Clinical proceedings of the CRAFT conference on Human Reproductive Health


  Clinical proceedings of the CRAFT
conference on Human Reproductive Health

LAHORE: Society for Human Reproductive Health in collaboration and CRAFT organized its conference here from May 27th to May 29th 2022 which was very well attended. Prof. M. Arshad Chohan was the chief organizer and scientific programme of the conference was spread over many Plenary sessions, Consensus Meeting besides workshops. The conference started with Workshops on Friday. There were three workshops on Complicated Labor, Instrumental delivery, shoulder dystocia, episiotomy repair and 4th degree perineal tear for which facilitator was Prof. Farhat Naz.

Group Photograph shows some of the speakers at one of the plenary sessions during the
CRAFT 2022 conference. Prominent among those include Prof. Arshad Chohan,
Dr. Saqib Siddique, Prof. Shaheena Asif, Prof. Farrakh Zaman and others.

Dr. Khalida Waheed facilitated the workshop on POP –Q classification and its clinical application while facilitator for workshop on Reconstructive Surgery for Mullerian Abnormalities was Prof. Arshad Chohan. Dr. Amina Zia Eusaph facilitated the workshop on Liquid Based Cytology and Abnormal Smear Management. This was followed by a Consensus meeting on Ill effects of DAI treatments for which facilitators included Prof. Aisha Malik, Prof. S. Anwar. It was attended by numerous Key Opinion Leaders in this field.

In the morning session on Saturday there were three keynote lectures and the speakers included Prof. Farakh Zaman who spoke on Maternal/perinatal mortality and gave Pakistan perspective. He also shared tips on how we can reduce it the under privileged area of Pakistan. Prof. Shaheen Zafar’s presentation was on Who is PCO and how such patients should be treated. Prof. Rubina Sohail discussed Multidisciplinary approach: Are we shifting our skills to other disciplines? In the next session Dr. Saqib Aziz from Punjab Healthcare Commission talked about Improving quality of care assuring patient safety in high risk of obstetrics and Gynaecology. He discussed in detail the safety of high risk medications, operating on the correct site, using correct procedure. He was of the view that we wish to achieve Internaitonal patient safety goals in Pakistan. Apart from clinical cases and scenario, mistakes can also be made on the management side hence all aspects need to be looked after to ensure patient safety. He also highlighted the importance of Patient Rights and patient education, hospital infection control, management of medications. Timely diagnosis of high risk cases in obstetrics is also extremely important. Diagnostic errors, procedures performed by unskilled staff, unsafe blood transfusion, DVT besides ineffective communication can also lead to increased morbidity and mortality which could compromise patient safety, he added.

Dr. Saqib Siddique was the next speaker who talked about what is new on the horizon of assisted reproductive techniques? Apart from IVF, he mentioned ICSI, PGO gastric engineering, cloning, NIPT, ovarian implants. He also referred to three parent baby in which the third parent is DNA. He then talked about stem cell technology.

Prof. Shaheena Asif an eminent obstetrician & gynecologist from Lahore Medical & Dental College
was one of the guest speakers at the CRAFT 2022 conference on Human Reproductive
Health held at Lahore recently. Photograph taken during the conference shows from (L to R)
Prof. Attiya Bari, Prof. Tayyaba Waseem, Mr. Shaukat Ali Jawaid, & Prof. Shaheena Asif.

Prof. Shahina Asif was the next speaker who mesmerized the audience with her life story and shared in detail how she has been defeating death during her adventurous life journey. She pointed out that her father was in Army who used to do poetry in English while her mother used Urdu language for her poetry. We had a very academic environment in our home. When I was born, there was severe cyclone which was an indication that Shahina Asif was born. I was born in CMH and my mother had severe bleeding and thrombosis but I was saved of any harm. Then in childhood I used to have lot of headache and whenever complained to my parents, they did not pay any attention and asked me to go and study. I used to vomit the food but then I was forced to eat. However, I used to go and vomit it again. One day I insisted to my mother that I was having severe headache and I cannot concentrate on studies. I was sent to MI room in CMH where luckily a young Capitan listened to me carefully, took detailed history and then opined that I need to be examined by a Neurosurgeon. He referred me to the Neurosurgeon. A lesion was found and I had neurosurgery to overcome my problem with headache. She emphasized that the message here was that whenever patient says something, we must listen to them carefully but we are most of the time too busy and are quick to come to the diagnosis and write prescription.

She amused all those present in the hall when she said that I was very fond of getting married and I often used to ask my family when I will get married. Then on the day I got married, we were travelling in a car to go home when our car had a major accident and everybody got serious injuries but I escaped any harm once again. After graduating I joined Army and served there for one year as a Capitan. My family used to ask me what I do and I will tell them that I do surgery. They were not comfortable with the fact that I had to examine and treat male patients and there was always lot of discussion on this which polluted the home atmosphere to some extent. These, Prof. Shahina Asif remarked are some of the professional hazards the female doctors have to face in particular.

