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Objective: To calculate the Maternal Near Miss Mortality Ratio and Mortality Index at a tertiary care hospital in a developing country with limited healthcare resources. Study Design: Retrospective analytical study. Place and Duration of Study: Department of Gynecology and Obstetrics, Shaikh Khalifa Bin Zayed Al Nahyan Hospital Azad Kashmir and Combined Military Hospital, Muzaffarabad Pakistan, from Jan 2015 to Dec 2018. Methodology: Four hundred and forty-nine severe maternal outcome cases admitted in Intensive Care Unit were included in our study. Maternal Near Miss Mortality Ratio and Mortality Index were calculated. SPSS version 23.00 used for statistical analysis. Results: The maternal near missed mortality ratio was 11:1, mortality index 8.68%, severe maternal outcome 1.58% with 39 maternal deaths. Most common causes of maternal morbidity were hemorrhage (56.1%); hypertensive disorders (24%); sepsis (3.5%) and cardiovascular diseases (1.8%). Hypertensive disorders of pregnancy (30.7%), hemorrhage (25.6%) and sepsis (25.6%) were the common causes of maternal deaths. The total ICU time in patient with near-miss was 1.9±1.7 days versus 2.6±3.14 days in deaths, p

Objective: To study the variation in Serum Sodium and Potassium concentration in Pre-eclampsia and Normotensive pregnant ladies. Study Design: Cross-sectional study. Place and Duration of the Study: Combined Military Hospital, Kharian District Gujrat Pakistan, from Jun 2020 to Jan 2021. Methodology: The study population Comprosed of 80 pre-eclamptic and 80 normotensive pregnant women recruited consecutively at their first, third trimester, and prenatal visits. Serum Sodium and Potassium were analysed using Ericson Photometer. Results: When the two Groups were compared, in the Normotensive Group, the mean Sodium concentration of 132±4.490 mEq/dl was significantly less than the Pre-eclampsia Group of 139.1±3.909 mEq/dl. On the contrary, mean Serum Potassium concentration was significantly less in Pre-eclampsia 3.54±0.511 mmol/L compared to the Normotensive Group to 4.0±0.513 mmol/L. Conclusion: High levels of Sodium and low level of Potassium were observed in the Pre-eclampsia Group. There may be a causal relationship between electrolyte fluctuations and Pre-eclampsia. Keywords: Electrolytes, Hypertension, Potassium, Pre-eclampsia, Sodium.

Objective: To detect complications associated with higher order versus lower order cesarean section. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Obstetrics and Gynecology, Combined Military Hospital, Mardan Pakistan, from Mar to Aug 2021. Methodology: The study was conducted on 210 women, the participants were categorised into two Groups: Group-I (Higherorder), who had undergone fourth and fifth cesarean sections, and Group-II (Lower order), who had undergone second and third Cesarean Sections. The presence of complications were noted in both the Groups. Results: The frequency of higher and lower-order Cesarean Sections was 75(35.7%) and 135(64.3%), respectively. Mean gestational age and parity were 38.96±0.69 weeks and 3.49±2.12, respectively. Dense omental adhesion was a significantly common complication in both Groups. Scar dehiscence was 35(25.9%) among Group-II. There was no significant association between the high-order cesarean section and its complications. Conclusion: The higher-order repeat cesarean section was not associated with more intraoperative complications when compared with lower-order cesarean section in our study. Certain factors like maternal age, parity and gestational age affect the intraoperative complications of the cesarean section.

