Background: We aimed to estimate pregnancy outcome after ICSI in terms of oocyte parameters, embryo quality, endometrial thickness, hormone and cytokine levels in women stratified on the basis of follicular output rate (FORT). Methods: Quasi experimental design was carried out after approval from "Ethical review board of Islamabad clinic serving infertile couples" from July 2010 to August 2013. One thousand and fifty females were selected with the criteria of age between 21-40 years, infertility of more than 2 years, body mass index of 18-35 kg/m 2 , menstrual cycle of 25 ± 7 days, both ovaries present with normal uterine cavity, serum FSH levels less than 8 IU/ml and normal thyroid-stimulating hormone levels. Females on short agonist or antagonist protocol with diagnosis of polycystic ovarian syndrome, fibroids or in their male partner sperms retrieved by testicular biopsy were excluded from the study. Down regulation of ovaries was followed by controlled ovarian stimulation, Ovulation Induction (OI), oocyte pick up, in vitro fertilization, Embryo Transfer (ET) and confirmation of pregnancy was done by serum beta hCG of more than 25 mIU/ml and cardiac activity on trans vaginal scan. Enzyme linked immuno sorbent assay was used for peak and mid luteal estradiol (E2), progesterone (P) and interleukin I-β estimation on OI and ET days respectively. FORT (ratio of preovulatory follicle count to antral follicle count × 100 on OI day) stratified females into low under the 33 rd percentile, medium between the 33 rd and the 67 th percentile and high above the 67 th percentile. Characteristics of groups were compared by one way analysis of variance. Results: Females 276 (33%), 288 (34%) and 282 (33%) comprised of low, medium and high FORT groups respectively. The number of retrieved, mature and fertilized oocytes, cleaved embryos, endometrial thickness and number of gestational sacs in the high FORT group was significantly high (P <0.001). High peak and midluteal E2 (P = 0.0025, 0.0001), low P (P = 0.0001) and high peak interleukin-1β (P = 0.0001) was observed in high FORT in comparison with medium FORT with resultant greater number of clinical pregnancies 183 (65%). Conclusions: The FORT in non PCOS patients may reflect good reproductive outcome after ICSI with maximum clinical pregnancies in high FORT group.

Background: Effect of dates on pregnancy outcomes is in debate among researchers for optimum results. Aim: To compare the fetomaternal outcome with and without use of dates in primigravidae presenting at 37-38 weeks Main outcome: The outcome was measured as fetal (Apgar score at 5 min) and maternal (onset and induction of labor) parameters. Study design: Randomized controlled trial Setting: Department of Obstetrics and Gynaecology, District Headquarter Hospital, Gujranwala Duration of study: 6 months 1st January 2020 to 30th June 2020 Methods: A total of 110 patients reporting to OPD in their first pregnancy between 18 to 35 years of age at 37 to 38 weeks were included whereas multigravidae and those with previous miscarriage were excluded. Consecutive Non Purposive Sampling technique was used and patients were randomly divided in two groups of 55 each. Group A consumed dates in late pregnancy while Group B was asked not to. Duration of first and second stage of labour and Apgar score at 5 minutes were recorded. SPSS version 21 was used to enter and analyze the data. Quantitative variables Apgar score were presented in the form of mean ± SD. Qualitative variables like spontaneous labour, need for induction and good Apgar score were presented in the form of frequency and percentage. Chi-square test was applied to compare spontaneous labour, need for induction, and good Apgar score in both groups. P-value ≤0.05 was taken as significant. Results: The mean apgar score at five minutes was 8.76±1.157. The analysis of qualitative variables showed that spontaneous labor was started in 75(68.2%) of patients and induction was required in 35 (31.8%) patients. There was successful induction in 1 (9.1%) of patients. At five minutes 101(91.8%) of neonates showed good apgar i.e. >7. Both groups were compared among each other in terms of both quantitative and qualitative variables. The onset of spontaneous labor, success of IOL and good apgar score at 5 minutes were compared among groups. The was significant difference among groups A and B in terms of these parameters except good apgar score i.e. p values of 0.008, 0.021 and 0.297 for spontaneous labor, IOL and good apgar scores Good apgar score at 5 min was not statistically significant among any stratification group. Conclusion: The consumption of dates significantly improves the fetomaternal outcomes in primigravida term pregnancies. The results should be validated in large randomized controlled trials. Keywords: Date fruit, Labour outcomes, Labour progression.

