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Research report complication During postpartum period




University of Gujrat                                    Internship Agency



                      Complications during postpartum period

                                                        A Case Study of Tehsil Gujrat




                           INTERNSHIP REPORT
                                           At
                               AZIZ BHATI HOSPITAL

                                        GUJRAT

                          (15 JULY TO 31 AUGUST)

                                           BY

                                Aroj Bashir
                       Muhammad Qasim

                                                                               Page 1
Research report complication During postpartum period


                                   Master in Population Sciences

                                           2nd semester


                                         Table of Content




                              Contents                             Page #
   Introduction
               1. Personal Biography
               2. Session
               3. Taught Courses
               4. My career Interest
               5. Motivation/ Reason for internship


   Host Institute
              1. Introduction
              2. Ongoing Programs
              3. Specialties
              4. Working mechanism
              5. Goals /Target
              6. Salient Achievements
   Focal Person
                  1. Name
                  2. Behavior toward Internee
                  3. Level of cooperation during work
                  4. Guidance to Complete Tasks
   Project /Assignment
     Research Project:
       1. Name Of Project
       2. Introduction
       3. Literature
       4. Objectives

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Research report complication During postpartum period


       5. Method
       6. General Findings
       7. Statistical Tests
       8. Discussions
       9. Conclusion
       10. References


   Relationship of Internship with Taught Courses
   Individual Benefits gained from internship
   Lesson Learned from Internship
   Conclusion of Internship




                                                        Page 3
Research report complication During postpartum period


Table of Contents

                                                                       Page

Chapter: 1                    Introduction



       Personal biography…………………………………………………………..                             07

       Session………………………………………………………………………                                     07

       Taught courses………………………………………………………………                                 07

       My career interests……………………………………………………………                             08

       Motivation/reason for internship…………………………………………….                     08

Chapter: 2                 Host Organizations/ Institute

       Introduction………………………………………………………………….                                 09

       Ongoing programs……………………………………………………………                                09

       Specialties…………………………………………………………………….                                 10

       Working mechanism…………………………………………………………                                11

       Goals/target…………………………………………………………………..                                11

  Chapter: 3                  Focal Person / Immediate Boss / Senior

       Name………………………………………………………………………...                                     12

       Behavior toward internee……………………………………………………                           12

       Level of cooperation during work…………………………………………...                    12

       Guidance to complete tasks………………………………………………….                         12




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Research report complication During postpartum period


Chapter: 4                       Project Assignment

       Name of the project………………………………………………………… 13

       Introduction………………………………………………………………... 13

       Literature review…………………………………………………………… 17

       Objectives………………………………………………………………….. 19

       Method…………………………………………………………………….. 19

       General findings…………………………………………………………… 20

       Discussions…………………………………………………………….....29

       Conclusion……………………………………………………………..…29

      References………………………………………………………………...30

       Relationship of Internship with Taught Courses………………………………31

       Individual Benefits gained from internship……………………………………31

       Lesson Learned from Internship………………………………………………31

       Conclusion of Internship………………………………………………….…32




                                                                      Page 5
Research report complication During postpartum period




                      Acknowledgement


My report is based on internship at “Aziz Bhatti Hospital Gujrat.”

I am very grate full to Sir Wajjid Tahir who gave me an opportunity to learn topic of “post-
partum complications among women” So, this topics teach me the complications during post-
partum period.

At Aziz bhatii hospital Gujrat all doctors were very cooperative me mostly I thanks full to Dr
Fouzia Arshad, gynecologist she guide me during my internship. She gave me full help related
to our field visit.

In the end I am really indebted to university of Gujrat which provided me the opportunity to
work in any organization in order to sharpen my skills and implement my knowledge in practical
field.




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Research report complication During postpartum period


                                       CHAPTER#1

Introduction
Personal Biography

My name is Aroj Bashir student of” Population Sciences at University of Gujrat”.

Student Of MPS 2nd semester.

Session

          Session (2010_2013)

Taught Courses

       1. Introduction to population sciences
       2. Gender and reproductive health
       3. Information education and communication
       4. Population and social Statistics (1)
       5. Population and social Statistics (2)
       6. Information technology
       7. Introduction to social sciences
       8. Planning and Management of Population Program
       9. Introduction to Technique of Population Program
       10. Population & Development




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Research report complication During postpartum period


My career Interests
Pakistan is a developing country and facing a lot of social, economic, demographic, heath and

Security problems. Social issues are the basis of all problems, so I decided to choose the social

sciences field. Being a social Scientist I want to do some thing for the betterment of our country.

Through my demographic field I can point out the social, heath, and demographic and

development problems of the Pakistani peoples, that can help the policy makers to make their

policies according to problems of the people and the country.I am student of population Science

and interested in research work and I want to enhance my research Work by learning quality

research tools so in this regard my internship remain very

Helpful for me and I conduct research on the topic “complication during postpartum period

Tehsil Gujrat” and during this work, I learned a lot about the research work tools.

Reason for Internship:
My internship is the part of my course of second semester. This is my learning process. Through

the internship. I gain more knowledge about our study. I will be able to know the real meaning of

our study and gain the confidence. Through internship I gain experience about the research work

and practical work in the field. I seen the problems and issues of the people in the field.




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Research report complication During postpartum period


                                          CHAPTER#2

                                    Host Organization
Introduction:
Name: Aziz Bhati Shaheed Hospital (DHQ) Gujrat
History:

The DHQ Hospital Gujrat was established in 1963 and renamed as Aziz Bhati Shaheed Hospital
in 1966 after war against India. It is sited on the north of Gujrat city. The hospital has been
attached with the Nawaz Sharif Medical College as the teaching hospital. It is not only catering
to the health care needs of local people, but also of the people of neighbouring districts and
towns such as Bhimber, Mandi Bahauddin and Lalamusa. Initially it was started with one
hundred beds and some departments. With the passage of time the number of beds and facilities
was increased and now 452 beds hospital. The pediatrics Department has the capacity of 30 beds.
Almost fifty six doctors and ninety nurses are working there. The hospital currently has 5 major
departments . The major departments are;

       General surgery
       General medicine
       Gynecology
       ENT department
       Eyes department

    And with some other departments

               Orthopedics
               Pediatrics
               Physiotherapy
               Radiology
               Urology/Dialysis Unit
               Tele-Medicine
               Cardiology
               Dentistry

Ongoing programs:
The basic purpose of organization is accrue &treatment of the patient and provides them best
medication facility. In addition to treatment of the patient the hospital’s ongoing programs are

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Research report complication During postpartum period


Vaccination of child, Hepatitis B,C treatment, vast management(preset), Dialysis(artificial
kidney facility and the training of dispensers and receives the emergency. This hospital is also providing
routine care services to the prisoners of District Jail, Gujrat.

