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 ...

Introduction: Poly Cystic Ovarian Disease (PCOD) is probably one of the most commonendocrinological disorders amongst the women during their reproductive years. Using USG criteria only 20-33% ofapparently healthy women in childbearing period, have been found to have PCOD in population study. Whereasprevalence of 4-10% in women of reproductive age is commonly reported when the diagnosis is based on clinical,biochemical and US scan features. Objective:-Diagnosis and management of polycystic ovarian disease. Setting SeyalMedical Centre, Multan. Duration From January 2002 to December 2003. Material and Methods: Sample size: 200patients. Results: Most of he patients were in the age group of 21-30 years. The youngest patient was of 17 years andeldest was of 42 years. Majority of the women were nulliparous or of low parity comprising 92% of cases. Thecommonest symptom was menstrual disorder in 168 Patients (84%). Ultrasound is very helpful for diagnosis of POD.About 80% of patients were diagnosed as PCOD on ultrasound. There is increased level of LH in 72% patients, 8%have raised prolactin levels. All patients were first treated with clomiphene citrate while surgical treatment is done inonly 30% of cases. GnRH analogue and purified FSH were not used because they are quite expensive. Conclusion:PCOD is found to be one of the commonest problem in reproductive years of life. Clomiphene citrate is first linetreatment in PCOD for infertility. Laparoscopic drilling has very good results especially in clomiphene resistant cases.

Objectives: To correlate preoperative diagnosis with operative findingsregarding the type of ovarian tumours. Material and Methods: Setting: Gynaecology Unit-I, Nishtar Hospital, Multan.Sample size: 50 patients. Duration: One year from October 2001 to October 2002. Study Design: A prospectiveanalytical study. Results: Most common age group in benign tumours was 20-40 years. 50% of patients with malignanttumours were between 30-50 years. Out of 50 patients, 33.3% benign tumours were in unmarried girls. Only 5% ofcancers were in nullipara, while 80% of patients had two or more children. Most common presenting symptom wasabdominal/pelvic pain. Abdominal distension was present in 75% of malignant cases. Pressure effects, metastaticsymptoms and general symptoms were more frequently seen in malignant than benign cases. On ultrasonography,benign tumours were cystic in 83.3% of patients and 46% of these cystic tumours had either internal septations orechoes. 85% of malignant tumours were either solid or mixed. Ascites was detected in 60% of cancers. Abdominalascites was found in 75% of malignant cases intra-operatively. Irregular tumours and those with surface adhesionswere more likely to be malignant. The accuracy of preoperative diagnosis was found to be 84%, 5 cases initiallyconsidered malignant were later on found to be benign, while 3 cases diagnosed as benign preoperatively provedmalignant. Out of 50 cases, 46 (92%) cases were diagnosed as epithelial cell tumour on histopathology, while 4 cases(8%) were germ cell tumours. Conclusion: It was concluded that identification of risk factors, detailed enquiry of thepresenting symptoms and proper clinical examination of the tumour provide important information about the type ofovarian tumour. Ultrasonography is the best preoperative technique available to differentiate benign from malignantovarian tumours.

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Objective: To compare the effects of epidural analgesia and parenteral nalbuphine in labouring women with term pregnancieson feto-maternal outcome. Study Design: Randomized controlled trial Setting: It was carried out in the Labour Room, Nishtar Hospital, MultanPeriod: From June 2009 to December 2009. Material and methods: A total of 60 patients were included in the study. Patients were divided intotwo groups, having 30 patients in each group. Results: In group-A, pain control was much better and satisfactory (VAS=00-1), duration of labourwas slightly prolonged and instrumental delivery was more common. Low Apgar score and birth asphyxia were seen in group-B. No babydeveloped RDS in both groups. Conclusions: Feto-maternal outcome is much better in women having epidural analgesia with bupivacaine ascompared to women having intramascular nalbuphine.