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The objective of this study is to examine the use of explainable artificial intelligence (XAI) for gathering and analyzing health-related data in medical services applications, particularly in predicting outcomes in mental health care. Artificial Intelligence (Al) is increasingly utilized in medical services and wearable technologies, such as Fitbits. Strategies in the field of explainable Al (XAI) aim to clarify the predictions made by Al systems, enhancing their application in health-related contexts. Data was collected from 970 individuals, incorporating clinical and sociodemographic information. The analysis focused on factors such as self-reported motivation, the type of reference (self vs. healthcare provider), and the Work Productivity and Activity Impairment Questionnaire. Additionally, pre-treatment scores from the Patient Health Questionnaire-9 and General Anxiety Disorder Screener-7 were evaluated. The study identified that self-reported motivation and the specified reference type significantly contributed to predictive outcomes. The irregular forest model achieved an accuracy of 0.71 for the test set, with a base rate of 0.67, an AUC of 0.60, and a p-value of 0.001. Adjusted accuracy was noted at 0.60, indicating a significant ability to predict reductions in anxiety and depressive symptoms. To improve the personalization and effectiveness of mental health care, it is essential to advance predictive models that accurately evaluate individual responses to therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of sublingual misoprostol in first trimester missed miscarriage among women seeking medical management as outpatient. Methodology: A descriptive cross sectional study was conducted at Hayatabad Medical Complex, Gynecology department, involving 179 women recruited through consecutive sampling. Eligible participants were women of reproductive age(20-40years) with singleton first-trimester miscarriage (<13 weeks gestation), residing near the hospital(at 15-30min distance) having >10Hb, hemodynamically stable and no active ongoing blood loss. The selected women received a single dose of 600 µg sublingual misoprostol in crushed form and were followed up for clinical and sonographic assessment of complete expulsion of conceptus. Data entry and analysis were performed using SPSS version 22. Results: Out of 179 women, 119 expelled the conceptus completely. Remaining patients switched over to other options due to retained products of conception or heavy bleeding. Success rate of sublingual misoprostol was found to be 66.5%. Satisfaction and acceptability is high for medical management of miscarriage 76.67% and 68.33% respectively, with statistically significant difference for satisfaction (p-0.004). Conclusion: Sublingual misoprostol is found to be effective in first trimester missed miscarriage among women seeking medical management as out patient. [ABSTRACT FROM AUTHOR]

Objective: To find out the fetomaternal outcome of patients referred to tertiary care hospital after trial of labour. Methodology: This descriptive study was conducted in the Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar. All patients admitted in the labour room who had trial of labour outside the hospital by midwife, lady health visitor (LHV) or doctor were included in the study. Patients who were not handled outside hospital were excluded. Patients were selected through non probability convenient sampling technique after informed written consent. At the time of admission detail clinical evaluation was done to assess the condition of both mother and fetus. Patients were then managed according to the labour suit protocols. Data were entered on a predesigned proforma and then analyzed using descriptive statistics including frequencies and percentages using SPSS version 20. Results: A total of 186 patients were included in the study. Mean age of the patients was 27±6.8 years. Majority of the patients were multigravida (38.70%). Most of the patients were handled by LHV/midwives 109(58.60%). About 43.54% patients underwent cesarean section and 13.43% were delivered by instrumental delivery. Ruptured uterus was diagnosed in 1.07% cases, while 2.5% were having scar dehiscence. Postpartum haemorrhage occurred in 25 (13.44%) women. About 64(34.40%) babies were delivered with low APGAR score and 18(9.67%) babies were admitted in NICU. Conclusion: Women who were handled outside hospital were associated with poor fetomaternal outcome. [ABSTRACT FROM AUTHOR]

