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Background: Preeclampsia is a pregnancy-specific multisystem progressive disorder, characterized by a new onset of hypertension and proteinuria or significant end-organ dysfunction without proteinuria typically after 20 weeks. If not controlled, it can lead to adverse fetal outcomes. Aspirin a COX inhibitor can delay or prevent the onset of PE. Its effectiveness and safety in relatively higher doses (150mg) need to be investigated in the local population. To compare the two different low doses of aspirin 75mg vs. high dose of 150mg in moderate and high-risk women for prevention of preeclampsia and its associated complications. Methods: A Parallel arm randomized control open-label study was conducted at the Department of Obstetrics and Gynaecology of Ziauddin University Hospital Kemari, Karachi. A sample of 156 women, age >18 years, with moderate and high risk of Preeclampsia was selected consecutively. Random allocation of 78 women each was done to group A (75mg) versus group B (150 gm) of Aspirin. Patients with multifetal gestation, major fetal anomaly, thrombocytopenia, peptic ulcer, or bleeding disorder were excluded from the study. Ethical approval was sought from the ERC of Ziauddin University. Descriptive and analytical results expressed through SPSS software. Results: Both groups were comparable in terms of their basic demographics. The effectiveness of Aspirin 75mg was 53% compared to 70% of Aspirin 150mg in the prevention of pre-eclampsia among high-risk women. With 75mg Aspirin the incidence of PE decreased slightly with increasing age while with 150mg, it increased (P values = 0.141, 0.111 & 0.290 respectively. Higher rates of placental abruption (54.3%) accompanied by preeclampsia were seen in group A as compared to (21.7%; p value = 0.016) in group B. The incidence of pre-term delivery, miscarriage, NICU admission & superimposed eclampsia were higher with low-dose aspirin (P values = 0.779, NA, 0.210, 0.592, NA & 0.772 respectively). Conclusion: Aspirin 150mg in moderate and high-risk pregnancies starting at 11-14 weeks is more effective and safer than 75mg Aspirin reducing the incidence of Preeclampsia.

Background: Risk of scar defect is inversely correlated with lower uterine segment thickness. The study aims to assess the diagnostic accuracy of sonographic measurement of the lower uterine segment thickness near term in predicting uterine scar defect in women with prior Caesarean section and ascertain the best cut-off value for predicting uterine rupture in our country. Methods: This observational case series study was carried out at Department of Gynecology and Obstetrics, Ziauddin University and Hospitals from January 2015 to June 2015. Women carrying singlet on pregnancy of 36-38 weeks with history of previous C-section were included in the study. Lower uterine segment measurement was done by transabdominal ultrasound at 36-38 weeks gestation and these women are followed up to the time of delivery. Results: A total of 180 patients based on inclusion criteria were recruited in the study. Significant association (p=.001) was found between LUS thickness values measured during pregnancy and status of scar at the time of delivery. No significant association was found between scar thickness and mode of delivery (p= .390). Scar dehiscence was noted in only one study participant. Conclusion: We support the proposition that antenatal measurement of lower uterine segment measurement in women with previous caesarean section is a reliable tool in deciding which women should be given a trial of labor. Key Words: Previous Caesarean Section, Lower Uterine Segment (LUS), Ultrasound Measurement, Pakistan

Background: Women of reproductive age develop menstrual irregularities along with infertility because of polycystic ovary syndrome (PCOS); the most common endocrine disorder. Myo-inositol (MI) is found to have a proven role in the treatment of this disorder. The objective of this study was to determine the efficacy of Myo-inositol in regulating the menstrual cycle in women with PCOS. Methods: The study was conducted in 2019 at the Obstetrics and Gynecology Department of a tertiary care hospital with a sample of 50 women aged 18-45 years, having PCOS diagnosed with complaints of irregular menstrual cycles. Women with ovulatory dysfunction were excluded. Myo-inositol was given as 2 gm/day for 3 months. Pre- and post-trial data were collected, compared and analyzed through SPSS version 23 and a p-value

Background: The foremost cause of maternal morbidity and mortality in third-world countries is Post-Partum Hemorrhage (PPH). To prevent PPH, often Misoprostol is used. This study aimed to find out the efficacy and safety profile of Misoprostol when administered rectally in comparison to oxytocin, to avoid the incidence of PPH. Methods: This quasi-experimental study on n=72 patients were performed at Ziauddin University and Hospital Karachi for 6 months (2021). The patients were divided into two groups. Oxytocin (10 IU) was administered intramuscularly to Group A(n=36) while 400ug of Misoprostol was given to group B(n=36) rectally, at the time of delivery. The level of hemoglobin was checked at the time of admission and 24 hours after delivery and side effects were also monitored. Chi-square and t-test were applied between both groups and a p-value

