Mean Gestational Age In Group Research Articles

MANUAL VACUUM ASPIRATOR (MVA)- A SAFE AND EFFECTIVE ALTERNATIVE TO CONVENTIONAL CURETTAGE IN THE SURGICAL MANAGEMENT OF 1ST TRIMESTER MISCARRIAGES

Objective: To compare the efficacy of manual vacuum aspiration and conventional evacuation & curettage (ENC) for first-trimester miscarriage management. Materials and Methods: This quasi-experimental study was carried out at the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from October 2022 to March 2023 including 150 patients with first trimester miscarriage dividing them into two groups (MVA and ENC) having equal number of patients. Efficacy in both groups was compared. Results: The mean age in the MVA group (group A) was 27.81±6.31years while in the ENC group (group B) it was 26.50±6.27 years. The mean gestational age in group A was 5.82±2.82 weeks while in group B it was 5.95±2.9 weeks. MVA was effective in 88% of participants while ENC was effective in 93.33% of participants (p-value, 261), which is not statistically significant. Conclusion: Surgical uterine evacuation utilizing MVA under local anesthetic is safe and successful, and it should be considered to minimize a lengthy hospital stay. MVA can be a viable alternative to surgical curettage like ENC. It is safe, cost-effective, and simple to conduct, eliminating general anesthetic, the requirement for theatre access, and an unnecessary hospital stay. Keywords: Manual Vacuum Aspiration, Evacuation, Curettage, miscarriage, efficacy.

Comparison of the Frequency of Neonatal Anemia in Early Versus Delayed Cord Clamping in Babies at Term

Aim: To compare frequency of the anemia in neonates in early versus delayed umbilical cordclamping in term infants. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics & Gynecology, Divisional Headquarters Hospital Mirpur AJK from 30th January 2021 to 29th July 2021. Methodology: The study enrolled 96infants which were delivered at term within the gestational range of 37-41 weeks (as assessed on LMP). Those infants who were born to diabetic, sepsis mother or with inborn metabolic errors, jaundice neonatorum or Rh incompatibility and PROM were excluded from the study. Then selected women were placed randomly into two equal groups i.e. Group A (early cord clamping) & Group B(delayed cord clamping) by lottery method. Respective group selection was performed through randomization. In group a neonates, early cord clamping (cord clamping within 15 seconds of birth) was done while in group B neonates, delayed cord clamping (cord clamping after 3 minutes of birth) was done. In both groups, blood sample of all infants was sent after 6 hours of birth for hematocrit level measurement and neonatal anemia was noted. Results: The mean age in years of patients in group A was calculated as 26.52±5.17 while in group B it was calculated as 27.17±3.89. The age of 80.21% patients was within 18 to 30 years and the mean gestational age was determined as 39.23±1.48 weeks. The mean gestational age in group A was 39.25±1.48 weeks and in group B was 39.21±1.49 weeks. Frequency of neonatal anemia in group A (early cord clamp) versus group B (delayed umbilical cord clamping) was 11 (22.92%) and 04 (8.33%) respectively with p-value of 0.049. Practical Implication: we recommend that delayed umbilical cord clamping should be preferred in our routine practice for prevention of neonatal anemia. Conclusion: This study concluded that the neonatal anemia is high after early cord clamping in infants at term as compared to delayed cord clamping Keywords: Cord Clamping, Delayed, Anemia.

Comparison of Outcome in Patients Undergoing Cesarean Section with Wound infiltration with Local Anesthetic Versus Narcotic Analgesia

Objective: To compare the outcome of wound infiltration plus local anesthetic agent versus narcotic analgesia in females undergoing cesarean section Material & Methods: This was a comparative study and study place and period was Unit 3, Department of Obstetrics & Gynecology, Services hospital, Lahore from july 2016 to January 2017. Patients were segregated into two groups. Group A was bupivacaine group. Group B was control group. During the immediate postpartum period, a 100mg dose of intravenous tramadol was administered. Patients were transferred to the postoperative wards and were monitored there for duration of 24 hours. During the next 24 hours patients were asked for pain >4 on VAS and tramadol was given. After 24 hours, pain score was measured. Results: The average age of patients was 26.98±4.87 years, with the mean gestational age in group A being 39.52±1.14 weeks and in group B being 39.62±1.14 weeks. The mean tramadol consumption was 74.53±13.21mg. A significant difference was observed between the study groups in terms of tramadol consumption, with a p- value of 0.000. Conclusion: The patients undergoing caesarean section with wound infiltration with local anesthetic agent showed significantly less tramadol consumption as compared to narcotic analgesia

Association of adolescence pregnancy and adverse pregnancy outcome.

