Each year approximately 20 million low birthweight babies are born globally. Prematurity is a leading cause of neonatal mortality in developing countries and results in 60%–80% of neonatal deaths. Neonatal mortality is the major contributor to under-5 mortality. According to Pakistan Demographic and Health Survey 2017–2018, neonatal mortality in Pakistan is 42 per 1000 live births and under-5 mortality is 74 per 1000 live births. One out of every 22 newborns dies in Pakistan, which is an alarming figure. Majority of these deaths are preventable. They can be prevented by well-trained midwives, safe delivery, early initiation of breast feeding within an hour after birth and skin-to-skin contact. Pakistan is among the top 10 countries with the highest number of preterm births and with limited resources to manage the burden. Kangaroo mother care (KMC) is a safe and economical alternative to provide preterm care in developing countries. In babies at gestational age less than 37 weeks or with neonatal weight less than 2.5 kg, skin-to-skin contact prevents hypothermia and infection. Neonatal mortality and morbidity can be reduced by providing preterm care through KMC. This case report is of a preterm baby who was delivered at 33 weeks of gestation with a weight of 1.3 kg and was saved by KMC in the paediatric department of Services Hospital in Lahore.

The study was planned to assess the effect of Kangaroo Mother Care on preterm and stable neonates in reducing neonatal morbidity and mortality. This is a case series design of 121preterm and low birth weight neonates, weighing less than 2500 gram, enrolled from 1 August 2016 till31 January 2017.Kangaroo Mother Care is initiated after birth, after performing early essential newborn care practices. Weight gain of 20-30 gram for three consecutive days, establishment of breast-feeding for 20-30 minutes every two hourly and maintenance of body temperature at 37 degree centigrade is the discharge criteria. During the periodof six months, total number of deliveries was 6459, out of them spontaneous vaginal deliveries were 52.2% (3372) and caesarean sections were 47.7% (3087). In 55.4%neonate’s(both preterm and term)early essential newborn care was practiced.Total preterm were 290 (4.5%), out of them 121 (2%) neonates were kept inKangaroo Mother Care position and 129 (44%) were shifted to neonatal intensive care unit. 14% parents refused for KMC position and discharged. Mortality in preterm newborn in neonatal unit was 29.4% (without KMC) but no mortality occurred after 3 months follow up in KMC babies. All the neonates from KMC unitwere discharged in satisfactory condition and called for follow up investigations. All Kangaroo Mother Care babies had exclusive breast-feeding. Taken together, the results indicate that prolonged skin-to-skin contact and exclusive breast feeding reduces neonatal mortality and morbidity in birth weight 1.5 to 2.5 kg in stable neonates in hospital. However KMC is limited to SHL at present. Workshops are being conducted to teach other doctors and nurses for early essential newborn care and kangaroo mother care. They are still facing controversies and challenges in initiation of KMC in many hospitals. However it is essential to strengthen KMC services in healthcare facilities as it significantly reduces neonatal mortality.

Objective: To identify the Incidence of and risk factors for perineal trauma. Study Design: Prospective research Place and Duration of Study: Department of Obstetrics & Gynaecology, Ayesha Hospital Nishat Colony Lahore from 01-07-2021 to 31-12-2021. Methodology: Four hundred and sixteen pregnant women with perineal trauma condition were enrolled who either delivered at homes or hospitals were detailed interviewed for their clinical history and characteristics regarding their condition. Results: The mean age of pregnant women was 24.2±3.3 years. Out of total births in singleton 264 were at hospital while 152 at home. The results showed that 2nd degree tear was significant higher (P<0.05) in hospital delivery multiparous case. Conclusion: Women having multipara had a 3-fold higher incidence of intact perineum than nullipara. Keywords: Perineal trauma, Nulliparous, Multiparous

Introduction: Early initiation of breast feeding that is breast feed given within first hour of birth prevents newborn from hypothermia, hypoglycemia and infections. It increases bonding with mother and promotes exclusive breast feeding. Objectives: To assess the factors influencing the mothers for early initiation of breast feeding and how much mothers practice it. Material and Methods: It was a retrospective study conducted at Pak Red Crescent Medical and Dental College, Dina Nath. The study was in form of questionnaire interview taken from delivered women including caesarean section and spontaneous vaginal delivery 293 and 57 women from out-patient department. Total number of women were 350. Duration of study was six months from 1 July 2021 to 31 December 2021. The influencing factors of early initiation of breast feeding and practice of giving milk within an hour after birth was assessed. Results: In our study percentage of early initiation of breast feeding was 13.4%. Maximum age for breast feeding was between 25 to 35 years that is 48.5% and regarding parity maximum in Para2 to 3 had 40%. The women who were willing for breastfeeding within first hour of birth had family support 26.2%, support by doctors or nurses 16.5% and 2% got counselling in antenatal period. Regarding factors that decrease EIBF, 53.4% women failed to initiate breast fed in first hour after birth due to pain, caesarean section under general anesthesia3.1%, discomfort due to episiotomy 6.2% and 10.5% babies were referred to neonatal unit immediately after birth due to danger signs. Conclusion: Counselling of mothers in antenatal period, improving counselling skills of health providers and strengthening community based support are likely to improve early initiation of breast feeding. Keywords: NICU neonatal intensive care unit, WHO World Health Organization EIBF early initiation of breast feeding

Introduction: Promotion of family planning has been shown to reduce maternal and neonatal mortality and promotes women empowerment. Contraception is regarded as an important preventive measure against unintended pregnancies. Although contraceptive methods are freely available in Family Planning centers, the utilization is low. Aims And Objectives: To assess the attitude, knowledge and practice of contraceptive methods in rural areas Material and Method: The study was carried in Pak Rd Crescent Medical and Dental College, Dinanath. Duration was 6 months from 1 July 2021 till 31 December 2021. It was a descriptive study. Sample size was 1200. Postoperative patients including caesarean section and spontaneous vaginal delivery and patients coming in outpatient department including antenatal and patients with gynecological problems were included. The women were interviewed regarding knowledge of contraceptive methods and choice to decide these methods. Most of them had knowledge but less number of women agreed to decide family planning method. Results: Usually women who gave interview were between age 31 to 40 years 37.6% and21 to 30 years 33.1%. Maximum parity 2 -4 were 47.1% and P 5 and above were 44.7%. 69.3% of them were illiterate. 86.4% women had knowledge of IUCD, 91.8% regarding COCP and 91.1% about injectable contraceptives.95.6% knew about male condoms. For the practice of contraceptive methods, maximum demand was of male condoms 13.8%, COCP 9.5%, IUCD 4% and injectables 4.6%. The reasons for not practicing family methods were husband and family pressure 30.1%, different myths about contraception 27.2%, family not complete 17.6%, cultural reasons 14.6%, lack of knowledge 8.8% and need for male gender 4.5% Conclusion: Although most of the ladies had knowledge of contraceptive methods but they were reluctant to practice them. Motivation of husband and mother in law is important factor to achieve positive attitude towards contraception. Counselling against myths and false belief is essential. Keywords: IUCD intra uterine contraceptive device, COCP combined oral contraceptive device