Obstetrics and Gynecology Commons^™

Nothing As Practical As A Good Theory? The Theoretical Basis Of Hiv Prevention Interventions For Young People In Sub-Saharan Africa: A Systematic Review, Kristien Michielsen, Matthew Chersich, Marleen Temmerman, Tessa Dooms, Ronan Van Rossem

Obstetrics and Gynaecology, East Africa

This paper assesses the extent to which HIV prevention interventions for young people in sub-Saharan Africa are grounded in theory and if theory-based interventions are more effective. Three databases were searched for evaluation studies of HIV prevention interventions for youth. Additional articles were identified on websites of international organisations and through searching references. 34 interventions were included; 25 mentioned the use of theory. Social Cognitive Theory was most prominent (n = 13), followed by Health Belief Model (n = 7), and Theory of Reasoned Action/Planned Behaviour (n = 6). These cognitive behavioural theories assume that cognitions drive sexual behaviour. Reporting …

Raising The Bar In Publishing: The Future Of Jogeca, Alfred Murage

Obstetrics and Gynaecology, East Africa

Excitement is in the air in Kenya, what with the looming elections and constitutional changes? JOGECA has not been left behind in these exciting times, we have a booming issue that readers will enjoy reading. And there are exciting developments in the pipeline to propel our journal into new heights.

Determining The Factors Associated With Unmet Need For Family Planning: A Cross-Sectional Survey In 49 Districts Of Pakistan, Waqas Hameed, Syed Khurram Azmat, Mohsina Bilgrami, Muhammad Ishaqe

Community Health Sciences

Introduction & Background: Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch national family planning program. The aim of this paper is to estimate the prevalence of unmet need for contraception and to indentify the factors associated with it.
Methods: A cross-sectional survey was conducted in forty nine districts of Pakistan across all …

The Association Between Parity, Infant Gender, Higher Level Of Paternal Education And Preterm Birth In Pakistan: A Cohort Study, Kiran Shaikh, Shahirose Sadrudin Premji, Marianne S. Rose, Ambreen Kazi, Shaneela Khowaja, Suzanne Tough

School of Nursing & Midwifery

Background:

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth, however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth.

Methods:

In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression …

Severe Propylthiouracil-Induced Hepatotoxicity In Pregnancy Managed Successfully By Liver Transplantation: A Case Report, Evan Sequeira, Sikolia Wanyonyi, Raj Dodia

Obstetrics and Gynaecology, East Africa

Introduction: Propylthiouracil-induced severe hepatotoxicity is a relatively rare occurrence, with very few cases reported in the literature. The management of this complication in pregnancy can be a challenge because of the effects of the various treatment options on the fetus.

Case presentation: We report a rare case of fulminant hepatic failure in a 36-year-old gravida 2 black woman of African descent that occurred at 17 weeks gestation following propylthiouracil treatment for Graves’ disease. Her liver failure was managed by liver transplantation and thyroidectomy. Her pregnancy was continued to term, though with not so favorable early childhood sequelae.

Conclusion: This case …

Evolution Of Foetal Echocardiography As A Screening Tool For Prenatal Diagnosis Of Congenital Heart Disease, Nuruddin Badruddin Mohammed, Anandakumar Chinnaiya

Department of Obstetrics & Gynaecology

Congenital cardiac anomalies are the most common anomalies, with an estimated incidence of about 4-13 per 1000 live births. Proper perinatal and neonatal management is dependent upon accurate prenatal diagnosis. Approximately 10% of foetuses with cardiac abnormalities have identified risk factors; hence, most of the anomalies occur in pregnancies without prenatal risk factors. Foetal echocardiography allows for prenatal diagnosis of congenital heart disease and serves as a routine screening tool for congenital heart defects. Advanced technology, has not only allowed more accurate and early detection of cardiac abnormalities but has also improved the care and outcome of selected foetuses with …

Prevalence Of Postpartum Depression Using The Edinburgh Postpartum Depression Scale At The Aga Khan University Hospital, Nairobi, Warfa Khadija

