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Objective: To assess the causes of infertility by laparoscopy. Study design:Observational study. (Prospective). Place & Duration of study: Imdad hospital & MahnazLaparoscopy Center, Quetta from 1st Jan 2013 to 31st Dec 2013. Methodology: All the infertilepatients either with primary or secondary infertility was included after thorough evaluation.Diagnostic laparoscopy was done on these patients. Different causes were seen like tubalblockage, T.B, Endometriosis, adhesion of previous abdominal surgery, polycystic ovaries.Results: The study group consisted of 35 cases of infertile patients’ aged between 16 to 46years. 19 (54.3%) patients comprised primary infertility and 16 (45.7%) patients had secondaryinfertility because of tuberculosis (TB), pelvic inflammatory disease, endometriosis, polycysticovaries and previous surgery. 37.1% were asymptomatic, while irregular cycles, dischargeand dysmenorrhea were common symptoms Normal findings were in 3(8.6%) women.8.5% had unilateral blockage and 14.3% had bilateral blockage. 22.9% (8) cases had pelvictuberculosis and endometriosis was found in 3(8.6%) patients.11.4% (4) had pelvic adhesions.No major complication occurred except nausea, vomiting, pain and mild fever. Conclusion:Pelvic tuberculosis was most common pathology detected followed by Endometriosis, Pelvicinflammatory disease and adhesions.

Objectives: The purpose of the study was to compare the complications ofdelivery in squatting and lithotomy position of mother. Study Design: Randomized controlledtrial. Setting: Gynecology/Obstetrics Unit-II, Sandeman Provincial Teaching Hospital, Quetta.Period: 6 months (05 Oct, 2011 to 05 April, 2012) Methods: Hundred and fifty one patients withlithotomy position in delivery were compared with hundred and fifty one patients with squattingposition in delivery regarding risks of perineal tears, periurethral tear, extended episiotomy,instrumental delivery, caesarean section and primary postpartum hemorrhage. Data wasrecorded on a specially designed Performa and was analyzed by using SPSS.V. 10. Resultswere compared using Chi-square test by keeping the p-value of < 0.05 as significant. Results:151 patients in lithotomy position and 151 patients in squatting position were compared andstudied for complications during delivery. Extension of the episiotomy was observed in (7%) ofnon-squatting groups. There were no extensions of episiotomy in squatting group. There wereno second degree, or third degree perineal tears in squatting group which were encounteredin (9%) patients in the lithotomy position group (P<0.05). Forceps application was also lessin squatting position group 11% patients, whereas 24% patients were delivered by forcepsin lithotomy group, (P<0.05). One patient in the lithotomy position had to have a caesareansection due to persistent occipito-posterior position. There was no case of retained placentaor postpartum hemorrhage in squatting group whereas there were 4% cases of retainedplacenta and 1 case of postpartum hemorrhage due to atony of the uterus in lithotomy positiongroup. Conclusions: It appears that the routine use of lithotomy position may have somedisadvantages in terms of more instrumental deliveries and episiotomies. Moreover womenexperience significant pain in this position. It is suggested that more trials should be conductedand the position at the moment of birth should be registered to measure its influence on birthoutcome.

Objective: This study was designed to determine the frequency of uterine atony in cases of primary postpartum hemorrhage (PPH) and to point out risk factors for it and observe different ways of management for control of atonic primary (PPH). Design: Prospective cross sectional study. Place and Duration of Study: This prospective cross sectional study was conducted in Obstetrics & Gynecology Department unit-I, Bolan Medical Complex Hospital Quetta from 1st January to 31st December 2002 (one year). The study was conducted on 80 patients. Subjects and Methods: The study included all the pregnant women either booked or non-booked, who gave the inform consent. The sampling technique was convenience non probability. The patients were admitted through out-patient department and emergency, irrespective of age, place and mode of delivery, developing atonic primary PPH within twenty four hours and diagnosed as a case of uterine atony. All the cases of primary PPH other than due to uterine atony were excluded. Complete history, general physical examination, abdominal examination and pelvic examination was done.All the data was analyzed by SPSS version 10. Results: Total number of deliveries during study period was 1438. Total number of patients with PPH were 155 out of which, the cases with primary PPH were 139, contributing about 89.7%. The incidence of primary PPH was 9.6 %. Out of 139 patients, the leading cause of primary PPH was uterine atony, contributing to 57.6%. The incidence of atonic uterus was 5.6 %. The highest incidence of uterine atony (37.5%) was found in women aged 26-30 years, followed by (27.5%) women aged 21-25 years.The highest incidence of primary PPH due to uterine atony was found in para 5-8 (56.3%), 6.3 % were primigravidas, 8.7% in para 1-4 and 28.7% in patients having more than eight children. Simple management included inj. Syntometrine, Oxytocin, uterine massage controlled bleeding in 53.7% cases. Prostaglandins (PGF2-alpha & PGE2) were administered in 32 cases & successful in 22 (68.7%) cases. Uterine packing was done in 8 cases, out of it, in 5 patients bleeding controlled (62.5%). Ligation of uterine arteries was performed in 5 cases, it proved successful in 4(80%) & hysterectomy was done in 7.5% cases. Conclusions: Uterine atony is a major cause of primary PPH and major threat to the life of women in reproductive age. Uterine atony is more common in grand multipara, young women and in home delivery. Major risk factor for atony are previous history of primary PPH, grand multiparity, baby weight > 3.5kg & prolonged labour.