Objective High maternal and neonatal mortality rates in developing regions like Pakistan are linked to low rates of institutional deliveries. One way to improve rates of institutional deliveries is through improving institutional delivery service satisfaction in women. The aim of this research is to identify which factors influence delivery service satisfaction during the period of COVID-19 and which socio-demographic characteristics of women are associated with greater fear of catching COVID-19 during institutional deliveries. Methods A total of 190 women who had given birth between May to June, 2020, were sampled from two private and two public sector hospitals in Lahore, Pakistan. A standardized tool was modified for use and a combination of descriptive statistics and multivariate regression was applied. ResultsThe results reveal that a majority of women, at 74.7%, are afraid of contracting COVID-19; specifically, women delivering at public hospitals, those who are illiterate or semi-literate, with more than four children, with low household income, and who are unemployed. Regression models are used to identify factors related to higher satisfaction, including the following: (i) pre-delivery care (explanatory power of R 2 = 0.651); (ii) during delivery care (R 2 = 0.716); (iii) after delivery care for women (R 2 = 0.525); and (iv) after delivery care for newborn (R 2 = 0.780). The main areas which influence satisfaction include the following: service quality of staff and administration; maintenance of hygiene and sanitation; involvement in decision-making; provision of necessary information; and advice for breastfeeding, immunization and family planning. Conclusions for Practice Based on our findings, we recommend improved regulation of delivery services in both public and private hospitals and increased protection for disadvantaged women groups to maintain service quality during the pandemic.

Objective: The objective was to compare the effectiveness of vaginal versus intramuscular progesterone to prevent preterm delivery in patients with history of preterm labor in previous pregnancy. Patients and Methods: It was a Randomized Control Trial carried out in the Gynecology Unit in a Public sector Hospital, Lahore from March to December 2015. A total of 800 patients were enrolled through Antenatal OPD and were randomly divided into two groups by draw method. In Group-A, patients were administered 200mg of vaginal progesterone pessary once daily and in Group-B 250 mg of intramuscular progesterone was injected weekly. Treatment was continued until 37 completed weeks of gestation. The patients were followed up through their contact numbers and on routine follow up. This practice was abandoned if premature rupture of membranes occurred and the fetus was delivered before 37 weeks. All the parameters were recorded by the researcher on proforma. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0. Chi Square test was applied to draw the comparison. Results: The mean age of patients was 26.16 ± 5.36 years (18 -35 years). The 296 patients were Para 1, 290 were Para 2, 142 were Para 3, 51 were Para 4 and 21 females were Para 5. In all females, the mean gestational age at time of presentation was 22.00 ± 1.47 weeks, whereas, at time of delivery, mean gestational age was 36.05 ± 2.38 weeks. In vaginal progesterone group, the mean gestational age at time of delivery was 36.67 ± 1.92 weeks while in IM group, mean gestational age at time of delivery was 35.43 ± 2.62 weeks. The difference between both groups was statistically significant (P < 0.05). Effectiveness (delivery ≥ 37 weeks) was achieved in 379 (47%) cases, out of which 228 (57%) cases belonged to vaginal progesterone group and 151 (37.8%) cases belonged to IM progesterone group (P < 0.05). Post stratification with age and parity also showed that vaginal progesterone is more efficacious than IM progesterone (P < 0.05). Conclusion: We concluded that vaginal progesterone is more effective than intramuscular progesterone for the prevention of preterm labor in patients with history of preterm labor in previous pregnancy.

Preeclampsia with generalized tonic-clonic convulsions is termed as eclampsia. Eclampsia isassociated with multiple maternal and fetal complications.  Eclampsiais an obstetric emergency and quick decision making is required to save lives. The objective of the study was to compare the maternal mortalityafter cesarean section versus vaginal delivery among eclampsiapatients. It is a descriptive case series conducted in Department of Obstetrics and Gynecology, Lady Willingdon Hospital, from December 2014 to June 2015. In our study, 62.86 % (n=88) patients were between18-25 years of age and 37.14 % (n=52) werebetween 26-35 years of age. The mean+SD was calculated as 25.12+4.53 years. Frequency ofvaginal delivery in patients with eclampsia was 30.71 % (n=43) while69.29 % (n=97) were delivered through cesarean section. Comparisonof maternal mortality in two groups was recorded, where out of 43 spontaneous vaginal deliveries mortality was recorded in 6.98 % (n=3). Out of 97 cesarean deliveries, mortality was recorded in 17.53% (n=17). We concluded that mortality rates are higher in patients undergoing cesarean section.

Objective:The objective of this study was to see treatment outcome of morbidly adherent Placenta.

