Objective: To compare the effect of age, gender and duration of diabetes mellitus on thyroid dysfunction in patients of diabetic Study Design: Comparative cross sectional study. Place and Duration of Study: Medicine department, Combined Military Hospital, Peshawar, from Oct 2015 to Oct 2017. Methodology: The study was conducted after taking permission from hospital ethical review committee. Information was entered in the proforma, which included demographic information like age in years, gender, duration of disease and type of diabetes mellitus (DM) type. Already diagnosed patients with diabetes mellitus were included in the study. Thyroid function tests were carried out by standard laboratory procedure. Results: A total of 179 patients were included in our study, 114 (63.7%) were female and 65 (36.3%) were male. Mean body mass index in our study was 29.85 ± 3.88 kg/m2. Out of 179 patients 46 (25.7%) had thyroid dysfunction (TD). Out of the 46 patients with thyroid dysfunction, 14 patients (7.8%) had clinical hypothyroidism, while subclinical hypothyroidism was seen in 25 patients (14%). Clinical hyperthyroidism was reported in 3 (1.7%), while subclinical hyperthyroidism in 4 (2.2%) patients respectively. Conclusion: Age of patients, gender and duration of disease affect thyroid functions in patients with diabetes mellitus. Thyroid profile should be carried out in diabetic patients whose blood sugar level is difficult to control.

Objective: To compare the frequency of perineal tears (3rd and 4th degree) with and without episiotomy in primigravida women. Setting: Department of Obstetrics and Gynecology at peoples Medical College Hospital (PMCH) Nawabshah. Duration of Study: Six month from March 2015 to September 2015. Study Design: Randomized control trial. Subject and Methods: In this study 322 primigravida women with singleton pregnancy and cephalic presentation were included. The patients were kept in labour room till the second stage of labour. The patients were divided into two groups equally. In Groups-A, right mediolateral episiotomy was performed after infiltration with local anaesthesia at the time of crowing. The Group B in which episiotomy was not given. After delivery, patients were examined for extension of episiotomy in Group A and 3rd and 4th degree perineal tear in both groups. Results:  Mean age was 27.83±6.27 years in group A and 27.60±4.93 years in group B (p=0.724). Mean gestational age was 38.17±1.25 weeks was in group A and 38.11±119 weeks in group B (p=0.644). The rate of 3rd and 4th degree perineal tear was significantly higher in group A as compare to group B [60.87% vs. 47.83% p=0.019] and [39.13% vs. 26.09% p=0.013] respectively. Conclusion: Episiotomy was found to be an important risk factor for extension of the perineal tear. It should be practiced only where it is indicated like rigid perineum, any instrumental delivery and shoulder dystocia.

Background: Grand multiparity considered as a risk factor of obstetrics because of the recorded complications linked to the condition. Grand multiparity typically considered as the distinctive reason for the raised, maternal and fetal morbidity and mortality because of expanded incidence of adverse outcome during pregnancy and birth. Objective: To determine frequency of antenatal complications in grand multipara. Study Design: Cross-sectional study. Settings: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi Pakistan. Duration: Study duration was six months from March 2016 September 2016. Methodology: Total 212 patients were included in this study. Anemia was taken as Hb of 11g/dl, PIH was taken as BP of >140/90mmHg after 20 weeks of gestation with or without proteinuria on two or more occasion 6 hours apart and placenta previa was confirmed via ultrasonography. All the information was collected via study proforma. Results: Patients mean age was 34.90±3.51 years. Most of the patients 96.7% had parity 5-9. Anemia was found 69.8% and pregnancy induced hypertension was 22.2%, while placenta previa was found to be 18.9%. Antenatal complications including anemia, pregnancy induced hypertension and placenta previa were found to be statistically insignificant according to age, parity and BMI, (p->0.05). Conclusion: Most common antenatal complication in this study was anemia followed by hypertension and placenta previa. Grand multiparity is at a greater risk of antenatal complications.

Objective: To determine frequency of adequate knowledge of contraceptive methods among married women attending tertiary care hospital for antenatal care. Study Design: Cross sectional study. Setting: Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Center, Karachi. Duration: From June to December 2016. Materials and Methods: Total 118 married women presented for antenatal care were included. Women were evaluated by administering a questionnaire to assess knowledge about contraception methods. Knowledge was labeled as adequate if responders correctly answered >70% of the questions. Descriptive statistics and Stratification were performed. Post-stratification Chi-square test was applied and p-value ≤0.05 was taken as significant. Results: The mean age was 29.25±5.08 years. Mean gestational age was 11.52±4.54 weeks. Mean duration of marriage was 4.50±2.77 years. 61% study subjects were found with adequate knowledge of contraception. Adequate knowledge had a significant correlation with age, duration of marriage, parity, residence, and education level. Conclusion: Around 61% of the married females were observed with adequate knowledge regarding contraceptive procedures. The female knowledge was significantly associated with age, duration of marriage, parity, residence, socio-economic status, and education level.

Background: Women with von Willebrand disease experiences more postpartum hemorrhage or the bleeding followed by surgery than the healthy women. Aim: To determine the frequency of Von Willebrand disease among females presenting with bleeding complaints at tertiary care hospital. Study Design: Cross sectional study. Methodology: Complete Blood Count, Bleeding Time, Prothrombin time, Activated Partial Thromboplastin Time were performed on the same day. Blood sample for CBC collected in EDTA tubes and for coagulation assays in tubes containing (3.2%) trisodium citrate. Von Willebrand’s factor: Ag and Factor VIII were analyzed on Sysmex automated blood coagulation analyzer CA (600) while Ristocetin cofactor assay (RiCoF) was performed on Aggregometer. The collected data was analyzed by using SPSS version 25. Chi square ware applied with P-value< 0.05 as significant. Results: Out of 80 patients, 56 patients were unmarried and 24 were married. VWD was found in 22/80 patients (27.5%). Type 3(50%) was the most frequent subtype followed by type2 (22.7%) and type 1(22.7%). In VWD, Menorrhagia (63.6%) was the most frequent symptom. APTT was prolonged in type3 VWD (50%). The mean VWF: Ag 18.5±20, VWF: RICOF 27.7±19 and factor VIII 74.9 ± 62.3 was noted in patients with VWD. Conclusion: It was concluded that VWD is the most common inherited bleeding disorder in females presented with bleeding complaints. Awareness about the disorder is the need of time in order to prevent life threatening bleeding. Keywords: Von Willebrand Disease, Menorrhagia and Bleeding Complaints