ABSTRACT Background: The frequency of hysterectomy varies in same geographical area. The objectives of this study were to determine the type, time trend and indications of hysterectomy in our population. Materials & Methods: This cross-sectional, study was conducted in the Department of Gynecology and Obstetrics, Gomal Medical College, D.I.Khan, Pakistan, from 1st January 2013 to 31st December 2016. A sample size of 571 was selected through consecutive technique. Inclusion criteria were all hysterectomies done for gynecological indications. Demographic variable was age groups. Research variables were type, time trend and indications for hysterectomy. All variables being categorical were expressed as frequency and percentages. 95% confidence interval for proportion were calculated. SPSS version 19 was used for statistical analysis. Results: Out of 571 hysterectomies, 333(58.31 %) were abdominal and 238(41.68 %) were vaginal. Age-wise distribution of hysterectomies shows >61 is the modal age group. The hysterectomy frequency increased from 7% of total gynecological admission during 2013 to 17% of total gynecological admission in 2016. The indication for hysterectomy by type from 2013-2016 was menstrual disorders and uterine prolapse. Conclusion: Trans abdominal hysterectomies were more common than vaginal hysterectomies. Most common age group for hysterectomy was older than 60 years. The indication for abdominal hysterectomy was menstrual disorders whereas the only indication for vaginal hysterectomy was uterine prolapse. Line diagram was showing an increase in hysterectomy frequency over time from 2013-16.

Background: Menstrual hygiene refers to the safe and easy access to menstrual products, infrastructure, information, and supplies, necessary for menstruating women to cope with their menstruation with decorum and console, along with systemic factors linking menstruation with health, empowerment and gender equality among other things. The effects of unmet menstrual hygiene needs on women's health have been the subject of very little research. Women around the globe have widespread unmet-menstrual-health requirements, including the inability to access safe, clean facilities and cheap period supplies, which exposes them to socioeconomic depression and serious reproductive tract infections. Aims: Therefore, to determine the unmet menstrual hygiene needs of impoverished women, this study was conducted in the Southern region of Khyber Pakhtunkhwa, Pakistan, during the year 2021, to identify the women's needs for menstrual hygiene, to rule out the risk of infections due to menstrual unhygienic, perceptions of females for unmet menstrual hygiene beyond affordable ranges and health hazards associated with it. Methods: The 1538 females took participation in the study, which investigated their unmet menstrual hygiene needs through an approved questionnaire in the area. Additionally, their period poverty, accessibility, and ability to acquire menstrual hygiene items were evaluated. Results: The average age range of the surveyed women was 28.50 + 3.12 (years) and their age at menarche was 11.8 + 2.4 (years). It was seen that a significantly higher percentage (P<0.05) of women (1506/1638; 97.91%), knew the use of menstrual pads to stop blood staining during menstruation, while, 2.66% of females knew how to use tampons. It was found that a significantly higher ratio (P<0.05) of women was suffering from the period property (59.68%) and most of them were deprived of using hygienic products in their menstrual cycle. Nonetheless, the majority of women used period pads (58.45%), followed by cotton (38.29%) and tampons (7.73%). While 9.03% (n=139/1538) of women were driven to use unsanitary diapers, rags, and other materials due to a lack of access to hygienic items, due to financial constraints. Significantly (P<0.05) less percentage of women were aware of the menstrual cycle (18.58%), the dangers of menstrual unhygienic (16.18%), and the risks of genital infections brought on by menstrual unhygiene (9.42%). But a substantially (P<0.05) larger fraction of females (1506/1638; 97.91%) were aware of using menstrual pads. However, just 2.66 percent of females knew how to use tampons, indicating that its use is not well known among women. The female population suffered from food insecurity at a rate of 17.94% and had a depressed socioeconomic position at a rate of 32.44%. Biological samples were obtained from 230 willing participants for the diagnosis of MHM-associated infections. Because urinary tract infections (UTI) and bacterial vaginosis (BV) are the two most prevalent illnesses linked with MHM in women, only 230 individuals consented to the collection of samples, which were then analyzed for these conditions in the laboratory. And 16% of females were revealed to have UTIs. While, 8.9 and 8.7% of females were infected with Trichomonas vaginalis and Gardnerella vaginalis bacterial vaginosis, respectively. Additionally, 6.1% of females had vaginal candidiasis. Practical implication: This study will create awareness among the general community that use of unhygienic products during menstruation are hazardous and may result in serious reproductive tract infections. Conclusion: According to the findings of our study, it was determined that due to their poverty, lower-class women lacked access to menstrual hygiene products, were susceptible to urinary and reproductive tract infections, and had a decreased socioeconomic standing in the community. Therefore, the government and non-government organizations should adopt stringent efforts to ensure gender equality and equity among menstruators and to assist low-income women in obtaining menstrual pads and other hygienic materials to protect their mental and physical health. Keywords: Bacterial vaginosis; Menstrual hygiene; Menstrual pads; Tampons; UTI.

