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Absenteeism', among physicians, has been a long-standing issue in Bangladesh, but little is known about the intersection between political structures, health system policy and shortages that drives provider behaviour. Using an in-depth interview guideline 30 interviews were conducted with physicians working in rural and urban facilities through purposive sampling. Data were analysed in Atlas ti and synthesized following Gales framework method. Senior doctors were usually absent due to the lack of opportunities to specialise/dual/private practice in rural facilities. Absence of career progression (especially among junior physicians), inadequate and unsafe living and workplace arrangements, absence of transport facilities, lack of community understanding and ownership, non-cooperation from colleagues and absence of incentives or recognition de-motivated physicians to stay at their posts in rural facilities. Incidences of abuse (verbal/physical) by local community were common with female physicians particularly vulnerable. Disciplinary actions against absenteeism were unclear, and many respondents were unaware of these. Almost all of the doctors wished to move out of rural areas. Those who were successful, used their social and political networks and the payments of bribes to facilitate movement into urban settings. Doctors who did not have access to financial resources or to these networks failed to move out of rural areas and one left the profession.

Introduction: Decreased amniotic fluid volume below the normal range expected for the gestational age is a challenging entity encountered by obstetricians. Normal range of amniotic fluid is Amniotic Fluid Index (AFI) 8-20cm. Amniotic Fluid Index (AFI) is a quantitative estimation of amniotic fluid volume seen and measured by ultrasonography during pregnancy. AFI is the sum of the deepest vertical pocket of fluid, excluding fetal parts and umbilical cord, in four quadrants between the maternal midline vertically and transverse line half way between the pubic symphysis and uterine fundus. Decreased AFI has different etiology, pathophysiology, presentation and effect on fetomaternal outcome. Objectives: To assess the incidence, aetiology, time and mode of delivery as well as to evaluate fetomaternal outcome associated with decreased amniotic fluid. Materials and Methods: Prospective observational study was carried out among 60 cases of pregnancy at 3rd trimester with decreased amniotic fluid index admitted in the Department of Obstetrics and Gynaecology, Combined Military Hospital, Dhaka Bangladesh from October 2012-March 2013. Amniotic fluid index was determined by the four quadrant ultrasonography technique on admission. Variables used are parity, gestational age, AFI, the colour of amniotic fluid, etiology and mode of delivery. Neonatal outcome variables were birth weight, APGAR scores at Iand 5 minutes and admission to the neonatal intensive care unit. Results: This study showed that 6% of the admitted patients were presented with decreased amniotic fluid. Among them 42% were borderline and 58% were severe oligohydramnios. Termination by caesarean section is high especially among the severe oligohydramnios patients 29 of 34. High rate of caesarean section is primarily due to fetal distress 60%. There was no maternal morbidity but there was 32% fetal morbidity. Conclusion: Decreased amniotic fluid volume has no significant effect or maternal morbidity other than increased rate of caesarean section, however there was significant neonatal morbidity mainly due to birth asphyxia, others are neonatal sepsis and meconium aspiration syndrome. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 67-70

Preterm labour & delivery are very challenging obstetric complications encountered by obstetricians. In this study we tried, to determine the incidence, risk factor and pregnancy outcome of patients presenting with preterm labour in Combined Military Hospital. Its a retrospective study in the department of Gynecology & Obstetric, Combined Military Hospital, Chittagong Cantonment from July 2012 to June 2013. Sample size: 116. Inclusion Criteria: Gravid women both primi and multi. Pregnancy of more than 28 weeks duration but less than 37 completed weeks of gestation. Patient is in active labour. Exclusion Criteria: Labour pain started before 28 weeks of pregnancy. Induced preterm labour in any cases like PIH, eclampsia, Preeclampsia, APH, foetal IUGR, etc. Incidence of preterm labour was 22.30% in this study. Preterm rupture of membranes and infection were the commonest causes of preterm labour. Significant risk factor associated with preterm labours in this study are maternal age <20->35 years, low socio-economic condition, lack of proper antenatal care, multiple pregnancy etc. Irrespective of use of a course of steroid neonated mortality was significantly high in babies before 34 weeks. Other perinatal outcomes of preterm labour are birth asphyxia, RDS, neonatal jaundice and septicemia. High incidence of preterm labour being the most serious problem facing our obstetrician. The incidence is higher in our set up, compared to the developed countries. As prevention is naturally best way to combat preterm labour, some modifiable risk factors are identified. Health care provider may encounter maternal age, nutritional status, infection and can identify the target population for betters prenatal care. JCMCTA 2014 ; 25 (2) : 41-45

