Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Effectiveness of Membrane Sweeping on Successful Initiation of Labor and Subsequent Vaginal Birth in Patients with Previous One Cesarean Section

2025-08-03T08:02:23+00:00

Objective: To assess the impact of membrane sweeping on labour initiation, the success of vaginal delivery and neonatal outcomes in patients who have had a prior caesarean section.

Methodology: This randomized controlled trial study registration no NCT06103071 was conducted at HIT Hospital, Taxila, in collaboration with POF Hospital, Wah Cantt, from 15th Jan 2023 to 15th July 2024. Three hundred and eight four pregnant females with previous cesarean section for non-recurrent cause were enrolled. Two groups were made. In Group A, membrane sweeping was done. In Group B, no membrane sweeping was done. The primary outcome measures the onset of labour. Secondary outcome measures of successful vaginal delivery and fetal outcome, i.e. admission to NICU, were recorded.

Results: Females in membrane sweeping had a mean age of 29.24 Â± 7.99 years, while in the control group, the mean age of females was 30.54 Â± 6.72 years. The onset of labour occurred in 119 (62%) cases with membrane sweeping versus 90 (46.9%) cases in the control group (p-value 0.003). In the membrane-sweeping group, 71 (37.0%) had normal vaginal delivery. In the control group, 60 (31.3%) had a normal vaginal delivery. There was no significant difference in NICU admission in both groups. In the control group, NICU admission was [22 (11.5%)], and in the membrane sweeping group was [20 (10.4%), p-value = 0.744].

Conclusion: Thus, membrane sweeping is found to be an effective and safe method to improve the spontaneous onset of labour in patients with previous cesarean section.

Comparison of Ferric Carboxymaltose Versus Iron Sucrose for Treatment of Iron Deficiency Anaemia in Pregnant Women

2025-08-03T08:02:41+00:00

Objective: To compare the mean rise in hemoglobin with ferric carboxymaltose versus iron sucrose for treating iron deficiency anaemia in pregnant women

Methodology: This randomized controlled trial study was conducted at Department of Obstetrics & Gynaecology, Combined Military Hospital Multan from February 2024 to July 2024. Sixty pregnant women (20-45 years, 28-34 weeks gestation) with iron deficiency anemia (Hb <10 gm%, ferritin <30 ng/ml) were randomized via lottery method to intravenous ferrous carboxymaltose (FCM; 1000 mg/sitting) or iron sucrose complex (ISC; 300 mg twice weekly). Both groups received anthelminthic therapy and folic acid. Total iron dose was calculated as (2.4Ã—weightÃ—Hb deficit) +500 mg. Hemoglobin, ferritin, and demographics were recorded. Post-treatment outcomes were assessed at 3 weeks. Descriptive statistics were run using SPSS version 23. The mean rise in hemoglobin between the groups was compared through independent t-tests at 5% significance level.

Results: Participantsâ€™ mean age was 31.4Â±3.9 years. Baseline Hb and ferritin were 8.8Â±0.5 g/dL and 31.6Â±12.8 ng/mL respectively. Post-treatment, FCM demonstrated higher mean Hb (10.7Â±0.4 vs.10.4Â±0.3 g/dL), ferritin (370.9Â±47.6 vs.261.1Â±34.2 ng/mL), and Hb rise (2.0Â±0.3 vs.1.4Â±0.2 g/dL) compared to ISC (p<0.001). Educational status, socioeconomic class, and baseline Hb differed significantly between groups. Stratified analysis confirmed sustained superiority of FCM across demographics (p<0.001).

Conclusion: Intravenous ferrous carboxymaltose outperformed iron sucrose in correcting haemoglobin and levels of ferritin in iron-deficient pregnant women, despite baseline disparities. FCM offers a more efficacious parenteral iron therapy option in this population.

