Department of Obstetrics and Gynecology, Isra University Hospital Sindh Pakistan. Objectives: To compare the efficacy of clomiphene citrate versus letrozole in attaining optimum follicular growth among infertile women of reproductive age group in Isra University Hospital Hyderabad. Study Design: Randomized Controlled trial. Setting: Department of Obstetrics and Gynecology, Isra University Hospital Sindh, Pakistan. Period: May 2016 to November 2016. Material & Methods: A total of 128 women with anovulation due to known endocrine disorders were included in this study. These were randomly allocated in group 1 and 2. Group 1 consisted of 64 women received 50mg of clomiphene citrate and 64 in group 2, treated with letrozole. Proformas were filled and results regarding the drug achieving follicular diameter of >18mm by Trans abdominal Ultrasound in maximum number of women in any of the group was supervised by consultant gynecologist practicing for more than 10 years. Stastical analysis was done using SPSS version 19.The average age of women was 27.21+3.21. Number of patients with primary infertility were 60 (93.8%) and 57 (89.1%) in group 1 and 2 respectively while secondary infertility was observed in 4 (6.3%) and 7(10.9%) in group 1 and 2 respectively. Regarding endocrine disorders, 34 (26.6%) were polycystic ovaries and 35(27.3%) hypothalamic. Results: The average age of women was 27.21±3.21 years. Efficacy was significantly high in clomiphene citrate (group 1) as compared to letrozole (group 2) [92.19% vs 79.69%; p=0.042]. Conclusion: This study demonstrates that clomiphene citrate is superior to letrozole as an inducer of ovulatory cycles. However there is need for larger well designed randomized trials to generate robust data in order to establish the true potential of clomiphene.

Introduction: Stress urinary incontinence is defined as involuntary loss of urine on physical exertion like coughing, sneezing, laughing or jumping. This condition in women is very distressing and it is usually kept disguised, so women remain untreated. This condition also causes feeling of inferiority and depression. There are different risk factors identified in causing urinary stress incontinence like constipation, traumatic and operative vaginal births, pelvic organ prolapse, abdominal mass, smoking, obesity, old age and menopause. The present study is design to know the actual magnitude of stress incontinence. There by strategies could be devised to reduce this morbidity. Objective: To determine the frequency of urinary stress incontinence in women after vaginal delivery Setting: This study was conducted at ISRA University Hospital, Hyderabad. Duration: Six months from Jan 2020 to June 2020. Design: Descriptive cross sectional. Subject and Methods: There were 141 women with history of urinary incontinence within 40 days of vaginal delivery were included in this study. Patient who fulfill the inclusion and exclusion criteria and came within forty days after vaginal delivery. The final outcome that is urinary stress incontinence was labeled as positive or negative on approved proforma. Results: The average age of the patients was 26.75±5.72 years. Frequency of urinary stress incontinence in women after vaginal delivery was observed in 14.18% (20/141). Conclusion: Results of this study suggest that the mechanical strain during labor may add to the risk associated with pregnancy itself. Prenatal counseling about routes of delivery should provide a balanced account of the advantages and disadvantages for mother and child. The information from this study provides important information for clinicians, patients, and policymakers regarding childbirth and incontinence. Keywords: Stress Urinary Incontinence, Vaginal Delivery, Operative Vaginal Births

