Women's preferences for place of delivery: a study at tertiary care hospital

Objective: To determine the preference for choice of birth place among pregnant women attending antenatal clinics at tertiary care Hospital. To find out the barriers which make their choices

Study Design: Prospective descriptive study

Place and Duration: This study was done in the Department of Obstetrics and Gynecology Isra University Hospital from January 2010 to July 2010

Methodology: In this study pregnant women [n = 912] attending antenatal clinics, were interviewed to collect data regarding socio demographic profile. Women views about their preferences for home delivery and hospital confinement were assessed. The data was recorded on structured questionnaires analyzed by SPSS version 16 and presented as frequencies and percentages

Results: It was observed that 553 [60.63%] of study participant preferred hospital birth. The main reasons for choosing hospital delivery were safety and good care 260 [47% of the women], better hygiene 138 [25%] and because of medical advice and services 70 [12 %]. About 359 [39. 36 %] were liked home birth reason were social support and privacy and good care at home 141 [40%] low cost 135 [38%] new born care being taken at home 44 [12.25] and local hygiene 17 [4 %] respectively

Conclusion: Majority of our study participant were preferred hospital birth because of provision of good care and safety. Social pressure were common in those who delivered at home so women preference should be acknowledged

Frequency and impact of premenstrual syndrome on quality of life

This study was conducted to determine the frequency and impact of premenstrual syndrome [PMS] on quality of life in women of reproductive age [15-49 years], and to determine if frequency estimates varied with menstrual flow. This cross-sectional study was carried out on 500 women of reproductive age currently menstruating, non-pregnant including women attending gynaecology outpatient department and female students of Isra University Hyderabad, from 1 -July-09 to 31 -December-09. Demographic data, and premenstrual Symptoms were recorded through interview and filling of predesigned questionnaire after taking verbal informed consent, and later analyzed on SPSS 11 for descriptive statistics and comparison of proportions using chi-squire test of Independence. This study shows very high frequency 81.25% of Premenstrual syndrome among women of reproductive age. The most frequent symptoms were reported Backache 446[89.2%] and fatigue in 446[89.2%] out of 500 women. Significant difference of weight gain, lower work or college performance, cramps, skin disorders, fatigue, mood swings, depression and tension were found in premenstrual and menstrual phases among study participants. Premenstrual syndrome is a common problem, have an adverse impact on a woman's quality of life and productivity

Diagnostic accuracy of transvaginal scan in the diagnosis of ectopic pregnancy

Objective: To determine the value of transvaginal sonography in the evaluation of women with suspected ectopic pregnancy [EP], a life-threatening condition in early pregnancy

Design: Adescriptive study

Place and Duration: The study was conducted in the radiology department of Liaquat University of Medical and Health Sciences from February to August 2005

Patients and Methods: A total of 7155 consecutive women presented to the radiology department during study period. Among them, 100 women were enrolled for study by non-probability convenience sampling. These patients underwent pelvic ultrasound examination. Both transabdominal and transvaginal scans were performed simultaneously in the patients. Serum beta hCG levels of all patients were greater than 1500iu/ml

Results: Ultrasound correctly identified EP in 34 patients. Transvaginal sonography [TVS] demonstrated EP in 24 patients while transabdominal scan [TAS] identified EP in 9 patients. Ultrasound diagnosis included adnexal mass in 16 patients, ecogenic ring in 10 patients, extrauterine gestational sac in 4 patients, live embryo in one patient, and intrauterine fluid in 21 patients

Conclusion: Timely diagnosis of EP with the help of TVS and serum beta hCG is the modality of choice and plays a vital role in the decreasing mortality rate caused by this complication of pregnancy

