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Category Title
ROLE OF LIGNOCAINE JELLY APPLICATION TO ALLEVIATE VAGINAL PAIN DURING 1ST TRIMESTER MTP UNDER LOCAL ANAESTHESIA
Jignesh J kansarial, SV Parulekar
A study of application of lignocaine jelly to alleviate vaginal pain during 1st trimester MTP under local anaesthesia was undertaken in 100 primigravidas. Signi.cant pain relief was achieved by this method on analyzing vaginal pain score before and during MTP, and patient satisfaction score after MTP. INTRODUCTION
Uterine cramps is a common complaint d u r i n g first trimester medical termination of pregnancy (MTP) by suction and evacuation (S and E) technique done under paracervical block (when the anaesthesia is inadequate). But a more frequent complaint is vaginal discomfort and pain, which has no relation with adequate paracervical block. We studied patients who underwent first trimester MTP with paracervical block and used liberal adequate amount of 2% lignocaine jelly to alleviate vaginal pain and discomfort. The outcome of the use of lignocaine jelly applied locally to the vagina, in terms of vaginal pain score and patient atisfaction score was assessed.MATERIAL AND METHODS
One hundred patients who desired .rst trimester MTP for varying indications were selected. These patients were all primigravidas, with h/o MTP in the past, the gestational age was 12 weeks or less. All the patients had normal vaginal caliber and no e/o vaginitis. They were counselled regarding MTP under local anaesthesia and willingly opted
for MTP under local anaesthesia. Haemoglobin and counselling.AIMS OF THE STUDY
1. To study the incidence of Contraceptive (TL and IUCD) awareness in eligible multiparous women.
2. To study the adequacy of the awareness.
3. To study the source of awareness.
4. To study the relationship of refusals for contraception (TL and IUCD) with time of awareness.
MATERIAL AND METHODS
A prospective cross sectional study was carried out for 765 women over a period of three months from Aug-Oct 2001 at LTMGH Sion, a major teaching institute and 1416 bedded tertiary centre, Mumbai, India.Table 1 shows a high (95%) refusal for sterilisation in the twenty to twenty .ve younger age group and a lower IUCD refusal compared to the other two age groups. The more than 30 years age group has high refusals for sterilisation and
IUCD and this group is less receptive to changes in contraceptive methods. Hence it is imperative to motivate the women during their formative reproductive years (i.e. less than thirty years of age) for sterilisation - Counsel them when young. After thirty years though the family size is completed, decision to undergo sterilisation is not readily arrived at, and the trend to use IUCD prevails.
Marital span, children status (L = Living issue) and distribution of refusals
As shown in Table 2 sterilisation refusals are highest (99%) in three years marital span with two living issues and in .ve years duration with two and four living issues. In more than eight years duration with more than 6 living issues, the sterilisation refusal is 100% which re.ects the Indian scenario where even today, these women defer sterilisation
and use IUCD and cannot exercise their independent contraceptive choices.In the four to five years marital span group, sterilisation refusal is seen higher in two living issues than in three living issues which also depicts that the two family norm has not yet seeped in and there is a want of the third child. IUCD refusals are also high in the four to .ve years marital span group with three living issues and in .ve to eight years marital span group with two living issues, though the sterilisation refusals are less in the former than the later group. It is these groupsthat need focused attention and counseling. Education wise status and refusals There were 74% refusals in the illiterate group vs 26% in the literate group (Table 3) in our series as ompared to the NFS-2 series which were 57% and
43% respectively.1 However the level of education studied was only to high school level in the NHFS-2 study. As the level of education increases, the incidence of refusals decreases. Education has a vital role to keep contraceptive refusals at bay, which also supports the Retherford study.
higher in two living issues than in three living issues which also depicts that the two family norm has not yet seeped in and there is a want of the third child. IUCD refusals are also high in the four to .ve years marital span group with three living issues and in .ve to eight years marital span group with two living issues, though the sterilisation refusals are less
in the former than the later group. It is these groups that need focused attention and counseling Education wise status and refusals There were 74% refusals in the illiterate group vs 26% in the literate group (Table 3) in our series as compared to the NFS-2 series which were 57% and 43% respectively.1 However the level of education studied was only to high school level in the NHFS-2 study. As the level of education increases, the incidence of refusals decreases. Education has a vital role to keep contraceptive refusals at bay, which also supports the Retherford study.2
Contraceptive awareness
All the women under study in our series admitted to be aware of the contraceptive methods available, similar to the NFHS-study 98-99 that showed 98% awareness.3 Of these only 22% had adequate know how of sterilisation and IUCD and 78% had inadequate information. Source of contraceptive awareness Tracing the source of awareness as depicted
in Table 4 in our series, spouse and media have been poor contributors as a source of contraceptive awareness. Refusals were minimum when thesource was spouse, inlaws and hospital. However refusals were maximum when the source was media, neighbours and friends. This can be attributed to the fact that even if the source is neighbours, family and media, the spouse and inlaws have a major role in decision making of contraceptive choices and women cannot exercise their independent choices for family planning method.
