Domestic Violence Among Pregnant Women.

BACKGROUND: Domestic violence during pregnancy is an important social & health issue in all societies. In Muslim world and particularly underdeveloped countries, domestic violence is often under reported. It is the need of hour to encourage reporting of such events & implementation of research-based policies for prevention of women abuse & support of the victims of domestic violence (DV). The objective of this study was to highlight this neglected social problem of our society & to identify at risk population. METHODS: This is a cross sectional study conducted at Ayub Teaching Hospital & Benazir Bhutto Shaheed Teaching Hospital, Abbottabad (January 2014 to December. 2016). Pregnant women were inquired regarding history of abuse by husband and sociodemographic characteristics were noted in a Performa to analyse the risk factors for domestic violence. RESULTS: The overall prevalence was found to be 35%. Out of 1000 pregnant women, 270 (27%) suffered from simple violence and 60 (6%) were victims of grievous assault. Violence among pregnant women is found to be more prevalent among residents of urban areas, women of older age being uneducated & belonging to poor socioeconomic status. CONCLUSIONS: Domestic violence during pregnancy is a common & often neglected psychosocial health problem. High risk population needs to be identified so that preventive strategies can be planned & implemented.

Symptoms Of Menopause In Peri And Postmenopausal Women And Their Attitude Towards Them.

BACKGROUND: The climacteric or perimenopause is the transitional phase during which reproductive function ceases. The average age of the menopause is 51.4 years with a duration of two years. Symptomatology include: vasomotor, psychological, urogenital/sexual, skin, menstrual irregularities and others. The objective was to study the attitude of these women towards menopause. METHODS: In this cross-sectional study, 500 women were included. RESULTS: Palpitations and headaches were found in 30% and 32% respectively in perimenopausal women compared to 16% and 20% in postmenopausal women. Irritability, anxiety and lethargy affected every 3 in 10 women while 24% reported forgetfulness and 12% had loss of libido in the peri menopausal group. The incidence of the above symptoms was much lower in the postmenopausal group, irritability being on the top (16%) followed by forgetfulness (12%), lethargy in 10% and loss of libido in 3%. Dyspareunia was reported by 18% of perimenopasual and 8% of menopausal women. Urinary complaints were found in 9% and 3% of the perimenopausal and menopausal women respectively. About 2 in 10 complained of dryness of skin. Menstrual irregularities affected 3 in 10 women and the commonest form of abnormality was delayed cycles (23%). Concerning their attitude towards menopause 46% perimenopausal and 76% of the postmenopausal women did not perceive menopause as a medical condition and were found satisfied as they had accepted it as a natural ageing process. Some 20-40% of women who were worried or dreading menopause were those who linked impairment of vision with menopause. CONCLUSIONS: Attitude of women in our society was found positive towards menopause.

Misoprostol for the purpose of mid-trimester termination of pregnancy: a comparative study with prostaglandin F2 alpha.

OBJECTIVE: To compare the efficacy of misoprostol verses prostaglandin F2alpha (PGF2alpha) in the medical management of termination of mid-trimester pregnancy due to medical reasons. METHODS: This experimental study was conducted in Obstetrics and Gynaecology Department, Bahawal Victoria Hospital, Bahawalpur for a period of 6 months from April 2005 to September 2005. Time interval between induction with misoprostol or PGF2alpha and expulsion of foetus, number of tablets of misoprostol used and total dose of injection PGF2alpha used for termination of pregnancy as well as the complications experienced with both drugs. Fifty patients of 18-35 years of age were randomly selected who presented to Gynaecology and Obstetrics outdoor with mid-trimester foetal loss or congenitally malformed foetus incompatible to life, confirmed on ultrasonography. These women were randomised to receive either intravaginal misoprostol or extra-amniotic PGF2alpha. RESULTS: Ninety-six percent of cases were managed successfully with Misoprostol as compared to 92% where PGF2alpha was tried (p > 0.5). Mean induction to expulsion duration for misoprostol and PGF2alpha were 9.02 +/- 4.57 and 16.04 +/- 6.22 hours respectively (p < 0.5). Complications profile was low especially in cases of PGF2alpha and only one case experienced significant haemorrhage. CONCLUSION: Misoprostol and PGF2alpha were found to be of same success rate but former was found to be more efficacious in terms of induction to expulsion duration.