Laparoscopic evaluation of female infertility

Sub-fertility is inability to ensure child bearing when it is wanted. Prevalence of sub-fertility in industrialised countries has been quoted as 20%, and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure and tubal patency was hysterosalpingography but it has now been largely superseded by laparoscopy and hysteroscopy. The objective of this study was to highlight the role of laparoscopy in establishing diagnosis of female infertility. This descriptive study was conducted in Gynaecology Unit of Liaquat University of Medical Health Sciences, Hyderabad, Pakistan from 28[th] August 2000 to 1[st] July 2001. Total 200 sub-fertile patients attended the gynaecology OPD. Out of these 30 patients were selected for laparoscopy and dye test who were suspected cases of endometriosis, abnormal HSG and unexplained infertility. Those patients who had medical disorders and contraindication for laparoscopy were excluded from study. Detailed history of every patient was recorded on a proforma and physical examination was performed. Laparoscopy was scheduled in proliferative phase of menstrual cycle. Data were analysed using SPSS 11. Frequency and percentages were calculated to describe the results. Out of 200 sub-fertile patients total 30 patients were selected for laparoscopy. Twenty [66%] patients were in primary infertility group while 10 [33%] patients were in secondary infertility group. Eleven [55%] patients of primary infertility belong to age group of 18-25 years while 6[60%] patients of secondary infertility belong to age group of 26-33 years [TABLE 1]. Mean duration of sub fertility at time of presentation in primary infertility group was 1.95 years while in secondary infertility was 2.70 years [Table 2]. In primary infertility group main associated symptoms were dysmenorrhoeal in 8 [40%], irregular cycles 5 [25%], and dyspareunia in 4 [20%]. In secondary infertility group 3 [30%] patients had dysmenorrhoeal and dyspareunia while 2 [20%] had irregular cycles. The commonest cause observed in patients with primary infertility was endometriosis spots which accounted for 11 [55%]. In secondary infertility tubal occlusion was more common which accounted for 3 [30%]. Laparoscopic procedures are less invasive, more convenient and more precise for diagnosis of sub-fertility in women

Torsion of fimbrial cyst

A case of fimbrial cyst torsion is presented in an 18-year-old virgin female. She presented with severe left lower abdominal pain. Ultrasound scan was suggestive of an ovarian cyst. On laparotomy, a large 22 x 22cm twisted leftfimbrial cyst was found and a left salpingectomy was performed. Although torsion of fimbrial cyst is rare, it should be considered in the diagnosis of acute abdomen in females

Attitudes towards menstruation among young women

To determine knowledge and different attitudes towards menstruation among young women. A descriptive study was carried out at Isra University Hyderabad and villages around the Isra University Hospital, from 1st April 2005 to 31st March 2006. Five hundred women from villages around Isra University Hospital and students of Isra University Hyderabad were selected by non-probability sampling who were of menstruating age irrespective of their marital and literacy status. Women with menstrual irregularities or any other gynecological or psychological problem were excluded. All information was recorded on a questionnaire Performa and analyzed on SPSS version 15.0. Out of 500 participants, 438 [87.6%] regarded menstruation as a natural process; whereas, 62 [12.4%] perceived it as a disease and curse from God. Out of 500, 415 [83%] of the participants responded that the menstruation process is good for health; however, 85 [17%] felt this process not healthy for themselves. Ignorance, false perceptions and unsafe practices regarding menstruation are not uncommon among young women, hence the importance of health education particularly of women living in rural areas. Then they will be better prepared emotionally to experience menstruation and will have less negative reactions

Frequency and indications of cesarean section in a tertiary care hospital

To determine the frequency of cesarean section and to analyze the indications, so as to introduce measures to control the cesarean section rate. This descriptive study was conducted in obstetric and gynecology department of Isra university hospital Hyderabad Sindh from 1st Jan 2007 to 31st Dce 2007.In this study clinical record of all the patients who underwent cesarean section was analyzed. It included all the pregnant ladies booked in the antenatal clinic and unbooked patients admitted in early labour for whom cesarean section was indicated later. It also included all those cases coming in emergency at any time for which cesarean section was indicated. Clinically diagnosed cases of ruptured uterus proved on laparotomy were not included in the study. Data was analyzed on SPSS version 11 and frequencies as wall as percentages were calculated. During one year study period, 380 cesarean section were performed. The rate of cesarean section was 64.7%. Emergency cesarean section was performed in 225 [59.2%] patients and elective cesarean section in 155 [40.7%]. Among 380 patients, 167 [43.9%] were booked while 213 [56.0%] were unbooked. Repeat cesarean section was the commonest indication seen in 73 [19.2%] patients followed by dystocia in 51 [13.4%] patients, fetal distress in 48 [12.6%] and ante partum hemorrhage in 45 [11.8%] patients. Miscellaneous indications contributed to 16 [4.2%] of the cases. Majority of patients who underwent cesarean section was unbooked and had an emergency cesarean section. The commonest indication was repeat cesarean section