Introduction: Down syndrome (DS) is the most common chromosomal aneuploidy to result in a live birth. Prenatal diagnosis of the affected fetuses can be performed using variety of sonographic features. Within the 11 to 14 weeks gestational age (GA) window, increased nuchal translucency has been the hallmark for identifying fetuses with Down syndrome. Objective: To estimate the Nasal Bone Length (NBL) of fetuses at 18 to 22 weeks GA in Bangladeshi population and establish the Nomogram of it and finally compare it with that of Caucasian population. Materials and Methods: The prospective observational study was conducted in Aklima General Hospital Limited, Mirpur, Dhaka, Bangladesh in the Feto-maternal Medicine Unit under Obstetrics and Gynaecology Department for tenure from February 2014 to June 2019. After considering the inclusion and exclusion criteria, 500 antenatal subjects married to Bangladeshi partners with singleton pregnancies attending the routine antenatal outpatient department for an anomaly scan (18-22 weeks) were included and followed up in the study. The nasal bone length was measured from the base of the nose closest to the frontal bones to the farthest extent of ossification on the nose. Results: The nasal bone lengths of the fetuses at 18 to 22 weeks were measured in 500 cases where for 19 cases of 18 weeks of GA fetuses have a mean NBL of 4.6 mm, 75 cases of 19 weeks of GA fetuses have a mean NBL of 4.8 mm, 161 cases of 20 weeks of GA fetuses have a mean NBL of 5.1 mm, 169 cases of 22 weeks of GA fetuses have mean NBL of 5.8 mm and 76 cases of 22 weeks of GA fetuses have mean NBL of 6.2 mm which is significantly shorter than those of Caucasian population. Conclusion: The nasal bone lengths of the fetuses at 18 to 22 weeks were significantly shorter to those of the Caucasian population. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 48-50

Introduction: Amniocentesis is a procedure in which amniotic fluid is collected from the amniotic cavity for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. Amniotic fluid contains fetal cells and various proteins and provides valuable information about baby's health. Aim: To evaluate the risk and associated complications during diagnostic amniocentesis. Methods: This prospective study was conducted by performing amniocentesis among pregnant ladies of early second trimester at Dhaka CMH, and Aklima General Hospital Limited, Mirpur, Dhaka from July 2016 to June 2019. A total of 50 patients were selected by age of the patient, history of previous pregnancy outcome, parental haemoglobinopathy and few other factors triggered these cases to be put under this study. Results: No major complications have been observed during and after the procedure because of appropriate pre-operative and post-operative management. Conclusion: There are some common and known risks which are associated with amniocentesis like miscarriage, amnionitis, fetal trauma etc. Through skilled execution with the help of real-time ultrasound guidance and proper pre-operative and post-operative care, we can avoid complications and get benefit from amniocentesis. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 42-45

Introduction: Health care is a continuous care from womb to tomb. Bangladesh has made tremendous achievement in the health sector over the last few decades. Early marriage, perception about pregnancy and high financial cost are the factors for less utilization of health care services. Many other barriers like gender inequality, cultural norms and traditions are important barriers too for seeking reproductive health care services.   Objectives: To further unpack the pattern of dynamic social barriers faced by urban women in accessing reproductive health care services, which in turn may assist the service stakeholders to design programs to overcome the barriers. Materials and Methods: This is a descriptive empirical social study was executed in Dhaka city from January 2019 to April 2019. Interviewer administered face to face in depth interview was employed to collect data from 122 samples, estimated by peer review and picked up by haphazard sampling, from among married women of reproductive age 15-45years. Data were analyzed by SPSS 20. Emic and etic interpretation were done on the information generated. All ethical issues were taken care of. Results: The perceived barriers to antenatal, natal, postnatal care and family planning practices were poverty, ignorance and husband non co-operation. As many as 78.7% respondents were house wives, about 71.0% respondent’s age at marriage was 13- 18 years, 36.1% were qualified up to intermediate level, 53.3% are 25-35yrs age group, 80% received antenatal care, 32% gone for home delivery and 68.7% were unwilling for postnatal care services. The present study found that ignorance and poverty were the main reasons for non-utilizing health care facilities. Conclusion: There is scope to improve the utilization of reproductive health care services of urban women. Social and cultural barriers are more common. Health care services are needed to be scaled up and the health education component should be strengthened in health care delivery system to achieve Sustainable Development Goal (SDG). Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 7-10

Hypocortisolism or hypoadrenalism is well known as Addison’s disease which is a long term endocrine disorder. In pregnancy it requires much awareness and attention of treating physicians. Early diagnosis, adequate supplement of glucocorticoid and mineralocorticoid and fetal surveillance through regular antenatal checkup is essential for pregnant ladies with Addison’s disease. Patients should be counselled appropriately regarding medication, life-style and precautions to be taken in case of infection, operational exposure or any other stress. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 134-137