Objective:To determine the risk factors, management modalities, fetomaternal outcome of uterine rupture cases at University teaching hospital in Pakistan.Methods:This retrospective descriptive study was conducted at the Department of Gynaecology and Obstetrics Liaquat University of Medical and Health Sciences (LUMHS) for a period of one year from January 1st to December 31st 2012. Main outcome measures were frequency, age, parity, booking status, risk factors, management modalities, fetal and maternal mortality associated with uterine rupture. The data was collected on pre-designed proforma analysed using SPSS Version 16 statistical package.Results:The frequency of ruptured uteri was calculated to be 0.67%, giving a ratio of 1:148 deliveries. Highest incidence was found in age group 25-30 (44.26%) with mean age of 30.36 years. and parity group 2-3 (57.37%) with mean parity 4.08. The risk factors for ruptured uterus include Caesarean section 43(70.49%), injudicious use of oxytocin 33(54.09%), obstructed labour 15 (24.59%) and multiparty 18 (29.50%). Repair of uterus was performed in 47(77.04%) cases. Maternal case fatality was 5(8.19%), while foetal wastage was 51 (83.60%).Conclusion:This study confirms the existence of a serious preventable obstetric problem, with significant maternal mortality and foetal wastage. Integrated efforts include Health education, focused antenatal care, skilled attendance, avoidance of injudicious use of oxytocin, and need of hospital based deliveries in patients with caesarean section which should be intensified to reduce this drastic obstetrical complication.

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Objective: To determine the Prevalence of Pre-eclampsia in women with peripartum cardiomyopathy (PPCM) and to compare the maternal outcome in cases of PPCM who develop pre-eclampsia with those cases who are normotensive.      Study design: This is a prospective observational study. Setting: Study carried out at department of Gynecology and Obstetrics, Liaquat university hospital Hyderabad from 20th February 2019 to 19th February 2020. Materials and methods:  This prospective observational study was conducted in department of Gynecology and Obstetrics and department of Cardiology Liaquat University Hospital Hyderabad. Inclusion criteria were patients admitted with a diagnosis of peripartum cardiomyopathy diagnosed clinically and confirmed by echocardiography. Exclusion criteria were cases with multiple pregnancies, smokers, those with chronic hypertension and chronic renal disease or diabetes. We assessed patients for pre-eclampsia. Outcome measures studied were serious maternal complications like Pulmonary oedema, Cardiogenic shock, intensive care unit admission, and death. Results:  During one year study period, there were 71 cases of peripartum cardiomyopathy. The mean age of patients was 29.77±6.8 years. Pre-eclampsia was seen in 62% cases of Peripartum cardiomyopathy. Mean ejection fraction was 33.24±6.49. In patients of PPCM, serious maternal complications including cardiogenic shock 11(15.5%) cases, intensive care unit admission 10(14.1%) cases, pulmonary oedema 35(49.3%) cases and prolonged hospitalization 58(81.7%) cases.  Conclusion: We conclude that pre-eclampsia has high prevalence in patients with PPCM. Both when combined, significantly increase the chances of serious maternal complications including death.

Objective: To determine the efficacy and safety of uterine artery ligation (UAL) in control of Postpartum Hemorrhage. Methodology: This case series study was conducted at Department of Gynecology and Obstetrics Peoples University of Medical & Health Sciences for Women Nawabshah. All the women age between 20-45 years, gestation duration at and beyond 34 weeks, antepartum hemorrhage; intraoperative atonic postpartum hemorrhage and discovery of a placenta accreta; or an adherent placental part after piecemeal removal of the placenta, with bleeding from the placental site were included. After failure of treatment from medical measures, the initial surgical approach of uterine artery ligation (UAL) was done. Efficacy was defined as positive when patient improves or clinically doesn’t develop any complication throughout admission after UAL. Safety was assessed by appearance of side effects if any occurred after procedure. Data was recorded via study proforma and analysis was done by using SPSS version 20. Results: Out of 76 patients admitted of postpartum hemorrhage mean age was 58 years. Most of the patients 59.2% were multiparous and 40.8% were primiparous. The most common cause of postpartum hemorrhage was uterine atony 56.5% and adherent Placenta accreta 43.42%. Most of the patients 81.6% had no postoperative complications except for 11 patients, who had developed gaping of the wound from which they recovered and discharged. The patients required hysterectomy due to intractable hemorrhage and 2.3% mortality was observed due to DIC. Conclusion:  Uterine devascularization by bilateral uterine artery ligation is a simple, effective and the safest initial surgical option with less blood loss and less surgical time for controlling postpartum hemorrhage during cesarean section. It should be used as the first surgical step of choice after medical managements fail in controlling postpartum hemorrhage due to minimal rate of complications and mortality.