Objective: Technological advancements extend the range of indications for gynecological laparoscopy. We are presenting the outcome of our experiences with gynaecological laparoscopies and assessed rate, indications, complications and its benefits in a teaching hospital. Study Design: Retrospective Observational study. Setting: MTI Hayatabad Medical Complex Peshawar. Period: January 2021 to December 2021. Material & Methods: we performed laparoscopic procedure for a total of 222 patients and all were included in the study. Laparoscopic surgeries were performed under general anesthesia. Successful creation of the pneumoperitoneum was done with the help of Veress needle, mostly by closed access technique and occasionally with the open method. Secondary ports were introduced under direct vision. After completing the surgery laparoscope and secondary ports were removed under direct vision to minimize any iatrogenic insult. Results: During the study period, 908 major gynaecological operations including 222 laparoscopies were performed. This gave the rate of 24.45% laparoscopies per 100 operations. Diagnostic laparoscopies were performed in 195 (87.84%) cases and operative were in 27 (12.16%) cases. Complications were only in 5 of the cases, two being of major nature. A ureteric ligation occurred during laparoscopic hysterectomy resulting in conversion of laparoscopic surgeries into open surgery and another was during cystectomy due to excessive bleeding. Conclusion: Laparoscopic surgery propounds unique benefits including definite diagnosis, mobilization and speedy recovery, minimal complications, less cost and shorter hospital stay. In young patients, laparoscopy helps in preserving their fertility with better prognosis in contrast to open surgery. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of antenatal corticosteroids on maternal blood glucose levels. Methodology: This observational study was conducted in the Department of Obstetrics and Gynecology at Hayatabad Medical Complex, Peshawar, after obtaining ethical approval from the Institutional Ethical Review Board. All patients admitted to the labor suite for antenatal corticosteroids were included in the study, while patients with diabetes or any other medical disorder requiring corticosteroids were excluded. Patients were selected using a non-probability convenient sampling technique. They were given two doses of Betamethasone (12mg) intramuscularly, with a 24-hour interval between doses. Maternal blood sugar levels were checked before administering the first dose of Betamethasone. Subsequently, patients were placed on a sugar profile for five days. All the data were entered in a pre-designed proforma. Result: A total of 247 patients were included in the study. The majority of the patients were multigravida (50.20%) and belonged to the age group of 21-30 (50.20%). The mean age of the patients was 26.4 ± 2.3 years. The majority of the patients (72.46%) had deranged blood sugar levels, either falling within the range of impaired glucose levels or full-blown diabetes. Antenatal corticosteroids mainly affected fasting blood sugar (FBS) and post-prandial blood sugar levels. Conclusion: Antenatal corticosteroids administered to normoglycemic patients result in significant but transient hyperglycemia. However, in the majority of patients, blood sugar levels normalize within five days following the administration of corticosteroid doses. [ABSTRACT FROM AUTHOR]

Objective: To assess immediate intra and postpartum perineal complications following normal vaginal delivery versus vaginal delivery with episiotomy in term pregnancy. Material and Methods: This Cross-sectional study, was conducted in Peshawar, Lady Reading Hospital, Gynae ward from 1st November 2019 to 31st January 2020 after approval from Institutional Research Board. A total of 250 patients (125 in each group), 120 in group A with normal vaginal delivery, 115 in group B (vaginal delivery with an episiotomy), and 15 patients were excluded due to different modes of delivery (instrumental delivery/cesarean section). All patients with full-term pregnancies were included. Patients who refused to give consent or had bleeding disorders and indications for instrumental delivery or cesarean section were excluded. Non-probable convenience sampling technique, P-value <0.05, 95% confidence interval, and Chi-square test used for statistical analysis Results: In the group, A mean age of 22 years, primigravida (PG) 84 (70%) multigravida (MG) 36 (30%) mean period of gestation (POG) 38 weeks, 96(80%) spontaneous, 24 (20%) induced labor. In group B the mean age was 21.8 years, PG 77 (66%), MG 38(33%), mean POG 41 weeks, 97 (84%) spontaneous, and 18 (15%) induced labor. Group A vaginal tears 6 (5%), cervical tears 4 (3%), mixed tears 9 (7.5%), para-urethral tears 2 (1.6%), and perineal tears 9(7.5%). Group B vaginal tears 3 (2.6%), cervical tears 3 (2.6%), mixed tears 2 (1.7%). No significant post-natal pain difference was observed in the groups. CONCLUSION: Routine practice of episiotomy should be discouraged as no significant difference was observed in both groups. [ABSTRACT FROM AUTHOR]

Objective: To determine the causes of menstrual disorders according to PALM COEIN classification system. Methodology: This descriptive study was conducted in Department of Obstretic & Gynaecology, Hayatabad Medical Complex, Peshawar, from 8th August 2019 to 9th August 2020. Patients admitted in the ward for hysterectomy/endometrial sampling due to abnormal uterine bleeding (AUB) were included in the study through non probability convenient sampling. Detail history, clinical examination and relevant investigations were recorded on a predesigned proforma. Abnormal uterine bleeding was then classified according to FIGO new system (PALM COEIN). Descriptive statistics were used in the form of frequencies and percentages. Results: A total of 78 patients underwent surgical intervention for abnormal uterine bleeding. The mean age of the participants was 44±3.9 years. Most of the patients were either multi or grand multipara (96.15%). Many reported to have regular (70.51%), frequent cycles (71.79%), prolonged (69.23%) and heavy flow (78.20%). The PALM portion comprised of 42.30% causes of AUB, while COEIN portion comprises of 37.17% causes, while 20.51%. AUB-L (Leiomyoma) was most common cause in the PALM group (16.66%), while AUB-E (Endometrial) in the COEIN group (16.66%). Sixteen (20.51%) cases were having more than one underlying pathologies. Conclusion: Multiple/mixed etiologies were the most common causes of AUB, followed by AUB-L and AUB-E. Most of the patients were having frequent, regular cycle with heavy and prolong flow. Adaptation of this new FIGO classification will help in the standardization of terminologies for better understanding. [ABSTRACT FROM AUTHOR]

Objective: To find out the determinants affecting the different management options of tubal ectopic pregnancy. Methodology: This cross sectional study was carried out in the Unit A of the department of obstetrics and gynecology, Hayatabad Medical Complex, Peshawar from December 2014 to March 2018. All the patients admitted with clinical/ultrasound diagnosis of tubal ectopic pregnancy were included in the study through convenient sampling technique after informed consent. Patients having other early pregnancy problems which would mimic tubal ectopic pregnancy and those having any medical contraindications to Methotrexate were excluded. A pre-designed performa was used to collect the data, which was analyzed using SPSS v.22.0. Results: The mean age of the sample (n=78) was 27.0±7.8 years. Maximum patients were multigravida (n=41, 52.6%), followed by primigravida (n=25, 32.0%). In treatment modalities, maximum of the cases (n=43, 55.1%) were managed medically via methotrexate with success rate of 93.0%, while 18 (23.1%) cases were managed conservatively with success rate of 83.3%, and 17 (21.8%) of the cases were managed surgically with 100% success rate. The maximum size of adnexal mass was found to be as 8.6x7, 10x7, and 8x6 in three management options, i.e., conservative, medical and surgical respectively, while in the same categories, maximum Beta-Human Chorionic Gonadotropin (β-hCG) level was found to be as 978, 43220, and 29844 mIU/ml respectively. Conclusion: Hemodynamic instability and rising β-hCG were the core determinants in the management of tubal ectopic pregnancy. The size of the adnexal mass and the initial β-hCG did not affect the management. [ABSTRACT FROM AUTHOR]

Byline: Bushra Rauf Rukhsana Karim Sadia Ali Rahat Jabeen and Rubina Akhtar Abstract OBJECTIVE: To determine the effect of fit-delivery interval on maternal and fetal outcome in antenatal eclamptic patients [...]

