Objective: To calculate the Maternal Near Miss Mortality Ratio and Mortality Index at a tertiary care hospital in a developing country with limited healthcare resources. Study Design: Retrospective analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Shaikh Khalifa Bin Zayed Al Nahyan Hospital Azad Kashmir and Combined Military Hospital, Muzaffarabad Pakistan, from Jan 2015 to Dec 2018. Methodology: Four hundred and forty-nine severe maternal outcome cases admitted in Intensive Care Unit were included in our study. Maternal Near Miss Mortality Ratio and Mortality Index were calculated. SPSS version 23.00 used for statistical analysis. Results: The maternal near missed mortality ratio was 11:1, mortality index 8.68%, severe maternal outcome 1.58% with 39 maternal deaths. Most common causes of maternal morbidity were hemorrhage (56.1%); hypertensive disorders (24%); sepsis (3.5%) and cardiovascular diseases (1.8%). Hypertensive disorders of pregnancy (30.7%), hemorrhage (25.6%) and sepsis (25.6%) were the common causes of maternal deaths. The total ICU time in patient with near-miss was 1.9±1.7 days versus 2.6±3.14 days in deaths, p<0.001. Operative delivery was statistically significantly (p value <0.001) more common mode of delivery in severe maternal outcomes (66.6%) and maternal deaths (33.3%). Conclusion: Our study has shown 1.58% severe maternal outcomes amongst admitted pregnant, maternal near missed mortality ratio being 11:1, mortality index being 8.68%. Eclampsia, hemorrhage and sepsis are major cause of maternal death.

Objective: To evaluate risk factors that predict Insulin requirements and outcomes in women with gestational diabetes in a resource-limited country. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Combined Military Hospital, Mangla Pakistan, from Jan to Dec 2019. Methodology: Our study included 100 pregnant women with gestational diabetes over a period of one year. The primary outcome was to calculate the frequency of gestational diabetes and the correlation between maternal age and parity with subdermal Insulin therapy in a peripheral (Class C) hospital. The secondary outcomes of this study included mode of delivery and neonatal birth weight. Results: Out of 1509 deliveries, our study included 100 pregnant women (6.62%). Sixty-two (62%) required Insulin to control hyperglycemia in addition to oral Metformin; 36% required oral Metformin alone. Maternal age (p=0.078), presence of co-morbidity (p=0.260), and parity (p=0.242) did not predict Insulin requirement. A caesarean section (69%) was the most common mode of delivery. Insulin requirements to control hyperglycemia didn’t correlate with mode of delivery (p=0.825). The neonatal birth weight was 3.30±0.33 kg in patients requiring Insulin versus 3.26±0.25 kg in other treatments (p=0.86). There was one intrauterine death. Conclusion: The frequency of gestational diabetes was 6.62%. Maternal age, parity, and the presence of maternal co-morbidities did not predict Insulin requirements. There was no correlation between Insulin therapy, mode of delivery, or neonatal outcome.

Objective: To ascertain the sensitivity and specificity of serum lactate dehydrogenase as an indicator for maternal and neonatal outcomes in hypertensive disorders of pregnancy. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesia and Gynecology & Obstetrics, Combined Military Hospital, Okara Cantt Pakistan, from Apr to Sep 2018. Methodology: Eighty-six pregnant women with pregnancy-induced hypertension were included in our study. Group-A included pregnant women with raised serum LDH, and Group-B included pregnant women with normal LDH levels. The patients were followed up until delivery and hospital discharge. Maternal and neonatal outcomes were studied. Results: The progression to hemolysis elevated liver enzyme low platelet (HELLP) syndrome was 4(4.8%) in Group-A versus zero in Group-B, p=0.022. The two groups did not vary in mode of delivery (cesarean section in 28 vs. 33); preterm delivery (22 versus 15); intrauterine growth retardation (8 vs. 6); intrauterine demise (9 vs 5); low APGAR at birth (13 vs. 7); eclampsia (3 vs. 3) which were comparable between the two groups, p-value>0.05. For overall maternal outcomes, the sensitivity for raised LDH was 57.1% and specificity 53.3%. The sensitivity was 51.2%, and the specificity was 54.7% for overall neonatal outcomes. Conclusion: Elevated serum LDH alone in pregnancy-induced hypertension cannot considered as a prognostic indicator for maternal and neonatal adverse outcomes, except HELLP syndrome

Background: Healthcare workers (HCWs) are especially prone to contracting SARS-CoV-2 infection due to their work requirements. This study was conducted to analyze the frequency of SARS-CoV-2 infection among frontline healthcare workers and various predictive factors of this infection in healthcare workers. Methods: This was a descriptive cross-sectional study. Data was collected at Obs/Gyn Department, Sheikh Khalifa Bin Zayed Al-Nahyan (SKBZ)/Combined Military Hospital Muzaffarabad, from Main Covid-19 Pandemic Data Collection and Information Centre, Muzaffarabad, from 15th April to 14th October 2021. Screening was offered to healthcare professionals and other supporting staff of all hospitals dealing with SARS-CoV-2 infection. Information was recorded on a structured questionnaire. Categorical variable were explained by frequency. Fischer exact test and ?2 test were used, and p<0.05 were considered significant. Results: There are 4,776 healthcare workers in AJK. A total of 2,219 individuals were COVID positive, out of them 118 were healthcare workers. Males were 53% and females were 47%; 77% of cases were aged 25?50 years. Physicians were 51.7% outnumbering nurses and allied staff. The cumulative incidence was 2.4%. Infection rate among frontline HCWs was 1%; it was 1.6 among HCWs in other departments, and 0.5% in HCWs with no patient contact. The rate of co-morbidities in affected HCWs was 33.05%. Conclusion: The risk of disease was high among frontline healthcare workers as compared to general population. The severity of infection was more in patients with co-morbidities. Among HCWs, the highest number of patients with COVID-19 were physicians. Pak J Physiol 2022;18(2):58–61

