SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

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Background: Pre-eclampsia with hyperuricemia is a complication of pregnancy associated with fetal mortality and morbidity. The main complications are preterm delivery, low birth weight and intrauterine demise of the fetus along with higher rate of cesarean section.Objective: To compare fetal outcome in pre-eclampsia with hyperuricemia and with normal uricemic controlMaterial and Methods: Study was conducted at department of the Gynecology “B” Hayatabad Medical Complex Peshawar from 1st August 2016 to 31st July 2017. Patients with pre-eclampsia were divided in two groups “A” and “B”. In group “A” patients with serum uric acid level > 6mg/dl and in group “B” patients with uric acid level of < 6mg/dl were included. The low birth weight, preterm birth, rate of cesarean sections and intrauterine death were observed in the two groups. Results: Among the 60 patients with hyperuricemia 34 (56.66%) babies born with low birth weight, rate of cesarean section was 53.33% (32), pre-term delivery 48.33% (29) and intrauterine deaths 6.66% (4). While in 60 patients with normal uricemic control 7 (11.66%) babies born with low birth weight, rate of cesarean section was 13 (21.66%), pre-term delivery 16 (26.66%) and intrauterine deaths 0 (0.00%).Conclusion: Increased uric acid level is a poor predictor for fetal outcome in terms of low birth weight, preterm birth, rate of cesarean sections and intrauterine death.

Background: Cross-cultural adaptation and validation are important for the reliable use of a scale. This study was conducted to translate and validate the polycystic ovarian syndrome quality of life scale (PCOSQOL) in Pashto. Methods: This study was conducted in tertiary care teaching hospitals of Peshawar from August to December 2021 on 333 patients diagnosed with polycystic ovarian syndrome. Using forward-backward method, three bilingual experts translated PCOSQOL from English to Pashto. The exploratory and confirmatory factor analyses, Cronbach alpha reliability and construct validity of PCOSQOL (Pashto version) was found out using SPSS version 25 and AMOS version 26 for data analysis. Results: The mean age of the sample was 25.73±5.89 years.  Majority were married (n=260, 78.1%), uneducated (n=180, 54.1%) and unemployed (n=303, 91%). Factorial validity of the Pashto version showed it to be a five-factor model. Regarding construct validity, the factor loading through Item total correlation scores revealed highly satisfactory correlation coefficients. The Cronbach’s alpha reliability of the Pashto version of PCOSQOL was 0.918. The confirmatory factor analysis (CFA) indicated a good fit model with a CFI of 0.91 and a RMSEA value of .08. Poor quality of life (89.98±28.5) was reported in 169 (50.8%) women and this was irrespective of their educational and occupational background (p>0.05) respectively. Pearson coefficient correlation test showed a significantly positive Inter-scale correlation (p<0.05). Conclusion: Pashto version of PCOSQOL is a reliable instrument to measure the quality of life in patients with polycystic ovarian syndrome and can be used in Pashto speaking patients.