Background: Induction of labour (IOL) or cervical ripening of an unfavourable cervix can be achieved by both pharmacological and surgical methods. When the cervix is unripe, Foley catheters and prostaglandins method of IOL is used. In this study, we aimed to compare the success rate and cost-effectiveness of vaginal prostaglandin E2 pessary with Foley catheter. Methods: This quasi-experimental study was conducted at the Gynaecological department of Ziauddin hospital from June-December 2019. A total of n=256 women at term were selected according to inclusion criteria. Group 1 was induced with Foley catheter and group 2 with Prostaglandins E2 vaginal pessary. The success rate to achieve delivery, the time interval between induction, delivery and the cost were recorded and compared between the two methods. Student’s t-test (continuous variables) and Chi-square (categories) were used for statistical analysis and p-value < 0.05 was considered statistically significant. Results: The mean age of the females was 27.15 ± 5.5 years. The mean induction to the delivery time interval for PGE2 (group 2) was 15.77 ± 7.37 hours and Foley catheter (group 1) 17.31 ± 7.19 hours (p=0.02). The study did not find any statistically significant difference between the two methods of labour induction(p>0.05). It was found that overall, 198 (77.3%) women delivered by spontaneous vaginal deliveries and 58 (22.7%) by lower Caesarean section (p=0.02, 0.04). However, the total cost of prostaglandins (Rs.1500/-) was higher than the cost of Foley catheter (Rs. 256/-) (p=0.00). Conclusion: Foley catheter to induce labour in an unfavourable cervix is an effective, safe, and inexpensive method of labour induction. Keywords: Foley Catheter; Prostaglandin E2; Induction of Labour; Cost.

Background: Caesarean Sections (CS), significantly on the rise worldwide, have been found frequently complicated with the presence of a scar at the site of CS. It is associated with various gynecological problems like postmenstrual spotting, infertility, miscarriage, and uterine rupture. The objective of this study was to determine the frequency of CS scar defects and associated gynaecological symptoms. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Ziauddin University Hospital Karachi from October 1st, 2017 to March 1st, 2018. A total of 162 patients’ (aged 20-40 years) were included, with CS history (elective or emergency) and complaints of chronic pelvic pain, infertility or menstrual irregularities, after an informed consent. Demographic details and medical history were recorded on performa. Chi-square was used to establish association between categorical variable such presence of scar defect, clinical symptoms and the shape of the defect. Results: Out of 162 patients, 86(53.1%) had one and 76(46.9%) had more than one caesarean scar. Majority of the patients 97(59.9%) were found to have scar defect (NICHE) present while in 65 (40.1%) patients had no caesarean scar defect. Regarding menstrual cycle, 58(35.8%) had heavy bleeding, 39(24.1%) continuous bleeding, and 27 (16%) irregular cycle. Significant association (p

Background: Exteriorization, a valuable repair of uterus technique during cesarean section, requires removal of uterus temporarily from the abdominal cavity to repair the incision. The objective of this study was to compare the postoperative symptoms of intra-abdominal to extra-abdominal repair of the uterine incision during caesarean procedure. Methods: A quasi experimental study done in the Obstetrics and Gynecology unit of Ziauddin University Hospital, Kamari and Clifton Campus, Karachi from 1st January 2017 to 30th June 2017. A total of 190 patients were divided into two groups (95 patients in each). In Group A Uterine incision was closed extra abdominally and in Group B the closure was done intra-abdominally. The rate of nausea, vomiting, hospital stay, wound infection, fever, returns of bowel sounds, blood loss, and uterine trauma was measured between the two groups. Statistical analyses were done by applying independent sample t-test and chi-square tests. Results: Exteriorization was better option above age 35 years and elective cesarean section(C/S) patients with less Intensity of pain and hospital stay (3 days) but the results were not statistically significant. Caesarean Section, hemoglobin both pre and post-operative, blood transfusion, the return of bowel sound after surgery, surgical site infection and uterine trauma between the two groups showed no significant difference. Conclusion: The postoperative management of Exteriorization was better compared to intra-abdominal repair but the results were not significant. Exteriorization is an easy, convenient and valid option without complications and can be used especially in cases where difficulty in visualization of uterine scar and hemostasis is at stake.

ackground: Induction of labor (IOL) is an obstetric intervention designed,usedin 20-30% of all pregnancies. The aim of this study was to assess the efficacy of oral misoprostol alone versus oral misoprostol and Foley’s catheter for IOL. Methods: All pregnant women age ≥18 years requiring induction of labor for various reasons and with unfavorable cervixes admitted in Ziauddin University Hospital Karachi are included in the study. Women were induced in “Group A” with an intracervical Foley’s catheter and tablet misoprostol 25 microgram given orally. In group B, women were given misoprostol 25 microgram tablets alone orally, subsequently every6 hourly for a maximum of four doses. Results: Normal vaginal delivery was significantly higher in group A (n=62, 59.6%) than that of group B (n=42, 40.4%) patients. Caesarean section was found higher in group B (n=25, 83.3%) patients than that of group A patients (n=516.7%; p-value