Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded. Results: During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04). Conclusion: PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome. (

ABSTRACT Objective: To assess the experience (during and post procedure) of women after immediate postpartum and post placental Insertion of intrauterine contraceptive device (IUCD), a long acting reversible contraceptive (LARC). Methods: This prospective and longitudinal study was conducted during February 2019 to September 2019 in Gynae and Obstetrics department Unit 1 at Abbasi Shaheed Hospital. All 141 booked and non-booked patients who delivered in the hospital and received immediate postpartum intrauterine contraceptive device (PPIUCD),either post placental, intra cesarean or within 48 hours after delivery were included in the study regardless of the mode of delivery either intra-cesarean or spontaneous vaginal delivery. Written consent was taken for the contraceptive device insertion and verbal consent was taken to fill the proforma which included basic demographic information, their overall experience with postpartum intrauterine contraceptive device. Immediate experience was measured by assessing the pain during procedure and post insertion period. Further all participants were followed at six weeks and 6 months to collect information about any complains removal of IUCD and overall experience. Results: The mean age was 27.3 years with a standard deviation (SD) of 4.42. Among all the participants, 77(54.6%) had Cesarean section and 64(45.4%) had vaginal delivery. During procedure only 5(3.5%) had complain of mild pain and no immediate post procedural complains was recorded.  86(73.5%) participants at 6 weeks and 78(69.03%) participants at 6 months had no complained. Overall experience was found satisfactory in 86(73.5%) participants. Conclusion: Postpartum intrauterine contraceptive device (PPIUCD) provided satisfactory experience to majority of the women. So we recommend its use for better maternal and child health.

Among the most frequent gynecological operations conducted is the hysterectomy. Objective: To determine the outcome of TLH in benign uterine pathology of up to 12-week size uterus. Methods: It was a prospective case series carried out at Obstetrics and Gynecology department of Memon medical institute hospital, Karachi from January 2019 to January 2021. All patients who underwent laparoscopic hysterectomy secondary to benign utero- ovarian pathology were consecutively enrolled. Demographic characteristics of the patients along with the presence of co-morbidities, hospital admission details, surgical procedure and intra and post-operative complications were noted. The surgery performed with similar technique in all cases. If patients were deemed to be fit for release after 48 hours following surgery, they were discharged. The postoperative follow-ups were performed at 10th, 30th, and 3 months. Results: Of 50 patients, the mean age was 50.5 years. The main indication of hysterectomy is adenomyosis diagnosed in 20 patients. There were 4 laparoscopic assisted vaginal hysterectomies and 46 were total laparoscopic hysterectomies. History of previous laparotomies was observed in 12, previous cesarean and bilateral tubal ligation in 6 each, history of mesh repair of umbilical hernia in 4 while history of VP shunt was observed in 2 patients. Eight patients converted into laparotomy due to technical difficulty in controlling hemorrhage of uterine artery. Total rate of intra and post-operative complications was 40%. Conclusion: Laparoscopic approach for hysterectomy is a safe alternative to conventional hysterectomy for benign uterine pathology of up to 12 weeks size uterus.

Aim: Literature reports are conflicting regarding the association of anomalies with misoprostol use. We conducted this study to assess the association of misoprostol with congenital abnormalities. Materials and methods: In this prospective case-control study, women with early pregnancy were recruited from the antenatal clinic and divided into cases and controls on the basis of exposure to misoprostol. They attended antenatal visits, delivered at the hospital, and their babies were examined for abnormalities before discharge. Results: There were 22 (9.2%) babies with abnormalities in the misoprostol group and 16 (6.2%) abnormalities in controls (p = 0.208). When stratified according to the type of exposure to misoprostol, abnormalities were significantly higher in those with intended exposure than in accidental exposure (12.3 vs 3.5%, p = 0.023). Misoprostol exposure was not significantly associated with abnormalities. Controls were less likely to have abnormalities than those with misoprostol exposure, but this did not remain significant after all cofounders were added to the model. Conclusion: Exposure to misoprostol leads to more congenital abnormalities. However, chances of having a baby with an abnormality are not significantly increased with misoprostol exposure when all other risk factors are controlled for. These findings may aid clinicians in reassuring low-risk women with accidental exposure in early pregnancy. Clinical significance: Women with accidental exposure to misoprostol are less likely to have congenital abnormalities than those with voluntary exposure because they were found to ingest a lesser amount of the drug.