Low Maternal Serum Cobalamin Levels Association With Gestational Diabetes Mellitus in Pregnant Women

2025-08-04T11:52:50+00:00

Objective: To compare the mean serum cobalamin levels in pregnant women with gestational diabetes mellitus (GDM) versus pregnant women without gestational diabetes mellitus.

Methodology: It was a prospective case control study carried out in department of Obstetrics & Gynecology, Sir Ganga Ram Hospital, Lahore from 1-12-2022 to 30-11-2023. Total 150 women in the age range of 20 to 35 years and at gestation of 26-36 weeks were enrolled after informed consent. Women already diagnosed with diabetes or metabolic disorder or using vit B12 supplements were excluded. The 75 patients in case group had fasting blood glucose level more than 95 mg/dl while other 75 in control group had less than 95mg/dl. Their blood samples were tested for serum cobalamin levels. The data was entered and analyzed using SPSS version 20.0, independent t-test was used taking P â‰¤ 0.05 as significant.

Results: The mean age of control group was 29.43Â±1.49 years and 31.95Â±1.27 years in cases. Gestational age was 34.67Â±2.69 weeks in controls and 32.75Â±2.53 weeks in cases which is statically similar. Low serum cobalamin level was found in women with gestational diabetes mellitus as compared to pregnant women without gestational diabetes (164.88Â±19.96 vs 236.56Â± 24.15 respectively) with p-value <0.001.

Conclusion: Mean serum cobalamin level was significantly lower in women with gestational diabetes making it one of the risk factor for development of gestational diabetes mellitus in pregnancy.

Correlation of Neonatal Birth Weight with Maternal Serum Ferritin Level in PAEC General Hospital, Islamabad

2025-08-03T11:27:36+00:00

Objective: To assess the correlation between maternal serum ferritin level and birth weight of neonate at the time of delivery.

Methodology: This cross-sectional study was conducted at Department of Obstetrics & Gynecology, PAEC General Hospital, Islamabad (six months duration from November 2022 to May 2023. A total of 95 eligible women presenting in labour room fulfilling inclusion criteria were enrolled for study. Informed consent was obtained. Demographics like name, age, BMI, parity, gestational age at delivery, antenatal care (booked / unbooked), stage at presentation was noted. Blood sample was taken by using 3cc disposable syringe and sent to the laboratory of the hospital for assessment of serum ferritin level of mother. Reports were assessed and serum ferritin level was noted. Mode of delivery was also noted. At the time of delivery, birth weight of neonate was assessed by using weighing machine.

Results: In our study of 95 cases, mean age was 29.47+3.82 years, according to gender distribution of neonates 52(54.7%) were male and 43(45.3%) females, mean gestational age at the time of delivery was 36.33+1.38 weeks, mean ferritin level was 24.37+2.38. Correlation between maternal serum ferritin level and birth weight of neonate at the time of delivery was positive, r value was 0.881. Effect modifiers influenced the strength of the correlation between birth weight and ferritin levels. The association was stronger in full-term neonates, in males, and in babies born to mothers with higher parity.

Conclusion: We concluded that there is a correlation between maternal serum ferritin level and birth weight of neonate at the time of delivery

Prevalence of Peripartum Cardiomyopathy in Pre-Eclampsia Patients Presenting To a Tertiary Care Health Facility

2025-08-06T02:30:44+00:00

Objective: To determine the frequency of Peripartum cardiomyopathy (PPCM) in Pre-eclamptic women presenting to a tertiary care facility.

Methodology: This descriptive cross-sectional study was conducted over a period of six months, from December 9, 2021, to June 10, 2022, in the Gynecology and Obstetrics Unit I of Liaquat University Hospital, Hyderabad. The study population comprised preeclampsia women aged 18 to 45 years, with a gestational age of more than 20 weeks as confirmed by early ultrasound, regardless of parity, and carrying a single alive fetus. PPCM was diagnosed based on echocardiographic findings, with the key diagnostic criterion being a left ventricular ejection fraction (LVEF) of less than 45%.