Specialties:
There are sixteen specialties of the hospitable

          General OPD
          General medicine
          Surgery
          Pediatrics
          Eye
          ENT
          Orthopedics
          Psychiatry
          Dental
          Skin
          OB/GYN
          Emergency/Casualty
          Home Cases
          Tibb/Unani Shifa Khana OPD cases
          Cardiology
          Other




                                                                                                 Page 10
Research report complication During postpartum period


   Working Mechanism:
   Medical Superintendent is the head of organization. All the management of the hospital is
   operates by the medical superintendent. He makes policies and arrangements for the hospital.
   The hospital has a deputy medical superintendent, that makes check and balance of doctors,
   nurses, paramedics, clerks and other staff of the hospital.

   Medical superintendent (MS)                                            ↓

       ↓                                                      Nursing Superintendent

   Deputy Medical superintendent                                     ↓
   .                                                               DNS (1)

       ↓                                                              ↓

   Paramedics                                                  Head Nurses(13)

        ↓                                                            ↓

   Dispenser (13) → Lab/Tech (4) → Lab/Att (3)                 Staff Nurses (78) ↓

   X-ray/Tech (3) → OTA (4) → Driver (6)                        MD/Wife-2 LHV’s-2

   Goals/targets:
    Our goal and targets are continuous improvement in…

      Visibility
      Competitiveness
      Accessibility
      Communication
      Education
      Total Health Management
   
      Promote the highest level of rehabilitation and independence through restorative nursing
       care using a team approach and collaborating with therapy disciplines as appropriat
      Provide quality care by teaching and monitoring client’s response.
      Provide high quality health care services in a cost-effective manner
      To provide the best health care services to the people of Gujrat and adjoining areas




                                                                                        Page 11
Research report complication During postpartum period




                                        CHAPTER#3




                    Focal person/immediate boss/senior



Name:
        Dr Fouzia Arshad

Behavior towards Me:
She is very nice, humble, and kind. Her behavior towards me is very nice. she taught me all the
work very efficiently and greatly. she helped me in every matter related to my work. she guided
me at every step.

Level of Cooperation During work:
Level of cooperation is very nice. e cooperates with me maximum and gives me maximum of
her   time. she cooperated to me in every matter related to my survey on “postpartum
complication. she told me about the diseases and socially and medically reasons behind the
complications. she helped me in every stage where I needed their help.

Guidance to Complete Tasks:
She very truly wants me to learn every aspect of my internship. She also gives short lectures me
to complete my work. she encouraged me to complete my task. She also appreciates my survey
work. She guided me at every step during internship.




                                                                                        Page 12
Research report complication During postpartum period


                                         CHAPTER#4

Project /assignment

Name of project

                         Complications during postpartum period


Introduction

The postpartum period is the time immediately after a woman delivers her baby. It is the time
when the mother's body is changing back to the non-pregnant state. It lasts approximately 6
weeks or until the reproductive organs return to normal size. During the postpartum period, a
woman can expect a variety of symptoms ranging from physical discomfort to emotional upsets.
“Postpartum hemorrhage is traditionally defined as blood loss greater than 500 mL during a va-
ginal delivery or greater than 1,000 mL with a cesarean delivery. However, significant blood loss
can be well tolerated by most young healthy females, and an uncomplicated delivery often re-
sults in blood loss of more than 500 mL without any compromise of the mother's condition.”

Feeling overwhelmed with the responsibility of caring for an infant is a normal postpartum
symptom. Other emotions may include sadness, feeling helpless, and a "let down" feeling. “Dis-
comfort in the perineum (area between the rectum and vagina) is expected and may cause diffi-
culty with sitting or walking. It is common for the breasts to be swollen and painful.”The new
mother may feel tired, experience hot flashes and sweating, and may be constipated.. All these
symptoms are normal, a temporary reaction to childbirth.

“Treatment for complications varies depending on the source of the problem. Infection usually
responds to antibiotic treatment.” Other special medications and procedures are available for
treating postpartum problems.

A new mother who experiences one or more of these symptoms should contact her provider im-
mediately.

There are some things which avoid postpartum complications and health problems. “Before baby
is born, eat a healthy diet that's high in leafy green vegetables, red meat, or legumes to avoid
iron-deficiency anemia.”

“During the immediate postpartum period, high levels of oxytocin in blood are helping uterus
return to its prep regnant size. “Stress creates adrenaline, which can make it more difficult for the
hormones to do their job.” Stay in bed and partner or a friend or relative (or paid help, if neces-
sary) care for mother.Eat nutritious foods and drink plenty of water. Don't lift anything heavier
than baby, and just try to rest and relax as much as can. Limit visitors.

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Research report complication During postpartum period


Postpartum infections are caused by bacteria entering the the urinary tract, or the site of an inci-
sion or tear. But there are also other kinds of infections that can occur during postpartum, such as
breast infections . Since infections can be serious, it's important to be on the lookout for fever
and other signs of infection during postpartum.

“The more objects enter vagina during labor or after birth, the more risk there is that infection-
causing bacteria could be pushed upward toward uterus. Limit internal exams during labor .

It's normal to lose some blood after giving birth. When the placenta separates from the uterine
wall, the resulting wound bleeds until the blood vessels close off with help from your contracting
uterus. And since body's blood volume increases by about 50 percent during pregnancy, some
blood loss won't affect health.

But sometimes, women bleed too much after giving birth, which is called a postpartum hemorr-
hage. This happens in up to 5 percent of all births, and is most likely to happen while the pla-
centa is separating or soon afterward Postpartum hemorrhage can be divided into 2 types: early
postpartum hemorrhage, which occurs within 24 hours of delivery, and late postpartum hemorr-
hage, which occurs 24 hours to 6 weeks after delivery. Most cases of postpartum hemorrhage,
greater than 99%, are early postpartum hemorrhage. most women are still under the care of their
delivering provider during this time. With many women delivering outside of hospitals and early
postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the
emergency department may be either early or late..

“Sometimes, a mother will hemorrhage days or even weeks after birth. This rare but serious con-
dition is called a late or delayed postpartum hemorrhage and is usually caused by retained mem-
branes or tissue in the uterus.” If experience unexpected heavy bleeding days or weeks postpar-
tum, lie down, stay warm, nurse baby if possible,

About 1 out of every 8 women has postpartum depression after delivery. It is the most common
complication among women who have just had a baby. Changes in the woman's hormones after
delivery probably cause postpartum depression. Women
who have been depressed before are at increased risk for postpartum depression. Postpartum de-
pression can begin at any time within the first 3 months after delivery. It can
seriously threaten both the woman and her baby. Since the mother is seriously ill, she may
not be able to care for her baby as she would if she were well. The disease may make it hard
for the mother to breastfeed or bond with her baby. For these reasons, postpartum depression
is a threat to newborns.

Postpartum depression can be treated in several ways. Support groups may help. Some women
go to therapy or counseling with a mental health professional. This professional may talk with
the woman about the risks and benefits of antidepressant medications.

“After the baby is born, many new mothers have the "postpartum blues" or the "baby blues." The
word "blues" is not really correct since women with this condition are happy most of the time.
But compared to how she usually feels, the new mother. Postpartum depression is not the same
                                                                                            Page 14
Research report complication During postpartum period


as the "postpartum blues," a condition that is more
common and less serious. Postpartum blues usually ends by the tenth day after the baby is
born. The postpartum blues peak three to five days after delivery.” They usually end by the tenth
day after the baby's birth. Although the postpartum blues are not pleasant, the woman can func-
tion normally. The feeling of the "blues" usually lessens and goes away over time.

