Objective: Comparative analysis of problems encountered betweenpatients of elective caesarean section and patients for whom elective caesarean section was planned but ended upin emergency caesarean section. Design: Descriptive prospective analysis. Setting: Gynae Unit-II, Services Hospital,Lahore. Duration: One year, 1 January 2006 to 31 December 2006. Patients & Methods: A prospective study of st st100 patients who presented for antenatal care (ANC) and for whom elective caesarean section (CS) was planned wasdone. Patients evaluation was done on a designed performa that included demographic, social and obstetrical histories.Problems encountered in the preparatory stage, logistic problems, administrative problems, problems encounteredduring surgery, maternal, fetal mortality and morbidity were noted. Results: The patients were divided into twocategories. Categories I: included patients who had elective CS and category II: included patients who ended up inemergency CS. Numerous problems were encountered for category II patients. In the preparatory phase there wasdifficulty in arranging medicines for 32 patients. (59.2%), arranging blood for 28 patients (51.8%), obtaining consentfor 1 patient (1.85%). Logistic problems included non-availability of operation theatre for 15 patients (27.75%), nonavailability of anaesthetist for 9 patients (16.65%), and non-availability of paediatrician for 38 babies (17.3%). Noneof the emergency CS were done with in the recommended 30 minutes interval. Despite this, there was no significantcoloration between the decision delivery interval (DDI) and perinatal outcome. In our study like threatening cases wereoperative within 60 minutes. Intra operative problems in the category II patients included adhesions in 40 patients (74%)vs 10 patients (21.7%) of category I, partial dehiscence in 16 patients (29.6%) of category II vs 4 patients (8.68%) ofcategory I. Excessive hemorrhage in 8 patients (14.8%) of category II vs 2 patients (4.34%) of category I. Among thepost operative complications anemia was present in 20 patients (43.4%) of category I vs 45 patients (83.25%) ofcategory II patients. Blood transfusion was required for 16 patients (29.6%) of category II vs 4 patients (8.68%) ofcategory I and all patients were given iron supplement. Major wound infection were seen in 9 patients (16.65%) ofcategory II vs 2 patients (4.34%) of category I. Resuturing was done after appropriate antibiotic cover and dailyantiseptic dressing. Minor wound infections were seen in 22 patients (40.7%) of category II vs 12 patients (26.04%)of category I. Urinary Tract Infections (UTI) was seen in 6 patients (11.1%) of category II vs 1 patient (2.17%) ofcategory I. Respiratory Tract Infection (RTI) was seen in 5 patients (9.25%) of category II vs 2 patients (4.34%) ofcategory I. All these were treated by appropriate antibiotic cover. Regarding the neonatal outcome 16 babies (29.6%)of category II were kept under observation in neonatal nursery (NNU) as compared to 6 (13.02%) babies of categoryI. Admission for 2-10 days in NNU were 8 babies (14.96%) of category II vs 2 babies (4.34%) of category I. 2 babies(3.74%) of category II expired later while none of category I. Conclusion: Patients for whom elective CS was plannedbut who ended up in emergency CS, the DDI was prolonged and there was increase risk of maternal morbidity, fetalmorbidity and mortality as compared to those patients who had elective CS.

To find outmaternal and fetal outcome in induction of labourcompared with expectant management for prelabour rupture of membranes at term. Design: Open randomizedcomparative study. Setting and period: Gynae Unit- II Services Hospital, from 1 April 2007 to 30 September 2007. stPatient and methods: 100 patients at > 37 weeks with ruptures membranes with no contraindication to vaginal deliverywere enrolled in the study. 50 patients were in the expectant group while 50 patients were in the induction group.Results: Both groups had the same general characteristics but the Misoprostol group had a significantly shorter latancyperiod (10-16 hour Vs 20-24 hours), shorter period of hospitalization, lesser LSCS rate (24% Vs 34%) lesser need ofaugmentation (40% Vs 62%), choroamnionitis (3%Vs 7.8%), and postpartumfever (1% Vs 1.8%) when compared withexpectant group. Rate of infected wound after LSCS were compared in induction and expectant groups (2.2% Vs2.6%), also there was no difference between them regarding neonatal morbidity and nursery admission. Conclusion:So it was concluded that there was slightly high maternal complications in expectant group but no long-term maternalmorbidity. Both groups have no effect on neonatal morbidity and mortality however the duration between PROM anddelivery effect the neonatal admission in nursery and antibiotic requirements.

