The most popular form of family planning is tubal ligation. Decades-long debates have surrounded the possibility of the post-tubal ligation syndrome of menstrual irregularities. Objective: To study the frequency of menstrual irregularities after tubal ligation in women attending gynecological outpatient department of a tertiary care hospital setting. Methods: A cross sectional study was conducted on 126 females who had history of post tubal ligation syndrome. Cases were verified and data were collected. Duration and length of menstrual cycle was noted. Laboratory examination was done. Duration of tubal ligation was also noted. Their age, name and hospital registration number were also noted down. A control group of 50 healthy females was made for the comparison of menstrual disturbance. Result: The patients mean age was 39.5±3.4 years. Maximum of the patients 71(56.3%) of the patients had age between 37 to 42 years. The duration of tubal ligation observed in 118 (93.7%) of the patients more than or equal to 1 year. Type of menstrual disturbance such as polymennorrhea in 76(60.3%), menorrhagia in 51(40.5%) and intermenstrual bleeding in 9(7.1%) of the patients respectively. Final outcome menstrual irregularity was presented in 74 (58.7%) of the patients. Age group with menstrual irregularity was presented in 40(53.5%) patients versus 31 (43.7%) patients who had absent menstrual irregularity. Similarly, duration of tubal ligation was compared with menstrual irregularity and presented in 69(58.5%) of the patient compared with 49(41.5%) patients who had absent menstrual irregularity. Conclusion: The older group of patients has high prevalence of menstrual irregularities.

Background and Aim: Acute kidney injury (AKI) is a serious complication in perilous patients substantially related to long-term chronic kidney disease (CKD) with increased morbidity, hospital duration, and mortality. AKI during pregnancy is a life-threatening disease related to maternal and fetal loss contributing to 30% to 60% of mortality. Though a rare cases of AKI during pregnancy has been reported in previous studies. But the present study aimed to assess the acute kidney injury during pregnancy and puerperium. Methodology: This cross-sectional study was conducted on 205 pregnant or puerperium women with acute kidney injury or acute renal failure in the Department of Gynaecology and Obstetrics and Nephrology, Liaquat National Hospital, Karachi from January 2019 to December 2021. All the pregnant women of age 22 to 40 years with no prior co-morbidities were enrolled in this study. Patients with history of autoimmune disease, chronic kidney disease before pregnancy, higher level of serum creatinine, hypertension before gestation and renal stone diseases, renal scarring on ultrasonography or small size of the kidneys were all excluded. An informed consent was taken from all the patients. Patient’s detailed history, laboratory investigations, demographic details, and clinical presentation were recorded. Laboratory examination involve CBC and renal function tests. Each patient had a thorough obstetric examination. Hemodialysis was performed as per standard indications. Acute kidney injury was assessed. SPSS version 25 was used for data analysis. Results: The incidence of acute kidney injury in pregnant and puerperium women was 21.5% (n=44). The overall mean age was 31.42 ± 4.35 years. Mean parity was 3.2. During pregnancy, the most prevalent cause of acute kidney injury was pre-eclampsia with incidence rate of 28 (63.6%) followed by postpartum hemorrhage in 8 (18.2%). About 6 (13.6%) patients had regain renal function and discharged from the hospital. Maternal mortality was found in 2 (4.5%) cases. Of the remaining 161 pregnant women without AKI cases, the prevalence of postpartum hemorrhage, HELLP syndrome, pre-eclampsia/eclampsia, and pregnant fatty liver were 58 (36.02%), 17 (10.6%), 66 (41%), and 20 (12.4%) respectively. Apart from hemorrhagic shock and amniotic fluid embolism, maternal outcomes was good. No significant association was found between acute kidney injury and outcomes with 5% level of significance. Conclusion: The present study found a higher prevalence of acute kidney injury in pregnant women. Pre-eclampsia and postpartum hemorrhage was the prevalent causes for AKI in pregnant women. Postpartum hemorrhage and amniotic fluid embolism were the major causes for mortality of pregnant women with AKI. The mortality of pregnant women with AKI is mostly caused by postpartum hemorrhage and pre-eclampsia. Poor outcome might be predicted by renal therapy need in acute kidney injury. Further studies is required to be conducted in order to improve pregnancy associated AKI outcomes. Keywords: Acute kidney Injury, Pregnant women, Puerperium