Results: Of 102 patients, the mean age of the patients was 25.57 Â±3.73 years. The mean height, weight, and BMI of the patients were 160.11 Â±8.89 cm, 75.09 Â±14.82 kg, and 29.08 Â±5.19 kg/m2 respectively. The mean 24 hours proteinuria level of the patients was 344.62 Â±16.35 mg/24 hours. The mean ejection fraction was found to be 55.01 Â±9.69%. Frequency of PPCM was observed in 9 (9%) patients, which was statistically insignificant according to age, residential status, BMI and mode of delivery (>0.05).

Conclusion: PPCM was concluded to be 9% among pre-eclamptic women, highlighting a notable association between pre-eclampsia and the development of cardiac dysfunction during the peripartum period, which underscoring the need for enhanced clinical observation and routine cardiovascular assessment in this population.

Clinical Utility and Diagnostic Accuracy of Diffusion Weighted Imaging in Early Detection of Endometrial Carcinoma with Histopathological Concordance/Discordance: Experience of a Tertiary Care Hospital

2025-08-06T08:04:32+00:00

Objective: To evaluate the diagnostic accuracy of diffusion-weighted imaging (DWI) in the early detection of endometrial carcinoma, using histopathological findings as the gold standard.

Methodology: This prospective cross-sectional study was conducted at the Radiology Department of Dr. Ziauddin Hospital, Karachi, from December 27, 2019, to June 26, 2020. A total of 280 women aged 40â€“80 years presenting with abnormal uterine bleeding and thickened endometrium on ultrasound were included. All patients underwent pelvic MRI with diffusion-weighted sequences, followed by diagnostic dilatation and curettage (D&C) for histopathological correlation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated using SPSS version 22.

Results: The average age of the patients was 59.17Â±9.0 years. Diagnostic accuracy of DWI-MRI was found to be 76.43% in diagnosis of endometrial carcinomas with sensitivity of 74.31%, specificity 78.68% PPV 78.68% and NPV 74.31% respectively.

Conclusion: DWI is a non-invasive, contrast-free, and cost-effective imaging modality that enhances diagnostic confidence in detecting endometrial carcinoma. When used in conjunction with conventional MRI sequences, it offers valuable information for preoperative staging and treatment planning, with diagnostic parameters closely aligned with histopathological outcomes.

Prevalence of Bacterial Vaginosis in Females Presenting in Preterm: A Cross-Sectional Study

2025-08-06T08:04:15+00:00

Objective: To determine the frequency of bacterial vaginosis in females presenting in preterm labor.

Methodology: This cross sectional study was conducted in Department of Obstetrics/Gynecology, PAEC General Hospital, Islamabad from 21st June 2021 to 21st Dec 2021, involved 100 participants of 18 to 40 years of age. Demographics like age, gestational age, parity, BMI, previous history of sexually transmitted infection, were noted. Patients were admitted in the obstetrics ward. One vaginal swab was utilized for the pH of vaginal discharge, the KOH test (whiff test), and the wet mount for clue cell detection. Gram staining was performed using the second vaginal swab. Without any delay, these two vaginal swabs were taken and forwarded to the microbiology lab. Findings will be recorded and Amsel's criteria were noted. If three out of four criteria were positive, then bacterial vaginosis was labeled.

Results: Age distribution shows that the majority (58%) were between 20-30 years. Gestational age distribution of 100 patients with preterm labor showed that 58% of participants were between 28-32 weeks pregnant, while 42% were in the >32-36 week range. Regarding history of sexually transmitted diseases (STD), 23% reported having a history, whereas 77% did not. Lastly, 33% of participants tested positive for bacterial vaginosis, while 67% tested negative. Age, BMI, gestational age were not statistically correlated with bacterial vaginosis while history of sexually transmitted diseases (STD) was significantly associated with BV (p = 0.002).

Conclusion: From our study we conclude that bacterial vaginosis is present in significant no of patients with preterm labor and has been found to be significantly associated with previous history of STDs and parity.

