Postpartum contraception utilization and its impact on inter pregnancy interval among mothers accessing maternity services in the public sector hospital of Hyderabad Sindh.

OBJECTIVE: To find out the particulars regarding contraceptive practices in the postpartum period and to see its impact on prolonging interpregnancy interval (IPI). METHODS: A cross sectional observational study was conducted in the Department of Obstetrics & Gynecology Unit 3, Liaquat University Hospital Hyderabad from 1st July to 31st December 2018. Out of 2100 total deliveries, 398 postpartum women with second or higher order births were included. Pregnant women, primiparas and those who were not willing to participate were excluded. They were interviewed face to face by principal investigator and her team members and required information was collected on predesigned Performa. Outcome variable was interpregnancy interval in months. Chi-square test was used to see association. RESULTS: Postpartum contraception utilization (PPC) was 24.6%(n=398). Most of the women choose condoms as contraceptive method (n=41, 10.3%) followed by oral contraceptive pills (n=18, 4.5%) and intra uterine contraceptive device (n=16,4%). Method related issues were the chief reasons for discontinuation while desire to have another child soon and spouse/family disapproval were among the reasons mentioned largely by non-utilizers of modern methods of family planning. The average interpregnancy interval was 16.4±1.45. Significant association was observed between interpregnancy interval and postpartum contraception use, particularly in the users of long acting reversible contraceptive methods (P-Value 0.0001). CONCLUSION: Uptake and continuation of modern methods of contraception was low after last birth culminating in short interpregnancy interval. Optimal IPI was observed in those utilizing modern methods of family planning, with marked effect in users of long acting reversible contraceptive methods.

A heartrending burden of gynaecological cancers in advance stage at nuclear institute of medicine and radiotherapy Jamshoro Sindh.

OBJECTIVES: In Pakistan gynaecological cancers are among the leading causes of women's morbidity and mortality posing huge financial burden on families, communities and state. Due to lack of national cancer registry exact facts and figures are unknown therefore this study was planned to find out prevalence, age, site and stage of presentation of gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy (NIMRA), Jamshoro. METHODS: A retrospective, cross sectional study was conducted from 1(st) January 2011 to 31(st) December 2011 at NIMRA Jamshoro. All cases of genital tract cancers were evaluated, required data was entered on predesigned performa and results were analyzed manually. RESULTS: Out of 2401 total registered cancer cases, 231 (9.6%) patients were suffering from gynaecological cancer making it third most common cancer. Ovary was commonest site followed by cervix and uterus. More than 60% cases presented in advanced stage, mostly during 4(th) and 5(th) decade of life. CONCLUSION: Gynecological cancer was among top three cancers at one of the busiest public sector cancer institute in Sindh province and significant number presented in advance stage making treatment difficult and expensive. There is urgent need for development and implementation of an effective health policy regarding cancer prevention and treatment.

Adverse fetomaternal outcome among pregnant overweight women.

OBJECTIVE: To compare the adverse fetometernal out come in overweight and normal weight pregnant women. METHODS: This comparative cohort study was conducted from 1(st) October 2010 to 30 September 2012. Total 200 gravid women 100 were overweight and 100 normal weight pregnant women with gestational age for 08-40 weeks were included. Women having BMI (25 - 29.9 Kg/m(2)) were measured overweight and included in group A and 100 women having normal BMI of 18.5 to 24.9 as controls were in-group B. Chi-square test was applied to compare the proportion of maternal and fetal outcomes. Significant P - value of < 0.05 was considered. RESULTS: The age range was between 30 to 45 years with mean age of 30±4.1 years in both groups. Overweight pregnant women had significantly high frequency of pre-eclampsia (27% versus 9% in controls), PIH (24% versus 8% in controls), gestational diabetes mellitus (22% versus 5% in controls), prolonged labour (4% versus 6% in controls), Caesarean section (44% versus 16% in controls), Wound infection (3% versus 2% in controls) and Postpartum Hemorrhage (5% versus 2% in controls). P-value < 0.001 was considered significance. Fetal complications in overweight pregnant women compared to controls i.e. Still birth (13% versus 2%), Early neonatal death (11% versus 1%), shoulder dystocia (5% versus 1%) and NICU admission (47% versus 10%). Results were statistically significant except shoulder dystocia. CONCLUSION: We conclude that the result of present study indicates obesity exerts deleterious effect, both on fetal and maternal outcome.

