Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Objectives: to compare the mechanical, pharmacological or combination of both in induction of labour. Methods: This comparative observational study was conducted in Department of Obs and Gynae, Lady Reading Hospital, from January 2019 to December 2019. In this study all women presenting to labor room with singleton pregnancy and gestational age > 37 weeks and admitted for induction of labor were included. All those women with multiple pregnancies, premature rupture of membrane, malpresentation, and prior Cesareans section were excluded. Total 300 patients were included in the study period, Patients were divided into 4 groups, Group A (mechanical methods), Group B (prostaglandin E2), Group C (mechanical + PGE2), Group D (misoprostol). Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). Results: In this study 300 patients were included, in mean age of 24.54±12 years, with age range of 16- 40 years. Majority were Primi gravida (167 (55.7%), and 99.7 had poor bishop score. Indication for induction of 109(36.3%) was due to eclampsia / pre-eclampsia, followed by postdate pregnancy 98(32.7%). In majority of cases 123(41%) time from induction to labour was 6-12 hours. prostaglandin group showed good success rate in term of normal vaginal delivery and low adverse effects and good maternal and neonatal outcomes, followed by misoprostol, lowest success rate was recorded in mechanical only group . (p<0.001) Conclusion: Our study concludes that among different methods available for induction of labour, PGE2 is safe, effective and have goof maternal and fetal outcomes Keywords: induction, labour, PGE2, misoprostol

Introduction: Pandemics and Epidemics are usually known for acute anxiety and even panic states, yet it has been documented that psychological effects remain in the post-pandemic period as well. These effects can impact not only the working capacity of individuals, but also their general and social wellbeing. Objective: To assess the mental health in terms of anxiety and depression in health care professionals (HCP) who have recovered from COVID 19. Materials & Methods: A descriptive study was conducted in the department of Obstetrics & Gynecology of Lady Reading Hospital, Peshawar from March to August 2020 on 34 health care workers who had confirmed COVID 19 (positive PCR on nasopharyngeal swab) and recovered by repeat negative PCR on nasopharyngeal swab, had joined their duties, and were 3 months post-covid. Persons with prior mental health issues and on psychiatric medication were excluded. After permission from Hospital Ethical Board, informed consent for inclusion in the study was taken from subjects.  The Hospital Anxiety Depression Scale (HADS), was filled by all subjects; they were categorized as either suffering from anxiety/depression or normal based on the inbuilt scoring system. Data were analyzed using SPSS version 20 for descriptive statistics. Results: Anxiety and depression scores based on HADS questionnaire were calculated and following are the percentages of participants with borderline anxiety score (32.5%), abnormal anxiety score (23.4%), borderline depression score (26.5%), and abnormal depression scores (32.4%). Conclusion: Post-covid mental health assessment is likely to reveal a sizeable number of health care workers showing long term effects of Covid-19, who could be candidates for rehabilitation psychotherapy.

Objective: To determine the outcome of oligohydramnios in term pregnancy ending in normal vaginal delivery or C Section irrespective of induction. Study Design: Descriptive Study. Place and Duration of Study: Department of Obs & Gynae, HMC, Peshawar from 23rd January 2022 to 22 July, 2022. Methodology: A total of 289 pregnant female patients at term (37-42 weeks) presented to the Gynae OPD of our hospital with oligohydramnios (diagnosed clinically having AFI < 5%) were enrolled through nonprobability consecutive sampling technique. Sample size was calculated taking 75%10 proportion of meconium-stained liquor cases as an outcome of oligohydramnios, 95% confidence interval and 5% margin of error on WHO sample size calculator. Patients with singleton pregnancy, nulliparity, Bishop score <5, gestational age of 37-42 weeks were included. Results: Statistically insignificant differences were observed for various outcomes variables in oligohydramnios at term as meconium-stained liquor, Apgar Score < 7 at 1 min, NICU admissions, apgar score < 7 at 5 min with respect to age of patients as p-values of 0.702, 0.489, 0.244, 0.489 and 0.900 were recorded respectively. Conclusion: This study demonstrated that oligohydramnios at term did not influence the outcomes in nulliparous women with unfavorable cervix.