Objective: The aim of the study was to evaluate maternal and fetal outcomes among patients of placenta previa (PP) with and without placenta accreta (PA). Methodology: All patients who underwent cesarean section for PP and PA were analyzed retrospectively at a tertiary care Combined Military Hospital Kharian, Pakistan, from February 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. Results: PA was found in 37 patients from 111 patients of PP and 74 were without PA with the rate of approximately 2/1000 and 4/1000 respectively were included in the study. The mean age was 31.16±2.65 (range 22–37) years, mean gravidity of 3.69 ±1.40 (range 1 - 9), mean parity 2.57±1.01 (range 1–5), mean number of cesarean sections 2.10±0.66, (range 1-3) and a mean gestational age at the time of cesarean section was 35.65±2.46 (range 28–41) weeks. The maternal risk factors revealed marked differences between placenta previa with accreta and without accrete. The mean intraoperative blood loss in PA was 3,000ml, with a loss of 2,000ml occurring in 60%, and 3,000 ml in 21% of the PA cases. The mean pRBC transfusion was 4 units, while 17% received 6 units. Fetal growth restriction was not seen. A total of 12 neonates were admitted in NICU, with 03 neonatal deaths. There was no maternal death. Neonates born to women with placenta accreta had significantly lower birth weight, Apgar scores at 1 min and 12% required admission to NICU with 3 neonatal deaths. Conclusion: The advanced maternal age, past cesarean or uterine surgery, high parity as well as multiple gravidity were the risk factors for adverse fetal and maternal outcomes.

Objective: To determine the mean platelet volume (MPV) in pre-eclamptic and normotensive women presenting in 3rd trimester of pregnancy. Study Design: Descriptive Cross-sectional study. Place and Duration: Department of Obstetrics & Gynecology, Multan Medical and Dental College/Ibn-e-Sina Hospital, Multan during from 29-May-2019 to 28-Nov-2019. Methodology: 246 pregnant females were included in this study. Patients were assessed for pre-eclampsia those who were history of blood pressure >140 mmHg and 90 mmHg diastolic as seen on examination on three consecutive readings. Data of maternal hemogram taken at presentation was recording using an automated hematology analyzer. mean platelet volume (MPV) was recorded at completion of 36th week of gestation. Results: Mean age of patients included in this study was 34.22±5.02 years. Mean body mass index (BMI) of patients was 24.58±4.65 kg/m2. Mean parity was 2.63±0.78. Mean blood pressure of patients was 128.37±15.06 mmHg. The mean platelet volume in patients with normotensive pregnancy was 9.27±1.31 fL versus 12.49±1.51 fL in patients pre-eclampsia. This difference was statistically significant with p-value of <0.0001. Conclusion: As a biomarker for preeclampsia severity, MPV is a valuable tool. In a clinical context, MPV is regularly acquired during a complete blood count, making it a potentially cost-effective prediction tool for evaluating pre-eclampsia Keywords: Pregnancy, Pre-eclampsia, Mean Platelet Volume (MPV)

Objectives: To evaluate deleterious impact of novel coronavirus infection 2019 (COVID-19), on both maternal and fetal well being during pregnancy. Study Design: Hospital-Based Cross-sectional Survey. Setting: Department of Gynecology & Obstetrics, Combined Military Hospital, Chiltan Road, Quetta (Balochistan); Department of Gynecology & Obstetrics, Frontier Corps Hospital, Quetta Cantonment (Balochistan), and the Department of Otorhinolaryngology (ENT), Combined Military Hospital, Chiltan Road, Quetta (Balochistan). Period: March 2020 till July 2020. Material & Methods: Careful history, clinical and obstetrical examination radiology and real time polymerase chain reaction of nasopharyngeal swab were carried out in pregnant patients presenting for childbirth. Deliveries were conducted through spontaneous vaginal birth and caesarean section as per indication. Neonatal evaluation and nasopharyngeal swab for COVID-19 real time polymerase chain reaction in all delivered fetuses were performed. Results: 516 pregnant women underwent spontaneous vaginal delivery and caesarean sections at these hospitals during the study duration. 4.06% (n=21) were confirmed as COVID-19 infected. All of the fetuses born to these infected mothers were delivered healthy and COVID-19 negative, except for one preterm fetus born at 22nd week of gestation on account of maternal gestational hypertension. Conclusion: Trans-placental spread of COVID-19 infection to the fetus is unlikely. However, the infection places a pregnant mother at much higher risk to develop complications which may occasionally lead to adverse pregnancy outcome.

Objective: To find out the incidence of C-Section rate and reducing it after auditing by use of Modified Robson Criteria. Methodology: This study was conducted by collecting data prospectively. All C-Sections were classified according to Modified Robson Criteria in 12 Groups after modification. Calculations were made as size of each group, rate of C-Section and contribution of each group. Audit of C-Section carried out after first six months, and then strategies were made to reduce the rate, which was implemented. Re-audit was carried out after six months, thus completing the audit cycle. Frequency and percentage were calculated by data analysis using Excel 2010 Result: C-Section rate was 51.54% initially then re-audit showed a reduced rate of 39.74%. Maximum contribution 26.05% to total C-Section rate was made by group 5 which was reduced to 20.04% in re-audit. While 11.48% was contributed by group12 which was reduced to 8.44% in re-audit. Conclusion: Modified Robson Criteria is an effective tool for the audit of C-section. It also allow us for exact identification of area for improvement and making modification of clinical practice to reduce C-Section rate Keywords: C-Section rate, Modified Rosbson Criteria, Clinical Audit and Re-Audit.

Objective: To compare the acceptability of insertion of post placental intra uterine contraceptive device, withrespect to gravidity between vaginal deliveries and caesarean sections. Study Design: Prospective comparative study. Place and Duration of Study: Frontier Corp Hospital, Quetta, from Jan 2019 to Jan 2020. Methodology: A total of 399 females with age of 18 to 45 years with gravidity (primi, multi and grand multigravida) were counselled during antenatal visits about benefits and risks of post placental intrauterine contraceptive device (PPIUCD) insertion. For complications, females were assessed at 1 and 6 weeks after delivery. Results: A total of 399 females with mean age 27.95 ± 5.07 years were included in study. About 235 (55.9%)women delivered vaginally and 164 (41.4%) women by caesarean section. Acceptance rate was 3.8% and 4.3% for vaginal and caesarean deliveries respectively. Eleven (73.3%) women were grand multi gravida and 4 women(26.6%) were multi gravid in vaginal delivery acceptance group versus 8 women (47%) grand multi and 9 women (52.9%) multi gravida in caesarean acceptance group. Five (15%) females presented with complications (3 with abdominal pain and 1 each with infection and expulsion). Conclusion: The overall acceptance rate of PPIUCD was low in this study, the acceptance rate was higher inwomen undergoing normal vaginal delivery (NVD) as compared to lower segment caesarean section (LSCS),similarly more of the grand multiparas accepted the method as compared to other participants however thedifferences were not statistically significant.