Comparison of Iron Sucrose Complex Versus Ferric Carboxymaltose for Establishment of Effective Breastfeeding: A Quasi-Experimental Study

2025-08-08T08:05:24+00:00

Objectives: To compare iron sucrose complex (ISC) versus ferric carboxymaltose (FCM) for establishment of effective breastfeeding

Methodology: This quasi-experimental study was conducted at Sir Ganga Ram Hospital Lahore from January to April 2025. Total 70 pregnant women with moderate-severe iron deficiency anemia were assigned, without randomization, into two equal size groups i.e. ISC and FCM. Baseline data were collected upon enrollment and outcome data at day-21 after intervention. Mann-Whitney U test used for comparing median (IQR), and Chi square test for frequency (percentage) between ISC and FCM groups. Linear regression analyses performed for neonatal weight gain and lactation initiation time; and multivariate binary logistic regression analyses for lactation adequacy.

Results: The distribution of baseline demographic and obstetric characteristics across study groups was equivalent (all p >0.05). At the day-21 follow-up, the ISC group, compared to the FCM group, showed less improvement in hemoglobin levels (0.8 vs. 1.9 g/dL, p <0.001) and serum ferritin (19.0 vs. 21.5 ng/mL, p 0.780). The ISC group also experienced a longer time to initiate breastfeeding (20 vs. 9 hours, p <0.001), but demonstrated higher lactation sufficiency (59.0% vs. 41.0%, p 0.072) and greater neonatal weight gain (680 vs. 31 grams, p <0.001). Being in FCM group showed negative association with neonatal weight gain (Î² -321.251, p <0.001) early breastfeeding initiation (Î² -8.396, p 0.004) and greater risk of lactation insufficiency (aOR 5.593, p 0.050).

Conclusion: Both ISC and FCM treatments offer unique benefits. FCM was better at improving maternal hemoglobin levels, while ISC showed advantages in terms of neonatal growth and early breastfeeding initiation. Therefore, selection of treatment should consider both maternal hematologic goals and neonatal well-being.

Keywords: Breastfeeding, Ferric carboxymaltose, Iron sucrose, Pregnancy

A Comparative Study of Pain Intensity After Episiotomy Repair Using Continuous and Interrupted Sutures

2025-08-09T08:07:27+00:00

Objectives: To compare the pain intensity after episiotomy repair using continuous and interrupted sutures.

Methodology: This randomized controlled trial no. NCT07050615 was conducted at the Department of Obstetrics & Gynecology, Shahida Islam Teaching Hospital, Lodhran, Pakistan, from August 2024 to January 2025, included 86 women (43 in each group) aged 20 to 40 who underwent an episiotomy during delivery in the labor room. Group-A comprised women who received continuous sutures, while Group-B included those with interrupted sutures. Both groups had their episiotomy repairs performed with Vicryl 2/0 sutures. The researcher followed up with all patients 48 hours postoperatively to evaluate postoperative pain, using the visual analogue scale (VAS). A score of â‰¤3 on the VAS was considered no pain.

Results: In a total of 86 women, the mean age was 27.82Â±4.60 years, and 62 (72.1%) women were aged between 20â€“30 years. Residential status of 49 (57.0%) women was rural. The mean duration of surgery was 29.24Â±7.31 minutes. In patients who underwent continuous suturing, pain was noted in 7 (16.3%) patients, compared to 16 (37.2%) among those who underwent interrupted suturing (p=0.028). Stratified analysis demonstrated that, among women aged 20â€“30 years, continuous suturing was associated with a significantly lower rate of no post-operative pain (12.5% vs. 33.3%, p=0.049).

Conclusion: Continuous suturing for episiotomy repair significantly reduces post-operative pain compared to interrupted suturing in the early postpartum period.

Coping Mechanisms of Menopausal Women and Its Impact on the Quality of Life at Mohan Pura, Rawalpindi

2025-08-15T09:11:45+00:00

Objective: To discover coping strategies, gauge awareness of menopausal symptoms, and measure the effect on quality of life among women.