Objective: To determine the association of adolescence pregnancy and adverse pregnancy outcome. Study Design: Prospective Cohort study. Setting: Department of Gynae and Obs, HBS General Hospital Islamabad. Period: June-2018 to April-2019. Material & Methods: A total of 226 pregnant females with singleton pregnancy of 20-24 weeks gestational age and 16 to 30 years of age were included in the study. Patients with known diabetics, h/o chronic hypertension, known smoker and any renal disease etc. were excluded. Women included were divided into two groups. All women between 16-20 years of age were included in adolescence group (group A) and age >20-30 years in adult group (group B). All patients were followed till delivery and outcome variables like adverse pregnancy outcome in terms of preeclampsia and small for gestational age infants were noted. Results: The mean age of women in group A was 18.15 ± 0.79 years and in group B was 25.42 ± 2.08 years. The mean gestational age in group A was 21.54 ± 1.46 weeks and in group B was 21.98 ± 1.07 weeks. Frequency of small for gestational age infants in adolescence group was 7.96% while in adult group was 1.76% with p-value of 0.030 and relative risk of 4.5 which is significant. Frequency of pre-eclampsia in adolescence group was 21.24% while in adult group was 4.42% with p-value of 0.000 and relative risk of 4.8 which is significant. Conclusion: This study concluded that the frequency of pre-eclampsia and small for gestational age infants in adolescence pregnancy is higher compared to adult pregnancy which shows adolescence pregnancy as a risk factor for pre-eclampsia and small for gestational age infants.

Comparison of efficacy in terms of prevention of preeclampsia in patients with calcium intake versus without calcium intake

Objective: To compare the efficacy in term of prevention of preeclampsia in patients with calcium intake versus without calcium intake Materials & Methods: Between April 2021 to October 2021, total 212 Women between 18-35 years of age, having 20 weeks of gestation assessed on LMP, normal blood pressure, no peripheral edema and no proteinuria, women with singleton pregnancy and patients upto para-5 were selected from Department of Obstetrics & Gynecology, MMC General Hospital Peshawar for this randomized controlled trial. Calcium was given to group A while group B was given only routine food. Prevention of preeclampsia in patients with calcium intake versus without calcium intake was assessed. Results: In group A (calcium intake group) & B (without calcium intake group) mean age was 23.15 ± 6.68 years and 23.41 ± 6.05 years respectively. The mean gestational age in group A was 34.71 ± 4.73 weeks and in group B was 33.42 ± 4.83 weeks. There was development of pre-eclampsia in 07 (6.60%) patients and no pre-eclampsia in 99 (93.40%) patients in Group A, in Group B, it was noted in 19 (17.92%) and 87 (82.08%) patients respectively (p=0.012). Conclusion: This study concluded that calcium intake during pregnancy is associated with higher efficacy in preventing pre-eclampsia compared to those without calcium intake. Keywords: Calcium supplementation, proteinuria, high blood pressure.

Comparison of the Efficacy (In Terms of No Pain) of Continuous and Interrupted Suturing in Episiotomy Repair

Objective: To compare the efficacy (in terms of no pain) of continuous and interrupted suturing in episiotomy repair. Materials & Methods: This randomized controlled trial was done at department of Obstetrics & Gynaecology, Civil Hospital, Bahawalpur during a period of six months from 7th November 2019 to 6th May 2020. Women with singleton pregnancy women who underwent episiotomy to facilitate the delivery of the head in the labour room, 20 to 40 years of age were included. Group 1 included the women in which continuous suturing was done while group 2 included the cases in which interrupted suturing was done. In both groups, episiotomy repair was done by the researcher herself. All patients were advised Tab. Diclofenac sodium 50mg 1xBD post-operatively and efficacy was noted after 48 hours by VAS scale. Results: The mean age of women in group 2 was 27.48 ± 3.59 years and in group 1 was 27.36 ± 3.52 years. Majority of the patients 75 (75.0%) were between 20 and 30 years of age. The mean gestational age of group 2 was 39.48 ± 1.27 weeks and in group 1 was 39.38 ± 1.28 weeks. Efficacy (in terms of no pain) was seen in 18 (36.0%) patients in Group 2 (interrupted group) while in Group 1 (continuous), it was seen in 36 (72.0%) patients with p-value of 0.0001. Conclusion: continuous suturing of episiotomy repair was observed to be the most effective in terms of significant less post-operative pain compared to interrupted suturing. Keywords: Episiotomy, continuous suturing, perineal pain

