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Objectives: To determine the prevalence, risk factors for macrosomia and pregnancy outcome in women with gestational diabetes (GDM)., Methods: In this prospective observational study, we included the data of 161 pregnant females diagnosed with GDM. The study was conducted from December 1st, 2020 to June 30, 2021, at the Maternity and Children Hospital (MCH) of Hail, Saudi Arabia. The data regarding risk factors of macrosomia was obtained from each patient. The patients were followed till the delivery of the baby. The data regarding the prevalence of fetal macrosomia and its associated outcomes was noted., Results: The prevalence of fetal macrosomia was 19.8%. Maternal obesity (OR 4.87), poorly controlled diabetes (OR 3.3), previous history of good-sized baby (OR 2.30), previous history of congenital abnormalities (OR 7.2) were the significant risk factors of fetal macrosomia. The prevalence of maternal and fetal complications was high among pregnancies complicated by fetal macrosomia. The prevalence of fetal macrosomia and other fetal complications was high in poorly controlled GDM patients in comparison to optimal control GDM patients., Conclusion: Fetal macrosomia is a common complication among GDM patients. Maternal obesity and poorly controlled diabetes are the common modifiable maternal factors contributing to macrosomia., Competing Interests: Conflict of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Objective: To compare the efficacy of sublingual with oral misoprostol for induction of labour in primigravida with prelabour rupture of membranes at term., Study Design: Randomized controlled trial., Place and Duration of Study: Department of Obstetrics and Gynaecology Unit-II, Sir Ganga Ram Hospital, Lahore, from June 2004 to January 2006., Methodology: The study included 100 primigravidas with singleton pregnancy at term, having pre-labour rupture of membranes and unfavourable Bishop score with no contraindication of induction of labour, vaginal delivery or misoprostol use. The cases were randomized into two equal groups, A and B. Women in the group A were given 100 microg of misoprostol orally at an interval of 4 hours to a maximum of 2 doses while patients in the group B were prescribed the medicine sublingually (50 microg, 4 hourly, maximum of 2 doses). Induction to delivery interval, mode of delivery and fetomaternal complications were main outcome measures of the study., Results: In the sublingual misoprostol group (B), 92% women delivered within 12 hours of induction while 84% of subjects delivered in this time period in oral group (A, p < 0.05). There was no failed induction in either group. Regarding dosage, 64% of women delivered with single dose in group B while only 32% delivered with single dose in group A (p < 0.05). The frequency of vaginal delivery was 92% in group B versus 80% in group A, while rate of caesarean section was 8% in the group B and 20% in the group A, which is statistically insignificant. No significant fetomaternal complications were seen in both groups., Conclusion: The efficacy of sublingual misoprostol in the dosage of 50 microg was comparable to 100 microg oral dose for the induction of labour in the primigravidas at term with pre-labour rupture of membranes.

Objective: To compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination., Study Design: Interventional, quasi experimental study., Place and Duration of Study: The Department of Obstetrics and Gynaecology Unit-II, Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore, from August, 2003 to October, 2004., Methodology: Sixty pregnant women at second trimester of gestation who were candidates for therapeutic termination of pregnancy were recruited for the study. Grandmultipara, women who had scarred uterus and history of hypersensitivity to prostaglandins were excluded. The subjects were assigned into two groups. Group 1 (n=30) had misoprostol orally, while the group 2 (n=30) received the drug by the vaginal route. Dosage regimen was similar in both groups that was 200 microg 4 hours apart till expulsion of fetus or maximum of upto 5 doses. Main outcome measures of the study were induction-expulsion interval, need for surgical evacuation and maternal complications., Results: The mean induction-expulsion interval in the group 1 and 2 was 11.8+/-8.3 and 12.8+/-8.5 hours respectively, which was not different statistically. The process of expulsion was complete in 53.3% of subjects in both groups by misoprostol only, while 36.6% required surgical evacuation in oral group versus 33.3% in vaginal group. The rate of failed induction in groups 1 and 2 was 10% and 13.3% respectively. There was no reported case of nausea, diarrhea, headache, dizziness, shivering, pyrexia and hyperstimulation in both the groups. However, a case of vomiting (3.3%) was observed in the vaginal group.

Objective: To evaluate the performance of visual inspection of cervix (VIA) after application of 3% acetic acid in cervical cancer screening in comparison with Pap smear., Design: Comparative study., Place and Duration of Study: This study was conducted at Sir Ganga Ram hospital, Lahore, from January 1996-December 1999., Subjects and Methods: Speculum examination was carried out to see the cervix in 501 women. All subjects were screened simultaneously by Pap smear and VIA after application of 3% acetic acid. Positive cases by both screening methods and grossly abnormal cervix even with negative screen were subjected to colposcopy. In case of colposcopic abnormality of atypia or advanced lesions, biopsies were taken. Histology of colposcopically directed biopsy was taken as gold standard to evaluate the performance of the test., Results: Out of 540 subjects, 356 were negative with both screening techniques. One hundred and fifty-six subjects were positive with VIA(28.9%) while Pap smear was positive in seventy-eight subjects (14.4%). The sensitivity of VIA was 93.9% and of Pap smear was 46.9%. Corresponding specificities were 30.4% and 69.5%. There was no significant difference between the positive predictive value (PPV) of both test (p < 0.05). The accuracy of VIA was 77.5% compared to 52.8% of Pap smear. The difference was highly significant (p < 0.01)., Conclusion: These results indicate that VIA is more sensitive and has a higher accuracy as compared to Pap smear. It could, therefore, be valuable in detection of precancerous lesions of cervix. Low cost, easy applicability and immediate results make VIA a useful screening test in developing countries like Pakistan as compared to Pap smear.