Feeling overwhelmed with the responsibility of caring for an infant is a normal postpartum
symptom. Other emotions may include sadness, feeling helpless, and a "let down" feeling.There
are symptoms that are not normal and may be considered postpartum complications. Contact
healthcare provider immediately if one of more of these symptoms develop:

      Chills
      Nausea Or Vomiting
      Moderate To Strong Abdominal Or Back Pain That Is More Than Just An Ache
      Increased Pain, Swelling, Redness, Or Drainage From The Episiotomy Or C-Section Inci-
       sion
      Bleeding Through More Than One Pad Per Hour
      Blood Clots The Size Of A Plum
      A Foul Smelling Vaginal Discharge
      Chest Pains
      Increasing Tenderness In The Lower Abdomen

      Red, Warm To The Touch, Painful Breasts
      A Severe Headache In The Forehead And Behind The Eyes, Accompanied By Extreme
       Pain While Sitting Or Standing

      Feeling Depressed Or Blue For More Than 3 Days
      Severe Weakness
      Extreme Paleness Or
      A Rapid, Racing Pulse
      Postpartum Hemorrhage
      Shock
      Infection In Blood Septicemia
      Anemia
      Genital Infection

Treatment for complications varies depending on the source of the problem. Infection usually
responds to antibiotic treatment. Other special medications and procedures are available for
treating postpartum problems.




                                                                                         Page 15
Research report complication During postpartum period



Literature review:
      Nupur Chaudhury ( 2003) argued that women who suffered from postpartum depres-
       sion after the birth of her fourth child, and that she attempted suicide twice for this
       very disorder One in ten women experience postpartum depression , a condition that
       often goes undiagnosed, and occurs in women after childbirth. A reason for the lack
       of diagnosis of postpartum depression is a milder, more common form of depression
       after childbirth, often known as the "baby blues". The baby blues occur in mothers
       three to five days after childbirth .
      MLA,( 2002) The writer reveals that postpartum depression is on the rise in the
       United States, due to increasing stress, and contends that more responsibility needs
       to be taken to ensure that women are prepared to handle the challenges that will
       come their way. The writer also hopes that more states will pass laws that mandate
       education and screening with women after delivery. Postpartum depression is a
       significantly under diagnosed pregnancy complication, which can have serious
       consequences. Sadness following the birth of a baby is believed to be as high as 85
       percent in new mothers and normally lasts under two weeks. Postpartum depression
       may last as long as 18 months. The condition is thought to be caused by hormonal
       changes and the condition can worsen if the woman is suffering additional stresses.
       Many women experience some mood changes after childbirth.
      Stanley Poulos (2008) Women are more likely than men to suffer from depression,
       especially during their reproductive years. Rates of depression are higher where
       stressful circumstances exist such as poverty, lack of education, sexual inequality,
       poor social support and in pregnancy. Single and adolescent pregnant women are
       especially at risk
      Abbas Mohila (2007,) ) conducted a study in Bangladesh and said A large
       proportion of these deaths are preventable by appropriate measures through the
       periods of antenatal, delivery and postnatal care . Complications of pregnancy and
       childbirth are still the leading causes of death and disability among women of
       reproductive age in developing countries common were weakness, anemia, and
       lower abdominal pain the main direct 1causes of severe maternal morbidity in West
       Africa were hemorrhage, obstructed labor, eclampsia, and sepsis .
      Vallely, Ahmed(2005) Information on the extent of postpartum maternal morbidity in
       developing countries is extremely limited. In many settings, data from hospital-based
       studies is hard to interpret because of the small proportion of women that have
       access to medical care. However, in those areas with good uptake of health care, the
       measurement of the type and incidence of complications severe enough to require
       hospitalization may provide useful baseline information on the acute and severe
       morbidity that women experience in the early weeks following childbirth. An analysis
                                                                                      Page 16
Research report complication During postpartum period


       of health services data from Lusaka, Zambia, is presented. the maternal referrals in
       the first 24 hours after delivery were for retained placenta and just over one-third
       were for pregnancy- related hypertension or eclampsia Three referrals were for
       postpartum hemorrhage. There were no maternal deaths in this group.
      Shane.(2001) There are an estimated 14 million cases of pregnancy-related
       hemorrhage every year; at least 128,000 of these women bleed to death.6 Most of
       these deaths occur within comprehensive emergency obstetric services. These
       services often are available only at a referral hospital and may require that the
       woman be transported a long distance, again increasing her risk of death. Women
       who survive PPH often suffer from severe anemia if the condition is not managed
       appropriately.4 Lifesaving blood transfusions are associated with risks of transfusion
       reactions and transmission of infections. Surgery, such as hysterectomy, carries its
       own risks from infection, anesthesia, and other complications, as well as high
       financial costs.




                                                                                     Page 17
Research report complication During postpartum period




0bjectives:


            To study the postpartum complication among women
            To study in which age women have most postpartum complication
            To study education status of gujrat district


Method:


       This research based on both primary and secondary data. Primary data is collected from the
       women patient of aziz bhati hospital which is facing postpartum complication through face to
       face interview and secondary data from the register of aziz bhati hospital gujrat. In the study
       researcher selected the respondent by non probability sampling because list of patient of
       the postpartum complication are difficult to find so this sampling technique was thought
       to be the best to select the respondents.




                                                                                                 Page 18
Research report complication During postpartum period




General Findings




                        Table No. 1 Age of Respondents




                           Categories    Frequency      percent
                           15-19                  10          10.0
                           20-24                  27          27.0
                           25-29                  24          24.0
                           30-34                  19          19.0
                           35-39                  20          20.0
                           Total                 100        100.0




       The table shows that majority of women (27%) are in age group of

20-24 years. It indicates that the women in age group of 20-24 years are

facing more complications.




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Research report complication During postpartum period


                         Table No. 2 Area of Respondents


                                    Categories Frequency         percent
                                    urban                   43      43.0
                                    rural                   57      57.0
                                    Total                  100     100.0


       This table shows that majority of women belonged to rural area.

And 43% women belonged to urban area.

Table No. 3 Husband Occupation



                Categories            Frequency     percent
                 govt. job           13            13.0
                 private. sector     23            23.0
                 own. business       36            36.0
                 agriculture         28            28.0
                 Total               100           100.0

This table shows that majority of men (36%) have their own business,




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                       Table No. 4 Husband Education



                     Categoreis
                                      Frequency     Percent

                                               18       18.0
                     primary
                     middle                    18       18.0
                     metric                    29       29.0
                     intermediate              15       15.0
                     graduation                14       14.0
                     master                     6        6.0
                     Total                    100      100.0


      This table shows that majority of men (29%) have done

matriculation and (18%) have done middle.




                                                               Page 21
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                       Table No. 5 Delivery Condition



                                  Categories   Frequency    Percent
                                  Normal               43      43.0
                                  C-section            57      57.0
                                  Total               100     100.0




      This table shows that majority of women had C-section delivery

which is 57% and normal deliveries were 43%.




