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Objective: To determine the frequency aplastic anemia among adult patients with pancytopenia. Place and duration of study:The study is conducted at Department of Medicine, MTI-Lady Reading Hospital, Peshawar and the duration of study is From 25-04-2018 to 25-10-2018. Material and Method: It is a Descriptive cross sectional study design having sample size of 135 patients, this study using 95% confidence level and 7% margin of error, under WHO software for sample size determination. The sampling technique we have used in this study is the non-probability consecutive sampling. All adult patients with newly diagnosed pancytopenia of any duration, Age group above 18 years to 60 years belongs to any gender are included in this study design. SPSS 23 was used to evaluate all the data.Mean and Standard Deviation was calculated frequency and percentages were calculated. Using the chi square test results are examine the effect modification. A p-value of 0.05 or below was considered significant. Results: At the MTI-Lady Reading Hospital in Peshawar's Department of General Medicine, 135 patients participated in this study. According to descriptive data, the mean and SDs for age were recorded as 55+12.85 and 3+1.18, respectively. In the 18–30 age range, there were 27 (20%) patients, whereas the 31–60 age group had 108 (80%) individuals. In a similar manner, 44 (32.59%) patients were recorded as female and 91 (67.40%) patients were recorded as male. According to frequency and prevalence rate for aplastic anaemia, 103 (76.29%) patients were identified as having this condition. Practical Implications: The current study's objective is to determine the prevalence of aplastic anaemia in people with adult pancytopenia. Despite the availability of study, statistics show that the severity of aplastic anaemia varies from population to population, and pancytopenia is not uncommon in our society. Conclusion: This study evaluated that aplastic anaemia is the most prevalent cause of pancytopenia in the Khyber Pukhtunkhwa population, and that bone marrow aspiration is a recognised diagnostic method for the assessment of pancytopenia. Keywords: Aplastic anemia, Bone marrow, Megaloblastic Anemia, Pancytopenia, Bone marrow failure Syndrome, . Myelophthisic anemia, Thrombocytopenia.

Objectives: To compare the safety and efficacy of uterovaginal packing and Foley’s catheter balloon tamponade in patients with excessive vaginal bleeding following vaginal delivery. Design : RCT ( Randomized Controlled Trial). Setting : Obstetrics & Gynaecology Deptt. , HFH ( holy family hospital) , RWP. Duration: Six Months. Materials & Methodology: 94 females who presented with excessive vaginal bleeding ( > 500 ml) following vaginal delivery, 18 to 40 years of age , gestational age (GA) ≥37 weeks were included. Patients with retained products of conception, PPH due to perineal, cervical or vaginal tear and coagulation disorders were excluded. The patients were distributed equally into 2 groups ; a and b based on the lottery method. Group a was managed with uterine packing and Group b was managed by the Foley’s catheter balloon tamponade. Efficacy and safety in both groups was measured. Results: In my study, efficacy was significantly high in uterine packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (89.36% versus 68.09%; respectively) with p-value of 0.012. In my study, safety was significantly high in uterovaginal packing group (Group a) compared to Foley’s catheter balloon tamponade (group b) (72.34% versus 31.91%; respectively) with p-value of 0.0001. Conclusion: Uterovaginal packing is more secure, prompt and efficient procedure to manage excessive hemorrhage after delivery compared to Foley’s catheter balloon tamponade. Keywords: Hemorrhage, uterovaginal packing ,foley’s balloon tamponade.

Objective: To evaluate the efficacy of oral nifedipine against vaginal micronized progesterone to treat threatened premature labour (24 wks to 36+6 wks). Design : Randomized Controlled Trial. Setting : Obs and Gynae Deptt, Bakhtawar Hospital, Multan. Study Duration : Six months (15-12-20 to 14-6-21) Material and Methods: 126 patients with diagnosis of threatened preterm labour were included in this study. Baseline demographic information of patients (age, gestational age and parity, previous history of preterm labour, smoking, BMI and socioeconomic status) was recorded. In 63 patients oral nifedipine was given for treating threatened premature labour and in remaining 63 patients, progesterone was administered vaginally to prevent preterm labour.Efficacy was noted for both groups on a especially designed proforma. Results: Mean of ages of women included was 28.05±4.49 yrs. Mean GA of patients was 33.54±1.83 weeks. Mean parity was 1.81±1.11. Mean BMI of patients was 24.33±3.33 Kg/m2. Previous history of preterm labour was found in 16 (12.70%). Oral nifedipine was effective in 47 (74.60%) patients & vaginal progesterone was noted successful in 58 (92.10%) patients with p-value of 0.009. Conclusion: Vaginal micronized progesterone is more effective than oral nifedipine for the prevention of threatened preterm labour. More research work is required to ascertain the superiority of vaginal progesterone over nifedipine for the prevention of preterm labour. Keywords: Oral nifedipine, micronized progesterone, preterm labour.

