Background: Massive obstetrical hemorrhage, a leading contributor towards maternal fatality in economically developing countries, is occasionally related with the passive and apathetic management of the third stage of labor. The increasing frequency of anaemia among pregnant women in developing countries, mild to moderate blood loss during labour necessitates massive transfusions with associated complications. Aim: Recent studies claimed that prophylactic tranexamic acid can significantly reduce the mean blood loss during 3rd stage of labour and advocated it in future practice. Methods: The research was conducted as randomized controlled trial carried out from February 2021 to October 2021 in the Department of Diagnostic Radiology and Obstetrics & Gynaecology Department, Ganga Ram Hospital, Lahore. A total of 116 pregnant women aged between 18-35 years presenting in labor at term (37-42 weeks of gestation as per dating scan) which were randomly allocated into two groups. Patients in Group-A were given additional tranexamic acid at the end of 2nd stage of labor while those in Group-B received conventional treatment alone. Results: Patients were 28.33±4.77 years with the mean age while the mean gestational age at delivery was 39.39±1.69 weeks. 30(25.9%) women were primiparas and 86 (74.1%) were multiaparas. The mean BMI of these patients was 27.50±3.90 Kg/m2 while the average duration of 3rd stage of labor was 4.69±1.83 minutes. Patients taking prophylactic tranexamic acid lost significantly less blood in the third stage of labors than controls (244.83±21.47 vs. 354.09±22.36 ml; p-value<0.001). Conclusion: In the present study, prophylactic tranexamic acid was found to significantly reduce the mean blood loss during 3rd stage of labor which along with low cost, widespread availability and oral administration advocates the routine use of tranexamic acid (during 3rd stage of labor) in future obstetric practice to minimize blood loss with subsequent decreased need for blood transfusion and better patient’s recovery. Keywords: Third Stage of Labor, Blood Loss, Tranexamic Acid

Objective: To assess the maternal outcome of primigravida patient with term pregnancy with engaged versus unengaged foetal head at onset of labour Design of the Study: It was a cohort study. Study Settings: The study was conducted at Department of Obstetrics & Gynecology Rashid Latif Medical College, Lahore from January 2021 to June 2021. Material and Methods: This study involved 160 primigravida at term (as per dating scan) aged between 18-35 years who were divided into cases (women with unengaged fetal head) and controls (those with engaged fetal head). Outcome variable were frequency of cesarean delivery, low birth weight, poor APGAR score at 1 and 5 minutes and NICU admission which were noted and compared between the groups. Results of the Study: The mean age of the patients was 23.9±3.8 years while the mean gestational age was 39.0±1.3 weeks. The frequency of poor APGAR score at 1 minute (25.0% vs. 5.0%; p-value<0.001; 95%CI RR=5.00) and cesarean delivery (38.8% vs. 16.3%; p-value=0.001; 95%CI RR=2.39) was significantly higher in women with unengaged fetal head at term. However, there was no statistically significant difference between the groups in terms of poor APGAR score at 5 minutes (5.0% vs. 2.5%; p-value=0.405; 95%CI RR=2.00), NICU admission (10.0% vs. 8.8%; p-value=0.786; 95%CI RR=1.14) and low birth weight (7.5% vs. 3.8%; p-value=0.303; 95%CI RR=2.00). Conclusion: In the present study, unengaged fetal head at term was associated with poor APGAR score at birth and increased risk of cesarean delivery which advocates that women with unengaged fetal head at term should be considered as high risk so that anticipated management may improve the fetomaternal outcome Keywords: Primigravida, Unengaged Fetal Head, Fetomaternal Outcome

The most common complication 0f the third stage of labour is postpartumhaemorrhage, which remains a leading cause of maternal mortality (25.0%), especially indeveloping countries. In developed countries, 3-5% of deliveries are complicated by postpartumhaemorrhage: in developing countries, it is 50 times more common .Third stage of labourwhich exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage andpuerperal infection. The best preventive strategy for these complications is active managementof third stage of labour. Active management includes administration of oxytocin within oneminute of birth of baby. Objectives: To compare the mean blood loss after administration ofintra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active managementof third stage of labour. Study Design: Randomized controlled trial. Period: Six months from1-1-2013 to 30-06-2013. Setting: Department of Obstetrics and Gynaecology, Unit-III JinnahHospital Lahore. Methodology: 100 patients fulfilling selection criteria were included in thestudy from labour room. These patients were randomly divided into two groups by usinglottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml ofnormal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocinintravenous stat at anterior shoulder. Total blood loss was noted after complete delivery ofplacenta. Results: Mean age was 25.0±3.9 and 24.4±3.5 in group-A and B, respectively. Meangestational age was 38.20±0.96 weeks in group-A and 38.40±0.94 weeks in group-B. Meanblood loss in intraumbilical oxytocin group was 311.20±27.23 ml and in intravenous oxytocingroup mean blood loss was 373.60±66.47 ml. There was statistically significant differencebetween two groups (p<0.001). In group-A 15 patients (30.0%) and in group-B 20 patients(40.0%) were primigravida while remaining patients were multigravida. Conclusion: The usageof intraumbilical oxytocin in active management of third stage of labour is beneficial in reducingthe blood loss in third stage and thus helps in preventing postpartum haemorrhage.

Background: Abnormal uterine bleeding (AUB) is a common and distressing condition effecting predominantly perimenopausal women. Heavy menstrual bleeding (HMB) is the most common presentation of AUB. There are many structural and non structural causes of AUB. Histopathology of endometrial curettings is well studies before but the histopathological patterns of hysterectomy specimens are not well studied. Objective: The objective of this study is to: Find out histopathological diagnosis of hysterectomy specimens in patients of AUB. Study Design: Retrospective Cohort study. Place and Duration of Study: Gynecology and Pathology departments of Azra Naheed and Rashid Latif medical colleges from January 2022 to January 2023. Methods: Histopathology reports of all hysterectomies done for AUB in both medical colleges allied hospitals were retrieved retrospectively and evaluated in detail. Four age groups were defined 30-40 years, 41-50, 51-60 and 61-70 years. Various patterns were recorded overall and separately for each group and results established. Results: A total of 221 abdominal hysterectomy histopathology reports were retrieved and evaluated. All hysterectomies were performed for AUB during one year period between January 2022 to January 2023. 40(18.09%) women were between 30-40 years of age, 134(60.6%) were between 41-50 years of age, 39(17.6%) were between 51-60 years of age and 08(3.61%) patients were between 61-70 years of age. Distorted proliferative phase endometrium was seen in 28(12.6%) of cases, Adenomyosis was seen in 76(34.38%), endometrial polyps in 19(8.55%), fibroids in 92(41.6%), metaplasia 07(3.1%), hyperplasia 10(4.5%), and endometrial carcinoma was seen 09 (4.07%) of cases. Conclusion: AUB is most common in perimenopausal women. Fibroids, Adenomyosis, and disordered proliferative endometrium were most common in perimenopausal women while carcinoma endometrium was most common cause of AUB in postmenopausal women. This study will help Gynecologists to better find out the cause of AUB and treat accordingly. Keywords: Abnormal uterine bleeding (AUB), Heavy menstrual bleeding (HMB), Perimenopausal, Hysterectomy. Histopathology, Endometrium