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Abstract   Background The caesarean section rate  is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and  hence caesarean section rate . Methods This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .  It included 56 low risk singleton  breech presentations from 36 wks- 40 wks after taking their informed consent  While those with < than 36 wks (primis) and >40 wks gestation, refusal to ECV , with absolute contraindication to ECV& with medical and obstetric complications (ie scarred uterus, liquor <than 8 cm & > than 17 cm, fetal growth restriction, preclampsia, gestational diabetes & abnormal cardiotocography) were excluded  from the study. ECV was performed by single obstetrician in labour room with facilities  of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus  for 30-40 min was done just before & after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound.  .Number  of successful ECVs & specific factors  of the women & the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby)  were chosen to observe their effect on success of  ECV. Results External cephalic version was successful in 27 (48.2%)  & unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech & type of breech (complete flexed) ( with p values .001, .000 & .001 respectively) had statistically significant positive association with successful external cephalic version. Conclusion ECV should be offered to all  women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &counselling the women regarding the success and failure of ECV.  

Objectives: Objective: To compare the maternal and perinatal outcomes of ursodeoxycholic acid with placebo in obstetric cholestasis. Method: It was an open randomized parallel-group study with convenient sampling, conducted at Pakistan ordinance factories hospital (POF Hospital) Wah Cantt, from 1st June 2016-30th May 2019. Patients with obstetric cholestasis of pregnancy, diagnosed between 24-34 weeks of gestation, were randomized to receive either ursodeoxycholic acid 500mg twice daily or placebo one capsule twice daily for 4 weeks. The data was collected on a pre-designed proforma. The data of 84 patients, who full fill the inclusion criteria were analyzed using SPSS vs 19. Maternal outcomes measured were a relief in pruritus and a decrease in hepatic alanine aminotransferase levels (ALT) at the end of 2 weeks and 4 weeks of treatment. The mode of delivery was noted. Fetal outcomes measured were meconium staining of amniotic fluid and the need for neonatal intensive care unit (NICU) admission. Results: The results showed significant improvement in maternal itch score (P=0.001) and serum transaminases level (p=0.001) in patients using UDCA as compared to placebo. Although there were less number of caesarean sections (p=0.36), meconium-stained liquor (p=0.29) and NICU admissions (P=0.33) in the UDCA group the differences were not statistically significant. Conclusion: Treatment with UDCA in obstetric cholestasis improved maternal complaint of itching and decreased raised transaminases levels but did not affect significantly the mode of delivery, incidence of meconium-stained liquor and NICU admissions. Keywords: Obstetric cholestasis, Ursodeoxycholic acid, perinatal outcome, Pruritus.

BACKGROUND & OBJECTIVE: Iron deficiency results in major disabilities and death all over the world, about two billion people are suffering from anaemia at the moment. To compare intravenous iron sucrose with intravenous ferric carboxymaltose in terms of mean change in hemoglobin level and mean corpuscular volume (MCV) for treatment of iron deficiency anaemia in pregnant patients. METHODOLOGY: Prospective comparative study was conducted at the department of Obstetrics/ Gynecology of POF Hospital Wah Cantt and HIT Hospital Taxila Cantt. The study duration was 2 years, from January 2017-December 2018. A total of 80 patients were included in the study. Patients were randomly divided into two groups; in Group-A; 40 patients were given intravenous iron sucrose, and in Group B, 40 patients were given intravenous ferric carboxymaltose. Patients were observed for hemoglobin level and mean corpuscular volume (MCV). Data analysis was done with SPSS version 24. An Independent t-test was applied, and results with p-value ≤0.05 were found significant. RESULTS: Post-treatment hemoglobin means level in the iron sucrose group was 9.90±0.4SD, and in the intravenous ferric carboxymaltose group, post-treatment hemoglobin was 10.71±0.9SD (p≤0.001). In the iron sucrose group, the post-treatment mean corpuscular volume mean level was 81.94±6.0SD and in the intravenous ferric carboxymaltose group mean post-treatment mean corpuscular volume was 88.08±7.1SD (p≤0.001) CONCLUSION: Treatment with intravenous iron caboxymaltose is superior to intravenous iron sucrose with respect to hematological response, which seems to be safe, as very few severe side effects were observed.

Objective: To compare the efficacy of oral diclofenac sodium and diclofenac suppository for perineal pain relief after episiotomy. Study Design: Prospective randomized clinical trial. Place and Duration: Obstetrics and Gynecology Department of Pakistan Ordnance Factories Hospital, Wah Cantt from 1st Jan 2021 to 30th June 2021. Methodology: The study included 260 patients, who were randomly divided into group A and B through a computer-generated list. Patients in group A were given diclofenac sodium tablet 50mg orally just after the completion of episiotomy repair and it was repeated after 12 hours. Diclofenac suppository 50mg was placed rectally after episiotomy repair in patients of group B and was repeated after 12 hours. Perineal pain was measured at 24 hours after episiotomy repair on Visual Analogue Scale. Results: The mean pain score was 2.93 in diclofenac suppository group and 3.98 in oral diclofenac group. The women in suppository group had less pain than oral group and the difference was statistically significant (p=0.001). Conclusion: Diclofenac suppository was more effective than oral Diclofenac Sodium for perineal pain relief at 24 hours after episiotomy. Keywords: Diclofenac Suppository, Diclofenac Tablet, Episiotomy, Mean Pain Score, Perineal Pain Relief, Visual Analogue Scale How to Cite This: Mushtaq I, Kalsoom S, Nisa K, Jamil M, Safdar F, Majeed N. Oral versus rectal Diclofenac Sodium: Comparison of efficacy for Perineal pain relief after Episiotomy. Isra Med J. 2022; 14(3): 104-107. DOI: https://doi.org/10.55282/imj.oa1329