Objective: Comparison between Methyldopa and combination of Methyldopa and Nifedipine in terms of mean change in blood pressure in pregnancy induced hypertension. Material and methods: This randomized controlled trial was conducted at Department of Obstetrics and Gynecology, Combined Military Hospital Bahawalpur from February 2020 to August 2020 over the period of 6 months. Total 80 patients with pregnancy induced hypertension as per operational definition having age 20-40 years and having gestational age ≥ 20 weeks assessed on LMP were selected. Results: Mean age of the patients was 30.81 ± 5.670 years, mean age of patients of group A was 31.50 ± 5.809 years and mean age of group B was 30.13 ± 5.515 years. Mean gestational age was 30.17 ± 5.981 weeks, mean gestational age of patients of group A was 29.70 ± 6.329 weeks and mean gestational age of patients of group B was 30.65 ± 5.65 weeks. In group A, mean diastolic blood pressure was decrease from 101.2250 ± 4.97938 to 84.5000 ± 3.26599 and in group B from 107.7750 ± 7.18434 to 82.5000 ± 2.25320. Comparison of mean decrease in diastolic blood pressure between group A (High dose Methyldopa) and group B (Low dose Low dose Methyldopa with Nifedipine) was done. Mean decrease in diastolic blood pressure in group A was 16.72 ± 3.935 and in group B was 25.28 ± 6.876. Statistically significant difference of mean decrease in diastolic blood pressure between the both groups was noted with p value 0.000. Conclusion: Results of this study showed that Low dose Methyldopa with Nifedipine combination is more effective as compared to High dose Methyldopa to reduce diastolic blood pressure in pregnant women suffering from pregnancy induced hypertension. Keywords: Diastolic blood pressure, Methyldopa, Nifedipine, Pregnancy induced hypertension, Systolic blood pressure

Objectives: To compare the intraoperative hemorrhage between blunt and sharp expansion of uterine incision at lower segment caesarean delivery. Study Design: Randomized controlled trial. Study Duration: 03-02-2022 to 02-08-2022 (6 months) Setting: Department of Obstetrics and Gynecology, D.G Khan Hospital D. G Khan Material and methods: Total 74 patients undergoing C-section, age range 20-40 years, with singleton pregnancy and patients with >37 weeks gestation. (on ultrasound) were included. Intraoperative blood loss was compared between blunt and sharp group. Results: Mean age was 32.31 ± 6.246 years, in Blunt and Sharp group, mean age was 35.70 ± 4.122 years and 28.92 ± 6.202 years. In Blunt group, mean blood loss was 201.62 ± 60.794 ml while in sharp group was 782.03 ± 153.819 ml. Difference of mean blood loss between Blunt and Sharp group was significant (P= 0.000). Conclusion: Results of present study reflects that there is significant difference of intraoperative mean blood loss between blunt and sharp groups. Most of the patients were between 31-40 years of age. After stratification of age, gestational age, parity and type of C-section, it was found that there is significantly low mean blood loss in blunt group as compared to sharp group. Keywords: Blood loss, C-section, Blunt, intraoperative haemorrhage,

Objective: The objective of this study was to compare 0.75% and 0.50% hyperbaric bupivacaine in terms of hemodynamic stability in elective cesarean section. Study Design: Randomized Controlled Trial. Place and duration: Department of Anesthesiology, Intensive care and pain management, Combined Military Hospital, Mardan from September 2021 to March 2022. Methodology: Total 104 women were randomly divided into Group-A (0.50% drug concentration) and Group-B (0.75% drug concentration) hyperbaric bupivacaine. Base line systolic blood pressure was noted. Lumber puncture was done in L3/L4 or L4/L5 space. Reading were taken at 1-min, 3-min, 5-min and 30-min. Drop in SBP<20% from baseline was taken as hemodynamic stability. Stability in SBP systolic blood pressure among the two groups A and B were compared. Results: The mean systolic blood pressure of group A was 123.77±8.43 mmHg while in group B it was 123.66±9.14 mmHg. In group A more than 20% decrease in SBP were noted in 42.3% while in group B it was observed in 63.5% patients. Hemodynamic stabilitywas noted in 57.7% patients and 36.5% patient respectively in study group A and B and difference was significant (p=0.031). Conclusions: The Hyperbaric Bupivacaine 0.50% is found superior than 0.75% interms of hemodynamic stability in patients undergoing elective Cesarean Section. Keywords: Hyperbaric Bupivacaine, Hemodynamic Stability, Elective Cesarean Section

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac) within one week) as compared to medical management in women with tubal ectopic pregnancy having β-hcg between 1000-3000 IU/L Keywords: Ectopic pregnancy, methotrexate, expectant, resolution

Objective: In our part of the world poverty and illiteracy has adversely affected our core objective of pregnancy i.e. healthy mother and healthy child. Exploring the role of a routinely used drug in reducing the duration of labor could be a breakthrough. Present study was planned accordingly to evaluate the effect of phloroglucinol (PHL). Materials and Methods: It was a Randomized controlled trial conducted at Department of Obstetrics & Gynecology, Combined Military Hospital, Bahawalpur from January 2019 to June 2019. This study included 60 cases of age 18 to 40 years, having singleton pregnancy and in active first stage of uncomplicated labor. Patients with history of multiple pregnancies, obstetrical and surgical complications and cardiorespiratory diseases were excluded. The cases were placed randomly into Group A & Group B and given intravenous PHL and a placebo respectively. After this, duration of the first stage of labor was recorded in minutes from when there was 3-4 cm cervical dilatation with regular uterine contractions to complete cervical dilation i.e. 10 cm and descent of the presenting fetal part. Results: Mean duration of active first stage of labor in experimental group A (230.20 ± 52.96 minutes) was significantly higher than that of control group B (345.30 ± 50.57 minutes). Conclusion: This study concluded that intravenous PHL has efficiently reduced the duration of active first stage of labor in these randomly selected nulliparous and multiparous women. PHL is a useful drug serving the purpose of a spasmolytic, analgesic and labor augmentation at the same time.