Background and Aim: Cesarean section rates are rising around the globe and are considered as the major surgical procedure conducted on females. Cesarean-related hemorrhage contributes to increasing mortality rates around the world. Due to the rise in cesarean rate and its associated complications, post-cesarean severe bleeding without proper management is a major concern. Therefore, the present study aimed to assess the intravenous tranexamic acid (TA) and sublingual misoprostol effect on reducing post-cesarean section bleeding. Materials and Methods: This cross-sectional study was conducted on 146 term pregnant women undergoing emergency or elective cesarean section at the Department of Obstetrics and Gynaecology, Qazi Hussain Ahmad Medical Complex, Noshehra during the period from 7th September 2020 to 6th March 2021. All the participants were randomly categorized into two groups. Each group comprised of 73 participants whereas groups I and II received sublingual misoprostol (600 µg) and 500 mg intravenous tranexamic at card clamping respectively. Both groups were administrated for postoperative 48 hours and blood loss was measured. The packed cell volume and postoperative Hb were evaluated and compared with initial values before surgery. The need for blood transfusion, drug side effects, and additional uterotonics was evaluated. SPSS version 20 was used for data analysis. Results: The mean age of groups I and II were 28.32±4.73 and 28.17±4.83 years whereas the overall mean age was 28.25±4.78years. A higher reduction of hemoglobin level was observed in an intravenous tranexamic group compared to the sublingual group (-2.39±0.93 versus -2.09±1.28g/dL) (p=0.001). Moreover, the intravenous tranexamic group had significantly higher blood suction and gauze usage than sublingual misoprostol (256.73± 83.25versus 189.68± 102.4 cubic centimeter (cc) and 4.59±1.43 versus 3.19±1.27) for a significant value of 0.001. The decrease in mean blood pressure during the cesarean section procedure was significant in intravenous tranexamic than sublingual misoprostol (p=0.001). Conclusion: Our study concluded that sublingual misoprostol significantly reduced total bleeding when compared to tranexamic acid. Furthermore, hemodynamic variables were stabilized more in the misoprostol group than in the tranexamic acid group. Keywords: Cesarean Section Bleeding; Intravenous Tranexamic acid; Sublingual misoprostol.

To know the approach of undergraduate medical students towards the contemporary examination system in Khyber Pakhtunkhwa, Pakistan. Materials and Methods: It was a cross sectional descriptive type of research which was conducted by the Department of Medical Education at Nowshera Medical College (NMC), Nowshera, Khyber Pakhtunkhwa, Pakistan. Students of NMC from 1st year to 4th year MBBS were inquired through a semi structured and pre-validated questionnaire. Results: Out of total 400 students inquired, 21.75% (87) students gave “A” grade, 31.5% (126) gave “B” grade, 30.75% (123) gave “C” grade and 16% (64) gave “D” grade to the present annual examination system. About 32.5% favored semester system, 26% favored Problem Based Learning (PBL) and 22.5% of total wished to be examined via interactive sessions. Conclusions: We found very low levels of satisfaction of students regarding current system and they want modifications to internationally recognized systems such as semester or PBL system of instruction and examination. They need a system that makes their concepts clear, more focused on main concepts, short and easy to go through annual examinations.

Objective: The aim of this study is to compare the effectiveness of intrauterine balloon tamponade and B lynch suture for management of severe postpartum hemorrhage. Study Design: Randomized Control trial Place and Duration: The study was conducted at Gynae & Obs department of Qazi Hussain Ahmad Medical Complex, Nowshera KPK for six months duration from January to 2021 to June 2021. Methods: There were one hundred and twenty patients with ages 20-45 years were presented in this study. All women had severe postpartum hemorrhage were included in this study. Demographically detailed of enrolled cases age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were equally divided into 2-groups I and II. Group I had 60 patients and received Lynch suture while in group II 60 patients received intrauterine balloon tamponade. Post-operative success rate among both groups were assessed and compared in terms of bleeding control within 10-15 minutes. SPSS 24.0 version was used to analyze the complete data. Results: In group I mean age was 29.09±2.53 years with mean BMI 25.11±7.64 kg/m2 while in group II mean age was 29.02±3.62 years with mean BMI 24.87±6.32 kg/m2. Mean gestational age in group I was 37.87±3.29 weeks and in group II mean gestational age was 38.19±6.41 weeks. Mean parity in group I was 4.03±1.19 and in group II it was 4.01±0.87. Frequency of success rate in group I was significantly higher among 54 (90%) cases as compared to group II 39 (65%) with p value < 0.05. We found that patients of group I was significantly satisfied than that of patients who received intrauterine balloon tamponade. Conclusion: In this research we concluded that lynch suture for the management of severe postpartum hemorrhage among females had higher effectiveness in terms of bleeding control within 15 minutes and with higher satisfaction among patients as compared to those females who received intrauterine balloon tamponade. Keywords: Postpartum hemorrhage, Lynch Suture, intrauterine balloon tamponade, Success Rate