Master of Medicine in Obstetrics and Gynecology

Background: Postpartum depression is an illness that affects 10-20% of mothers following delivery; the impact it has on the family, partner and the new born baby is significant. There are insufficient data in Kenya as its rate and severity hence the impact is unknown. Screening could allow earlier treatment of these mothers and prevent the long term effects on the family. Objectives: The primary objective was to identify the prevalence of postpartum depression at the Aga Khan University Hospital and to identify associations between participant’s socio demographics and depression. Methods: Cross sectional study to screen postpartum women six weeks after …

The Use Of Mcv And Mch To Screen For Iron Deficiency In Pregnancy Among Women With Normal Haemoglobin Values, Charles M. Muteshi

Master of Medicine in Obstetrics and Gynecology

Background: Worldwide the commonest cause of anaemia is inadequate nutritional supply manifest as iron deficiency. Iron deficiency affects 25% of the world’s population and up to 50% in the developing world. Most susceptible are women of child bearing age and infants. In pregnancy most iron deficiency is detected when there is already resultant anaemia by measuring the haemoglobin content. It is important to develop a tool that could pick out women who are iron deficient before anaemia ensues. This study aims to determine the predictive ability of red cell mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) in screening …

Domestic Violence And Pregnancy: The Challenge Of Framing A European-Wide Research Question., Caroline Andries, Nicola Buckley, Kristien Roelens, Ingunn Studsrød, Marleen Temmerman, An-Sofie Van Parys, Elisabeth Willumsen

Obstetrics and Gynaecology, East Africa

No abstract provided.

Care During Labor And Birth For The Prevention Of Intrapartum-Related Neonatal Deaths: A Systematic Review And Delphi Estimation Of Mortality Effect, Anne C. C. Lee, Simon Cousens, Gary L. Darmstadt, Hannah Blencowe, Robert Pattinson, Neil F. Moran, G. Justus Hofmeyr, Rachel A. Haws, Shereen Zulfiqar Bhutta, Joy E. Lawn

Department of Obstetrics & Gynaecology

Background: Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events ("birth asphyxia") in term babies for use in the Lives Saved Tool (LiST).

Methods: We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert …

Evaluation Of Compliance And Outcomes Of A Management Protocol For Massive Postpartum Hemorrhage At A Tertiary Care Hospital In Pakistan, Lumaan Sheikh, Nida Najmi, Umair Khalid, Taimur Saleem

Department of Obstetrics & Gynaecology

Background: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated.

Methods: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss >= 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode …

Primary Hyperparathyrodism In Pregnancy And Review Of Literature, Tahira Naru, Rozilla Sadia Khan, Mohammed Ataullah Khan

Department of Obstetrics & Gynaecology

hyperparathyroidism (PHPT) is rare condition during pregnancy; however, it can carry significant risks to both mother and foetus during and after the pregnancy. The definitive treatment is parathyroidectomy undertaken preferably in the second or early third trimester. A case of asymptomatic PHPT diagnosed and treated by parathyroidectomy in the third trimester is described.

Parental Control And Monitoring Of Young People's Sexual Behaviour In Rural North-Western Tanzania: Implications For Sexual And Reproductive Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania.

Methods

This study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software. …

Participating In A Community Of Learners Enhances Resident Perceptions Of Learning In An E-Mentoring Program: Proof Of Concept, Timona Obura, William. E. Brant, Fiona Miller, I. J. Parboosingh

Obstetrics and Gynaecology, East Africa

Background

Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences.

Methods

A six-month e-mentoring pilot was offered to 10 Radiology residents in …

Fmic Annual Report 2011 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Anthropometric Measurements As A Risk For Hypertensive Disorders In Pregnancy: A Hospital Based Study In South Asian Population, Ferha Saeed, Ahmed Jawad, Asma Azmat, Iqbal Azam Syed, Safdar Kagazwala

Department of Obstetrics & Gynaecology

Objectives: To determine the relationship between pregnancy induced hypertensive diseases and obesity.

Methods: A retrospective case controlled study was performed at Aga Khan University Hospital including records from July 2000 to June 2005. All women developing hypertension with or without proteinuria after 20 weeks of pregnancy (n = 218) were included. Categories of pregnancy induced hypertensive diseases (PIHD) were defined according to National high blood pressure working group and ACOG committee bulletin. Controls were selected randomly with a ratio of 1:1.7 between cases and controls.

