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 ...

Objective: The post-partum intrauterine contraceptive device (PPIUCD) is a highly effective, long acting, reversible, economical and easily accessible family planning method. The aim of the study was to estimate the proportion of pregnant women aware of immediate post-partum intrauterine contraceptive device and to analyze the factors associated with acceptance. Methodology: This is a cross sectional study in which 300 pregnant were selected who were visiting the antenatal clinics and admitted in early labor in labor ward. Their awareness and acceptance for PPIUCD was assessed through a structured questionnaire. Factors associated with acceptance were analyzed and the reasons for acceptance or refusal were determined. Results: In this study the awareness of PPIUCD was found to be 46% and the acceptance rate of PPIUCD was 18%. The major reason for refusal was that women don’t think they need contraception immediately after delivery and secondly, they need to talk to their partners for the decision. Most common reasons for acceptance of PPIUCD was that it is long acting and reversible. Gravidity (p= 0.006), parity (p< 0.001), unplanned pregnancy (p= 0.002) and inter pregnancy interval (p= 0.004) were the factors significantly influencing the acceptance of PPIUCD. Conclusion: This study revealed that awareness regarding PPIUCD is increasing in women but acceptance is still poor. It was due to misconception that no contraception is needed in postpartum period. Provision of adequate knowledge regarding convenience and effectiveness of post-partum contraception in preventing unintended pregnancies can play vital role to increase its acceptance.

Background: College is the time where most mental health disorders are triggered. Due to an extremely strenuous curriculum, medical students are prone to develop high levels of stress. Teaching students stress management skills can be crucial for their mental and physical well being. Objectives of the study were to measure perceived stress level among undergraduate medical students of Year 5 using PSS Scale, and to explore if students find stress management activities helpful in reducing stress. Methods: It was a quasi experimental study.5th year medical students were asked to take part in a full day workshop regarding stress management. During the day they were introduced to different stress management activities. Stress levels were measured using PSS before the workshop and 1 month after the workshop.  Results: On the PSS 1, 17.9% participants scored in the low stress category, 61.1% participants scored in the moderate stress category and 21.1% scored in the high stress category. On the PSS 2, 11.6% participants scored in the low Stress category, 76.8% participants scored in the moderate stress category and 11.6% scored in the high stress category. Pre and post intervention PSS stress results were statistically significant, p< 0.05. Conclusion: Majority of the final year students had moderate stress. Training undergraduate medical students in integrated stress relieving activities can help lower their perceived stress.

Background and Aim: The obstetrical complications of pregnant women might elevate to a severe stage due to ongoing severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). Limited study focused on association between COVID-19 and pregnant women adverse outcomes. The present study was carried out to evaluate the severity of COVID-19 among pregnant women and risk of adverse maternal outcome. Materials and Methods: This cross-sectional study was carried out on 242 pregnant women of confirmed COVID-19 cases hospitalized in Aziz Fatimah Hospital, Faisalabad and Holy Family hospital Rawalpindi for six months duration from 5th December 2020 to 5th May 2021. Pregnant women demographic details, obstetric characterizations, adverse maternal outcomes, and laboratory findings were noted. Positive tested pregnant women through RT-PCR regardless of clinical symptoms and signs were enrolled as confirmed cases while negative tested pregnant women were excluded. Hypertensive disorders, preexisting pulmonary, obesity, renal, nulliparity, and cardiovascular disease were the maternal risk factors. Different variables were assessed through fisher’s test and regression logistics model. Results: Of the total 242 pregnant women, the prevalence of mild to moderate symptoms, and severe disease were 187 (77.3%) and 43 (17.7%) respectively. About 12 (5%) had a critical stage of the disease. During this study period, about 31 (12.8%) were admitted to the intensive care unit (ICU) and 9 (3.7%) died. Mode of delivery, maternal age, underlying conditions, parity, and admission to ICU were the important demographic factors in severe COVID-19 disease. Other severe maternal outcomes were fever, cough, breath shortness and anosmia. Increase ICU admission and cesarean section delivery were significantly associated with disease severity. Conclusion: Our study founds a mortality rate of 3.7% among pregnant women with COVID-19. A higher prevalence of intensive care admission and cesarean delivery were reported in acute and severe COVID-19disease. The obstetrical and neonatal outcomes significantly affected by the severity of maternal disease; neonatal prematurity, ICU admission, and cesarean sections complications. Keywords: COVID- 19, Pregnant women, Adverse maternal outcomes