Hepatitis C: frequency, risk factors and pregnancy outcome

To determine the frequency of HCV in pregnant women, to find out the risk factors for HCV in pregnant women and to compare the pregnancy outcome of HCV positive with HCV negative mother. Case - control study. Obstetrics and Gynecology Department of Isra University Hospital Hyderabad, from Nov 2007 to August 2008. Study was conducted on pregnant women who were screened for HCV antibody during antenatal consultation and were admitted for delivery. Five ml blood was drawn from each patient and serum was tested for anil HCV by ELIZA. Detailed history was taken for evaluation of risk factors. All results were analyzed on statistical software SPSS version 16. Fishers exact test or Chi square were applied among the categorical variables. Frequencies and percentages and 95% confidence intervals were calculated. Student t test was also used to compare the mean [2 tailed] of numerical parameters. P value of less than or equal to 0.05 was considered as significant. Frequency of hepatitis C in our study was 8% [n-23]. After computing the measures of association for cases and controls with regard to the risk factors, history of previous surgery [p=0.01], blood transfusion [p=0.02], dental surgery [p=0.004] and history of injections [p=0.01] were found to have significant association with HCV positive status of the patients. Logistic regression was used to control the effects of various risk factors under study and to find out the direct effect of risk factors on HCV positive status. Using logistic regression, history of previous surgery [p=0.01], blood transfusion [p=0.02], dental surgery [p=0.04] and history of injections [p= <0.001] were found to have significant association with HCV positively in our study. Statistically no significant difference was found in birth weight, gestational age and Apgar score of new bom in cases and control groups. Frequency of hepatitis C in our study was 8%. No adverse effect on pregnancy outcome was observed when compared to controls

Perinatal outcome in diabetic mothers at Isra university hospital

To evaluate perinatal outcome in diabetic mothers in our tertiary care set up. A descriptive study. Out patients department and labour ward of Obstetrics and Gynaecology Unit, Isra University Hospital Hyderabad, Sindh- Pakistan, from 3[rd] January 2007 to 2[nd] January 2008. Total 110 pregnant women between the age of 20 and 40 years with diabetes, irrespective of their parity and previous obstetric history were selected by convenience [non-probability] sampling. Women with eclampsia, antepartum haemorrhage, pregnancy induced hypertension and medical disorders were excluded from the study. All information was recorded on preformed proforma and analysed through SPSS version 11.0. Among perinatal complications, macrosomia was seen in 41.8% of fetuses, biochemical abnormalities in 85.3% infants, moderate to severe birth asphyxia in 33.6% and congenital malformations in 6 infants of diabetic mothers. Perinatal complications of diabetic pregnancy are more common in high parity women. Macrosomia, biochemical abnormalities and asphyxia are the common perinatal complications in our set up

Silent uterine rupture at 24 weeks in twin gestation

Scar dehiscence is a preventable condition. If recognized earlier, the lives of the woman and child may be saved. We present a case of twin pregnancy with a previous lower segment caesarean section. The uterus ruptured at 24 weeks of gestation without uterine contraction

Presence of postgraduate students in gynecology outpatient department: how do patient feels?

Objectives: the purpose of this study was to document the views of patients about presence of postgraduate students during gynecology consultation, to highlight the reasons of acceptance or refusal of student's participation in outpatient care and to make implications for both patient satisfaction and medical training

Design: descriptive study

Place and duration of study: conducted on patients who attended gynaecology outpatient services at Isra university hospital from 1st April to 1st June, 2007

Patients and methods: total 115 patients were selected randomly. 20-40 year aged patients were included in this study while pregnant women and unmarried girls were excluded. Total number of postgraduate students was 15. No more than six students were present at a time during consultation. All were female trainees for fellowship of College of Physicians and Surgeons Pakistan [FCPS] trainees. These trainees were present to observe and discuss management of patients with consultant. Written informed consent was taken from all women for participation in this study. Information was collected through questionnaire

