Objective: To determine the impact of leiomyoma in pregnant women a tertiary care set up in Hyderabad. Methods: This prospective observational study conducted at OPD of Gynecology unit-III, Liaquat University of Medical and Health Science Hyderabad, from June 2018 to December 2018. A total of 18,402 pregnant women of age 20-45 years were attended, out of which 195 had leiomyoma and they were asked to take part in study. Data regarding demographic characteristics including complications during pregnancy, and indications of caesarean section was collected via study proforma. Results: Total 186 out of 195 females were studied, their mean age was 31.23+3.12 years, average gestational age was 33.12+3.15 weeks and average size of Leiomyoma was 3.12+2.15cm. The most common complications were PPH among 28.49% of cases, blood transfusion was required in 39.25% of the cases, miscarriage occurred in 6.45% of the cases, cord prolapse was seen in 24.3% cases, placental abruption in 5.91% cases, placenta previa in 11.32% cases and retained placenta was observed among 1.61% of the cases. Preterm labour occurred in 5.38% of the cases and IUGR was seen in 10.22% of the cases. Out of all cases, 10 females underwent preterm delivery, while 12 underwent fetus delivery before 24 weeks (miscarriage). Among all term pregnancies, 78.66% underwent C-Section due to failure in progress, cord prolapsed, fibroid in lower segment, breech presentation and low-lying placenta. Conclusion: Fibroid complicates pregnancy itself and also the outcome. Rural area dwelling women are at more risk, which include increase in caesarean section and a multifold increased risk of PPH and associated hysterectomy in these cases. Keywords: Leiomyoma, Uterine Fibroids, Pregnancy, complications.

Objective: To determine the frequency of the second stage intervention and maternal outcome among those undergoing 2nd stage intervention (forceps versus vacuum) at Liaqat University hospital Hyderabad. Material and methods: This cross-sectional comparative study was conducted at the gynecology and obstetrics department of Liaquat University Hospital Hyderabad during one year from October 2014 to September 2015. Cases having a singleton pregnancy with cephalic presentation as per fresh fetal well-being ultrasound, gestational age 36 weeks or more, undergoing instrumental vaginal deliveries (vacuum or forceps) of either age or parity were included. The position of the head and pelvis and the status of the cervical dilatation were assessed. In the Labor Room, all instrumental forceps and vacuum-assisted deliveries were performed. The time of instrument application, the time of delivery, the type of instrument used, the number of pulls, the number of detachments in the case of ventouse, and the analgesia/anaesthetic provided were all recorded. The consultants who delivered the patient assessed the level of maternal trauma right away. Perineal tears, extension of episiotomy, ulceration of the vagina, cervical tears, and other maternal outcomes were measured. The data were entered and analyzed in the statistical program SPSS version 26.0. Results: During the study period, 2135 pregnant women were identified, with 265 receiving second-stage intervention (14.70%). These women were 27.84+5.13 years old on average. 52.83% women received ventouse/vacuum extraction and 47.16% received forceps assistance. The majority of females 73.58% were un booked. The interval decision-to-delivery was substantially shorter in patients of the forceps group than in the vacuum patient’s group (p-0.0001). Maternal trauma of soft tissues was the most common complication among 58 cases and out of them vaginal tears were significantly higher 18.4% in the Forcep group compared to vacuum group 7.14%, while cervical tear 4% in the Forcep group and 3.57% in the vacuum group and 3rd degree perineal in 8% of the Forcep group and 3.57% in the vacuum group. Findings regarding cervical tear, 3rd degree perineal, PPH, LSCS and other maternal complications were statistically insignificant according to both procedures (p->0.05). Conclusion: It was concluded from this study that maternal outcomes in assisted vaginal deliveries suggested that ventouse application is associated with less maternal complications than with forceps. The frequency of the second stage interventions was observed to be 14.70% and no adverse maternal outcomes were observed. Keywords: Vacuum extractor, Obstetric forceps, maternal morbidity