Objective: To compare the successful outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hcg 1000-3000 IU/L. Materials & Methods: In this randomized controlled trial, total 90 patients of ectopic pregnancy having age 18-40 years and having size of ectopic mass< 4cm were selected from the Department of Obstetrics & Gynecology Combined Military Hospital, Bahawalpur from March 20 to September 20. Group A included patients in which expectant management was done while Group B included the patients in which medical management (single intramuscular injection of methotrexate in a dose of 50mg/m2) was done. After one week, successful outcome was compared between the both groups. Results: Total 90 women with tubal ectopic pregnancy were selected for this study. Comparison of successful outcome between the bot study groups was done. Mean age of the patients was 31.66 ± 6.44 years, mean gestational age was 7.83 ± 2.33 weeks and mean β-hcg levels 1565.45 ± 517.89 IU/L. In study group A, outcome was found successful in 40 (88.89%) patients and 31 (68.89%) patients of group B was found with successful outcome. After applying chi-square test, difference of successful outcome between the both groups was found statistically significant with p value 0.037. Conclusion: This study concluded that expectant management is associated with better outcome (β-hcg levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac) within one week) as compared to medical management in women with tubal ectopic pregnancy having β-hcg between 1000-3000 IU/L Keywords: Ectopic pregnancy, methotrexate, expectant, resolution

Objectives: To compare the perinatal outcome (low birth weight, preterm delivery) in women with <6 month versus 12-17 months of interpregnancy birth interval. Material and methods: This Cohort study was conducted at Department of Obstetrics and Gynecology, Lahore General Hospital Lahore from March 2020 to September 2020. Total 420 patients with age range 18-40 years, singleton pregnancy, women with previous live birth, parity 1-4 and Gestational age > 28 weeks assessed on LMP were selected for this study. Patients were divided into two groups (A & B) according to their inter-pregnancy interval i.e. <6 months group labelled as A group and 12-17 months group labelled as B group. All patients in both groups will be followed till delivery and the perinatal outcome i.e. preterm delivery (birth occurred before completion of 37 weeks of gestation) and low birth weight (those babies whose weight less than 2.5 Kg at the time of birth) were noted. Results: The mean age of women in group A was 26.73 ± 6.56 years and in group B was 26.73 ± 6.56 years. The perinatal outcome was preterm delivery in 189 (90.0%) and low birth weight babies in 143 (68.10%) women of <6 months while in 12-17 months interpregnancy interval, it was noted in 111 (52.86%) and 102 (48.57%) women respectively Conclusion: Our study concluded that appropriate inter pregnancy interval could reduce the rate of preterm delivery and low birth weight babies and optimal interval associated with the lowest risk of adverse perinatal outcome was 12-17 months. Keywords: Birth spacing, short interval, preterm delivery, low birth weight.

Apart from the physical effects of Covid-19, psychological effects are seen as well in the general population. In pregnant females, psychological impact leads to adverse pregnancy and neonatal outcomes. Due to limited data, the mental health of COVID-19 positive pregnant patients is not clear especially in relation to isolation in hospital, treatment, time and mode of delivery. Objective: To determine and compare frequency of anxiety and depression in pregnant women with and without COVID-19. Material and Methods: It was a comparative cross-sectional study that was conducted in the department of Obstetrics and Gynaecology, SGRH, Lahore. 60 pregnant females were enrolled and underwent nasopharyngeal swab for PCR and had HRCT to determine Covid-19 status. HADS was applied on all pregnant females to assess depression and anxiety and findings were subjected to statistical analysis. Results: The mean age, gestational age, anxiety scores and depression scores were 29.93±4.15, 31.1±6.28, 10.56±3.29 and 10.02±2.72 respectively. There were 60% Covid positive pregnant females, depression was present in 31.7% and anxiety was present in 65% females. Comparison of pregnant females with or without Covid infection in terms of depression and anxiety using independent T-test revealed that anxiety was significantly associated with Covid positive status (p=0.032), however, no significant association was seen between depression and covid status (p=0.641) (table 3). Conclusion: Covid-19 was frequently seen in pregnant females and was significantly associated with high frequency of anxiety. Depression was less commonly seen and was not significantly associated with Covid-19 infection. Keywords: Covid-19, Pregnancy, Depression, Anxiety, HADS