Women's Health Commons^™

Long-Term Safety And Efficacy Of Non-Absorbable Abdominal Mesh For Apical Prolapse Surgery: A 10-Year Experience At Tertiary Care Hospital, Samia Aijaz, Novera G. Chughtai, Urooj Kashif, Summera Malik

Department of Obstetrics & Gynaecology

Objectives: To evaluate the complications of apical prolapse correction with abdominally placed mesh and to assess the long-term efficacy of Sacrohysteropexy and Sacrocolpopexy.
Method: A retrospective cohort study was conducted at the Department of Gynecology and Obstetrics, Aga Khan University Hospital. All women who underwent apical prolapse surgery using abdominal mesh from January 2010 to December 2019 at AKUH were included. Patients with missing routine follow up visits and incomplete data up to one year post op were excluded. Patient notes were reviewed, and subjective and objective success and complications were analyzed. Safety was measured by incidence of intra, early …

Knowledge, Attitudes, And Practices (Kap) Towards Covid-19 Pandemic Among Pregnant Women In A Tertiary Hospital In Karachi, Pakistan, Sumaira Naz, Syeda Dur E Shawar, Shamila Saleem, Ayesha Malik, Amir Raza

Department of Obstetrics & Gynaecology

Background: The aim of this study was to evaluate the knowledge, attitude, and practices (KAP) of the pregnant population during the COVID-19 pandemic in a tertiary care hospital.
Methods: This cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. KAP towards COVID-19 was assessed using 21-item questionnaires. A score for each category was calculated and points were summed. The outcome variables of KAP were compared with demographic characteristics. Data were analyzed by using SPSS 19.
Results: A total of 377 patients participated in the study. The majority of the patients were multiparous (36.8%) in the age group of …

Pregnancy Outcomes Of Patients With Ultrasound-Indicated And History-Indicated Mcdonald Cervical Cerclage, Zaibunnisa Memon, Naureen Anjum, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Objective: To assess pregnancy outcomes of patients with ultrasound-indicated and history-indicated McDonald cervical cerclage.
Materials and methods: This was a cross-sectional study of pregnant women who had cervical cerclage performed at Aga Khan University Hospital, Karimabad campus. We obtained Institutional Review Board approval and reviewed the medical records of patients. A purposive continuous sampling technique was used. A total of 88 patients were included. There were no exclusion criteria. Outcome data were collected from the medical record of patients from January 2010 to December 2016.
Results: Analysis reported a statistically significant lower gravidity and parity in the scan-indicated group as …

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Shama Munim

Department of Obstetrics & Gynaecology

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.
Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, …

Adapting The Fast-M Maternal Sepsis Intervention For Implementation In Pakistan: A Qualitative Exploratory Study, Sheikh Irfan Ahmed, Bakhtawar M H. Khowaja, Rubina Barolia, Raheel Sikandar, Ghulam Kubra Rind, Sehrish Rani, Raheela Rani, James Cheshire, Catherine Louise Dunlop, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called 'FAST-M' consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.
Setting: The study was conducted at the Liaquat University of Medical and Health Sciences, which …

Factors Influencing Utilisation Of Services Provided By Community Midwives And Their Non-Retention In District Thatta, Pakistan: A Qualitative Study Protocol, Bakhtawar M Hanif Khowaja, Anam Shahil Feroz, Sarah Saleem

Department of Obstetrics & Gynaecology

Introduction: Drawing on the well-acknowledged evidence of community midwives services to address the issue of high maternal mortality, the Government of Pakistan initiated the Community Midwifery (CMW) programme in 2006 to provide skilled birth attendance to pregnant women living in rural areas. Despite a large investment in CMW programme, the availability of community midwives in rural areas following their training is a constant struggle. The concerns related to the training, support and acceptability of community midwives need to be studied in order to identify gaps in the provision of skilled maternal and newborn healthcare. Therefore, this study aims to explore …

Risk Factors And Compliance Of Surviving Sepsis Campaign: A Retrospective Cohort Study At Tertiary Care Hospital, Farheen Yousuf, Ayesha Malik, Ayesha Saba, Sana Sheikh

Department of Obstetrics & Gynaecology

Background and objective: Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis.
Methods: This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from …

Impact Evaluation Of The Efficacy Of Different Doses Of Vitamin D Supplementation During Pregnancy On Pregnancy And Birth Outcomes: A Randomised, Controlled, Dose Comparison Trial In Pakistan, Sidrah Nausheen, Atif Habib, Maria Asif Bhura, Arjumand Rizvi, Fariha Shaheen, Kehkashan Begum, Junaid Iqbal, Shabina Ariff, Lumaan Sheikh, Syed Shamim Raza, Sajid Bashir Soofi

Department of Obstetrics & Gynaecology

Background: Vitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.
Methods: We conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births …

Evaluation Of The Feasibility Of The Fast-M Maternal Sepsis Intervention In Pakistan: A Protocol, Sheikh Irfan Ahmed, Raheel Sikandar, Rubina Barolia, Bakhtawar M H. Khowaja, Kashif Ali Memon, James Cheshire, Catherine Dunlop, Arri Coomarasamy, Lumaan Sheikh, David Lissauer

Department of Obstetrics & Gynaecology

Background: Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called "FAST-M" for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the …

A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears, Saida Abrar, Raheela Mohsin Rizvi, Urooj Kashif

