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Objective: To evaluate the effectiveness of employing Foley's catheter and modified thermal balloon ablation to treat heavy menstrual bleeding (HMB). Study Design: Prospective Interventional Randomized Control study. Setting: Departments of Gynecological of Three Semi Government Hospitals of the City. Period: January 2021 to September 2022. Material & Methods: In the study, 12 patients between the ages of 42 and 50 who complained of menorrhagia and who had not responded to treatment for at least 6 months were recruited. Pre-ablation endometrial curettage was performed on each patient. A 30-50 ml latex covered Foley's Catheter was evaluated after being introduced into uterine cavity, inflated as much as the cavity would allow under moderate pressure, and changed every two minutes with fresh boiling saline for eight minutes. Following that, hysteroscopic examination and a 6-month follow-up were performed to look for endometrial scarring. Results: Significantly shorter hospital stays, shorter recovery times following surgery, and quicker return to normal daily and sexual activities. Regarding problems, menstrual alterations, amenorrhea rate, and failure rate during the course of follow-up, there was no discernible difference between patients. This method has a success rate of almost 88%. Conclusion: In situations with limited resources, improved thermal balloon ablation with a Foley's catheter can be a potential treatment for HMB. It is a more affordable option that the preliminary endometrial ablation approaches. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of clomiphene citrate compared with clomiphene citrate and metformin combination used as infertility treatment in polycystic ovarian syndrome. Study Design: Randomized Controlled study. Setting: Combined Military Hospital, Nowshera, KPK. Period: March 2021 to November 2021. Material & Methods: One hundred and forty eight infertile patients aged between 20 to 34 years diagnosed with PCOS were enrolled for the investigation. Using blocked randomization technique, the participants were divided into two groups. Group A patients received clomiphene citrate 50 mg day on days 2 to 6 and dose was gradually increased to 150 mg day. Patients in Group B received metformin 500 mg three times a day along with the above mentioned dosage of clomiphene citrate. Collectively, the patients in both groups were provided with a follow up for six months. Efficacy in both groups was assessed on the basis of positive urine pregnancy test. Results: The rate of ovulation in group B was high in comparison to group A (39.2%vs 21.6%; P value = 0.02) the results were statistically significant. The rate of efficacy/conception in group B was significantly greater as compared to group A (32.4%vs 16.2%; P value = 0.02). Conclusion: We conclude that clomiphene citrate along with metformin, used in combination is significantly much efficacious as compared to clomiphene citrate alone for treating infertility in patients with polycystic ovarian syndrome. [ABSTRACT FROM AUTHOR]

Objective: To compare the ovulation induction of letrozole and clomiphene citrate in sub-fertile women with polycystic ovarian syndrome. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Jun 2018 to Aug 2019. Methodology: A total of 116 married sub-fertile women with polycystic ovarian syndrome, 16-40 years of age were included. Patients with previous surgery related to genital tract, hypothyroidism and chronic renal failure were excluded. Letrozole 5.0 mg daily from Day 5-9 of menstruation was prescribed to group A women and clomiphene citrate 100 mg daily from Day 5-9 of menses was given to group B women. Results: In group A and in group B, mean age was 29.78 ± 4.71 years and 29.95 ± 4.22 years respectively. Most of the patients 59 (50.86%) were between 18-30 years of age. Mean duration since marriage was 4.23 ± 1.42 years. Mean body mass index was 29.71 ± 2.65 kg/m2. Frequency of ovulation of clomiphene citrate and letrozole in sub-fertile women with polycystic ovaries was 28 (42.28%) versus 42 (72.41%) respectively (p-value=0.008). Conclusion: This study concluded that ovulation induction of letrozole is better than clomiphene citrate in sub-fertile women with polycystic ovarian syndrome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate lipidprofile amongst patients diagnosed with preeclampsia and compare it with normal pregnant patients. Study Design: Cross-sectional comparative study. Place and Duration of Study: Obstetrics Unit, Combined Military Hospital Rawalpindi, from Jan to Mar 2021. Methodology: A total of 80 patients were enrolled and divided into two groups. Group A preeclampsia patients and group B normotensive pregnant patients in third trimester. Inclusion criteria were patients between 20-35 years in third trimester of pregnancy. Patients with preexisting hypertension, diabetes, autoimmune disease and renal problems were excluded. Demographic and reproductive profiles including age, parity, period of gestation and body mass index (BMI) noted. Blood samples after 12 hours of fasting were obtained. Serum total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), serum triglycerides and very low density lipoproteins (VLDL) levels calculated. Demographic profile and test results of the two groups were compared. p-value of ≤0.05 was considered statistically significant. Results: A total of 80 patients were enrolled in the study. Mean age of two groups was 28.6 ± 3.8 yrs, mean parity 1.8 ± 1.1, gestational age 33.6 ± 2.6, body mass index 27.7 ± 2. Mean values calculated of the lipid profile of both groups was cholesterol 5.22 ± 1.2, high density lipoproteins 1.68 ± 0.65, low density lipoproteins 3.07 ± 1.1, triglycerides 2.5 ± 0.93, very low density lipoproteins 1.24 ± 0.44. Difference between age, parity, gestational age and body mass index was not significant between the two groups but difference between serum cholesterol and triglyceride levels was significant (p<0.0001). Conclusion: Our pregnant population generally has raised lipid levels. Women with preeclampsia have lipid profile derangements which are significant in comparison to normotensive patients. [ABSTRACT FROM AUTHOR]

