Introduction Pakistan is among the countries with the highest maternal death rates. Obstetric hemorrhage accounts for 41% of these deaths. Uterine rupture is a grave obstetric emergency with high maternal and neonatal morbidity and mortality. It is important to identify its frequency and associated risk factors to formulate programs for its prevention and management. This study aimed to assess the frequency, associated risk factors, fetomaternal outcomes, and management of women with the ruptured uterus at our hospital. Material and methods It was a retrospective study of 206 women to review data collected from cases of uterine rupture managed at the WCTH Bannu, Pakistan from October 2016 to October 2018. A structured proforma was designed and used to extract data from operating theatre registers and the hospital medical records. In our hospital, there is a strong system of maintaining all information of the patients related to demographics, obstetric information, operative notes, and postoperative course during their hospital stay in the patient’s charts. Detailed information on operative procedures is further maintained in the operation theater register and all these registers are checked in the weekly statistical meetings to ensure proper documentation. Data was entered and analyzed in SPSS package version 21 (IBM Corp.; Armonk, NY, USA). Frequency and percentages were calculated for the categorical variables. For inferential statistics, chi-square or Fischer exact tests were used. A p-value of < 0.05 was considered statistically significant. Results The overall incidence of the ruptured uterus was 1.71%. The important etiological factors were grand multiparity 62 (35.2%), obstructed/neglected labour 58 (32.9%), injudicious use of Oxytocin 56 (31.8%) and prostaglandins 26 (14.7%), previous cesarean section 35 (19.8%) and previous pelvic surgery (0.5%). Hysterectomy was done in 80.6% of cases, 34 (19.2%) patients underwent uterine repair and 4.5% had bladder repair. The mortality rate was 21%, mainly due to irreversible shock or disseminated intravascular coagulation. Perinatal mortality was 91.4%. Duration of surgery more than two hours and presentation to the hospital at night time was significantly associated with poor maternal outcome (p = 0.00). Conclusion Uterine rupture is a preventable obstetric emergency associated with high fetomaternal morbidity and mortality. The main causes were grand multigravidity, obstructed labour, previous C-sections and injudicious use of oxytocin and prostaglandins. Women with prolonged surgery and admission at night time had a poor maternal outcome.

OBJECTIVES To evaluate the effectiveness and factors associated with the failure of intrauterine balloon tamponade (IUBT) in managing postpartum hemorrhage (PPH). METHODOLOGY We conducted a retrospective observational study including data from 160 patients aged 21-30 years at the Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, managed for PPH with IUBT, after failed medical treatment from Jan 2020 to December 2021. Data were collected retrospectively in three months, from January to March 2022. IUBT was successful if, after 24 hours of insertion, no or less than 100ml bleeding occurred.RESULTS Among the patients managed by IUBT, the majority had uterine atony (81.25%), 17.5% had lower segment hemorrhage, and 1.25% of cases had a placental abruption. The mean estimated blood loss was 1263.7±398.7 ml. The procedure was successful in 89.3% of cases. Sixteen patients underwent a hysterectomy for failed IUBT. There were six maternal deaths, mainly due to acute renal failure and disseminated intravascular coagulation (DIC). Between the successful and unsuccessful cases of IUBT, there was a statistically significant difference in the gravidity, mode of delivery, gestations, booking, peripartum BP, pulse rate, hemoglobin, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), blood loss during the procedure, DIC, and intensive care unit admissions (p<0.00). The median hemoglobin, hematocrit, platelets count, and lymphocytes were significantly higher before IUBT insertion (p<0.00).CONCLUSION IUBT is an effective, easy-to-use, inexpensive, and safe tool in the management of PPH. Low hemoglobin, thrombocytopenia, high PT, aPTT, and DIC are associated with low success rates

Vesicovaginal fistula (VVF) is "an abnormal communication between the bladder and the vagina which results in the continuous involuntary leakage of urine into the vaginal vault". About 2-3 million women have been reported to have obstetric fistulas worldwide. 1 In Pakistan, about 3500 cases of obstetric fistula occur every year, and about 3% of women of reproductive age experience obstetric fistula signs. 2,3 The most common cause of VVF in low-income countries is prolonged obstructed labor (97%), 4 whereas iatrogenic injury to the urinary tract, mostly from benign gynecologic surgery, is the main cause in the high-income countries. 5 It is estimated that about 0.8/1000 of all hysterectomies are complicated by VVF. 6 Other causes reported