Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Comparison of Effect of Antenatal Dexamethasone Versus Betamethasone on Antepartum Cardiotocography

Ifra Shafique, Amara Arooj, Humaira Bilqis, Lubna Ejaz Khaloon, Tallat Farkhanda — Fri, 17 Apr 2026 00:00:00 +0000

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

Khushboo Sarwar, Najma Bano , Aisha, Arti Devi, Sapna Lohya, Adeela Ameen — Fri, 17 Apr 2026 00:00:00 +0000

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

Omema Akhtar, Haleema Yasmin, Memoona Rehman, Urooj Jamal Siddiqui, Iqra Jam — Fri, 17 Apr 2026 00:00:00 +0000

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

Musarrat Ahad, Kalavanti Bai, Amna Baloch, Beena Mairaj , Sanam, Farheen Malik — Fri, 17 Apr 2026 00:00:00 +0000

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

Association between maternal height and mode of delivery among nulliparous pregnant women delivered at tertiary care hospital

Tue, 31 Mar 2026 08:11:12 +0000

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.

Evaluating the adequacy of tissue using manual vacuum aspiration (MVA) versus metal curettage method in endometrial sampling in abnormal uterine bleeding

qurat nauman, Mahham Janjua — Tue, 31 Mar 2026 16:16:05 +0000

ABSTRACT

Objective: To compare the adequacy of endometrial tissue obtained through Manual Vacuum Aspiration (MVA) versus Metal Curettage Method in females with abnormal uterine bleeding.

Study design: Quasi-experimenta1 study

Study place and duration: Obstetrics & Gynecology Department, Sir Ganga Ram Hospital, Lahore from April to October 2024.

Methodology: All 160 patients, presenting with AUB were included and were divided into two groups. Group A was undergoing endometrial sampling using MVA, while Group B was using sharp metal curettage. Samples from both groups were sent for histopathology, and adequacy was recorded. All the data were analyzed in SPSS version 25.

Results: Total 160 patients, the mean age was 56.49 years, and the mean BMI was 28.39 kg/m². There were 68 cases of adequacy (46.9%) in Group A and 77 cases (53.1%) in Group B. There was a significant relationship of adequacy between study groups. (P<0.05).

Conclusion: The conclusion of the study that adequacy of endometrial sampling was significantly higher in the metal curettage group (Group B) compared to the MVA group (Group A). These findings suggest that metal curettage may be more effective in obtaining adequate samples for histopathological analysis.

Endoscopic evaluation of refractory gastrointestinal symptoms in pregnant patients unresponsive to conservative and medical therapy

Tue, 31 Mar 2026 16:19:19 +0000

Background: Gastrointestinal (GI) symptoms are common in pregnancy, but a subset of patients remains refractory to conservative and medical management. Evidence on the role and outcomes of endoscopy in such patients, particularly in Pakistan, remains limited.
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.
Methods: 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.

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

Tue, 31 Mar 2026 16:22:17 +0000

Background: Cesarean section (CS) is the most frequently performed surgical procedure worldwide. Surgical site infections (SSIs) become a source of additional maternal morbidity after this surgery. Different surgical techniques and materials influence the risk of developing SSI. The existing body of literature does not prioritize one suture material over the other for skin closure during CS.

Aim: 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 1^st April, 2025 to 30^th September, 2025. Two hundred and one eligible gravid females were randomized into groups of absorbable (A; n=100) and non-absorbable (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 10^th 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 Vitamin D with Uterine Fibroid in Women of Reproductive Age

Shamila Ijaz — Tue, 31 Mar 2026 16:28:15 +0000

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

Study Design: Quasi-experimental trial.

Settings: Department of Obstetrics and Gynaecology, Sir Ganga Ram hospital, Lahore.

Study Duration: one year from 18^th July 2022 to 17^th January 2023.

Materials & Methods: This was Quasi- experimental study done in Department of Obstetrics and Gynaecology, Sir Ganga Ram hospital, Lahore for a period of 6 months from 18^th July 2022 to 17^th January 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 difference in size and volume of the uterine fibroid was noted.

Results: The mean fibroid size at baseline and post-treatment was 34.23 Â± 9.66 mm and 27.18 Â± 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 Â± 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 the Mean Duration of 3rd Stage of Labour between Intraumbilical and Intravenous Oxytocin

Anam Javed, Saba Nadeem — Sat, 18 Apr 2026 06:04:17 +0000

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 mean gestational age was 38.6±1.2 weeks in the IU group and 38.7±1.0 weeks in the IV group (p=0.652). There were 63 (63.0%) women who were booked cases, with no significant difference between groups (p=0.534). Obesity was present in 36.0% of the IU group, and 42.0% of the IV group (p=0.539). The median duration of TSL was significantly shorter in the IU group (2.5 minutes, IQR: 2.1–3.2) compared to IV group (3.4 minutes, IQR: 3.0–3.8; p<0.001). Postpartum hemorrhage occurred in 2 (4.0%) IU and 4 (8.0%) IV cases (p=0.400). Need for additional uterotonics (p=0.558), maternal tachycardia (p=0.646), and hypotension (p=0.558) were low and similar between groups.

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