Objective: To determine the frequency of spontaneous labour in the swept and non-swept groups. Study Design: Quasi-experimental study. Study and Duration of Study: Department of Gynaecology and Obstetrics, Sheikh Khalifa bin Zayed Hospital, SKBZ Hosp/AK CMH Muzaffarabad, from Nov 2019 to Apr 2020. Methodology: Patients were randomly divided into two groups (with lottery method). Group-A underwent a sweeping membrane while group-B was the control group. Spontaneous labour and other outcomes were observed in both groups. Results: A total of 250 women were included in the study. There were 125 women in each group. The mean age of women was 23.4 ± 1.3 years in swept-group and 24.5 ± 1.7years in the non-swept group. The swept-group showed a high frequency of spontaneous labour compared to the non-swept group (24.8% vs 15.2%, p=0.01). Swept-group showed less postpartum haemorrhage (p=0.001), pain (p=0.001), pre-labour membrane rupture (p=0.03) and admission to neonatal intensive care unit (p=0.01). Conclusion: Sweeping of the membrane is a safe and beneficial procedure for labour induction among low-risk term pregnant women. It is an effective procedure preventing women from reducing the incidence of post-term pregnancy with minimum complications.

Objective: To find out low molecular weight heparin (LMWH) efficacy inlate second trimester oligohydramnios cases. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital Malir, from Jan to Jun 2017. Methodology: A total of 30 patients having amniotic fluid index (AFI) <8 on ultrasound scan during their late second trimester phase were enrolled in the study after informed consent. Exclusion criteria included congenital anomalies on U/S, PPROM, and drug-induced oligohydramnios. Personal, medical and obstetric history was obtained for age, parity and co-morbids like hypertension, antiphospholipid syndrome, and previous oligohydramnios. Low molecular weight heparin was started at dose of 0.5mg/kg of body weight subcutaneously for 8-12 weeks and stopped 24 hours prior to delivery. Rescan for amniotic fluid index and fetal bio-metry assessment done every 2 weeks till date of delivery. Fetal outcome in terms of maturity, mode of delivery, birth weight, APGAR score and need for NICU admission were measured. Results: There were 28 live births and two intrauterine deaths. Twelve patients were delivered normally and 18 had elective LSCS. Of twenty eight cases, eight were premature low birth weight (LBW) babies. Twenty six patients showed significant improvement in amniotic fluid index. Average birth weight was 2.5kg. Neonates showed an average APGAR score of 7. Eight neonates admitted in NICU (for prematurity and/or low birth weight) and discharged within a week. Conclusion: Low molecular weight heparin plays significant role in treating oligohydramnios in cases with or without risk factors. However further studies with large sample............

Objective: To find out the magnitude of hepatitis B and hepatitis C seropositivity during antenatal screening of pregnant women aged 20 years and above. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Hyderabad, Sindh Pakistan, from Jan 2014 to Dec 2014. Methodology: This study was conducted on 1769 admitted pregnant females 20 years age and above which were selected by non-probability consecutive sampling technique. For sample collection 3ml of blood was taken in clot activated bottle. Quantitative detection of HbsAg and Hepatitis B from serum of patients were done by rapid chromatographic immunoassay (ICT kit used for HbsAg and Anti Hepatitis B by Healgen Scientific, London). Seropositivity for HbsAg and anti-hepatitis C virus among selected pregnant patients was also checked. Results: Out of 1769 pregnant females mean age 22 ± 2.23 years screened for hepatitis B and C seropositivity, 129 (7.299%) females were found to be positive for serum antibodies for hepatitis B and C. Out of 129 seropositive females 99 (76.7%) were anti-hepatitis C virus (HCV) positive and 30 (23.3%) were HbsAg positive. Out of 129 seropositive females 80 (62%) patients delivered by caesarean section and 23 (38%) had normal vaginal delivery. Multiparas patients were 110 (85.3%) more than prim gravidas 19 (2%). Conclusion: Magnitude of hepatitis B and C virus is alarming among pregnant women. This study shows high frequency of Anti-hepatitis C than HbsAg which is alarming due to non-availability of prophylactic vaccine against the disease.

Objective: To identify the frequency, associated risk factors and intraoperative reasons for conversion of Laparoscopic Cholecystectomy to open Cholecystectomy. Study Design: Case series study. Place and Duration of Study: This study was conducted in department of Surgery, Combined Military Hosptial Rawalpindi, from May to Oct, 2018. Methodology: Patients admitted for laparoscopic cholecystectomy were included in the study. Demographic information, ASA Score of physical health, Ultrasonogram Abdomen findings and presence of pericholecystic fluid were documented. The reasons for conversion from laparoscopic cholecystectomy (LC) to open Cholecystectomy (OC) for example excessive haemorrhage, visceral injury, equipment failure, injury to Common bile duct were also noted. Results: In this study 15 (8.77%) patients were converted from laparoscopic cholecystectomy to open cholecystectomy. The most common reason 6 (40%) of conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. In patients who converted most 10 (66.7%) were 41-60 years old and in patients who had successful laparoscopic cholecystectomy majority 70 (44.9%) patients belonged to age group 21-40 years. The male gender had significantly (p-value <0.05) higher rate of conversion (53.3% vs. 46.7%). There was significant (p-value <0.05) association of ASA score and presence of pericholecystic fluid with rate of conversion. Conclusion: Male gender, higher ASA score, and presence of pericholecystic fluid are significant contributors for conversion of laparoscopic cholecystectomy to open cholecystectomy. The most common reason for conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation.