Purpose: To determine the psychological impact and perception of covid -19 pandemic on pregnant women presenting to a tertiary care hospital, KPK, Pakistan. Methodology: An observational cross-sectional study was conducted on pregnant women in the outpatient department of Lady Reading Hospital, Peshawar from 1st February 2020 to 31st March 2021. All pregnant women (n=424) visiting gynae OPD who fulfilled the inclusion/exclusion criteria were included. The questionnaire was filled out by physicians for patients and the Kessel-10 scale was used to classify the anxiety. Findings: Fifty one 51% females fall in the 19-25 years age group. 54.5% were illiterate with most of the women (94.6%) being housewives. The majority of the 424 women in the study were multiparous (59%) and 59.1% presented in their third trimester. The highest number of patient women in the age group 19-25 years suffered mild distress. Moderate stress was found in 54 women. In all age groups, a total of 11 patients suffered severe psychological distress. 144 women reported having no stress.  Nulliparous women were 109 in total and most of them had either mild disorder (n=54) or no stress at all (n=48). the majority of ladies who were housewives stated that they have been mildly stressed (n=208) or not stressed at all (n=139). A total of 11 women had faced severe stress. 247 women had third-trimester pregnancies and most of them (n=129) had mild stress. Severe distress affected 8 of the third-trimester women and 3 of the 2nd-trimester women. Most women (71.9%) believed that elective Cesarian surgery is not better than vaginal delivery during the covid -19 pandemic. COVID-19 pandemic has created anxiety in more than half (53%) of pregnant women visiting OPDs. The literacy rate and occupational status of women had little effect on the occurrence of psychological distress. Recommendations: Strict SOPs must be observed in hospitals and pregnant women should receive counseling regarding their fears and anxiety from medical care-takers. More studies are needed to measure mental health challenges in pregnant and postpartum women, as well as the resilience and risk factors associated with beneficial outcomes, to attenuate the pandemics' long-term mental health impacts.

BACKGROUND: Infertility is not uncommon in our female population as we live in a geographicalarea where the population growth rates are amongst the highest in the world. A variety of cultural normsand values force couples to enhance family. So a sensitive and dedicated efforts need to be made to lookinto the causes of secondary infertility and their treatment.OBJECTIVES: To determine the frequency of bilateral tubal obstruction and common factors leadingto it among women presenting with secondary infertility.METHODOLOGY: It was a hospital based descriptive cross sectional study conducted at thedepartment of obstetrics & gynecology Postgraduate medical institute LRH Peshawar from 8th August2011 to 8th July 2013. Data was collected by non probability consecutive sampling technique. A total of260 patients were enrolled in study. In patients presenting with secondary infertilityhysterosalphingography was performed, in those with bilateral tubal obstruction detailed history wastaken to detect, the history of instrumentation to genital tract, lower abdominal surgery or history ofPID. Laparoscopy was done in all patients with bilateral tube obstruction to confirm the diagnosis anddetermine causes.RESULTS: In this study mean age was 30 with standard deviation of ±2.12. Bilateral tubal obstructionwas found in 73(28%) of the cases, out of which history of pelvic inflammatory disease was presentin15 (21%) followed by history of instrumentation of genital tract in 11(15%) of cases. Positive historyof lower abdominal surgery was present in 4(5%) and 3(4%) patients had fibroids.CONCLUSION: Tubal pathology is one of the main causes of female infertility. A great caution isrequired in pelvic operative techniques to prevent infection and tubal damage.KEY WORDS: secondary infertility, bilateral tubal obstruction, pelvic inflammatory disease.

Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified

Objective: To determine the fetal outcome of Caesarean Sections (CS) performed for abnormal Cardiotocography (CTG) Material and Methods: This retrospective data review was conducted in Gynaecology and Obstetrics unit B of Lady Reading Hospital Peshawar from June 2015 till June 2016 after approval from the hospital ethical committee, using a non-probability convenient sampling technique. The hospital record of 234 patients who had CS for fetal distress was reviewed. Patients with singleton and term gestation, who had CS for fetal distress diagnosed based on abnormal Cardiotocography were included in the study.  The fetal outcome was noted in terms of Apgar score at 5 minutes, admission to neonatal intensive care unit (NICU), and perinatal mortality. Fetal blood sampling (FBS) and postnatal analysis of fetal arterial blood gases and PH were not carried out in any patient because of non-availability. The results are expressed in frequencies and percentages, shown in tables and figures. Results: In one year, a total of 1255 C-sections were performed. Amongst these, 234 (18.64%) patients fulfilling inclusion criteria were enrolled. Babies delivered with 5 minutes Apgar score of 7 or above were 166 (70.94%).  Twenty-one (8.97%) babies were admitted to NICU and perinatal mortality was 6 (2.54%).  Conclusion Out of 234 patients who underwent CS due to abnormal CTG, more than 2/3rd of patients had normal babies with an Apgar score of 7 or more, which indicates that abnormal CTG alone should not be used as an indication for CS  Keywords: Fetal Distress, CTG, Caesarean section

Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified