Objective: To determine the frequency of complications in patients with intrahepatic cholestasis of pregnancy. Study Design: Descriptive Case Series. Setting: Department of Obstetrics & Gynecology, Shahida Islam Medical College, Lodhran. Period: July 2019 to December 2020. Material & Methods: A total of 141 patients with intrahepatic cholestasis of pregnancy of age 18 to 40 years were included. Patients with multiple pregnancies, history of alcohol intake, CR and preexisting chronic liver disease were excluded. All women were followed till delivery (gestational age ≤ 41 weeks) and feto-maternal outcome i.e. postpartum hemorrhage, cesarean section, APGAR score <7 at 5 minutes, low birth weight, prematurity, meconium stained liquor and intrauterine fetal death (yes/no) was noted. Results: Feto-maternal outcome was as follows; postpartum hemorrhage in 18 (12.77%), cesarean section in 47 (33.33%), preterm birth in 34 (24.11%), APGAR score <7 at five minutes in 13 (9.22%), meconium stained liquor in 45 (31.91%) patients, low birth weight in 14 (9.93%) and Intra-uterine fetal death in 11 (7.80%) patients. Conclusion: Our study concluded that we should develop some serious recommendations for these high risk patients in our routine practice. It will reduce the morbidity and mortality related to this high risk condition.

Objectives: To assess and compare the maintenance of tocolysis in preterm labor by using vaginal and intramuscular progesterone. Study design: Randomized controlled trial. Settings and study duration: Department of Obstetrics & Gynecology, Civil Hospital, Bahawalpur between 12th March 2019 and 11th September 2019 Materials & Methods: A total of 96 women ranging from 18 and 40 years of age presented with threatened preterm labour, at gestational age between 28 to 36 weeks were included. Out of total, Patients having multiple pregnancy, preterm premature rupture of membrane, medical disorders, IUGR and APH were excluded .All patients were given acute tocolytic therapy with oral nifedipine. Then they were divided in 2 groups. In the Group A, vaginal progesterone (Cyclogest 200mg) was given daily while in group B patients, a single intramuscular injection(IM) of 250 mg of 17-alpha-hydroxyprogesterone caproate (17 OHP) was given weekly. All patients in both groups were evaluated upto the delivery and efficacy was documented. Results: The mean age was 29.34 ± .4.92 years. The gestational age was from 28 to 36 weeks with mean age of 30.91 ± 1.44 weeks. Efficacy ( no preterm birth) was seen in 42 (87.50%) in group A (vaginal progesterone) and 34 (70.83%) in group B (intramuscular progesterone) with p-value of 0.044. Conclusion: The verdict of the study is that for preventing preterm birth the efficacy of vaginal progesterone is better than intramuscular. Keywords: vaginal progesterone, preterm birth, perinatal mortality, preterm labour, hydroxyprogesterone, tocolytic maintenance.

Objective: The purpose of this study is to compare the prevalence of pre-eclampsia in obese primigravida compared to those who are not obese. Study Design: Prospective cohort study Place and Duration of Study: The research was conducted at the Gynecology and Obstetrics Department at the bahawal Victoria hospital Bahawalpur from 01 June 2021 to 31 December 2021. Materials and Methods: The study consisted of sixty (60) patients, selected using a non-probability consecutive sampling technique. All primigravida between the ages of 20 and 35, with singleton pregnancies of >26 weeks and with a BMI>30kg/m2 in the obese group and BMI<30kg/m2 in the non-obese group, were included. This data was collected on a specially designed Performa. An analysis of the data was conducted using SPSS version 16. Frequency and percentage were calculated for qualitative variables, such as pre-eclampsia (present/absent). Using Chi-square, we compared the frequency of pre-eclampsia. A p-value <0.05 was considered significant. Results: The range of age of participants in the study ranged from 20 to 35 years, with a mean age of 27.08 ± 3.59 years. The mean gestational age was 34.65 ± 4.35 weeks. The mean BMI in group A was 37.50 ± 5.47 kg/m2, while in group B it was 26.77 ± 3.64 kg/m2. The frequency of preeclampsia in Group A (obese primigravida group) was 43.33% (13%), while in group B (non-obese primigravida group) it was 13.33% (4%). Conclusion: The results of this study suggest that the frequency of preeclampsia in obese primigravida is higher compared to non-obese primigravida (43.33% versus 13.33%). This shows that obesity is a risk factor for preeclampsia and that there exist a positive relation between BMI and preeclampsia. Keywords: Obese Primigravida, Pre-eclampsia, Eclampsia, Risk Factors for Pre-eclampsia – Eclampsia, High risk pregnancy, Complicated during pregnancy. Obesity and Pregnancy.

Objective: To compare the efficacy of clomiphene citrate and clomiphene citrate with metformin in anovulatory infertility with PCOS (polycystic ovarian syndrome (PCOS). Study Design: Randomized controlled trial. Place and Duration of Study: This research took place in the Department of Gynecology and Obstetrics at the combined military hospital Bahawalpur. The study was carried out over a six-month period, starting on 1st November 2022 and concluding on 30 April 2023 Materials and Methods: The study comprised 176 married women aged between 18 and 40 years who had been experiencing anovulatory infertility and PCOS for more than 6 months. In group A, for a period of three menstrual cycles, patients received 500 mg of metformin three times a day consistently and 100 mg of clomiphene citrate daily from the fifth to the ninth day of their menstrual cycle. In contrast, patients in group B were given 100 mg of clomiphene citrate daily from the fifth to the ninth day of their menstrual cycle for up to three months. We recorded and analyzed the treatment efficacy for all participants in both groups. Results: In this study, the metformin and clomiphene combination showed a 71.59% ovulation rate compared to clomiphene alone (39.77 %). The pregnancy rate was 31.82% with clomiphene citrate (CC) and 64.77% with a combination (clomiphene citrate and metformin). Efficacy in the study was observed in 57 (64.77%) patients treated with metformin and CC. group and 28 (31.82%) patients in the clomiphene citrate alone group (p = 0.002). Conclusion: The findings from this study suggest that the combination of clomiphene citrate and metformin demonstrated superior efficacy compared to the use of clomiphene citrate alone in treating anovulatory infertility associated with polycystic ovary syndrome. Keywords: Polycystic ovarian syndrome, clomiphene citrate, metformin.