Assessment of pregnancy outcome in primigravida: comparison between booked and un-booked patients.

BACKGROUND: Primigravida (PG), defined as a woman who conceives for the first time, is in a high-risk group. Objective of this study was to evaluate the pregnancy outcome in booked and un-booked primigravida. METHODS: This was a hospital based comparative study conducted in Women and Children Hospital Abbottabad from May 1998 to November 1999. A total of 322 patients were included in the study. Inclusion criteria was all primigravida, both booked as well as un-booked patients. Evaluation was done by taking detailed history, clinical examination and relevant investigations. Antenatal, intrapartum and postnatal complications were noted in the mothers. Perinatal morbidity and mortality was assessed in both the groups. RESULTS: Out of 322 cases, 52 patients were booked and 270 patients were un-booked. Majority of un-booked patients belonged to the rural areas and were from lower socioeconomic group, between the age group of 15-35 years. The rate of instrumental deliveries was high (87.5%) in un-booked patients as compared to booked patients (12.5%). Caesarean section rate in un-booked patients was higher (76.5%) as compared to booked patients (23.5%). Twenty-three (20%) patients of un-booked group presented in emergency mainly with obstructed labour. Twenty-two (19.8%) patients had pregnancy induced hypertension, while foetuses of 48 (43.2%) patients developed foetal distress. Antipartum haemorrhage was present in 12 (10.8%) patients, while prolonged labour with foetal distress was noted in 26 (23.4%) patients in un-booked group. Postpartum haemorrhage and puerperal pyrexia was more common in un-booked patients (7.7% and 18.6% respectively). Perinatal mortality was high in un-booked patients (19.5%) as compared to booked patients. CONCLUSION: Primigravida are high-risk patients. Comprehensive antenatal care should be provided in this group of patients to have better maternal and foetal outcome.

Incidence of endometrial hyperplasia in 100 cases presenting with polymenorrhagia/menorrhagia in perimenupausal women.

BACKGROUND: To study the Incidence of endometrial hyperplasia in perimenupausal women presenting with polymenorrhagia/menorrhagia. This observational study was conducted at Gynae 'B' unit of Khyber Teaching Hospital Peshawar from January 2000 to December 2001. METHODS: One hundred consecutive patients who presented at Gynaecology OPD with Polymenorrhagia/ Menorrhagia were registered and incidence ofendometrial hyperplasia evaluated in them. All women were above 45 years of age. Post-menopausal bleeding cases were excluded from the study. RESULTS: Out of 100 patients, 15 patients were found to have endometrial hyperplasia, 10 patients (66.6%) simple cystic hyperplasia, 3 patients (20.0%) had adenomotous hyperplasia, 2 patients (13.3%) had atypical hyperplasia, 8 patients (53.3%) with menorrhagia, 1 (6.6%) with polymenorrhagia, and 6 patients (40.0%) with polymenorrhoea. Duration of symptoms was from 4 months to 1 year. Thirteen (86.6%) patients were treated medically, 5 patients (33.33%) needed surgical treatment following medical treatment, 2 patients (13.3%) underwent Total Abdominal Hysterectomy (TAH) and Bilateral Salpingooophorectomy (BSO) who were 51-53 years of age with atypical hyperplasia. CONCLUSION: endometrial hyperplasia is a pre-malignant condition; if treated in time, incidence can be reduced and early treatment can increase life expectancy and quality in women over age of 45 years.

Effectiveness and safety of vaginal misoprostol for induction of labour in unfavourable cervix in 3rd trimester.

