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Objective: To determine frequency of adverse pregnancy outcomes in patients presenting with uterine fibroids at a tertiary care hospital. Study Design: Descriptive Cross Sectional. Setting: Department of Obstetrics and Gynecology, Independent Medical Collage, Faisalabad. Period: January 2021 to December 2022. Material & Methods: A descriptive cross sectional study was performed over a period of two year from January 2021 to December 2022 at Obstetrics and Gynecology department of Independent University Hospital, Faisalabad. Results: Among total 48 patients of our study 7 patients were aged <20 while 18 were between 20 to 30 years of age and 23 were in 30 to 40 yr age group. Out of 48 patients, 27 were primigraidas, 18 patients were in G2 to G4 group and 10 were >G4. Among 48 patients, 8 had body mass index<25 kg/m2.12 patients had BMI between 26-30kg/m2 and 28 patients had BMI>30kg/m2. 7 patients had symptoms <6 months.14 patients had symptoms for more than 6 months but less than 1 yr while 27 patients had symptoms >1 yr. In our study, 6 patients has spontaneous miscarriages. In our study 9 patients had preterm birth and 22 patients needed caesarean section and 10 patients had PPH. Conclusion: Pregnancy in patients with fibroids, should be considered as high risk, as it is associated with adverse pregnancy outcome. So pregnancy has to be cautiously reserved in the antenatal period, through regular follow up, to detect any obstetric complications and so improve the outcome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate our experience in treatment of Caesarean Scar Pregnancy (CSP). Study Design: Cross Sectional Descriptive study. Setting: Department of Gynecology and Obstetrics, Independent Medical College Faisalabad. Period: Jan 2016 to Jan 2021. Material & Methods: The data for this study retrospectively obtained from outpatient department, emergency ward and labor ward registers. Data was analyzed by simple descriptive statics. Diagnosis of CSP was made by using transvaginal ultrasound and color flow Doppler ultrasound. Treatment offered was either medical management as systemic methotrexate or surgical as D&C or laparotomy. The aim was to do conservative treatment for fertility sparing. Patient age, gestational age at time of presentation, number of previous Cesarean Section and success of overall management strategy was analyzed. Results: In this study we had 12 patients diagnosed to have CSP with at least one scar on uterus of previous caesarean section. The mean age of patients was 32.5± 2 years and the gestational age range was from 5 weeks and 3 days to 10 weeks and 2 day. The diagnosis was done by using transvaginal ultrasound and color flow Doppler ultrasound. Which showed high velocity and low impedance flow in sub trophoblastic area. Out of 12 patient's 58.33 percent were treated with systemic methotrexate and had successful outcome. These were followed by B-hCG levels till non pregnant serum level of B-hCG of <5.1IU was achieved. 16.66 percent patients underwent D&C, but due to hemorrhage they were treated with laparotomy as supplementary procedure. 41.55 percent Patients were treated by laparotomy as their primary management with aim of fertility sparing surgery. The laparotomy was found to be successful treatment in all the patients who underwent surgical management as their primary treatment. Conclusion: Prompt diagnosis has pivotal role in reducing morbidity and mortality associated with CSP. Medical management is found to be successful at early gestational age. Fertility sparing surgery is better option as gestation advances more than 8 weeks to avoid undesirable outcome like hemorrhage and hysterectomy. [ABSTRACT FROM AUTHOR]

Commiphora wightii has massive economic value and a wide array of medicinal uses in both ancient and modern therapeutics. It has been observed that the number of C. wightii populations in Rajasthan are declining substantially because of anthropogenic activities in the form of over-exploitation for resin and fuel. Very limited molecular studies have been reported on the molecular characterization of Commiphora wightii at national and international level. The present investigation aims to assess the genetic diversity within and among different populations to determine the relationship of genetic variability with geographical distribution of Rajasthan and to offer genetic resource information for future meaningful implementation of conservation programs applicable for C. wightii. The present study comprised of 11 RAPD markers generated 37 loci of which two were polymorphic with an average 4.85% DNA polymorphism. The maximum polymorphism (33.33%) was detected for OPU-8 marker. Similarly, 9 ISSR markers generated 47 loci of which 10 were polymorphic with an average 22.11% DNA polymorphism. The maximum polymorphism (33.33%) was observed for ISSR marker 811P, 814P and UBC857. Jaccard's similarity coefficient varied from 0.55-1.00 among the populations of Commiphora wightii using all the ISSR marker, while it ranges 0.20-0.95 for RAPD markers. The row dendrogram constructed using unweighted pair group method with arithmetic averages or UPGMA with a SAHN module of the NTSYS software which showed a phenetic representation of genetic relationships as revealed by the similarity coefficient for all the ISSR and RAPD profiles. [ABSTRACT FROM AUTHOR]

