Objective: To determine the frequency of factors responsible to small for gestational age infants in primigravid women. Study Design: Cross Sectional Study Setting: This study was carried out in the department of obstetrics and gynaecology of Agha Khan University Hospital, Karachi Duration of Study: This study was conducted from 15th September 2018 to 10th January 2019. Subjects and methods: A total of 127 women with singleton pregnancy and gestational age 28-35 weeks by LMP with 0 Parity were included. Women with history of miscarriage, diabetes and family history of SGA babies were excluded. Ultrasound was done to all women and Small for Gestational age babies (as per operational definition) was recorded. All the women was interviewed regarding smoking and detailed history and examination was done to make clinical assessment and for ordering the proper investigations to establish medical disorder by the researcher herself. Venous blood was collected from all women and was immediately sent to laboratory. Hemoglobin < 10 g/dL was recorded as anemia. Ultrasound examination was done for oligohydroamnios as per operational definition. Patients BMI were calculated. Hypertension was also calculated as per operational definition. Data was recorded for factors. Results: Age range in this study was from 18-40 years with mean age of 27.968± 2.05 years and mean gestational age 31.692±2.40 weeks, mean weight 71.645±12.94 Kg, mean height 1.549±0.10 meters and mean BMI was 29.924±5.12 Kg/m2. Majority of patients were from 18-30 years age group (89.8%). As far as risk factors are concerned smoking was seen in 5.5%, overweight 65.4%, hypertension 13.4%, oligohydramnios 29.1%, anemia 12.6%, preeclampsia 15.7%, hypothyroidism 16.5%, hyperthyroidism 6.3%, antiphospholipid antibody syndrome 13.4% and diabetes mellitus was 8.7%. Conclusion: A variety of risk factors have been discovered for newborns deemed SGA by customized centiles. SGA is associated with a number of lifestyle factors, many of which are controllable, such as food, smoking, and exercise. Future research is needed to verify our findings. Keywords: Small for Gestational Age, Primigravid women, Factors

Aim: To determine the maternal outcomes in women presented with severe pre-eclampsia. Study Design: Prospective/Observational Place and Duration: Obs & Gynae department of Akhtar Saeed Medical and Dental College and Hospital, Lahore and Kausar hospital/Khairpur Medical College, Khairpur Mir’s Methods: Total 100 patients with ages 18 to 45 years presented with pre-eclampsia were included in this study. Patients detailed demographic including age, parity, gestational age, and body mass index were recorded after taking written consent. Patients complete blood picture was examined. Complications associated with preeclampsia were examined. Data was analyzed by SPSS 23.0. Results: Out of 100 patients 23 (23%) were ages <20 years, 42 (42%) were ages 20 to 30 years, 30 (30%) were ages 31 to 40 years and 5 (5%) were ages above 40 years. 41 (41%) were primigravida while 59 (59%) were multigravida. Mean gestational age was 34.11±3.88 weeks. HELLP syndrome found in 21 (21%) patients, 11 (11%) patients had eclampsia, and 16 (16%) patients had placental abruption, coagulopathy found in 4 (4%) patients, 3 (3%) patients developed acute renal failure and 2 (2%) patients were died. Conclusion: It is concluded that pre-eclampsia is highly associated with major maternal complications such as HELLP syndrome, eclampsia, placental abruption and maternal mortality. Keywords: Pre-eclampsia, HELLP Syndrome, Placental Abruption, Eclampsia, Mortality

Aim: To determine the safety and efficacy of immediate postpartum intrauterine contraceptive devices insertion after vaginal and caesarean and vaginal deliveries. Study Design: Retrospective study Place & Duration: Conducted at Gyne & Obs Department, Shahida Islam Teaching Hospital Lodhran, during from 1-06-2020 to 30-06-2021. Methods: In this study 120 patients were included in this study. Patients’ ages were ranging from 20 to 45 years. Patients’ detailed medical history including age, residence and socioeconomic status were examined after taking written consent. All the patients divided into two groups, 60 caesarean, 60 vaginal. IPPIUCDs were inserted in all the patients. Outcomes were examined at follow-up and compared between both groups. Data was analyzed by SPSS 24.0. P-value <0.05 was considered as significant. Results: 48 (40%) patients had ages between 20 to 30 years, 56 (46.7%) patients had ages 31 to 40 years and 16 (13.3%) patients had ages above 40 years. Complications rate was low. Perforation and pregnancy rate was 0%. Menstrual disturbance reported in 20 (16.7%) which was significantly higher in vaginal group. Expulsion rate was 9 (7.5%) and significant higher in vaginal group p<0.05. Removal was done in 14 (11.7%) cases and rate of removal of IUCD was high in vaginal group. Continuation rate at follow-up was 106 (88.3%). Conclusion: It is concluded that the insertion of immediate postpartum intrauterine contraceptive devices was effective and safe method with low complications rate.