Can Expectant Management Gives Better Outcome than Immediate Delivery in Females Presenting with Preterm Premature Rupture of Membrane Close to Term

Objective: To compare the outcome of expectant management versus immediate delivery in females with preterm premature rupture of membrane close to term. Study Design: Randomized controlled trial Place and Duration of Study: Department of Obstetrics & Gynaecology Unit III, Fatima Memorial Hospital Lahore from 20th June 2018 to 20th December 2018 Methodology: Three hundred females were included through emergency. They were divided in two groups; females of group A managed conservatively and females of group B were induced for delivery and immediate delivery was conducted. After delivery in both groups, outcome was recorded i.e. neonatal distress, poor Apgar score or NICU admission. Results: The mean age of group A was 27.53±4.99 years and group B was 25.81±4.92 years. The mean gestational age of group A was 33.92±1.41 weeks and group B was 33.88±1.40 weeks. In group A there were 28 (18.7%) women with parity 1, 40(26.7%) with parity 2, 42 (28%) with parity 3 and 40 (26.7%) with parity 4 whereas in group B there were 28(18.7%) women with parity 1, 40 (26.7%) with parity 2, 42 (28%) with parity 3 and 40 (26.7%) with parity 4. In group A there were 54 (36%) women with normal BMI, 44 (29.9%) were overweight and 52 (34.7%) were obese while in group B there were 63 (42%) women with normal BMI, 38 (25.3%) were overweight and 49 (32.7%) were obese. There was no significant (P=0.329) association between neonatal distress and study groups and also no significant (P=0.202) association between poor APGAR score and study groups. Conclusion: Incidence and rate of neonatal distress in complicated pregnancies by PPROM within 34 and 37 weeks of gestation is very low Keywords: Delivery, Preterm, Premature, Rupture of membrane, Term, Outcome, Expectant, Management

Role of Manual Vacuum Aspiration Versus Sublingual Misoprotol in First Trimester Miscarriage in a Tertiary Care Hospital PMC, Nawabshah

Objective: To compare the efficacy of manual vacuum aspiration versus sublingual misoprostol in first trimester miscarriage at people's medical college hospital Nawabshah. Study Design: Randomized Controlled Trial. Settings: Department of Gynaecology and Obstetrics, Peoples Medical University & Hospital Nawabshah. Duration of Study: 7th April 2021 to 6th October 2021. Materials & Methods: A total of 100women with first trimester incomplete abortion, 18 to 45 years of age were included. Patients having allergy to misoprostol or other prostaglandins, contraindication to prostaglandin therapy (asthma, hypertension, glaucoma) and suspected ectopic pregnancy assess on ultrasound were excluded. Group A received a single dose of 600 microgram of sublingual misoprostol every three hours and group B who underwent MVA for evacuation of retained products of conception. Efficacy was noted. Results: The mean age of women in group B was 30.14 ± 4.12 years and in group A was 30.20 ± 3.69 years. Majority of the patients 51 (51.0%) were between 18 to 30 years of age. The mean gestational age in group B was 7.92 ± 2.42 weeks and in group A was 7.48 ± 2.32 weeks. In this study, success was seen in 46 (92.0%) women in group B (manual vacuum aspiration) and 37 (74.0%) women in group A (sublingual misoprostol) with p-value of 0.017. Conclusion: This studyconcluded that manual vacuum aspiration (MVA) is effective and safe procedure as compared to sublingual misoprostol in first trimester incomplete abortion. Keywords: first trimester incomplete abortion, manual vacuum aspiration, misoprostol

Efficacy of oral versus vaginal misoprostol in the management of first trimester incomplete miscarriage.

