Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Comparison of Effect of Antenatal Dexamethasone Versus Betamethasone on Antepartum Cardiotocography

2026-04-19T19:19:50+00:00

Objective: To compare the outcome of antenatal dexamethasone versus betamethasone on antepartum cardiotocography in terms of mean number of accelerations and long-term variability at day 0, 2 and 4 following drug administration

Methodology: This single blind Randomized Controlled Trial was carried out at Department of Obstetrics & Gynecology, Holy Family Hospital, Rawalpindi from 13th July 2025 to 15th October 2025. The trial was registered with clinicaltrials.gov (NCT07078786). The study enrolled 110 patients with 55 in each group. In Group A, patients received a 24 mg intramuscular injection of dexamethasone, administered as two doses of 12 mg 24 hours apart. In diabetic patients, the total dose was administered in four equal divided doses 12 hours apart. In Group B, patients received a 24 mg intramuscular injection of betamethasone, administered as two doses of 12 mg 24 hours apart.

Results: Baseline characteristics were comparable between groups (all p>0.05). Acceleration counts were similar at baseline (p=0.881) but were significantly higher in the dexamethasone group at day 4 (p<0.001), with significant within-group decline from baseline in both groups (p<0.001). Fetal heart rate variability was significantly better with dexamethasone at day 2 (p=0.006) and day 4 (p=0.013).

Conclusion: Administration of both Dexamethasone and Betamethasone to mother causes transient decrease in both fetal heart rate accelerations and variability with greater effect seen in case of Betamethasone

Frequency and Maternal Outcomes in Women with Severe Iron Deficiency Anemia Presenting in Third Trimester

2026-05-18T14:36:14+00:00

Objective: To determine frequency of severe iron deficiency anemia (IDA) and maternal outcome among women presenting in third trimester to a tertiary care Hospital

Methodology: A descriptive cross-sectional study was carried at department of Obs and Gynae LUMHS, from July 2025 to December 2025. Women aged 18 to 45 years, during third trimester (gestational age 25 to 37 weeks) with singleton fetus were included. A 3 cc blood sample was drawn from each case and send to the institutional laboratory to evaluate the severe iron deficiency anemia, which was defined in terms of hemoglobin level <7 gm/dl with serum ferritin <12 ng/mL. Furthermore patients were assessed for maternal outcomes. All the data was collected via study proforma and analyzed on SPSS version 20.

Results: Mean age of women was 30.4 ± 4.4 years, mean gestational age of 36.3 ± 2.6 weeks, mean BMI 24.3 ± 3.3 kg/m², and the overall mean hemoglobin level was 8.0 ± 2.2 g/dL. Around one-third of the women (29.1%) had severe IDA, followed by moderate anemia (45.5%), and mild anemia 25.5%. Gestational hypertension and prolonged labor were observed most common complications, (33.6% and 32.7%) respectively, followed by preterm births (31.8%), antepartum hemorrhage 12.7%, postpartum hemorrhage (PPH) and wound infection each affected 10.9%. Moreover the less commonly, AKI was occurred in (4.5%) cases and ICU admissions were (4.5%), while no maternal mortality was noted. However, the most of the adverse outcomes were significantly associated with severe anemia in contrast to mildly anemic patients (p<0.05).

Conclusion: The severe Iron deficiency anemia was observed highly frequent among women during third trimester of pregnancy as a significant maternal health concern, predominantly affecting low-income, multiparous women with poor iron supplementation

Pelvic Organ Prolapse in Women Aged ≤30: Frequency, Predisposing Factors, and Clinical Outcomes

2026-05-14T08:02:29+00:00

Objective: To determine the frequency, associated risk factors and clinical outcomes of pelvic organ prolapse (POP) among women aged ≤30 years.

Methodology: The cross-sectional research was carried out at the Department of Obstetrics & Gynaecology, Ward-08, Jinnah Postgraduate Medical Centre, Karachi, based on the medical records of the period between January 2022 and December 2024.A total of 138 women diagnosed with POP with complete demographic and clinical information available were included in the study.Information was extracted on the age, obstetric history, BMI status, comorbidities, lifestyle factors, and management received.Chi-square tests were used to examine the associations between POP and potential determinants.A regression test (logistic regression [univariate and multivariate]) was conducted to determine independent predictors.

