Objective:To observe the fetomaternal morbidity and mortality with induction of labour in pregnant women with gestational hypertension.Methods:The subjected study population included was 138 pregnant women with gestational hypertension. These pregnant women were between 34-40 weeks of gestational period in whom labour was induced, while the pregnant women who had labour induction for other reasons were excluded. These women were registered on the predesigned proforma. The data was collected and analyzed on SPSS version 21.Result:Out of the 138 cases, mean age of the women was 25.93±5.037, prim gravid women were 78(56.5%), gestational period in majority of these women 71(51.4%) varied between 35-38 weeks. The common presenting symptoms were oedema 119(86.23%), headache 90(65.21%). Labour induction in majority of the cases 81(58.7%) was carried with prosten pessary. The Caesarean section was needed in 39(28.3%) women in emergency due to maternal and fetal reasons or due to failed induction. Maternal complications were uncontrolled hypertension 23(16.7%), intensive care unit admission 21(15.2%), fits 15(10.9%), post partum haemorrhage 13(9.4%). Fetal complications were birth asphyxia 49(35.5%), neonatal intensive care unit admission 17(12.3%), neonatal death 14(10.1%).Conclusion:The emergency Caesarean section rate was quite high with induction of labour in pregnant women with gestational diabetes. The maternal morbidity as well as fetal morbidity and mortality rate was also high.

Objectives: To observe the effects of vaginal discharge during pregnancy on maternal and fetal outcomes. Methods: This observational study was undertaken form June 2018 to 31 May 2019 period in the Department of Obstetrics and Gynaecology at Liaquat University of Medical and Health Sciences hospital Jamshoro Unit IV. Data were collected from a convenience sample of 85 pregnant women. All the pregnant women with vaginal discharge were included in the study, while the women with bleeding and other medical disorders during pregnancy were excluded. Data was analyzed. Results: Women’s mean age as 27.4 (±4.7) years and most were 28-35 weeks pregnant (n=29, 34%) and primigravida (n=35, 41%). Seventy six women (89%) presented with vaginal discharge while nine women (11%) reported no vaginal discharge. Of those with vaginal discharge,53 women (69.7%) had vaginal infections: bacterial vaginosis (n=21, 39.6%), vaginal candidiasis (n=17, 32.1%) and vaginal trichomoniasis (n=15, 28.3%). Pathological vaginal discharge (PVD) was associated with vaginal irritation (n=30, p<0.0001), vaginal pain (n=50, p<0.0001), fever (n=12, p=0.015), uterine contractions (n=31, p<0.0001), premature membrane rupture (n=29, p<0.0001), abortion (n=13, p=0.009), pre-term delivery (n=24, p<0.0001) and post-partum endometritis (n=19, p=0.0006). PVD was associated with neonatal outcomes i.e. low birth weight (n=24, p<0.0001), low Apgar score at birth (n=22, p=0.0001), neonatal respiratory distress syndrome (n=21, p=0.0002), neonatal intensive care hospitalisation (n=20, p=0.002) and early neonatal death (n=16, p=0.003). Conclusion: Pathological vaginal discharge (PVD) during pregnancy is more frequent and is associated with adverse maternal and perinatal outcomes. doi: https://doi.org/10.12669/pjms.37.5.4187 How to cite this:Khaskheli M, Baloch S, Baloch AS, Shah SGS. Vaginal discharge during pregnancy and associated adverse maternal and perinatal outcomes. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4187 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 20-year-old primigravida married since 1 year, was admitted with 36 weeks pregnancy along with a mass and acute pain in the abdomen. In early pregnancy she visited local doctors for the confirmation of pregnancy. Thereafter she had no antenatal checkup. At 35 weeks of pregnancy she noticed an excessive enlargement of the abdomen but she did not visit any doctor. On the day of admission she had a sudden severe pain in the abdomen which was associated with vomiting and fainting. She went to a local doctor who after initial resuscitation referred her to this hospital. Her complaints were continuous pain all over the abdomen, aggravated by movements and associated with vomiting. She was afebrile, pale, and normotensive with tachycardia. Symphysio fundal height was 42cm. Abdomen was tender, fetal heart sounds were present and regular, ultrasound examination revealed 37 weeks fetus with active heart beat, 2.5 kilogram in weight. There was a huge cystic mass with internal echoes and thin septations, measuring 19x15cm in size lying above the uterus in the epigastric region Her hemoglobin was 9.0 gm%. She underwent emergency laparotomy. On exploration, she had dual pathology i.e. huge ovarian cyst without any torsion while the full term pregnant uterus was found twisted at lower uterine segment (Fig. 1). The uterus was untwisted; a live baby boy was delivered by lower segment caesarean section. The baby was hypoxic at the time of birth, resuscitated by the pediatrician. The ovarian cyst was having benign features, 20x18cm in size, and 7.5 kg in weight (Fig. 2). The other tube and ovary were normal. Right salpingo-oophorectomy was done. Her postoperative period remained uneventful. She was discharged on the 8th postoperative day. Histopathology report of the removed tumor was serous cystadenoma. DiscussionUterine torsion is the twist of the uterus at the junction between the cervix and the corpus more than 45 degrees around its long axis and mostly the degree of twist is 180 0 . Rarely does torsion of pregnant uterus occurs to such an extent that the uterine circulation is arrested leading to acute maternal symptoms and also threatenfetal survival. Thus it is usually associated with abruptio placentae. The risk factors for uterine torsion are abnormal fetal presentation i.e. transverse lie, uterine distention due to the leiomyoma, mullerian anomalies, pelvic adhesions and large neoplasms distorting the uterine shape or position. In this case the associated factor was large ovarian cyst. The incidence of the ovarian tumor in pregnant women is 1/1000 1 deliveries.Torsion of the full term pregnant uterus is a rare obstet-