                 Table No. 6 Respondents Blood pressure



                                Categories Frequency Percent
                                Normal          33          33.0
                                High            29          29.0
                                Low             37          37.0
                                Total           100         100.0




      This table shows that majority of women had low blood pressure

(37 %.) and the patients of hypertension were 29%.


                                                                      Page 22
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                      Table No. 7 Chill Fever Vomiting



                        Categories     Frequency        Percent
                        yes               25             25.0
                        no                    4           4.0
                        Total             29             29.0
                        System            71             71.0
                        Total             100            100.0



      This table shows that 25% women had chill fever and vomiting

during postpartum period.



                  Table No. 8 Abdominal or Back Pain

                                              Frequenc
                          Categories              y    Percent
                          yes                     37        37.0
                          no                      18        18.0
                          Total                   55        55.0
                          System                  45        45.0
                             Total                100      100.0


      This table shows that 37% women had abdominal and back pain

during postpartum period.



                                                                   Page 23
Research report Diseases Among Elder people




                  Table No. 9 More bleeding and Blood Clots

                                         Frequency           Percent
                          Categories
                          yes                           41       41.0
                          no                             8        8.0
                          Total                         50       50.0
                          System                        50       50.0

                          Total                        100      100.0




      This table shows that 41% women had more bleeding and blood

clots as compare to others, during postpartum period.


Table No. 10 Headache

             Categories      Frequency       Percent
             yes                        40      40.0
             no                         23      23.0
             12                          1        1.0
             21                          1        1.0
             Total                      65      65.0
             System                     35      35.0
             Total                     100     100.0
This table shows that 40% women had headache during postpartum

period.

                                                                        Page 24
Research report Diseases Among Elder people


                          Table No. 11 Feeling Depressed



                    Categories    Frequency        Percent
                    yes               45              45.0
                    no                40              40.0
                    11                2                 2.0
                    Total             87              87.0
                    System            13              13.0
                  Total              100             100.0


      This table shows that 45% women felt depressed during

postpartum period.


           Table No.12 Weakness. Paleness .Rapid Pulse



                   Categories     Frequency Percent
                   yes                        50      50.0
                   no                         25      25.0
                   Total                    75        75.0
                   System                   25        25.0
                  Total                    100       100.0



      This table shows that 50% women had weakness, paleness and

rapid pulse during postpartum period.



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Research report Diseases Among Elder people


                   Table No.13 Postpartum Hemorrhage



             Categories    Frequency     Percent
              yes          37            37.0
              System       63            63.0
            Total          100           100.0



      This table shows that 37% women had postpartum hemorrhage

during postpartum period.




                                 Table No.14 Shock

             Categories Frequency      Percent
             yes          14           14.0
             System       86           86.0
          Total           100          100.0



      This table shows that 14% women had shock during postpartum

period.




                                                              Page 26
Research report Diseases Among Elder people


Table No.15 Infection in blood and septicemia



     Categories      Frequency Percent
     yes                     10      10.0
     System                  90      90.0
    Total                   100    100.0




      This table shows that 10% women had infection in blood and

septicemia during postpartum period.


                              Table No.16 Anemia


            Categories   Frequency      Percent
            yes                    21         21.0
            System                 79         79.0
            Total                 100       100.0


      This table shows that 21% women were anemic during postpartum

period.




                                                                   Page 27
Research report Diseases Among Elder people


Table No.17 genital infection




       Categories     Frequency     Percent
       yes                     11      11.0
       System                  89      89.0
      Total                   100     100.0
      This table shows that 11% women had genital infection during

postpartum period.

Discussion

The women living in Gujrat who came for medical checkup or treatment at Aziz Bhatti
Shaheed (DHQ) Hospital, Gujrat were facing various complications during postpartum
period i.e. abdominal pain, bleeding, feeling depressed, postpartum hemorrhage, shock
conditions, septicemia, anemia, and genital infections. The women from rural areas
were at high risk of complications and had more visits to DHQ, Hospital for medical
checkup and treatment purposes than urban women. The majority of women reported
low blood pressure. Many women were facing nutritional deficiencies and relevant
diseases. It seems that the other socio-economic factor have strong influence on
women health in Gujrat. Mostly women belonged to rural area and their husband have
own business and agriculture. the education level is also t high so they do not
awareness about health.
Conclusion:
There are many villages attached to gujrat. Most patient of aziz Bhatti Shaheed hospital
belong to rural areas. During the pregnancy and after pregnancy women go through
many complications. There are many genetic changes occur in their body due to which
they often get depression. so no one behave rude with her and particularly take care of
their nutrition as to maintain their and also child health.




                                                                                 Page 28
Research report Diseases Among Elder people



Reference:
Francis 2007 Tips for a Healthy Postpartum Period retrieved from
http://www.netplaces.com/postpartum-care/postpartum-complications-and-health-
concerns/tips-for-a-healthy-postpartum-period.htm


Yaa A B Yiadom2010 Postpartum Hemorrhage in Emergency Medicine retrieved from
http://emedicine.medscape.com/article/796785-overview


Dimes 2006Postpartum depression retrieved from
http://www.marchofdimes.com/postpartum_depression.html


Hawkins Drive 2002 Postpartum complications retrieved from
http://www.uihealthcare.com/topics/pregnancyandchildbirth/preg4879.html

Nupur Chaudhury ( 2003) Postpartum Depression retrieved from
http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/nchaudhury.html

MLA,( 2002) Postpartum Depression retrieved from
http://www.academon.com/Research-Paper-Postpartum-Depression/118600

Stanley Poulos (2008) Postpartum Depression retrieved from http://www.xanax-
effects.com/

Mirza Abbas Mohila Degree College, Shahjahanpur, 2007 Journal of Applied Sciences
Research, 3(11): 1320-1326,2007, INSInet Publication retrieved from
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Vallely, Ahmed(2005) Centre for International Child Health, Institute of Child Health, University
College London, London, UK retrieved from http://www.biomedcentral.com/1471-2393/5/1

Shane.(2001) preventing postpartum hemorrhage               volume 13 Seattle, Washington 98109-1699 U.S.A.
Retrieved from http://www.reproline.jhu.edu/english/2mnh/2articles/otlkpph.pdf




                                                                                                        Page 29
Research report Diseases Among Elder people


Relationship of internship with taught courses:

The courses which I taught during session have a strong relation with my internship. I taught
reproductive health in course as my internship topic is “complication during during postpartum
so it helps me a lot to understand my topic. we were taught skills of research work and in
internship I implemented those learned research tools practically to conduct a research project.
So taught courses remain helpful throughout my project work and I was guided at every step of
research by my studied courses.

Individual’s benefits gained from internship

I have learnt from this internship about research programs and counseling of patients. I have
learnt that how to communicate and counsel the patient. I got awareness about complications
after pregnancy and their management. I understood how we can educate and aware the
women about their health problems so that these complications can be reduced.

