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

Objective: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan

Methods: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis [SPSS-21], qualitative data was expressed as frequencies and percentages; quantitative as mean +/- standard deviation [SD]. Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables

Results: Response rate was 53.2% [n-426]. Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age [p<0.001], client's education [p<0.001], husband's education [p<0.001], number of children [p<0.001], religion [p0.013], socioeconomic class [p<0.001], and religious beliefs about use of contraceptives [p<0.001]. More Muslims considered contraception irreligious than non-Muslims [p 0.02]. There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised [p 0.114]

Conclusion: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly

Subdural hematomas following intracranial aneurysm rupture: a rare phenomenon

Acute Subdural Hematoma [aSDH] due to aneurysm rupture and no subarachnoid bleeding are very rare with only 29 cases reported in literature. A 56-year female presented with headache and drowsiness and a previous history of loss of consciousness. Clinical examination revealed a GCS of 14 and a right sided hemiparesis. Workup revealed a pure subdural hematoma due to a middle cerebral artery aneurysm rupture with no subarachnoid hemorrhage. Laboratory workup was otherwise normal and she had no history of falls or head trauma consistent with the usual etiology of an aSDH. She underwent evacuation of the hematoma with clipping of the aneurysm. She had an uneventful recovery with good outcome and no residual neurological deficits at one-year follow-up

Pattern of severe acute maternal morbidity at CMH Quetta

To determine the pattern of severe acute maternal morbidity [SAMM] at Combined Military Hospital Quetta. Descriptive Study. Department of Gynae Obs, Combined Military Hospital Quetta from March 07 to Sept 08. One hundred admitted patients of severe acute maternal morbidity [SAMM] were identified through random sampling procedure. Thorough history, examination and laboratory investigation were considered to identify the pattern of SAMM that is; severe hemorrhage, hypertension, sepsis, pulmonary embolism, uterine rupture, inversion, ruptured ectopic pregnancy etc and to recognize patient features common in cases of SAMM like maternal age, parity, socio-economic/ educational status and level of antenatal care. Out of 100 patients of SAMM, 52% had severe obstetrical hemorrhage, 32% had hypertension, 10% had both severe pre-eclampsia and massive obstetrical hemorrhage, 4% had ruptured Ectopic pregnancies, 1% had septic induced abortion and 1[1%] had puerperal sepsis. These complications were greater in booked multi-gravidas of 20 to 40 years, para 3 to 5, under matric and with less than Rs.10,000/month income. Massive Hemorrhage and uncontrolled hypertension are the major contributors of severe acute maternal morbidity. SAMM is more prevalent in women of 20 to 30 years [reproductive age], parity 3-5, under metric and with monthly income of less than Rs.10,000.

Severe acute maternal morbidity; a review in a tertiary care hospital

To determine the frequency and pattern of severe obstetric morbidity and mortality. Cross sectional study. Period: 1st Oct 2005 to 30th Sep 2007. Military Hospital Rawalpindi. Cases of severe acute maternal morbidity and maternal mortality were collected and comparisons made of disease profile, organ system dysfunction, parity, mode of delivery, whether incident occurred at home or in the hospital and also whether patient was booked or unbooked. One hundred and ten cases of Severe Acute Maternal Mortality [SAMM] and eleven cases of maternal mortality were identified. More maternal deaths occurred in patients who had not booked themselves for antenatal care. The four most frequent cases of severe morbidity were: hypertension 36 [32%], haemorrhage 32 [29%], anemia 16 [14%], sepsis12 [10%] in this order. The four causes of deaths were: sepsis 4 [36%], hypertension 4[36%], amniotic fluid embolism 2[18.%], haemorrhage 01[10%]. There were statistically significant number of patients in mortality arm of sepsis group [p=0.01]. In patients with SAMM there was a higher percentage of patients undergoing caesarean sections in haemorrhage and hypertension arm compared to background rate of 35%. Multi organ failure, cerebral and respiratory system involvement was linked to both SAMM and morbidity. Maternal mortality index was highest for sepsis [25%], and lowest for haemorrhage [3%] with hypertension intermediate in position [10%]. Conclusions: A review of Severe Acute Maternal Morbidity offers a non threatening stimulus for improving quality of care. Comparison of Severe acute maternal morbidity with maternal death gives a different disease pattern and shows that different factors operate in each condition. Therefore both reviews complement each other

Three-year prospective study of the prognosis of cardiomyopathy with pregnancy and its outcome at a single institution

To describe the characters of pregnancy with cardiomyopathy and its outcome. A case series study. This study was done in the Armed Forces institute of Cardiology [AFIC] and Military Hospital Rawalpindi from October 2003 to October 2006. The study of case series consisted of thirteen consecutive women who were admitted with diagnoses of Cardiomyopathy with pregnancy. For the diagnosis of Peripartum Cardiomyopathy [PPCM], strict 4 point criteria were used. During the study period we managed a total of 13 pregnancies with Cardiomyopathy as outdoor cases, 08 with PPCM 4 with hypertrophic Cardiomyopathy and one due to thyroid disease. The number of patients were only 11 as 2 were back again within a year. We had one mortality with peripartum Cardiomyopathy who presented within 20 days of delivery with sudden cardiac failure. For peripartum Cardiomyopathy the average age at presentation was 28 years. Most patients presented with dyspnoea 4 cases, palpitations 7 and one patient with syncope. Left Ventricular Ejection Fraction [LVEF] was 0.35 on the average. The time of diagnosis was antepartum for three patients and postpartum for five. There were no cases of multiple pregnancies in this series. In hypertrophic cardiomyopathy majority of the patients had caesarean sections, less so in other categories. These were performed under general anaesthesia due to uncertainty about the safety of regional anaesthesia in these cases. Cardiomyopathy is a poorly understood ominous complication of pregnancy. It accounts for a rising proportion of maternal mortality. Diagnosis should be considered whenever women present with heart failure in peripartum period. Improved case ascertainment requires heightened awareness among obstetricians and cardiologists

Rising caesarean section rate; making sense of it is it unavoidable?

Compare indications for caesarean section in Military Hospital Rawalpindi in the year 1999 with the year 2005, six years apart, with an aim to identify areas where caesarean section rates could be decreased. Prospective Survey of caesarean section using information provided by doctors/midwives entering data in labour ward /theater registers. The study was designed as a process evaluation. Indication for caesarean section, parity, previous caesarean section, emergency / elective, labour / pre labour, presence of previous caesarean section scar, induced or spontaneous labour were noted. Data was plotted into 2 separate classifications and indications compared across the 2 years 1999 versus 2005. Statistical significance was calculated and value of <0.05 was considered significant. Overall section rates rose from 16.9% to 34.6% which showed almost doubling of rates in a span of 6 years. The chief contributors to rising rates were as follows. Caesarean section rate rose from 132 [2.2%] to 355 [4.6%] for previous one Caesarean section [p<0.001], from 172 [2.9%] to 383 [5%] for previous >1 caesarean [p<0.001], that for nullipara increased from 203 [3.3%] to 632 [8.3%], prelabour or induced labour [p<0.001] and for dystocia from 150 [2.5%] to 490 [6.4%] which was again significant [p<0.001]. Increase in section rate for antepartum haemorrhage, diabetes, previous infertility and intrauterine growth restriction was insignificant. A decrease in the number of caesarean sections may be achieved by reducing the number of primary caesarean section and/or encouraging more patients to take a trial of scar. A decrease in induction rates may also lead to lowering of caesarean section rates