Evaluation of bleeding pattern,side effect and satisfaction with subdermal contraceptive etonogesterel implant(implanon): a comparison between postpartum and non postpartum user

Objective : The aim of this study was to compare the bleeding pattern, side effects and level of satisfaction between postpartum and non post partum Implanon® users. Study design : A prospective study was conducted from July 2010 till June 2012 at Hospital Tengku Ampuan Afzan, Pahang. A total of 110 women ( 60 postpartum and 50 non postpartum women ) who had Implanon inserted, were followed up at 3 and 6 months after insertion. The bleeding pattern, side effects and satisfaction level were analyzed and compared accordingly. Result : The mean age for postpartum group was 31.2 and for non postpartum group was 33.6.There was no difference in body mass index and parity between these two groups. Majority of the Implanon® users were using Oral Contraceptive Pills as previous method of contraception. There was no difference in bleeding pattern at 3 months between postpartum and non postpartum women. However there was significant difference at 6 months for amenorrhoea and infrequent bleeding pattern (p value of 0.005 and 0.024 respectively). About half of the users from each group had the side effects of weight gain ( 53.3% postpartum vs 56.0% non postpartum ) There was significant difference of side effects of headache and acne between postpartum and non postpartum women. Despite the side effects, majority of the users from both groups satisfied with this method of contraception ( 93.3% of postpartum and 88.0% of non postpartum ). Conclusion : Implanon® is a highly effective long acting reversible hormonal contraception. Weight gain was the most common side effect reported. There was significant difference in bleeding patterns and non menstrual side effects between post partum and non postpartum users of Implanon® in the first six months of usage. The overall satisfaction was high among most users

Future career as obstetrician and gynaecologist: final year medical students perspective point of view

Obstetrics and gynaecology is unique as all patients are female and involves persons awra’ or private part. It is a fardhu kifayah for muslim doctors to undertake this specialty. Thus, we should encourage our students, especially female to enter this specialty and find ways to keep them interested in this field. To determine the medical students' career decision regarding obstetrics and gynaecology and to identify factors related to this decision making. Male to female respondents were also compared. The gender preferences when selecting their obstetrician and gynaecologist doctor were also analyzed. The study was conducted among final year medical students. They were asked to answer the questionnaires to assess their decision and justifications and also other preferences as their future career.100 final year medical students completed the survey, comprising of fifty-two females and forty-eight males. Out of fifty-two female students, twenty-two (42.3%) choose to further their study in obstetrics and gynaecology while another thirty students choose other specialty. 50.0 % feels that female patient should be treated by female doctor as fardhu kifayah and 36.4% feel that this career is interesting and challenging. Only two out of forty-eight male students (4.2%) choose to further their study in obstetrics and gynaecology. 95% of students preferred female doctors to treat them (or their spouse). Only 24% of students want to further their study in obstetrics and gynaecology. Female students were more likely to choose this career compared to male. Majority of students select their Obstetrician and gynaecologist based solely on gender. Religious reason was the strongest factor rated by students as why they choose this specialty

An examination on the influence of small and medium enterprise (SME) stakeholder on green supply chain management practices

In this paper, climate change and global warming are the biggest current issues in the industrial sectors. The green supply chain managements (GSCM) is one of the crucial input to these issues. Effective GSCM can potentially secure the organization's competitive advantage and improve the environmental performance of the network activities. In this study, the aim is to investigate and examine how a small and medium enterprises (SMEs) stakeholder pressure and top management influence green supply chain management practices. The study is further advance green supply chain management research in Malaysia focusing on SMEs manufacturing sector using structural equation modelling. Structural equation modelling is a multivariate statistical analysis technique used to examine structural relationship. It is the combination of factor analysis and multi regression analysis and used to analyse structural relationship between measure variable and latent factor. This research found that top management support and stakeholder pressure is the major influence for SMEs to adopt green supply chain management. The research also found that top management is fully mediate with the relationship between stakeholder pressure and monitoring supplier environmental performanc

A clinical evaluation of bleeding patterns, adverse effects, and satisfaction with the subdermal etonogestrel implant among postpartum and non-postpartum users