Continuing Prof. Shahina Asif said, she went to England for postgraduate training. I had two daughters. I had s subtotal hysterectomy. Just like cat has nine lives I escaped death numerous times in my life. When I returned to Pakistan, late Prof. Hajira Haneef removed my cervix and uterus. Then I had lump in my left breast. I had biopsy in Cancer Hospital and nodule was resected. I was on chemotherapy for two years and it had its own complications and adverse effects. I lost most of my hair. I served in Allama Iqbal Medial College, King Edward Medical College. After some time, I decided to go to Thailand for holiday and as the luck would have it, soon after takeoff, the pilot announced that there is some technical fault in the areophane and we are going back to Thailand and will have to attempt belly landing. The plane had belly landing on foam and it was a miracle that I escaped any harm this time too. I was fond of cars and had bought an expensive car. One day some people who were perhaps following me, decided to snatch the vehicle. I suddenly felt that someone had grabbed me from behind and was pressing my breasts. I tried to fight it out, injured him through my teeth, he was bleeding but then suddenly I realized that he was not alone but few other people were also standing at a distance. One of them fired in the air to scare me and when they were trying to flee I got hold of one of them my leg. They fired again near me not to kill me but frighten me and took away the vehicle an my purse. I lodged a complaint FIR in the police station just nearby. What was most surprising was the fact that while I was fighting with the robbers, people standing nearby did not intervene. Later on they said, they thought perhaps it was some domestic dispute.

I identified the man later who had snatched the vehicle who was the brother of sitting Member of the National Assembly. I was posted in Bahawalpur. When Mr. Tariq Basheer Cheema’s wife came for consultation, I told them the whole story who promised to help me. My vehicle was traced but then the Judge while signing the papers asked me what will be the price of this vehicle? On listening the price, he refused to sign the papers and wished to be paid some amount. I took him to task and I was reminded that he is a Judge to which I said, he is not a Judge but a criminal that is how the situation is in Pakistan and how the police and other government functionaries work, she remarked.

I pioneered to establish Surgimed Hospital, later established Lahore Medical & Dental College the first private medical college in Lahore with the help of other colleagues. I again had a head injury when I fell due to load shedding as the light had just gone and there were few minutes before the generators could start. I had surgery. Fracture of my shoulder seriously affected its movements and that is how I have suffered throughout my life one tragedy after the other but survived. Then a time comes in one’s life when you have everything that you wish in life. I had everything and so I got myself engaged in charity work. That is how the Charity Champions started, she remarked.

In the next session Prof. Shamsa Humayun highlighted the role of Doppler in FGR. She pointed out that in case of normal umbilical artery flow, don’t consider delivery. However, if CTG shows late deceleration then go ahead and deliver the baby. She also talked about abnormal venous flow, various Doppler studies which are helpful to decide when to intervene. After thirty-two weeks, the positon is easy. Every effort, she stated, must be made to avoid un-necessary C. Sections.

Prof. Farid Al-Zafar another noted obstetrician and gynecologist in his presentation highlighted the fact that Pakistan was 7th in the prevalence of IUGR. Use of alcohol which is not much prevalent in Pakistan, smoking are the known risk factors. Delivery he opined, should be customized for individual patient. He discussed in detail the risk factors i.e. age of mother more than thirty-five years, better antenatal care is extremely important. Late marriages, cousin marriages have their own consequences. He highlighted the importance of early assessment of high risk patients, good antenatal care of all high risk pregnancy, pre-pregnancy counselling, booking visit, risk assessment, use of progesterone, HCG, Metformin and use of supplements. During the year 2020, we had 471 babies with IUGR while it increased to 670 in 2021. He also discussed the causes of IUGR in the patients at Lahore General Hospital in this study.

Prof. Rubina Sohail in her presentation on climate change and its effects on maternal and neonatal health referred to the water crisis throughout the world and in Pakistan in particular. It is because of water shortage that this year we had less production of wheat and mango crops. Non-communicable diseases were spreading like an epidemic. We have a large elderly population, pregnant women. She made a passionate plea to increase the quality of air in the country, overcome pollution which are extremely important to improve maternal health and wellbeing. Deteriorating water quality will also increase water borne diseases. Climate change, she stated, will adversely affect the mother and newborn. We are likely to have eighty thousand more cases of malaria. We talk about poor quality of maternal and neonatal health in Africa but we might see a similar situation in Pakistan if we failed to take some timely measures, she warned. She then discussed the strategies to deal with pre-term births, low birth weight babies. Each one of us should become an advocate for climate change to ensure health and wellbeing of mother and children. We need multisectoral approach, let us work together to work on capacity building, empower women and work for a Green World, she remarked.

A number of other important topics were discussed by the speakers in the other concurrent sessions. There were sessions on Diabetes Mellitus, workshop on postpartum hemorrhage and the Bundle approach, keynote lectures on Endoscopic surgery in pelvic pathology, recurrent miscarriages and how to counsel the couples who is suffering, Normal delivery vs C. Section, workshop on Assisted Reproductive Techniques, Consensus meetings on Contraception, Antenatal Care. Prof. Tayyaba Waseem discussed management options in Fibroid and how to counsel the patients.

On last day of the conference, there was workshop scheduled on endoscopic surgery, Consensus meeting on prolonged pregnancy, Hypertensive disorders of pregnancy, Session on Anemia, workshop on Placenta Accretia- an innovative suturing technique. Other topics which were scheduled to be discussed by various speakers included Endometriosis and infertility, PCO and Infertility, Hypothyroidism in pregnancy, maternal and fetal complications for COVID19, Endometrial cancer and total mesometrial resection, its impact on disease free survival, morbidity associated with scar pregnancy etc.

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