Objective: To determine the frequency and types of urinary incontinence in pregnant women reporting to a tertiary care hospital. Methodology: This descriptive study was carried out in the Department of Obstetrics and Gynaecolgy 'B' Unit, Hayatabad Medical Complex, from September 2017 to February 2018. All the pregnant women who had urinary incontinence were selected for the study by non-probability convenient sampling after taking informed consent. These patients were then sub-classified into either urge, stress or mixed urinary incontinence. Detailed history regarding their period of gestation, risk factors for incontinence, type of incontinence and gestational age at presentation of urinary incontinence were recorded. Data were analyzed using SPSS version 21. Results: In our study, total 2880 antenatal women were interviewed; out of which 317 were having urinary incontinence making the frequency of urinary incontinence to be 11%. Maternal age ranged from 18-42 years with mean age of 28.04 ±2.3 years. Most of the patients presented in the last trimester followed by 2nd and 1st trimester respectively. Mixed urinary incontinence was the most common type of incontinence (n=133, 41.95%), followed by urge urinary incontinence (n=108, 34%) and stress urinary incontinence (n=76, 24%). Conclusion: Incontinence of urine was a significant problem during pregnancy. Mixed urinary incontinence was the most common type of incontinence of urine. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To find out the role of Terbutaline in external cephalic version (ECV) in terms of successful version to cephalic presentation. METHODS: This observational study was conducted in Peshawar Health Center (PHC), University Town, Peshawar, Pakistan from 15th August 2015 to 9th November 2016. Patients having uncomplicated breech presentation with 36-42 weeks' gestation and having no contraindication for ECV were included in the study. All patients were given Injection Terbutaline subcutaneously(s/c) 15 minutes before the procedure. ECV was performed by a single skilled consultant obstetrician. After the procedure the mother and the fetus were observed for any complication. Success was defined in terms of conversion of the fetus from breech to cephalic presentation. All the relevant data including demographic data was entered in a pre-designed proforma and was evaluated using SPSS version 17. RESULTS: A total of 80 patients having uncomplicated breech fetuses at 36-42 weeks were included in the study. Mean age of the patients was 29.37±7.04 years. Twenty-nine were primigravida (36.25%), 38(47.5%) multigravida and 13(16.25%) were grand multi gravida. Success rate was 83.7%.There were no serious maternal or fetal complications except 2(2.5%) fetuses having transient bradycardia. CONCLUSION: Terbutaline is a safe tocolytic drug for ECV in terms of successful version to cephalic presentation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore the discrepancies regarding screening, diagnosis and management of gestational diabetes mellitus (GDM) among postgraduate trainees of Obstetrics and Gynaecology (OBG) and Medicine disciplines. METHODS: This multicentre cross-sectional study was conducted from 1st to 31st August 2022. The questionnaire regarding screening, diagnosis, management of GDM, and postnatal follow-up with neonatal care were distributed among postgraduate trainees of medicine/OBG through googleform/hardcopies. Data was analysed through SPSS-22. RESULTS: Out of 236 trainees, 184 (78%) were following national institute of clinical excellence (NICE) guidelines for management of GDM. Majority of medicine (n=87/120 (72.5%) and OBG (n=76/116; 65.5%) trainees failed to identify the correct cut-off of oral glucose tolerance test for GDM. A big chunk of both OBG (n=93/116; 80.2%) and Medicine (n=96/120; 80%) trainees were unable to differentiate pre-existing diabetes mellitus from GDM. The clinical knowledge about carbohydrate diet (n=119/236; 50.4%), calories intake (103/236; 43.6%) and low glycaemic index (138/236; 58.5%) was poor among trainees of both specialities. Surprisingly, the medicine trainee's knowledge about insulin types, dose and tocolytic agent was not evidence-based. The practicing knowledge of both specialities was poor about identification of neonatal hypoglycemia (n=30/236; 12.7%) and its management (n=47; 19.9%). Trainees of both specialities had poor knowledge about postnatal follow-up (n=64/236; 27.1%) of GDM patients. CONCLUSION: GDM is a common domain for OBG and medicine disciplines with no consensus guidelines for its uniform management. This study has identified some basic gaps in the clinical practice of future consultants regarding GDM management, urging the need of combined local guidelines. [ABSTRACT FROM AUTHOR]