The etonogestrel implant (Implanon; Merck Sharp and Dohme, Kenilworth, NJ, USA) is an effective contraceptive with a good safety profile for up to 3 years [1]. However, its adverse effects include irregular vaginal bleeding (affecting 68.0% of users), weight gain (20.7%), acne (15.3%), breast pain (9.1%), and headache (8.5%) [2]. To provide further information about contraception options for women in the postpartum period, the aim of the present study was to investigate the bleeding patterns and adverse effects reported by women who underwent Implanon insertion within 8 weeks of delivery and compare them with those experienced by non-postpartum women. A prospective study was undertaken at Hospital Tengku Ampuan Afzan, Pahang, Malaysia, between July 1, 2010, and June 30, 2012. Women attending the postnatal clinic or family planning/gynecology clinic who met WHO medical eligibility criteria 1 and 2 (no medical restriction for use of contraception or advantages of using contraception outweigh the risks) [3] were enrolled. Nulliparous women and women who had last delivered 8 weeks to 6 months previously were excluded. The institutional ethical committee approved the study and informed consent was obtained from participants. Participants were divided into two groups. Women in the postpartum group had delivered up to 8 weeks previously and underwent Implanon insertion 4–8 weeks after delivery. Women in the non-postpartum group had last delivered at least 6 months previously and underwent Implanon insertion between day 1 and day 5 of menses. Baseline body weight was recorded for each participant. Follow-up visits were scheduled at 3 and 6 months. Bleeding patterns were categorized using the WHO 90-day reference period [4]. Non-menstrual adverse effects and satisfaction were recorded at 6 months. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA). The Student t test and Fisher exact test were used to compare variables. P < 0.05 was considered statistically significant. A total of 110 women were included in the study, 60 in the postpartum group and 50 in the non-postpartum group. There were no differences in bleeding patterns between the groups at 3 months (Table 1). However, at 6 months, amenorrhea was significantly more common in the postpartum group than in the non-postpartum group (P = 0.005), and infrequent bleeding was more common in the non-postpartum group (P = 0.024) (Table 1). With regard to non-menstrual adverse effects, headache and acne were significantly more common in the non-postpartum group than in the postpartum group (P = 0.001 and P = 0.040, respectively) (Table 1). There were no significant differences for other adverse effects. Weight gain was the most frequent adverse effect, but there was no significant difference between groups (Table 1). Most users from both groups were satisfied with Implanon, with no difference in terms of satisfaction between groups ( Table 1). This finding implies that most women who experienced adverse effects were able to tolerate them. In conclusion, the present study has shown that bleeding patterns and non-menstrual adverse effects can differ according to timing of Implanon insertion after delivery. However, despite menstrual irregularities and other adverse effects, Implanon was well accepted in both groups

Knowledge, perception and attitude among pregnant mothers towards ibadah

To determine the knowledge, perception and attitude of pregnant mothers towards ibadah with regard to pregnancy and inpatient stay. All Muslim mothers admitted to antenatal ward of Hospital Tengku Ampuan Afzan, who agreed to participate were included in the study. Questionnaires were answered accordingly during her inpatient stay. Demographic data were collected and data entry and analysis performed using SPSS. Eighty patients( n=80) were enrolled into the study. About sixty percents (60%) had educational level of secondary school. Two third (n= 63,80%) mothers were from low parity (0-2). Approximately forty percents (40%) of mothers are admitted for latent phase of labour and premature contraction. About 45% were admitted due to other obstetric reasons. In the majority (87%), the length of stay was between 1 to 3 days. Half of the mothers (51%) did not pray during their stay. Sixty three percent of them admitted that they did not know that they should pray while in the ward. Three percent stated that they were shy while 5% indicated that they were uncomfortable to do so. These were in spite of the fact that the majority actually prayed five times per day at home. Only 13% gave the correct duration of nifas while 52% did not answer (most likely they did not know). The majority of the pregnant mothers have minimal knowledge regarding the need of solat during their hospital stay. Key words: Knowledge, perception, attitude, pregnant, ibada