Distribution of birthweights of hospital born Pakistani infants.

OBJECTIVE: To determine the distribution of birthweights among newborns and its relationship to specific sociodemographic and medical factors. METHODS: All babies born after 24 weeks of gestation between November, 1994, and June, 1996 were included irrespective of the fact whether they were live or still borns. Infants having birth weights 2.5 to 4 kg were termed as normally weighed babies, under 2.5 kg as low birth weight and above 4 kg as macrosomics. Data gathered included sociodemographic and medical variables. Birthweights of the newborns were measured without clothes to the nearest 10 gm on an infants beam balance within 15-30 minutes of birth. The baby scale was calibrated daily for accuracy. RESULTS: Mean birth weight of the newborns was 2.91 kg. Weight of 78% babies ranged from 2.5 to 4 kg, 19% had low birth weight and 3% of neonates weighed above 4 kg. Of 1156 low birth weight babies 70% were preterm, 16% were growth retarded and 14% were both premature and growth retarded. Macrosomic babies were commonly born to the mothers who were either 35 years age or more or were para > 5, whereas 59% cases of low birth weight was associated with primipartiy and grandmultiparity. Causes of low birth weight included APH, twin pregnancy, PROM and severe preeclampsia and eclampsia. Risk factors for fetal macrosomia were advanced maternal age and parity, postdatism and diabetes mellitus. CONCLUSION: In this study the relative impact of some of the factors related to birthweight in reference to our population was highlighted. Further explorations preferably in population based studies are required as birthweight data is essential for monitoring and evaluating the progress towards achieving national goals for lowering neonatal and infant morbidities and mortalities.

Prevalence and determinants of caesarean section in a teaching hospital of Pakistan.

A retrospective analysis of 10 863 caesarean sections was carried out at a teaching hospital in Pakistan to examine the factors responsible for the high caesarean section rate. The caesarean section rate (CSR) during the study period (1985-1996) was 24.1/100 births and 78% of the caesareans were emergency procedures. The caesarean section rate was significantly higher among primigravida (27.26%) compared with 22.31% in multipara (P<0.01). Even for each indication, the frequency of caesarean section was higher among prinigravida (P<0.05). The three leading indications were dystocia (6.32%), repeat section (5.8%) and fetal distress (3.5%). Specific socio-demographic and child bearing patterns of our women, flaws in antenatal surveillance, ineffective working of the referral chain and departmental polices regarding management of cases with dystocia, Previous, abdominal delivery and fetal distress seem to be the major underlying causes of the high CSR.

Lecture as a mode of instruction in undergraduate medical education.

OBJECTIVE: This study was carried out to determine the place of lecture as a mode of instruction in undergraduate medical education by examining the views of the students about some selected aspects of the lecturing sessions and their ability to recall the varying percentages of the content of the delivered lecture after a specified period of time. METHODS: An observational cross sectional study was carried out in which the final year students of Fatima Jinnah Medical College for Women, Lahore belonging to sessions 1995-1996 and 1996-1997 participated. The study comprised of two parts; first was administration of a questionnaire containing the questions regarding students' opinions about the lectures attended, duration of lecturing sessions and comparison between lecture and clinical classes. The second part consisted of two surprise tests examining the ability of the students to recall the subject taught in a particular lecture after one week and one month intervals. RESULTS: According to 74% students lecturing sessions were not beneficial. Only 12% students remained attentive throughout the lecture their reason being ineffective and boring presentations and 55% participants wanted the existing duration of the lecture period to be halved. Clinical sessions were considered to be superior by 79% respondents. About 34% to 35% students could recall more than 50% of the content of the delivered lecture after one week and 20% were able to do so after one month. CONCLUSION: Consideration should be given to the feedback received and follow up studies should be carried out so that appropriate changes in the curriculum could be induced in order to ensure the effectiveness of the lecture and to avoid wastage of resources and time and to justify the place of lecture as a mode of instruction in undergraduate medical education.

