Background: After menstrual irregularities, second common gynecological problem is vaginal discharge. Change in dynamic ecosystem of vaginal flora can cause the overgrowth of pathological microorganism that creates vaginal discharge. Owing to syndromic approach in low income countries, the identification of specific causative organism is masked. Aim: To determine the frequency of various micro-organism in high vaginal swab obtained from women in outpatient department presenting with vaginal discharge. Methodology: We conducted this cross sectional descriptive studybetween January 2022 to December 2022 at Hayatabad Medical Complex, Peshawar. 431 patients were enrolled according to selection criteria. Attending Gynecologist carried out the complete evaluation & established a clinical diagnosis & collected HVS and sent to microbiological laboratory of the institution for reporting. In order to evaluate the participant characteristics and the prevalence of vaginal infections, descriptive statistics were performed. Results: Of the 431 patients who presented with vagina discharge, their high vaginal swabs were sent for culture, 245(57.1%) cases were found positive for pathogens. Among the positive cases, bacterial vaginosis (29.21%) was followed by vaginal candidiasis as the most prevalent microbiological cause of abnormal vaginal discharge (21.2%), trichomonasvaginalis (15.5%) and combined infection (1.63%). Among the positive culture (32.2%) women had normal flora and (43.2%) patients with vaginal discharge had no growth on culture. Practical implication: To detect the most common organism found in vaginal discharge and treat promptly to reduce drugs resistance and prevent complications like chronic pelvic pain preterm labour and infertility. Conclusion: Bacterial vaginosis is the most frequent finding of women presenting with vaginal discharge in Out-Patient Department of our hospital followed be vaginal candidiasis and Trichomonasvaginalis. Keywords: High vaginal swab,Trichomonasvaginalis, Bacterial vaginosis, Vaginal discharge Vaginal candidiasis.

Objective: A Study to Determine the Perinatal Outcome in Isolated Oligohydramnios at Term Pregnancy Study Design: A cross-sectional study Place and Duration: Department of Gynecology and Obstetrics, Hayatabad Medical Complex from October 2022 to March 2023 Methodology: Our sample size was 250 which were divided into 1:1 including 125 cases with isolated oligohydramnios and 125 control cases. Patients with chronic medical disorders and having fetal anomalies or IUGR were excluded. The mode of delivery was noted. Neonatal outcomes in the form of Apgar score, baby weight and need for NICU were noted. Results: The cases with isolated oligohydramnios were associated with an increased incidence of CTG changes, meconium-stained amniotic fluid and the cesarean section as compared to women with normal amount of amniotic fluid. There was no difference between the cases and controls as regards duration of labor, need for oxytocin augmentation, need for neonatal resuscitation, APGAR score at 5 minutes, NICU admission birth weight of neonates or incidence of LSCS for fetal distress. A significant association (OR=1.85, P<0.001) was found between caesarean section in mothers with oligohydramnios compared to controls. Conclusion: Our study found increase cesarean section rate due to CTG changes and meconium stained liquor in isolated oligohydramnios. However neonatal outcome in the form of birth weight, Apgar score and NICU admission was same for both cases and control. Keywords: Oligohydramnios, Perinatal, Term Pregnancy

Objective: The aim of this study is to review the current guidelines regarding the management of HMB, including screening for anemia, Iron studies and iron-based and non-iron-based treatment of ID/IDA. Methods: The literature searched for this article included the latest Guidelines for HMB. The data was collected from authentic websites such as pubmed and well-known clinical guidelines from professional societies. Results: More than 50 guidelines throughout the world were searched and studied for this review. Among them 22 were selected for this review. 16 of these guidelines focused on screening of women with HMB for anemia. There were some inconsistencies concerning screening for ID with eleven of the 22 guidelines providing no recommendation for screening of Iron levels and four even strictly advising against screening for iron levels initially. Almost one third of the selected guidelines provided guidance for oral iron therapy as first line in ID, 4 guidelines provided guidance for use of IV iron replacement in severe anemia, non-responders to oral treatment and prior to surgery. 3 of the guidelines had HB threshold for selecting between oral and IV route while further 4 guidelines were of the view of transfusion in case of severe anemia. Conclusion: Although many of the guidelines are of the view to treat anemia due to HMB, there is lack of consensus regarding screening for ID and treatment with iron supplements, due to this most of the IDA related with HMB goes undiagnosed. Therefore, a proper guidance is required that addresses all the aspects of ID/IDA including screening, relevant tests and treatment in patient with HMB in order to optimize the health outcome of these patients. Keywords: Anemia, Blood, Menstrual Cycle, Surgery