Objective: To assess the control of gestational diabetes with metformin and to study maternal and fetal outcome in patients using metformin. Study Design: Cross Sectional study. Setting: Department of Obs & Gynae, Independent University Hospital. Period: September 2019 to July 2021. Material & Methods: Eighty six patient diagnosed as having gestational diabetes mellitus by oral glucose tolerance test included in study and Metformin used as first line therapy along with diet for control of blood sugar levels. While patients with insulin dependent diabetes and type 2 DM were excluded from study. Results: It was observed in study, that with metformin use glycemic control was excellent in 70 (81.3%) of patients. Maternal outcome like risk of maternal weight gain>10kg, preeclampsia, and premature births were low in patient usung metformin in pregnancy and as well as neonatal risk of macrosomia, prematurity, neonatal hypoglycemia and need for hospital admission were low with the use of metformin in patients suffering from gestational diabetes. Conclusion: GDM associated adverse outcome for mother like maternal weight gain, pregnancy induced hypertension operative delivery and neonate like macrosomia, birth trauma, neonatal hypoglycemia are well controlled by the use of life style modification and metformin use in almost >80 % of cases only in few cases there is additional need of insulin therapy. Maternal and fetal outcome found to be satisfactory with the use of metformin. Further studies are required to build a more confidence. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material & Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (> 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material & Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (> 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value

Objectives: To determine the maternal and fetal outcome in patients presented with major degree Placenta previa and to evaluate the Potential risk factors. Study Design: Descriptive Case Series study. Setting: Department of Obstetrics and Gynecology Independent University Hospital Faisalabad. Period: January 2020 to February 2021. Material & Methods: All patients with major degree previa confirmed by ultrasonography beyond 28 weeks of gestation were selected irrespective of their parity, type of placenta previa and with live or dead fetus. Results: Total 38 patients were selected with Major degree placenta previa in 1 year of duration. 47% patients were in age group 31-35 years and 65.7% patients were grand multi-para. In our study 73.6% patients were having previous scar uterus. All patients received blood transfusions and cesarean hysterectomy in 36.8% of patient's done due to placenta previa and uncontrolled hemorrhage. Only 2 patients got bladder injuries during surgery and in one patient required hysterectomy has to be done later. Regarding neonatal outcome 47.3% neonates were active and required no resuscitation and 21% neonates expired within 48 hours. Conclusions: Now a day's major degree placenta previa is a main obstetrical challenge associated with blood transfusion, ICU admissions and Obstetrical hysterectomy. Fetal outcome was relatively satisfactory. Maternal complications can be reduced by early diagnosis, Identification of the risk factors, correction of Anemia, Blood arrangement & Team work in Territory care hospital. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy of Progesterone supplementation for prevention of preterm birth. Study Design: Descriptive Interventional Study. Setting: Department of Obstetrics and Gynecology at Independent University Hospital, Faisalabad. Period: January 2018 to December 2020. Material & Methods: Data collected by using Non probability consecutive sampling techniques. Total 156 patients were included in study. Data was collected after informed consent, on pre designed proforma. Patient presented in 1st trimester and having previous history spontaneous preterm labour and recurrent miscarriages. We included patient presenting after 24 weeks of pregnancy and patient having threatened or actual preterm labour. Results: Among 156 patients, more than 82% of patient were delivered after 34 weeks of gestation and 18% were delivered before 34 weeks of gestation. Fetal outcome was very good in those patients who were delivered after 34 weeks of gestation with the use of Prophylactic progesterone therapy. Conclusion: Prophylactic use of progesterone helps in prolongation of pregnancy beyond 36 weeks and also help in decreasing the morbidity associated with premature delivery. [ABSTRACT FROM AUTHOR]

