Frequency of postnatal depression in a tertiary care hospital: A cross sectionalstudy

Background: Postnatal depression can affect health of among many mothers

Objective: To assess the frequency of depression among postnatal women in a tertiary care setting of Pakistan. Methodology: Study Design: Cross Sectional Study. Two hundred and fifty Postnatal women were recruited voluntarily through Gynecology and Obstetrics ward Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. A structured Proforma was prepared and later screened through 10-item Edinburgh Postnatal Depression Scale [EPDS]. The results were analyzed through SPSS version 21. Frequency of depression was presented as percentage

Results: The mean age of the postnatal recruited women was 27.5 years. It was noted that 75 [30%] of the Postnatal women were depressed; among Primigravida [28%] and Multigravida [30%] have depression. Poverty, lack of social support, female children only and birth of female child were enlisted as common among the risk factors

Conclusion: The study showed that one third the mothers have postnatal depression. Hence effective preventive strategy should be opted by the health care professionals for early detection and management. In addition to, awareness, de-stigmatization and vigilant measures should be taken in the community in order to prevent the distress

Frequency of common maternal complications following obstetric cholestasis

Background: Pregnant women may present with obstetric cholestasis

Objective: To determine the frequency of common maternal complications like gestational hypertension, pre-eclampsia and gestational diabetes in obstetric cholestasis

Methodology: Study Design: Cross sectional study. Setting: Department of Obstetrics and Gynecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Duration: Six months from 30th September 2014 to 29th March 2015. Seventy eight women admitted in the inpatient Department of Obstetrics and Gynecology ward, meeting the inclusion criteria were included. They were enrolled for study after taking informed consent. Women with obstetric cholestasis were followed till delivery and noted for any complications like gestational hypertension, preeclampsia or gestational diabetes mellitus. The outcome variables noted were; gestational hypertension, preeclampsia or gestational diabetes mellitus on specifically designed proforma along with demographic features of the patients. Data was analyzed by using SPSS version 17

Results: Mean age of the patients was 26+/-3 years, mean gestational age was 33+/-2 weeks, mean AST was 103+/-31 U/L, Mean ALT was 110.71+/-35.74 U/L and mean GGT was 84.81+/-17.59 U/L. Gestational hypertension was the most common complication 29 [65.9%] in patients presented with intrahepatic cholestasis of pregnancy. Gestational diabetes was present in 7[15.39%] patients while pre-eclampsia was noted in 8 [18.2%] patients having intrahepatic cholestasis of pregnancy

Conclusion: Gestational hypertension was the most common complication in patients presented with intrahepatic cholestasis of pregnancy, followed by pre eclampsia and gestational diabetes

Obstetric and neonatal outcomes of pregnant indian pilgrims

Objectives: The Hajj, an annual mass gathering of Muslim pilgrims, is known for its high morbidity and mortality rates. However, pregnant women sometimes participate in this pilgrimage, despite guidelines that discourage such an undertaking due to potential fetomaternal complications. This study aimed to evaluate fetomaternal outcomes among pregnant Indian Hajj pilgrims

Methods: This prospective cross-sectional study was conducted at two Indian Hajj Medical Mission [IHMM]-affiliated secondary care hospitals in Saudi Arabia during the Hajj periods of August–October 2015 and 2016 and July-September 2017. All female Indian pilgrims of reproductive age who underwent pregnancy screening at secondary care IHMM hospitals during this period were included in the study. Definitive obstetric care was provided at the Makkah Maternity and Child Hospital. Data regarding the pilgrims' obstetric characteristics, antenatal complications, management and fetomaternal outcomes were evaluated

Results: A total of 114 pregnant Indian pilgrims were identified during the study period. The most common antenatal complications were respiratory tract infections [51.75%], followed by iron deficiency anaemia [17.54%], hyperemesis gravidarum [14.04%], hypothyroidism [9.65%] and gestational diabetes mellitus [5.26%]. There were 20 vaginal deliveries [17.54%], two Caesarean sections [1.75%] and 32 abortions [28.07%]. The cumulative three-year birth rate was 24.60 per 1,000 females

Conclusion: During Hajj, pregnant pilgrims have a high risk of abortion, respiratory tract infections and various antenatal, perinatal and neonatal complications which may go unreported or untreated. Women should therefore be educated regarding the risk of adverse fetomaternal outcomes which may occur while undertaking a Hajj pilgrimage during pregnancy

Neovaginoplasty in congenitally absent vagina with bilateral pudendal thigh fasciocutaneous flaps

Background: Vaginal agenesis repair technique expensive and demanding in terms of expertise

Objective: To evaluate functional and aesthetic outcome of vaginal reconstruction using pudendal-thigh fasciocutaneous flaps

