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Objectives: To determine the frequency of common hematological abnormalities in patients with malaria. Study Design: A cross-sectional study. Place and Duration of the Study: Department of Medicine, Saidu Teaching Hospital, Swat Pakistan from November 2019 to May 2020. Material and Methods: A total of 137 patients of both genders aged between 18-60 years and who presented with malaria in emergency or outpatient department were analyzed. Ten cc blood was taken from all enrolled patients and sent to institutional laboratory for the detection of anemia, thrombocytopenia, leucopenia and disseminated intravascular coagulation (DIC). Frequency of common hematological abnormalities among patients of malaria was noted. For data analysis, SPSS version 26.0 was used. Results: In a total of 137 patients, 95 (69.3%) were male and 42 (30.7%) female. Overall, mean age was 29.2±13.18 while 84 (61.3%) patients were aged between 18 to 30 years. Mean duration of disease was 1.2±1.09 weeks while 89 (65.0%) patients had duration of disease <1 week. Table-1 is showing baseline characteristics of all patients. Anemia was found in 121(88.3%) patients, thrombocytopenia in 67(48.9%), leucopenia in 20 (14.6%) and 35 (25.5%) had DIC. Conclusion: The frequency of hematological abnormalities in patients with malaria was high. Anemia was found in 88.3% malaria cases, thrombocytopenia 48.9%, leukopenia 14.6% and DIC 25.5%. Keywords: Anemia, Leukopenia, malaria, thrombocytopenia.

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Objectives: To determine frequency of fetal iron deficiency anemia at the time of birth in obese mothers. Study Design: Cross-sectional Descriptive study. Setting: Department of Obstetrics and Gynecology, Nishtar Hospital Multan. Period: September 2018 to February 2019. Material & Methods: A total of 368 obese pregnant women with singleton pregnancy between 37 -40 weeks of gestation were included in the study after informed consent. Cord blood was collected after delivery via syringe aspiration from the umbilical vein. Fetal Iron status in the form of serum iron, hemoglobin, transferrin saturation was measured with calorimetric endpoint assay. Obesity in pregnancy is defined as BMI equal and more than 30kg/m2. Fetal iron deficiency anemia was defined as fetal hemoglobin less than 14.5g/dl, fetal iron 97.3micro gram/dl and transferrin saturation 39.6% at birth. Results: Among 368 cases, 87.8% of cases were having their BMI 30kg/m2 to 34.9kg/m2. BMI between35kg/m2 to 39.9kg/m2 was noted in 10% of cases and in 2.2% of cases BMI was equal to or more than 40kg/m2. Frequency of neonatal iron deficiency anemia was 22.8%. Conclusion: There is a increase prevalence of obesity in women of childbearing age however maternal obesity has no significant correlation of fetal iron deficiency anemia.

Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m2 and in Group (B) it was 26.361 ±4.33 kg/m2. In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.

Objective: To determine the association of meconium stained amniotic fluid with puerperal pyrexia. Study Design: Cohort Study. Setting: Department of Obstetrics & Gynecology, Nishtar Hospital, Multan. Period: 1st January 2018 to 31st December 2018. Material & Methods: A total of 66 women with singleton pregnancy, gestational age 37-40 weeks of any parity undergoing elective caesarean section were eligible for study. Patients with rupture of membranes (≥18 hours), preterm delivery and postdate pregnancy were excluded. During elective caesarean section, after rupture of membranes, women were divided in two equal groups. Thirty three patients with meconium stained liquor group (MSAF) and 33 patients with clear liquor group. Puerperal pyrexia was defined as temperature of ³ 38°C on any two occasions was reported during first ten days postpartum excluding first 24 hours. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p £ 0.05 as significant. Results: Age range in this study was from 15 to 45 years with mean age 15 to 45 years with mean of 29.5± 2.5 years in MSAF group while 28.5 ± 3.5 years in clear liqour group. Mean gestational age was 39.1±1.0 weeks in MSAF group while 38.5±1.10 weeks. Puerperal pyrexia was seen in 45.5% patients in MSAF group as compare to 10% in clear liqour group (p=0.005). Conclusion: There is strong correlation between meconium stained amniotic fluid and postpartum febrile illness.

Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: From12-May-2017 to 11-May-2018. Material & Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m2. Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications.

Objective: To determine the frequency of anemia and its causative risk factors in patients attending the gynecology outpatient department of Nishtar Medical University and Hospital. Study Design: Cross sectional study. Setting: Gynecology Outpatient Department attendees of Nishtar Medical University and Hospital. Period: 1st September to 31st December 2019. Material & Methods: Total 361 females between 19-49 years of age were enrolled and included those patients who consented to be tested for blood hemoglobin estimation. Their brief history was taken after proper consent according to predesigned proforma to rule out the risk factors. Patients with chronic kidney disease, chronic lung diseases and liver diseases were excluded. Blood test was done by obtaining the blood sample by finger prick method. Hemoglobin analysis was performed by portable Hemocueanalyser. Frequency of anemia, severity of anemia and their stratification was performed against the risk factors like age, educational status, socioeconomic status, status of pregnancy, parity and contraception were obtained to rule the causative factors. Anemia was defined per standard criteria as hemoglobin less than 11gm/dl. Results:  Majority of patients 65% were between 19-35 years of age and 34% were 36-49years of age. Frequency of pregnant patients and non-pregnant patients was 63.4% and 36.6%.  Frequency of anemia was 56.8%, mean hemoglobin 10.48±1.18 with mild, moderate and severe anemia were 36.8%, 17.2% and 2.8%. Majority of females 82.9%, never went to school and had primary education, 71.70% belong to very poor and poor socioeconomic status, 79.02% were multipara and 81.95% never and infrequently practiced the contraceptive methods. Conclusion:  Frequency of anemia is very high in females presenting to tertiary care hospital being more common in younger age group. Frequent pregnancies, poor socioeconomic status and low level of educational attainment were the major determinants of anemia in females.