Perinatal mortality; a review at department of obstetric

To evaluate the determinants of neonatal mortality. DESIGN: Prospective hospital based study. SETTING: Department of Obstetrics and Gynaecology Allied Hospital [P.M.C], Faisalabad. PERIOD: Jan 1994 to April 1995. MATERIAL AND METHODS: Total number of births during Jan 1994 to April 1995 were included in the study which was 4230. A perinatal mortality rate of4l.80/100 birth was noted, with a still birth rate of 22.22/1000 births. Perinatal mortality rate was much higher in children born to uneducated parents. Patients having antenatal care had lesser number of perinatal deaths as compared to the ones who had no antenatal care. Education of parent good nutrition for the mother and antenatal care can reduce perinatal mortality remarkably

Management of eclampsia; 7 year study in Faisalabad

OBJECTIVE: 1. To evaluate various factors responsible for the disease. 2. Effectiveness of mother and child health activities and outcome of the management. DESIGN: Prospective study. PERIOD: [January 1989-Dec 1995. SETTING: Department of Obstetrics and Gynaecology Allied Hospital Faisalabad. PATIENTS AND METHODS: Out of 16952 total births, 249 patients had eclampsia and were managed according to the set protocol. The incidence of eclampsia was 1.4% and matena1 mortality was 13.6%. Eclamptic patients from rural area were 66.5% and that of urban area was 33.7%, 54% patients were primigravida and 46% were multigravidas. The percentage of ante, Intra and postpartum eclampsia were 56, 57, and 12 respectively. 45% patients had abdominal delivery, 30% had forceps delivery, 11% delivered at home, 8% had vaginal delivery in hospital and 6% expired undelivered. Community education programme created awareness about the importance of antenatal check up which led to early detection and treatment of pre-eclampsia thereby preventing development of eclampsia. Special programme of training the traditioinal birth attendants [TBA] to recoginized pre-eclampsia in early stage and to refer the patient to the hospital, and availability of reliable transport to bring the patient from periphery or patient's home to the hospital where prompt treatment be started by the experienced staff would certainly decrease the incidence of eclampsia and its adverse outcome

Non surgical female sterilization

Non surgical sterilization was performed on 2100 women in Faisalabad by a single insertion of 7 pellets [250 mg] of quinacrine hydrochloride through intrauterint contraceptive device [IUCD] inserter. During one year follow-up, only 9 pregnancies [1.34%] were recorded. No serious complications or side-effects were reported. Although the study is of short duration and of limited follow up, yet it clearly shows that quinacrine tubal occlusion is a highly acceptable [84%], effective [98.6%], and inexpensive method of contraception, which has very few side effects [6.85%] and negligible chances of ectopic pregnancy

Effectiveness of obstetric flying squad in Faisalabad city

Obstetric flying squad can play an important role in decreasing maternal and foetal morbidity and mortality in developing countries. Faisalabad obstetric flying squad service was started on 16th March 1988 but no call was received for a period of 9 months. Intensive community education through street camps proved to be very effective in introducing the squad as the first call came on 15th January 1989 from the area where street camp was held in the morning. In a period of one year [15th January 1989 to 15th January 1990] 73 calls have been received by traveling 1715 kilometers within the municipal limits. Most of the calls were for obstructed labour, postpartum haemorrhage and antepartum haemorrhage. The flying squad was mainly summoned by patient's attendants, LHVs and TBAs. No patient was found dead when flying squad reached and all patients except 2 were discharged from the hospital in satisfactory condition. Some problems were faced in smooth running of the service due to illiteracy and non co-operation of the patients or their relatives. The maternal mortality of Faisalabad is reduced to 0.86/1000 in Faisalabad city in year 1989 compared to 1.86/1000 in 1987 [2]. In addition to other factors. [TBA training/refresher courses, community education, free services in hospital and home death delivery survey] flying squad is the major contributing factor for reduction of maternal mortality

Maternal mortality 1990: results from a Survey of faisalabad metropolitan

An analysis of 55 maternal deaths which took place in 1990 in Faisalabad city presented. These deaths included 25 [45%] in teaching hospitals, 11 [20.0%] homes and 19 [23.6%] at various private clinics/hospitals. All these deaths we surveyed using a questionnaire filled by a doctor with the help of TBAs, LHVs or doctors who were present at the time of delivery. The study reflects that TBA training/refresher courses, intensive community education, antenatal check up in local areas, free services in hospitals and obstetric flying squad services have played a major role in reducing maternal mortality. Maternal mortality was found to be 0.94 per thousand live births