Methodology: Our case series was conducted at departments of plastic surgery and Obstetrics and Gynecology, Sheikh Zayed Hospital, Rahim Yar Khan from 1[st] September 2012 to 31[st] August 2015. Vaginal reconstruction was done with bilateral island pudendal thigh flaps in 08 consecutive female patients with congenital absence of vagina. Each flap was raised just lateral to labia majora and then after passing under the labia majora both flaps were sutured together to form a neovaginal tube. This neovaginal tube was then inserted into a newly created space between the rectum and bladder

Results: Out of 8, three patients [37.5%] were diagnosed with Mayer Rokitansky Kauser Hauser Syndrome and 5 [62.5%] with isolated vaginal atresia. One patient [12.5%] developed necrosis of distal part of a unilateral flap followed by severe infection that was managed conservatively. The same patient also developed excessive hair growth in the neovagina. In rest of the seven patients all the flaps survived comletely and the neovaginal length and width was adequate. The mean vaginal length was 9.5 cm and width was 3.8 cm one year post operatively

Conclusion: Neovaginoplasty using bilateral islanded pudendal-thigh flaps is suggested as one of the best methods of vaginoplasty. This technique is very simple and reliable and has shown satisfactory functional and cosmetic results. The neovagina was sensate and has a natural angle for intercourse. No postoperative stenting or dilatation was required. The donor site was closed primarily and the resulting scar was in the groin crease with little secondary deformity

comparison between vaginal + oral misoprostol and sublingual misoprostol in second trimester termination of pregnancy

Objectives: Misoprostol is a drug indicated in situations where missed abortion and congenital malformed fetuses are detected. This drug is used in various ways, vaginal + oral and sublingual routes. This study was conducted in an attempt to compare the efficacy and adverse effects of two misoprostol regimens used for second trimester termination of pregnancy

Methods: This study was carried out in Obstetrics and Gynecology Department in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2006 to May 2007. Atotal number of 50 patients were included who required medical termination of pregnancy between 14-26 wks of gestation due to different reasons. Two groups were made and misoprostol was given to Group A through vaginal and oral route whereas Group B received misoprostol through sublingual route. Main outcome measures included induction-abortion interval, adverse effects and success of medicine in the form of complete or incomplete expulsion

Results:There was significant difference in induction-abortion interval between two groups. Group A had expulsion in an average of 14 hours, whereas Group B in average of 21.35 hours. Maternal side effects were markedly reduced in vaginal and oral misoprostol [Group A] as compared to Group B. Complete expulsion occurred in 84% patients in Group A and 76% in Group B

Conclusion: Vaginal and oral route of misoprostol was more effective in terms of induction-abortion interval, maternal side effects and complete expulsion requiring no surgical intervention

Copper-t presenting as vesical calculus

Intrauterine contraceptive devices [IUCD], in various forms have been in use since the time immemorial. Perforation of the uterus and migration of IUCD to adjacent structures is not an unusual occurrence but their intra vesical migration with secondary stone formation is a unique complication. We present an interesting case of a 3 5 years old lady who met with this complication. This lady had intrauterine contraceptive device [Copper-T] placement 9 years back and a few days earlier presented to us with lower urinary tract symptoms. She underwent ultra-sonographic scan and stone bladder was detected as the cause of her symptoms. Open cystolithotomy was performed and a T-shaped vesical calculus retrieved

Oral contraceptives, pill; myths and the truth

Objective of Study: To assess the efficacy, safety popular believes, regarding oral contraceptives in general public and their validity in the face of medical evidence. Design: A cross-sectional and observational study. The sample consisted of 328 sexually active women using Combined Oral Contraceptives [COC] as mode of contraception. These women were interviewed according to a questionnaire, seeking information about the age, parity, education, social status and age at which first COC was taken. In women who ever used COCs, information was obtained regarding the duration, preparation, side-effects and their believes regarding COC

Setting: Department of Obstetrics and Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore. Period: November, 2003- June, 2004

Material and Methods: Women presenting in OPD and wards

Results: 17% women were taking oral contraceptive pills as mode of contraception. 78% believed that pill causes weight gain. 67% thought that women need a break while taking the pill. 42% considered pills as effective acne treatment and 62% thought that COCs affect fertility. 55% women believed that pills reduce sexual performance. 75% thought that pill causes breast cancer while 58% had no knowledge about non-contraceptive benefits of the pill. 80% had no information that pill can protect from ovarian cancer

Conclusions: Despite myths, pill is still widely used worldwide. There are some women who will not consider the pill because of the myths they have heard. It is very important for women to be educated about the birth control pill so that they are able to base their contraceptive decisions on facts and not on myths and misinformation