SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

Background: Women who have had abortions are almost immediately pregnant-risk, low post-abortion family planning usage perceived to be one of the primary and significant factors that cause of induced abortion and spontaneous abortion. The aim of the study was to determine the factors in which the women accept post-abortion contraceptive methods among abortion care service patients in our hospital. Study Design: It was a cross-sectional study conducted in the Obstetrics and Gynecology Department of Riphah International hospital, Islamabad, for six month duration from March 2022 to August 2022. Methods: 125 out of 150 participant (abortion clients) selected by sampling technique were interviewed in Mayo hospital, Lahore. We analyzed dependent and independent variables. Data analysis was done statistically by SPSS 20 version. Results: This study included 150 participants who had a first trimester abortion between the study periods, 25 participants in this study were not willing to participate in the study, ultimately the responding rate of 83%. Among the 125 participants 92% were within the age group 21-39. The maximum participants were Muslim 92% and 8% non-Muslim. The maximum participants were married 96% and 4% unmarried. Most of the participants had only received the educational status 76%. This study indicate the strong relationship between women age 21-39 with the high usage of post-abortion contraceptive 92% as compared to >40 years. The participants in our study were used 85% contraceptive method. Conclusion: Our finding shows that providing appropriate medical advice and contraceptive counseling services can increase contraceptive acceptance. Keywords: Post-abortion contraceptive, family planning, contraceptive counseling services.

Background: Abnormal uterine bleeding (AUB) is a common gynecological problem that affects the women of all ages. It is defined as any irregular or excessive bleeding from the uterus that is not related to the woman’s normal menstrual cycle. It can be caused by a many of underlying factors such as hormonal imbalance, fibroids, polyps or endometriosis. Study design: It is a randomized controlled study conducted at Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Lady Willingdon Hospital Lahore for the duration of six months from June 2022 to November 2022. Material and Methods: The study was carried out for two groups. Intrauterine group included the patients that received intrauterine dose of progesterone and oral group patients had progesterone orally. The study was approved by the review board committee of the hospital. The use of pads for both groups was studied and it was found that oral group used the most pads 18.7 and 12.9 before and after the study respectively. Results: Duration of bleeding was examined. The patients in intrauterine group stated about bleeding for 7.8 days before the study and 5.9 days after the study. In case of oral group participants, they bled for 8.9 days before the study and 6.7 days after the study. Standard deviation and p value was calculated and results were statistically significant. Conclusion: The investigation of oral and intrauterine progesterone for patients suffering from dysfunctional uterine bleeding was studied and it was found that the rate of bleeding was more in case of oral group. Keywords: Intrauterine progesterone and oral progesterone.

Objective: To describe the trends in maternal mortality in tertiary care hospitals in the last five years and compare the mortalities in the previous ten years. Methods: All pregnant women from January 2016 to December 2020 were analyzed. The primary outcome of this research was maternal mortality ratios. Various causes of maternal mortality were also evaluated. The correlation between maternal characteristics and maternal mortality was inspected using logistic regression models. Pregnancy outcomes of mothers who died versus mothers who survived were also evaluated. Results: One hundred seventy-three maternal deaths were noted in 49283 pregnant women in 2016-2020. The average maternal mortality ratio in 5 years period was 409 per 100,000 live births. It showed a decreasing curve over the five years, from 539/100,000 live births in 2016 to 295 in 2020. Five year clusters also demonstrated a falling trend, from 856/100,000 live births to 409. Hemorrhage (34.68%), hypertensive disorders of pregnancy (21.38%), suspected cases of thromboembolism (20.80%) were the leading causes of maternal mortality. Pregnancy outcomes in mothers who survived and who expired were evaluated. Almost 33% of maternal deaths had stillbirths as compared to 4.69% in alive mothers (RR 6.87); similarly, unknown outcomes (RR7.56) and ectopic pregnancies (RR 3.01) were more frequent in cases of maternal demise. Conclusion: Trends in maternal mortality show a decreasing curve. Hemorrhage remains the leading cause. Attainment of SDGs requires interventions both at primary and tertiary health care. Keywords: Maternal mortality and Maternal Mortality Ratio (MMR), trends, causes of maternal mortality.

Aim: The aim of the study is to govern the incidence of urinary incontinence in pregnant women and its impact on the life quality as well as its relationship with the number of births and age. Study design: A Cross-sectional study. Place and Duration: In the Obstetrics and Gynecology department of Habib Medical Complex, Private Health Care Facility Peshawar for six-months duration from July 2021 to December 2021. Methods: In the third trimester, i.e., after 28 weeks, according to LMP (last menstruation) or ultrasound in the first trimester, 320 healthy pregnant women were interviewed and the information on proforma was recorded. Women who had been diagnosed with urinary incontinence, renal dysfunction, diabetes or gestational diabetes prior to pregnancy were omitted from the analysis. The main outcomes measured were incidence of urinary incontinence among pregnant females as recorded from interviews. The data was analyzed with SPSS 21.0 version. Results: Out of 320 women, 147 reported urinary incontinence and its incidence was 45.9%, 116 (78.9%) had stress incontinence (SI), and urge incontinence in 31 (21.1%). The general SI prevalence is 36.2 % and the UI prevalence is 9.7%. 130 primigravida participated in the study, 51 of which reported urinary incontinence. The incidence of UI in the third trimester of pregnancy was 45.9%. Conclusion: The result of this analysis shows urinary incontinence is a common occurrence during pregnancy. The results could help develop more intensive training programs to avoid UI during pregnancy by growing urinary incontinence awareness among healthcare professionals caring for pregnant females. The UI frequency in the pregnant population was 45.9%. Keywords: Stress urinary incontinence, urinary incontinence, religious activities and urge incontinence.