Objective: To investigate the duration and course of labour, the need for intervention and feto-maternal outcome in a primigravida with an unengaged fetal head at term in labour. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2018 to Oct 2019. Methodology: This study was carried out on 150 term primigravida women with an unengaged head in labour. Informed consent, detailed history and examination were made along with ultra-sonographic and pelvic assessment. Results: Deflexed head was a frequent cause 49(32.67%), cephalopelvic disproportion 24(16%), and loop of cord around theneck 8(5.34%), however, no cause was found 54(36%) women with unengaged fetal head. Ninety three patients (62%)continued with spontaneous labour, while the rest had to be induced. Vaginal deliveries were 100(66.67%), while 50(33.34%) were delivered via Lower Segment Caesarean Section. Out of the 57patients who received induction of labour, 25(43.86%) had vaginal deliveries, while 32(56.14%) underwent Lower Segment Caesarean Section. Five (3.34%) went into a postpartum haemorrhage. Grade 3 perineal tears were seen in 3(2%) patients, and one had a wound infection. APGAR score at ten minutes was between 7 and at ten minutes in 115(76.67%) neonates. Conclusion: In primigravida at the onset of labour with an unengaged fetal head at term gestation, vaginal delivery is possible with watchful expectancy and appropriate intervention. However, there is a need to ensure that all inductions are strongly indicated.

Objective: To measure the healthcare utilization, induced labour and frequency of C-sections in the pregnancy after stillbirth in the tertiary care setting. Study Design: Comparative prospective study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2018-Sep 2019.Methodology: A total of 181 pregnant women were recruited and divided into two groups; Group-1=75pregnant women afterstillbirth and Group-2=106 pregnant women after live birth. Data regarding the healthcare utilization, induced labour, onset and mode of delivery and caesarean section was collected after the informed consent. Results: Mean age of the study population (n=181) was 28.73±5.0 years (Range:19-40 years). Group-1 females had more antenatal visits (7.88±3.60) compared to women of Group-2 (6.18±2.90) (p-value=0.001). History of Induced labour and caesarean section were also more in Group-1 (Stillbirth-Group). Pregnant women in Group-1 were found to be significantly more worried about the pregnancy outcome in 53(70.7%) as compared to Group-2 in 5(4.7%) with a p-value of <0.001. Conclusion: Pregnant women after stillbirth were significantly avid users of healthcare services and had more induced labour and caesarean section.

O b j e c t i v e : To compare fetal outcome in normal umbilical artery Doppler findings to abnormal umbilical artery Doppler findingsin pregnant women with fetal growth restriction.Main o u t c o m e m e a s u r e s : Umbilical artery Doppler studies, apgar score at 1 minute and apgarscore at 5 minutes after delivery.Study D e s i g n : Cross-sectional, comparative study. Setting: Department of Obstetrics and Gynaecology,Military Hospital and Combined Military Hospital, Rawalpindi. From Jan 2005 to Jan2007.Methods: Patients with fetal growth restriction between28 to 37 weeks of pregnancy were selected, in whom diagnosis was confirmed by ultrasonography. All patients were followed up with umbilicalartery Doppler studies. The study group consisted of 48 women (group I), where the umbilical artery waveform was compromised. The outcomein these was compared with an equal number of controls, where growth restricted fetuses had normal Doppler waveforms (group II). R e s u l t s:The mean age of patients in group I was 26.9 years and in group II was 28.6 years. Fetuses with abnormal umbilical artery Doppler findingshad higher incidence of maternal gestational hypertension and oligohydramnios. Rate of emergency cesarean section for fetal distress wasalso higher in this group. Growth restricted babies with abnormal umbilical artery Doppler waveforms had lower apgar scores. In babies withnormal Doppler studies, 91.6% had apgar score above 7 at 5 minutes after birth. In babies with raised Rl 78.1%, in babies with abscent enddiastolic flow 54.5% and in babies with Reversed end diastolic only 20% had apgar score above 7 at five minutes after birth. The differencewas statistically significant (P=0.001 (.Conclusion: Umbilical artery velocimetry can distinguish the group of growth restricted fetuses at riskof poor apgar. Growth restricted fetuses with normal Doppler studies are at a lower risk than those with abnormal Doppler findings in terms ofpoor apgar score.