Background and Aim: Maternal morbidity is a major health problem affecting approximately millions of women annually and had a substantial influence on fetal and infant health that might lead to maternal mortality. Maternal mortality is an indicator of the quality of obstetric care in a community directly reflecting the utilization of health care services available. The present study was conducted in order to analyze the maternal morbidity and mortality cases referred to a tertiary care hospital. Methodology: This cross-sectional study was conducted on 89 maternal deaths out of 9874 obstetrical admissions or births referred to department of Gynae/Obs of tertiary care hospitals i.e Makran Medical College, Turbat/ Teaching Hospital, Kech and Dow University of Health Sciences, Karachi over a period of five years from 2017 to 2021. All the pregnant women with gestation age >24 weeks admitted for any obstetrical emergencies were enrolled in this study. Patient’s demographic characteristics, clinical features during admission, and maternal relevant information were collected on pre-designed proforma. SPSS version 21 was used for data analysis. Results: Out of total 9874 births, maternal deaths were 89; the mortality incidence with prevalence was hemorrhage 7 (7.9%), hypertensive disorders 34 (38.2%), anesthetic issue 2 (2.2%), sepsis 14 (15.7%), and medical complications 31 (34.8%). The occurrence of direct and indirect maternal death was 55 (61.8%) and 34 (38.2%) respectively. The incidence of the mortality rate was 22.9%. Of the total 387 morbidity cases, hypertensive disorders were the prevalent cause with 295 (76.2%) cases followed by obstetric hemorrhage 55 (14.2%), medical complications 25 (6.5%), sepsis 11 (2.8%), and anesthetic complications 1 (0.3%). The incidence of morbidity was 77.4 per year. Conclusion: Medical complications, sepsis, and hemorrhage are the leading causes of maternal mortality, followed by hypertensive disorders. Mortality and morbidity rates were 22.9% and 3.9% respectively. All of these causes can be avoided with proper antenatal care facilitation. Keywords: Hemorrhage, Maternal mortality, Sepsis

The association of polycystic ovarian syndrome (PCOS) and hypothyroidism is increasingly being recognised. Both syndromes share some common characteristics. In the patients of these two disorders, sub fertility appears frequently. Background and Objective: Hypothyroidism and PCOS are those syndromes that affects the women of child bearing age.These syndromes leads to subfertility. Risk of subfertility can be prevented in the patients of hypothyroidism by treatment at the onset of the disease. As hypothyroidism occurs more commonly in the patients of PCOS, so it is very important to explain its clinical impact. The objective of this study is to find out how hypothyroidism affects the patients who are suffering from polycystic ovarian syndrome. Study Design: The study design of this article is meta-analysis research. Material and Method: In last two months, we have studied many patients in our clinic.Out of these patients, some were diagnosed as patients of hypothyroidism and there were some patients of PCOS. All patients were females.Data including age and BMI was noted from their record sheets. We also noted the level of different hormones of their body.Venous blood samples were drawn and thyroid volumes was checked. Place and Duration: This study is conducted at Gynae and Obs department of Makran Medical College, Turbat and Teaching Hospital Kech, in the last two years in and outdoor from June 2019 to June 2021. Result: The values of triglycerides, cholesterol, fasting glucose , fasting insulin were significantly higher in the patients of PCOS. Levels of different hormones Including FSH, LH, TSH were also different in affected females as compared to control group.Women suffering from pcos are also unable to conceive.Total thyroid dysfunction was seen in almost 50% patients of pcos. Conclusion: Females who were suffering from hypothyroidism had higher volume of their ovaries and cystic ovaries as well.Meanwhile, females who suffered from pcos had more thyroid related diseases as well.Hypothyroidism changes the level of reproductive hormones in females and makes them unable to conceive (causes subfertility). Keywords: Hypothyroidism, Subfertility, Insulin resistance, PCOS, BMI, Hormones level.