Lesson learned from internship

I have done my internship in Aziz Bhatti Shaheed Hospital Gujrat, I have seen that doctors and
staff do not perform their duties honestly due to which patient gets into trouble. No one attends
patient carefully or attentively, if all the doctors and staff perform its duty honestly then many
problems can be solved out. Patient can get better treatment and better compliance. I have
learnt from this internship that we should perform our duties honestly, carefully and attentively,
we should not be harsh or rude to patients, as some one’s life is dependant on us, so we should
not keep ignorant attitude as if we are in life saving profession. As QURAN says

“If anyone saved a life of a man it would be as if he had saved the life of whole mankind”

May ALLAH guide us on right path.




                                                                                             Page 30
Research report Diseases Among Elder people


Conclusion of internship

The conclusion of this internship is that small or little mistakes can bring about big mishaps or
upsets. Little ignorance can cause serious complications. Our home environment, education of
the women and economic condition effects women health. I have observed during this
internship that the women who belongs to rural areas shows more postpartum complications as
compare to those who lives in urban areas. The reason is lack of awareness regarding their
health problems. Education is also a key point concerning the health problems because an
educated woman can take good care of not only her as well as her family’s health, but illiterate
woman fails to do so due to lack of awareness. Another reason is depression which badly
effects women health. Women whom delivery is carried out by mid-wives are at more risk to
have genital infections.




                                                                                           Page 31

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Complications during postpartum period