Objective: To find out the difference between active and expectant management of third stage of labour in terms of amount of blood loss and duration of third stage of labour. Methodology: This quasi experimental study was conducted in the Unit "B" of department of Obstetrics and Gynaecology, Lady Reading Hospital from June - December 2006. A total of 100 patients were included in the study, out of which 50 patients under went active management of third stage of labour (AMTSL) and 50 patients had expectant management. Formal consent was obtained from all the patients. Apart from the demographic data, details regarding the amount of blood loss and duration of third stage were recorded on a semi structured proforma and analyzed by using Chi Square test, with p value of <0.05 considered as significant. Result: In the active management group most of the patients had blood loss less than 100ml while in the expectant group most of the blood loss was between 100-200ml. Mean blood loss in the active group was 72.5±36.83ml and expectant group was 177.4±59.65ml, p value <0.001. Similarly the difference in the duration of the third stage was statistically significant between the two groups (p value <0.001). Conclusion: AMTSL was associated with statistically significant decrease in the blood loss and shorter duration of third stage of labour. [ABSTRACT FROM AUTHOR]

Objective: To find the frequency and pattern of distribution of antenatally diagnosed congenital anomalies and the associated risk factors. Methodology: This descriptive study was carried out at the department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar from March 2012 to April 2013. Women with ultrasound report of congenitally abnormal fetus irrespective of the gestational age were included. They were evaluated for the presence of risk factors including periconceptional use of folic acid, maternal medical disorders e.g diabetes, epilepsy and history of smoking, maternal and paternal ages, consanguineous marriages and family history of anomalies. Results: A total of 62 women were included in the study. Fifty seven (91.9%) were having isolated anomalies while 5 (8.1%) presented with complex anomalies. Central nervous system (CNS) was the most commonly involved system (79%). Lack of folic acid use and consanguineous marriages were two most important risk factors; however their correlation with congenital anomalies was not significant. Forty eight (77.4%) women have never used folic acid and consanguineous relation was present in 52 (83.9%). Other risk factors like maternal medical disorder e.g. diabetes, epilepsy, maternal and paternal ages, family history and maternal smoking were non-significant. Conclusion: Lack of periconceptional use of folic acid and consanguineous marriages were two most important risk factors. Awareness among the general population and improvement in the antenatal care can help in the early detection and management of congenital anomalies. [ABSTRACT FROM AUTHOR]

Objective: To compare vaginal delivery and cesarean section in terms of neonatal morbidity and mortality in undiagnosed breech presented in labour. Methodology: This comparative study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from January to December 2011. Total of 119 undiagnosed breeches admitted in labour ward were included in the study. Apart from the demographic details neonatal outcome including Apgar score, intrapartum fetal death and neonatal intensive care unit admission were recorded on a semi structured proforma and analyzed by Chi square test using SPSS v. 17. Results: The mean age of the women delivered vaginally was 27.91±6.37 years while the mean age of those that underwent cesarean section was 23.88±3.32 years. The overall mean age of the sample was 27.03±6.06 years. The mean gestational age of the fetuses in both the groups was between 37-40 weeks. Out of 93 breeches which were delivered vaginally, 12(12.9%) neonates were having Apgar score <7.While those delivered by cesarean section only 2(2.1%) neonates were having low Apgar score (p-value=0.511). Two(2.1%) neonates were admitted in neonatal intensive care unit in the vaginally delivered group, while among in the cesarean section group there was no neonatal intensive care unit admission(p value=0.462).There was no intrapartum death in both the groups. Conclusion: Undiagnosed, uncomplicated breeches presenting in labour can be safely delivered vaginally, but large randomized study is needed to decide about the best mode of delivery. [ABSTRACT FROM AUTHOR]

