The Impact of use of Modified WHO Partograph on Labour Progress and Delivery: Outcome among Spontaneous and Induced Labour in Nulliparous Women at Term

Labour is a normal physiological process considered by a progressive rise in frequency, intensity, and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Spontaneous or Induced labour has a significant role in the eventual mode of delivery and neonatal outcome. This study aims to compare mean duration of labour and maternofoetal outcome of spontaneous versus induced labour among nulliparous women. This was a prospective observational study conducted in the Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2016 to September 2017. The study was conducted in nulliparous women coming at term (38-41) weeks in active phase of labour (with cervical dilatation at least 4cm) either spontaneous or induced, both group of labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery, and the maternofoetal outcome. A total of 160 women were enrolled in this study into two groups. There was no difference in mean age group, but BMI and gestational age were noted significant (p=0.001) More women had spontaneous normal vaginal delivery among those with spontaneous labour (86.25% vs. 78.75%). The mean duration of the second stage of labour was significantly more in induced (17.65 minutes) than in spontaneous labour (14.78 minutes) with a significant P-value (p=0.001). The mean Apgar score between the groups showed almost same. No statistically significant difference was found (p>0.05). This study prevailed that, requirement of oxytocin for augmentation of labour and mean duration of labour was less in spontaneous group and most of the patient delivered vaginally but in induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. We observed that induced labour can be a safe procedure among nulliparous women if labour is monitored by modified WHO partograph.

Treatment Seeking Practices and Etiology of Infertile Couples in Bangladesh

Infertility is a major reproductive health problem, at least in part, a cultural problem also. In developing countries like Bangladesh, infertility is a devastating experience for a couple, particularly in women. For this reason many women suffer from many social and medical consequences. Most of the infertile patients of Bangladesh have no access to adequate comprehensive treatment. Also due to lack of proper knowledge, some couples use varied traditional methods and religious practices. This study was done to assess the treatment seeking behavior of infertile couple and also to find out the gross causes of infertility of patients attending at Motherhood Fertility center, Dhaka, Bangladesh. This prospective study was done over 3 years from June 2016 to June 2019. Two thousand two hundred and fifty (2250) patients attending a secondary infertility center at Dhaka were included in this study. Out of 2250 infertile patients 56.00% were rural and 44.00% urban. Of 737 (58.49%) rural and 658 (66.46%) urban infertile patients had consulted with General practitioner and Gynae specialist before coming to secondary and tertiary care center. Out of 1260 rural, 463(36.75%) and 990 urban, 291 (29.39%) had visited the infertility center as the first choice for treatment. Still about 8.8% infertile couple visited quacks and traditional healers for solving infertility. The overall primary and secondary infertility were 67.69% and 32.31% respectively. In 12.57% couples, male factor was the obvious cause (azoospermia and abnormal semen parameters). In 27.43%, female factors and in 28.0% couples both male and female had obvious reasons responsible for infertility. Thirty two percent (32.00%) cases were unexplained infertility. Out of female factors 43.00% anovulation, 29.00% tubal factors, 11.00% endometriosis, 5.00% Uterine factors, 2.00% POF (premature ovarian failure) and 10.00% others (Thyroid disorder, DM, Hyper-prolactinemia, Luteal phase defect). Infertility is an important health problem in Bangladesh. Etiology of infertility varies from regional, social and cultural conditions so that it requires proper diagnosis and then treats this problem accordingly. It is necessary to build up proper referral system and also proper training should be needed to service provider and traditional healers. Reproductive technology should be widely available in our society where motherhood is one of the most desired stages of a women's life.

Feasibility and Safety of Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Thalassemia in Bangladesh

Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia. All CVS are done at Fetal Medicine Centre, Family Foundation, Green Road, Dhaka, Bangladesh from June 2013 to December 2016. A total of 236 couples who were referred for prenatal diagnosis of thalassemia (Beta thalassemia & Hb-E beta thalassemia) were studied. Transabdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. Most procedures were done between 11 and 13 weeks (range 11-14 weeks). All CVS were performed with the "2 operators" technique. The samples were sent for prenatal diagnosis by genetic analysis. Results were recorded and analyzed for descriptive statistics. Out of 236, 123 (52.1%) fetuses were diagnosed as trait (Beta trait or HbE trait), 64 (27.1%) as healthy fetuses and 49 (20.7%) as affected fetuses. A total of 236 CVSs were performed as outdoor basis. Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% & 1.3% respectively which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases. Transabdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis of beta thalassaemia in early pregnancy without significant risk to the mother and the fetus.