Objective: To compare the efficacy of oral versus vaginal misoprostol in first trimester incomplete miscarriage. Study Design: Cross-sectional study. Setting: Gynae B Unit of Lady Reading Hospital, Peshawar. Period: November 2017 to January 2018. Material & Methods: In this study 274 patients (i.e. 137 in each group) with incomplete miscarriage, who have gestational age of less than or equal to 12 weeks were included by convenience sampling. Women in group A had received 800 microgram oral misoprostol and women in group B had received 800 microgram vaginal misoprostol. In both groups same dose was repeated 4 hours after initial dose if the patient had not passed the product of conception. Patient who had no products of conception on pelvic ultrasound or Transvaginal scan were discharged from hospital. On the other hand patients found to still have products of conception were managed by surgical evacuation on next day. Results: In Group A (oral misoprostol) was effective in n=115 (84%) patients and ineffective in n=22(16%) patients and Group B (vaginal misoprostol) was effective in n= 125(91%) patients and ineffective in n=12(9%) patients. No significant difference was found between the efficacies of the two routes. Age distribution among two groups was analyzed as in Group A mean age was 23.9±3.7 years while in Group B it was 23.7±3.9 years. Mean gestational age in group A was 68.8±1.6 days and in group B was 68.7±1.3 days. Insignificant difference was found when the age and gestational age of the patients of group A and B were compared. Conclusion: Vaginal misoprostol is equally effective as oral misoprostol in terms of expulsion of products of conception in patients with incomplete miscarriage.

Correlation of HMGB1, PON-1, MCP-1, and Periodontal P. gingivalis with Amniotic Fluid Fecal Dye.

Background This paper aims to investigate the correlation between high mobility group protein-1 (HMG-b1), antioxidant enzyme-1 (paraoxon-1, PON-1), monocyte chemoattractant protein-1 (monocyte chemoattractant protein-1, MCP-1), P. gingivalis, and MSAF. Materials and Methods The total sample size comprised of 73 cases in both groups. These patients were further subdivided into 2 groups: the MSAF group and the control group. 38 women were in the MSAF group and 35 women with term amniotic fluid serum were in the control group. The MSAF group was selected as a full-term singleton amniotic fluid fecal infection group. Clinical data were collected, and specimens were collected. Fecal staining of amniotic fluid and full-term amniotic fluid removes the placenta and umbilical cord blood. The expression of HMGB1 in the placenta was observed by immune-histochemical staining of MSAF and control groups. The content of PON-1 in cord blood was determined by ELISA. Results Correlation between maternal and neonatal clinical data and MSAF was done; MSAF group mean gestational age was 41.38 ± 1.40 weeks; control group mean gestational age was 39.20 ± 1.24 weeks. This study found no correlation between the birth weight, maternal age, sex, first/transmaternal, hyperthyroidism, hypothyroidism, and anemia between the MSAF and control group with nonsignificant P value (P > 0.05). However, the fatal age, gestational diabetes, gestational hypertension, umbilical cord abnormalities, placental abnormalities, and neonatal asphyxia factors were statistically different with a significant P value of <0.05 between both groups. HMGB1 and Periodontal P. gingivalis are mostly expressed in placental trophoblast, vascular endothelial cells, and amniotic epithelial and interstitial cells. After HE staining of 72 placentas by HE in MSAF and control, 6 had acute chorioamnionitis (5.1 control), 32 had chronic (23.9), 35 had abnormal placentas, and three in MSAF had chorionic columnar metaplasia. In immune-histochemistry experiments, the HMGB1 expression intensity of placental tissue was higher in the MSAF group (P < 0.05); however, the level of PON-1 was lower in the MSAF group as compared to the controls (P < 0.05). Conclusions Gestational age and placental abnormalities are clinical high-risk factors for MSAF. HMGB1, PON-1, MCP-1, and Periodontal P. gingivalis may be involved in the development of MSAF, suggesting an oxidative/antioxidant imbalance with inflammation, and may be one of the mechanisms for MSAF development.

