Objective: To determine the frequency of obstetrical hysterectomy in the morbidly adherent placenta in women with previous cesarean sections in tertiary care hospital. Study design: A cross-sectional study Place and Duration: Gynecology and obstetrics department of Liaquat university hospital Hyderabad from 5th November 2020 to 5th May 2021 Methodology: This study comprised 62 women who had placentas that were identified as morbidly adherent by Doppler ultrasound. Repeat ultrasound scans were used to monitor cases with grossly adherent placentas. The condition of the mother and fetus was routinely evaluated in the hospital, where blood was cross-matched for transfusion. All information was entered into a pre-made proforma. Results: The women were 30.68 ±4.70 years of age on average. When a placenta was morbidly adherent and in a woman who had previously had a caesarean section, 7.41% (17/62) of those women underwent an obstetrical hysterectomy. These women spent an average of 4.92 ±2.65 days in the hospital. Conclusion: - In 7.41% of cases, obstetrical hysterectomy was performed on women who had previously undergone caesarean section because of a morbidly attached placenta. These findings suggest that a morbidly adhered placenta can seriously interfere with a female's ability to procreate. It is crucial to make a well-informed decision about having a C-section in the first place, and following previous C-sections, vaginal birth should be given some thought. Keywords: caesarean section, morbidly adherent placenta, hysterectomy

Intrauterine development restriction and low birth weight in the newborn are two negative pregnancy outcomes that can result from maternal hypovitaminosis D. Objective: To determine the association between maternal vitamin D level and neonatal anthropometry (birth-weight, birth length and head circumference). Methods: This cross-sectional research was conducted in Post-Natal Ward of Liaquat University of Medical and Health Sciences, Hyderabad/Jamshoro, after getting official permission from July 2021 to Dec 2021. Healthy Mothers with alive Newborn aged < 24 hours were enrolled via Non-probability, convenience sampling. After taking due approval and written informed consent from mothers. Data were collected into a structured questionnaire, containing enquiries pertaining to basic biodata, sociodemographic details, Vitamin D levels, and anthropometric measurements of baby. Results: The mean age of the mothers was 26.82 (SD ± 7.4) years, predominantly hailing from urban areas (78.5%), with a mean BMI of 23.702 kg/m2 (SD ± 4.32). A low birth weight was reported in 53% while very low birth weight was reported in 4% of the cases. Majority of neonates were found to be of small for gestational age irrespective of their gestational age of delivery. Conclusions: In compared to babies whose mothers had adequate levels of vitamin D, the study reported that babies of moms with lower levels of vitamin D have smaller birth weights and are smaller for gestational age

ObjectiveMaternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (Fluids,Antibiotics,Source identification and treatment,Transfer andMonitoring) for early identification and management of maternal sepsis in low-resource settings. This study aimed to determine feasibility of FAST-M intervention in a low-resource setting in Pakistan. The FAST-M intervention consists of maternal sepsis screening tools, treatment bundle and implementation programme.Design and settingA feasibility study with before and after design was conducted in women with suspected maternal sepsis admitted at the Liaquat University of Medical and Health Sciences hospital Hyderabad. The study outcomes were compared between baseline and intervention phases. In the baseline phase (2 months), the existing sepsis care practices were recorded, followed by a training programme for healthcare providers on the application of FAST-M tools. These tools were implemented in the intervention phase (4 months) to assess any change in clinical practices compared with the baseline phase.ResultsDuring the FAST-M implementation, 439 women were included in the study. 242/439 were suspected maternal infection cases, and 138/242 were women with suspected maternal sepsis. The FAST-M bundle was implemented in women with suspected maternal sepsis. Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements (25.5% vs 100%; difference: 74%; 95% CI: 68.4% to 80.5%; p<0.01), fetal heart rate assessment (58% vs 100%; difference: 42.0%; 95% CI: 33.7% to 50.3%; p≤0.01) and measurement of urine output (76.5% vs 100%; difference: 23.5%; 95% CI: 17.6% to 29.4%; p<0.01). Women with suspected maternal sepsis received all components of the treatment bundle within 1 hour of sepsis recognition (0% vs 70.5%; difference: 70.5%; 95% CI: 60.4% to 80.6%; p<0.01).ConclusionImplementation of the FAST-M intervention was considered feasible and enhanced early identification and management of maternal sepsis at the study site.Trial registration numberISRCTN17105658.

Introduction The World Health Organization and partners developed and evaluated a maternity-specific sepsis care bundle called ‘FAST-M’ for low-resource settings. However, this bundle has not yet been studied in Asia. Our study sought to evaluate the perceptions of healthcare providers about the implementation of the FAST-M intervention in Pakistan. Materials and methods The study was conducted at a public sector hospital in Hyderabad. We conducted three focus group discussions with healthcare providers including doctors, nurses, and healthcare administrators (n = 22) who implemented the FAST-M intervention. The Consolidated Framework for Implementation Research was used as a guiding framework for data collection and analysis. The data were analyzed using a thematic analysis approach and deductive methods. Results Five overarching themes emerged: (I) FAST-M intervention and its significance including HCPs believing in the advantages of using the intervention to improve clinical practices; (II) Influence of outer and inner settings including non-availability of resources in the facility for sepsis care; (III) HCPs perceptions about sustainability, which were positive (IV) Integration into the clinical setting including HCPs views on the existing gaps, for example, shortage of HCPs and communication gaps, and their recommendations to improve these; and (V) Outcomes of the intervention including improved clinical processes and outcomes using the FAST-M intervention. Significant improvement in patient monitoring and FAST-M bundle completion within an hour of diagnosis of sepsis was reported by the HCPs. Conclusions The healthcare providers’ views were positive about the intervention, its outcomes, and long-term sustainability. The qualitative data provided findings on the acceptability of the overall implementation processes to support subsequent scaling up of the intervention.

Objective: To determine the awareness, practice, knowledge and attitude toward the Covid 19 among antenatal patients at tertiary care Hospital. Methodology: This was a cross sectional survey which was conducted at Gynae and obstetrics department at Liaquat University Hospital Hyderabad. Study duration was six months from March 2020 to August 2020. All the pregnant women visited antenatal clinic age 18 to 40 years and either of parity were included. All the pregnant females were interviewed by using a questioner regarding awareness, attitude and practice toward the Covid19 after taking informed consent. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20. Results: Total 173 pregnant women were interview regarding COVID-19, their mean age was 29.34+13.12 years. Most of the women were presented with age between 18 to 37 years. 70.5% were multigravida and majority of women were uneducated. Mostly women 75.1% had heard regarding. 72.8% women said, they should stay at home and 25.4% said should wear the face mask, while 38.7% said the women should inform the health care provider in advance before visit to Hospital if developed any symptom. Most of the women had good knowledge and attitude, while preventive practice was found to be unsatisfactory. Conclusion: knowledge and awareness were found to adequate; while preventive practice has been observed unsatisfactory among pregnant women during antenatal clinic. Clinicians should provide appropriate counseling to reassure and elucidate doubts of pregnancy females regarding COVID-19 during antenatal visits.