Objective: The aim of this study is to compare the vitamin D level among vaccinated and non-vaccinated pregnant women with COVID-19. Study Design: Observational/comparative study Place and Duration: The study was conducted at the department of Gynae and Obs Quaid-e-Azam International Hospital, Islamabad and Qazi Hussain Ahmad Medical Complex, Nowshera for Duration of six months from October 2020 to March 2021. Methods: Total 120pregnant women had coronavirus disease were presented. Informed written consent was taken for details demographics age, gestational age, parity and body mass index. 18-45years was the women ages. Patients were categorized into 2-groups. Group I had 60 vaccinated patients and in group II 60 non-vaccinated pregnant women. Blood sample of all the patients were taken for the level of serum 25-hydroxy vitaminD3 [25 (OH) D3]. Vitamin D deficiency was calculated and compared among both groups. Sufficient serum vitamin D level was considered >30ng/ml. SPSS 23.0 version was used to analyze complete data. Results: In group I age was 28.4±8.55 years with mean BMI 24.08±1.18 kg/m2 and in group II age was 27.41±6.37 years with mean body mass index 23.12±4.42 kg/m2. Mean gestation age in group I was 33.12±9.42 weeks and in group II mean gestational age was 34.07±5.63 weeks. Mean parity in group I was 3.88±7.27 and in group II 4.01±4.14 was mean parity. We found 28 (46.7%) primigravida cases in I-group and 30 (50%) primigravida females in II-group. In group I 51(85%) patients had vitamin D deficiency and in group II 54 (90%) had deficiency of vitamin D. Among 51 deficient women of group I, number of severe deficiency (<10ng/ml) women were 8 (13.3%), deficiency (10-20ng/ml) were 13 (21.7%) and not-sufficient (20-30ng/ml) were 30 (50%) and in group II prevalence of severity (<10ng/ml) patients were 10 (16.7%), deficient cases (10-20ng/ml) were 15 (25%) and not-sufficient cases (20-30ng/ml) were 29 (48.3%). Deficient vitamin D serum levels were 15.01±1.22 in group I and 14.34±4.12 in group II. Conclusion: In this study we concluded that prevalence of vitamin D deficiency was highly among pregnant women and most probably in non-vaccinated pregnant patients but did not find any significantly difference among both groups. Keywords: Pregnancy, COVID-19, Vitamin D, Vaccination

Background: Short pregnancy interval after caesarean section increases the risks of morbidity, mortality and surgical interventions. This can be easily avoided by post placental insertion of IUCD during caesarean section. Immediate post placental IUCD insertion is defined as insertion of IUCD within 10 minutes of delivery of the placenta. It is a very promising an appealing approach as patient does not have to come for a separate postpartum visit. Objectives: To determine the outcome (safety, complications, failure and continuation rate) of post placental IUCD insertion during caesarean section. Materials and Methods: Our study was a prospective cross-sectional study, carried out in the Department of Obstetrics and gynecology at Qazi Hussain Ahmad Medical Complex, Nowshera. All the pregnant women willing for post placental intrauterine contraceptive device were included in the study. Women who had postpartum hemorrhage, chorioamnionitis, structurally malformed uterus and fibroid uterus were excluded from the study. Follow up visits were scheduled at one month, 3 months and 6 months. Results: 156 women were included in this study. Majority(35.2%) belonged to 31- 35 years age group. 46.7% of them were illiterate and 30.7% have just primary education. 40.38% of women belonged to low socio-economic group. 26.2% of women were para 4. 26.9% had previous 3 caesarean section. The most common adverse events during follow up of 6months were vaginal discharge, menstrual irregularities and pelvic pain. At the end of 6 months there were 9expulsions, 12 removals and 2 pregnancies with the gross cumulative expulsions, removal, failure and continuation rate of 5.7%, 7.6%, 1.28% and 85.2% respectively. The incidence of undescended strings at the end of 6 months was high (32.4%). Conclusion: Post placental intra uterine Copper T 380 A insertion is a safe, effective and easy reversible method of contraception with low expulsion and high continuation rates. Keywords: Intrauterine device,Intra-cesarean section, Post placental insertion