Teaching obstetrics and gynaecology to male undergraduate medical students: student's perception.

BACKGROUND: In Pakistan there is a dearth of male practitioners in obstetrics and gynaecology (ObG) to cater for emergent needs. The Study was done to explore views of male medical students towards ObG as part of curriculum and to identify the problems during clerkship and its impact on selection of ObG as career. METHODS: The study used a 20-item questionnaire-based survey at Shifa College of Medicine from November 2010 to December 2011. Third and fourth year male students (n=124) who completed ObG rotation were the participants. Inquiries were made regarding patient doctor interaction under residents and faculty members, perception of gender- bias during clerkship, inclusion of ObG in curriculum and subsequently as career. Results were analyzed using binary regression analysis. RESULTS: Sixty percent students were satisfied though embarrassed and under pressure during gynaecological examination in consultant supervision. Another 61% said that ObG should be a part of curriculum (p-0.013) and necessary for male students (p-0.008). 62% of the respondents were of the view that faculty has a major role in encouraging the students to take up ObG as career. 84% students replied in negative to adopt it as profession (p 0.002). CONCLUSION: Although basic obstetric curricular objectives are important for medical practitioners, our social set up discourages male students to have concrete clinical interaction. The faculty needs to take a special supportive role to encourage learning and motivation for this specialty.

Emergency contraception: knowledge, attitude and practices among doctors of a tertiary care hospital.

BACKGROUND: In Pakistan maternal mortality rate (MMR) is very high and more than one in five women die from pregnancy related causes; solution to this is to have low fertility rate. The emergency contraceptives (ECs) can be used to prevent unwanted pregnancies. The aim of this study was to assess the knowledge, attitude and practice about ECs among doctors. METHODS: Institution-based cross-sectional descriptive study on knowledge, attitude and practice of ECs was conducted at Rawal Hospital from Feb to May, 2012. Data was collected using structured questionnaire and analysed using SPSS-16. RESULTS: Fifty-seven percent of the respondents were > 30 years of age, 94% were Muslim, 81% were married and 51% were women. Ninety-seven percent had heard of ECs before, only 17% knew Intra-uterine contraceptive device (IUCD) a method of EC. Sixty-one percent responded that IUCD should be removed if patient gets pregnant (p = 0.007) and according to 31% ECs were not abortifacient (p = 0.045). Regarding attitude, 55.5% of the participants supported its use (p = 0.027) and agreed to its easy accessibility (p = 0.004). Thirty-eight percent responded an increased dose of birth control pills as a form of EC (p = 0.008), while 40% did not agree that ECs are effective when taken before intercourse (p = 0.011). CONCLUSION: Knowledge and practice of ECs is very low among doctors but a positive attitude is there. Evidence-based knowledge to family physicians regarding emergency contraception is strongly recommended to reduce the chances of MMR.

Trial of extra amniotic saline infusion with oxytocin versus prostaglandin E2 pessary for induction of labor.

OBJECTIVE: To determine the effectiveness and safety of cost-effective extra-amniotic saline infusion (EASI) and simultaneous intravenous oxytocin infusion versus prostaglandin E2 vaginal pessary (PGE2) for induction of labor. DESIGN: Prospective randomized comparative study. PLACE AND DURATION OF STUDY: Labor room at the Mother and Child Health Centre, PIMS, Islamabad from September 2000 to December 2001. SUBJECTS AND METHODS: Women with singleton alive pregnancies and Bishop score < or =6, requiring induction of labor at > or =37 weeks gestation were randomly assigned to induction either with PGE2 3 mg vaginal pessary in two doses 6 hourly or EASI for 12 hours with simultaneous intravenous oxytocin infusion. Artificial rupture of membranes was done 12 hours post-induction and oxytocin infusion started in PGE2. Main outcome measures were induction delivery interval and the mode of delivery. Secondary outcome measures were the change in modified Bishop score 6 hours postinduction and neonatal outcome in the two induction modes. RESULTS: After 4 exclusions, 100 women were recruited in each arm. Mean induction delivery interval was 11.1 and 14.3 hours (p=.00) in PGE2 and EASI respectively. The cesarean rate was 11% and 15% (p=0.4) in PGE2 and EASI respectively. Mean Bishop score at induction was 3.2 in PGE2 and 3.1 in EASI, while after 6 hours it was 4.8 and 6.8 (p=0.00) respectively. Mean APGAR scores at 1 and 10 minutes were identical that is 6.2 and 8.6 respectively. CONCLUSION: Both the modes of induction were equally safe and effective in terms of the mode of delivery and APGAR score. EASI, however, had more rapid cervical ripening and shorter induction delivery interval.