Background and objectivePre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women. MethodologyThis was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery's flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria. ResultsTwenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE. ConclusionAbnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Background: To compare the effectiveness of postpartum intrauterine contraceptive device (PPIUCD) with interval IUCD in terms of effectiveness, expulsions, bleeding pain and other complications at Tertiary care Hospital.Methods: Current study was conducted among 224 women, at Gynaecology and Obstetrics of Reproductive Health Services-A (RHS-A) Centre of Jinnah Post Graduate Medical center, Karachi, for a period of Six months. Approval from Ethical committee and informed consent was taken from women and her husband before starting the study. The WHO medical eligibility criteria for contraceptive use (MEC) were followed and IUCD was inserted in 112 women in PPIUCD group and in 112 women in interval IUCD group. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.Results: The two groups were identical in mean ± SD age, parity, residence and baseline hemoglobin level. PPIUCD (Group-A) was more effective i.e., 87.5% as compared to interval IUCD (Group-B) i.e., 83.9%. Pain, PID, bleeding and expulsion of IUCD were more prevalent with interval IUCD (Group-B) than PPIUCD (Group-A) patients. Stratified analysis showed that age, parity & mean baseline hemoglobin were non-significant effect modifiers on the effectiveness among the two groups.Conclusions: Postpartum IUCD use was found to be a safe, simple, inexpensive and reversible procedure with higher chances of retention for a longer period. Additionally, there is decreased risk of complications and lower expulsion rates when compared with interval IUCD.

Background: Adequate regulation of plant nutrients may constitute a promising approach to overcome the deleterious effects of salinity on plant growth and development. Among these nutrients, nitrogen (N) can be a stand out option to improve plant adaptation to saline environment. However, plant response to N under salinity stress may vary depending upon NH4 + : NO3 - ratio in the growth medium. Aims: The present study aimed to determine the efficiency of different NH4 + : NO3 - ratios for improving salt resistance of tomato under alkaline conditions. Methods: Experimental plan comprised of five NH4 + : NO3 - ratios 100:0, 75:25, 50:50, 25:75, and 0:100, and three salinity levels (no salinity, moderate salinity of 7 dS m−1, and high salinity of 10 dS m−1), with five replications. Plants were grown up to maturity and fruits were harvested for quality analysis. Results: NH4 + : NO3 - ratios produced a differential response in ameliorating salinity toxicity. Plant growth and fruit yield characteristics reduced with salinity but the extent of reduction varied significantly with NH4 + : NO3 - ratio under both salinity levels compared to respective NH4 + : NO3 - ratio without salinity. Physiological characteristics viz. chlorophyll, photosynthesis, malondialdehyde, glutathione, electrolyte leakage and relative water content were also got optimized in favor of the high plant growth and yield by NH4 + : NO3 - ratio of 50:50 under salinity stress. Among different NH4 + : NO3 - ratios, 50:50 had greater potential not only to reduce Na+ and Cl− but also to promote N, K+, and Ca2+ accumulation in roots, shoots, and fruits, and thus gave more protection against the deleterious effects of salinity. Fruit quality characteristics improved with salinity, except for vitamin C. Shoot N correlated positively with photosynthesis (R2 = 0.94) and fruit yield (R2 = 0.98). Conclusions: Overall, NH4 + : NO3 - ratios ranked in order of 50:50 > 0:100 > 25:75 > 75:25 > 100:0 to regulate the growth, yield and physiological characteristics of tomato under salinity stress, however best fruit quality characteristics were recorded in 100:0 NH4 + : NO3 - ratio.

IntroductionInduction of labor (IOL) is characterized by stimulating contractions of the uterus just before the instantaneous onset of labor, with or without amniotomy. According to the recommendation of the World Health Organization (WHO), induction must only be carried out when there is a clear medical need for one and when potential benefits outweigh the expected harm that may be caused by it. The present study was to determine the frequency of fetomaternal outcomes among pregnant women subject to the induction of labor. MethodsThe present prospective cross-sectional study was conducted over a period of one year starting from June 17, 2018, to July 25, 2019, in the Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi. After institutional ethical committee approval, 302 pregnant women who were subject to induction of labor were enrolled using a non-probability consecutive sampling technique. Outcome variables, i.e., postpartum hemorrhage, mode of delivery, hospital stay more than seven days, birth asphyxia, Apgar score < 7 at five minutes, neonatal jaundice, and low birth weight were noted. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY) was used for data analysis. ResultsA total of 302 women with an average age range was 18-45 years with a mean age of 28.5 ± 4.47, body mass index (BMI) 29.83 ± 3.83, and mean gestational age was 37 ± 4.3. Almost 205 (67.9%) of the cases were booked. One hundred and eighty (59.6%) were nulliparas, 57(18.8%) had para-1, 43 (14.4%) had para-2, and 22 (7.14%) had par-3. When fetomaternal outcome among the pregnant women subject to induction of labor was observed, postpartum hemorrhage was observed in 55 (18.21%), hospital stay more than seven days was in 51 (17%), birth asphyxia was in 45 (14.9%), neonatal jaundice was in 53 (17.6%), low birth weight was in 15 (4.96%), Apgar score < 7 was in 48 (16%), 39 (13%) women underwent for C-section and 263 (87%) of the women delivered vaginally. ConclusionThis study concludes that the induction of labor (IOL) is safe and reliable and less risk of adverse fetomaternal outcome is associated with pregnancies between 37 weeks and 42 weeks of gestation. The evidence regarding IOL prior to 37 weeks and beyond 42 weeks of gestation is inadequate to reach any conclusion.

Objectives: To determine the frequency of preterm labour in association with interpregnancy interval among pregnant women visiting tertiary care Hospital. Subject and Methods: This prospective cross-sectional study was performed at Unit-I, Obstetrics and Gynaecology Department, Civil Hospital Karachi; from June to November 2020. A total of 190 women with singleton pregnancy confirmed by ultrasound were included. After taking detailed medical history regarding previous fetal death and C-section was recorded either patient goes into preterm labour or not and confirmed by history for short and prolong interpregnancy interval (IPI). Data was collected by pre-designed study proforma. Results: The average age of study subjects was 26.27±4.07 years. The frequency of preterm labour among the pregnant women was 51.05%. The rate of preterm was significantly higher in those women who had with short inter interpregnancy interval (p=0.0005). Conclusion: Our findings clearly show that a short interval in inter-pregnancy is a cause of premature birth. Preterm birth can also be indicated by the antenatal care visits, inter-pregnancy complications, and having a birth defect. Premature birth minimization can enhance overall newborn's health and can lead to considerable minimization of neonatal death in the future. Keywords: Preterm labor, prolong pregnancy interval, neonatal health