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Objectives: To focus on the benefits of focal resection of the lower uterine segment as compared to obstetric hysterectomy in patients with morbidly adherent placenta. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Okara, Oct 2019 to Nov 2020. Methodology: Fifty-two women between 34 to 38 weeks of gestation were operated for morbidly adherent placenta. Group-I women (focal resection of the lower uterine segment) and Group-II (obstetric hysterectomy) were twenty-six each. In Group-I, hemostasis was secured by a figure of 8 sutures, purse-string sutures or continuous sutures. In Group-II, hemostasis was secured, and internal iliac artery ligation was done as required. Results: Group-I undergoing focal resection of lower uterine segment hemostasis was addressed by the figure of 8 sutures in 21 (80%) women and purse-string sutures in 7 women (27%). Hemostasis of the posterior uterine wall was done in 12 (47%) women. Balloon tamponade was used in 10 (40%) women and B-Lynch suture in 5 (20%) women. Internal iliac artery ligation was done in 4 (11%) women, and the bladder was injured in 10 (40%) women. Group-II undergoing obstetric hysterectomy hemostasis was secured for leftover placental tissue in 5 (18%) women, and internal iliac artery ligation was done in 9 (35%) women. Bladder repair was done in 12 (47%) cases. Conclusion: Although time-consuming, focal resection of the lower uterine segment and hemostasis are associated with less morbidity. [ABSTRACT FROM AUTHOR]

Objective: To find the appropriate timings for intervention in women with intrahepatic cholestasis of pregnancy. Study Design: Prospective observational study. Place and Duration of Study: Gynaecology and Obstetrics Department Combined Military Hospital Okara, from Oct 2019 to Nov 2020. Methodology: Patients between 34-40 weeks of gestation with intrahepatic cholestasis were included in the study. With clinical and biochemical findings patients were monitored and conventional treatment was given. Intervention by delivery was done when required. Maternal and fetal outcome were followed. Results: Out of 380 patients with pruritus between 34-40 weeks of gestation, intrahepatic cholestasis was found in 53 patients. Most of the patients 27 (51%) were delivered at 37-completed weeks. At 35-weeks of gestation 6 (11%) patients were delivered, at 36-weeks 8 (15%) patients were delivered, while 2% patients delivered at 39 and 40 weeks of gestation. The number of intrauterine deaths was 1 at 34 weeks of gestation and 2 at 35 weeks of gestation. Transient tachypnea of newborn was observed in 23% neonates. Respiratory Distress Syndrome was observed in 6 (12%) newborns. Neonatal sepsis was observed in 5 and hyperbilirubinaemia was observed in 4 (8%) neonates. Conclusion: Patients with intrahepatic cholestasis should be preferably delivered between 37 to 38 weeks for a better foetal outcome. [ABSTRACT FROM AUTHOR]

