Objective: To evaluate the indications of primary cesarean section in multipara and to assess the obstetric outcome including maternal, fetal morbidity and mortality, perinatal outcome. Study Design and Setting: It was a hospital based study of primary caesarean sections (CS) done on multiparous patients in duration of two years between January 1, 2016, and December 2017 at Jinnah medical college hospital Karachi. Methodology: Multiparous patients were those who had delivered through vaginal route one or more times (i.e. 28 weeks of gestation or above) or had 1–4children and grand-multiparous are those who had 5 or more children. All the cases included in the study were hospital based and cesarean section was decided by specialist. The procedure was performed by registrars and specialists. The selected patients were followed up till they were discharge from the ward with minimum hospital stay of three days. Data was compiled and results were carried out by SPSS version 23. Results: During the two years of study period, the number of total deliveries were 2064. The primary CS rate in multipara was 37.17%. These women have more likely to have an emergency cessarean sections compared to elective i.e. 85% and15%. The mean age of women was 29.5 years, booked cases were 72.5% and unbooked were 27.5%. Regarding indications for cesarean sections, non-progress of labour ranked first 25.5% followed by fetal distress 20%, pre eclampsia 12 % and ante partum hemorrhage 10.5% etc. Increase incidence of morbidity and mortality was seen in patients undergoing cesarean section due to different reasons. Conclusion: Primary caesarean sections in multipara comprise only a small percentage (37.17%) of total deliveries but were related to high maternal and fetal morbidity

Background: Improving maternal and child health is prioritized globally; however, adolescent pregnancies remain the prime one among the many obstacles. The study aimed to determine the maternal and perinatal outcomes in adolescent and adult primigravida. Methodology: This cross-sectional study was carried out between 1st December 2018 to 30th November 2019, over a sample of 487 pregnant women (primigravida), presenting at the Jinnah Medical College Hospital, Karachi, for childbirth/delivery. The patients were categorized as adolescents (aged ≤19 years) and labelled as group A and adults (aged 20-34 years) labelled as group B, comprising 83 and 404 patients. Data were recorded using a structured questionnaire containing details pertaining to socio-demographic characteristics, labour, delivery and immediate postpartum period complications of pregnancy. The data was analyzed using SPSS version 23.0. Results: A total of 1738 deliveries were completed in the study duration at Jinnah Medical College Hospital, Karachi. The mean age of the women was 18.35 ± 0.06 years, and the modal age was 27 years. The mean gestational age of the women was 36.86 ± 2.15 weeks among teens and 38.55 ± 0.55 weeks among adults. The incidence of adverse outcomes was higher among maternal [anemia; 46.9% (p-value 0.05)] and perinatal [preterm delivery (20%), low birth weight (22%), stillbirth (11.5%) and perinatal mortality (10%); p<0.05] was higher among teens. Conclusion: It is concluded that teenage pregnancies are comparatively riskier than adult pregnancies for the child and the mother, as is apparent from the significant

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

OBJECTIVE: To explore the perception of undergraduate students of United Medical and dental college towards objective structured clinical examination as an assessment tool. MATERIAL & METHODS: A cross-sectional observational study included undergraduate medical students, RESULTS: 153 students who completely filled the proforma were included in study among them 31% were male and 69% were females. Mostly agreed that stations in OSCE were simple and easily interpretable and assessed practical skills thoroughly. Majority of students accepted that skills inquired were taught in clinics, stations were according to course and stations were appropriately timed. 66 % confirmed that adequate instructions were provided before exam. 84.31% believed that OSCE is preferable to viva. 57.51% of candidates stated that examiners during OSCE were attentive and gracious but 20.91 % objected it , while 21.57% remained neutral. Almost half of examinees labelled it as comprehensive clinical assessment .Overall, 67.97 % perceived OSCE as demanding and tough assessment. Finally views of students for statement that OSCE is unbiased, reliable and valid were positive in 50.32%.There was a significant difference in the opinion of male and female( p-value is less than 0.05) in statement that OSCE thoroughly assessed practical skills, stations were according to course of instruction, Adequate instructions were provided before exam, superior and preferable to viva, assists in improvement of clinical skills, demanding and tough and finally OSCE was unbiased, reliable and valid CONCLUSION: OSCE was perceived as fair, comprehensive, un-biased format of examination but believed it was more stressful than traditional examination methods . KEY WORDS: Assessment, Attitude, OSCE, Perception, Undergraduate Medical students.

Objective: To determine the reasons of opting to stay in the Pakistan or abroad between students of tow public and private medical colleges. Materials and Methods: Descriptive cross-sectional, questionnaire-based study was conducted in a Private and Public sector medical college in Karachi from October to November 2018. A sample of 400 medical students 200 from each college, 40 students (20 males; 20 females) from each of first to final (5th) year batches separately were selected randomly. Study protocol was approved by the Ethical Review Committee of DUHS while permission for data collection on a questioner of 16 items was sought from authorities of both Medical Colleges. Data were entered & analyzed into SPSS version 26. Results: The mean age of students was 22.18 ± 1.788 years. Father of 20.3% (n=81) and the mother of 12.8% (n=51) students were MBBS, or BDS and almost all of them were practicing. It was found that with the increasing age / class year preference of working in Pakistan (and UK) increased (Up to 1.5 times; p value < 0.380). Likewise; females prefer Pakistan, UK and Gulf countries more than males who had Pakistan and USA top preference to medicine career in the future (P value = 0.758). Although abroad preference was statically significant among private university student (P value = 0.001). Conclusion: Private university medical students were more observed for opting the foreign countries mostly UK and USA compared to the government Medical University students. Financial Reward, life-Style and job Opportunities were observed the commonest reasons. The lack of career counselling and guideline results in health industry losing many future doctors every year as well as loss of potential resources on their training. Keywords: Medical Education, Motivational factors, Emigration