Hypertension has been recognized as a global health concern.  In developing countries, it is not addressed and described to the extent that the actual prevalence of the disease makes it necessary. In these countries, control of blood pressure (BP) remains suboptimal. Worldwide BP reduction is a serious issue, and the situation is more alarming situation in our country. Pakistan is one of them, more than 46% of the Pakistani population are hypertensive. In 2010, hypertension was the leading cause of death and disability worldwide, and a greater contributor to events in women. South Asia contributes 24% of world population and is undergoing a rapid epidemiological transition with significant rates of hypertension in different countries. The prevalence of hypertension in low socioeconomic population in Pakistan is 39% in women vs. 37% in men. There is no proper data regarding hypertension in women in Pakistan, except for a few populations based surveys conducted which showed the prevalence of hypertension. The pooled prevalence in Pakistani women is 24.76% vs. 24.9% for men for an age bracket of above 40 years. The occurrence is higher in urban compared to rural areas. General practitioners (GP) in Pakistan underdiagnose and undertreat high BP, especially in the elderly women. Only in 37% of patients, the treatment was initiated by a GP. 23% of this group received only sedatives alone or combination of sedatives and hypertension control medication. We lack published guidelines regarding hypertension. Hypertension still remains the major preventable cause of cardiovascular disease. Hypertension is a leading cause of mortality globally, and especially in our continent. The purpose of these guidelines is to highlight the neglected population (i.e., Women) of Pakistan, who are physically and hormonally different from men.  They have more complications as a result of hypertension. Early diagnosis and proper treatment and adherence to the treatment is therefore important. The task of developing guideline on hypertension is by Go Red Chairperson and Scientific Council Pakistan in collaboration with Pakistan cardiac society. This is first clinical practice guidelines for management of hypertension which is a need of our time with the objective to control the epidemic of hypertension in women. This scientific document on hypertension in women with local recommendation which are made local studies and randomized trials and south Asian studies. These educational tool help the health care providers GP and doctors because all see the women in theirs practice and using this guideline facilitate them for treatment because specially in elderly women usually received only sedative alone or in combination with antihypertensive medicines by GPS. Our efforts will encourage GPs and medical practitioners to practice these guidelines in their clinical judgment about risk and complications, as well as in the determination and implementation of preventive, diagnostic or therapeutic medical strategies for control of hypertension. What is new in this guideline is that we focused on treatment of hypertension according to our circumstance as women have limited access to health care and are undertreated.  That is the reasons why more women develop complications of hypertension as delay in diagnosis, initiation of recommended treatment and the control is only in 50% in women. These guidelines focused on risk factors and complication throughout the life cycle of women. Lifestyle management should be started in adolescent and more focus should be given to adherence to treatment. This is crucial for control of hypertension. New topics like management of hypertension in chronic kidney diseases is added. Recommendation-based treatment should be started in such cases. The initiation of widespread and intensive continuing medical education for all physicians involved in the management of women patients with hypertension will be the main benefit from this guideline.

Mullerian duct anomalies are congenital defects of female genital system that arise from abnormal embryological development of the mullerian ducts. A didelphys uterus, also known as double uterus is one of the least common amongst mullein duct anomalies. This report discuss a case of 25 years old girl, married since 6 years with one missed miscarriage 4 years back. Her complains were severe dysmenorrhea and dyspareunia. Ultrasound scans showed double uterus with left ovarian endometriosis cyst. On laparotomy there was right sided communicating rudimentary uterus with small fallopian tube and normal ovary attached to it. Another enlarged non communicating uterine horn was present at right side, with dilated tube and cystic ovary attached to it. Resection of noncommunicating uterine horn with salpingoopherectomy was done.

Objective: To compare depression scores in genitourinary fistula patients according to Glasgow depression scale pre and postoperatively in tertiary care hospital. Study Design: Prospective Cohort study. Setting: Inpatient and Outpatient Department of Gynecology and Obstetrics, Isra University Hospital Hyderabad. Period: December 2018 to December 2019. Material & Methods: Patients with confirmed genitourinary fistulas undergoing corrective surgery were included. Glasgow Depression scale questionnaire was filled in Gynae ward at time of admission, postoperatively at discharge (14-21 days after surgery) and at 6 months follow-up after discharge in Urogynaecological Out Patient Department. In Glasgow depression scale 20 questions were asked from patients scoring 0,1 and 2 according to answers. Those scored greater than 13 were referred to primary mental health care center and Psychologist. Results: Total of 164 patients had successful genitourinary fistula repair. The average age of women was 47.63 (SD = ±17.1) years. Mean of depression scores preoperatively, at time of discharge and after 6 months of discharge was 19.69 (SD= ±2.61), 14.90 (SD= ±2.22) and 11.34 (SD= ±2.01) respectively. Mean decrease in depression score from preoperative to six months after discharge was 8.35 units, considered statistically significant with p-value less than 0.01. Conclusion: There is significant difference in depression scores preoperatively and postoperatively. Psychological symptoms decreases after surgical correction of fistulas.