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Background: With the increase in life expectancy of women all over the world, women are expected to spend almost 1/3rd of their life in menopause phase, usually starting in 4th to 5th decade of life.Objective: This study was planned to look for quality of life of women during menopause in Pakistan. Material and methods:This cross-sectional study was conducted at Gynaecology and Obstetrics department of Lady Atchison Hospital, Lahore over a period of 3 months from June, 2015 to August, 2015. Menopause-Specific Quality of Life Questionnaire (MENQOL) was distributed among 120 patients with the age range of 51-80 years presenting in Outdoor department of the institution. All the demographic details and MenQol results were analyzed. Also Odd's ratio (OR) was calculated for these symptoms according to age groups of the patients. Results:The mean age of the patients was 60 ± 5.8 years. The mean age of patients at time of menarche was calculated as 13.4 ± 1.80 years and the mean age at menopause was 49.10 ± 3.98 years. We found that the most common symptom of the patients in our study was low backache and the least reported symptom was drying skin.

The increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives:  To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods:  This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results:  Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion:  It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.

A study was conducted to review the learning curve of gynecological laparoscopic surgery from January 2012 to December 2014. Total 310 cases were included in the study. These patients had pelvic surgery including hysterectomy either total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy and Adenexal surgery (cystectomy, oophorectomy or adhesionolysis). After preoperative evaluation counseling and consent procedures were performed. Data was collected regarding patients profile variables, indications for surgery, intraoperative findings, intraoperative time, post operative recovery findings, analgesia requirements and discharge time from the hospital. Regarding the intraoperative time, comparison was made for duration of surgery in the 2012 and at the end of study period 2014.

In Pakistan, improvement of health care structure and evolution of perinatal care, have led to momentous drop in pregnancy related deaths, however obstetrical haemorrhage maintains to be the principal cause of maternal motility. The aim of this study was to probe the utilization of activated, and recombinant, Factor VII (rFVIIa) in cases of severe postpartum haemorrhage (PPH). This study was carried out at Unit 2 of Obstetrics & Gynaecology Department of Sir Ganga Ram Hospital (Fatima Jinnah Medical University), Lahore, over a period of 10 weeks, from 15/01/2023, to 31/03/2023. Fifteen females with severe PPH who were treated with rFVIIa were included in this study. The overall observed median and mean blood loss were 8639 mL and 11835 mL respectively. The management prior to rFVIIa involved trans-arterial embolization in five patients, while three of them had hysterectomy. One patient had one single dose, two of them had two doses, three of those patients had four doses, two patients had five plus doses, and a single patient had twenty plus doses of rFVIIa. The mean (± SD) of single dose was at 81.60 ± 16.25 µg/kg. Fourteen of those females could survive, however one of them died due to complication. The cause of that death was uterine rupture, and the quantum of haemorrhage in that case of death, was 6428–43 810 mL. This may, therefore, lead us to conclude that, irrespective of the fact whether a patient would survive or otherwise, much dependents upon her general health and proceeding rFVIIa infusion, rather than haemorrhage. Four of those females presented thromboembolic events post rFVIIa management deep vein thrombosis (DVT), DVT plus pulmonary embolism (PE), PE and acute myocardial infarction (MI). This study revealed that rFVIIa infusion had promising effects for severe PPH and markedly reduced the maternal motility. Keywords: Post-Partum Haemorrhage, Hystectomy, rFVIIa, thromboembolism

A better health care delivery system is dependent on many factors. For effectivehealth delivery, its important to identify those factors. Objectives: This study was conducted tostudy the factors responsible for health care delivery system in a tertiary care hospital. Studydesign: An exploratory study. Period: June 2015 to August 2015. Methods: The study wasconducted at Sir Ganga Ram hospital. Fifty doctors were interviewed on a designed Performato know the medical services quality & its attributes. Results: Quality of health services isinfluenced by the factors related to patients, health care system and factors related to healthcare providers. The factors related to patients were very important as seriousness for seekinghealth services was dependent on these factors. Conclusion: Health services are dependenton multiple factors. Factor related to patient’s attitude towards health services needs to beaddressed.

A better health care delivery system is dependent on many factors. For effective health delivery, its important to identify those factors. Objectives: This study was conducted to study the factors responsible for health care delivery system in a tertiary care hospital. Study design: An exploratory study. Period: June 2015 to August 2015. Methods: The study was conducted at Sir Ganga Ram hospital. Fifty doctors were interviewed on a designed Performa to know the medical services quality & its attributes. Results: Quality of health services is influenced by the factors related to patients, health care system and factors related to health care providers. The factors related to patients were very important as seriousness for seeking health services was dependent on these factors. Conclusion: Health services are dependent on multiple factors. Factor related to patient's attitude towards health services needs to be addressed.

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