  • 1. Research report complication During postpartum period University of Gujrat Internship Agency Complications during postpartum period A Case Study of Tehsil Gujrat INTERNSHIP REPORT At AZIZ BHATI HOSPITAL GUJRAT (15 JULY TO 31 AUGUST) BY Aroj Bashir Muhammad Qasim Page 1
  • 2. Research report complication During postpartum period Master in Population Sciences 2nd semester Table of Content Contents Page # Introduction 1. Personal Biography 2. Session 3. Taught Courses 4. My career Interest 5. Motivation/ Reason for internship Host Institute 1. Introduction 2. Ongoing Programs 3. Specialties 4. Working mechanism 5. Goals /Target 6. Salient Achievements Focal Person 1. Name 2. Behavior toward Internee 3. Level of cooperation during work 4. Guidance to Complete Tasks Project /Assignment Research Project: 1. Name Of Project 2. Introduction 3. Literature 4. Objectives Page 2
  • 3. Research report complication During postpartum period 5. Method 6. General Findings 7. Statistical Tests 8. Discussions 9. Conclusion 10. References Relationship of Internship with Taught Courses Individual Benefits gained from internship Lesson Learned from Internship Conclusion of Internship Page 3
  • 4. Research report complication During postpartum period Table of Contents Page Chapter: 1 Introduction Personal biography………………………………………………………….. 07 Session……………………………………………………………………… 07 Taught courses……………………………………………………………… 07 My career interests…………………………………………………………… 08 Motivation/reason for internship……………………………………………. 08 Chapter: 2 Host Organizations/ Institute Introduction…………………………………………………………………. 09 Ongoing programs…………………………………………………………… 09 Specialties……………………………………………………………………. 10 Working mechanism………………………………………………………… 11 Goals/target………………………………………………………………….. 11 Chapter: 3 Focal Person / Immediate Boss / Senior Name………………………………………………………………………... 12 Behavior toward internee…………………………………………………… 12 Level of cooperation during work…………………………………………... 12 Guidance to complete tasks…………………………………………………. 12 Page 4
  • 5. Research report complication During postpartum period Chapter: 4 Project Assignment Name of the project………………………………………………………… 13 Introduction………………………………………………………………... 13 Literature review…………………………………………………………… 17 Objectives………………………………………………………………….. 19 Method…………………………………………………………………….. 19 General findings…………………………………………………………… 20 Discussions…………………………………………………………….....29 Conclusion……………………………………………………………..…29 References………………………………………………………………...30 Relationship of Internship with Taught Courses………………………………31 Individual Benefits gained from internship……………………………………31 Lesson Learned from Internship………………………………………………31 Conclusion of Internship………………………………………………….…32 Page 5
  • 6. Research report complication During postpartum period Acknowledgement My report is based on internship at “Aziz Bhatti Hospital Gujrat.” I am very grate full to Sir Wajjid Tahir who gave me an opportunity to learn topic of “post- partum complications among women” So, this topics teach me the complications during post- partum period. At Aziz bhatii hospital Gujrat all doctors were very cooperative me mostly I thanks full to Dr Fouzia Arshad, gynecologist she guide me during my internship. She gave me full help related to our field visit. In the end I am really indebted to university of Gujrat which provided me the opportunity to work in any organization in order to sharpen my skills and implement my knowledge in practical field. Page 6
  • 7. Research report complication During postpartum period CHAPTER#1 Introduction Personal Biography My name is Aroj Bashir student of” Population Sciences at University of Gujrat”. Student Of MPS 2nd semester. Session Session (2010_2013) Taught Courses 1. Introduction to population sciences 2. Gender and reproductive health 3. Information education and communication 4. Population and social Statistics (1) 5. Population and social Statistics (2) 6. Information technology 7. Introduction to social sciences 8. Planning and Management of Population Program 9. Introduction to Technique of Population Program 10. Population & Development Page 7
  • 8. Research report complication During postpartum period My career Interests Pakistan is a developing country and facing a lot of social, economic, demographic, heath and Security problems. Social issues are the basis of all problems, so I decided to choose the social sciences field. Being a social Scientist I want to do some thing for the betterment of our country. Through my demographic field I can point out the social, heath, and demographic and development problems of the Pakistani peoples, that can help the policy makers to make their policies according to problems of the people and the country.I am student of population Science and interested in research work and I want to enhance my research Work by learning quality research tools so in this regard my internship remain very Helpful for me and I conduct research on the topic “complication during postpartum period Tehsil Gujrat” and during this work, I learned a lot about the research work tools. Reason for Internship: My internship is the part of my course of second semester. This is my learning process. Through the internship. I gain more knowledge about our study. I will be able to know the real meaning of our study and gain the confidence. Through internship I gain experience about the research work and practical work in the field. I seen the problems and issues of the people in the field. Page 8
  • 9. Research report complication During postpartum period CHAPTER#2 Host Organization Introduction: Name: Aziz Bhati Shaheed Hospital (DHQ) Gujrat History: The DHQ Hospital Gujrat was established in 1963 and renamed as Aziz Bhati Shaheed Hospital in 1966 after war against India. It is sited on the north of Gujrat city. The hospital has been attached with the Nawaz Sharif Medical College as the teaching hospital. It is not only catering to the health care needs of local people, but also of the people of neighbouring districts and towns such as Bhimber, Mandi Bahauddin and Lalamusa. Initially it was started with one hundred beds and some departments. With the passage of time the number of beds and facilities was increased and now 452 beds hospital. The pediatrics Department has the capacity of 30 beds. Almost fifty six doctors and ninety nurses are working there. The hospital currently has 5 major departments . The major departments are;  General surgery  General medicine  Gynecology  ENT department  Eyes department And with some other departments  Orthopedics  Pediatrics  Physiotherapy  Radiology  Urology/Dialysis Unit  Tele-Medicine  Cardiology  Dentistry Ongoing programs: The basic purpose of organization is accrue &treatment of the patient and provides them best medication facility. In addition to treatment of the patient the hospital’s ongoing programs are Page 9
  • 10. Research report complication During postpartum period Vaccination of child, Hepatitis B,C treatment, vast management(preset), Dialysis(artificial kidney facility and the training of dispensers and receives the emergency. This hospital is also providing routine care services to the prisoners of District Jail, Gujrat. Specialties: There are sixteen specialties of the hospitable  General OPD  General medicine  Surgery  Pediatrics  Eye  ENT  Orthopedics  Psychiatry  Dental  Skin  OB/GYN  Emergency/Casualty  Home Cases  Tibb/Unani Shifa Khana OPD cases  Cardiology  Other Page 10
  • 11. Research report complication During postpartum period Working Mechanism: Medical Superintendent is the head of organization. All the management of the hospital is operates by the medical superintendent. He makes policies and arrangements for the hospital. The hospital has a deputy medical superintendent, that makes check and balance of doctors, nurses, paramedics, clerks and other staff of the hospital. Medical superintendent (MS) ↓ ↓ Nursing Superintendent Deputy Medical superintendent ↓ . DNS (1) ↓ ↓ Paramedics Head Nurses(13) ↓ ↓ Dispenser (13) → Lab/Tech (4) → Lab/Att (3) Staff Nurses (78) ↓ X-ray/Tech (3) → OTA (4) → Driver (6) MD/Wife-2 LHV’s-2 Goals/targets: Our goal and targets are continuous improvement in…  Visibility  Competitiveness  Accessibility  Communication  Education  Total Health Management   Promote the highest level of rehabilitation and independence through restorative nursing care using a team approach and collaborating with therapy disciplines as appropriat  Provide quality care by teaching and monitoring client’s response.  Provide high quality health care services in a cost-effective manner  To provide the best health care services to the people of Gujrat and adjoining areas Page 11
  • 12. Research report complication During postpartum period CHAPTER#3 Focal person/immediate boss/senior Name: Dr Fouzia Arshad Behavior towards Me: She is very nice, humble, and kind. Her behavior towards me is very nice. she taught me all the work very efficiently and greatly. she helped me in every matter related to my work. she guided me at every step. Level of Cooperation During work: Level of cooperation is very nice. e cooperates with me maximum and gives me maximum of her time. she cooperated to me in every matter related to my survey on “postpartum complication. she told me about the diseases and socially and medically reasons behind the complications. she helped me in every stage where I needed their help. Guidance to Complete Tasks: She very truly wants me to learn every aspect of my internship. She also gives short lectures me to complete my work. she encouraged me to complete my task. She also appreciates my survey work. She guided me at every step during internship. Page 12