Results: Of 138 women presenting with POP, 35 (25.4%) were aged ≤30 years and 103 (74.6%) were older. Most of them were multiparous (88.4% delivered vaginally), and 27.5% of them had a history of instrumental delivery. The intervals between pregnancies were short (85.5%), and the majority of the women were overweight/obese (84.8%). Significant associations were found between POP and mode of delivery (p = 0.001), instrumental delivery (p < 0.001), and diabetes mellitus (p < 0.001). The multivariate analysis proved instrumental delivery to be an independent predictor (OR = 0.047: 95% CI = 0.003-0.806). The management involved pessary placement (13.8) or surgery (86.2) with vaginal hysterectomy being the most frequent (58). In 98.6% of cases, clinical improvement was noted.

Conclusion: POP among women ≤30 years was uncommon but notable. Instrumental delivery emerged as a significant predictor, emphasizing the need for safer obstetric practices and early pelvic floor assessment. Strengthened obstetric care and preventive strategies may reduce long-term POP burden in young women.

Neonatal Outcomes in Diabetic Patients (Known Diabetic / GDM) With and Without Dexamethasone at >34 Weeks of Gestation: A Comparative Cohort Study

2026-05-17T08:02:45+00:00

Objective: To compare neonatal outcomes in diabetic patients (known diabetic and GDM) who received dexamethasone versus those who did not at gestational age greater than 34 weeks.

Methodology: This comparative study was conducted at Obstetrics and Gynecology Department, Kharadar General Hospital, Karachi from July 2025 to October 2025. A total of 139 pregnant women with confirmed diabetes (PGDM or GDM) at gestational age >34 weeks were enrolled and divided into two groups: Group A received antenatal dexamethasone (n=70) and Group B did not (n=69). Neonatal outcomes assessed included respiratory distress syndrome (RDS), hypoglycemia, neonatal intensive care unit (NICU) admission, Apgar scores, birth weight, and early neonatal mortality. Maternal glycemic profiles post-dexamethasone administration was also recorded.

Results: Average maternal age was 29.4 ± 4.7 years. GDM constituted 67.6% (n=94) and PGDM 32.4% (n=45) of cases. In Group A, RDS incidence was significantly reduced (8.6% vs. 24.6%, p=0.01) and NICU admissions were lower (21.4% vs. 37.7%) compared to Group B p=0.04. However, neonatal hypoglycemia was markedly higher in Group A (34.3% vs. 13.0%, p=0.005), reflecting reactive fetal hyperinsulinism. Mean birth weight was 2.98 ± 0.42 kg in group A versus 2.89 ± 0.38 kg in group B (p=0.19). Apgar scores at 5 minutes ≥7 was in 91.4% of group A compared to 85.5% of neonates in group B (p=0.28). Early neonatal mortality was low in both groups (2.9% vs. 4.3%) p=0.62.

Conclusion: Neonatal outcomes among women with GDM beyond 34 weeks of gestation showed some better among those who received dexamethasone. Mostly neonates among both groups had favorable respiratory status, with low need for advanced respiratory support. The NICU admissions emerged higher among the non-dexamethasone group, while overall neonatal course was statistically insignificant

Comparison of the Mean Duration of 3rd Stage of Labour between Intraumbilical and Intravenous Oxytocin

2026-06-16T16:58:38+00:00

Objective: To compare the mean duration of third stage of labour (TSL) between intraumbilical (IU) and intravenous (IV) oxytocin.

Methodology: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Sadiq Abbasi Hospital, Bahawalpur, Pakistan, from October 2024 to March 2025. One hundred women aged 18–40 years with term singleton pregnancies and spontaneous vaginal delivery were enrolled and randomly allocated to receive either IU (10 U in 10 mL saline) or IV oxytocin (20 U in 500 mL saline). Data were analyzed using SPSS version 26.0, with group comparisons performed using appropriate statistical tests, considering p<0.05 as significant.