Time of contraceptive awareness
Fig. 1 shows that the earlier the awareness is obtained in the reproductive career, i.e. before marriage or the .rst pregnancy and even before the current pregnancy and even at the .rst early antenatal visit, the contraceptive refusals are low i.e..33.3%, 28.9%, 41.5% and 58.6%. A dip in graph at 44.24% suggests that counseling for more than two occasions in antenatal visit prepares the women to decide the contraceptive method. Postnatal counseling have the highest refusals. Postnatal period is one where the woman has experienced freshly the child birth process and even though may have decided not to go through the process again, gives way to family pressures of want of another child. This revolves around the social culture of the Indian women who put everybody else before herself even in the contraceptive decisions. The in.uence of inlaws is so strong that the couple cannot withstand this in.uence even in the postpartum period. Hence antenatal counseling must include the spouse and/or inlaws in tertiary setups and a
change in the antenatal setup is mandatory, where the relatives or spouse accompanying are not kept out of the antenatal clinic doors.
CONCLUSION
1. Refusals are common in twenty to twenty-.ve and more than thirty year age group. Marital span of > 5 years and illiterate group. Education plays a key role.
2. Contraceptive adequacy is only 22% and it needs improvisation by use of scientific content as information through media sources like documentaries shown in TV/Cable/Theatres/Hoardings at cross roads, bus, railway station,
health articles and talks through newspaper, magazines and radio involving the corporate two occasions in antenatal visit prepares the women to decide the contraceptive method. Postnatal counseling have the highest refusals. Postnatal
period is one where the woman has experienced freshly the child birth process and even though may have decided not to go through the process again, gives way to family pressures of want of another child. This revolves around the social culture of the Indian women who put everybody else before herself even in the contraceptive decisions. The influence of inlaws is so strong that the couple cannot withstand this influence even in the postpartum period. Hence antenatal counseling must include the spouse and/or inlaws in tertiary setups and a change in the antenatal setup is mandatory, where the relatives or spouse accompanying are not kept out of the antenatal clinic doors.
CONCLUSION
1. Refusals are common in twenty to twenty-.ve and more than thirty year age group. Marital span of > 5 years and illiterate group. Education plays a key role.2. Contraceptive adequacy is only 22% and it needs improvisation by use of scientific content as information through media sources like documentaries shown in TV/Cable/Theatres/Hoardings at cross roads, bus, railway station, health articles and talks through newspaper, magazines and radio involving the corporate
3. Amongst the various sources. Inlaws, spouse and hospital ensure lesser refusals. Media itself was a poor contributor as a source. Friends and neighbours are not potential sources as they cannot withstand spouse and relatives influence.
4. Earlier the awareness in the reproductive career lesser are the refusals hence counsel them when young. Postpartum counseling have maximum refusals hence counsel early in pregnancy and ensure repeat reminders.
ACKNOWLEDGEMENTS
We express or gratitude to our Dean Dr ME Yeolekar who has permitted to publish our hospital data. We thank our Head
of the Department Dr Mrs VR Badhwar who has been the force behind our efforts and all those women who opened to us freely their minds, constraints and desires, without which the study would have been incomplete.REFERENCES
1. Socio-Economic differentials in current use of FP Methods:NFHS2 1998-99 National Report India: International
institute for Population Sciences: 134-5.
2. Retherford and Ramesh et al 1996, Fertility and contraceptiveuse in Tamil Nadu, Andhra Pradesh, Uttar Pradesh National FHS Bulletin No. 3, Mumbai: International institute for population Sciences and Honolulu East-West Center.3. Knowledge of FP methods: NFHS 2 1998-99 National report India: International institute of population sciences:sector.
3. Amongst the various sources. Inlaws, spouse and hospital ensure lesser refusals. Media itself was a poor contributor as a source. Friends and neighbours are not potential sources as they cannot withstand spouse and relatives influence.
4. Earlier the awareness in the reproductive career lesser are the refusals hence counsel them when young. Postpartum counseling have maximum refusals hence counsel early in pregnancy and ensure repeat reminders.
ACKNOWLEDGEMENTS
We express or gratitude to our Dean Dr. ME Yeolekar who has permitted to publish our hospital data. We thank our Head
of the Department Dr Mrs. VR Badhwar who has been the force behind our efforts and all those women who opened to us freely their minds, constraints and desires, without which the study would have been incomplete.
REFERENCES
1. Socio-Economic differentials in current use of FP Methods: NFHS2 1998-99 National Report India: International
institute for Population Sciences: 134-5.
2. Retherford and Ramesh et al 1996, Fertility and contraceptive use in Tamil Nadu, Andhra Pradesh, Uttar Pradesh National FHS Bulletin No. 3, Mumbai: International Institute for population Sciences and Honolulu East-West Center.
3. Knowledge of FP methods: NFHS 2 1998-99 National report India: International Institute of population sciences:
HAEMATOLOGICAL CHANGES SIGNAL OUTCOME IN SARS PATIENTS
Lymphopenia was present in 98%, neutrophilia in 82%, and thrombocytopenia in 87%. Also, low CD4 and CD8
cell counts and a high concentration of lactate dehydrogenase at presentations were associated with adverse outcome. Depletion of lymphocytes, which was found in various lymphoid organs at postmortem examination, may be a good.
BMJ, 2003; 326 : 1358.
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