ABSTRACT Background: The frequency of hysterectomy varies in same geographical area. The objectives of this study were to determine the type, time trend and indications of hysterectomy in our population. Materials & Methods: This cross-sectional, study was conducted in the Department of Gynecology and Obstetrics, Gomal Medical College, D.I.Khan, Pakistan, from 1st January 2013 to 31st December 2016. A sample size of 571 was selected through consecutive technique. Inclusion criteria were all hysterectomies done for gynecological indications. Demographic variable was age groups. Research variables were type, time trend and indications for hysterectomy. All variables being categorical were expressed as frequency and percentages. 95% confidence interval for proportion were calculated. SPSS version 19 was used for statistical analysis. Results: Out of 571 hysterectomies, 333(58.31 %) were abdominal and 238(41.68 %) were vaginal. Age-wise distribution of hysterectomies shows >61 is the modal age group. The hysterectomy frequency increased from 7% of total gynecological admission during 2013 to 17% of total gynecological admission in 2016. The indication for hysterectomy by type from 2013-2016 was menstrual disorders and uterine prolapse. Conclusion: Trans abdominal hysterectomies were more common than vaginal hysterectomies. Most common age group for hysterectomy was older than 60 years. The indication for abdominal hysterectomy was menstrual disorders whereas the only indication for vaginal hysterectomy was uterine prolapse. Line diagram was showing an increase in hysterectomy frequency over time from 2013-16.

Background: In Pakistan population explosion is an important issue. Objectives of this study were to determine frequency of contraception users, frequency of different types of contraceptives used and association between contraceptive barriers and socio demographic variables. Materials & Methods: This comparative cross-sectional study was conducted at Department of Community Medicine, Gomal medical College, D.I.Khan, Pakistan from 1st February to 31st March 2019. Sample size was 100. Sampling technique was consecutive. Only married women of reproductive age having already one child at least were included in the sample. Sociodemographic variables were age, residence, education, family income, family type, awareness of contraception, willingness for contraception, use of different contraceptive methods, age of marriage, age at first pregnancy and number of live children. Research variables were personal, religious, cultural and service barriers to use of contraception. All variables were recorded on categorical scale, whereas age of marriage, age at first pregnancy and number of live children were numerical variables expressed as mean and standard deviation. Chi-square test of association was performed. Results: Out of 100 respondents, 49% were from 15 to 30 years. Family income was

Background: Over diagnosis of isolated oligohydramnios is associated with increased obstetrical intervention without improving maternal and perinatal outcome. Objective of this study is to evaluate two methods of amniotic fluid volume assessment regarding obstetrical intervention frequency and its effect on maternal and perinatal outcome. Materials and Methods: This prospective study was conducted at a Private Hospital of Dera Ismail Khan and Khyber Teaching Hospital, Peshawar from 1st January 2017 till 31st December 2019. All pregnant patients with singleton, un-complicated pregnancy with period of gestation from 41 weeks to 41 weeks 6 days, live fetus were included in the study. Women who met the eligibility criteria were assigned to two different techniques of amniotic fluid assessment, first amniotic fluid index( AFI) method and second single deepest vertical pocket(SDVP) method. Data was recorded on a specially designed proforma. The socio-demographic variables were age in years, parity. Continuous variable was measured on numerical scale and expressed as mean and SD. Research variables were maternal outcome and perinatal outcome in terms of oligohydramnios frequency, induction of labour, caeserean section, fetal distress, NICU admission, A/S < than 7 at 5 minutes. Chi-sq test of significance was applied. Results: A total of 160 patients met the inclusion criteria. In first group 30 (37.5%) and in second group18 (22.5%) had oligohydramnios. In AFI group 10 (33.3%) and in SDVP group 3(16.66%) had caesereans section. Induction of labour was 30(37.5%) in AFI group and 18(22.5%) in SDVP group. These results were statistically significant with a p value less than .05 at 5% significance level. Fetal distress, A/S < than 7 at 5 minutes, NICU admission results were not statistically significant for two groups. Conclusion: SDVP technique gave less abnormal results, less intervention with no significant difference in maternal and perinatal outcome. Keywords: Amniotic fluid, Oligohydramnios, Caesarean section.

