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Background: Anesthesia is needed to ensure both maternal and fetal safety during cesarean sections. General anesthesia can be used for the rapid procedure in obstetric emergencies while regional anesthesia can be used for cesarean section due to its effectiveness.Objective: The objective of this study was to compare intra-operative and postoperative maternal and fetal complications with general and spinal anesthesia during cesarean section.Material and Methods:  A total of 100 patients admitted for cesarean sections were included in this study and categorized into two groups (50 each) based on the anesthesia used either general or spinal anesthesia. All the demographic data, type of anesthesia, and post-anesthesia complications were determined. Results: A total of hundred patients were included and categorized into two (GA and SA) equal groups of 50 patients each. The mean age of the General anesthesia group was 29.9±3.8 while the spinal anesthesia group's mean age was 29.8±3.0. Parity was 1.6±0.7 and 1.9±0.7 in the general anesthesia and spinal anesthesia group respectively. The preoperative hemoglobin and hematocrit values were insignificant with p=0.257 and p=0.165 respectively. 24 hours after the operation were significantly lower in the general anesthesia group than in the spinal anesthesia group (P <0.001 and P=0.004, respectively). The proportion of newborns with 5th-min Apgar scores < 7 was not significantly different between the two groups, although the general anesthesia group had a significantly larger proportion of newborns with 1-min Apgar scores <7 than the spinal anesthesia group P=<0.001). Keywords: General anesthesia, Spinal anesthesia, Caesarean section, Apgar score.

BackgroundThe prevalence of fetal macrosomia varies worldwide. Its trend has increased over the past decades in many developed nations. It is associated with various maternal and fetal complications. The information regarding the frequency of fetal macrosomia among non-diabetic women is limited in resource-limited countries such as Pakistan. Therefore, this study aimed to determine the number of fetal macrosomia cases among nondiabetic women. MethodologyThis was a cross-sectional study conducted in a tertiary care hospital in Peshawar, Pakistan. A total of 119 pregnant women were enrolled in the study. All pregnant women aged 15 to 45 years who had singleton pregnancies with any parity or gravida and a gestational age of ≥37 weeks were included in the study. Pregnant women with underlying chronic systemic disorders such as diabetes mellitus, gestational diabetes mellitus, hypertension, renal or cardiac disorders, and sickle cell anemia were excluded from the study. Women who did not consent to participate and those with a gestational age of ≥42 weeks at the time of delivery were also excluded from our study. Based on a 5.2% prevalence of fetal macrosomia in the general population, the sample size was calculated using the World Health Organization calculator at a confidence interval of 95%, absolute precision of 0.05 with anticipated population proportion, and a 4% margin of error. The required sample size was calculated at 119. The chi-square test was applied. P-values of ≤0.05 were considered significant. ResultsOut of 119 participants, fetal macrosomia among non-diabetic women was seen in 10 (8.4%) cases. The mean age of patients in our study was 29.80 ± 4.33 years. The mean gestational age was 36.05 ± 1.31 weeks, whereas the mean body mass index of participants was 29.17 ± 2.36 kg/m 2 . Post-stratification, spontaneous vaginal delivery was the only significant variable with a P-value of <0.05 in our study. ConclusionsThe number of fetal macrosomia among non-diabetic women in our study was 10 (8.4%). Because this was a single-center, hospital-based, cross-sectional study, we need to conduct large multi-centered randomized controlled studies to identify the actual prevalence of fetal macrosomia in non-diabetic women in our population.

Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified

Introduction: Ectopic pregnancy is the commonest gynecological emergencies. If not treated timely, it places major morbidity upon future fertility and family. Ectopic pregnancy presents a major health problem for women of childbearing age. The increased incidence of ectopic pregnancy has been partially attributed to improved ability in making an earlier diagnosis. Anything that hampers the migration of the embryo to the endometrial cavity could predispose women to ectopic gestation. The most logical explanation for the increasing frequency of EPs is previous pelvic infection; however, most patients presenting with an EP have no identifiable risk factor. Objective: To determine the frequency of fertility outcome (intrauterine pregnancy and extrauterine pregnancy) in patients having history of ectopic pregnancy. Materials and Methods: A total of 92 patients having history of ectopic pregnancy were included in the study in a consecutive manner and assessed for fertility outcome in terms of extrauterine or intrauterine pregnancy. The study utilized descriptive cross sectional study design. The study settings was department of gynecology, Lady Reading Hospital, Peshawar. The study duration was from 1st January 2019 to 31st December 2020. Results: The mean age of the sample was 30.3 + 6.1 years. The mean parity of the sample was 2.1 + 1.5, mean BMI was 26.4 + 3.5kg/m2 and mean gestational age at presentation was 6.7 + 2.1 weeks. With regards to fertility outcome, 39.1% women had extrauterine pregnancy and 60.9% had intrauterine pregnancy. Extrauterine pregnancy though less than intrauterine is still a significant problem in the study’s population with previous history of ectopic pregnancy. Recommendation: The study recommend more research projects particularly interventional studies for proper management of ectopic pregnancy and reduce the burden of extrauterine pregnancies so that even with history of ectopic pregnancy, term delivery can be assured.