Methodology: A mixed-methods design was employed in the study, with a sample size of 200. A semi-structured questionnaire was used to collect quantitative data from 185 women aged 45 years and above, and a qualitative understanding was achieved through interviews with 15 participants. SPSS version 25.0 was used to conduct statistical analysis, and descriptive statistics and the chi-square test were used to examine the correlations and patterns in the data. This methodology gave an in-depth insight into the menopausal experiences, knowledge, and coping strategies.

Results: In a total of 200 women (185 Quantitative &15 Qualitative) with an average age of 52.83 Â± 5.70 years. There were 83 (44.9%) women in the 46â€“50-year age group. The age group 51-55 years comprised 57 (30.8%) women, among 56-60, there were 25(13.5%), while the age group 61-65 years included 16 (8.6%) women. Participants' drug histories varied: 19.5% did not use any medicine, 14.6% used hormone treatment, 22.7% used oral hypoglycemic and antihypertensive meds, and 20.5% used other medications. Out total of 135(73.0%) participants had knowledge of the postmenopausal symptoms.

Conclusion: Psychological support, herbal medication, and health-related services were very effective in reducing the menopausal symptoms, whereas lifestyle modifications did not affect the symptoms, which emphasizes the significance of inclusive and accessible healthcare interventions.

Adverse Perinatal Outcomes in Isolated Borderline Amniotic Fluid Index at Term Pregnancies

2025-08-11T08:07:40+00:00

Objective: To determine the frequency of adverse perinatal outcomes, specifically low Apgar scores and NICU admissions, in term pregnancies with isolated borderline AFI, and to assess the influence of maternal age and parity on these outcomes.

Methodology: This prospective observational study was conducted in the Department of Obstetrics and Gynecology of Watim Hospital, Rawalpindi from August 2024 to November 2024. A total of 163 gravid women aged 20 to 35 years with singleton pregnancy (37- 40 weeks) and isolated borderline AFI: 5â€“8 cm, were included in the study. Written informed consent was taken. AFI was measured by ultrasound. Data was analyzed using SPSS version 22.0.

Results: The majority aged 20-30 years (27.4Â±3.68). Most deliveries occurred between 37-38 weeks' gestation, with a mean gestational age of 38.23 Â± 0.97 weeks. Neonatal outcomes showed that 36.8% of newborns had an APGAR score <7 at 1 minute, which improved significantly to 18.4% at 5 minutes. NICU admission was required in 67.5% of cases. Stratification analysis showed that neonates of mothers aged 20-30 years have higher rates of low APGAR scores at both 1 minute and 5 minutes compared to those aged 31-35 years. Primiparous women had more neonates with APGAR scores <7 at 1 minute and 5 minutes than multiparous women. Conclusion: There is significant perinatal morbidity due to isolated borderline AFI resulting in low Apgar scores and consequently higher NICU admissions in term pregnancies. The patientâ€™s age and parity influenced the outcomes.

Role of Tranexamic Acid in Control of Intraoperative Blood Loss in Women Undergoing Elective Cesarean Section

2025-08-13T08:11:02+00:00

Objectives: To compare the mean intraoperative blood loss in pregnant mothers undergoing elective cesarean section after prophylactic tranexamic acid versus 5% glucose (placebo).

Methodology: This double blind, randomized controlled trial study was conducted in department of Obstetrics and gynaecology, Combined Military Hospital Multan from November 2023 to April 2024. Sixty-eight pregnant women aged 20-45 years, at 37-40 weeks of gestation and scheduled for cesarean delivery under spinal anesthesia were consecutively enrolled in the study. Participants were equally randomized to receive either 1g intravenous tranexamic acid or 5% dextrose placebo fifteen minutes before surgery. Intraoperative bleeding was measured using the weight difference of surgical gauze / towels and suction volume. Data were analyzed using SPSS version 23. Mean Â± SD for quantitative data and frequency and percentages for categorical data are reported. The independent sample t-test is applied for blood loss comparison between the groups. P-value <0.05 is taken significant.