Background: In developing countries, miscarriage is one of the common and increasing problems of pregnancy. The objectives of this study were to determine the frequency of pre-gestational diabetes mellitus among pregnant women with miscarriage in our population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 3rd November 2015 to 2nd May 2016. Sample size was 268 pregnant women with miscarriage selected through consecutive sampling technique. Inclusion criteria were all pregnant women with miscarriage. Exclusion criteria were molar pregnancy, ectopic pregnancy and diabetics. HbA1c levels of ≤6% was taken as normal, whereas a level >6 was taken as raised level or pre-gestational diabetes. Variables were age, pre-gestational diabetes mellitus, number of pregnancies and duration of pregnancy (≤24, >24). Mean and SD were calculated for quantitative while frequency and percentages for qualitative variables. Descriptive analysis was performed by using SPSS version 16. Results: Mean age of the patients was 27.66 ±4.93 years. Out of 268 participants, 81(30.22%) were having pre-gestational diabetes mellitus and 187(69.78) were normal, 234(87.31%) were having first pregnancy whereas 34 were having >1 pregnancies, the pre-gestational age ≤ 24 weeks were 130(48.51%) and >24 weeks were 138(51.49%). Conclusion: One third of the patients with miscarriage were having pre-gestational diabetes mellitus. Almost half of the patients were having gestational age of

Introduction: Polycystic ovary syndrome (PCOS) is the most common cause of chronic hyper androgenic anovulation and the single most common cause of infertility in young women. Anovulatory cycles are frequent in adolescents. The common signs of adult hyperandrogenism are less reliable in adolescents than in adults: hirsutism is in a developmental phase, and acne vulgaris is common. Objective: To determine the frequency of polycystic ovary disease in adolescent presented to outdoor. Study Design and Setting: This cross sectional study was carried out in the Department of Obstetrics & Gynecology, DHQ, Zanana Hospital, Dera Ismail Khan. Duration of Study: This study was conducted from 1st July 2019 to 31st December 2019. Subjects and methods: A total of 128 girls presenting to OPD due to irregular periods were included. Ultrasound was done to all participants under supervision of consultant gynecologist of 3 years post fellow ship experience. 5 ml venous blood samples was collected from all participants by a 3rd year resident and was subsequently sent to laboratory for androgen levels. Polycystic ovary disease as per operational definition was noted. Results: Age range in this study was from 14 to 20 years with mean age of 18.195±1.29 years, mean weight 52.898±4.92 Kg, mean height 1.571±0.08 meters and mean BMI was 21.557±2.80 Kg/m2. 19.5% patients were with family history of polycystic ovary disease. Polycystic ovary disease was seen in 7.8% patients. Practical implication: To determine the frequency of polycystric ovary disease in adolescent presented to outdoor. Conclusion: Polycystic ovarian syndrome is affecting the lives of young unmarried girls. The clinical manifestations are variable with obesity playing the key role. Keywords: Adolescent, Irregular period, Polycystic ovary syndrome, Frequency

Background and Aim: The coronavirus illness (COVID-19) is a public health disaster on a worldwide scale. The present COVID 19 epidemic will cause significant interruption to healthcare systems long after it has passed its peak. Sexual and reproductive health (SRH), including contraception, must be viewed as a critical service. The aim of the present study was to assess the COVID pandemic effect upon utilization of contraceptive services. Methods: This epidemiological study was carried out on 1284 women at risk of unplanned pregnancy whose longitudinal data was collected from June 2021 to 31 November 2021 in Gynae & Obs department of Hayatabad Medical Complex Peshawar and KMU Institute of Medical Sciences, Kohat. Baseline details, association of contraceptive dynamics with COVID-19 experiences, and causes for contraceptive non-use were measured outcomes during COVID pandemic. Our key outcome was the dynamics of contraceptive usage classified into four groups: a) persistent non-use, b) persistent use, c) adoption, and d) cessation. Secondary outcomes were contraceptive uptake, cessation, and switching. Factors such as socioeconomic status, reproductive health, and COVID-19 status have been associated with contraceptive behavior. Sociodemographic details consist of age, education, residency, and parity. Results: Of the total 1284 unplanned pregnancy women, during COVID-19, no changes in contraceptive status was seen in 64.8% women, whereas those who responded were much more inclined to adopt a device 26.2% than to discontinue 9.0%. The majority of women who shifted contraceptives were using more efficient techniques than the one they used before the pandemic. In Pakistan, higher contraceptive protection was connected with economic insecurity due to COVID-19. Among all the cases, non-contraceptive users 9.1% (n=117) had cited COVID-19-related causes for not utilizing contraception. Conclusion: The present study concluded that contraceptive status among the majority of women with unexpected pregnancy during COVID pandemic unaltered their contraception status, and adoption was more acceptable to women than discontinued techniques. COVID-19 was mentioned by a minority of women for not using the vaccine, highlighting the significance of extending safe forms of service delivery amid health crises. Keywords: COVID-19, Pandemic, Contraception services

