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All the praises and thanks to Almighty Allah who bestowed His innumerable blessings upon mankind, one of which is known a distinction for mankind. I offer my gratitude to the Holy Prophet Muhammad who preached us to seek knowledge for the betterment of mankind in particular and other creatures in general. This dissertation is the end of my journey in obtaining my Ph.D. degree. This dissertation has been kept on track and seen through to completion with the support and encouragement of numerous people including my all teachers, friends, colleagues and various institutions.

At this moment of accomplishment, first of all, I pay homage to my supervisors Dr. Hussain Ali. This work would have not been possible without his guidance, support and encouragement. Under their guidance, I successfully overcame many difficulties and learned a lot. I am very much thankful for their valuable advice, constructive criticism and his extensive discussions around my work.

I am also extremely indebted to Prof Dr. Gul Majid Khan (Chairman), for providing the necessary infrastructure and resources to accomplish my research work.

Last but not least, I would like to pay high regards to my Father, Mother, brothers, Grandfather, and family for their prayers, sincere encouragement, and inspiration throughout my research work and lifting me uphill this phase of life. I owe everything to them.

Ayesha Tayaba

List of Tables

Table No.


Page No

Table 3.1.

Demographic characteristics of respondents in the study population


Table 3.2

Percentage and Frequency of used medications


Table 3.3. A questionnaire, the percentage, and frequency of responses received



to analyze the use of the tocolytic drug for preterm labor prevention.

Table 3.4.

Frequency and percentage of responses related to contraindications


of tocolytic agents with other drugs and conditions.

Table 3.5.

Frequency and percentage of responses related to goals of tocolysis



Table 3.5.

Frequency and percentage of responses related health barrier in


management of preterm labor

Table 3.6.

Correlation between experience and Study variables


Table 3.7.



Table 3.8.

Principle drug treatment is chosen by obstetricians at different state of the cervix in to arrest preterm labor at 32 weeks gestation and a cervical dilatation of 4 cm


Table 3.9. Principle drug treatment is chosen by obstetricians at different state of the cervix in to arrest preterm labor at 32 weeks gestation and a cervical dilatation of 2cm


Table 3.10. Principle drug treatment is chosen by obstetricians at different state of the cervix in to arrest preterm labor at 28 weeks gestation and a cervical dilatation of 3cm


Figure No.

List of Figures Title

Page No.

Figure 3.1. The frequency of the population based on age groups


Figure 3.2.

Education wise distribution of population studied


Figure 3.3.

Experience wise distribution of population studied.


Figure 3.4.

The job description of the participants


Figure 3.5.

Study diagram shows a response rate of the obstetrician questionnaire



Figure 3.6.

Percentage of medications used in tocolysis.


List of Abbreviations


American College of Gynecologist


Calcium Channel Blockers


Medical officers


National Essential Medicine List


United Nations Children's Fund


Neonatal intensive care unit


Non-steroidal anti-inflammatory drugs



PG- trainee

Post Graduate Trainees


Pregnancy-induced Hypertension


Premature rupture of membranes


Premature preterm rupture of membranes


Preterm birth


Preterm labor


Social Science software version 21


World Health Organization


All over the world Preterm labor is one of the most significant health conditions with multiple medicos psychological and socio-economic risk factors. It is the leading cause of infant morbidity and mortality resulting in substantial healthcare costs. Epidemiological studies have indicated that preterm labor is an increasingly common health problem in Pakistan as in other developing countries. In this research project, our major focus of the study is to examine local ongoing practice patterns of tocolysis for suppression of Preterm Labour. The present research project was a multicenter descriptive observational study conducted in public and private maternity units of Islamabad Hospitals from September 2017 to March 2018. Population size is unknown for statistically sufficient sampling. All doctors in an obstetrical department were approached and asked to complete the questionnaire after a brief explanation. Convenient purposive sampling technique is being utilized for sample collection. The total response rate of the survey was 72 %. Initially, 207 obstetricians wereapproached forthe study and questionnaires were distributed.82% (171/207) of surveys returned 17% (26/150) were of Consultant and 56% (85/150) of Post Graduate Trainee and 28% (87/315) of Medical Officers. Out of 207 respondents, 159 (77%) obstetricians are currently practicing. Incomplete questionnaires 9(4.3%) returned were excluded from the study. We have identified 82% obstetrician claimed routine suppression of preterm labour. Pakistani obstetricians (99%) mainly suppress preterm labour to prolong pregnancy for steroid administration. The data highlights the need for educational, managerial and regulatory interventions to rationalize the tocolytic drug use in Pakistan.