Results: The estimated prevalence of pre-eclampsia in our institution is 1.9%. Earlier reports suggested mostly …

Post-Dural Puncture Posterior Reversible Encephalopathy Syndrome, Fauzia N. Minai, Syeda Fauzia Hasan, Mughis Sheerani

Department of Anaesthesia

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there …

Bacterial Vaginosis Is Associated With Uterine Cervical Human Papillomavirus Infection: A Meta-Analysis, Evy Gillet, Joris Fa Meys, Hans Verstraelen, Carolyne Bosire, Philippe De Sutter, Marleen Temmerman, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV), an alteration of vaginal flora involving a decrease in Lactobacilli and predominance of anaerobic bacteria, is among the most common cause of vaginal complaints for women of childbearing age. It is well known that BV has an influence in acquisition of certain genital infections. However, association between BV and cervical human papillomavirus (HPV) infection has been inconsistent among studies. The objective of this meta-analysis of published studies is to clarify and summarize published literature on the extent to which BV is associated with cervical HPV infection.

Methods: Medline and Web of Science were systematically searched for …

The Epidemiology Of Bacterial Vaginosis In Relation To Sexual Behaviour, Hans Verstraelen, Rita Verhelst, Mario Vaneechoutte, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic microorganisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.

Discussion: G. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced …

Evaluation Of Health Workforce Competence In Maternal And Neonatal Issues In Public Health Sector Of Pakistan: An Assessment Of Their Training Needs, Shabina Ariff, Sajid B. Soofi, Kamran Sadiq, Asher B. Feroze, Shuaib Khan, Sadiqua N. Jafarey, Nabeela Ali, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods: …

Examining The "Urban Advantage" In Maternal Health Care In Developing Countries, Zoe¨ Matthews, Amos Channon, Nyovani Madise, William Stones

Obstetrics and Gynaecology, East Africa

Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty.

Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care.

The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services.

There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in …

The Efficacy Of Intravenous Hyoscine-N-Butylbromide (Buscopan®) For The Acceleration Of Labour In First Time Parturients: A Randomised, Double-Blind, Placebo-Controlled Trial, Mukaindo A. Mwaniki

Master of Medicine in Obstetrics and Gynecology

Objective: to establish the safety and efficacy of hyoscine-N-butylbromide (Buscopan®) in accelerating labour in first time parturients. Design: a randomised, double-blinded, placebo-controlled clinical trial. Setting: the antenatal clinic and maternity unit of the Aga Khan University Hospital Nairobi, Kenya. Population: first time parturients in spontaneous labour at term. Methods: women were randomised to receive 40mg of hyoscine-N-butylbromide or sterile water for injection intravenously once they were confirmed to be in active labour. The dose could be repeated once after four hours. Outcome measures: the main outcome measure was the duration of labour from diagnosis of active stage to delivery. Secondary …

Is It Possible To Reduce Rates Of Placenta Praevia, Sheena Memon, Kaweeta Kumari, Haleema Yasmin, Sheerin Bhutta

Department of Obstetrics & Gynaecology

To determine factors responsible for rising rates of placenta praevia. This comparative study was performed at Jinnah Post Graduate Medical Centre Karachi, (Group-A) from September 2000 to February 2002 and (Group-B) from January 2008 to January 2009. All women with major degree of placenta praevia diagnosed on ultrasound who came in emergency or through out patient department were included in the study. Patients with mild degree of placenta praevia were excluded. Group A had 100 patients and Group B, 58 patients. Chi-Squire test was used for comparison of previous study and current study. The number of unbooked cases in both …

Birth Weight Estimation--A Sonographic Model For Pakistani Population, Waseem Akhtar, Arif Ali, Mubashir Aslam, Farah Saeed, Salman, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To develop a sonographic birth weight estimation model for Pakistani population and to validate the published models in the same population.

METHODS: Data was collected for pregnant women who presented to Radiology Department of Aga Khan University Hospital Karachi from January 2007 to July 2008 and had undergone ultrasound estimation of foetal weight within 4 days prior to a term delivery (37-42 weeks gestation). The neonate's actual birth weight was used to validate the published foetal weight estimation models and modified sonographic birth weight estimation model was derived for our population by using linear regression.

