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 abnormal fetal heart rate in continuous versus discontinuous use of oxytocin infusion for augmentation of labour. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Feb to Aug 2018. Methodology: After fulfilling the inclusion criteria, 76 patients were equally divided in two groups A and B. In both groups, at 3 cm dilatation, intravenous infusion of 5 IU oxytocin in 500 cc normal saline was initiated at infusion rate 3.3mIU/minute Carditocography was initiated 10 minutes before infusion and then continued. An increment in infusion of 3.3mIU/minute was done every 20 minutes till 4 to 5 contractions in 10 minutes were achieved. After this, no more increment was done. The maximum rate was 30mIU/minute. Once cervix was 5 cm dilated, infusion was continued in group A and discontinued in group B for 2 hours. Fetal heart rate was noted on cardiotocography from 20 minutes before initiation of infusion till 2 hours after 5cm. Results: Age of the patients was 25.4 ± 3.5 years in group A and 26.1 ± 2.4 years in group B. Mean gestation age was 39.2 ± 1.1 weeks in group A and 38.6 ± 1.3 weeks in group B. Group A had significantly more abnormal fetal heart rate compared to group B (p=0.016). Conclusion: Discontinuous oxytocin infusion in labour showed significantly less abnormal fetal heart rate compared to continuous oxytocin infusion (p=0.016).

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

Background & Objective: A substantial number of pregnant women develop gestational diabetes mellitus (GDM). Various biomarkers are being used to diagnose gestational diabetes mellitus. Early detection of GDM can done by using inflammatory markers like neutrophil-to-lymphocyte ratio (NLR) and the platelet- to-lymphocyte ratio (PLR) that are rapid, inexpensive and easy to use in different clinical setting. The objective of this study was to evaluate diagnostic accuracy of raised neutrophil to lymphocyte ratio for detection of gestational diabetes mellitus taking OGTT as gold standard. Methods: This was a cross-sectional study held in Department of Obstetrics and Gynecology CMH Lahore from November, 2018 –May, 2020. After approval from hospital ethical review committee and taking an informed consent, 473 pregnant women enrolled in first trimester between age 18-35 years, fulfilling the inclusion criteria were included whereas known diabetics, patients with cardiovascular disorders, previous history of GDM were excluded. Blood samples in sterilized manner were drawn and sent to hospital laboratory for analysis of NLR. Then they were screened during 24-28 weeks of gestation for diagnosis of gestational diabetes mellitus on OGGT. The females were labelled for positive NLR and GDM as per operational definition. Diagnostic accuracy of NLR was calculated for development of gestational diabetes mellitus. Results: Mean age of females was 26.72 ± 4.90 years and mean gestational age was 15.50 ± 1.67 weeks. 94(19.9%) females who had raised neutrophil to lymphocyte ratio while 397(80.1%) females had normal neutrophil to lymphocyte ratio and there were 90(19%) females who had gestational diabetes mellitus while rests of 383(81%) did not have gestational diabetes mellitus. The sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of NRL was 95.56%, 97.91%, 91.49%, 98.94% and 97.46%, respectively. Conclusion: The study concluded that raised neutrophil to lymphocyte ratio is significantly high among gestational diabetes mellitus and NLR has a high diagnostic accuracy for predicting gestational diabetes mellitus.