Introduction: Many women of reproductive age experience polycystic ovary syndrome (PCOS), characterized by growth of cysts on the ovaries that range in size from 2 to 10mm in antral measurement, oligomenorrhea, menorrhagia, acne and hyperandrogenism. Objective: The study aimed to correlate the rational of PCOS with infertility in women. Place and Duration: The study was conducted in different districts of Sindh in Pakistan during the period 2020-22. Methods: This cross-sectional study aimed to determine how common infertility was among women with PCOS who sought care at different gynecological clinics. Pathological investigation of the patient's hormonal profile, including serum insulin, serum prolactin, LH, FSH, and serum testosterone levels were also investigated. Results: 316 of infertile women (63.20%) were diagnosed with PCOS. Females had oligomenorrhea as the predominant (p<0.05) pattern of the PCOS-affected females. Acne, hirsutism, and hyperandrogenism were significantly (P<0.05) more common among these women. In women with PCOS, the level of testosterone was significantly elevated (132+2.39 ng/dl; P<0.05). Conclusion: PCOS is the leading cause of infertility owing to anovulation, as affected women displayed severe clinical manifestations of oligomenorrhea, hirsutism, acne, hyperandrogenism, and elevated testosterone levels and thus can easily be diagnosed and treated accordingly.

Background and Aim: Polycystic ovary syndrome (PCOS) is a new rising disorder of reproductive, metabolic, and endocrine disorders of young females of reproductive age suffering from insulin resistance, increased levels of androgens, and altered morphology of ovaries with multiple cysts, and oligoanovulation. The burden of disease is significantly high with a global prevalence of 5% - 10% of reproducing females. Literature has reported a positive correlation between diabetes mellitus in the family and the resultant risk of developing PCOS among the female population. This study will aim to assess the correlation between the familial history of diabetes mellitus and concurrent risk of developing PCOS in a tertiary care hospital in Lahore, Pakistan. Methodology: A cross sectional study was conducted in the Medicine and Gynecology department of Sir Ganga Ram Hospital, Lahore for duration of four months from October 2021 to January 2022. Participants were recruited following inclusion and exclusion criteria. Sample population was estimated to be 150 females. Participants were recruited by convenient sampling. After recruitment participants underwent physical, clinical, and serological assessment. Diagnosis of PCOS was made by following Rotterdam criteria. Data collection was done by 14 points questionnaire and history interview. Results: This study showed that all participants diagnosed with PCOS have a history of early menarche, increased level of heartbeats, a large volume of ovaries, and a lesser volume of uterus. Patients also showed increased peripheral follicles. Serologic outcomes of participants showed a generalized increase in TT levels and a generalized decrease in SHBG levels with 1.71 (1.04-2.23) nmol/L and 45.39 ± 24.44 nmol/L respectively. About 56.2% (n= 83) of the participants gave a history of the abnormal menstrual cycle and 70.3% (n= 104) of the population agreed to abnormal hair growth on the body. When assessing the history of diabetes mellitus prevalence among families of the participants, the results showed that 19% of the population (n= 28) gave a positive history of diagnosed diabetes mellitus of both mother and father, 21.1% of the participants (n= 31) suggested that their parents were never tested for diabetes mellitus before, whereas remaining 43.8% (n= 89) gave no familial history of diabetes mellitus. Conclusion: The study concludes that the most common characteristics of PCOS among the population of Pakistan is increased weight followed by abnormal hair growth, participants present with increased TT and decreased SHBG levels. Familial history of diabetes mellitus is considered a risk factor for developing PCOS. Keywords: Familial diabetes, Diabetes mellitus, Polycystic ovary syndrome, Risk factors of PCOS