Objective: To compare Clomiphene Citrate, ovulation induction efficacy following using insulin sensitises, Metformin versus Myo-inositol in subfertile women with polycystic ovary syndrome. Study Design: Prospective comparative study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Jun to Nov 2021. Methodology: A total of 316 patients with polycystic ovary syndrome and infertility who were included in the study. Group-A was administered Metformin, whereas Group-B as given Myo-inositol. Both groups were given clomiphene citrate for ovulation induction and were followed for six months. Results: There were 316 patients (158 in each Group). The mean age was 29.2±0.5 years, and the BMI of 23.2±1.7 Kg/m2 in both. Ovulation recorded in Group-A (Metformin) was 141(44.6%) versus Group-B (Myo-inositol), 103(32.6%). The pregnancy test was positive 33(21.1%) patients of Group-A versus 29(18.4%) of Group-B. The common complaints seen in both groups were nausea and vomiting 2(0.6%), while headache 1(0.3%) and dizziness 2(0.6%) occurred only in Group-B. Conclusion: Clomiphene citrate with Metformin, as first-line therapy for sub-fertile women with polycystic ovary syndrome, improved ovulation and had fewer side effects than Myo-inositol.

Objective: To assess the impact of fetal echocardiography in altering the course of action for neonatal cardiac expertise and services available in Pakistan following an antenatal diagnosis of congenital heart defect (CHD). Study Design: Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2020 to Sep 2021. Methodology: Fetuses aged 18 to 38 weeks of gestational age referred to the Pediatric Cardiac Unit due to risk of or suspicion of congenital heart disease underwent fetal cardiac echo. Data were collected and reviewed retrospectively to seek any impact of the antenatal diagnosis on post-natal planning. Results: The mean age of the mothers was 29.79±5.24 years (range, 17-47 years), and the mean gestational age at which the fetal echocardiography examination was performed was 27.29±4.47weeks (range: 12–38 years). Of the 609 pregnancies, fetal echocardiogram evaluation was performed, and sixty-three (10.3%) fetal echocardiograms were abnormal. Of the 63, only 06(9.5%) returned to the neonatal cardiac unit for follow-up and treatment in the first ten days of life. Conclusion: The real impact of fetal echocardiography is possible only with the availability of well-developed, readily accessible fetal and neonatal cardiac services. Poverty and a struggling healthcare infrastructure confound the benefits.

Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Obstetrics & Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021. Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma. Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 μmol/L and 451.86±120.62μmol/L, with a significant difference between PIH and eclampsia (p

Objective: To find the association of preterm delivery with metabolic syndrome in females presenting in a tertiary care hospital. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics & Gynecology, Combined Military Hospital Kharian, from May 2020 to Oct 2020. Methodology: A total of 150 females fulfilling inclusion criteria were enrolled in the study which were divided into two equal groups ‘A’ and ‘B’. Group ‘A’ was with metabolic syndrome and group ‘B’ without it. These females were followed in OPD till active labor, assessed and followed till delivery of fetus. If delivery occurred before 37 weeks, then preterm delivery was labeled. All this information was recorded on a pre-designed proforma. Results: The risk for preterm delivery was 2.18 times higher in group ‘A’ as compared to group ‘B’. (Relative Risk = 2.18, CI (95%) 1.1529 - 4.12). Conclusion: There is a strong association of preterm delivery with metabolic syndrome in females.

Objective: To identify the frequency, associated risk factors and intraoperative reasons for conversion of Laparoscopic Cholecystectomy to open Cholecystectomy. Study Design: Case series study. Place and Duration of Study: This study was conducted in department of Surgery, Combined Military Hosptial Rawalpindi, from May to Oct, 2018. Methodology: Patients admitted for laparoscopic cholecystectomy were included in the study. Demographic information, ASA Score of physical health, Ultrasonogram Abdomen findings and presence of pericholecystic fluid were documented. The reasons for conversion from laparoscopic cholecystectomy (LC) to open Cholecystectomy (OC) for example excessive haemorrhage, visceral injury, equipment failure, injury to Common bile duct were also noted. Results: In this study 15 (8.77%) patients were converted from laparoscopic cholecystectomy to open cholecystectomy. The most common reason 6 (40%) of conversion was Fibrosis at Calots Triangle and Adhesions due to inflammation. In patients who converted most 10 (66.7%) were 41-60 years old and in patients who had successful laparoscopic cholecystectomy majority 70 (44.9%) patients belonged to age group 21-40 years. The male gender had significantly (p-value