Efficacy And Safety of Nifuratel-Nystatin in The Treatment of Mixed Vaginitis, in Pregnant Women From Quindío, 2013-2017. Randomized Clinical Trial

Introduction: Women with abnormal vaginal discharge usually suffer from bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonas vaginitis (TV) or any combination of these. Objective: To compare the efficacy and safety of the combination nifuratel-nystatin with metronidazole -nystatin in the treatment of mixed vaginitis in pregnant women, and its adverse effects. Materials and methods: Randomized, double-blind, parallel-group clinical trial in 153 pregnant women, diagnosed with mixed vaginitis; in a complex private medical institution in Armenia (Colombia), between 2013 and 2017. The patients were randomized 1:1 to receive a daily intravginal egg for six days: nifuratel (500mg) - nystatin (200,000 IU) (Group "A") and metronidazole (500mg) - nystatin (100,000 IU) (Group "B"). A follow-up of the healing of symptoms was determined at one week and an evaluation of the microbiological negativization at one month. Safety was assessed based on reports of adverse events. Descriptive statistics were used. Results: The mean age of the population was 27.59±3.71 years. The mean gestational age in group "A" was 18.56±2.87 weeks compared to 19.57±2.95 weeks in group "B" (p=0.87). The clinical cure rates at 7 days in group "A" were 84.61% vs. 81.33% in group "B", (p=0.91) The microbiological negativization at one month was 91.02% in group "A" vs. 86.66% in group "B", (p=0,072) The recurrence rate was 1.28% in group "A" vs. 5.33% in group "B", (p=0.37) Adverse events were present in the metronidazole-nystatin group, which were mild and self-limited. Conclusion: Both drugs have comparable efficacy and similar safety results in the treatment of mixed vaginitis in pregnant women; therefore, they can be used interchangeably. Studies in larger populations with a control group and random assignment are required to provide better evidence regarding this management.

Efficacy And Safety of Nifuratel-Nystatin in The Treatment of Mixed Vaginitis, in Pregnant Women From Quindío, 2013-2017. Randomized Clinical Trial

Introduction: Women with abnormal vaginal discharge usually suffer from bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonas vaginitis (TV) or any combination of these. Objective: To compare the efficacy and safety of the combination nifuratel-nystatin with metronidazole -nystatin in the treatment of mixed vaginitis in pregnant women, and its adverse effects. Materials and methods: Randomized, double-blind, parallel-group clinical trial in 153 pregnant women, diagnosed with mixed vaginitis; in a complex private medical institution in Armenia (Colombia), between 2013 and 2017. The patients were randomized 1:1 to receive a daily intravginal egg for six days: nifuratel (500mg) - nystatin (200,000 IU) (Group "A") and metronidazole (500mg) - nystatin (100,000 IU) (Group "B"). A follow-up of the healing of symptoms was determined at one week and an evaluation of the microbiological negativization at one month. Safety was assessed based on reports of adverse events. Descriptive statistics were used. Results: The mean age of the population was 27.59±3.71 years. The mean gestational age in group "A" was 18.56±2.87 weeks compared to 19.57±2.95 weeks in group "B" (p=0.87). The clinical cure rates at 7 days in group "A" were 84.61% vs. 81.33% in group "B", (p=0.91) The microbiological negativization at one month was 91.02% in group "A" vs. 86.66% in group "B", (p=0,072) The recurrence rate was 1.28% in group "A" vs. 5.33% in group "B", (p=0.37) Adverse events were present in the metronidazole-nystatin group, which were mild and self-limited. Conclusion: Both drugs have comparable efficacy and similar safety results in the treatment of mixed vaginitis in pregnant women; therefore, they can be used interchangeably. Studies in larger populations with a control group and random assignment are required to provide better evidence regarding this management.

Frequency of Vitamin B12 Deficiency in Pregnant Women with Gestational Diabetes Mellitus

Objective: To determine the prevalence of vitamin B-12 deficiency in pregnant women with gestational diabetes mellitus. Study Design: Retrospective study Place and Duration of Study: Department of Medicine, OMC Hospital, Jail Road Lahore from January, 2020 to December, 2020. Methods: Two hundred and thirty pregnant females were enrolled age between 18-45 years. Detailed demographics of enrolled cases age, gestational age, gravidity and body mass index were recorded after taking informed written consent. Among 230 cases, 100 women were non GDM (group I) and 130 had gestational diabetes mellitus (group II). Blood samples were taken from all the patients for measuring vitamin B12 status. Vitamin B12 was defined as &lt;300 pg/ml. Results: Mean age of the patients in group I was 31.64±7.45 years with mean BMI 25.88±8.65 kg/m2 while mean age among GDM group was 34.55±5.71 years with mean BMI 27.36±9.44 kg/m2. Mean gestational age in group I was 33.72±4.21 weeks and in group II 35.08±9.27 weeks. In group I 20 (20%) had vitamin B12 deficiency and in group II rate ofvitamin B12 deficiency was high among 90 (69.2%) cases. We found a significantly relation between vitamin B12 and GDM with p value &lt;0.0007. Conclusion: The prevalence of vitamin B-12 deficiency among pregnant women of gestational diabetes mellitus was significantly high as compared to normal pregnant women. Keywords: Pregnant Women, Gestational Diabetes Mellitus, Vitamin B12 deficiency

