Background: Every year, 2.7 million stillbirths occur worldwide, mostly in developing countries. The United Nations Sustainable Development Goals (SDGs) include reducing childhood mortality under five years of age. Perinatal death audit is an intervention to reduce preventable neonatal mortality. The aim of this study was to determine the Perinatal Mortality Rate (PMR) and the factors responsible for perinatal deaths at a Tertiary Care Hospital in Karachi-Pakistan. Methodology: This was a prospective study of all the stillbirths and early neonatal deaths in Abbasi Shaheed Hospital Karachi, Gynecology Unit I. Details of each perinatal death were filled in the standard form. We used Aberdeen Obstetric classification to classify causes of perinatal deaths. Results: There were 1627 deliveries and 43 perinatal deaths during the study period. Our study's perinatal mortality rate was 27.14/1000 births, and the stillbirth rate was 13.25/1000 births. Antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) and anemia were the common causes of perinatal deaths. Conclusion: Antepartum hemorrhage, pregnancy-induced hypertension and anemia are the leading causes of perinatal deaths. Most of these complications can be reduced by educating women and providing effective antenatal care.

Background: Thyroid hormones are vital for fetal development and regulation of neuropsychological function. Therefore an adequate amount of thyroid hormone levels are necessary for brain development cognitive function. Newborn screening for congenital hypothyroidism is a great achievement in preventive medicine. Screening for hypothyroidism disorder using heel prick samples is considered essential for preventing intellectual dysfunction and delayed growth. The objective of the present study was to determine the frequency of hypothyroidism disorder in newborns. Methodology: A cross-sectional study was conducted at Abbasi Shaheed Hospital, Gynae & Obstetrics Department, Karachi, Pakistan. Blood samples were obtained from 257 neonates between 3rd & 5th day after birth by the heel prick method. Babies of Mothers having thyroid diseases were excluded from the study. Serum Thyroid-stimulating hormones (TSH) were tested using the enzyme-linked immunosorbent assay method. Newborn serum TSH > 20 miu/L was considered abnormal. Results: The overall mean age of neonates was 3.47 ± 0.57 days. Out of the total 257 neonates screened, female babies had higher TSH levels and congenital hypothyroidism was found in 4(1.55%) cases. The observed mean TSH level was 4.09 ± 0.24 mIU/L.   Conclusion: In conclusion, the observed frequency of neonatal hypothyroidism in this single-center study prompts the need for early screening and diagnosis. The screening should be included in the post-natal period to prevent sequels associated with hypothyroidism for timely diagnosis and treatment of newborns.

Objective: To find out the frequency of vitamin-D deficiency during pregnancy by using Serum 25 hydroxy vitamin-D3 leveland to evaluate the risk factors associated with low level of vitamin-D. Study Design: Cross Sectional Study. Setting: Gynae and obstetricunit II in Abbasi Shaheed Hospital Karachi. Period: February 2011 to July 2011. Material and methods: Design: All patients with historyof chronic renal disease, liver disorder, PIH, GDM, twin gestation, anti tuberculous treatment and antiepileptic treatment with excluded.Data was collected by predesigned proforma through personal interview. Result: This study showed 49 cases (98%) of primigravidawere vitamin-D deficiency. The highest low level was in 15-25 years of age. The mean concentration of 25bOH vitamin-D 3 was 10.30ng/ml.60 % of women had severe vitamin-D deficiency with level of 25 OH vitamin-D3 was lessthan 10ng/ml. Risk factors associated withlow level of vitamin-D3 included dietary deficiency , lack of sun exposure and practicing veil. Conclusions: Pregnant women includingprimigravida in Pakistan are at risk of vitamin-D deficiency. 25 (OH) assay should be used as an aid in assessment of vitamin-D deficiencyduring pregnancy so that proper correction can be achieved. Women who are deficient in vitamin-D should be counseled regardingmaternal and neonatal risk, a balanced diet ,limited sun exposure and compliance of vitamin-D supplement to ensure normal maternal andfetal outcome. Every women should provided by vitamin-D supplement prior to pregnancy.

Placenta previa with accreta is a rare cause of major obstetric hemorrhage resulting in maternal morbidity and mortality. A case series of 08 patients of placenta previa with accreta presented at Abbasi Shaheed hospital Gynecology unit 1 from January 2018 to December 2018. Seven (07) patients were delivered by Caesarean Section and one vaginally. In 05 patients placenta was left in situ and injection methotrexate was given. Removal of placenta during Lower Segment Caesarean Section (LSCS) and bilateral internal iliac artery ligation was done in 02 cases. Febrile illness occurred in 02 patients. One patient required laparotomy on fifteenth postoperative day due to uterine scar dehiscence. Two cases required obstetrical hysterectomy due to torrential hemorrhage. Conservative management in women with placenta previa with accreta has proven to be successful in carefully selected cases at tertiary care hospital with multi-disciplinary team.