Female Urogenital Diseases and Pregnancy Complications Commons^™

Institutional Deliveries And Stillbirth And Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry, Shivaprasad S. Goudar, Norman Goco, Manjunath S. Somannavar, Avinash Kavi, Sunil S. Vernekar, Antoinette Tshefu, Elwyn Chomba, Ana L. Garces, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Background: Few studies have shown how the move toward institutional delivery in low and middle-income countries (LMIC) impacts stillbirth and newborn mortality.
Objectives: The study evaluated trends in institutional delivery in research sites in Belagavi and Nagpur India, Guatemala, Kenya, Pakistan, and Zambia from 2010 to 2018 and compared them to changes in the rates of neonatal mortality and stillbirth.
Methods: We analyzed data from a nine-year interval captured in the Global Network (GN) Maternal Newborn Health Registry (MNHR). Mortality rates were estimated from generalized estimating equations controlling for within-cluster correlation. Cluster-level analyses were performed to assess the association between …

Maternal Risk Factors And Short Term Outcome Of Prematurity: A Descriptive Study At A Secondary Care Hospital, Heeramani Lohana, Shakeel Ahmed, Nigar Jabeen, Farida Karim, Sarwat Urooj, Ayesha Ahmed

Department of Paediatrics and Child Health

Background: Approximately 15 million babies are born premature (before 37 weeks of gestation) and 1 million babies die due to prematurity complications every year. Less is known about risk factors of prematurity in middle and low-income countries. The prevalence of prematurity ranges from 5% - 18%.
Objective: To determine the prevalence of premature births and to assess the rate of survival, along with the morbidity, among preterm newborns. Furthermore, to document our experience with different gestational age groups of preterm births; and to analyze the association among these strata and their clinical outcomes.
Study Design: A descriptive study.
Place …

Multiomics Characterization Of Preterm Birth In Low- And Middle-Income Countries, Fyezah Jehan, Muhammad Imran Nisar, Muhammad Ilyas, Usma Mehmood, Aneeta Hotwani, Ambreen Nizar, Sajid Muhammad, Waqasuddin Khan, Javairia Khalid, Furqan Kabir

Department of Paediatrics and Child Health

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.
Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.
Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in …

Role Of Oxidative Stress And Altered Thyroid Hormones In Unexplained Infertility, Rehana Rehman, Hiba Ismail Rajpar, Mussarat Ashraf, Najeeha Talat Iqbal, Salima Lalani, Faiza Alam

Department of Biological & Biomedical Sciences

Objective: To explore the link between altered thyroid profile and oxidative stress marker in females with unexplained infertility.
Methods: The cross-sectional case-control study was carried out at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2016 to August 2017, and comprised women aged 18-40 years regardless of ethnic background who were divided into two groups; those with unexplained infertility were the cases, while fertile women acted as the controls. Serum was analysed for triiodothyronine, thyroxine and thyroid stimulating hormone as well as for oxidative stress markers including manganese superoxide dismutase, glutathione reductase and adrenaline using enzymelinked immunosorbent assay. …

Twin Pregnancy Complicated By Intrauterine Death Of One Fetus And Herniated Bowel Loops Over Gravid Uterus, Malika Hameed, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Effect Of Psychological Distress On The Emerging Cause Of Infertility, Faiza Kausar

Journal of Asian Midwives (JAM)

Background: Infertility is a growing issue of the recent era, and it represents significant crises for most couples. Psychological distress has often been suggested as a cause of unexplained infertility. Male infertility accounts for 40% of all infertility problems, while female infertility accounts for 40% of all infertility problems; others are unexplained. Previous studies have indicated that stress and depression negatively impact various infertility parameters in both partners. To determine the relationship between infertility and psychological distress and the level of different types of stress among infertile couples, and to relate the significant stressors responsible for worsening infertility or …

The Politics Of Abortion And Maternal Health: A Discussion Paper, Ihsan Ullah, Ayaz Ayub, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

Abortion should be legally allowed for women because it can save mothers from childbirth-related complications and death. Legal abortion is one of the safest methods to terminate a pregnancy when there is a risk to the mother’s health by childbirth or severe deformity of the fetus or it is unwanted. Unfortunately, approximately half of all abortions worldwide mostly in nations where abortion is severely restricted and are performed in dangerous settings. These risky abortions are a significant contributor to maternal morbidity and disability. Limiting a woman's access to an abortion does not stop abortion; rather, it just encourages more risky …

Influence Of Body Mass Index And Polycystic Ovarian Syndrome On Icsi/Ivf Treatment Outcomes: A Study Conducted In Pakistani Women, Rehana Rehman, Rozina Mustafa, Rabiya Ali, Saeeda Shaharyar, Faiza Alam

Department of Biological & Biomedical Sciences

Background: Obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome (PCOS) females.
Objective: To compare results of intra-cytoplasmic sperm injection (ICSI) in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females.
Materials and methods: A cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS (recognized by Rotterdam criteria) females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin (β-hCG) and transvaginal …

Trends And Determinants Of Stillbirth In Developing Countries: Results From The Global Network’S Population-Based Birth Registry, Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M. Mcclure, Janet L. Moore, Iqbal Azam Syed, Sangappa M. Dhaded, Shivaprasad S. Goudar, Ana Garces, Sumera Aziz Ali, Farnaz Naqvi

Community Health Sciences

Background: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.
Methods: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Twin Chorionicity And Prospective Stillbirth Risk: Experience At A Tertiary Care Hospital, Shazia Masheer, Zaheena Islam, Dhanwanti Dileep, Shama Munim

Department of Obstetrics & Gynaecology

Objective: To determine the prospective risk of stillbirth, perinatal death and neonatal morbidities in twins.

Methods: This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised cases of twin pregnancies from January 2001 to December 2012. . Cases of both monochorionic diamniotic and dichorionic diamniotic twin pregnancies were included. SPSS 19 was used for data analysis.

Results: Of the 394 cases, 84(21.3%) were monochorionic diamniotic twins and 310(78.7%) were dichorionic diamniotic twins. There were no cases of stillbirth beyond 30 and 34 weeks in monochorionic and dichorionic twins, respectively. Neonatal mortality stood reduced beyond 36 …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …

Important Strategies For Effective Family Planning Counseling, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

No abstract provided.

Wilson’S Disease In Pregnancy: Case Series And Review Of Literature, Ayesha Malik, Ali Khawaja, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Background: Wilson’s disease is a rare, autosomal recessive inherited disorder characterized by impaired liver metabolism of copper leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson’s disease has been shown to cause subfertility and even in cases where pregnancy occurs, it often results in spontaneous miscarriage.

Case presentations: We present four cases of successful pregnancy outcomes in three patients diagnosed with Wilson’s disease along with the literature review. All the patients were managed with zinc sulphate without any postnatal complications.

Conclusion: Patients with Wilson’s disease receiving regular treatment who remain asymptomatic …

A Review Of Comparison Of Complications Of Vaginal Hysterectomy With And Without Concomitant Surgery For Sui: A 5 Years’ Experience At A Tertiary Care Hospital Of Pakistan, Raheela Mohsin Rizvi, Munnazza Akhtar, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH …

Factors Associated With Failed Induction Of Labour In A Secondary Care Hospital, Neelofur Babar Khan, Iffat Ahmed, Ayesha Malik, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the factors associated with failed induction of labour (IOL) in a secondary care hospital.
Method: This is a retrospective cross sectional study on women admitted for labour induction in Aga Khan Hospital for women Karimabad from 1st Jan, 2009 to 31st Dec, 2009. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean Section.
Result: Eighteen percent of our pregnant population who underwent induction of labour failed to deliver vaginally. About 25% of 328 nulliparous women had failed induction. With a Bishop score of <5 in 84.3%. In 28.2% with prolonged latent phase of more than 20 hours in Caesarean section had to be performed.
Conclusion: Nulliparity, poor Bishop score and …

Umbilical Cord Prolapse--A Review Of Diagnosis To Delivery Interval On Perinatal And Maternal Outcome, Rozilla Sadia Khan, Tahira Naru, Faryal Nizami

Department of Obstetrics & Gynaecology

Objective: To determine the significance of the Diagnosis to Delivery Interval (DDI) on perinatal outcome and maternal complications in patients with umbilical cord prolapse.
Methods: This was a case series of 44 patients identified with "Umbilical cord prolapse" during a 10-year period at the Aga Khan University Hospital. Data was retrieved for gestational age, foetal presentation, DDI, incision to delivery time, delivery method, apgar score, birth weight and outcome, and maternal complications. The influence of DDI on perinatal mortality, apgar scores at 5 minutes, neonatal intensive care unit (NICU) admission and maternal complications resulting from mode of delivery with cord …

Juvenile Ewing Sarcoma Presenting As A Pelvic Mass, Tahira Naru, Fauzia Haq Nawaz, Javed Rizvi

Department of Obstetrics & Gynaecology

A teen aged girl with rapidly developing pelvic mass, associated with weight loss and left leg weakness, was evaluated and found to have Ewing's sarcoma of non-osseous origin from pelvis, which is a rare situation. She was treated by a multidisciplinary approach by surgery, chemotherapy and rehabilitation by physiotherapy to effective response.

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Social Environment And Depression Among Pregnant Women In Urban Areas Of Pakistan: Importance Of Social Relations., Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza Niaz, Gail A. Wasserman

Community Health Sciences

Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants …

Maternal And Fetal Complications Of Antiphospholipid Syndrome: A Case Report With Long-Term Follow-Up, Tahira Naru, Mohammad Khurshid, Zafar Nazir

Department of Obstetrics & Gynaecology

We report a case of a 26- year old woman having antiphospholipid syndrome in pregnancy with long-term follow up. She presented with recurrent miscarriages, venous thrombosis, avascular necrosis of femoral head, mid-cerebral artery infarction and skin ulcers. Antiphospholipid syndrome is a recognized disorder of pregnancy. Diagnosis requires a high index of suspicion when evaluating women with recurrent pregnancy losses and vascular thrombosis. A low dose aspirin combined with heparin can reduce morbidity and improves the pregnancy outcome.

Transitional Cell Carcinomas Of The Urinary Bladder. A Histopathological Study, Z. Ahmed, S. Muzaffer, M. Khan, N. Kayani, Shahid Pervez, A. S. Husseini, S H. Hasan

Department of Pathology and Laboratory Medicine

Objective:

To determine the histological grading and muscle invasion in Transitional Cell Carcinomas of the Urinary Bladder; and to evaluate whether any correlation exists between tumour grade and muscle invasion.

Method:

A Retrospective study of all consecutive cases of Transitional Cell Carcinomas of the Urinary Bladder diagnosed at Aga Khan University Hospital between 1st Jan 1997 and 31st Dec 2000.

Results:

This study included 495 cases of Transitional Cell Carcinoma of the Urinary Bladder. M: F ratio was 4:1. Ages of patients ranged from 30 years to 87 years. Mean age in males was 59.1 years and in females 58.8 …

Aggressive Angiomyxoma Of Vulva, Farrukh Aijaz, Shahid Pervez, Shehnaz Wasti, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

No abstract provided.