Objective: To determine the frequency of newly diagnosed gestational diabetes mellitus (GDM) and common associated factors in recurrent GDM. Study Design: Cross sectional. Place and Duration of Study: The study was conducted in the department of Obstetrics and Gynecology unit A of Lady Reading Hospital, Peshawar from 27th July 2016 to 27th Jan 2017. Materials and Methods: 336 women meeting the eligibility criteria (18-45 years, of any gestational age with gestational diabetes mellitus history and diagnosed as recurrent gestational diabetes) were included in the study. All patients who were labeled as a case of recurrent gestational diabetes was further investigated for any risk factor associated with its recurrence. Results: The recurrence of Gestational Diabetes was observed in 99 (29.46%) patients, in which 77% of patients had family history positive. Conclusion: Keeping in view the recurrence of gestational diabetes proper screening and medical care for GDM in women during the childbearing years is highly recommended.

Objective: To compare the effect of intravenous ondansetron versus intravenous tramadol on post-spinal shivering and nausea/vomiting in caesarean sections. Study Design: Prospective comparative study Place and Duration of Study: The study was carried out at Department of Anesthesia, Frontier Corps Hospital Quetta from 2nd July 2019 to 1st November 2019. Materials and Methods: Ninety patients, who were scheduled for elective cesarean section under spinal anesthesia were randomly allocated to one of three study groups to receive intravenous ondansetron (group O), tramadol (group T) or normal saline/placebo (group P). Intra- and post-operative shivering score, nausea/vomiting score and hemodynamic changes were recorded. Descriptive data was expressed as means and standard deviations (SD). Analysis of variance (ANOVA) and repeated measure analysis were used for continuous parametric variables. Within groups, comparisons were made using the Tukey's post-hoc analysis. Chi-square test was used for association of shivering and nausea/vomiting among the groups. Results: Both groups were comparable for the age and weight. Shivering was reported 0.35±0.59 in ondansetron group 0.73±0.55 in Tramadol group and 1.90±0.84 in Placebo group (p value< 0.001). Postoperative nausea and vomiting (PONV) was reported 0.25±0.53 in ondansetron group 1.04±0.63 in tramadol group and 0.99±0.71 in placebo group (p value<0.001).There was a significant difference in post- spinal shivering and nausea/vomiting in ondansetron (O) group versus tramadol (T) group and placebo group. Conclusion: The effect of intravenous ondansetron is better than intravenous tramadol in preventing shivering as well as nausea/vomiting.

Objective: To compare the acceptability of insertion of post placental intra uterine contraceptive device, withrespect to gravidity between vaginal deliveries and caesarean sections. Study Design: Prospective comparative study. Place and Duration of Study: Frontier Corp Hospital, Quetta, from Jan 2019 to Jan 2020. Methodology: A total of 399 females with age of 18 to 45 years with gravidity (primi, multi and grand multigravida) were counselled during antenatal visits about benefits and risks of post placental intrauterine contraceptive device (PPIUCD) insertion. For complications, females were assessed at 1 and 6 weeks after delivery. Results: A total of 399 females with mean age 27.95 ± 5.07 years were included in study. About 235 (55.9%)women delivered vaginally and 164 (41.4%) women by caesarean section. Acceptance rate was 3.8% and 4.3% for vaginal and caesarean deliveries respectively. Eleven (73.3%) women were grand multi gravida and 4 women(26.6%) were multi gravid in vaginal delivery acceptance group versus 8 women (47%) grand multi and 9 women (52.9%) multi gravida in caesarean acceptance group. Five (15%) females presented with complications (3 with abdominal pain and 1 each with infection and expulsion). Conclusion: The overall acceptance rate of PPIUCD was low in this study, the acceptance rate was higher inwomen undergoing normal vaginal delivery (NVD) as compared to lower segment caesarean section (LSCS),similarly more of the grand multiparas accepted the method as compared to other participants however thedifferences were not statistically significant.