This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for each variable was selected. These charts will help radiologists and clinicians in predicting dates of delivery, assessing fetal growth and identifying intrauterine fetal insufficiency in the Pakistani population.

Background -Primitive neurocetodermal tumor / Ewing's sarcoma (PNET/ES) of uterine cervix is extremely rare tumor and only 27 cases have so far been reported in the literature. We hereby present one case report diagnosed by histopathology and IHC and review of literature. Objective -A young girl aged 20 years was admitted. Her routine investigations and CT and MRI scan of chest, abdomen and pelvis were performed. Biopsy was taken from vaginal mass and histopathologist reported as round cell tumor. The slides were reviewed by another pathologist and found to be rhabdomyosarcoma. Thus immunohistopathology was done and a diagnosis of PNET/ES was established. Methods -The patient presented with complains of vaginal bleeding, generalized body ache, poor nutritional intake, found extensive loco regional disease with metastases to liver, lung and multiple bones, stage FIGO IV, performance score ECOG -4. Owing to her low general condition, we could not plan any anti-cancer treatment like chemotherapy or radiation therapy. She was discharged on symptomatic treatment. Results -Her biopsy and immunohistopathology turn out to be PNET/ES of uterine cervix. Conclusion -The rarity of this entity poses a challenge to pathologists and oncologists. The PNET/ES of uterine cervix can be potentially curable if presented at an early stage and found operable. IHC plays an important role in establishing this rare diagnosis.

Background: Our country has achieved 77% reduction in maternal mortality rate (MMR) over last three decades. Most of the tertiary care institutions record high MMR because they face the influx of women in critical condition needing caesarean deliveries as well as intensive care unit (ICU)-care; thereby increasing the burden of mortality as well as near miss morbidity. The present study is an effort to evaluate the changing needs at the tertiary level of care. Aims and Objectives: Evaluate MMR for the past 10 years, assess causes of death, trend over 10 years against resource up gradation and suggest areas of improvement. Methods: Case records of all maternal deaths over 10 years (2010–2019) at our institute were studied (age, parity, residence, antenatal care booking, causes of death, and admission to death interval). Hospital statistics were obtained for total vaginal births, caesarean sections, high dependency unit–ICU admissions, and resource up gradation over past 10 years. Results: Total live births over 10 year’s period were 106,872 and maternal deaths were 311. Average MMR during 10 years was 291. Maximum deaths occurred in 21–25 years (56.27%), primiparas (58.19%), women from rural areas (68.16%), unbooked/referred cases (91.64%), and postpartum cases (81.67%). Direct causes were responsible for 78.77% and indirect causes for 21.22% deaths. Majority of deaths (80.38%) occurred within 24 h of admission. Conclusion: Upgradation of resources, encouraging early referrals from rural areas, arranging critical care ambulances, and training of manpower in obstetric critical care may bring down MMR at tertiary care hospitals.

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