BackgroundThe rate of the caesarean section has been on a progressive rise ever since its association with improved fetal prognosis was established. This study was conducted to assess the effect of local wound infiltration with ropivacaine on the postoperative analgesia requirement and pain scores in caesarean section patients.MethodsThis was a prospective single-blinded randomized control trial conducted at the Department of Obstetrics and Gynecology, KRL Hospital, Islamabad, Pakistan over a duration of six months from January 2018 to June 2018. All the women aged 19 to 40 years, who underwent elective caesarean sections under spinal anesthesia, with American Society of Anesthesiologists (ASA) score II, were included in the study and randomized into two groups. The primary outcome studied was the efficacy of ropivacaine in controlling postoperative wound pain compared to no local analgesic. Pain severity was assessed using the visual analog scale (VAS) which was explained to the patient beforehand and which comprised a range of score from zero (no pain) to 10 (worst pain imaginable). Initially, paracetamol 1 g intravenous (IV) was given every six hours, over 24 hours. If pain did not settle on this, ketoprofen 3 mg/kg IV was given every eight hours, and in case of further analgesic demand by the patient, nalbuphine 10 mg was given IV, if necessary. The data was collected on a specific questionnaire and analyzed on the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 23.0. A p-value of less than 0.05 was considered significant.ResultsA total of 100 patients were randomized into two groups. Pain scores were significantly reduced in the ropivacaine group at four, six, and 12 hours after surgery. The percentage of patients who requested the multiple doses of IV paracetamol, ketoprofen, and nalbuphine, was significantly lowered in the ropivacaine group as compared to the placebo group (p<0.001).ConclusionsLocal infiltration with ropivacaine during caesarean section significantly reduces the postoperative analgesic requirement and visual analog scores, reducing the incidence of side effects.

Objective: To determine feto maternal outcome in patients with cesarean section and comparing outcome following TOLAC and elective repeat cesarean delivery. Study Design: Descriptive, Cross-sectional study. Setting: Department of Obstetrics & Gynecology, Kahuta Research Laboratory (KRL) Hospital, Islamabad. Period: 10th September 2019 to 9th March 2020. Material & Methods: 93 pregnant women of gestational age 37-42 weeks with previous transverse cesarean section were included. Patients with a history of multiple pregnancies, ruptured uterus, placenta previa, polyhydramnios or oligohydramnios, and fetal malpresentation were excluded. In each patient, the labor trial was done; if not possible, then a cesarean section was done on the elective list. Each case was done by the researcher herself in the presence of a consultant gynecologist and the mode of delivery (vaginal/cesarean), was noted. After this fetal outcome i.e. live birth (yes/no), NICU admission (yes/no), and Apgar score >6 at 5 minutes (yes/no) was noted.  Results: Maternal outcomes in a previous cesarean section was found to be a cesarean section in 60 (64.52%) and VBAC in 33 (35.48%), an APGAR score >6 at 5 minutes after VBAC was seen in 100.0% and after elective cesarean delivery in 81.67% of neonates. NICU admission is 0.0% in TOLAC compared to 20.0% with elective repeat LSCS. Live birth after emergency cesarean delivery was seen in 93.33% and 100% after VBAC. Conclusion: This study concluded that the maternal outcome in a previous cesarean section was found to be a cesarean section in 64.52% and VBAC in 35.48% of women and fetomaternal outcome following TOLAC is better.

analyzed using SPSS 21.0. All the females were aged between 25 to 35 years. Amongst these, 6 patients were primigravida,1 was diagnosed during the first trimester, 3 in the second trimester and remaining in third trimester. Only one patient had severe disease with symptoms of cough, shortness of breath and remained on oxygen support. But majority of patients were either asymptomatic or had symptoms like flu, fever, generalized body weakness. No maternal mortality, venous thromboembolism, or need of ventilatory support noted. Only one of the patients had an intrauterine death while the rest had neonates who were monitored in the postnatal period and only 1 needed admission due to RDS. None of the baby developed COVID infection. Majority of patients had asymptomatic infection that does not appear to affect the obstetrical outcomes. But the adverse outcomes were seen in those patients who did not attend the antenatal clinics due to the lockdown situation. Overall universal screening for pregnant women is recommended to further elucidate the effects of COVID-19 on pregnancy and vice versa.

Objectives: To determine frequency of low lying placenta (placenta previa) in previous two cesarean sections. Study Design: Descriptive, Cross-sectional study. Setting: Department of Obstetrics and Gynaecology, KRL Hospital, Islamabad. Period: October 2020 to February 2021. Material & Methods: Total 157 pregnant population of gestational age >28wks with history of two cesarean sections of age group 18 to 40 years had been selected. Results: The general public of patients 56.05% had been among 18 to 30 years of age, mean gestational age located in the study was 31.50weeks. The frequency of low lying placenta (placenta previa) in the previous two cesarean sections is pretty excessive 38 (24.20%) patients. Conclusion: Frequency of low lying placenta (placenta previa) in previous cesarean sections is quite high.