Objectives: To determine frequency of benign and malignant tumors among perimenopausal women presenting with ovarian masses at a tertiary care Hospital. Study Design: Descriptive Cross Sectional study. Setting: Department of Obstetrics & Gynecology, Jinnah Hospital, Lahore. Period: Six Months from August 2017 to January 2018. Material & Methods: A total 127 premenopausal females with ovarian masses visiting Obstetrics & Gynaecology Department, Jinnah Hospital, Lahore were selected. After detailed medical history and clinical examination patients underwent ultrasonography to diagnose status of ovarian masses. Data was entered in self-made proforma. Results: Total 127 patients were selected. Mean age of cases was 48.87 ± 3.04 years, with mean BMI of 26.52±2.43 kg/m2 and obese patients were 30.7%. Out of all 73.2% patients had benign masses and 26.8% patients had malignant masses. Obesity and family history were significantly correlated with malignant tumors among premenopausal women having ovarian masses p-value 0.001. Conclusion: It was observed that the malignant tumors are frequently linked to pre-menopausal women with ovarian masses. Obese and family history positive patients are on high risk of malignant tumors.

Aim: To explore the perceptions of undergraduate medical students about integrated modular curriculum and to identify the factors affecting it. Study design: Mixed method study Place and duration of study: King Edward Medical University (KEMU) from 1st November 2021 to 30th April 2022. Methods: The questionnaires were distributed to 391 MBBS students. In depth interviews were conducted from 16 students and audio-recorded. Results: Three hundred and fifty seven (91.3%) considered integrated curriculum a useful approach, 88% preferred this approach over traditional, more than 70% considered it useful for clinical insight and improvement in academic performance. Many (43%) of the students complained that the institutional environment was not helpful regarding implementation of integrated curriculum which was further explored by in-depth interview. Conclusion: The majority of students have shown a positive response to the modular integrated curriculum .It has helped them in improving academic performance and clinical insight. There is a need to improve university environment to implement integrated assessment more effectively. Keywords: Integrated modular curriculum, undergraduate, medical students, perception

Background: Active management of 3rd stage of labor is done routinely to enhance the process of the placental delivery and decrease the duration of 3rd stage of labor so as to minimize the risk of postpartum hemorrhage. A recent study concluded that intraumbilical administration of oxytocin shortened the duration of 3rd stage of labor significantly as compared to control group and suggested its use in routine practice for its role in the reduction in the risk of postpartum hemorrhage. OBjectives: The objective of this study was to compare the mean duration of 3rd stage of labor in patients treated with and without intraumbilical vein injection of oxytocin. Methods: It was a randomized controlled trial conducted at Department of Obstetrics & Gynecology, Government Teaching Hospital, Shahdara from 15/01/2022 to 14/07/2022.This study involved 60 pregnant women undergoing vaginal delivery which were further divided into two groups. After clamping and cutting of umbilical cord, in addition to routine management of 3rd stage of labor, women in Group-An also received intraumbilical oxytocin while the women in Group-B were taken as controls and only routine management of 3rd stage of labor was performed. The outcome variable was mean duration of 3rd stage of labor which was recorded in minutes from delivery of baby till delivery of placenta and was compared between the groups. A written informed consent was taken from each patient. Results: The mean age of the patients was 27.2±4.3 years while the mean parity was 2.85±1.83. There were 22 (36.7%) primiparas, 21 (35.0%) multiparas and 17 (28.3%) grand multiparas. The mean BMI of the patients was 27.5±3.9 Kg/m2 and 19 (31.7%) patients were obese. The mean duration of 3rd stage of labor was significantly shorter in women receiving intraumbilical oxytocin as compared to controls (4.33±1.52 vs. 9.40±2.77 minutes; p-value<0.001). Similar difference was observed between the groups across various subgroups based on patient’s age, parity and BMI. Conclusion: Intraumbilical administration of oxytocin significantly reduced the mean duration of 3rd stage of labor which along with anticipated reduction in the risk of postpartum hemorrhage calls for the preferred use of intraumbilical oxytocin in the active management of 3rd stage of labor in future

Objective: To determine the diagnostic accuracy of Uterine artery and Umbilical artery Doppler flow studies in predicting Intrauterine growth restriction taking birth weight as gold standard. Patients and methods: It was a Cross Sectional validation Study conducted at Department of Obstetrics and Gynaecology, Lady Willingdon Hospital, Lahore from 1st January 2021 to 30th April 2022. The uterine and umbilical arteries were analysed using Doppler. The newborn's weight in grammes was recorded right after birth. Results: In the diagnosis of intrauterine growth restriction, uterine artery Doppler has showed a sensitivity of 66%, specificity of 96.4%, diagnostic accuracy of 89%, PPV of 84.6%, and NPV of 90.4%. Conclusion: Uterine and umbilical arteries combined the greatest sign for predicting IUGR is Doppler. Keywords: Uterine artery Doppler, Intrauterine growth restriction, Diagnostic accuracy, Umbilical artery Doppler,