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Objective: To determine the frequency of contraceptive usage, the social barriers affecting their use, and the frequency of unplanned pregnancies during the COVID-19 pandemic Methodology: This is a prospective cross-sectional study carried out at the Department of Obstetrics and Gynaecology, Fazaia Ruth Pfau Medical College & PAF Hospitals from July 2020 to September 2020. All women of reproductive age attending the outpatient department were consecutively included. A pre-structured questionnaire was used for the purpose of collection of data. We obtained information regarding the use of contraception before and during the COVID-19 pandemic and the contraception methods used by these women. Furthermore, reasons for discontinuing contraception amongst those women who were using it earlier. The occurrence of pregnancy during pandemic was also noted. Results: Of the 350 women, 306 (87.4%) women practiced contraception before and 288 (82.3%) practiced it during the lockdown. Of 306 women practicing contraception before the lockdown, 265 (86.6%) continued practicing during the lockdown as well. Condom 145 (50.3%) and withdrawal method 116 (40.3%) were the most used methods amongst the 288 women practicing contraception during the lockdown. The noticeable increase in the number of those using withdrawal method was due to the lack of consultation following the fear of getting COVID (17 women, 41.5%) and no access to the clinic (14 women, 34.1%). These were the most common reasons for not using contraception, amongst the 41 women practicing contraception before the pandemic. Pregnancies were reported by 93 (26.6%) women out of whom 75 (80.6%) reported these to have been unplanned. Conclusion: The COVID pandemic has largely affected the utilization of contraceptives among women who were already practicing different contraceptive methods. Moreover, unplanned pregnancies are increasingly reported by women.

Low birth weight is a key determinant of infant survival, health and development. Low birth weight infants are at a greater risk of morbidity and mortality than an infant of normal birth weight and create a substantial strain on the healthcare system. Objectives: To determine the frequency of low birth weight at term and maternal contributing risk factors in women attending antenatal clinic at Creek General Hospital Korangi, Karachi. Study Design: Descriptive cross sectional study. Setting: Department of Obstetrics and Gynecology of Creek General Hospital, United Medical and Dental College Karachi. Period: From May 2017 to April 2018. Material & Methods: Those women who gave birth to babies with less than 2500gm at term, were included in the study to ascertain the frequency and risk factors of low birth weight including age, parity, booking status for antenatal care, pre-pregnancy BMI, history of tobacco intake, medical disorders arising in pregnancy like anemia, pregnancy induced hypertension and gestational diabetes mellitus, birth weight and fetal gender. The data was analyzed on SPSS software. Results: The prevalence of term low birth weight was 22%. Percentage of low birth weight babies among teenage mothers was 72.8%, among the studied mothers 67.4% were primipara, 91.5% had standard antenatal care, Pre-pregnancy BMI was found to be normal in 93% of mothers, 9 mothers (7%) had history of tobacco/ betel nut chewing habit. In this study, iron deficiency anemia was found to be most significant factor leading to LBW babies (62 %). 12% and 8% of mothers were diagnosed with Pregnancy induced Hypertension and Gestational Diabetes mellitus respectively. Regarding fetal gender, 68 were females (52.7%) and 61 (47.3%) were males. Conclusion: Low Birth Weight is an important contributing risk factor for perinatal mortality and morbidity in Pakistan. Anemia was found to be most significant risk factor leading to Low birth weight in our study.