ObjectiveA maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called ‘FAST-M’ consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.SettingThe study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad.Design and participantsA qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation.ResultsFour overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs’ perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting.ConclusionThe study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local contextTrial registration numberISRCTN17105658.

Background Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. Methods The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings. Discussion The utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis.

ABSTRACT… Objectives: To find out the significance of the transvaginal sonography (TVS) in postmenopausal women (PMW) with postmenopausal bleeding (PMB) and compare it with the histopathological diagnosis at curettage, so that unnecessary operations could be avoided. Study Design: Descriptive study. Setting: Radiological Department for TVS and H/P at the Department of Gynecology & Obstetrics (Gynae: Unit IV) at Liaquat University Medical, Health Sciences Hospital Jamshoro and Hyderabad. Period: September 2010 to September 2011. Material and Methods: The present study was conducted on patients with postmenopausal bleeding. Results: The mean age + SD of the women was 51 + 3.1 years, ranging from a minimum of 49 to 55 years. The mean endometrial thickness was from 1.8-15mm. Transvaginal Sonography and Histopathological Findings: Histopathological findings revealed endometrial atrophy in 64 (57.14%) patients, Endometrial hyperplasia in 24(21.4%), endometrial polyp in 7(6.25%), Endometrial carcinoma in 8 (7.14%), Pyometra in 5(4.46%) and Fibroid uterus in 4(3.57%). With a cut off value of 4mm endometrial thickness, TVS showed a sensitivity of 100%, specificity of 73.33%, a positive predictive value of 76.47%, a negative predictive value 100% and an accuracy of 85.71%. At a cut off limit of 5mm endometrial thickness (endometrium >5mm indicating pathology), the sensitivity of the present study was 92.3% and the specificity was 86.6 %. The positive predictive value was 85.71%, the negative predictive value was 92.86 % and the accuracy was 89 %. Conclusion: TVS is a useful tool to triage post menopausal women with bleeding and avoid un convenient invasive procedure.

Background: The risk of vertical transmission of hepatitis C virus (HCV) is ≈6%, and evidence suggests HCV negatively affects pregnancy and infant outcomes. Despite this, universal antenatal HCV screening is not available in most settings, and direct acting antivirals (DAA) are yet to be approved for use in pregnancy or breastfeeding period. Larger safety and efficacy trials are needed. At current there is limited understanding of the acceptability of routine HCV screening and use of DAAs in pregnancy but only among women in high HCV burden countries. Methods: We conducted a cross-sectional survey of pregnant or post-partum (<6 months since delivery) women attending antenatal clinics or maternity hospitals in Egypt, Pakistan and Ukraine. In Ukraine, this included one HIV clinic. Acceptability of free universal antenatal HCV screening and potential uptake of DAA treatment in the scenario of DAAs being approved for use in pregnancy was assessed. Results were stratified by HCV status and in Ukraine by HIV status. Descriptive statistics were used to explore differences in acceptability of treatment in pregnancy by country. Findings: Among 630 women (n=210 per country) who participated, the median age was 30 [interquartile range (IQR) 26, 34] years, 73% were pregnant and 27% postpartum, and 27% ever HCV antibody or PCR positive. 40% of women in Ukraine were living with HIV. Overall 93% of women supported free universal HCV screening in pregnancy, with no difference by country. 88% would take DAAs in pregnancy if approved for use: 92%, 98% and 73% among women in Egypt, Pakistan and Ukraine, respectively. Motivation for use of DAAs in pregnancy (to avert vertical transmission or for maternal HCV cure) varied by country, HCV status and HIV status (in Ukraine). No predictors for acceptability of DAAs were identified. Interpretation: Our survey across 3 high burden countries found very high acceptability of free universal HCV screening and DAAs if approved for use in pregnancy. Clinical trials to evaluate the safety and efficacy of DAAs during pregnancy and breastfeeding are urgently required.

No abstract

No abstract

ABSTRACT… Objectives:To determine the frequency of macrosomia in obese primigravid women. Study Design: Case series study. Period: Six months. Setting: Department of Gynecology and Obstetrics Department Jamshoro. Patients and Methods: The inclusion criteria of the study were primigravida women between age 18 to 35 years with singleton pregnancy and gestational duration of 37 to 42 weeks, and during labour with BMI 30 or >30kg/ m2 and All booked women who were primigravid during antenatal visit try to come and BMI calculated by weight in kg and height in meter square. The variables include post-delivery if the weight of baby is 4.5 kg is macrosomic and mode of the delivery. The data was analyzed in SPSS version 17, the frequency and percentage was calculated while the chi-square test was applied on categorical variables and the p-value ≤0.05 was considered as significant. Results: During six months study period total 203 pregnant obese ladies were observed for macrosomic babies. Age group was analyzed which shows that in age group between 18-25 years were 105(52.00%) women, in age group of 26-30 years were 62 (30.69%) women and age group of 30 years and above were 35 (17.31%) women with mean age ± SD of ladies was 24.6 ±6.2 years. Regarding modes of delivery shown 132 (65.02%) ladies had C-section and 71 (34.97%) ladies had vaginally delivery. Weight of the babies was assessed which shows 27 (13%) were born with less than 2.5 Kg, babies having weight between 2.6-3 Kg were 71 (35.3%) , babies were having weight 3 kg to 4.5kg 38 (18.7%) and babies having more than 4.5kg which shows 67 (33%). Neonatal complications observed were macrosomic babies 67 (33.1%). Frequency of macrosomic babies was higher in women with BMI more than 3.5kg/m2 44(21.67%) and in women with BMI between 30 to 35kg/m 2 25(12.31%). Conclusion: Obesity responsible for complications during pregnancy and delivery for both mother and babies. Fetal complications are macrosomia and these obese ladies should motivate for maintenance of weight. Key words:Macrosomia, Obesity, Primigravid. Article Citation: Junejo RR, Junejo RR, Sikandar R, Baloch S, Khaskheli M. Obese primigravid women; frequency of macrosomia.

Background Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth and the postpartum period. It is estimated to account for between one tenth and half of all maternal deaths globally. An international stake-holder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan. Methods The proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase, we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion (the Adaptation Phase). In the second phase, we will evaluate the feasibility of the FAST-M intervention (the Feasibility Assessment Phase). Discussion The utilisation of bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate and optimise a bundled care approach in low-resource settings in Pakistan to minimise the burden of maternal morbidities and mortalities due to sepsis.