Background & objectives: Several positions are used for performing subarachnoid block with varying difficulty of spinal access. Pendant position is known to reduce lumbar lordosis in patients’ especially pregnant patients making spinal access easier. The most ideal position for the easy spinal access is yet to be determined. This study was planned to compare ease of spinal access in pendant position vs. traditional sitting position (TSP) in pregnant females, and to establish the superiority of the former. Methodology: This randomized controlled trial was conducted in our hospital on 232 subjects over 6 month period. Parturients undergoing elective lower segment cesarean section (LSCS) were randomly divided into two groups: Group A (pendant group) and Group B (TSP group). Spinal puncture was performed at L3-L4 interspace, randomly making one of the two positions. Time for successful spinal, number of needle-to-bone contacts and total number of attempts were recorded. Results: The median age of the patients was 29 yrs with the interquartile range (IQR) 7. The number of needle-to-bone contacts in Group A was significantly higher compared to Group B (59.48% vs. 33.62%, p = 0.000). Mean time for successful spinal puncture was less in Group A than Group B (17.69 sec vs. 25.54 sec, p = 0.001). The difference in number of attempts for spinal in both positions was not significant. Conclusion: Pendant position is better than traditional sitting position in achieving successful spinal puncture in terms of needle-to-bone contacts and the time to puncture. However there is no difference in number of attempts for both positions. Key words: Traditional sitting position; Pendant position; Spinal anesthesia; Cesarean section Citation: Arshad QUA, Jadoon H, Raza A, Furqan Z, Shahani YA. Comparison of successful spinal puncture between pendant position and traditional sitting position for cesarean deliveries. Anaesth. pain intensive care 2020;24(6):--- Received: 13 July 2020, Reviewed: 28 September 2020, Accepted: 29 September 2020

Introduction: Eclampsia is an acute obstetrical emergency carrying high maternal and perinatal morbidity and mortality. High blood pressure during pregnancy after 20 weeks of gestation is associated with proteinuria and generalized tonic-clonic convulsions. The purpose of the study is to observe seasonal variation in the presentation of eclampsia in a tertiary-level hospital. Methods: This is two years study conducted in the Gynae A unit, Ayub teaching hospital, Abbottabad, from January 2021 to December 2022. The study included all the patients admitted to the unit with eclampsia. It included antenatal patients and patients who developed eclampsia in labour or perpurium. Patients with a history of fits due to epilepsy or any other neurological disease were excluded from the study.  Results: The total number of patients admitted with eclampsia during this period was 88 (1.22 %). The majority of patients were in the age group between 21 to 35 years (78.3%). There were 52 primigravidas out of 88(59.1%). There were 46 multigravidas (40.9%). 78 patients out of 88(88.6 %) belonged to areas more than 25 kilometres away from a medical facility. The season was cross-tabulated with different variables, and no statistical significance was found. Conclusion: Eclampsia is a severe obstetrical emergency usually involving young primigravidas with poor socioeconomic status and no antenatal care. Primary prevention is regular antenatal care. Early referral and time management will reduce maternal and perinatal morbidity and mortality. The incidence of eclampsia is more in the fall and winter seasons.

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Purpose Women of reproductive age who carry fragile X premutation (PM) alleles have 56 to 200 CGG repeats in the 5′-untranslated region of FMR1 gene are at increased risk for producing children with intellectual disabilities (ID) or autism spectrum disorders (ASD) due to expansion of PM alleles to full mutation alleles (> 200 repeats) during maternal transmission. Methods In present study fragile X PM carrier screening was performed in total 808 women who were consulting primary health care centers for preconception care in Khyber Pakhtunkhwa region of Pakistan between April, 2018 and December, 2020. Polymerase chain reaction (PCR) was performed for detection of PM carrier women and the CGG repeats number was confirmed by Southern blotting and capillary electrophoresis. Results The prevalence rate for PM carriers among preconception women was found to be 0.7% that was contributed by 0.5% women in risk group (RG1) with family history of ID and 0.2% in risk group 2 (RG2) with family history of ASD. PM carrier women had at least one affected child or sibling. In addition, the preconception women with FMR1 PM alleles were found to be at increased risk for primary ovary insufficiency (RG1: P = 0.0265, RG2: P = 0.0389), postpartum depression (RG1: P = 0.0240, RG2: P = 0.0501) and neuropsychiatric disorders (RG1: P = 0.0389, RG2: P = 0.0432). Conclusions Current study provides first evidence of fragile X PM carrier screening in Pakistani preconception women in primary care consultation. Findings of current study may help to improve preconception care and to reduce burden of fragile X associated disorders in our population.