Results: A total of 100 women were enrolled, with mean age of 27.6±4.4 years. The median duration of the TSL was significantly less in the IU oxytocin group compared to the IV group, at 2.5 minutes (IQR: 2.1–3.2) versus 3.4 minutes (IQR: 3.0–3.8), respectively (p<0.001). Post-partum hemorrhage (p=0.400), need for additional uterotonics (p=0.558), maternal tachycardia (p=0.646), and maternal hypotension (p=0.558) were relatively similar among study groups.

Conclusion: Intraumbilical oxytocin significantly shortens the duration of the TSL compared to intravenous oxytocin.

Association Between Maternal Height and Mode of Delivery Among Nulliparous Pregnant Women Delivered at Tertiary Care Hospital

2026-06-16T19:47:52+00:00

Objective: To observe the impact of maternal height upon mode of delivery among nulliparous women. Maternal and neonatal morbidities are secondary aims associated with this study.

Material and Methods: This study is prospective observational study which is carried out at Department of Obstetrics and Gynaecology, Combined Military Hospital, Rawalpindi, from 1^st January 2024 to 31^st December 2024. A total of 350 pregnant women, with age range 20 years to 30 years selected who were admitted with labor pain in between 38 weeks to 40 weeks of gestation. Mode of delivery with different height of patient was obtained. Data was analyzed by using SPSS version 23 and p value of <0.05 was considered statistically significant.

Results: The mean maternal age of patients is 25.06±5.07 years, with the majority (61.71%) having a height between 150–159 cm. , The percentage of normal vaginal delivery increases with increasing maternal height 51.3% (<150cm), 60.2% (150-159cm) and 74.7% (>159cm). The chi- square test indicates a statistically significant association between maternal height and the mode of delivery. The rate of caesarean section decreases with increasing maternal height, 38.5% (<150cm), 36.1% ( 150-159cm) and 23.2% (>159cm). Our study demonstrates the significant association between low maternal height (<150 cm) and increased likelihood of cesarean delivery (CD).

Conclusion:This study highlights the significant associations between maternal height and various delivery outcomes, emphasizing the need for further investigation into how these factors can influence clinical practices to improve maternal and neonatal health.

Comparing Doses of Intrathecal Dexmedetomidine Along With Bupivacaine for Cesarean Section: A Double-Blind Randomized Clinical Trial

2026-06-21T08:18:21+00:00

Objective:
To compare the duration of sensory and motor blockade produced by two different intrathecal doses of dexmedetomidine (5 µg and 10 µg) when added to hyperbaric bupivacaine in patients undergoing elective cesarean section.

Study Design:
Prospective, double-blind, randomized clinical trial.

Place and Duration of Study:
Department of Anesthesiology, Bahria International Hospital, Rawalpindi, conducted over a period of three months following approval from the College of Physicians and Surgeons Pakistan (CPSP) and the institutional ethical review board.

Methodology:
Sixty ASA II parturients aged between 20 and 40 years scheduled for elective cesarean section under spinal anesthesia were enrolled. Patients were randomized into two equal groups (n=30 each). Group A received 5 µg dexmedetomidine with 12.5 mg of 0.5% hyperbaric bupivacaine, while Group B received 10 µg dexmedetomidine with the same dose of bupivacaine. Duration of sensory and motor blockade were recorded as primary outcomes. Hemodynamic parameters including heart rate and mean arterial pressure were recorded as secondary outcomes. Statistical analysis was performed using SPSS version 26.

Results:
The mean duration of sensory blockade was significantly longer in Group B (351.2 ± 46.8 minutes) compared to Group A (286.4 ± 52.3 minutes) (p < 0.001). Similarly, the duration of motor blockade was significantly prolonged in Group B (361.5 ± 15.9 minutes) compared to Group A (312.1 ± 29.7 minutes) (p < 0.001). Hemodynamic parameters remained stable in both groups, with no statistically or clinically significant adverse effects observed.

Conclusion:
Intrathecal dexmedetomidine at a dose of 10 µg significantly prolongs the duration of sensory and motor blockade compared to 5 µg when used as an adjuvant to hyperbaric bupivacaine for elective cesarean section, without compromising maternal hemodynamic stability.

