Acknowledgments

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
i
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 35

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 36

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 37

of the cervix in to arrest preterm labor at 28 weeks gestation and
a cervical dilatation of 3cm
ii
List of Figures
Figure No. 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
iii
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
iv
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.

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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

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

Table 3.5. Frequency and percentage of responses related health barrier in 31

management of preterm labor

Table 3.7. Correlations 34

Table 3.8. Principle drug treatment is chosen by obstetricians at different 35

Table 3.9. Principle drug treatment is chosen by obstetricians at different state 36

Table 3.10. Principle drug treatment is chosen by obstetricians at different state 37

Figure No. Title Page No.

Figure 3.1. The frequency of the population based on age groups 18

ACOG American College of Gynecologist

CCBs Calcium Channel Blockers

NEL National Essential Medicine List

UNICEF United Nations Children's Fund

NICU Neonatal intensive care unit

NSAIDs Non-steroidal anti-inflammatory drugs

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

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