Post-Partum IUCD insertion is safe and convenient for women to control population-Sadiah Ahsan Pal

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 Pak China MEDCONG proceedings-II

Post-Partum IUCD insertion is safe and convenient
for women to control population-Sadiah Ahsan Pal

Counselling for population control should be done
by all HCPs including Gynaecologist - Dr. Nusrat Shah

KARACHI: One of the scientific sessions during the recently held First Pak-China MEDCONG at Karachi was devoted to Obstetrics and Gynaecology.  In this session, Dr. Fakhera Feroze from London gave details of SAMEO which is based in London. Its objective, she said, was to provide high quality reproductive, maternal and child health. At present only 20-30% of pregnant women in Pakistan are delivered by skilled birth attendants. This organization will have a sub office in Pakistan and Experts will come to Pakistan to train the healthcare professionals including doctors, midwives, and teachers on how to save mothers, children. Obstetrics simulators will be used and the participants will be provided computerized skilled training as Dynamic memory, she opined, is more useful as compared to static memory. During my visit to Pakistan, she said, she was horrified to listen to a young girl who just got married that she has been ordered by her mother-in-law to get pregnant within three months otherwise she will be divorced, she remarked.

Dr. Sadiah Ahsan Pal spoke about controversies regarding post-partum IUCD insertion. At present she said,only 35% of women use Intra Uterine contraceptive Devices or other population planning methods.  Pills are needed immediately to control population while withdrawal was not an effective method. IUD is an alternative to tubal ligation. Immediate post-partum insertionis convenient for women. There are certain myths about IUCD and it is said it causes infertility, miscarriage, cancer, birth defects. She pointed out that it does not go to the heart of brain, there is no pain during sex. There is reduced risk of ectopic pregnancy, it rarely causes pelvic inflammatory disorders. In fact it is safe and it can be inserted within forty eight hours. More than 50% Chinese women use IUDs and China was leader in the use of IUCDs. During the discussion it was pointed out that JPMC has a 27% PPIUCD insertion rate. Cesarean Section rates are very high and it is about 20-40% because of various reasons.

Dr. Nusrat Shah talked about P-sepsis. She pointed out that even in 21st century almost 60% of women in Pakistan are delivered by Dais. P-sepsis is an infection of the genital tract and the patients present with lower abdominal pain and fever. Almost 15% mothers die due to sepsis. Risk factors include anemia, poor nutrition, poverty, prolonged, obstructed labor in addition to socio cultural risk factors like lack of transport. Unclean hands, unsterilized instruments also play havoc. Management of these patients she said consists of an intensive course with triple antibiotics to treat septic shock. Prevention is the better option. As such it is important that Dais and Midwives are trained as they are causing problems and they should be made a part of the healthcare team. She also emphasized the importance of employing skilled birth attendants which remains a big problem in Pakistan even today. These deaths are avoidable. We also need to improve literacy, eliminate poverty and improve nutrition, she added.

Dr. Fakhera Feroze’s second presentation was on NICE Guidelines on Pre-Eclampsia. She discussed the risk factors. Children with HELLP syndrome, she said, should not be treated with steroids. She also briefly spoke about fluidbalance and volume expansion.

Dr. Aliya gave details of PPIUCD during two years from October 2013 to Sept. 2015. It was a project of MCMNH. In this twenty one hospitals were selected form Karachi, Islamabad, Lahore. The staff were trained for PPIUCD. A total of 70, 7166 women attended these hospitals of which 105,744 had deliveries. Of this eighty four thousand women were counselled by the staff. About 68% of these women were approached for counselling for PPIUCD and most of the counselling was done by the MNC staff. The patients accepted the advice from doctors much better as compared to other staff. About 18,512 PPIUCD were inserted which is about 18%. Of this almost 48% insertions were done during the ten months period, 48% during C. Section. They were followed up after six weeks but usually follow up is not common in Pakistan. About 3% expulsion of these IUCDs was noted, 8% had to be removed and the rest 89% continue till to date. She also pointed out that there has been a reluctance from the Head of the Department as counseling they feel is an additional work. There are some challenges. In most hospitals mid-level workers are not allowed to perform deliveries and insertion of PPIUCD. Patients also want to be delivered by senior doctors and get the PPIUCD inserted from them. She felt that family planning services should be available twenty four hours seven days a week at the healthcare facilities and not up to 2.00 PM on working days.

Responding to a question during the discussion Dr. Sadiah Ahsan Pal said that family planning is by choice and the family should think how many children they can afford. Abortion is legal up to sixteen weeks if it threatens the life of the mother and the baby. However, it cannot be used as a birth control measure.

Dr. Wajiha from Green Star Social Marketing gave details of their project promoting family planning with immunization. The patients are given vouchers. They included 28,000 pregnant women and 89% of the vouches they were given were redeemed. Almost 75%of the children were fully immunized. Women whose children were immunized were more likely to take up family planning. It was emphasized that every healthcare professional including obstetrician and gynecologists should do counselling andit is their moral duty. Ethical medical practice also came under discussion and some of the participants were of the view that counselling for family planning should also be done by the gynecologists without any incentives.