BACKGROUND: The use of prostaglandin preparations with or without oxytocin infusion, is widely recognized and accepted as a standard method of induction of labour. It has been shown to reduce induction time and the risk of failed induction. The objective of this quasi-experimental observational study was to determine the effectiveness and safety of Misoprostol administered vaginally for induction of labour to achieve vaginal delivery. METHODS: This study was conducted from October 2004 to October 2007. The study was conducted at Shaheena Jamil Teaching Hospital, Frontier Medical College, Abbottabad and Women and Children Hospital Abbottabad. A total of 6299 obstetric patients were received for delivery and 946 patients had to undergo induction of labour. Primary outcome measures were to address clinical effectiveness (delivery within 24-hours) and safety (uterine hyper-stimulation, Caesarean Section and serious Maternal Morbidity). Secondary outcome measures included neonatal outcome. RESULTS: Out of 946 cases, successful vaginal deliveries were achieved in 843 (89.1%) cases. Time interval between induction and delivery was 4-24 hours. Oxytocin was required in 107 (12%) patients. Caesarean Section had to be done in 103 (10.8%) cases. The indications for Caesarean Section were foetal distress in 42 (40%), occipito-posterior position in 8 (7.7%), abruptioplacentae 2 (1.9%), cord around the neck 9 (7%), uterine hyperstimulation 6 (5.8%) and failure to progress in 20 (19%) cases. Admission to NICU was 28 (3.3%) and Neonatal deaths were 5 (0.5%). Postpartum Haemorrhage (PPH) was observed in 22 (2.3%) patients. There was no case of rupture uterus. CONCLUSION: Vaginal Misoprostol appears to be safe and effective for cervical ripening in 3rd Trimester. It helps vaginal delivery within 24 hours, does not increase incidence of Caesarean Section and has no adverse effect on foetal outcome. It could also be used in circumstances where extensive monitoring techniques are not available though close observation and vigilance is mandatory.

An audit of primary post partum hemorrhage.

BACKGROUND: Postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Its causes & risk factors are important for its prevention and management. Poor, unhealthy, high parity women delivering away from health facility are usual victims. The purpose of this study is to determine causes of PPH, risk factors, preventable factors and to assess treatment measures adopted. METHODS: This retrospective study is carried out in Gynaecology 'B' unit of Ayub Teaching Hospital Abbottabad. All patients admitted with PPH or developed PPH within hospital from 1st Jan-31st Dec 2006 are included. Exclusion criteria were patients with bleeding disorders and on anticoagulants. Records of admissions, deliveries, caesareans, major & minor procedures and history charts were thoroughly evaluated for details. Details included age, parity, socioeconomic status, transportation facility, distance from hospital, onset of labours, birth attendant skilled/unskilled, evaluation of risk factors, duration of labour and mode of delivery. Patient's general health, anaemia, shock, abdominal and pelvic examination and laboratory findings were also taken in to account. Treatment measures including medical, surgical, blood transfusions were evaluated. RESULTS: The most important cause was uterine atony, 96 (70.5%) and traumatic lesions of genital tract, 40 (29.4%). Factors causing uterine atony were augmented labour 20 (20.9%), prolonged labour 21 (21.9%), retained placental tissues, 11 (12.5%), retained placenta, 11 (11.4%) Couvelliar uterus, 10 (10.4%), placenta preavia, 8 (8.3%), placenta increta, 7 (7.3%), chorioamnionitis 5 (5.2%), and multiple pregnancy, 2 (2.1%). Risk factors, grand multiparity 70 (51.5%), antepartum haemorrhage 12 (8.9%), instrumental delivery 10 (7.3%), previous PPH, 6 (4.5%), choreoamnionitis, 5 (3.6%), multiple pregnancy, 2 (1.5%), no risk factor, 21 (15.4%). Socioeconomic status was poor (75) & lower middle class (61). Induced labour, 33 (24.3%), augmented labour 62 (45.5%). Uterotonics used for prophylaxis in 30 (22%), for treatment of PPH, 106 (78%). Patients delivered by traditional birth attendants 70 (51.4%), lady health workers 40 (29.4%) & doctors 26 (19.2%). Uterine massage performed in 30 (22%), minor surgical procedures 33 (24.3%), manual removal of retained placenta, 11 (8%), hysterectomy, 50 (36.7%), & compression sutures were applied in 3 (2.2%). Maternal deaths due to PPH were 6 (40%). CONCLUSIONS: PPH can be prevented by avoiding unnecessary inductions/augmentations of labour, risk factors assessment and active management of 3rd stage of labour. It needs critical judgment, early referral and early resuscitation by birth attendant. There is room for temponade and compression sutures. Hysterectomy should be the last option.