Objective: To compare the efficacy of manual vacuum aspiration versus sublingual misoprostol in first trimester miscarriage at people's medical college hospital Nawabshah. Study Design: Randomized Controlled Trial. Settings: Department of Gynaecology and Obstetrics, Peoples Medical University & Hospital Nawabshah. Duration of Study: 7th April 2021 to 6th October 2021. Materials & Methods: A total of 100women with first trimester incomplete abortion, 18 to 45 years of age were included. Patients having allergy to misoprostol or other prostaglandins, contraindication to prostaglandin therapy (asthma, hypertension, glaucoma) and suspected ectopic pregnancy assess on ultrasound were excluded. Group A received a single dose of 600 microgram of sublingual misoprostol every three hours and group B who underwent MVA for evacuation of retained products of conception. Efficacy was noted. Results: The mean age of women in group B was 30.14 ± 4.12 years and in group A was 30.20 ± 3.69 years. Majority of the patients 51 (51.0%) were between 18 to 30 years of age. The mean gestational age in group B was 7.92 ± 2.42 weeks and in group A was 7.48 ± 2.32 weeks. In this study, success was seen in 46 (92.0%) women in group B (manual vacuum aspiration) and 37 (74.0%) women in group A (sublingual misoprostol) with p-value of 0.017. Conclusion: This studyconcluded that manual vacuum aspiration (MVA) is effective and safe procedure as compared to sublingual misoprostol in first trimester incomplete abortion. Keywords: first trimester incomplete abortion, manual vacuum aspiration, misoprostol

Background: Premature rupture of membranes (PROM) is always of clinical significance either it occurs before onset of labour at term or preterm. It is defined as spontaneous rupture of fetal membranes which results in leakage of amniotic fluid. PROM is related with maternal and perinatal morbidity and mortality if not treated sensibly on time, due not only to conditions causing it but also likelihood of emergency cesarean delivery. Aim: To ascertain frequency of C- section in women presented with premature rupture of membranes at tertiary care hospital. Study Design: Cross-sectional descriptive study Place and Duration of Study: Department of Obstetrics and Gynaecology Unit 1, Sheikh Zayed Women Hospital, Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st October 2020 to 30th April 2021 Methodology: One hundred and eighty six pregnant women having gestation from 28 weeks till 40 weeks and diagnosed as premature rupture of membranes were included. Results: The average age 27.97±5.66 years. 29.57% of caesarean section presented PROM was observed. Conclusion: PROM remains an imperative cause of maternal and fetal morbidity and increased rate of cesarean section delivery to focus upon. Timely evaluation of reasons leading to PROM can help us in reducing the soaring rate of cesarean section in developing countries. Keywords: Premature rupture of membranes, Caesarean section, complications.

Background: Infertility is always been considered as social issue because of its impact on individuals as well as on families. Unexplained infertility defined as inability of a couple to conceive after one year of unprotected intercourse even in the absence of any specific reason for it. Aim: To compare the efficacy of letrozole and clomiphene citrate among patients presenting with unexplained infertility Study design: Prospective observational study. Place and duration of study: Department of Obstetrics & Gynecology, Sheikh Zayed Women Hospital Larkana from 1st January 2020 to 31st December 2020. Methodology: Three hundred and thirty six women having unexplained infertility were randomly allocated into two groups. One hundred and sixty eight patients in group A were given letrozole 2.5mg and 168 women in group B received clomiphene citrate 50mg for three months with successive increase in dose up to 3 cycles, if not conceived in first cycle. They were assessed for pregnancy after 4, 8 and 12 weeks of treatment. Results: The average age of the patients was 27.01±2.53 years. Efficacy of letrozole was significantly high as compare to clomiphene citrate [82.1%vs.62.5%;p=0.0005]. Conclusion: The efficacy of letrozole was significantly high as compared to clomiphene citrate. Letrozole is a better alternative for ovulation induction in anovulatory women because it has high pregnancy rates with shorter time to pregnancy and chances of multiple pregnancies are less because of high monofollicular growth. Keywords:-Infertility, Clomiphene citrate, Letrozole, Unexplained infertility.