Objective: To see the efficacy of the gynecological procedure of outdoor endometrial biopsy using pipelle biopsy. Study Design: Prospective observational study. Place and Duration of Study: Sampling was done at obstetrics and gynecology department Pak-Emirates Military Hospital Rawalpindi, from Jan 2018 to Aug 2018. Methodology: A 100 cases of perimenopausal/postmenopausal women presenting with menorrhagia/menorrhagia after the age of 40 years were selected for the study. Pipelle biopsy was employed in all the cases. Results: The patients presenting with metorrhagia, menorrhagia, polymennorrhagia and postmenopausal bleeding with mean age of 46 ± 3.26 were included in the study. Sixty eight (68%) patients had metorrhagia, 10 (10%) presented with menorrhagia, 10 (10%) patients had polymennorrhagia while 12 (12%) patients had postmenopausal bleeding. Histopathological results showed that 5 (5%) patients were suffering from chronic endometriosis, 20 (20%) had hormonal imbalances, 45 (45%) had proliferative endometrium, 18 (18%) had endo-metrial benign hyperplasia. Conclusion: It is concluded that outdoor endometrial conventional biopsy using pipelle biopsyis cost-effective and convenient method for diagnosing endometrial diseases. The procedure while providing reliable histopathological results in all cases is cheap and causes minimal discomfort to patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the autonomy of young Pakistani women in house hold decision making and the use of modern contraception; and to find association between couples’ joint participation in decision making and use of modern contraception. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Aug 2018 to Aug 2019. Methodology: The study took place at Gynae & Obstetrics department Pak Emirates Military Hospital, Rawalpindi from Aug 2018 to Aug 2019. Cross-sectional study design was adopted. Results: Out of 360 women, 179 (49.7%) had 3-5 children while only 17 (4.7%) had more than 6 children. According to 261 (72.5%) women both husband and wife wanted same number of children while in only 2 (0.6%) cases husband wanted fewer children. Socioeconomic status showed a statistically strong association (p=0.035) with using modern contraceptives. Education status showed a statistically strong association with desire for more children (p=0.004), usage of modern contraceptives (p=0.004) and respondents role in household decision making (p=0.041). Conclusion: It was found that in substantial number of couples decision for usage of modern contraceptives was mutual. A very alarming finding was that most of the women have not had an encounter with family planning worker in last six months despite the fact that most of the women in the study did not have desire to have more children. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of genitourinary syndrome of menopause on well-being, functioning and quality of life (QoL) in postmenopausal women. Study Design: Cross-sectional survey. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2019 to Mar 2020. Methodology: The study participants aged 30-60 years old, had last menstrual period about one year ago. The day-to-day impact of vaginal ageing" (DIVA) questionnaire was filled by the study participants who had one vaginal symptom regardless of its intensity and who was postmenopausal to assess its impact on well-being and quality of life. The comparisons of the mean score of every domain of the day-to-day impact of the vaginal ageing questionnaire were performed for the women with genitourinary syndrome of menopause and without genitourinary syndrome of menopause. Results: A total of 410 postmenopausal women were included in the study. A total of 302(75.3%) women reported with vaginal symptoms and genitourinary syndrome of menopause, while 99(24.68%) with no diagnosis of genitourinary syndrome of menopause. The score was significantly high (p0.001) in the women with genitourinary syndrome of menopause as compared to the women without genitourinary syndrome of menopause. The highest value was reported for the long in the genitourinary syndrome of the menopause Group and the lowest for the daily life activities of both groups. Conclusion: The quality of life of postmenopausal women, their well-being and functioning are impacted by the vaginal symptoms, specifically their sexual function, body image and self-esteem. The scientifically higher impact was found in the women with genitourinary syndrome of menopause. [ABSTRACT FROM AUTHOR]

Objective: The present study was designed to study the role of antenatal check upon caesarean section (C-Section) rate in patients reporting to labour room. Study Design: Prospective cohort study. Place and Duration of Study: The study was carried out at Combined Military Hospital (CMH) Attock, from Oct 2014 to Mar 2015. Material and Methods: A total of 447 patients who underwent treatment in CMH Attock were included in this study. Patients were divided into two groups: 1) Booked patients - the ones who consulted obstetrician regularly during pregnancy, 2) Unbooked patients - These patients do not consult obstetrician for ante-natal checkup during the pregnancy. The data was collected on a proforma and was statistically analyzed. Results: About 77.85% of the total recruited patients in the study were booked while 22.15% were un-booked. A 37.6% of the booked patients had to undergo caesarian section (c-section) while 62.4% patient underwent spontaneous vaginal delivery (SVD). Whereas 51.5% un-booked patients had c-section while 48.5% patients underwent SVD. Point two percent and 2.5% of the overall patients had gestational diabetes and anaemia respectively. Three percent of the total pregnant patients were diagnosed as being hypertensive. Patient history revealed that 3% patients had bad obstetrics history and 76.9% of them attended ante-natal clinic. Conclusion: In our set up overall C-section rate was 42.6% but in the booked group the rate was 37.6% as compared to the much higher 51.5% in the un-booked group thus indicating that high C-section rate in the unbooked group contributed in a major way to the overall C-section rate. [ABSTRACT FROM AUTHOR]