Objective: To describe the presenting signs and symptoms, clinic-pathological findings of ovarian masses and to establish diagnostic value of clinical examination, ultrasonography and its correlation with histopathological diagnosis. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Jun 2017 May 2018. Methodology: Women who underwent surgery for ovarian masses were included. Data was collected from hospital records including; age, presenting symptoms, duration of symptoms, changes in menstrual cycle, and the results of the physical examination. The preliminary diagnoses as well as the final diagnosis were noted. Results: A total of 83 patients with ovarian masses, who underwent surgery over the period of a year, were included. The most common symptom was abdominal pain in 56 (67.5%) followed by abdominal distention 9 (10.8%), dysmenorrhea 8 (9.6%). When both clinical and sonological diagnosis were combined, the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign and malignant ovarian neoplasms were 87.5%, 96.7%, 70%, and 98.88%, respectively. Conclusion: In this study most, common symptom was abdominal pain both in benign and malignant ovarian masses. Whereas, abdominal distention was more common in malignant masses. Preoperative diagnostic approach should always include careful history taking, physical examination, imaging and evaluation of tumor markers. Early detection, thorough treatment and regular follow-up are the need of time to reduce the morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical course and outcome of hospitalized pregnant patients with laboratory confirmed SARS CoV-2 (COVID-19) infection. Study Design: Prospective observational study. Place and Duration of Study: Obstetrics Unit of Pak Emirates Military Hospital (PEMH) and Combined Military Hospital (CMH) Rawalpindi, from May 2020 to Jun 2020. Methodology: All patients reporting for childbirth were tested for SARS CoV-2 and those testing positive were included. Demographic and reproductive profile including age, parity, occupation, contact and travel history, period of gestation at diagnosis and mode of delivery where applicable noted. The primary outcome was Virus clearance time and categorization according to severity of disease into asymptomatic, mild, moderate, severe and critical. Comparison was done between presence of co-morbid conditions and symptoms to category of COVID19. Neonatal sample evaluation for SARS CoV-2 was done. Results: Out of the 881 women giving birth 41 (4.6%) tested positive for SARS Cov-2. Majority were asymptomatic 28 (68.3%) followed by mild 08 (19.5%), moderate 04 (9.8%) and severe 01 (2.4%) category. There was significant association of COVID category with presence of symptoms (p-value <0.005) and comorbid (p-value <0.001). Mean virus clearance time was 8.2 ± 1.66 days. During hospital stay 34 (82.9%) delivered. All 34 (100%) of the delivered babies had no evidence of vertical transmission. Conclusion: Pregnant women with COVID-19 infection have nearly comparable clinical course to non-COVID women in this study. There is also no evidence of vertical transmission to the neonate. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of SARS CoV-2 (COVID-19) infection amongst women admitted for child birth and to categorize patients according to disease severity. Study Design: Prospective cohort study. Place and Duration of Study: The study was conducted at Obstetrics Unit of Combined Military Hospital (CMH) Rawalpindi, from 1st May 2020 to 15 June 2020. Methodology: Pregnant patients reporting for childbirth were initially screened and tested for SARS CoV-2 using RT-PCR kits. Primary outcome was number of positive patients and categorization according to severity of disease into asymptomatic, mild, moderate, severe and critical. Screening parameters were symptoms like fever, cough, flu, myalgia, breathing difficulty, gastrointestinal symptoms, travel history and history of contact. Comparison was done between COVID category of asymptomatic and symptomatic patients. Results: Based on PCR testing out of the 525 women giving birth during the study period 43 (8.1%) was COVID positive. Out of the total screened patients 484 (92%) were a symptomatic and 41 (7.8%) were screen positive. 20 (48.7%) of screen positive were PCR positive too. According to disease severity 28 (65%) patients were asymptomatic, 10 (23%) mild, 4 (9.3%) moderate and severe (1%). COVID category for screen positive and negative patients was compared and was statistically significant for screen positive patients (p<0.0001). Conclusion: pregnant women with COVID-19 infection are a unique subset of patients. As majority of the patients were asymptomatic and only diagnosed with a positive laboratory test so the recommendation is to do universal testing in this pandemic to prepare for childbirth ina safe environment for patient, neonate and health care workers. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology and Obstetrics Department, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Dec 2018. Methodology: The study included 130 women aged 18-40 years who had first-trimester pregnancy loss. Patients with chronic renal failure, known thyroid disorders and taking medication that can affect thyroid functions were excluded. Venous blood samples were taken to analyse thyroid function tests, and subclinical Hypothyroidism was noted. Results: The mean age of the women was 28.68±4.80 years. Most patients 77(59.23%), were between 18 and 30 years old. The mean BMI was 29.42±2.50 kg/m2. 16(12.31%) women with first-trimester miscarriage had subclinical Hypothyroidism. Conclusion: This study concluded that the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss was significant. Proper management protocol for early recognition and management of subclinical Hypothyroidism in women can improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergency contraception Pills (ECP) provides a safe and effective means of post coital treatment and prevents at least 75% of expected pregnancies resulting from unprotected intercourse. The purpose of the study was to assess the awareness regarding emergency contraception and to see the knowledge attitude and preference about emergency contraception., Methods: This was a descriptive cross sectional study carried out at Combined Military Hospital (CMH) Khuzdar. A total of 200 married women of reproductive age group who agreed to participate in the study were interviewed using a self-reported comprehensive, structured closed ended questionnaire., Results: 77% of the women were practicing some contraceptive method at the time of study. Most were using condoms for contraception. 16% of all respondents have never used any contraceptive in their life. 70% believe that religion of Islam is not a barrier in family planning. Only 7.5% of the women were aware about ECP., Conclusion: Knowledge about ECP is poor among the women of child bearing age. There is a room for improvement regarding the awareness and use of ECP which can contribute to prevention of unwanted pregnancies.