  • 13. Research report complication During postpartum period CHAPTER#4 Project /assignment Name of project Complications during postpartum period Introduction The postpartum period is the time immediately after a woman delivers her baby. It is the time when the mother's body is changing back to the non-pregnant state. It lasts approximately 6 weeks or until the reproductive organs return to normal size. During the postpartum period, a woman can expect a variety of symptoms ranging from physical discomfort to emotional upsets. “Postpartum hemorrhage is traditionally defined as blood loss greater than 500 mL during a va- ginal delivery or greater than 1,000 mL with a cesarean delivery. However, significant blood loss can be well tolerated by most young healthy females, and an uncomplicated delivery often re- sults in blood loss of more than 500 mL without any compromise of the mother's condition.” Feeling overwhelmed with the responsibility of caring for an infant is a normal postpartum symptom. Other emotions may include sadness, feeling helpless, and a "let down" feeling. “Dis- comfort in the perineum (area between the rectum and vagina) is expected and may cause diffi- culty with sitting or walking. It is common for the breasts to be swollen and painful.”The new mother may feel tired, experience hot flashes and sweating, and may be constipated.. All these symptoms are normal, a temporary reaction to childbirth. “Treatment for complications varies depending on the source of the problem. Infection usually responds to antibiotic treatment.” Other special medications and procedures are available for treating postpartum problems. A new mother who experiences one or more of these symptoms should contact her provider im- mediately. There are some things which avoid postpartum complications and health problems. “Before baby is born, eat a healthy diet that's high in leafy green vegetables, red meat, or legumes to avoid iron-deficiency anemia.” “During the immediate postpartum period, high levels of oxytocin in blood are helping uterus return to its prep regnant size. “Stress creates adrenaline, which can make it more difficult for the hormones to do their job.” Stay in bed and partner or a friend or relative (or paid help, if neces- sary) care for mother.Eat nutritious foods and drink plenty of water. Don't lift anything heavier than baby, and just try to rest and relax as much as can. Limit visitors. Page 13
  • 14. Research report complication During postpartum period Postpartum infections are caused by bacteria entering the the urinary tract, or the site of an inci- sion or tear. But there are also other kinds of infections that can occur during postpartum, such as breast infections . Since infections can be serious, it's important to be on the lookout for fever and other signs of infection during postpartum. “The more objects enter vagina during labor or after birth, the more risk there is that infection- causing bacteria could be pushed upward toward uterus. Limit internal exams during labor . It's normal to lose some blood after giving birth. When the placenta separates from the uterine wall, the resulting wound bleeds until the blood vessels close off with help from your contracting uterus. And since body's blood volume increases by about 50 percent during pregnancy, some blood loss won't affect health. But sometimes, women bleed too much after giving birth, which is called a postpartum hemorr- hage. This happens in up to 5 percent of all births, and is most likely to happen while the pla- centa is separating or soon afterward Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage, which occurs within 24 hours of delivery, and late postpartum hemorr- hage, which occurs 24 hours to 6 weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are early postpartum hemorrhage. most women are still under the care of their delivering provider during this time. With many women delivering outside of hospitals and early postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the emergency department may be either early or late.. “Sometimes, a mother will hemorrhage days or even weeks after birth. This rare but serious con- dition is called a late or delayed postpartum hemorrhage and is usually caused by retained mem- branes or tissue in the uterus.” If experience unexpected heavy bleeding days or weeks postpar- tum, lie down, stay warm, nurse baby if possible, About 1 out of every 8 women has postpartum depression after delivery. It is the most common complication among women who have just had a baby. Changes in the woman's hormones after delivery probably cause postpartum depression. Women who have been depressed before are at increased risk for postpartum depression. Postpartum de- pression can begin at any time within the first 3 months after delivery. It can seriously threaten both the woman and her baby. Since the mother is seriously ill, she may not be able to care for her baby as she would if she were well. The disease may make it hard for the mother to breastfeed or bond with her baby. For these reasons, postpartum depression is a threat to newborns. Postpartum depression can be treated in several ways. Support groups may help. Some women go to therapy or counseling with a mental health professional. This professional may talk with the woman about the risks and benefits of antidepressant medications. “After the baby is born, many new mothers have the "postpartum blues" or the "baby blues." The word "blues" is not really correct since women with this condition are happy most of the time. But compared to how she usually feels, the new mother. Postpartum depression is not the same Page 14
  • 15. Research report complication During postpartum period as the "postpartum blues," a condition that is more common and less serious. Postpartum blues usually ends by the tenth day after the baby is born. The postpartum blues peak three to five days after delivery.” They usually end by the tenth day after the baby's birth. Although the postpartum blues are not pleasant, the woman can func- tion normally. The feeling of the "blues" usually lessens and goes away over time. Feeling overwhelmed with the responsibility of caring for an infant is a normal postpartum symptom. Other emotions may include sadness, feeling helpless, and a "let down" feeling.There are symptoms that are not normal and may be considered postpartum complications. Contact healthcare provider immediately if one of more of these symptoms develop:  Chills  Nausea Or Vomiting  Moderate To Strong Abdominal Or Back Pain That Is More Than Just An Ache  Increased Pain, Swelling, Redness, Or Drainage From The Episiotomy Or C-Section Inci- sion  Bleeding Through More Than One Pad Per Hour  Blood Clots The Size Of A Plum  A Foul Smelling Vaginal Discharge  Chest Pains  Increasing Tenderness In The Lower Abdomen  Red, Warm To The Touch, Painful Breasts  A Severe Headache In The Forehead And Behind The Eyes, Accompanied By Extreme Pain While Sitting Or Standing  Feeling Depressed Or Blue For More Than 3 Days  Severe Weakness  Extreme Paleness Or  A Rapid, Racing Pulse  Postpartum Hemorrhage  Shock  Infection In Blood Septicemia  Anemia  Genital Infection Treatment for complications varies depending on the source of the problem. Infection usually responds to antibiotic treatment. Other special medications and procedures are available for treating postpartum problems. Page 15
  • 16. Research report complication During postpartum period Literature review:  Nupur Chaudhury ( 2003) argued that women who suffered from postpartum depres- sion after the birth of her fourth child, and that she attempted suicide twice for this very disorder One in ten women experience postpartum depression , a condition that often goes undiagnosed, and occurs in women after childbirth. A reason for the lack of diagnosis of postpartum depression is a milder, more common form of depression after childbirth, often known as the "baby blues". The baby blues occur in mothers three to five days after childbirth .  MLA,( 2002) The writer reveals that postpartum depression is on the rise in the United States, due to increasing stress, and contends that more responsibility needs to be taken to ensure that women are prepared to handle the challenges that will come their way. The writer also hopes that more states will pass laws that mandate education and screening with women after delivery. Postpartum depression is a significantly under diagnosed pregnancy complication, which can have serious consequences. Sadness following the birth of a baby is believed to be as high as 85 percent in new mothers and normally lasts under two weeks. Postpartum depression may last as long as 18 months. The condition is thought to be caused by hormonal changes and the condition can worsen if the woman is suffering additional stresses. Many women experience some mood changes after childbirth.  Stanley Poulos (2008) Women are more likely than men to suffer from depression, especially during their reproductive years. Rates of depression are higher where stressful circumstances exist such as poverty, lack of education, sexual inequality, poor social support and in pregnancy. Single and adolescent pregnant women are especially at risk  Abbas Mohila (2007,) ) conducted a study in Bangladesh and said A large proportion of these deaths are preventable by appropriate measures through the periods of antenatal, delivery and postnatal care . Complications of pregnancy and childbirth are still the leading causes of death and disability among women of reproductive age in developing countries common were weakness, anemia, and lower abdominal pain the main direct 1causes of severe maternal morbidity in West Africa were hemorrhage, obstructed labor, eclampsia, and sepsis .  Vallely, Ahmed(2005) Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalization may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis Page 16
  • 17. Research report complication During postpartum period of health services data from Lusaka, Zambia, is presented. the maternal referrals in the first 24 hours after delivery were for retained placenta and just over one-third were for pregnancy- related hypertension or eclampsia Three referrals were for postpartum hemorrhage. There were no maternal deaths in this group.  Shane.(2001) There are an estimated 14 million cases of pregnancy-related hemorrhage every year; at least 128,000 of these women bleed to death.6 Most of these deaths occur within comprehensive emergency obstetric services. These services often are available only at a referral hospital and may require that the woman be transported a long distance, again increasing her risk of death. Women who survive PPH often suffer from severe anemia if the condition is not managed appropriately.4 Lifesaving blood transfusions are associated with risks of transfusion reactions and transmission of infections. Surgery, such as hysterectomy, carries its own risks from infection, anesthesia, and other complications, as well as high financial costs. Page 17