Objective: To make a rough estimate of the frequency of abruption, its likely risk factors and its various complications, among the cases of APH in hospitalized patients. Design: Prospective descriptive study Setting: Obstetrical inpatients Department of Bakhtawar Hospital, Multan. Duration of study: 1 year (1/6/20 – 31/5/21) Subjects and Methods: Patients with objective evidence of placental abruption, were initially recruited and managed accordingly. Those cases in which abruption was a likely cause, were selected for the study purpose and other cases of APH were dropped from the study. Results: Frequency of abruption was 2.3% of all obstetrical admissions and about 32.7% (1/3 rd) of all cases of APH. The most likely risk factors identified were grand multiparity (46.1%), pregnancy induced hypertension (38.4%), advanced maternal age (43.5%) and previous history of abruption (12.8%). Majority (82%) of the patients belonged to lower socioeconomic class, with no proper antenatal care throughout pregnancy. In this class, increased obstetrical complications were due to anemia, trend of grand multiparity and too late approach to health care professional. Conclusion: The study addresses the frequency of abruption placenta, which is one of the serious obstetrical emergencies and timely aggressive management can reduce its complications. All professionals who care for women during pregnancy and child birth must be aware of it and have a clear plan in mind for its prompt diagnosis and management. Keyword: Frequency of abruption, APH, abruption placenta.

Objective: To find out how commonly infections occur in cesarean section skin wound in post operative period and what factors are commonly encountered in these patients. Design: Descriptive Case Series. Setting: Obs & Gynae Deptt., Nishtar Hospital Multan (NHM). Duration of Study: Six Months. Subjects and Methodology: 121 patients undergoing cesarean section due to various reasons were enrolled in this research. These subjects were followed till 30 days of the procedure and examined through this interval for presence/absence of wound infection . These patients were evaluated for the presence of anemia, PIH/ pre-eclampsia, DM , PROM, obesity & type of cesarean section. Results: Age range was 18 to 45 yrs & Mean calculated i.e 28.289±2.74 years, mean gestational age 37.983±1.75 weeks, mean BMI 26.281±1.47 Kg/m2 and mean parity was 1.545±1.17. Post cesarean wound infection was seen in 9.9% patients. Factors leading to post-cesarean section wound infection were anemia found in 16.7%, diabetes mellitus in 16.7%, PROM in 16.7%, hypertension in 25%, obesity in 75%, emergency caesarean section in 75% and elective caesarean section in 25% were noted. Conclusion: Identification of causative factors of cesarean section wound infection, their correction and modification may help reduce wound infection rates among postoperative patients leading to reduction in maternal morbidity. Keywords: Cesarean section, Wound infection, Factors leading to wound infection.

Objective: To determine the association between preeclampsia and hypovitaminosis D in females presenting during third trimester of pregnancy. Design: case control study Setting: This research was conducted at department of Obs & Gynae, Lady Willingdon Hospital ( LWH ) , Lahore. Duration of study: 6 months Sampling Technique: Non probability consecutive sampling Material and methods: Total 330 pregnant females in their third trimester, were recruited for the research. The patients were divided into 2 groups comprising 165 in each group. After obtaining informed consent from all patients, blood samples were drawn and taken to the lab for measuring Vitamin D level. If vit.D level was

Objective: To find out prevasiveness of urinary tract infections in pregnant females who undergo premature deliveries. Design: Cross sectional study Setting: The study was conducted in Obstetrics and Gynaecology Deptt. Nishtar Hospital Multan. Duration of study: Six months (01-12-2017 to 01-05-2018). Subjects and Methods: Patients fulfilling the inclusion criteria and who underwent preterm deliveries in labour room, unit 1 were included in the research. 357 pregnant women who delivered prematurely were included in our research. Midstream urine samples were collected in sterilized bottles and was immediately shifted to pathology laboratory for culture and sensitivity. Results: Gestational Age Mean of patients noted to be 29.98 ± 2.29 weeks and 219 (61.3%) were 30 wks pregnant . Mean age of pregnant females was 27.47 ± 3.97 years (varied b/w 20 – 37 yrs ). Out of 357 pregnant ladies, 97 (27.2 %) were from villages and 260 (72.8 %) lived in cities. Earning per month , up to 30000 Rs. was noted in 206 (57.7%) while > 30000 Rs. Observed in 151 (42.3%). Mean BMI noted was 25.9 ± 1.38 kg/m2 and 109 (30.5 %) were obese . Out of 357 pregnant females, urinary tract infection was found in 137 (38.3%) patients undergoing preterm labor. Conclusion: Urinary tract infection ( UTI ) was commonly found among women undergoing preterm labor. Urinary tract infection had significant association with GA, age, residence , monthly earning, obesity, parity & literacy. Clinicians treating such patients undergoing preterm labor should always be vigilant for these infections as early detection and prompt treatment will decrease disease related morbidity and improve perinatal outcomes. Keywords : Urinary Tract Infection, Preterm labor, Frequency.