Compare the Outcomes of Subcutaneous Drains versus No Drains in Patients with Repeated Cesarean Section

Objective: The aim of this study is to compare the outcomes of subcutaneous drains versus no drains in patients with repeated cesarean section. Study Design: Randomized control trial Place and Duration: Conducted at Gyne &amp; Obs Department, Shahida Islam Teaching Hospital Lodhran, during from 8-01-2020 to 8-08-2020. Methods: Total 90 pregnant women with repeated cesarean section were presented in this study. Patients were aged between 22-50 years. Detailed demographics of enrolled cases including age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were categorized into two groups, group I had 45 patients with subcutaneous drain and 45 patients of group II were without drain. Post-operative outcomes were assessed and compared among both groups. VAS was used to compare pain among both groups. SPSS 22.0 version was used to analyze the data. Results: Mean age of the patient in group I was 30.6±8.44 years with mean BMI 33.08±5.26 kg/m2 but in group II mean age was 29.03±7.37 years with mean BMI 31.12±11.58 kg/m2. Mean gestational age in group I was 37.9±3.9 weeks and in group II mean gestational age was 37.3±2.7 weeks. There was no any significantly difference in parity among both groups. Post-operative mean haemoglobin in group I was lower 7.9±1.6 gm% as compared to group II 8.11±0.4 gm%. Mean pain score in group I was 6.8±4.7 and in group II was 8.2±4.11. Prevalence of wound infection was greater in group II 5 (11.1%) as compared to group I 3 (6.7%). Hospital stay was shorter in group I 9.7±2.11 days as compared to group II 10.8±1.14 days. Frequency of superficial SSI and wound seroma were significantly higher among patients of group II. Conclusion: In this study we concluded that those patients who received subcutaneous drain undergoing cesarean section resulted low post-operative pain with fewer chances of wound infection as compared to the patients undergoing C-section without drain. Except this frequency of SSI and hospital stay was shorter among patients of drain group. Keywords: Cesarean, Drain, Wound Infection, Superficial Surgical Site Infection, Pregnant Women

B Lynch Suture and Intrauteribne Balloon Tamponade for Management of Severe Postpartum Hemorrhage: A Comparative Study

Objective: The aim of this study is to compare the effectiveness of intrauterine balloon tamponade and B lynch suture for management of severe postpartum hemorrhage. Study Design: Randomized Control trial Place and Duration: The study was conducted at Gynae &amp; Obs department of Qazi Hussain Ahmad Medical Complex, Nowshera KPK for six months duration from January to 2021 to June 2021. Methods: There were one hundred and twenty patients with ages 20-45 years were presented in this study. All women had severe postpartum hemorrhage were included in this study. Demographically detailed of enrolled cases age, body mass index, gestational age and parity were recorded after taking informed written consent. Patients were equally divided into 2-groups I and II. Group I had 60 patients and received Lynch suture while in group II 60 patients received intrauterine balloon tamponade. Post-operative success rate among both groups were assessed and compared in terms of bleeding control within 10-15 minutes. SPSS 24.0 version was used to analyze the complete data. Results: In group I mean age was 29.09±2.53 years with mean BMI 25.11±7.64 kg/m2 while in group II mean age was 29.02±3.62 years with mean BMI 24.87±6.32 kg/m2. Mean gestational age in group I was 37.87±3.29 weeks and in group II mean gestational age was 38.19±6.41 weeks. Mean parity in group I was 4.03±1.19 and in group II it was 4.01±0.87. Frequency of success rate in group I was significantly higher among 54 (90%) cases as compared to group II 39 (65%) with p value &lt; 0.05. We found that patients of group I was significantly satisfied than that of patients who received intrauterine balloon tamponade. Conclusion: In this research we concluded that lynch suture for the management of severe postpartum hemorrhage among females had higher effectiveness in terms of bleeding control within 15 minutes and with higher satisfaction among patients as compared to those females who received intrauterine balloon tamponade. Keywords: Postpartum hemorrhage, Lynch Suture, intrauterine balloon tamponade, Success Rate

