Background: Efforts should be made to minimize the blood loss at the time of cesarean section. The techniques used to reduce the blood loss include finger splitting versus scissor cutting of incision, in situ stitching versus exteriorization and stitching of uterus and finally spontaneous or manual removal of the placenta. Objective: The main objective of this study is to correlate the frequency of loss of blood between the placenta removed manually and spontaneously during cesarean section. Methods: Randomized controlled trial in the department of Obstetrics and Gynecology, Fauji Foundation Hospital, Rawalpindi. The sample is collected through Consecutive (non- probability) sampling. The study was conducted after approval from the hospital ethical and research committee. Informed written consent was taken from all the patients. The patients were divided into two groups, group A and group B randomly by using random table numbers. Group A had spontaneous placental delivery. Group B had manual placental delivery. Each patient was examined thoroughly and detailed history was taken. Data Analysis: Data was analyzed using SPSS 20 for windows. The frequency and percentage of blood loss were measured. A chi-square test was applied to correlate the blood loss between the two groups. p values <0.05 were considered statistically significant. Effect modifiers like age, gestational age, parity were controlled by stratification. Results: The blood loss was compared between both groups using the chi-square test not assuming null-hypothesis. The blood loss was comparatively high in-group in which the placenta was removed manually (p=0.007). Keywords: Caesarean Section, Placenta removal, Spontaneous, Manual, Blood loss.

Background: Chronic pain in the lower back of adults is a common problem and mostly associated with Vitamin D deficiency. Along with standard treatment, vitamin D supplementation can help in early and better relief from back pain. Objective: To assess the effectiveness of vitamin D supplementation in patients with chronic lower back pain. Study Design & Methods: This Quasi-experimental trial was conducted at Department of Orthopaedics, Benazir Bhutto Hospital for 6 months. The patients aged between 15 to 55 years with chronic low back pain were included and pain score was noted by using a visual analogue scale (VAS). Patients were prescribed with oral vitamin D3 with a dose of 50,000 IU weekly for eight weeks (induction phase) and oral vitamin D3 with a dose of 50,000 IU once monthly for 6 months (maintenance phase). Outcome parameters included pain measured by VAS, functional disability by modified Oswestry disability questionnaire scores, and Vitamin-D3 levels at baseline,2, 3 and 6 months post-supplementation. Results: Mean age of patients was 44.21± 11.92 years.There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd& 6thmonths (35.5 ± 11.4, 30.2 ± 9.4 & 25.8 ± 10.6, respectively) as compared to baseline 46.4 ± 13.2 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months. Conclusion: Prescription of Vitamin D in addition to standard therapy for chronic lower back pain can be beneficial in getting relief from pain and improving the functional ability of the patient.

Background Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that can have harmful impacts on maternal and neonatal outcomes. Literature shows that elevated serum maternal ferritin levels may cause dysregulation in glucose metabolism in GDM. This study aims to determine the association between serum ferritin, iron and hemoglobin levels in GDM patients at the time of delivery as well as cord hemoglobin and iron levels in newborns. Methods In this case-control study, a total of 100 patients were included i.e., 50 cases (GDM) and 50 controls (non-GDM) having aged-matched individuals of normal pregnancy. The hemoglobin, iron and serum ferritin, and hsCRP levels of the mother were determined using maternal blood. A cord blood sample was taken to determine neonatal iron and hemoglobin levels. Results The  study participants mean age  was 29.2 ± 5.6 years. The ferritin levels of GDM mothers (42.3 ± 6.7) were significantly higher than non-GDM patients (34.4 ± 3.8) with p<0.001. Similarly, Cord hemoglobin levels of newborns of GDM mothers were significantly higher than newborns of non-GDM patients (p<0.01). In GDM mothers, maternal ferritin levels were inversely correlated to cord hemoglobin levels (r= - 0.29, p =0.004). Conclusions Elevated maternal serum ferritin levels are linked to increased oxidative stress and effects fetal intrauterine and post-partum health. The placental iron transfer and fetal hemoglobin synthesis will be affected by oxidative stress.

Objective: To determine the perinatal outcome of first and second twin delivered vaginally in terms of frequency of poor APGAR score and NICU admission in the patient at term in a tertiary care health facility.Introduction: This study aims to improve the perinatal outcome of twin pregnancies through awareness of the need for antenatal care, the recommendation of regular antenatal visits, early recognition of complications, and the presence of neonatal intensive care facilities to improve neonatal outcome by knowing the burden of adverse outcomes in our population.Materials and Methods: This is a descriptive study, conducted at the Department of Obstetrics and Gynaecology at DHQ Hospital, Rawalpindi from January 2019 to June 2019.A total of 91 individuals (female pregnant ladies) who delivered twins (Dichorionic Diamniotic) babies through normal vaginally were selected for descriptive study in the Department of Obstetrics and Gynaecology, DHQ hospital Rawalpindi. All consecutive patients admitted in the labour ward with twin pregnancies were included. Before delivery, the fetal wellbeing of both the twins was evaluated also by ultrasonography. Data collection was done by interview schedule from the patients. Data were analyzed using descriptive statistics using SPSS version 17. For all the quantitative variables like age, gestational age and intertwine interval in seconds.Results: Out of 6278 deliveries during the study period, 91 twin births gave a frequency of 15.16/1000 births. Patients' mean age was 30.14+2.64 years, and mean gestational age was 37.47+0.72 weeks. The mean inter twin delivery interval (mins) in the study was 23.74+4.75. Perinatal outcome of first and second twin in terms of frequency of poor APGAR score and NICU admission in a patient at term was 09 (9.9%) and 27 (29.7%), (p<0.001) respectively.Conclusion: The study concludes that there was a high risk of perinatal outcomes in the second twin as compared to the first twin delivered vaginally. Poor Apgar score and neonatal intensive care admission were more so for the second twin.

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