Visual prognosis of macular involvement in peripheral retinal vascular malformations.

The visual prognosis in eyes with and without macular pathology, after treatment of the primary, peripheral retinal vascular malformation (PRVM) was studied. Seventeen patients (16 eyes) underwent treatment of the PRVM with laser/cryopexy. In 13/17 eyes (76.4%) associated macular pathology included, macular oedema and/or hard exudates (5 eyes), epiretinal membrane (2 eyes), exudative retinal detachment (3 eyes), vascular malformation in macula (2 eyes) and macular hole (1 eye). Initial visual acuity ranged from counting fingers 20/200. After treatment of the primary lesion, the visual acuity improved in five eyes, decreased in one eye and remained stable in 7 eyes. Of the four eyes without macular involvement, the vision improved after treatment in two eyes and remained stable in two eyes. We conclude that a variety of macular lesions can reduce central vision in eyes with PRVM. After treatment of only the primary lesion, the macular lesions also show changes. Visual acuity can improve or remain stable after treatment of the primary lesion. Rarely, the vision can decrease.

Complications attributed to illicit abortions.

A four year prospective study was carried out involving 83 cases of induced abortions, 72 were induced illegally and 11 were medically indicated, to determine the incidence and types of complications of illegally induced abortions as well as those of therapeutic ones. The prevalence of illegal abortion was 3.61% and that of therapeutic was 0.55%. In illegally induced group, age of 48 (66.66%) women ranged between 21-35 years, 34 (47.22%) were grand multiparas and 79% were illiterate. In 31 (43.25%) women, illegal abortions were carried out by TBAs and the most commonly used method was instrumentation employed in 46 (63.88%) of cases. The commonest complication detected was haemorrhage occurred in 31 (43.25%) patients, followed by sepsis in 24 (33.33%) and trauma in 13 (18%) cases. Indications of therapeutic abortions included maternal malignant diseases and fetal anomalies. Only one patient developed post abortal endometritis.

Awareness of health care personnel about preventive aspects of HIV infection/AIDS and their practices and attitudes concerning such patients.

The study was carried out at a tertiary care hospital in Lahore to assess the level of awareness of health care personnel regarding various preventive aspects of HIV/AIDS and determine their practices and attitudes while dealing with such patients. Study population consisted of 147 (55.68%) physicians, 82 (31.06%) nurses and 35 (13.26%) paramedics. Most of the participants had awareness regarding prevention of sexual transmission, however there were gaps in their knowledge as to how spread could be checked through the use of screened blood and sterilized syringes and instruments and perinatal transmission. One hundred and twenty three (46.5%) respondents were unaware of precautionary measures to be observed by health care providers while looking after these patients and 140 (53.03%) made improper responses when inquired about their responsibility and practices concerning HIV seropositive individuals and AIDS patients. As a result of misconceptions and ignorance, 108 (40.90%) participants' responses regarding their attitudes towards HIV/AIDS cases were incorrect and improper.

Justification of caesarean section for fetal distress.

A study was done from May 1995 to February 1996 to evaluate the justification of caesareans for fetal distress by examining the circumstances leading to operative delivery for compromised fetus. Of the 1096 caesareans, 179 (16.33%) were for fetal distress. One hundred and seven (59.78%) were nulliparas and 127 (71%) came with the clinical features of fetal hypoxia. In 142 (79%) parturients at the time of c-section, cervical dilatation varied from 0-3 cm and in 144 (80%) the presenting part remained unengaged. The method most commonly employed to diagnose fetal distress was the external cardiotocography, used in 141 (79%) patients either alone or in combination with other options. Predictivity value of the parameters used to identify the fetuses at jeopardy was found to be more sensitive when used in combination. Neonatal outcome related poorly with the preoperative diagnosis if only one parameter was used. Poorest neonatal outcome was observed in the presence of thick particulate meconium. Great care should be exercised by the obstetricians while making a decision for caesarean for fetal distress so as to avoid unnecessary procedures and neonatal complications.