Introduction: Using acetic acid to inspect the vaginal canal is a simple screening procedure done with the naked eye. During a speculum examination, the cervical transformation zone is painted with acetic acid 3% to 5% or vinegar. It is a simple, cost-effective screening tool that can be used in poor developing countries with high rates of invasive cervical cancer mortality because acetic acid coagulates nuclear proteins, resulting in white discoloration of the transformation zone in CIN and early invasive cancer. Objective: This study aims to measure the effectiveness of a simple and economical screening test, visual inspection with acetic acid (VIA), for diagnosing cervical intraepithelial lesions in comparison to the gold standard of histopathology using a study population of women attending a gynecology outpatient department. Study Design: The study used a cross-sectional design to validate the findings. Study Area: This study was conducted in the Obstetrics & Gynecology Department, Women and Children Teaching Hospital, Dera Ismail Khan. Study Duration: This study took place between November 2018 and April 2019. Materials and Methods: The study included 414 women with abnormal vaginal bleeding. Under a good light source, a lubricated Cusco's speculum was introduced into the vagina to evaluate the cervix for gross abnormalities. A cotton swab was used to apply 3% acetic acid to the cervix and acetowhite changes were observed for one minute. Positive results were considered when distinct acetowhite areas were detected, while negative results were considered when light, faint, or doubtful aceto-white areas were detected. Results: There was a range of age from 18 to 40 years in this study with a mean age of 30.772 years and a mean weight of 71.644 kilograms. For diagnosis of cervical intraepithelial lesions, acetic acid visual examination has shown a sensitivity of 84.38%, specificity of 97.11%, diagnostic accuracy of 95%, PPV of 84.38%, and NPV of 97.11% (p=0.000). Practical implication: The purpose of this study is to compare the efficacy of a simple and inexpensive screening test, visual inspection with acetic acid (VIA), to the gold standard of histopathology in a study group of women attending a gynecological outpatient service. Cervical cancer is a leading cause of death among women in developing countries, where access to advanced diagnostic tools is limited. If VIA proves to be an effective screening tool, it could be widely implemented in low-resource settings to improve early detection and treatment of cervical cancer. Conclusion: VIA is considered an appropriate screening alternative for a large population. In contrast to cytology-based programs, it is highly sensitive, low-cost, and yields immediate results. Keywords: Cervical Cancer; Visual Inspection with Acetic Acid; Screening

Objective: To determine the mean prolongation of pregnancy via human Chorionic gonadotropin (H.C.G) in patients presenting with preterm labor. Materials and methods: This descriptive case study was conducted in obstetrics and gynecology department, Women and children teaching hospital Dera Ismail khan from October 21, 2019, to April 20, 2020. Result: A total of 123 pregnant women with preterm labor were included in the study. Average age was 25.44 years+4.70sd with range 16-35 years. Prolongation of pregnancy by human chorionic gonadotropin (HCG) of more than 30 days. Fifty-eight (47.2%) of preterm women were observed with prolongation of pregnancy of less than 30 days. Practical implication: Suppression of Preterm Labor in the females using H.C.G. Conclusion: The trial concluded that HCG is the better option in the prolongation of pregnancy in women with preterm delivery. Keywords: Preterm delivery, Prolongation of pregnancy, NICU.

Background: In developing countries, miscarriage is one of the common and increasing problems of pregnancy. The objectives of this study were to determine the frequency of pre-gestational diabetes mellitus among pregnant women with miscarriage in our population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 3rd November 2015 to 2nd May 2016. Sample size was 268 pregnant women with miscarriage selected through consecutive sampling technique. Inclusion criteria were all pregnant women with miscarriage. Exclusion criteria were molar pregnancy, ectopic pregnancy and diabetics. HbA1c levels of ≤6% was taken as normal, whereas a level >6 was taken as raised level or pre-gestational diabetes. Variables were age, pre-gestational diabetes mellitus, number of pregnancies and duration of pregnancy (≤24, >24). Mean and SD were calculated for quantitative while frequency and percentages for qualitative variables. Descriptive analysis was performed by using SPSS version 16. Results: Mean age of the patients was 27.66 ±4.93 years. Out of 268 participants, 81(30.22%) were having pre-gestational diabetes mellitus and 187(69.78) were normal, 234(87.31%) were having first pregnancy whereas 34 were having >1 pregnancies, the pre-gestational age ≤ 24 weeks were 130(48.51%) and >24 weeks were 138(51.49%). Conclusion: One third of the patients with miscarriage were having pre-gestational diabetes mellitus. Almost half of the patients were having gestational age of