To investigate the occurrence of adverse perinatal outcome in pregnancies with short inter pregnancy interim. Study Design: A Cross – sectional study. Setting: Obstetrics & Gynaecology Unit 1,Combined Military Hospital Multan. Study Duration: 6 months ,( 25-10-2019 to 24-04-2020) Subjects and Methods: Baseline information like age, obesity, parity and educational status was noted. The patients with short Inter pregnancy interval were recruited for perinatal outcomes. Results: Calculated mean of age of gestation of the patients was 38.45 ± 0.21 wks and 147 (61.3%) were at > 38 wks of gestation. Mean age of patients included, was 28.21 ± 4.37 years. Of the 240 study cases, 158 (65.8 %) were living in countryside and 82 (34.2 %) came from inner-city. Of these 240 study cases, 166 (69.2 %) pregnant females had no primary education even and only 74 (30.8%) ladies were literate. Mean BMI of the subjects was 24.99 ± 2.17 kg/m2 while 33 (13.8 %) pregnant females were found obese . Parity mean found to be 2.11 ± 0.78 and 184 (76.7 %) had parity up to 3. Mean of marriage period was 5.22 ± 3.67 yrs and 124 (51.7%) marriage period upto 4.9 years. Preterm birth was noted in 47 (19.6%), premature rupture of membranes was noted in 95 (39.6%) while postpartum hemorrhage was noted in 31 (12.9%). Conclusion: A brief interim (< 1.8 yrs) between two pregnancies, was found to be associated with more risks of preterm births (PTB), premature rupture of membranes (PROM) and postpartum hemorrhage (PPH). Higher frequencies of PTB, PROM and PPH have been observed in our study. Repeated unplanned pregnancies with brief interim between two pregnancies in under-developed countries particularly, lead to high maternal and neonatal morbidity and mortality. Since lack of optimization of maternal health has untoward consequences, awareness and education of mothers in pre and post natal visits about effective contraception is an important component of safe motherhood. Keywords: Inter pregnancy interim, IPI, perinatal outcomes.

Objective: To find out the prevalence of hyperprolactinemia in subfertile females attending outpatient department (OPD) in a tertiary care hospital of South Punjab, Pakistan Design: Cross sectional Setting: Gynaecological outpatient department (OPD) Nishtar Hospital Multan, Pakistan Duration of study: Six months Subjects and methods: After approval from the hospital ethical committee, 379 patients, who meet the set standards, having primary and secondary subfertility, were included from Gynae outpatient department (OPD) of Nishtar Hospital Multan. After informed consent, serum prolactin level was measured of all selected women. Data was entered into a computer using SPSS version 10 for Windows. Results: Most women (39.05%) were 26-30 years old and were nullipara. BMI > 30 was observed in 21.89% of cases. Majority of patients (66.75%) were having primary subfertility. Secondary subfertility was reported in 33.24% of cases. Duration of subfertility was < 5 years in 63.06% of patients and in 36.93% of cases duration of subfertility was ≥5 years. Frequency of hyperprolactinemia in subfertile women was 29.28%. Conclusion: Hyperprolactinemia causes anovulatory cycles because of suppression of endogenous gonadotrophins and it is commonly encountered in patients who primarily find unable to conceive as compared to those who have previously conceived. Keywords: High prolactin levels, primary infertility, secondary subfertility, prolactinoma.

Introduction: To determine the risk factors of hypertensive disorders of pregnancy (HDP) among pregnant women. Methods: In this study, we included 200 patients, 100 were those who were diagnosed with any HDP and 100 were control patients, who were pregnant and did not have any HDP. The study was conducted in Nishtar Hospital Multan from June-2021 to June-2022. Women having blood pressure (BP) ≥140/90 mmHg was 20 weeks of gestation were labelled as having HDP. Risk factors of HDP were noted. Results: Mean age of patients was 28.45±8.45 years in cases and 30.41±9.61 years in controls. On univariate analysis, age >35 years Univariate analysis was done to determine the risk factors of HDP. Age >35 years (OR 3.63 (1.08-12.18), p-value 0.02), obesity (OR 3.16 (1.03-9.68), p-value 0.03), living in rural area (OR 2.26 (1.01-5.05), p-value of 0.04), nulliparity (OR 3.45 (1.22-9.75), p-value 0.016), positive family history of hypertension (OR 4.04 (1.21-13.43), p-value 0.017), twin pregnancy, lack of regular visit of antenatal clinics (OR 0.31 (0.12-0.95), p-value 0.02), Previous history of abortion (OR 9.33 (1.12-77.7), p-value 0.01), chronic hypertension (OR 4.5 (0.91-22.7), p-value 0.04). Conclusion: This study revealed rural lifestyle, old age, multiple pregnancy, and pre-pregnancy weight as independent risk factors. It is advised that health care providers employ these indicators as a screening tool for the prediction, early diagnosis, and timely intervention of pregnant hypertensive problems. Keywords: Gestational hypertension, Preeclampsia, Hypertensive disorders of pregnancy.