Cervical carcinoma in 26 years old primigravida

A case of 26 years old primigravida with cervical carcinoma is presented. Carcinoma cervix was diagnosed at 25th week but the pregnancy was allowed to proceed to 32 weeks, when the child was delivered by caesarian section. Wertheim hysterectomy was performed later on. Incidence and prognosis of diseases is discussed

study of socio-economic factors affecting mother and child health in Faisalabad city

This study investigates the socio-economic factors affecting mother and child health in Faisalabad city. One of the neglected colonies i.e., Gulzar Colony, was selected for data collection. Over all 993 married females were interviewed after a door to door survey. It was found in the present study that literacy level had a strong relationship both with mother vaccination and infant vaccination. Females, whose husbands were educated and whose annual income was high, had higher percentage of vaccination of themselves and their babies. As far as occupation of mother was concerned, it did not prove to be a good indicator

Exclusive breast feeding and its impact on establishment of lactation

The practice of exclusive breast feeding commenced immediately after delivery was studied in 600 cases of our ward. Patients from different age groups, parity and delivered by different modes were selected for the trial. It was found that the pregnant ladies who were well informed about the hazards of traditional infant feeding, [including mixed or partial bottle feeding] care of breast and preparation of nipple during their antenatal classes, preferred the practice of exclusive breast feeding. Results were very hopeful and 90% of patients were discharged from the ward with established lactation. Follow up revealed that 258 [43%] women were breast feeding at the end of 6 months, 198 [33%] at the end of 4 months, 90 [15%] at the end of 3 months and 54 [9%] at the end of 2 months, and 54 [9%] at the end of 2 months

Repair of vesico-vaginal fistula absorbable versus non absorbable suture

In the repair of Vesico-Vaginal fistula absorbable and non-absorbable suture material has been compared in 38 cases after random selection during 3 year period ending January, 1988. Absorbable suture [catgut 00] was used in 19 cases and non-absorbable suture [prolene 00] in other 19 cases; all other factors being identical in both the groups. There were four failures in the first group [success rate 78%] and one failure in the second group [success rate 95%]. The purpose of the study was to establish the effectiveness of non-absorbable suture material in VVF repair due to the fact that it causes less tissue reaction and better wound healing. There have been no comparable studies

Faisalabad flying squad service

Faisalabad Flying Squad Service was started to reduce maternal/foetal mortality and morbidity. Flying Squad answered its first call on 15-01-1989 for antepartum haemorrhage and since then has travelled 157 k.m. attending to 11 calls for help. Since its inception, no call has gone unanswered. There have been 4 calls for APH, 4 for PPH, one call premature labour and one call for retained placenta. Most of the calls came in the evening and help was asked by Traditional Birth Attendents [TBAs] Lady Health Visitors [LHVs]. No patient was dead at the time of arrival and all tits were discharged from hospital in satisfactory condition. Out of 10 cases, one patient of haemorrhage was so collapsed that venesection was done at home for initial resuscitation. She was treated for acute cortical necrosis with peritoneal dialysis and survived

TBA training and maternal mortality in Faisalabad district

Unlike sexually transmmitted diseases, psychosexual disorders are common in Pakistan. An analysis of symptoms, beliefs and sexual inclivations of 190 patients, who presented with psychosexual disorders, is presented. Multiple symptoms were commonly reported but lack of erection [28.9%] and lack of sexual [26%] were the most frequent symptoms. Twenty patients [10.5%] attended the hospital before marriage for fear of being impotent and eight patients [4.2%] reported inability of intromissiorz during the first week of marriage. Masturbation and seminal discharge in urine were blamed as main causes for most psychosexual disorders by 42.1% and 27% patients respectively. Feeling of guilt for mastubation was significant and complete ignorence of sex education existed. Hantostauably was practiced by only 2.6% of the patients and was considered to be the - heterosexual relations by 1% of the cases. Simple psychotherapy was extremely useful. Nuxvonica Yohimbine and testosterone was not found to be useful therapeutic agents

Last home delivery death of 1988 in Faisalabad city

A case of last home delivery death of 1988 in Faisalabad city is described. A 20 years old full-term pregnant women into labour at home on December 29, 1988. She was attended by a Traditional Birth Attendent [TBA] and expired on 30.12.1988, during child birth. A retrospective survey confirmed the inability of TBA to refer the high risk women to hospital in time. Moreover, the family members of poor woman were reluctant for her confinement to hospital because of the inconveniences experienced by them due to the behaviour of hospital staff during her last child birth

Day case vaginal pomeroy tubectomy: a simplified technique

The experience of vaginal tubectomy in 5214 cases over a period of 6 years is presented. Complications and failure rates following vaginal tubectomy were minimal. The main advantage over abdominal tubectomy were a relatively short operation [under local anaesthesia and analgesia] no hospitalization, minimal post operative complications and discomforts with no abdominal scars