Comparison of Slow versus Rapid Feeding Regimen in Preterm Neonates in the reduction of hospital stay

Introduction: In preterm babies delay in the achievement of full feeds causes prolonged hospital stay. This study will help in the nutritional management of preterm babies which will shorten the hospital stay and reduce the economic burdens on parents.&#x0D; Objective: To compare the mean duration of hospital stay of preterm neonates with two different feeding protocols(slow feeding regimen versus rapid feeding regimen).&#x0D; Materials and Methods: This study was conducted in the neonatal unit at Izzat Ali Shah Hospital from October 2019 to March 2020 through a randomized controlled trial. A total of 102 (51 in each group) were randomized to slow feeding (Group A) and Rapid feeding(Group B). Depending on the birth weight and gestational age, a certain amount of breast milk was initiated, with increments of 15-20 mL/kg/day in the slow feeding group &amp; 25-30 ml/kg/day in the rapid feeding group. Feeding was stopped temporarily in case of any sign of feeding intolerance, suspected necrotizing enterocolitis, recurrent apnoeic episodes, and neonatal seizures. The total target feed was 180 ml/kg per day. Infants were continued in the study until discharged from the hospital. &#x0D; Results: Our study shows that the mean gestational agein Group A (Slow feeding) was 34 weeks with SD ± 2.68 while the mean gestational agein Group B (Rapid feeding) was 35 weeks with SD ± 1.98. In Group A (Slow feeding) 55% neonates were male while 45% neonates were female. Whereas in Group B (Rapid feeding) 57% neonates were male while 43% neonates were female. In Group A (Slow feeding) mean hospital stay was 22 days with SD ± 7.02. In Group B (Rapid feeding) mean hospital stay was 13 days with SD ± 3.72. &#x0D; Conclusion: Our study concludes that mean hospital stay in the rapid advancement of feeds was shorter as compared to the slow feeding of preterm neonates.

Efficacy of Intravenous Paracetamol Infusion Versus Intramuscular Tramadol as an Intrapartum Labour Analgesia

Background: Various studies have debated intravenous paracetamol as analgesic agent However, there are no significant trials regarding comparison of paracetamol with other agents like Tramadol regarding analgesic effect on labor pain. Objective: To compare the efficacy of intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labour analgesia. Methodology: In this quasi experimental study, a total of 110 women with active phase of labour of term pregnancy, 18 to 40 years of age, were included. Duration and setting: May to November, 2019 at Department of Obstetrics and Gynaecology, Shaikh Zayed Hospital Rahim Yar Khan. In Group A, single 100 ml intravenous infusion containing 1000 mg of paracetamol while in Group B patients, tramadol hydrochloride 100 mg intramuscular, was given. All patients in both groups were evaluated by visual analogue scale and efficacy (yes/no) was noted. SPSS 20 was used for data analysis. Results: The mean age of women in group A was 27.73 ± 5.35 years and in group B was 27.36 ± 5.61 years. The mean gestational age in group A was 39 ± 1.53 weeks and in group B was 38.95 ± 1.56 weeks. Parity was from 0 to 5 with mean parity of 2.46 ± 1.17. Efficacy (in terms of VAS score 0-3) was seen in 21 (38.18%) in group A (intravenous paracetamol infusion) and 09 (16.36%) in group B (intramuscular tramadol) with p-value of 0.010. Conclusion: This study concluded that efficacy of intravenous paracetamol infusion is better than intramuscular tramadol as an intrapartum labour analgesia.