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Objective: To differentiate between normal and pathological vaginal discharge (PVD) in pregnant women and to identify causes of and adverse pregnancy outcomes associated with PVD. Design: A cross-sectional study. Setting: Outpatient antenatal clinics. Population / Sample: Pregnant women, Convenience sample (N=85). Methods: Data were collected through history, clinical examination and laboratory investigations. Data analysed by frequencies, descriptive statistics and Chi-Squared tests. Main outcome measures: Vaginal discharge (VD), age, gestation, parity and adverse pregnancy outcomes. Results: Women's mean age was 27.4 (±4.67) years. Majority of women were 26-31 years old (40%), 28-35 weeks pregnant (34%) and primigravida (41%). Of 89% (n=76) women with VD, 32% (n=24) had normal VD and 68% (n=52) PVD. Normal VD was watery (100%) and odourless (96%) while PVD was yellowish curd like (33%) and foul smelling (52%). PVD was significantly associated with bacterial vaginosis (P < 0.0001), candidiasis (P = 0.005) and trichomoniasis (P = 0.018). A higher proportion of women with PVD reported irritation (P < 0.0001), pain (P < 0.0001), uterine contractions (P < 0.0001), premature membrane rupture (P < 0.0001), abortion (P < 0.042), pre-term delivery (P < 0.0001) and post-partum endometritis (P < 0.0001). PVD was also associated with low birth weight (P < 0.0001), low Apgar score at birth (P < 0.0001), respiratory distress syndrome (P < 0.0001), intensive neonatal care hospitalisation (P = 0.001) and early neonatal death (P = 0.002). Conclusions: Vaginal discharge in pregnancy requires early investigation to avoid any adverse fetomaternal outcomes associated with pathological vaginal discharge.

Objective:To observe the impact of acute renal morbidities with obstetrical emergencies on maternal health.Methods:In this study pregnant women between 28-40 weeks gestational period and delivered women in their puerperal period up to 42 days after delivery having acute renal problems associated with obstetrical emergencies were included. Pregnant and delivered women with obstetrical emergencies and associated other morbidities were excluded. These women were registered on the predesigned proforma after taking written informed consent and taking approval from institutional ethic research committee. The data was collected and analyzed on SPSS version 21.Result:Out of these 196 total registered women, majority of these women 81(41.32%) were between 21-30 years of age and multiparous women with parity four and above were 83(42.34%). Commonest presenting symptoms were generalized oedema 123(62.75%) and oligouria 92(46.93%). Frequent obstetrical emergencies observed were pre-eclampsia 53(27.04%), post partum haemorrhage 48(24.48%) and ante partum haemorrhage 36(18.36%) women. The complete recovery was observed in 86(43.87%) women, while mortality was seen in 56(28.57%) women.Conclusion:Renal morbidities were more frequently observed in obstetrical emergencies leading to high morbidity and mortality rate.