Keywords:
Dexmedetomidine, spinal anesthesia, cesarean section, bupivacaine, sensory block, motor block

Endoscopic Evaluation of Refractory Gastrointestinal Symptoms in Pregnant Patients Unresponsive to Conservative and Medical Therapypy

2026-06-22T06:13:56+00:00

Objective: To evaluate the diagnostic yield and clinical outcomes of endoscopy in pregnant patients with refractory gastrointestinal symptoms that persist despite conservative and medical treatment.
Methodology: This prospective observational study was conducted at Combined Military Hospital (CMH), Kharian, Pakistan, from June to August 2025. Pregnant patients with persistent GI symptoms despite conservative and medical therapy were enrolled. Endoscopic procedures were performed under strict maternal-fetal safety protocols. Data on patient demographics, symptom profile, trimester, endoscopic findings, and post-procedure clinical outcomes were systematically collected. Associations between patient characteristics and endoscopic findings were analyzed using chi square test, while symptom improvement before and after endoscopy was assessed with McNemar’s test.
Results: A total of 40 patients were included, with a mean age of 28.4±4.6 years. The most common presenting symptoms were dyspepsia (55%) and nausea/vomiting (35%), while 20% had upper GI bleeding. Endoscopy revealed abnormalities in 29 patients, giving a diagnostic yield of 72.5%. Gastritis (27.5%) and reflux esophagitis (15%) were the most frequent findings, followed by duodenal ulcer (10%), esophageal varices (10%), and Mallory–Weiss tear (5%). Symptom improvement after endoscopy-guided management was significant (100% vs. 25%, p = 0.0001). No maternal or fetal complications were observed.
Conclusion: Endoscopy is a safe and effective diagnostic modality for selected pregnant patients with refractory GI symptoms, enabling timely management and improved clinical outcomes.

Gap Assessment and AI-Based Quality Enhancement In Medical Curriculum: CIPP Framework

2026-07-06T11:16:01+00:00

Objective: The current study aims to evaluate and redesign the curriculum of one of Pakistan's leading medical institutes by identifying its strengths and gaps and designing a more robust corrective plan.

Methodology: The CIPP model (Context, Input, Process, Product) was used as the main evaluation model in the present study. It incorporated Harden’s SPICES principles and the famous eleven steps of the Integration model. The current study identified gaps in the 5th year MBBS curriculum of UHS and further proposed an artificial intelligence (AI) based quality enhancement tool to bridge this gap.

Results: The study has found the need for regular use of AI assistance for the evaluation of curriculum and quality enhancement. We identified that the curriculum of UHS is suffering deficiencies at the levels 6 and 7 (Harden’s 11-step integration model) and recommends for employment of AI synchronization model for more vigorous improvement in integration throughout the curriculum.

Conclusion: A comprehensive curriculum evaluation should be performed for the incorporation of the latest high-tech advances in medical education. An artificial intelligence-based AI synchronization model proposed in the current study could efficiently and effectively improve teaching, learning, and assessment.

Association of Vitamin D with Uterine Fibroid in Women of Reproductive Age

2026-07-06T10:59:59+00:00

Objectives: To determine the mean change in fibroid size after vitamin D supplementation in Vitamin D deficient women visiting a tertiary care hospital of Lahore.

Methodology: This quasi-experimental trial study was conducted in department of Obstetrics and Gynecology, Sir Ganga Ram hospital, Lahore. from July 2022 to June 2023. A total of 115 premenopausal women between 40 and 45 years of age having fibroids of less than 5 cm by ultrasound were checked for vitamin D levels. The women having vitamin D levels less than 20ng/ml were included. Vitamin D 200,000IU oral supplementation, once weekly was given till the vitamin D level reached 50ng/ml or above or for 12 weeks’ duration whichever was earlier. After 12 and 24 weeks all women had an ultrasound and a difference in size and volume of the uterine fibroid was noted. Mean and standard deviation were calculated for numerical variables like Age, duration of symptoms, BMI and size of fibroid (pre, post and change). Post-stratifications, independent ‘t’ test was applied taking p ≤ 0.05 as statistically significant.

Results: The mean fibroid size at baseline and post-treatment was 34.23 ± 9.66 mm and 27.18 ± 9.39 mm respectively (p-value <0.0001). Mean change in fibroid size after vitamin D Supplementation in Vitamin D deficient women was 6.79 ± 1.98 mm.

