BACKGROUND: Infertility is not uncommon in our female population as we live in a geographicalarea where the population growth rates are amongst the highest in the world. A variety of cultural normsand values force couples to enhance family. So a sensitive and dedicated efforts need to be made to lookinto the causes of secondary infertility and their treatment.OBJECTIVES: To determine the frequency of bilateral tubal obstruction and common factors leadingto it among women presenting with secondary infertility.METHODOLOGY: It was a hospital based descriptive cross sectional study conducted at thedepartment of obstetrics & gynecology Postgraduate medical institute LRH Peshawar from 8th August2011 to 8th July 2013. Data was collected by non probability consecutive sampling technique. A total of260 patients were enrolled in study. In patients presenting with secondary infertilityhysterosalphingography was performed, in those with bilateral tubal obstruction detailed history wastaken to detect, the history of instrumentation to genital tract, lower abdominal surgery or history ofPID. Laparoscopy was done in all patients with bilateral tube obstruction to confirm the diagnosis anddetermine causes.RESULTS: In this study mean age was 30 with standard deviation of ±2.12. Bilateral tubal obstructionwas found in 73(28%) of the cases, out of which history of pelvic inflammatory disease was presentin15 (21%) followed by history of instrumentation of genital tract in 11(15%) of cases. Positive historyof lower abdominal surgery was present in 4(5%) and 3(4%) patients had fibroids.CONCLUSION: Tubal pathology is one of the main causes of female infertility. A great caution isrequired in pelvic operative techniques to prevent infection and tubal damage.KEY WORDS: secondary infertility, bilateral tubal obstruction, pelvic inflammatory disease.

To determine diagnostic accuracy of spot urine protein to creatinine ratio (PCR) for estimation of significant proteinuria in patients of preeclampsia based on 24-hour urine protein. METHODS: This cross-sectional validation study was conducted at Gynae B unit, Lady Reading Hospital, Peshawar from July 2014 to December 2014. Out of 253 patients, 222 women were finally enrolled as per inclusion and exclusion criteria by using non-probability convenient sampling technique. After taking proper history and calculating period of gestation, blood pressure was measured using standard sphygmomanometer while urinary protein by urine dipsticks. Following standard protocol, urine was collected for 24 hours followed by spot midstream urine. Samples were analyzed for urine protein and creatinine. 24 hours urinary protein level ≥300 mg/day and spot urine PCR was ≥3 mg/mmol was considered significant proteinuria. SPSS v 16.0 was used a statistical instrument. RESULTS: Out of 222 patients with preeclampsia, 24-hours urinary protein level estimation was ≥300 mg/day in 179 (80.6%) cases and <300 mg/day in 43 (19.4%) cases. Spot urine PCR was ≥3 mg/mmol in 175 (78.8%) cases and <3 mg/mmol in 47 (21.2%) cases. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of spot urine PCR against 24-hours urinary protein level estimation was 95.5%, 90.6%, 97.7% 82.9% and 94.5% respectively. CONCLUSION: In our study, spot urinary protein/ creatinine ratio shows a high sensitivity, specificity, PPV, and NPV (at a cut off value >0.3 mg/mmol). This test can be regarded as a reliable investigation among pre-eclamptic patients.