Prevalenceinstigating factors and help seeking behavior of physical domestic violence among married women of HyderabadSindh.

UNLABELLED: Background and Objectives : Domestic violence against women is highly prevalent but under reported issue having social, legal, health and economic implications. It needs to be identified and addressed in order to decrease the sufferings of women. Our objective was to find out prevalence, instigating factors and help seeking behavior of physical domestic violence against married women. METHODS: A total of 378 married women who were attending Department of Obstetrics & Gynaecology, Liaquat University Hospital from January 1, 2013 to March 31, 2013 for different obstetrical & gynaecological problems were randomly selected and interviewed. After informed consent, required information was collected on predesigned performa including demographic details, prevalence, instigating factors, help seeking behavior for physical domestic violence. RESULTS: About 31% (120) of women reported lifetime physical domestic violence. Husbands and in-laws were perpetrators in 70% (84) and 30% (36) cases respectively. Wives being disobedient and making arguments were the most common instigating factors for violence followed by husband's drug addiction, extra marital relationship and infertility. It was severe enough to require medical care in 24% (29) cases. Only 2% (2) women sought social and legal aid. CONCLUSION: Domestic violence was quite common among married women, however help seeking was minimal. There is need to identify and address this menace effectively.

Seroprevalence and risk factors for hepatitis C virus (HCV) infection in pregnant women attending public sector tertiary care hospital in Hyderabad Sindh.

BACKGROUND AND OBJECTIVES: Pakistan is among the countries having high prevalence of HCV infection in the population but there is dearth of proper epidemiological data regarding acquisition of HCV infection in the pregnant population. Our objective was to determine the seroprevalence of HCV antibodies in healthy pregnant women and to assess the potential risk factors for HCV infection in HCV positive subjects and in the control group. METHODOLOGY: This cross sectional and comparative study was conducted from 1(st) January to 31(st) December 2010 in the Department of Obstetrics/Gynaecology Unit-I, Liaquat University Hospital Hyderabad. Sera were collected from all admitted pregnant women and tested for HCV anti bodies using Elisa kits (Abbott, USA). Data were analyzed using SPSS version 16.0 statistical package. RESULTS: The seroprevalence of HCV among pregnant population was found to be 4.7%. HCV positive women were more likely to have a history of blood transfusion (OR 1.99, 95% CI 1.26- 3.12), History of therapeutic injection use (OR 2.46, 95% CI 1.43-4.26), history of surgery (OR 1.72, 95% CI 1.12-2.66) and history of sharing household products (OR 1.81, 95% CI 1.14-2.87). CONCLUSION: HCV seropositive pregnant women were more likely to have a history of blood transfusion, therapeutic injection use, surgery and sharing household items.

Impact of Training on General Practitioner's Knowledge, Attitude and Practices Regarding Emergency Contraception in Hyderabad.

OBJECTIVES: To elaborate the impact of family planning training on general practitioners' knowledge, attitude and practices regarding emergency contraception. METHODS: A cross sectional survey involving 270 general practitioners was conducted in Hyderabad from 1(st) Oct to 31(st) Dec 2010. Participants were divided into two groups on the basis of attending family planning training course after graduation and were interviewed face to face. Data was noted on questionnaire asking their knowledge, attitude and practices regarding emergency contraception. Data was analyzed on SPSS version 11. Student t-test was applied to compare the proportions among two groups. RESULTS: Out of 270 general practitioners, male & female participants were 132 (48.9%) and 138 (51.1%) respectively. Mean experience as private general practitioner was 7.48 + 7.6 years. One third of the participants 84 (31.1%) have attended five days training course on family planning in the past, while 186 (69.9%) did not have any training. Source of training was government institutes 46(17%) and non government organization in 38 (14.1%) cases. Significant positive difference was noted on emergency contraception knowledge, attitude and use in group who attended family planning training. CONCLUSION: Educational intervention has a positive impact on health care provider's knowledge, attitude and practices of emergency contraception.

Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary Hospital care.

BACKGROUND: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. OBJECTIVE: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. MATERIALS AND METHODS: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. RESULTS: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%. CONCLUSION: PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high.

To compare the outcome (early) of neonates with birth asphyxia in-relation to place of delivery and age at time of admission.

OBJECTIVE: To determine the frequency of birth asphyxia and short-term (early) outcome in relation to age at admission and place of delivery. METHODS: A descriptive cross-sectional study was conducted in the Paediatric Department, Neonatal Ward of Liaquat University Hospital (LUH) Hyderabad from January to December 2009. All babies were received at our nursery or delivered in LUH with birth asphyxia were included, while babies having major congenital abnormalities, with birth weight < 1800 gm or preterm were excluded. After consent and enrollment their detailed history including peri-natal history, Apgar score, resuscitation measures, problems and outcome were recorded on a pre-designed study proforma. Short-term outcome was measured after 7 hours as clinically improved, developed neurological disability (Hypoxic Ischaemic Encephalopathy stage II or III) or death. RESULTS: The frequency was (n = 600; 25%) of LUMHS born and (n = 310; 61.63%) were received within 6 hours, (n = 272 45% were LUMHS born and n = 7 7% were out born), (n = 37; 38.95%) within 24 hours and (n = 9; 10.3%) after 24 hours. On initial neurological evaluation (n = 90; 15%) were normal while clinical signs of HIE were present in 85%, with (n = 180; 30%) in stage I, (n = 210; 35%) in Stage II and (n = 120; 20%) in stage III of HIE. Outcome was measured after 72 hours, around 53.3% (320) were normal, 31.6% (190) developed neurological disability, while 15% (90) babies expired. Outcome was better in Liaquat University of Medical Health Sciences (LUMHS) born than out-born with statistically significant difference in terms of disability (Chi-square test P-value < 0.0001) but no difference was noted in terms of disability to death. There was a statistically improved outcome for babies received within 6 hours than those after 6 hours of birth (Chi-square test P-value < 0.0255). CONCLUSION: Early recognition of birth asphyxia and timely referral to tertiary center can reduce morbidity and mortality.

Effect of preoperative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity.

OBJECTIVE: To determine the effectiveness of pre operative vaginal cleansing with an antiseptic solution to reduce post caesarean infectious morbidity. METHODS: An observational case control study was conducted at Department of Obstetrics and Gynaecology, Unit-III, Liaquat University Hospital, Hyderabad from February to July 2010. The 100 women in control group received the standard abdominal preparation only, while the 100 subjects in interventional group also received preoperative vaginal cleansing with 10% pyodine along with the usual abdominal scrub. All subjects received prophylactic antibiotic cover during the surgery. Maternal demographics, surgical parameters and infectious outcome were collected and data compiled on a pre-designed proforma and analysis was done using SPSS 15. RESULTS: The comparison between two groups did not show a significant difference in patient's demographics, labour and surgical variables. Post caesarean endometritis occurred in 1% of case group and 7% of controls (p value: <0.03). There was no measurable effect seen on development of fever and wound infection However, statistically significant reduction in overall composite morbidity i.e. p value: <0.02 and odds ratio 0.335 (CI=0.125-0.896) was seen in patients with vaginal cleansing group when compared with controls. CONCLUSION: Preoperative vaginal cleansing with pyodine has reduced post caesarean infectious morbidities.

Acute abdomen secondary to torsion of Krukenberg tumour.

Krukenberg tumour is a rare clinical entity. We report an unusual case of acute abdomen due to right sided adnexal torsion in a 23 year old nulliparous girl with bilateral Krukenberg tumour and primary gastric carcinoma. Possibility of Krukenberg tumour should always be kept in mind while managing ovarian tumours.

Hyperhomocysteinaemia, vascular related pregnancy complications and the response to vitamin supplementation in pregnant women of Pakistan.