Conclusion: This study concluded that Serum Vitamin D level inversely correlated with size of uterine fibroid and possibly supplementation of vitamin D reduces size of fibroid in vitamin deficient women.

Comparison of Surgical Site Infections Using Absorbable and Non-Absorbable Sutures during Skin Closure in Patients Undergoing Caesarean Section

2026-07-09T14:27:15+00:00

Objective: To determine the rates of SSIs between patients undergoing subcuticular skin closure during CS using absorbable (polyglactin) or non-absorbable (polypropylene) suture materials.

Methodology: This randomized clinical study was conducted in the Department of Obstetrics and Gynecology of Federal Government Polyclinic (FGPC) Hospital, Islamabad from April 2025 to September 2025. Two hundred and one eligible gravid females were randomized into groups of absorbable (Group A; n=100) and non-absorbable (Group B; n=101) skin closure groups. The randomization method employed was alternating suture material type every other day. Group A patients underwent skin closure using polyglactin 2-0 in a subcuticular running manner, whereas those of group B received subcuticular skin closure with polypropylene 2-0 suture. Subsequently, they were prospectively followed until the 10th postoperative day for the development of SSIs and their signs (redness, pus discharge, and swelling).

Results: The mean age of the population was 28.32 ± 5.46 years, the median parity was 2, and the mean BMI was 24.26 ± 3.39kg/m2. The rates of SSI were 7% in group A and 18.8% in group B (odds ratio [OR] 3.078, 95% confidence interval [CI] 1.232 - 7.694, p=0.013). The group A patients with SSIs showed erythema and swelling in 42.8%, compared to 78.9% (p=0.003) and 73.7% (p=0.006) in group B.

Conclusion: Patients with skin incision closure by absorbable suture had not only a low risk of SSI, but also a lower severity of wound infection. Hence, we recommend preferring the absorbable suture material over the non-absorbable for this purpose.

Association of Intimate Partner Violence and Perinatal Outcomes

2026-07-16T09:18:31+00:00

Objective: To determine the association between intimate partner violence (IPV) and perinatal outcomes among women delivering at Liaquat University Hospital Hyderabad.

Methodologys: A case control study was conducted in the Department of Obstetrics and Gynaecology at Liaquat University Hospital (LUH) Hyderabad, from August 2025 to January 2026. The sample of 127 women with singleton pregnancies was enrolled consecutively, including 64 with intimate partner violence and 63 without. The sample of patients was divided in two groups; 64 women with a history of intimate partner violence during pregnancy or within the last twelve months were included in the exposed group and 63 women without intimate partner violence served as controls. Intimate partner violence was assessed through structured interviews and perinatal outcomes were recorded after delivery. Chi square test and odds ratios were applied with a significance level of 0.05.

Results: The mean maternal age was 28.6 ± 5.1 years in the IPV group and 27.9 ± 4.8 years in the non-IPV group. Low birth weight (LBW) (35.9% vs 14.3%; OR 3.36), preterm birth (28.1% vs 11.1%; OR 3.13), IUGR (21.9% vs 7.8%; OR 3.30) and PROM (25.0% vs 9.5%; OR 3.16) were significantly higher among IPV-exposed women, while miscarriage, IUD and neonatal death showed non-significant association with IPV.

Conclusion: The intimate partner violence found significantly associated with adverse perinatal outcomes, including higher rates of low birth weight, preterm birth, IUGR and PROM, indicating the need of proper strategies development to reduce IPV-related maternal and neonatal risks.

Platelet Distribution Width as a Severity Marker of Pre-clampsia

2026-07-16T15:20:29+00:00

Objective: To determine the platelet distribution width among women with “mild and severe pre-eclampsia.

Methodology:: This Cross-sectional study was conducted at Department of Obstetrics & Gynecology, CMA teaching and research hospital, Lahore. 113 women who met the inclusion criteria were enrolled after consent. Based on the dating scan, all patients at ≥28 weeks of gestation who were diagnosed with pre-eclampsia, and singleton pregnancy were included. Each patient was evaluated and further categorized as “mild” or “severe pre-eclampsia.” Approximately 5 mL of venous blood was collected via venipuncture and sent to the laboratory for assessment of platelet distribution width. Data was collected on a structured proforma and analyzed using SPSS 23.

