Study Objective: The objective of this study is to describe the maternal and perinatal outcome of conservative managementin PPROM. Design: Descriptive prospective study. Period: One year from August 2006 to August 2007. Setting: Maternal and child health(MCH) Centre PIMS Islamabad. Material and Methods: 50 patients between 28-36 weeks of gestation presenting with PPROM. Results:The mean age was 27+5.1 years, 14(28%) were having gestational age between 28to 32 weeks and 36 (72%) were between 33 to 36weeks of gestation. 34 (68.0%) of the mothers had no history of abortions while 10 (20.0%) had 1-2 abortions and 6 (12.0%) had 3 ormore abortions. Sixteen (32.0%) women had previous PRROM while 10 (20.0%) had previous history of preterm labor. Inversecorrelation was observed between latency period and gestational age. Among 14(28%) women with gestational ages between 28 to 32weeks 10 delivered within 48 hours and 4 after 48 hours. Among 36(72%) women with gestational ages between 33-36 weeks 31(62%)delivered in less than 48 hours and 5 (10 %) women delivered after 48 hours.14(28%) of the 50 babies were admitted in NICU withsepticemia, 7(14.0%) with RDS, hypoglycemia in 2(4.0%) and necrotizing enterocolitis in 3(6.0%). 3 neonates died from septicemia and2 from RDS. On first follow-up 34.0% mothers had infections and 8.0% had post-partum hemorrhage. Conclusions: Expectantmanagement till 36 weeks is a suitable option as gestational age at delivery and birth weight both affect neonatal survival and offer time toadminister corticosteroids to allow foetal lung maturity. Foetal deaths occurred due to septicaemia and RDS with direction co-relationshipwith low birth weight.

Objectives: To evaluate the use of ultra-sound guided transversus abdominisplane block for effective postoperative analgesia in patients undergoing gynaecological surgeryvia transverse lower abdominal skin incision. Study Design: Randomized Control Trial. Period:Six months from April 2013 to October 2013. Setting: Department of Anesthesiology, HolyFamily hospital, Rawalpindi .Sampling technique: Consecutive non-probability sampling.Material and Methods: 200 female patients undergoing gynecological surgery via transverselower abdominal skin incision were enrolled in the study. They were divided into two groups;both received ultra-sound guided transversus abdominus plane block with either bupivacaine(Group A) or saline (Group B). SPSS version17.0 was used to analyze the data. Results:Two hundred female patients undergoing gynecological surgeries were included. Mean ageof patients was 41 yrs (17-71yrs). There were 100 patients in each group. Both groups werecomparable with respect to baseline features. The US-TAP block significantly reduced painintensity as compared to standard care in the PACU at 4hrs(5.2±3.1vs.8.4±1.3,p=0.003).Therewas insignificant difference between the visual assessment score of pain at 8hrs between thetwo study groups(3.6±2.3vs.2.3±2.4,p=0.4). Conclusions: Ultrasound guided transversusabdominis plane block (TAP) is an effective modality for reducing postoperative pain aftergynaecological surgery via transverse lower abdominal skin incision.

Objective: The objective of this study is to compare the effects of inhaledbeclomethasone with oral montelukast in long term management of moderate persistent asthmain children. Design: Quasi experimental study. Period: 6 months, from July 20,2007 to January20, 2008. Settings: Out patient paediatric department at Fauji Foundation hospital, Rawalpindi.Material and Methods: 8o children between 5-12yrs of age presenting with moderate persistentasthma, divided in two groups of 40 each. Group A treated with beclomethasone inhaler whileGroup B was started on oral montelukast. Drugs effect was recorded on a 2 wkly proforma for 8weeks. Results: There were 54(67.5%) male and 26(33%) female. Most common triggeringfactor seen in 54(67.5%) patients was recent history of respiratory tract infection, exposure tocarpet dust in 43(53.75%), cigarette smoke in 42(52.5%),recent psychological stress in 28(35%) ,pollen allergy in 26 (32.5%) , pets exposure in 8 (10%) and to mite was noticed in 5(6.25%)children. Marked improvement was observed in day time cough in group A with 10(25%) patientsbeing free of cough with inhaler, while 20(50%) showed mild intermittent symptoms. 1(2.5%)showed mild persistent symptoms. In Group B 3(7.5%) patients were symptom free,23(57.5%)with mild intermittent and 4(10%) with mild persistant symptoms while 6(15%)continued to have moderate persistent symptoms. P value was 0.01. Regarding day timebreathlessness, P value was significant of 0.258. Similarly marked improvement was observed innight symptoms of breathlessness, cough and sleeplessness in both groups. P value was lessthan 0.05 in majority of the variables showing statistically significant improvement with inhaledbeclomethasone than with oral montelukast. Conclusions: Inhaled beclom

The aim of this study was to assess the frequency of various forms of in-lawperpetuated reproductive control asserted on the female and any possible factor such aseducation level or early age of marriage which might be responsible for it as various studieshave demonstrated that violence against women has been documented to be perpetuatednot only by male partners but also by the family members of male partners. This multi-centriccross sectional observational study was carried out on 424 consecutive patients in 6 hospitals.The mean age (+ S.D) was 33.7+7.8 years and age of marriage (+S.D) was 21.3+2.8years.116(27.4%) were uneducated, 142(33.5%) had obtained education till primary level,124(29.2%) had secondary education and 42(9.9%) had higher level of education. Upon askingabout any life time in-law perpetuated reproductive control 205 (48.3%) of the females answeredone or more than question as yes and 142 (33.5%) of the participating females said that thein-laws advised their husbands to go for a second marriage if they did not become pregnant.The more uneducated the participants of the study were, more abuse was faced at the handsof her in-laws (p-value <0.005). The most common form of reproductive control asserted bythe in-laws was telling the husband to go for a second marriage if the female did not becomepregnant and this was most commonly seen in the less educated females (p-value <0.005).Inconclusion increased efforts are needed to involve the in-laws in programs that seek to improvewomen’s reproductive health.