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Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Obstetrics & Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021. Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma. Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 µmol/L and 451.86±120.62µmol/L, with a significant difference between PIH and eclampsia (p<0.001). Mode of delivery was a vaginal, primary cesarean section, and repeat cesarean section in 31(34.4%), 38(42.2%), and 21(23.4%) patients, respectively (p<0.001). Liquor was meconium stained in 49(54.4%) while clear in 41(45.6%) births, with (p<0.001). Early neonatal deaths 6(6.7%) participants had significantly higher uric acid levels than no NICU admission 22(24.4%). In maternal outcomes, 83 patients (92.2%) required routine post-operative care, while 7(7.8 %) went to the intensive care unit. Uric acid levels had a negative correlation with gestational age. Conclusion: Maternal uric acid levels differ significantly in different hypertensive disorders of pregnancy and affect the mode of delivery and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To calculate the Maternal Near Miss Mortality Ratio and Mortality Index at a tertiary care hospital in a developing country with limited healthcare resources. Study Design: Retrospective analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Shaikh Khalifa Bin Zayed Al Nahyan Hospital Azad Kashmir and Combined Military Hospital, Muzaffarabad Pakistan, from Jan 2015 to Dec 2018. Methodology: Four hundred and forty-nine severe maternal outcome cases admitted in Intensive Care Unit were included in our study. Maternal Near Miss Mortality Ratio and Mortality Index were calculated. SPSS version 23.00 used for statistical analysis. Results: The maternal near missed mortality ratio was 11:1, mortality index 8.68%, severe maternal outcome 1.58% with 39 maternal deaths. Most common causes of maternal morbidity were hemorrhage (56.1%); hypertensive disorders (24%); sepsis (3.5%) and cardiovascular diseases (1.8%). Hypertensive disorders of pregnancy (30.7%), hemorrhage (25.6%) and sepsis (25.6%) were the common causes of maternal deaths. The total ICU time in patient with near-miss was 1.9±1.7 days versus 2.6±3.14 days in deaths, p<0.001. Operative delivery was statistically significantly (p value <0.001) more common mode of delivery in severe maternal outcomes (66.6%) and maternal deaths (33.3%). Conclusion: Our study has shown 1.58% severe maternal outcomes amongst admitted pregnant, maternal near missed mortality ratio being 11:1, mortality index being 8.68%. Eclampsia, hemorrhage and sepsis are major cause of maternal death. [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 find the association of preterm delivery with metabolic syndrome in females presenting in a tertiary care hospital. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics & Gynecology, Combined Military Hospital Kharian, from May 2020 to Oct 2020. Methodology: A total of 150 females fulfilling inclusion criteria were enrolled in the study which were divided into two equal groups ‘A’ and ‘B’. Group ‘A’ was with metabolic syndrome and group ‘B’ without it. These females were followed in OPD till active labor, assessed and followed till delivery of fetus. If delivery occurred before 37 weeks, then preterm delivery was labeled. All this information was recorded on a pre-designed proforma. Results: The risk for preterm delivery was 2.18 times higher in group ‘A’ as compared to group ‘B’. (Relative Risk = 2.18, CI (95%) 1.1529 - 4.12). Conclusion: There is a strong association of preterm delivery with metabolic syndrome in females. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency, associated risk factors and intraoperative reasons for conversion of Laparoscopic Cholecystectomy to open Cholecystectomy. Study Design: Case series study. Place and Duration of Study: This study was conducted in department of Surgery, Combined Military Hosptial Rawalpindi, from May to Oct, 2018. Methodology: Patients admitted for laparoscopic cholecystectomy were included in the study. Demographic information, ASA Score of physical health, Ultrasonogram Abdomen findings and presence of pericholecystic fluid were documented. The reasons for conversion from laparoscopic cholecystectomy (LC) to open Cholecystectomy (OC) for example excessive haemorrhage, visceral injury, equipment failure, injury to Common bile duct were also noted. Results: In this study 15 (8.77%) patients were converted from laparoscopic cholecystectomy to open cholecystectomy. The most common reason 6 (40%) of conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. In patients who converted most 10 (66.7%) were 41-60 years old and in patients who had successful laparoscopic cholecystectomy majority 70 (44.9%) patients belonged to age group 21-40 years. The male gender had significantly (p-value <0.05) higher rate of conversion (53.3% vs. 46.7%). There was significant (p-value <0.05) association of ASA score and presence of pericholecystic fluid with rate of conversion. Conclusion: Male gender, higher ASA score, and presence of pericholecystic fluid are significant contributors for conversion of laparoscopic cholecystectomy to open cholecystectomy. The most common reason for conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of fetal echocardiography in altering the course of action for neonatal cardiac expertise and services available in Pakistan following an antenatal diagnosis of congenital heart defect (CHD). Study Design: Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2020 to Sep 2021. Methodology: Fetuses aged 18 to 38 weeks of gestational age referred to the Pediatric Cardiac Unit due to risk of or suspicion of congenital heart disease underwent fetal cardiac echo. Data were collected and reviewed retrospectively to seek any impact of the antenatal diagnosis on post-natal planning. Results: The mean age of the mothers was 29.79±5.24 years (range, 17-47 years), and the mean gestational age at which the fetal echocardiography examination was performed was 27.29±4.47weeks (range: 12-38 years). Of the 609 pregnancies, fetal echocardiogram evaluation was performed, and sixty-three (10.3%) fetal echocardiograms were abnormal. Of the 63, only 06(9.5%) returned to the neonatal cardiac unit for follow-up and treatment in the first ten days of life. Conclusion: The real impact of fetal echocardiography is possible only with the availability of well-developed, readily accessible fetal and neonatal cardiac services. Poverty and a struggling healthcare infrastructure confound the benefits. [ABSTRACT FROM AUTHOR]

Objective: To compare the management outcome of induction of labor with expectant management in patients with term pre labor rupture of membranes (PROM). Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in the department of Obstetrics & Gynaecology; Combined Military Hospital Rawalpindi from 25th July 2010 to 25th January 2011. Methods: A total of 384 patients were selected for this study, which were divided into two groups by lottery method. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma. Results: The mean duration between PROM to onset of active labor in group A was significantly less (8.4 ± 2.3 hours) as compared to group B in which it was (9.6±2.1 hours) (p = 0.000). The mean duration between PROM to delivery in group A was significantly less in group A (17.4 ± 2.0) versus group B (22.2 ± 2.0 hours) (p = 0.000). The spontaneous vaginal delivery (SVD) rate was considerably higher (p=0.056) in group A in which 161 (83.8%) patients delivered by SVD and 31 (16.1%) patients by LSCS. In group B, 146 (76.0%) patients delivered by SVD and 46 (23.9%) patients by LSCS. In group A, 8 (4.1%) patients developed chorioamnionitis and 13 (6.7%) patients in group B (p = 0.262). In group A there were 178 (92.7%) neonates with APGAR score of > 5 at 1 minute in contrast to 173 (90.1%) in group B with (p = 0.363). Similarly in group A at 5 minutes, there were 178 (92.7%) neonates with APGAR score of > 7 and 173 (90.1%) in group B (p = 0.460). There were 9 (4.6%) cases of neonatal sepsis in group A, in comparison with 12 (6.2%) patients in group B (p = 0.501). Conclusion: The mean duration of labor in induced patients was less as compared to patients with expectant management. [ABSTRACT FROM AUTHOR]