Department of Obstetrics & Gynaecology

Objective: To perform a clinical audit of the practices related to the management of third and fourth degree perineal tears.
Methods: The retrorspective study was conducted in 2019 at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2008 to December 2018 of women having singleton term vaginal delivery and sustaining obstetric anal sphincter injuries. The change in practices regarding tear management was compared with a previous audit done at the same institution in 2008. Data was analysed using SPSS 20.
Results: Of the 25,370 deliveries, 142(0.56%) sustained obstetric anal sphincter injuries. There was a significant increase …

Determinants Of Short Birth Intervals Among Married Women: A Cross-Sectional Study In Karachi, Pakistan, Sidrah Nausheen, Maria Asif Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, David Canning, Iqbal Shah, Sajid Bashir Soofi

Department of Obstetrics & Gynaecology

Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.
Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were …

Achieving Accurate Estimates Of Fetal Gestational Age And Personalised Predictions Of Fetal Growth Based On Data From An International Prospective Cohort Study: A Population-Based Machine Learning Study, Russell Fung, Jose Villar, Ali Dashti, Leila Cheikh Ismail, Eleonora Staines-Uria, Eric O. Ohuma, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta, International Fetal And Newborn Growth Consortium For The 21st Century (Intergrowth-21st)

Department of Obstetrics & Gynaecology

Background: Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18-36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth.
Methods: …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Uterine Arteriovenous Malformations After Suction Evacuation Of Missed Miscarriage, Arshia Javed, Reeta Chander, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is an uncommon but life-threating source of bleeding. AVM is an abnormal connection between uterine arteries and veins. Patients typically present with vaginal bleeding following miscarriage (medical/surgical) or cesarean section. The treatment of choice depends on the symptoms, age, desire of fertility, localization and size of the lesion. Uterine artery embolization is the first choice in symptomatic patients of reproductive age group. We report a case of AVM presenting after dilation and evacuation with extensive lesion, which was successfully treated with bilateral uterine artery embolization.

Comparison Of Foeto-Maternal Outcome In Pregnant Women With Hepatitis E - A Review Of 12 Years., Tahira Naru, Farheen Yousuf, Ayesha Malik, Sumaira Naz, Humera Ismail

Department of Obstetrics & Gynaecology

Objective: To compare adverse maternal and foetal outcome in pregnant women with hepatitis E immunoglobulin M reactive versus non-reactive.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of pregnant patients at any gestational age with clinical and biochemical evidence of hepatitis E from January 2002 and December 2014. . Maternal and perinatal outcome of the subjects were analysed. SPSS 20 was used for data analysis.
Results: Out of the 200 subjects, 168(84 %) were hepatitis E immunoglobulin M reactive and 32(16%) were non-reactive. The overall mean age was 26.7±4.5 years. Also, 12(7%) …

Implementation Of Warning Tool To Improve Maternal Newborn Health Outcomes In A Developing Country, Sana Sheikh, Rahat Qureshi, Sidrah Nausheen, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Objective: To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours.

Methods: This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively.

Results: Of the 200 participants, there were 100(50%) in each group. The overall mean age was …

Maternal And Fetal Outcome In Renal Transplant Recipients, Wajeeha Syed, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To determine maternal and fetal outcome in renal transplant recipients.
Methodology: Retrospective analysis of the antenatal patients with renal transplant
was done between January 1st 2005 till December 31st 2015 and maternal
and fetal outcomes were determined. Data was entered and analyzed in SPSS
version 20.
Results: 08 pregnancies in 07 women who had undergone renal transplant
were included in this study. The mean age at the time of transplantation was
25.29 ±5.5 years (16-32 years). 25% cases had gestational diabetes mellitus,
75% had anemia and 50% had urinary tract infection. The mean birth weight
of babies was 2210 …

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

Is Risk Malignancy Index A Useful Tool For Predicting Malignant Ovarian Masses In Developing Countries?, Aliya Aziz, Nida Najmi

Department of Obstetrics & Gynaecology

Introduction: Risk of Malignancy Index (RMI) is widely studied for prediction of malignant pelvic masses in Western population. However, little is known regarding its implication in the developing countries. The objective of this study is to determine how accurately the RMI can predict the malignant pelvic masses.

Materials and Methods: The study is a retrospective review of patients attending the gynecological clinic between January 2004 and December 2008 with adnexal masses. Information on demographic characteristics, ultrasound findings, menopausal status, CA125, and histopathology was collected. RMI score for each patient in the study group was calculated.

Results: The study …

A Risk Prediction Model For The Assessment And Triage Of Women With Hypertensive Disorders Of Pregnancy In Low-Resourced Settings: The Minipiers (Pre-Eclampsia Integrated Estimate Of Risk) Multi-Country Prospective Cohort Study, Beth A. Payne, Jennifer A. Hutcheon, J. Mark Ansermino, David R. Hall, Zulfiqar Ahmed Bhutta, Shereen Z. Bhutta, Christine Biryabarema, William A. Grobman, Henk Groen, Farizah Haniff, Jing Li, Laura A. Magee, Mario Merialdi, Annettee Nakimuli, Ziguang Qu, Rozina Sikandar Sultanali, Nelson Sass, Diane Sawchuck, D. Wilhelm Steyn, Mariana Widmer, Jian Zhou, Peter Von Dadelszen

Department of Obstetrics & Gynaecology

Background: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.

Methods and Findings: From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …

Silent Uterine Rupture Of Scarred Uterus--An Unusual Presentation As Amniocele, Aisha Syed Wali, Tahira Naru

Department of Obstetrics & Gynaecology

Obstetricians should be aware of the possibility of silent rupture of scarred uterus. Ultrasound has an important role in the diagnosis of silent uterine rupture. A case of silent uterine rupture with foetal demise, that remained undiagnosed for many weeks, is described.

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 …