Objectives: (1) To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. (2) To determine the relationship of age with type of ovarian tumour. (3) To categorize the management of these cases according to the intra-operative findings. (4) To analyze the occurrence of various histopathological types of tumour. Date Source: Medline Study Design: Single centered prospective descriptive study of 150 cases. Place and Duration of Study: Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to,31st December 2006. Subject and method: 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Results: Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain (53%) followed by menstrual disturbances (30%), abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Conclusions: Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management.

Objectives: For selecting the topic was to compare the efficacy of different methods of induction of labour. Design: Prospective observational study. Setting: Department of Obstetrics and Gynaecology Unit 11, Ghurki Trust Teaching Hospital Lahore. Period: One year, From 1st Jan 2004 to 31st Dec 2004. Subjects and methods. This study included pregnant ladies, irrespective of parity who were selected for induction of labour for different indications, after 28 weeks of gestation. Patients having abnormal presentation such as breech and patients with suspected cephalopelvicdisproportion were not included. Induction method was selected according to parity, indication for induction and Bishop scoring. Results. Total no of patients admitted in the said ward during the study period was 3500, 205 were induced with different methods. This gives prevalence of induction of labour in the study group as 5.86%. Age of the patients ranged from 17-45 years/with parity varying from 0-8. Five patients with previous caesarean section were also induced. Conclusion. The most common indication for induction of labour was pregnancy induced hypertension. Success rate of method used depends on Bishop scoring, PGE2 helps in cervical ripening and gives good results in patients with poor Bishop score.

Objectives: To compare obstetric outcomes in the pregnancy subsequent to still birth with that following live birth in first pregnancy. Data Source: Medline data base. Study Design: Prospective cohort study. Setting: Ghurki Trust Teaching Hospital Lahore. Materials & Methods: The study included women who delivered a stillbirth between 2005 - 2007(exposed cohort). A group of women with live birth (unexposed cohort) was matched for delivery within the same year, maternal age (+/- 3 years), parity (+/- 1). In 2009, the charts of these women were examined for subsequent pregnancies. Main outcome measures Maternal and neonatal outcomes in the second pregnancy, pre eclampsia, placental abruption, labour induction, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth. Results: The exposed cohort group B (n =50) was at increased risk of preeclampsia (44% versus 28%, p value = 0.001<0.05) and placental abruption (20% versus 2%) and malpresentation (18% versus 4%). labour induction (20% versus 8%) instrumental delivery (16%versus 8%) and emergency caesarean (40%versus 16%); and prematurity (62%versus 26%, p value = 0.001<0.05), low birthweight (86% versus 54%, p value = 0.000<0.05) and stillbirths (6% versus 2%, p value = 0.489>0.05) of the infant as compared with the unexposed cohort group A (n =50). Conclusions: Majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a highrisk group with an increased incidence of adverse maternal and neonatal outcomes.

Aims and Objectives: To evaluate whether serial monitoring of fetuses beyond 40 weeks with biophysical profile and non-stress test improves the fetal outcome in terms of morbidity and mortality determined by APGAR score at 5 minutes, presence of meconium in liquor, weight of baby and admission of neonate in nursery and to compare the maternal morbidity associated with prolonged pregnancy, labour induction and mode of delivery in the study and control group. Materials and Methods: It is a prospective controlled study conducted in the department of obstetrics and gynaecology Ghurki Trust Teaching Hospital, Lahore from 1st September 2007 to 31st August 2009. 200 patients at 40 weeks of pregnancy matching the inclusion criteria were enrolled for the study. They were divided into a study and a control group consisting of 100 patients each. Patients in the study group were subjected to fetal monitoring in the form of cardiotocography (CTG) and biophysical profile (BPP) while those in the control group were evaluated clinically and by kick count chart (KCC). The outcome of the two groups beyond 40 weeks was compared with each other. Results: The percentage of patients reaching 42 weeks was 4 in each group. The rest went into spontaneous labour, were induced or had emergency caesarean sections due to various reasons. The difference between the rest of the parameters like maternal morbidity, mode of delivery, fetal APGAR score and admission in neonatal intensive care unit (NICU) between the two groups were not statistically different. Conclusions: After 40 weeks of gestation fetal monitoring should be started with proper counseling of the patient, clinical assessment and fetal kick chart. NST and biophysical profile should be used selectively in patients with sluggish fetal movement or suspected reduced liquor clinically. All patients who reach 42 weeks must be induced.

Objective: To assess the frequency of hepatitis C in admitted patients of department of obstetrics and gynaecology Ghurki trust teaching hospital, Lahore. Design: Descriptive study Place and duration of study: This study was conducted on patients admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore from 1st January 2005 to 31st December 2005. Patients and methods: A total of 1569 patients of age between 20 to 70 years were admitted in obstetrics and gynaecology ward Ghurki trust teaching hospital, Lahore and were screened for anti-HCV antibodies by 3rd generation ELISA. All positive patients were asked about previous history of jaundice, surgery, blood transfusion, multiple injections and dental procedures. Results: Out of 1569 patients 107 were found to be anti-HCV positive. Mean age of patients was 34.5 years. Frequency of anti-HCV was maximum (38.3%) in 31-40 years age group and in gynaecology patients (12.5%). Previous history of multiple injections and dai handling were the most commonly associated factors. Co-existent hepatitis B and C was found in only 2 (1.8%) patients. Conclusion: Hepatitis C is becoming an alarmingly common problem in the area of Ghurki Trust Teaching Hospital, Lahore. Its modes of transmission need to be properly evaluated for its control and prevention.