RESULTS: Modified sonographic birth …

Health Related Quality Of Life Changes Among Users Of Depot Medroxyprogesterone Acetate (Dmpa) For Contraception, Sikolia Wanyonyi

Master of Medicine in Obstetrics and Gynecology

Background: Contraceptive use is often a lifestyle choice that could impact on the quality of life. Depot medroxyprogesterone acetate (DMPA), like any other contraceptive method has other effects besides fertility control. Understanding how these impacts on the quality of life could assist in client counseling, eventually leading to informed choices. Objective: To determine health related quality of life changes associated with the use of DMPA for contraception. Methods: A longitudinal observational study was carried out between December 2008 and September 2009 at family planning clinics at the Aga Khan University Hospital and Family Health Options, Kenya (FHOK) after institutional and …

Parent-Child Communication About Sexual And Reproductive Health In Rural Tanzania: Implications For Young People's Sexual Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Many programmes on young people and HIV/AIDS prevention have focused on the in-school and channeled sexual and reproductive health messages through schools with limited activities for the young people's families. The assumption has been that parents in African families do not talk about sexual and reproductive health (SRH) with their children. These approach has had limited success because of failure to factor in the young person's family context, and the influence of parents. This paper explores parent-child communication about SRH in families, content, timing and reasons for their communication with their children aged 14-24 years in rural Tanzania.

Methods …

Reproductive Health Services For Populations At High Risk Of Hiv: Performance Of A Night Clinic In Tete Province, Mozambique, Yves Lafort, Diederike Geelhoed, Luisa Cumba, Carla Das Dores Mosse Lázaro, Wim Delva, Stanley Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.

Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held …

Non-Invasive Prenatal Determination Of Fetal Rhd Genotyping From Maternal Plasma: A Preliminary Study In Pakistan, Nuruddin Badruddin Mohammed, Fatima Kakal, Mehreen Somani, Wajiha Zafar

Department of Obstetrics & Gynaecology

Objectives: To determine the accuracy of the non-invasive pre-natal real-time polymerase chain reaction based fetal RhD genotyping from maternal plasma.

Study Design: Cross-sectional study.

Place And Duration Of Study: Juma Health Sciences Research Laboratory, The Aga Khan University Hospital, Karachi, from July to December 2008.

Methodology: Cell-free plasma DNA from 21 D-negative women with D-positive spouse between 20-39 weeks of gestation was tested for the presence of exon 5 region of RhD gene using real-time polymerase chain reaction. b-globin was employed as the house-keeping gene. Sensitivity and specificity of the real-time PCR-based non-invasive fetal RhD genotyping was obtained by calculating …

Presenting Signs And Symptoms Of Ovarian Cancer At A Tertiary Care Hospital, Ambareen Khan, Khusro Sultana

Department of Obstetrics & Gynaecology

Objective: To identify early warning signs and symptoms of ovarian cancer to create awareness for early diagnosis and management of the disease.
Methods: This study was conducted at the department of Gynaecology and Obstetrics, Liaquat National Hospital, Karachi from 2003 to 2007, having 75 patients. The information collected included age, education, and self perceived state of socio-economic class, presenting clinical signs and symptoms, basic and specific laboratory investigations. The disease was staged from I to IV upon surgical staging and the type of cancer was determined by histopathological examination.
Results: Mean age of the patients was 51 +/- 12.3 years. …

Factor Vii Deficiency And Pregnancy: A Case Report And Review Of Literature, Syed Mohammad Asad Zaidi, Rahat Qureshi, Salman Naseem Adil

Department of Obstetrics & Gynaecology

Factor VII deficiency is one of the 'rare inherited disorders of coagulation.' Few cases of Factor VII deficiency have been reported during pregnancy, a state which could potentially cause fatal haemorrhage. Here we report a case of a pregnant lady with a history of heavy menorrhagia and multiple first pregnancy failures. Delivery was carried out via Caesarean section due to non-reassuring foetal heart monitoring. Patient was treated with Fresh Frozen Plasma (FFPs) and Factor VII concentrates, however, the patient developed bleeding postoperatively. Literature indicates that whilst Factor VII levels rise during pregnancy in normal women, no increase is seen in …