  • 18. Research report complication During postpartum period 0bjectives:  To study the postpartum complication among women  To study in which age women have most postpartum complication  To study education status of gujrat district Method: This research based on both primary and secondary data. Primary data is collected from the women patient of aziz bhati hospital which is facing postpartum complication through face to face interview and secondary data from the register of aziz bhati hospital gujrat. In the study researcher selected the respondent by non probability sampling because list of patient of the postpartum complication are difficult to find so this sampling technique was thought to be the best to select the respondents. Page 18
  • 19. Research report complication During postpartum period General Findings Table No. 1 Age of Respondents Categories Frequency percent 15-19 10 10.0 20-24 27 27.0 25-29 24 24.0 30-34 19 19.0 35-39 20 20.0 Total 100 100.0 The table shows that majority of women (27%) are in age group of 20-24 years. It indicates that the women in age group of 20-24 years are facing more complications. Page 19
  • 20. Research report complication During postpartum period Table No. 2 Area of Respondents Categories Frequency percent urban 43 43.0 rural 57 57.0 Total 100 100.0 This table shows that majority of women belonged to rural area. And 43% women belonged to urban area. Table No. 3 Husband Occupation Categories Frequency percent govt. job 13 13.0 private. sector 23 23.0 own. business 36 36.0 agriculture 28 28.0 Total 100 100.0 This table shows that majority of men (36%) have their own business, Page 20
  • 21. Research report Diseases Among Elder people Table No. 4 Husband Education Categoreis Frequency Percent 18 18.0 primary middle 18 18.0 metric 29 29.0 intermediate 15 15.0 graduation 14 14.0 master 6 6.0 Total 100 100.0 This table shows that majority of men (29%) have done matriculation and (18%) have done middle. Page 21
  • 22. Research report Diseases Among Elder people Table No. 5 Delivery Condition Categories Frequency Percent Normal 43 43.0 C-section 57 57.0 Total 100 100.0 This table shows that majority of women had C-section delivery which is 57% and normal deliveries were 43%. Table No. 6 Respondents Blood pressure Categories Frequency Percent Normal 33 33.0 High 29 29.0 Low 37 37.0 Total 100 100.0 This table shows that majority of women had low blood pressure (37 %.) and the patients of hypertension were 29%. Page 22
  • 23. Research report Diseases Among Elder people Table No. 7 Chill Fever Vomiting Categories Frequency Percent yes 25 25.0 no 4 4.0 Total 29 29.0 System 71 71.0 Total 100 100.0 This table shows that 25% women had chill fever and vomiting during postpartum period. Table No. 8 Abdominal or Back Pain Frequenc Categories y Percent yes 37 37.0 no 18 18.0 Total 55 55.0 System 45 45.0 Total 100 100.0 This table shows that 37% women had abdominal and back pain during postpartum period. Page 23
  • 24. Research report Diseases Among Elder people Table No. 9 More bleeding and Blood Clots Frequency Percent Categories yes 41 41.0 no 8 8.0 Total 50 50.0 System 50 50.0 Total 100 100.0 This table shows that 41% women had more bleeding and blood clots as compare to others, during postpartum period. Table No. 10 Headache Categories Frequency Percent yes 40 40.0 no 23 23.0 12 1 1.0 21 1 1.0 Total 65 65.0 System 35 35.0 Total 100 100.0 This table shows that 40% women had headache during postpartum period. Page 24
  • 25. Research report Diseases Among Elder people Table No. 11 Feeling Depressed Categories Frequency Percent yes 45 45.0 no 40 40.0 11 2 2.0 Total 87 87.0 System 13 13.0 Total 100 100.0 This table shows that 45% women felt depressed during postpartum period. Table No.12 Weakness. Paleness .Rapid Pulse Categories Frequency Percent yes 50 50.0 no 25 25.0 Total 75 75.0 System 25 25.0 Total 100 100.0 This table shows that 50% women had weakness, paleness and rapid pulse during postpartum period. Page 25
  • 26. Research report Diseases Among Elder people Table No.13 Postpartum Hemorrhage Categories Frequency Percent yes 37 37.0 System 63 63.0 Total 100 100.0 This table shows that 37% women had postpartum hemorrhage during postpartum period. Table No.14 Shock Categories Frequency Percent yes 14 14.0 System 86 86.0 Total 100 100.0 This table shows that 14% women had shock during postpartum period. Page 26
  • 27. Research report Diseases Among Elder people Table No.15 Infection in blood and septicemia Categories Frequency Percent yes 10 10.0 System 90 90.0 Total 100 100.0 This table shows that 10% women had infection in blood and septicemia during postpartum period. Table No.16 Anemia Categories Frequency Percent yes 21 21.0 System 79 79.0 Total 100 100.0 This table shows that 21% women were anemic during postpartum period. Page 27
  • 28. Research report Diseases Among Elder people Table No.17 genital infection Categories Frequency Percent yes 11 11.0 System 89 89.0 Total 100 100.0 This table shows that 11% women had genital infection during postpartum period. Discussion The women living in Gujrat who came for medical checkup or treatment at Aziz Bhatti Shaheed (DHQ) Hospital, Gujrat were facing various complications during postpartum period i.e. abdominal pain, bleeding, feeling depressed, postpartum hemorrhage, shock conditions, septicemia, anemia, and genital infections. The women from rural areas were at high risk of complications and had more visits to DHQ, Hospital for medical checkup and treatment purposes than urban women. The majority of women reported low blood pressure. Many women were facing nutritional deficiencies and relevant diseases. It seems that the other socio-economic factor have strong influence on women health in Gujrat. Mostly women belonged to rural area and their husband have own business and agriculture. the education level is also t high so they do not awareness about health. Conclusion: There are many villages attached to gujrat. Most patient of aziz Bhatti Shaheed hospital belong to rural areas. During the pregnancy and after pregnancy women go through many complications. There are many genetic changes occur in their body due to which they often get depression. so no one behave rude with her and particularly take care of their nutrition as to maintain their and also child health. Page 28
  • 29. Research report Diseases Among Elder people Reference: Francis 2007 Tips for a Healthy Postpartum Period retrieved from http://www.netplaces.com/postpartum-care/postpartum-complications-and-health- concerns/tips-for-a-healthy-postpartum-period.htm Yaa A B Yiadom2010 Postpartum Hemorrhage in Emergency Medicine retrieved from http://emedicine.medscape.com/article/796785-overview Dimes 2006Postpartum depression retrieved from http://www.marchofdimes.com/postpartum_depression.html Hawkins Drive 2002 Postpartum complications retrieved from http://www.uihealthcare.com/topics/pregnancyandchildbirth/preg4879.html Nupur Chaudhury ( 2003) Postpartum Depression retrieved from http://serendip.brynmawr.edu/bb/neuro/neuro03/web2/nchaudhury.html MLA,( 2002) Postpartum Depression retrieved from http://www.academon.com/Research-Paper-Postpartum-Depression/118600 Stanley Poulos (2008) Postpartum Depression retrieved from http://www.xanax- effects.com/ Mirza Abbas Mohila Degree College, Shahjahanpur, 2007 Journal of Applied Sciences Research, 3(11): 1320-1326,2007, INSInet Publication retrieved from http://www.aensionline.com/jasr/jasr/2007/1320-1326.pdf Vallely, Ahmed(2005) Centre for International Child Health, Institute of Child Health, University College London, London, UK retrieved from http://www.biomedcentral.com/1471-2393/5/1 Shane.(2001) preventing postpartum hemorrhage volume 13 Seattle, Washington 98109-1699 U.S.A. Retrieved from http://www.reproline.jhu.edu/english/2mnh/2articles/otlkpph.pdf Page 29
  • 30. Research report Diseases Among Elder people Relationship of internship with taught courses: The courses which I taught during session have a strong relation with my internship. I taught reproductive health in course as my internship topic is “complication during during postpartum so it helps me a lot to understand my topic. we were taught skills of research work and in internship I implemented those learned research tools practically to conduct a research project. So taught courses remain helpful throughout my project work and I was guided at every step of research by my studied courses. Individual’s benefits gained from internship I have learnt from this internship about research programs and counseling of patients. I have learnt that how to communicate and counsel the patient. I got awareness about complications after pregnancy and their management. I understood how we can educate and aware the women about their health problems so that these complications can be reduced. Lesson learned from internship I have done my internship in Aziz Bhatti Shaheed Hospital Gujrat, I have seen that doctors and staff do not perform their duties honestly due to which patient gets into trouble. No one attends patient carefully or attentively, if all the doctors and staff perform its duty honestly then many problems can be solved out. Patient can get better treatment and better compliance. I have learnt from this internship that we should perform our duties honestly, carefully and attentively, we should not be harsh or rude to patients, as some one’s life is dependant on us, so we should not keep ignorant attitude as if we are in life saving profession. As QURAN says “If anyone saved a life of a man it would be as if he had saved the life of whole mankind” May ALLAH guide us on right path. Page 30
  • 31. Research report Diseases Among Elder people Conclusion of internship The conclusion of this internship is that small or little mistakes can bring about big mishaps or upsets. Little ignorance can cause serious complications. Our home environment, education of the women and economic condition effects women health. I have observed during this internship that the women who belongs to rural areas shows more postpartum complications as compare to those who lives in urban areas. The reason is lack of awareness regarding their health problems. Education is also a key point concerning the health problems because an educated woman can take good care of not only her as well as her family’s health, but illiterate woman fails to do so due to lack of awareness. Another reason is depression which badly effects women health. Women whom delivery is carried out by mid-wives are at more risk to have genital infections. Page 31