Objective: Tostudythe relationship between duration and contentof general practice consultations for patients with chronic conditions. Design: A qualitative analysis of transcripts of consultations. The majorthemes and concepts of psychosocial supportwere identified and coded using the Ethnograph computer package.Setting: A mix of rural and urban general practices in two Statesof Australia in 1993-1994.Participants: 14 selected general practitioners and 50 of their patients with complex chronic conditions.Results: Transcriptions of 106 consultations were analysed. General practitioners (GPs) led mostconsultation dialogue and emphasised disease management. The majorthemes were provision of information by the GP, review of treatment by the GP, review of illness by the GP, and description and explanations of their illness by patients (patient narrative). The first threethemes predominated in consultations of all lengths. Longer consultations (20 minutes and over) contained moredialogue initiated by patients and more patientnarrative about livingwith their illness. Conclusions:Patients with complex chronic conditions may require longer consultations to allowadequate time for review of their illnessand treatment as well as an opportunity to raise issuesand concerns abouttheir illness, its impact on their lives and their personal management strategies. Longer consultations may thus provide the mechanism for what has been described as patient"enablement".

ObjectiveTo assess the association between general practitioner (GP) billing for “longer” consultations, patient factors linked with health care need, and other consultation characteristics. DesignRetrospective analysis of data from Medicare (1984‐1992), Australian Morbidity and Treatment Survey (1990‐1991) and Australian Capital Territory Record Linkage Study (1988‐1992). SettingAustralian general practice, 1984 (introduction of Medicare) to 1992. Main outcome measuresConsultations billed as longer (< 20 or >25 minutes) compared with standard; type of billing (bulk or private); patient health care need (defined as health and sociodemographic factors linked to worse health outcomes); consultation continuity, type of care given and number of problems managed. ResultsLonger billed consultations Increased between 1984 and 1992, from 2.8% to 6.7% of all standard and longer consultations. Longer consultations were more likely to be bulk‐billed than privately billed (odds ratio [OR], 1.74). They were more likely than standard consultations to deal with psychological diagnoses (OR, 2.06; 95% confidence Interval [95% Cl], 1.83‐2.32) or multiple problems (OR for four versus one diagnosis, 5.18; 95% Cl, 4.31‐6.22) and to Involve patients aged under 50 years, new to the practice or with new problems, but not chronic disease. In the ACT, those billed for longer consultations were more commonly tertiary educated (OR, 1.99; 95% Cl, 1.35‐2.94), bulk‐billed (OR, 2.75; 95% Cl, 2.51‐3.10), aged 40‐49 years and non‐obese. ConclusionLonger billed consultations were not associated with greater patient need, other than psychosocial need, but with bulk billing and patient socioeconomic advantage. However, evaluation was complicated by the effects of continuity of care and number of problems managed In the consultation.

Background and Objective:The immensely increasing rate of population is one of the biggest hindrances in the progress of under developing world including Pakistan. One of the main component of Sustained Millennium Development Goals was to reduce maternal mortality and morbidity by fulfilling the unmet needs of contraception. Keeping these challenges into consideration, program of Post Placental Intrauterine Contraceptive Device (PPIUCD) insertion was initiated at tertiary care hospital settings in Pakistan.Objective of this study is to explore the factors affecting the rate of PPIUCD insertion rate.Methods: This cross sectional study was carried out at the Government Teaching Hospital Shahdara Lahore, Pakistan within 15 months (July 2019 to Sep 2020). A total of 4474 pregnant females were included using non probability consecutive sampling. A trained counselorcounselled the patients regarding benefits of PPIUCD and predesigned structured proforma was filled regarding demographic data, obstetric data and other factors related to insertion of PPIUCD. After the subjects were delivered, PPIUCDs were inserted in consenting females. Data was analyzed for statistical inferences.Results: Out of the 3292 participants who qualified for insertion, 802 females consented for PPIUCD insertion with an average insertion rate of 24.36%. The main factor affecting rate of PPIUCD insertion was presence of a trained counselor. Conclusion:The counseling services by a trained counselor are imperative for success in PPIUCD insertion rate.

Objectives: To evaluate the effects of episiotomy on the frequency of perineal lacerations. Design: Cross-Sectional analytical study. Place & duration of study: Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. Patients & methods: 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 (48.63%) of these women. There were 1095(37.53%) primiparae and 1823 (62.47%) multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 (9.2%) perineal tears were sustained by these women during vaginal delivery . Episiotomy was associated with 151 (10.6%) perineal tears compared to 116(7.7%) without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Conclusion: Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications.

Cesarean section scar ectopic pregnancy (CSEP) is defined as a pregnancy in which blastocyst is implanted within the scar of previous cesarean section. It is a rare form of ectopic but its frequency is increasing due to increasing rate of cesarean section. In this case, a 36 years old G3P2A0, married for 10 years, previous II C/Sections, LCB 7 years back, presented with ultrasound report of the viable pregnancy at 11+1 weeks with gestational sac incorporating into previous scar of cesarean section. She was otherwise asymptomatic and stable. Serum Beta hCG was 73664.78 IU/L. Laparotomy was done as an elective procedure. Dense adhesions were noted on opening the abdomen between anterior abdominal wall, uterus, bladder and gut. Scar ectopic pregnancy was excised after dissecting the adhesions. Her Serum Beta hCG 48 hour post-operatively was 1397.0 IU/L.Patient was discharged home on 2nd post-operative day in good condition. She was counselled about risk of a recurrent scar ectopic and rupture of uterus in next pregnancy. Her serum Beta hCG declined to normal by 4 weeks post operatively. Keywords: Cesarean section, scar ectopic, laparotomy