Results: The study participants' mean age was 27.7±4.4 years, and their mean gestational age was 34.3±2.0 weeks. Pre-eclampsia was diagnosed in 14 (9.3%) women; 69 (61.06%) women had “mild pre-eclampsia,” and 44 (38.94%%) had “severe pre-eclampsia.” The mean platelet distribution width was significantly higher in women with “severe pre-eclampsia” compared to those with “mild pre-eclampsia” (14.21±0.25 vs. 13.12±0.26 fl; p-value<0.0001). Furthermore, a statistically significant difference was observed in platelet distribution width between mild and severe pre-eclamptic women across various strata based on women's age, gestational age, parity, BMI, and platelet count.

Conclusion: Mean platelet distribution width was greater in women with severe pre-eclampsia compared to those with mild pre-eclampsia, indicating a direct association with disease severity.

Prevalence of Anal Incontinence in Women Attending Gynecological Outpatient Department

2026-07-09T10:23:34+00:00

Objective: To determine the frequency of anal incontinence among women who visiting the
gynecological OPD at a tertiary care Hospital.
Material and methods: This descriptive study was conducted on 375 women attending the
gynecological outpatient department at Isra university Hospital Hyderabad. Women aged 18 years and
above presenting to the gynecological OPD were included. A structured validated questionnaire was
used to assess the frequency, severity, and type of anal incontinence (flatus, liquid, solid stool).
Severity was graded using the Wexner Continence Grading Scale. Demographic variables including
age, parity, mode of delivery, BMI, menopausal status, and obstetric history were recorded. Data were
stratified by age groups, parity, and menopausal status, using SPSS version 23, with significance level
at p<0.05.
Results: Overall prevalence of anal incontinence was 34.7% (n=130). Flatus incontinence was most
prevalent (21.6%), followed by liquid stool incontinence (16.8%) and solid stool incontinence (8.3%).
Mean Wexner score was 8.3 ± 3.6 among affected patients. Stratification revealed significantly higher
prevalence in women above 50 years (54.2%) (p<0.001), grand multiparous women (parity ≥5)
demonstrating 2.8 times higher odds compared to nulliparous women (OR=2.8, 95% CI: 1.6–4.9;
p<0.001). Vaginal delivery was also identified as a significant risk factor compared to cesarean section
(48.3% vs. 19.4%; p<0.001). Overall advancing age (p<0.001), vaginal delivery (p<0.001), grand
multiparity (p=0.002), and menopausal status (p=0.003) were identified as independent predictors of
anal incontinence.
Conclusion: Anal incontinence is a considerably prevalent yet underreported condition among women
attending gynecological outpatient services in our population. Advancing age, vaginal delivery, grand
multiparity, instrumental delivery, and postmenopausal status were identified as significant
independent risk factors.
Keywords: Anal incontinence, fecal incontinence, women, gynecological outpatient, prevalence,
pelvic floor dysfunction, vaginal delivery, multiparity.

VAGINAL BIRTH TRAUMA AND PRIMIPARITY; EXPERIENCE AT A TERTIARY CARE HOSPITAL

2026-07-09T10:24:17+00:00

Objective: To determine the effects of perineal tears during vaginal birth in primiparous
women
Methodology: This Cross-Sectional Study was conducted at the Department of Obstetrics
& Gynae, Unit I, LUMHS, Jamshoro, from October 27, 2022 to April 26, 2023. All
women who fulfilled the inclusion criteria and admitted in emergency in labour ward
were included in the study. Informed written consent was taken after explaining the
procedure, risks and benefits. Data were entered in predesigned proforma containing
basic biodata, sociodemographic details, gestational age, mode of onset of labour
(spontaneous or induced), vaginal delivery with episiotomy, instrumental vaginal
delivery with perineal tears, type I, II, III and IV- degree. All the data were collected and
analyzed on SPSS version-21.
Results: The mean maternal age was 24.86±5.70 years. Among women with perineal
tears, instances of bleeding were noted in 21.1% of 1st degree tears and 24.6% of 2nd
degree tears. Anesthesia-related issues were reported in 7.0% and 14.9% of cases,
respectively. Puerperal sepsis was documented in 4.4% of 1st degree tears and 0.9% of
2nd degree tears. For 3rd degree tears, bleeding was observed in 2.6% of cases, with
anesthesia-related complications reported in 5.3% and puerperal sepsis in 2.6%.
Rectovaginal fistula was not observed in any tear degree, while vesicovaginal fistula was
documented in 0.9% of 1st degree tears and 4.4% of 2nd degree tears. The mean lengths
of hospital and ICU stays were 24.76 ± 15.73 hours and 3.26 ± 1.41 hours, respectively.
In-hospital mortality was noted in 3.3% of participants, and perineal tears were observed
in 37.6% of cases.
Conclusion: The bleeding and anesthesia-related issues were more common in 2nd
degree tears compared to 1st degree tears. Puerperal sepsis was relatively rare but more
frequent in 1st degree tears. Vesicovaginal fistula occurred more frequently in 2nd
degree tears. Mortality was relatively low.
Keywords: Perineal Tears, Primiparity, Vaginal Birth, Morbidity, Mortality