Introduction: In Pakistan, cervical incompetence has been recognized as the leading cause of recurrent abortions in mid trimester. The elective cerclage based on history and clinical findings applied in second trimester overcomes the risk of emergency procedure. This problem is quite common in patients visiting IUH Faisalabad. Objectives: Assess gestational age at delivery after elective cervical cerclage application in mothers with recurrent mid trimester abortions. List the immediate and late complications of cerclage. Assess the fetal outcome after cerclage. Outcome Measures: 1. Percentage of mid trimester abortion in current pregnancy. 2. Frequency of prolongation of gestational age at delivery. 3. Complications of the procedure. 4. Birth weight of the baby. 5. Percentage of live births. 6. Fetal survival rate. Study Design: Interventional: Quasi experimental study. Setting: Department of Obstetrics and Gynaecology, Teaching Hospital IUH FSD. Period: Oct 2016 to July 2018. Subjects: Fifty patients with recurrent mid trimester miscarriage due to cervical incompetence. Methods: Patients were admitted through outdoor with history of previous mid trimester abortions possibly due to cervical incompetence. USG evidence of normal pregnancy with no obvious congenital anomaly was a pre requisite for cervical cercalge. Technique used was MCDonald’s suture under general anaesthesia. Results: Effectiveness of cerclage was 90%; 78% had term deliveries, 12% preterm delivery and 5 spontaneous mid trimester abortions. There were 81% live births. The complications included cervical trauma after delivery (2%), spontaneous abortions (10%), pre term delivery (13%) and pre prom (2%). Conclusion: Elective cerclage at 12-14 wks of gestation in recurrent mid trimester abortions results in good fetomaternal outcome with almost no complications. [ABSTRACT FROM AUTHOR]

This article addresses the various properties and different methods of estimation of the unknown parameter of length and area-biased Maxwell distributions. Although, our main focus is on estimation from both frequentist and Bayesian point of view, yet, various mathematical and statistical properties of length and area-biased Maxwell distributions (such as moments, moment-generating function (mgf), hazard rate function, mean residual lifetime function, residual lifetime function, reversed residual life function, conditional moments and conditional mgf, stochastic ordering, and measures of uncertainty) are derived. We briefly describe different frequentist approaches, namely, maximum likelihood estimator, moments estimator, least-square and weighted least-square estimators, maximum product of spacings estimator and compare them using extensive numerical simulations. Next we consider Bayes estimation under different types of loss function (symmetric and asymmetric loss functions) using inverted gamma prior for the scale parameter. Furthermore, Bayes estimators and their respective posterior risks are computed and compared using Markov chain Monte Carlo (MCMC) algorithm. Also, bootstrap confidence intervals using frequentist approaches are provided to compare with Bayes credible intervals. Finally, a real dataset has been analyzed for illustrative purposes. [ABSTRACT FROM AUTHOR]

Post term pregnancy is used to describe pregnancy that continues for 294 days or more following the first day of last menstrual period. Post term pregnancy has been considered to occur in 10-20 % of all pregnancies. PGE2 have been used vaginally for induction of labour for the last two decades. Routine induction of labour after 41 weeks gestation appears to reduce perinatal mortality. Objectives: The study was done to: 1) To calculate the induction-delivery time with prostaglandins E2 in prolonged pregnancy. 2) To find frequency of normal vaginal delivery versus caesarean section after induction with prostaglandins E2. Study design: It was descriptive study. Setting: It was study of fifty patients carried out in Gynae unit 1 Allied Hospital Faisalabad. Period: 03 March 2005 to 02 March 2006. Subjects: Inclusion Criteria: 1) All patients with prolonged pregnancy of more than forty two weeks were included. 2-Only singleton pregnancies were included. Exclusion criteria: 1-Patients who had previous caesarean section were excluded from the study. 2) Patients who had associated obstetric condition that modify the mode of delivery were excluded. Data collection procedure: Detailed history and examination was carried out with availability of dating ultrasound to ascertain dates. Bishop score assessed. Tests of foetal well being carried out. After informed consent induction of labour carried out with prostin E2, and effect studied on induction-onset and delivery intervals and mode of delivery. Results: Induction onset interval was 3.5 hours in Primigravida, was 2.8 hours in group 2(G2 & G3) and 2.0 hours in group 3(G4 & more). Induction delivery interval was 18 hours in group 1, 14 hours in group 2 and 10-12 hours in group 3. Mean percentage of normal vaginal delivery was 78.5% in all groups. Forceps delivery was 5.6% and caesarean section was 15.7%. Number of patients successfully induced was 84.2% Conclusion: The study confirmed the efficacy of PGE2 tablets in achieving cervical ripening. It was also seen to decrease induction delivery interval more so in multigravida. [ABSTRACT FROM AUTHOR]