OBJECTIVES: To elaborate the relationship between serum homocysteine (hcy) levels and vascular related pregnancy complications in pregnant women as well as to assess the homocysteine lowering effects of folate, vitamin 812 and 86. The secondary objectives were to establish a link between serum homocysteine levels and maternal age, parity, gestational age, foetal birth weight, mean arterial pressure and albuminuria. METHODS: A total of 332 pregnant women (gestational age: >24 weeks) attending Liaquat University Hospital Hyderabad, Pakistan, were enrolled. Of these 112 were healthy normal pregnant women; 61 pregnant women had pre-eclampsia, 49 with eclampsia and 110 with placental abruption. A cohort of 30 patients with elevated hcy levels (>8.2 micromol/liter), were given folate, vitamin B12 and B6 as supplements for 6 weeks. Fasting blood samples were collected, centrifuged and stored at 2 to 8 degrees C. Hcy levels were determined by IMx immunoassay. RESULTS: Higher serum hcy levels, higher mean arterial blood pressure (MAP), pre-term deliveries and low foetal birth weights were noted in women with pregnancies complicated by pre-eclampsia and eclampsia as compared to control and those with placental abruption. Significant hcy lowering effects of folate, vitamin 812 and B6 supplementation were observed. Significant and positive correlation was found between hhcy and MAP (r = 0.001; p < 0.001), albuminuria (r = 0.004; p < 0.01) and low birth weights (r = 0.05; p < 0.06). CONCLUSION: Higher hcy levels in pregnancies complicated by pre-eclampsia and eclampsia have been noted. Data support the hypothesis that folate, vitamin 812 and B6 lower hcy levels in hyperhomocysteinaemic women.

Risk factors and clinical outcome of placental abruption: a retrospective analysis.

OBJECTIVE: To determine frequency, obstetrical risk factors and the subsequent feto-maternal outcome in women suffering from placental abruption. METHODS: A retrospective case series study was carried out in the Department of Obstetrics and Gynaecology Unit One, Liaquat University Hospital Hyderabad, Pakistan from 1st January 2006 to 31st December 2006. All women with the diagnosis of placental abruption having more than 24 weeks gestation were included in the study. RESULTS: Of the 2224 delivered women 106 (4.7%) had placental abruption. All of the 106 women were unbooked, with 67 (63%) in the age group 20-35 years, 68 (64%) belonged to rural areas. 98 (92%) patients were multiparous and 57 (54%) were preterm. The commonest medical disorders observed were anaemia in 84 (79%), Diabetes Mellitus in 8 (8%) and gestational hypertension in 8 (8%) patients. There were five maternal deaths, showing case fatality rate of 5%. The foetal prognosis was characterized by low birth weight seen in 74 (70%), low apgar score in 30 (28%) and high still birth rate in 54 (51%), constituting perinatal mortality rate of 25.62/1000 deliveries. CONCLUSION: Abruptio placentae is associated with adverse maternal and foetal outcome. Multiparity, un-booked status, rural residence and maternal anaemia are important risk factors.

Contraceptive knowledge and practices in two districts of Sindh, Pakistan: a hospital based study.

OBJECTIVE: To assess contraceptive knowledge, practices, availability and accessibility of family planning services and reasons for non-utilization of family planning services in interior of Sindh province, Pakistan. METHODS: A hospital based cross-sectional survey was conducted in 2003. In person interviews were carried out with attendees of Gynaecology and Obstetrics out patient clinics of two districts hospitals in Tando Allahyar and Jamshoro. Data was collected regarding socio-demographic features, reproductive profile, availability and accessibility of family planning services and reasons for non-use of contraception. RESULTS: Current contraceptive practice at the time of survey was 29%. However, use of family planning was more in district Tando-Allahyar as compared to district Jamshoro (p <0.001) inspite of similar socio-demographic and reproductive profile. Mean age of marriage of wife and husband was 17.73 +/- 3.8 and 23.82 +/- 5.8 years respectively. In both districts mean parity and number of living children was around 4. Contraceptive use increased with increasing age of mother, parity and number of living children. Tubal ligation (9.5%) and condoms (9.0%) were the most popular methods of family planning. Mass media was the primary source of information,in approximately 72.5% of the study population. Fear of side effects was the main reason given by non-users. CONCLUSION: The current contraceptive practices are not at the expected levels. Community health workers have provided good services at raising awareness.