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

Objective: To compare the frequency of perineal trauma in women undergoing the spontaneous vs the Valsalva-type pushing in the second stage of labour. Study Design: Randomized controlled trial Duration of Study with Dates: The study was carried out from 15-12-2020 to 19-03-2021. Setting: Department of Obstetrics and Gynaecology, Combined Military Hospital, Lahore.National University of Medical Sciences NUMS. Material and Methods: A total of 154 labouring females were enrolled in the study. These females were randomly assigned to one of two groups, A (the Valsava-type pushing method group) and B (the spontaneous pushing group). After the delivery of the placenta, the patients were all examined for any perineal trauma as per the operational definition. Results: Patients ranged between 18-40 years of age with a mean age of 26.3±4.0 years in Group A and 27.0±3.3 years in Group B. All the patients were between 38-40 weeks of gestation at the time of enrollment with mean gestational age being 39±0.7 weeks for group A and 38.9±0.7 for group B. There were 61 primigravida (39.6%, 34 in Group A and 27 in Group B) and 93 multigravida (60.4%, 43 in Group A and 50 in Group B). All women delivered vaginally in the cephalic presentation. The mean length of the second stage of labor was 25.7±29.0 min for the Valsalva pushing group and 31.6±37.5 min for the spontaneous pushing group. The mean fetal weight was 3.1±0.3 kg for both groups. 43 (55.8%) patients in the Valsalva pushing group and 46 (59.7%) in the spontaneous pushing group underwent an episiotomy during delivery. 9 (11.7%) patients in each group sustained perineal trauma (x2 = 0.0, p = 1.0). No one in the sample suffered greater than a second degree laceration. Out of the nine patients that did incur perineal trauma in the Valsalva type pushing group, 4 (44.4%) were first degree perineal tears and 5 (55.6%) were second degree perineal tears while among those in the spontaneous pushing group, 2 (22.3%) fell in the first degree tear category and 7 (77.7%) in the second degree tear category (x2 = 1.0, p = 0.317). Conclusion: Our findings suggest that there is no association between the rate of perineal trauma among patients who underwent the directed Valsalva- type method of pushing and those that employed the spontaneous pushing method during the second stage of labour. Keywords: Perineal trauma, Perineal tears, Second stage of labour, Pushing methods in labour, Valsalva- type pushing, Directed pushing, Spontaneous pushing

Objective: To determine the frequency of pre-eclampsia among high-risk pregnant women treated with low dose aspirin (LDA) presenting in a tertiary care hospital. Study design: Descriptive study Duration of study: Six months from 20-02-2018 to 19-08-2018. Setting: Study was conducted in OPD of Obstetrics and Gynaecology Department, Combined Military Hospital, Lahore National University of Medical Sciences NUMS Material and methods: A total of 175 patients were included in the study. Pregnant females diagnosed as high risk were treated with low dose aspirin (75 mg) daily started at 12 to 16 weeks of gestation till the end of pregnancy. 24 hours urine protein test was done for patients with B.P. >140/90mmHg after 20 weeks of gestation and if at least 300mg protein was present in 24 hours urine then patient was labeled as pre-eclamptic. Results: Patients ranged between 20-35 years of age with mean age of 25.9±3.6 years. Mean gestational age was 14.4±1.1 weeks and mean BMI was 27.3±4.3 kg/m2. Pre-eclampsia developed in 27 patients (15.4%). Obesity found in 53 patients (30.3%). There were 27 (15.4%) primigravida and 148 (84.6%) multigravida patients. Conclusion: In conclusion, low dose aspirin is effective in prevention of preeclampsia in high-risk patients. Indications for aspirin in primary prevention are a matter of debate, but recent publications suggest a strategy based on first-trimester screening of preeclampsia (with clinical parameters, biomarkers and uterine artery Doppler measurements) and aspirin administration to high-risk patients. Keywords: Aspirin, High risk pregnancy, Pre-eclampsia

Background: Genital herpes is a lethal infection prevalent in fertility age women and can lead into mortality and morbidity of neonates on transmission. Objective: To analyze the management techniques for genital herpes infection during gestation. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Saadan Hospital Allaho Chowk Johar Town, Lahore from 10-01-2020 to 09-07-2020. Methodology: Fifty females presenting genital herpes clinical symptoms were completely analyzed through symptoms and laboratory analysis and managed for their genital herpes through anti- viral drugs. Results: The mean age was 28.9±3.2 years. Thirty-two females were having genital herpes at their third trimester. The anti-viral drugs reduced genital herpes in 90% cases with 1.2% transmission rate in caesarean delivery while 7% transmission risk in vaginal delivery. Conclusion: Genital herpes can be managed by using antiviral medications and c sections in majority of the cases. Keywords: Genital herpes, Caesarean, Transmission

Objective: To determine the effectiveness of Multiple Choice Questions (MCQ) construction as a learning toolfor empowering the students towards self-directed learning.Study Design: Mixed quantitative and qualitative study.Place and Duration of Study: The study was carried out at Department of Obstetrics and Gynaecology, CMHst th Lahore Medical College, from 1 April to 30 September 2019.Materials and Methods: All students of final year MBBS were divided into two groups. After a pre-test (test 1)of MCQs, they attended a workshop on construction of MCQs, followed by construction and vetting of MCQs bystudents. The students took a test (test 2) based on those MCQs and evaluated it, followed by post-test (test 3)08 weeks later to assess deep learning. Semi structured in-depth interviews of 10 randomly selected studentsbased on 10 open ended questions were conducted about their perceptions of learning. Quantitative dataanalysis was performed using SPSS version 17. A thematic analysis was performed for the qualitative data.Results: Comparison of pre and post-tests yielded a p value of 0.013, which is statistically significant.Comparison of the mean results of tests 1 and 2 yielded a p value of 0.001, which is also statistically significant.The qualitative component of the study revealed that use of MCQ construction to enhance self-directedlearning was highly appreciated by the students as a learning tool.Conclusion: MCQ construction when used as a learning tool improved the self-directed learning of thestudents. Experience of construction of MCQs enhanced the cognitive skills of the students while being highlyacceptable.