Results: mean age of the patients was 33.35 years. Out of 115 patients, 78.3% [90] patients felt comfortable in the presence of post-graduate students and accepted their presence, while 21.7% [25] patients refused their presence. Among 78.3% [90] women who accepted the presence of students, 96.7% [87] were willing to be examined in front of students in future, if they come to hospital for any other problem. While 3.3% [3] patients refused to be examined in front of students

Conclusion: majority of patients were willing to have postgraduate students presence during their consultation. Women who refused their presence, had reasons of previous bad experience, shyness, no privacy, diversion of doctor's attention from patient to trainee and because number of trainees were more during examination . Reducing number of trainees during consultation and doing discussion with post graduate students at the time when patient have left the room will further increase the willingness of patients for students presence. Information brochure should be distributed to patients highlighting the benefits of clinical teaching may help to persuade some unwilling patients to reconsider the presence of post graduate students

Innovation in teaching strategies for undergraduate medical students at Isra University Hyderabad, Sindh-Pakistan

Objective: to evaluate the academic performance and to assess the experience of 4th year MBBS students before and after introduction of Problem Based Learning Curriculum [PBLC]

Study design: a comparative study

Place and duration of study: academic session of 2006-2007 at Isra University Hyderabad, Sindh-Pakistan

Subjects and methods: one-hundred and nine students of 4th year MBBS were taught Obstetrics and Gynecology by Traditional curriculum [TC] and Problem Based Curriculum; both for 150 hours. Their academic performance was evaluated by 06 continuous assessment tests [CATs] scheduled fortnightly. At the end of every curriculum their experiences were recorded on a questionnaire. Data were analyzed and Chi- square test and student's t-test were used to obtain significant values

Results: study detected statistically significant difference of class test attendance [p<0.001] and marks obtained in each test [p<0.001] after PBLC and TC. Students liked PBLC more and their experience was excellent and good [p<0.001] with PBLC than with TC. Classroom attendance was not different in both curriculum as 75% of attendance was required by student to be eligible to appear in the end-semester examination as per rules of examination department of the university

Conclusion: PBLC introduced in the 4th year MBBS at Isra University with traditional curriculum significantly improves the academic performance of students. Students' experience of PBLC was good and they liked it because of more understanding of the subject, feeling of independence and confident

Frequency, intensity and impact of premenstrual syndrome in medical students

To determine the frequency and severity of Premenstrual Syndrome [PMS] in medical college students, evaluate the impact of the condition on the quality of life and find out the associated risk factors. An observational study. Isra University Hospital, Hyderabad, Sindh, Pakistan, from August to December 2006. Unmarried medical students aged 18-25 years with regular menstrual period for the last 06 months were recruited by convenience sampling. PMS-related data was collected on daily record of severity of problems [DRSP] for two prospective cycles. Health-related quality of life data was collected on medical outcome study Short Form 36 [Sf- 36] after taking informed consent from participants. Descriptive and inferential analysis was done by two-tailed t-test and multivariate logistic regression analysis. Study participants [n=172] had mean age of 21.2 +/- 1.9 years. Eighty-nine [51%] girls met the criteria for PMS recording to ICD - 10, among them, 53 [59.5%] had mild PMS, 26 [29.2%] had moderate and 10 [11.2%] had severe PMS. Ten [5.8%] girls were found to have Premenstrual Dysphoric Disorder [PMDD] according to DSM - IV criteria. The order of frequency of symptoms were anger, irritability, anxiety, tiredness, difficult concentration, mood swings and physical symptoms like breast tenderness and general body discomfort with great impairment in social life / activities and work efficiency/productivity. Dysmenorrhea [p=0.003] and family history of premenstrual syndrome [p <0.001] were significantly associated with premenstrual syndrome on univariate and multivariate analysis. Sf - 36 score on Mental Component Summary [MCS] and Physical Component Summary [PCS] were significantly lower in the affected group. Premenstrual syndrome is a common problem in young girls which adversely affects their educational performance and emotional well-being. Strategies should be adopted for detection and management of PMS in young girls