Objectives: To compare oral maternal hydration and intravenous infusion in women with third trimester isolated oligohydramnios in terms of mean change in amniotic fluid. Study Design: This is a Comparative Study. Setting: The study was conducted in Department of Gynecology, Pakistan Institute of Medical Sciences, Islamabad. Period: Between 1st May, 2015 to 31st July, 2016. Material & Methods: One hundred and fourteen pregnant females with singleton pregnancy, beyond 28 weeks gestation and AFI < 5cm were included. Placental insufficiency was ruled out on Doppler ultrasound of umbilical artery. Basal AFI and routine intake of fluid of all patients was noted. Patients were randomized either to receive oral maternal hydration or intravenous infusion. AFI measurement was repeated at 6th day after hydration therapy. Data was stratified for mean difference in improvement in amniotic fluid index. Results: One hundred and fourteen patients with mean age of 27.33 ± 3.87 years were included. 52 patients (45.6%) were primigravida and remaining 62 patients (54.4%) were multipara. Mean AFI value before treatment in sampled population was 3.35 ± 0.744 in oral hydration and 3.33 ± 0.787 in intravenous hydration (p=0.903). Mean AFI value after treatment was 5.53 ± 0.966 in oral hydration and 5.68 ± 1.490 in intravenous hydration, independent sample test showed non-significant (p=0.903) difference. Mean increase in AFI before and after treatment was cross tabulated and resultant difference was significant (p value=0.001). There is no effect of age, gestational age, history of oligohydramnios on improvement in amniotic fluid index. Conclusion: Both treatment modalities i.e. oral maternal hydration and intravenous infusion are effective in terms of improvement of amniotic fluid index but there is no difference in both treatments in pregnant females with isolated oligohydramnios in 3rd trimester at current sample size.

Objectives: Compare the mean pain score with subcutaneous sterile water injection versus normal saline water injection over the sacrum in females presenting with severe back pain undergoing normal vaginal delivery at term. Study Design: Randomized Control Trial. Setting: MCH Centre, Pakistan Institute of Medical Sciences, Islamabad. Period: 21-08-2019 to 20-11-2019. Material & Methods: The non-probability, consecutive sampling technique was used to include patients. In group A, patients injection was given 4 intracutaneous injections of 0.5 ml sterile water in the lumbar- sacral region in the sitting position. One injection was given at the posterior superior iliac spine on both sides and second injection at 1 cm medial, and 1-2 cm inferior to the first point on both the sides using an insulin needle. These points overlie the area called Michaelis' rhomboid. In group B, patients were given injections of 0.5 ml isotonic saline in the same region using an insulin needle. Then patients were followed-up for 90 minutes (1.5hours). After 90 minutes, pain on VAS was again measured. Results: In this study the mean pain score at baseline of the patient was 79.82±12.99 and the mean pain score after the 90 minutes was 54.05±18.52. Statistically there is highly significant difference was found between the study groups and pain after 90 minutes of the patients i.e. p-value=0.000 Conclusion: Our study results concluded that sterile water group patients showed better pain relief as compared to normal saline group in in females presenting with severe back pain undergoing normal vaginal delivery at term.

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.