OBJECTIVES To determine and compare the efficacy of Uterovaginal packing versus uterine balloon tamponade to control postpartum haemorrhage due to uterine atony unresponsive to medical treatment. METHODOLOGY This comparative prospective cross-sectional study was conducted in Hayatabad Medical Complex, OBG department. A total of 140 patients were categorised into two groups, group A underwent Uterovaginal packing and group B underwent uterine balloon tamponade. All women of 18 to 40 years with a history of delivery after 28 weeks of gestation, who developed primary postpartum haemorrhage due to uterine atony, unresponsive to medical treatment were included in the study. Women with a history of delivery before 28 weeks of gestation, secondary postpartum haemorrhage, genital tract trauma, retained placental tissue and membranes, placenta previa, morbidly adherent placenta, febrile illness and uterine structural lesion were excluded from the study. Efficacy was labelled if there was no ongoing blood loss after the procedure with concomitant hemodynamic stability. All information was recorded in a predesigned proforma, and data were analysed using SPSS version 22.RESULTS Our study included 140 women; 113 had a normal vaginal delivery, and 27 underwent cesarean section. Among cases with normal vaginal delivery, 45 women had Uterovaginal packing, and 68 had uterine balloon tamponade, while among cases of cesarean sections, 25 women had uterovaginal packing and 2 had uterine balloon tamponade. The efficacy of Uterovaginal packing was 90%, and that of uterine balloon tamponade was 87.1%, with no significant difference statistically (p- 0.51). Overall efficacy of both procedures was 88.6%.CONCLUSION All orthodontic and non-orthodontic treatment group participants required oral hygiene instructions and had periodontal treatment needs (TN1). The patients requiring scaling and prophylaxis and Oral hygiene instructions (TN 2) were more in the orthodontic treatment group than the non-orthodontic treatment group. A higher percentage of patients requiring complex treatment (deep scaling, root planning and complex surgical procedures), scaling and prophylaxis and Oral hygiene instructions (TN3) belonged to the non-orthodontic treatment group.

Background: Placenta previa is one of the major causes of antepartum hemorrhage. Although placenta previa accounts for approximately 0.4 – 0. % of all pregnancies, still it remains a major cause of fetomaternal morbidity and mortality. Aim: To determine the incidence of major degree placenta previa and its relation to fetomaternal outcome in a tertiary care hospital. Methods: This is a prospective observational study which was carried out in the department of Obstetrics and Gynecology Hayatabad medical complex, a tertiary care hospital in Peshawar Khyber Pakhtunkhwa from January 2022 to December 2022. Study was started after ethical approval was taken from institutional ethical committee. Total 35 pregnant women with ultrasonographic diagnosis of major degree placenta previa were enrolled in the study after fulfilling inclusion and exclusion criteria. Detailed history was taken, relevant Obstetrical examination was performed and relevant baseline labs and pre-op workup was done. All the relevant data was entered in a predesigned proforma and fetomaternal outcome was studied in addition to the incidence of major degree placenta previa. Results: Total no. of deliveries were 5712 in the study period. Total number no. of major degree placenta previa were 35 making its incidence as 0.6%. In present study majority of the patients presented between age 21-35 years. All the patients with a diagnosis of major degree placenta previa were multigravida and there was no single case of primigravida in the present study. Majority patients were unbooked. Majority of the patients ended up in emergency C/Section due to massive bleeding episode. Previous C/Section was the most important risk factor found in present study. 29 women required blood transfusion, 5 women had accidental diagnosis of the morbidly adherent placenta and cesarean hysterectomy was done in 4 cases. Uterine packing was done in 16 cases. There was no maternal mortality in the present study. Majority of the patient delivered between 33-36 weeks of gestation and majority of the babies had a birth rate of > 2.5Kg. Practical implication Patients with or without previous history of cesarean section and with major degree placenta previa diagnosed on ultrasonography should be booked and admitted earlier in Tertiary Care Hospital with all pre-op preparation to prevent maternal morbidity and mortality and better neonatal outcome. Conclusion: The higher fetomaternal morbidity and mortality, associated with placenta previa can definitely be curtailed by early antenatal diagnosis of placenta previa, advance planning, timely referral, delivery at a tertiary care hospital with availability of round the clock blood bank facility, NICU facility and obstetric ICU / HDU facility. Keywords: Major degree Placenta previa, maternal mortality, perinatal mortality, fetomaternal morbidity.