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Acknowledgments

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.

Title

Page No

Table 3.1.

Demographic characteristics of respondents in the study population

16

Table 3.2

Percentage and Frequency of used medications

21

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

23

 

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

Table 3.4.

Frequency and percentage of responses related to contraindications

27

of tocolytic agents with other drugs and conditions.

Table 3.5.

Frequency and percentage of responses related to goals of tocolysis

29

treatment.

Table 3.5.

Frequency and percentage of responses related health barrier in

31

management of preterm labor

Table 3.6.

Correlation between experience and Study variables

32

Table 3.7.

Correlations

34

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

35

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

36

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

37

Figure No.

List of Figures Title

Page No.

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

18

Figure 3.2.

Education wise distribution of population studied

18

Figure 3.3.

Experience wise distribution of population studied.

19

Figure 3.4.

The job description of the participants

20

Figure 3.5.

Study diagram shows a response rate of the obstetrician questionnaire

survey.

21

Figure 3.6.

Percentage of medications used in tocolysis.

22

List of Abbreviations

ACOG

American College of Gynecologist

CCBs

Calcium Channel Blockers

MO

Medical officers

NEL

National Essential Medicine List

UNICEF

United Nations Children's Fund

NICU

Neonatal intensive care unit

NSAIDs

Non-steroidal anti-inflammatory drugs

Obs

Obstetrician

PG- trainee

Post Graduate Trainees

PIH

Pregnancy-induced Hypertension

PROM

Premature rupture of membranes

PPROM

Premature preterm rupture of membranes

PTB

Preterm birth

PTL

Preterm labor

SPSS

Social Science software version 21

WHO

World Health Organization

Abstract

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.