Objective: To determine the exact magnitude of the problem in our setup which will help to develop consensus guidelines with the contribution from various specialists especially obstetric medical specialist. Study Design: Prospective Observational study. Setting: It was conducted on 2448 patients who were ill due to various medical conditions during pregnancy and admitted to PNS Shifa and CMH Kharian. Period: 1st Jun 2019 till 31st May 2021. Material & Methods: Data was collected from the patients in the wards and delivery room and analysed using SPSSV28. Descriptive statistics were applied and means, and frequencies were calculated for different variables. Results: The total number of antenatal admissions was 8775, in which 2488 (28%) were patients. The mean age of our study population was 28 S.D (+ 4.78) years while the mean parity was 4 (S.D + 1.407). Hypertensive disorders were the most common medical disorder followed by haematological and liver disorders. Endocrine disorders were found in 372 (15%) of the study population. A total of 864 (38%) patients in the total study population had haematological abnormalities. Among these, anaemia was the most common haematological abnormality. Regarding respiratory disorders COVID-19 336(14%) was the most common respiratory medical disorder during pregnancy. Conclusions: All medical conditions in pregnancy are common and require a multidisciplinary approach which should be managed by a team involving Obstetric medical specialist.

Objective: To assess the knowledge of healthcare officials about COVID-19 disease and its effects on the mental health of healthcare workers (HCWs). Study Design: Cross-sectional Survey. Setting: Tertiary Care Hospital in Karachi. Period: 1st February to 30th June 2020. Material & Methods: After approval of the hospital’s ethical committee, 70 HCWs, filled the pre-formed questionnaire including their demographic features, specialty and questions related to fear, stressful factors and strategies to mitigate this stress. Results: A total of 120 questionnaires were distributed to healthcare workers at a peripheral hospital with a return of 58.3%. Majority were females, 59(84.3%).  The mean age was 30.32 years ±8.17 SD. All of our participants perceived it their professional and ethical responsibility to perform duties during COVID-19 pandemic. 97.1% felt proud to be serving humanity.  57.1% of HCWs were anxious. 52.9% were satisfied with hospital policies and felt appreciated. Triggering factors for the mental stress included: psychological conflict between profession and personal safety 71.4%, 87.1% feared intubation of colleagues, lack of family support among 38.6%, 92.9% were afraid of transmitting the infection to their families while 88.6% had anxiety due to uncertainty regarding when the pandemic will end. Various techniques employed by HCWs to cope with this stress included prayers, sports and exercise (95.7%), self-motivation (88.6%)and psychologist’s help (41.4%). Conclusion: The COVID-19 pandemic has led to mental stress to HCWs from multiple factors and special attention to strategies to alleviate this stress is strongly recommended.

Objective: To compare the effectiveness of two types of haemostatic sutures to secure bleeding in thinned out caesarean section scars. Study Design: Comparative Interventional Study. Setting: CMH Okara, Pakistan. Period: September 2019 to September 2021. Material & Methods: Patients were divided in four categories. Category I was previous one scar patients while category II was previous two scars patients. Similarly, categories III and IV were previous three and four scar patients respectively. In each category hemostasis was secured either by purse string suture or transverse mattress sutures. Hemostasis whether achieved with difficultly or without difficulty was assessed and time utilized was also calculated. Results: In patients with previous one caesarean section 3 out of 15 (20%) had haemostatic difficulty with both purse string suture and horizontal mattress suture. In patients with previous two caesarean sections the number was 5 (33.33%) and 6 (40%) in both purse string and horizontal mattress suture respectively. In patients with previous three caesarean sections there were 7 (46.66%) women who had difficulty in haemostasis in both group I and II. The average time to achieve the procedure in group I (purse string suture) was 3.25 minutes while it was 7.5 minutes in group II (Horizontal mattress sutures). There was two times difference in time consumption between two groups. Conclusion: Purse string suture is more effective, convenient and quicker to apply as compared to transverse mattress sutures for haemostasis in thinned caesarean section scars.

Objective: To analyse the prevalence of myths related to trial of labour after caesarian section (tolac) and vaginal birth after caesarian section (VBAC). Study Design: Cross-sectional Knowledge, Attitude and Practice study. Setting: PNS Shifa Hospital Karachi; A Tertiary Care Centre. Period: January 2020 to June 2020. Material & Methods: A questionnaire was designed including demographic details; age, education level, socioeconomic status and whether or not patient has received counselling about (VBAC) from obstetrician and answers to fifteen close ended questions related to prevalence of myths concerning trial of labour after c section(TOLAC) and vaginal birth after c section (VBAC). Every question had three possible answers: Yes (myth), No (correct answer) and don’t know (unsure). SPSS 22 was used for data analysis. Results: Of the 1000 forms, 850 were completed and returned. The mean age of study population was 34.22±11. 63 years. 480 participants (56.48 %) gave more than 50% yes answers and 370 participants (43.52%) gave more than 50 % no answers. There was significant inversely proportional impact of education (p<0.001) and socioeconomic class (p<0.002) and attendance of antenatal counselling on VBAC by obstetrician on prevalence of myths (p<0.001). The effect of age on the prevalence of myths was not significant (p<0.017). Conclusion: Our study delineated the fact that while considering vaginal birth after c section, myths and misconceptions overshadowed medical evidence in guiding patient’s decisions.