Feedforward interview technique in obstetrics and gynaecology residents: a fact or fallacy.

OBJECTIVE: To determine the role of Feedforward Interview (FFI) technique in motivating residents of Obstetrics and Gynaecology for better learning and performance. STUDY DESIGN: An explorative study with mixed method approach being employed. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Sandeman (Provincial) Hospital, Quetta, from November 2010 till May 2013. METHODOLOGY: Feedforward interview technique was complimented by survey questionnaire employing similar philosophy of FFI to triangulate data through two methods. Survey questionnaire was filled-up by 21 residents and analysed by SPSS version 17. Fourteen of these participants were identified for in-depth Feedforward Interviews (FFI), based on nonprobability purposive sampling after informed consent, and content analysis was done. RESULTS: Feedforward interview technique enabled majority of residents in recalling minimum of 3 positive experiences, mainly related to surgical experiences, which enhanced their motivation to aspire for further improvement in this area. Hard work was the main personal contributing factor both in FFI and survey. In addition to identifying clinical experiences enhancing desire to learn, residents also reported need for more academic support as an important factor which could also boost motivation to attain better performance. CONCLUSION: Feedforward interview technique not only helps residents in recalling positive learning experiences during their training but it also has a significant influence on developing insight about one's performance and motivating residents to achieve higher academic goals.

Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan.

Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.

Prevalence of hepatitis B and C: a Jinnah Postgraduate Medical Centre experience.

AIM: To determine the prevalence of carriers of hepatitis B and C viruses among the obstetrical and gynecological population, the incidence of vertical transmission in obstetrical patients and to ascertain the risk factors associated with their transmission. METHODS: We conducted a prospective study over a 1-year period, from 1 January to 31 December 2005, comprising of an obstetrical population of 5902 deliveries and 548 major gynecology surgery patients. The study population was recruited by simple convenient sampling at Unit-I, Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Booked obstetrical and major gynecological surgical patients were routinely screened by Enzyme Immunoassay for hepatitis B surface antigen (HbsAg) and anti-hepatitis C antibodies (anti-HCV) on venous blood samples. Liver function and carrier profile tests were performed on mothers who were positive for HBsAg. Babies of mothers with HbsAg were tested at birth for both HbsAg and HbeAg. RESULTS: Hepatitis B was detected in 275 pregnant women (4.6%) and in 70 (12%) gynecological patients. Hepatitis C was detected in 108 (1.8%) pregnant women and in 89 (16%) gynecological patients. Babies born to mothers with HBV or HCV infections tested negative. Four gynecological patients tested positive for both HBV and HCV infections. Unsafe surgery, injections and inadequately screened blood transfusions were the main underlying causes of infection. CONCLUSION: Routine screening of the obstetrical population detected more cases of HBV infection than HCV, whereas HCV was more prevalent in the gynecological population, emphasizing the need for safe medical practices and patient education.

Vaginitis and sexually transmitted infections in a hospital based study.

OBJECTIVE: To determine the frequency of Sexually transmitted infections (STIs) in immigrant population versus the local population, comparing the symptomatic patients against the asymptomatic women as controls. METHODS: A cross-sectional comparative study was conducted in Gynaecology Clinic of Unit 1, Bolan Medical Complex Hospital, Quetta. The study duration was six months from 1st April, 2004 to 31st October, 2004, examining 500 women. World Health Organization (WHO) recommended questionnaire was answered and High Vaginal Swab (HVS) was taken from posterior fornix of patient's vagina. Gram staining was done by the Pathology Department of the same hospital and description was based on Nugent's score and modified Spiegel's criteria. Blood was analyzed for human immunodeficiency virus (HIV) and hepatitis-B surface antigen (HBsAg) by immunochromatography. Analysis of results was done by Chi square test, screening test validity and incidence testing. RESULTS: Women with vaginal discharge had higher incidence of STI (84%) than without it (38%). Refugees and women with grand multiparity made the high risk groups of targeted testing (P < 0.001). The commonest notifiable infections, in this study were vaginitis (33.48%), bacterial vaginosis (30.7%), candidiasis (10%), trichomoniasis (7.2%), gonorrhea (1.35%) and 1 case each of lymphogranuloma venereum and chancroid, and 3 carrier states of HbsAg were detected. No case of syphilis or HIV/AIDS, or genital herpes was found. CONCLUSION: This study will serve as a marker for the tip of an iceberg of STI in Balochistan, needing targeted testing in high risk groups.

Perinatal mortality rate in relation to gender.

OBJECTIVE: To calculate the gross and gender adjusted perinatal mortality rate (PMR) and determine the association between gender and susceptibility towards perinatal death. DESIGN: A cross-sectional hospital-based study conducted at Gynae Unit-I of Bolan Medical Complex Hospital, Quetta from 1st January to 31st December, 2002. PATIENTS AND METHODS: The study included the total births and perinatal deaths over one year period. The cause of death was ascertained through specifically-designed questionnaires and external autopsy. PMR was defined as the number of fetal deaths from 28 weeks of gestations to early neonatal deaths within 7 days after birth. Birth weight of >1000 grams or 35 cms crown-heel length was considered in lieu of unknown gestational age. Multiple pregnancies and stillbirths occurring at home were excluded. Extended Wiggles Worth classification was used to study the etiology of perinatal death separately. RESULTS: The PMR was calculated to be 113 per 1000 births. Stillbirth rate was 103 per 1000 total births; out of these, 56.5% were intrapartum and 43.3% antepartum. Male stillbirths were 89.24% in intrapartum and 62.5% in antepartum (df=1,X2=16, p < 0.001). Out of 16 early neonatal deaths, 11 were male infants. Aberdeen classification revealed obstetric causes of PMR as antepartum haemorrhage (34 cases;76% males), malpresentations (28 cases; 57% males), and congenital anomalies (26 cases; 80% males), after adjusting for maternal age and parity. CONCLUSION: This study shows fetal gender as statistically significant risk factor and it will pave the way for future community-based studies to confirm such an association, after adjusting for other co-variables.