Objectives: To find out common causes of reduced fetal movements. The purpose is to reduce perinatal morbidity and mortality. Methodology: This Prospective, Observational study was conducted at Izzat Ali Shah Maternal and child health center, unit III Gynae, Wah medical college Wah Cantt, from January 2019 to December 2019. A total of participants 160, who presented in the antenatal outpatient or emergency department with reduced fetal movements, were included in the study. Patients in the active phase of labor were excluded from the study. Patients were followed up till delivery. All necessary information, investigations, and examination points were noted on the predesigned proforma. Data were analyzed by using SPSS version 22. Results: Out of a total of 160 patients, 144 had alive and stable babies. Regarding the age group, out of 160, six patients were teenagers (3.75%), 98 (61.25%) were between 20-30 years, and 55(34.3%) were in the age group of 30-40 years. Regarding gestational age at presentation, 27 out of 160(16.8%) were between 30-35 weeks, 133(83.12%) was at 36-40 weeks. None of the patients presented below 30 weeks. Concerning the number of pregnancy, primigravida 82(51.25%), 60(37.5%) were multigravida, and 18 (11.25%) was grand multipara. Regarding medical history, anemia was seen in 31 patients (19.37%), pregnancy-induced hypertension in 20(12.5%), and 65 %( 104) has no significant medical history. Concerning past obstetrical history, 107(66.8%) fell under low-risk pregnancies, 18(11.25%) had previously normal deliveries but 08(05%) patients had H/O still births. Regarding placental position, 71(44.37%) had anterior, 71(44.37%) had posterior, and 18 (11.25) had fundal placenta. Regarding UAD, 136(85%) had normal umbilical artery Doppler, 13(8.12%) had altered, 06(3.75%) were Absent and 05 (3.12%) has reversed end diastolic flow. During study, 78(48.7%) had normal AFI, 69(43.12%) has Oligohydramnios, 10(6.25%) anhydramnios, while only 03(1.87%) had polyhydramnios. Regarding birth weight, 122(76.25%) had average weight, 32(20%) were low birth weight and 05(3.12%) were very low birth weight. 61(38.12%) went into NICU, while 99(61.8%) no admission required. Conclusion: Most common risk factor or cause of reduced fetal movements was reduced liquor, (79). Out of which 69 remained alive and stable after birth, while 15 had early neonatal deaths. The second cause found was abnormal umbilical artery Doppler,(24). Out of which, 14 had early neonatal deaths and intrauterine deaths. This study showed the increased obligation of care required by patients with decreased fetal movement. Although the number of live births is more as compared to demise, it results in increased neonatal unit admission rates, higher induction and cesarean section rates, higher surveillance demands, and an increased financial burden on parents. It signifies the need for more vigilance in this area of practice. But we can’t neglect the perception of a mother. Mother’s feelings are more important than any other test.
Background: Shivering is a normal physiologic protective mechanism of the body, which in response to core hypothermia, increases metabolic heat production that results in involuntary, oscillatory muscle activity. Spinal anesthesia promotes redistribution of body heat from central to the peripheral compartments. After spinal anesthesia shivering occurs in 40-60% of patients. Tramadol is synthetic codeine analog that is weak Mu opioid receptor agonist. It also has effect of norepinephrine and serotonin reuptake inhibition. It proves to be more effective in prevention and treatment of shivering and it also has less side effects then Mu opioid agonists. Objective: To compare the outcome of hyperbaric bupivacaine alone, with combination of hyperbaric bupivacaine and tramadol to prevent frequency of shivering in spinal anaesthesia. Study Design: Randomized clinical trial study. Place and Duration of Study: Department of Anaesthesiology & Gynaecology, POF Hospital, Wah Cantt, HIT Taxilla and Izzat Ali Shah Hospital, Wah Cantt from 1st December 2018 to 31st December 2020. Methodology: One hundred and 100 patients were included and divided into two equal groups. Patients in Group A received 2ml of 0.75% hyperbaric bupivacaine (15mg) and group B received 2ml of 0.75% hyperbaric bupivacaine (15mg) and preservative free tramadol (10mg, 0.2ml) in spinal anesthesia. Results: There were 13 (26%) female patients in group A and 37 (74%) male patients. In group B there were 35 (70%) male patients and 15 (30%) female patients. The mean age in group A was 42±8.05 years and 42±8.02 years in group B. Thirty two (64%) in whom shivering was present and 18 (36%) no shivering accrued in group A while in group B, 11 (22%) in whom shivering was present and 39 (78%) no shivering accrued (P<0.05). Conclusion: Post-anesthetic shivering appeared to be present in post spinal anaesthesia patients very commonly. Administration of tramadol has proved to significantly reduce incidence of shivering. More studies still need to be done on tramadol to confirm its efficacy in preveting and stopping shivering without systemic effects on patients. Keywords: Spinal anaesthesia, Bupivacaine, Tramadol, Shivering
Aim: To compare the adequacy of Pap-smear in the same patient obtained by Ayer’s spatula and cytobrush. Study design: Comparative cross-sectional study Methodology: One hundred and fifty patients were enrolled. Each patient was subjected to both the tools i.e. cytobrush and Ayer’s spatula. Results: The mean age was 41.6±10.4 years. 83.3% of patients using Ayer’s spatula while 94.7% was using cytobrush and statistically the significant (P=0.002) results were found. Conclusion: Sampling with cytobrush resulted in better percentage of adequate samples as compared to Ayer’s spatula. Keywords: Cervical cancer, Cervical cancer screening, cervical cancer screening techniques
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