Objectives: To determine the prevalence of retinal changes in pregnancy-related hypertensive disorders and their association with maternal and fetal outcomes. Introduction: There is a grave risk to both mother and child when hypertensive problems complicate pregnancy. However, hypertensive sort of disorders during pregnancy have been allied to poor maternal and also neonatal outcomes. This research aimed to evaluate effects of hypertensive sort of disorders of pregnancy on both mothers and their unborn children by analyzing the prevalence, causes, and treatment of these conditions. Subjects and methods: BBH Rawalpindi, Inpatient Department of Gynecology and Obstetrics conducted the case-control research during the period from January 2021 to June 2021. In all, 149 patients participated in the research. Because seven patients could not be located, 142 cases were analyzed. Mild class preeclampsia (65.0 instances), severe class preeclampsia (32.0 hot cases), and also eclampsia (one case) were the subcategories used to categorize patients further, according to research. Thirty-one women who were not hypertensive throughout pregnancy were enlisted as controls. Results: Ninety percent of cases manifested with some edema. About a quarter basically patients had proteinuria above 300.0 mg/24 hours (26.76%), nearly half had proteinuria over two g/24 hours (47.18%), and about a quarter had urine protein based excretion of 3.0-5.0 g/24 hours (25.35%). Usually, incidence of specially HELLP (normally hemolysis, increased liver based special enzymes, and also squat platelet tot up) set of symptoms was 2.80%, raised bilirubin levels were seen in 47%, illustration symptoms occurred in 6.4%, vaginal based hemorrhage occurred in 11.30%, in addition to 42.2% of cases involved the central nervous system. It was shown that eclampsia was the cause of mortality in 2.8% of all maternal deaths. 16.9 percent of births were stillbirths, while 4.23 percent of newborns died. Conclusion: Compared to pregnant women with normal blood pressure, those who suffer from hypertensive disorders of pregnancy have a higher risk of having a baby born with complications. Our research did find a declining trend, although it was less than those seen in other studies; this may be because more of our study's births occurred in hospitals. Keywords: Neonatal outcome, maternal outcome, acute renal failure, and the HELLP syndrome

Background: Concept of short stay surgery is getting popular globally to maximize use of available health resources. The objective of the study was to determine thirty day readmission rate due to complications after short stay hysterectomy. Material & Methods: This descriptive cross sectional study was conducted in Department of Obstetrics & Gynae from 1st January 2018 to 31 December 2018. Sample size was 72. Sampling technique was consecutive, non-probability. Patients having obstetrical hysterectomy or co-morbidities needing prolonged hospital stay were excluded. Data collecting tool was specially designed proforma. The observation for readmission was spread over a span of 30 days. Our socio-demographic variables were age in years, parity, residence and education. Age and parity were measured on numerical scale and expressed as mean and SD. Education and residence were categorical variables. Research variables were type of hysterectomy and re-admission due to complications measured on nominal scale. Categorical were analyzed as frequency and percentages using SPSS version 17. Results: Out of 72 hysterectomies, 42(58.33%) were performed abdominally and 30(41.67%) were performed vaginally. In TAH group, 3(7.14%) patients and in VH group, 2(6.66%) patients had complications that required readmission. Pelvic Hematoma was found in 2(4.76%) patients of TAH group and in 1(3.3%) patients of VH group. Pelvic abscess was formed in VH group in 1(3.33%) of patients but not in TAH group. Urinary retention occurred in 1(2.38%) of TAH group but not in VH group. Conclusion: Short stay hysterectomy has lower re-admission rate due to less number of complications, with a view to explore ways to increase bed availability in our setup.