Results: The maternal age was 32.4Â±5.1 years and mean gestational age was 37.8Â±1.3 weeks. The groups were comparable in baseline characteristics except for a higher median number of previous cesareans in placebo group (2 versus 1, p = 0.014). Mean loss of blood was substantially less in tranexamic acid group (501.5Â±143.8 ml) compared to placebo (813.2Â± 264.9 ml; p < 0.001). This difference remained after stratification, though not statistically significant among women with last vaginal delivery (p=0.068) or no cesarean section ever (p=0.078).

Conclusion: Prophylactic administration of tranexamic acid reduced intraoperative blood loss significantly during cesarean deliveries.

Key Words: Cesarean section, Tranexamic acid, Blood loss.

Association of High Maternal Serum Uric Acid with Adverse Fetal Outcomes in Patients with Preeclampsia

2025-08-15T08:09:23+00:00

Objective: To determine the association of high maternal serum uric acid with adverse fetal outcome (IUGR, preterm birth, low birth weight) in patients with preeclampsia.

Methodology: A cohort study was done at conducted in Department of Obstetrics and Gynaecology, Sharif Medical City Hospital, Lahore, from October 2021 to April 2022. Blood was drawn to measure maternal serum uric acid. Females were then split into high-uric acid and normal-uric acid groups. All ladies were monitored in OPD till delivery. Serial ultrasounds assessed fetal biometry for IUGR and low birth weight infants in females.

Results: Overall patients mean age was 31.22+5.38 years. Moderate preeclampsia was 51.1%, and severe in 48.9%. IUGR occurred in 70.4% of exposed vs. 29.6% of controls â€œRRâ€¯=â€¯2.37, pâ€¯=â€¯0.022â€, preterm birth in 70% vs. 30% â€œRRâ€¯=â€¯2.33, pâ€¯=â€¯0.017â€, and low birth weight in 70% vs. 30% â€œRRâ€¯=â€¯2.33, pâ€¯=â€¯0.017â€. Additionally based parity IUGR was significantly higher in primiparous exposed women, while low birth weight was significantly higher in multiparous exposed women p <0.05. Furthermore severity of pre-eclampsia revealed a significant association of preterm birth with raised uric acid in mild disease and low birth weight in severe disease p <0.05.

Conclusion: Study revealed a clear association between elevated maternal serum uric acid levels and an increased risk of adverse fetal outcomes, including IUGR, preterm birth, and low birth weight among patients of pre-eclampsia.

Mindfulness-based Practices Along with Mediating Role of Resilience Among Medical Students

2025-08-17T08:13:10+00:00

Objectives: To explore the effects of mindfulness-based practice and the mediating role of resilience among medical students.

Methodology: A cross-sectional study was conducted among 200 students of Abwa Medical College from April 2024 to September 2024, using the purposive sampling technique. A self-administered questionnaire was designed, and a pilot study was conducted to validate the questionnaire. Participants were assessed using a 35-item questionnaire with a Cronbachâ€™s alpha score. The data were analyzed in SPSS 26 on Windows 11 platform using the correlational matrix and regression analysis.

Results: Out of the 200 participants in the study, 102 (51%) of the participants were females and 98 (49%) were males. The overall Cronbachâ€™s alpha score for the 35 items was 0.930, indicating high reliability. Female participants reported higher self-awareness, present-moment attention, and overall mindfulness practice than male participants, with statistical significance (P = 0.005). The correlational matrix between embracing the present, self-awareness, emotional regulation, and future orientation revealed statistically significant correlations among these variables. The Regression analysis revealed a linear relationship between mindfulness practice and resilience among the medical students.

Conclusion: The practice of mindfulness leaves a positive impact and refines the approach of medical students towards the prevailing stressful conditions during their medical career.