Antibiotic prophylaxis before skin incision versus after cord clamping in the prevention of maternal and neonatal infectious morbidity after cesarean section

Abstract Background the purpose of antibiotic prophylaxis in surgical procedures is not to sterilize tissues but to reduce colonisation pressure of microorganisms introduced at the time of the operation to a level that can be overcome by the patient’s immune system. Aim of the study to compare the effects of antibiotic prophylaxis administered in cesarean section preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate. Patients and Methods This comparative study was carried out between August 2017 and February 2018, at Ain Shams maternity hospital and Al-Galaa teaching hospital, a prospective randomized control comparativestudy of 874 pregnant ladies undergoing cesarean section after obtaining the approval of the local ethical committee and a fully-informed written consent. Results Of 874 pregnant ladies undergoing cesarean section, mean gestational age in group A (38.71±1.09); while in group B mean gestational age (38.86±1.06). In group A, wound infection 8 cases (1.6%), endometritis 25 cases (5.7%), UTI 18 case (4.1%). In group B, wound infection 16 cases (3.7%), endometritis 35 cases (8%), UTI 28 case (6.4%). No cases suffered from early or long term neonatal complications. Conclusion there is no significant difference between timing of antibiotic either before skin incision or after cord clamping, however there are risk factors that increase the maternal, fetal infectious morbidity as high BMI, low gestational age, previous section, general anaesthesia.

Efficacy of surfactant administration to preterm infants via thin catheter versus InSurE technique.

Objectives: To compare the efficacy of administering surfactant to preterm infants using thin catheter and Intubate-Surfactant-Extubate (InSurE) techniques in terms of need of mechanical ventilation within 1st 72 hours of life. Study Design: Randomized controlled trial. Setting: Neonatal intensive care unit (NICU), Federal Postgraduate Medical Institute and Shaikh Zayed Hospital (FPGMI and SZH), Lahore. Period: From November 2014 to April 2015. Material &amp; Methods: A total of one hundred preterm infants who developed respiratory distress syndrome (RDS) and fulfilled the inclusion criteria were enrolled in the study. The enrolled infants were randomly divided into two groups each comprising fifty infants. The infants in Group A were administered surfactant via thin catheter technique, whereas those in Group B by InSurE technique. The infants were monitored by clinical and laboratory parameters for the need of mechanical ventilation within 1st 72 hours of life. Descriptive statistical analyses were performed. Results: Majority of the preterm infants in Group A (54%) and Group B (56%) were born through Caesarean section. Group A constituted 58% (n=29) males and 42% (n=21) female infants, while Group B constituted 52% (n=26) males and 48% (n=24) females. Mean gestational age in Group A and Group B was found to be 29.43±4.24 weeks and 28.54±3.87 weeks, respectively. Mean birth weight in Group A and Group B was found to be 1375.87+143.36 and 1392.87+129.27 grams, respectively. Efficacy of surfactant was recorded as 64% (n=32) in group A and 44% (n=22) in group B (p=0.04). Conclusion: Surfactant administration using thin catheter is significantly more efficacious than InSurE in respect of the need of mechanical ventilation during 1st 72 hours of life.

Evaluation of effect of gestational diabetes mellitus on composition of the initial oral microbiota of neonates.

Background:Gestational diabetes mellitus (GDM) is one of the commonly occurring high-risk obstetric complications that accounts for 4%–9% of total pregnancies. The present study was an attempt to assess the effect of GDM on composition of the neonatal oral microbiota.Materials and Methods:In this study, oral samples from 155 full-term vaginally delivered newborns were collected with sterile swabs. Seventy-five mothers diagnosed with GDM group and 80 were nondiabetic mothers (control). The oral microbiota was evaluated and analyzed by SPSS software.Results:The mean gestational age in Group I was 38.1 weeks and in Group II was 39.6 weeks. Firmicutes was present in 38.1% in Group I versus 77.6% in Group II patients, Actinobacteria was seen in 15.2% in Group I and 7.4% in Group II, Bacteroidetes in 27.6% in Group I and 7.9% in Group II, Proteobacteria in 9.5% in Group I and 3.8% in Group II, and Tenericutes in 9.6% in Group I and 3.3% in Group II. There was a significant difference in major genera Prevotella, Bacteroidetes, Bifidobacterium, Corynebacterium, Ureaplasma, and Weissella in both groups (P < 0.05).Conclusion:There was increased bacterial microbiota in neonates born to mothers with GDM as compared to neonates born to nondiabetic mothers. Assessment of initial oral microbiota of neonates could help in assessing the early effect of GDM on neonatal oral microbial flora.