Neonatal Outcomes in Diabetic Patients (Known Diabetic / GDM) With and Without Dexamethasone at at >34 Weeks of Gestation: A Comparative Cohort Study.

2026-07-14T15:29:59+00:00

Objective: To compare neonatal outcomes in diabetic patients (known diabetic and GDM) who received dexamethasone versus those who did not at gestational age greater than 34 weeks.
Methods: This comparative study was conducted at a tertiary care hospital in Pakistan. A total of 139 pregnant women with confirmed diabetes (PGDM or GDM) at gestational age >34 weeks were enrolled and divided into two groups: Group A received antenatal dexamethasone (n=70) and Group B did not (n=69). Neonatal outcomes assessed included respiratory distress syndrome (RDS), hypoglycemia, neonatal intensive care unit (NICU) admission, Apgar scores, birth
weight, and early neonatal mortality. Maternal glycemic profiles post-dexamethasone administration was also recorded.
Results: Average maternal age was 29.4 ± 4.7 years. GDM constituted 67.6% (n=94) and PGDM 32.4% (n=45) of cases. In Group A, RDS incidence was significantly reduced (8.6% vs. 24.6%, p=0.01) and NICU admissions were lower (21.4% vs. 37.7%, p=0.04) compared to Group B. However, neonatal hypoglycemia was markedly higher in Group A (34.3% vs. 13.0%, p=0.005), reflecting reactive fetal hyperinsulinism. Mean birth weight was 2.98 ± 0.42 kg vs. 2.89 ± 0.38 kg (p=0.19), with no significant difference. Apgar scores at 5 minutes were ≥7 in 91.4% vs. 85.5% of neonates respectively (p=0.28). Early neonatal mortality was low in both groups (2.9% vs. 4.3%, p=0.62). Caesarean delivery rate was 72.9% overall, consistent with regional Pakistani data.
Conclusion: Dexamethasone administration in diabetic pregnancies beyond 34 weeks offers pulmonary benefits but necessitates vigilant neonatal glucose monitoring. Individualized risk- benefit assessment is essential, and findings align with emerging Pakistani obstetric literature advocating for protocol-driven corticosteroid use in high-risk pregnancies.
Keywords: Gestational diabetes, dexamethasone, neonatal outcomes, antenatal corticosteroids,
respiratory distress syndrome, neonatal hypoglycemia, Pakistan.

Hematometra in a 15-Year-old Female with Mckusick- Kaufman Syndrome: A Case Report

2026-07-15T08:28:43+00:00

McKusick-Kaufman Syndrome (MKS) is a genetic disorder affecting the development of the heart, genitals, and limbs. Clinical manifestations of MKS include polydactyly, labial fusion, and cryptorchidism; in some cases, severe cardiac abnormalities are also observed. The MKS gene associated with this disorder is located on chromosome 20. The primary goal of treatment is symptom management; Surgical intervention may be recommended based on genetic testing and clinical evaluation. Patient prognosis depends on the severity of the issues. A 15-year-old girl was treated for hydrometra, polydactyly with hand and foot deformities, and a mild atrial septal defect (ASD). As genetic testing was unavailable at the time, most data were collected through routine examinations and simple clinical observations. Multidisciplinary collaboration was crucial for accurate diagnosis.