Objective: To find out the effect of decreased amniotic fluid index (AFI) on adverse pregnancy outcome at term. Methodology: This experimental study was conducted at Gynae “B” unit Lady Reading Hospital Peshawar from September 2004 to August 2005. A total of 100 pregnant women admitted in labour ward were included in the study. Fifty cases with an amniotic fluid index of <5cm comprised the patient group. Fifty controls having AFI>5cm were matched with the cases regarding age (±3years), parity and antenatal complication (hypertension, diabetes). Apart from demographic details, maternal outcome measures such as induction of labour; mode of delivery; meconium stained liquor; and fetal outcome measures such as Apgar score and admission to neonatal intensive care unit were recorded on a semi structured proforma for both the groups and analyzed by Chi square test using SPSS v.11. Results: Labour induction was significantly higher in patients having AFI<5cm as compared to the control group (p-value=0.009). Meconium stained liquor (p-value=0.023) and cesarean section rate for fetal distress (p-value=0.000) were higher in patients having AFI<5cm. Neonatal complications were found to be more frequent in the patients having AFI<5cm and these include, low Apgar score <7 (p=0.001) and neonatal intensive care unit admission (p=0.078). There was no perinatal mortality in both the groups. Conclusion: Amniotic fluid index of <5cm was associated with adverse pregnancy outcomes in the form of meconium stained liquor, induction of labour, cesarean section for fetal distress, low Apgar score and neonatal intensive care unit admission. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the perinatal outcome of first and second twin in terms of perinatal morbidity and mortality in vaginal delivery. Methodology: This comparative study was conducted at Department of Obstetrics and Gynaecology, Lady Reading Hospital Peshawar from April 2006 to February 2007. Fifty patients with twin gestations admitted to labour ward for delivery at and above 36weeks' gestation were selected according to the inclusion/exclusion criteria. Information including maternal age, parity, birth weight, Apgar score, perinatal morbidity and mortality of both twins were recorded on a semi structured proforma and analysed by chi square test using SPSS v 12. Results: The differences of the Apgar scores at one minute and five minute were significantly increased in the second twin compared to that of the first twin (p =0.040, and 0.038 respectively). The admission to nursery was also found to be significantly increased in second twins as compared to first twins (p = 0.43). The perinatal morbidity was also found to be significantly increased in second twins than the first twins (p= 0.05), while neonatal mortality was not statistical significant. Conclusion: The perinatal outcome of vaginally delivered twins at or after 36weeks' of gestation showed that second twins are at greater risks of perinatal morbidity than the first born twins. But the early neonatal mortality was not significantly different between the two groups. [ABSTRACT FROM AUTHOR]

Objective: To assess the role of Metformin in Polycystic ovarian syndrome (PCOS). Methodology: This interventional, quasi-experimental study was conducted at Department of Obstetrics & Gynaecology, Lady Reading Hospital Peshawar from October 2004 to October 2006. A total of 35 patients with PCOS were included fulfilling Rotterdam Criteria. Metformin was given in a dose of 850 mg twice a day. Patients' reassessment was done clinically on a three monthly basis while laboratory investigations and Transvaginal scan was done after two years. Data was analysed using SPSS v. 16. Results: The mean age of the sample was 27±5.2 years. Out of 35, 29(82.8%) had primary infertility while 6(17.2%) had secondary and only 7(20%) of those conceived. Menstrual irregularities were present in 30(85.7%) patients, 27(55.5%) with oligomenorrhea, 2(5.7%) with amenorrhea and 1(2.86%) with polymenorrhea. Out of these 15, 2 and 1 showed improvement, respectively. Regarding hyperandrogenism, 22(62.8%) patients were with hirsutism, 3(9.4%) had acne and 10(28.5%) had hair loss. Out of these 0, 2 and 3 improved, respectively. Transvaginal scan showed polycystic ovaries in all patients at baseline while the cysts dissolved in 15(42.8%) patients. Biochemical investigations like Leutinizing Hormone:Follicle Stimulating Hormone(LH:FSH), Serum Testosterone, Serum Prolactin, Random Blood Sugar(RBS) and Serum Insulin was raised in 32(91.4%), 24(68.5%), 9(25.7%), 3(8.5%) and 10(28.5%) patients respectively and 17(53.1%), 13(54.2%), 4(44.4%), 1(33.3%) and 4(40%) patients improved respectively. Conclusion: Metformin is an effective drug to improve the menstrual irregularities, LH:FSH and serum testosterone but it does not show improvement in clinical signs and symptoms of hyperandrogensim. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of nifedipine and salbutamol in the treatment of preterm labour. Methodology: This comparative clinical trial was conducted in the department of Obstetrics and Gynaecology Hayatabad Medical Complex Peshawar on 176 pre natal patients. All patients with preterm labour aged 15-45 years with any gravida or parity presenting through outpatient department (OPD) or emergency room (ER) with uterine contraction associated with cervical effacement and dilatation before 36 weeks and 6 days of gestational period were included in the study. Patients were divided into two groups by lottery method. Women in group A were put on tablet nifedipine while women in group B were given salbutamol. The drug was considered effective in case of cessation of the uterine contraction within 2 hours of initiation of the drug and continuation of the effect till minimum of 48 hours. Results: Mean age was 28.53 ± 5.84 in group A and 28.26 ± 5.47 in group B. Nifedipine was found to be more effective than salbutamol in prolonging pregnancy for more than 48 hours, whereas no significance difference was found between the two drugs in delaying delivery after 1 week of pregnancy prolongation (30.68% versus 32.95%). Conclusion: Nifedipine is more effective than salbutamol in the treatment of preterm labour. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal and foetal outcome of active versus conservative management of premature rupture of membranes after 37 completed weeks of pregnancy. Methodology: This quasi-experimental study was carried out at Gynae unit, Lady Reading Hospital, Peshawar from September 2004 to September 2005 and included 100 patients out of which 50 were managed conservatively and 50 actively. After confirming the leakage of amniotic fluid, patients were randomized by lottery method to conservative or induced group. The patients in the group that was managed conservatively were shifted to obstetrical ward to await the onset of regular uterine activity for at least 48hrs. After Bishops scoring, patients were induced with vaginal prostaglandin E2 tablet. Both groups received intravenous antibiotics. Results: Total number of patients with PROM at term was 3.84%. Total cost of stay in hospital and management was greater in induced group (P. value <0.05%). Latent time was short in induced group whereas hospital stay was prolonged in induced group. About 80% of patients in conservative group delivered by NVD as compared to 60% in induced group. Among complications mild fever and PPH were significantly (P. value <0.05) more common in conservative group. There was neither neonatal death nor stillbirth in both groups. No statistically significant difference (P. value >0.05) was observed in respect of perinatal outcome and infectious morbidity in babies. Conclusion: Conservative management of PROM at term should be viewed more positively for at least 48hrs under appropriate antibiotic cover and with active management of 3rd stage of Labour. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal morbidity in elective versus emergency caesarean section in a tertiary care teaching hospital. Methodology: This comparative study was conducted at Department of Gynecology & Obstetrics, Lady Reading Hospital Peshawar, Pakistan, from July 2006 to June 2007. A total of 100 patients, 50 in emergency and 50 in elective caesarean section group through convenient sampling were included in the study. The sample size was calculated as 100 by keeping 8% prevalence of caesarean section in Pakistan and using WHO software for sample size estimation. The complications were compared in both groups using a semi structured proforma. The comparison was done by using Chi-square test and p-value≤ 0.05 was considered statistically significant. Results: The mean age was 31.54+4.64 and 30.83+5.08 in emergency and elective caesarean section group respectively. Anesthesia related complications were only observed in 11 cases of emergency caesarean section group [Delayed recovery with 8 Cases occurred most] and none in the elective group. Tears in cervix and uterus were noted in 8 cases of emergency caesarean section group only. Hemorrhage was noted in 58% and 4% patients in emergency and elective caesarean section groups respectively. Postoperative complications were found higher in emergency caesarean section as compare to elective caesarean section groups like anemia (70%vs.40%), post partum hemorrhage(40%vs.6%), fever(30%vs.8%) and abdominal distention(30%vs.8%) with p-values of 0.004, 0.007, 0.01, 0.01 respectively. Conclusions: The maternal morbidity including anesthesia related complications, Intra-operative, and post operative complications were more in the emergency caesarean section as compared to elective caesarean section group. [ABSTRACT FROM AUTHOR]