Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Cousin Marriages: Pakistan’s Genetic Time Bomb

2025-11-12T08:48:55+00:00

Cousin marriages or consanguineous marriages in Pakistan are a health pandemic we can no longer overlook. Marrying within the family, especially between first cousins, is a tradition passed down through generations. However, over the last two decades, increasing research indicates that this decision incurs significant costs, e.g., increased prevalence of genetic abnormalities, newborn mortality rates, and cognitive implications in subsequent generations, imposing burdens on both families and the national public health structure.

Inter-Pregnancy Interval: A Clincher for Obstetric Outcome

2025-11-09T07:52:23+00:00

Objective: To examine the association between interpregnancy interval (IPI) and obstetric outcomes among women delivering at a tertiary care hospital.

Methodology: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Jinnah Hospital Lahore, from January to June 2025. A total of 176 booked pregnant women with parity 1–4 and interpregnancy intervals of <18 months and 18–24 months were enrolled. Women with chronic illnesses, multiple pregnancies, or grand multiparity were excluded. Participants were followed throughout the antenatal period until delivery to record maternal and perinatal outcomes. Data were analyzed using SPSS version 28. The Chi-square test and t-test were applied, with p < 0.05 considered significant.

Results: Most mothers (55.7%) were aged 20–30 years, and 58.5% belonged to the lower socioeconomic class. The majority (75.6%) delivered by caesarean section. Fetal outcomes showed 25.0% of babies had low birth weight and 13.6% were preterm. Maternal complications included anemia (17.0%) and gestational diabetes (8.0%). A statistically significant relationship (p = 0.000) was found between short interpregnancy interval and adverse maternal and fetal outcomes. No significant association was observed between interpregnancy interval and sociodemographic variables.

Conclusion: Short interpregnancy intervals (<18 months) are significantly associated with adverse obstetric outcomes, including anemia, preterm birth, and low birth weight. Promoting optimal spacing between pregnancies (18–24 months) through postpartum counseling and family planning can improve maternal and neonatal health outcomes.

Ki-67 as a Prognostic Indicator in Serous Types of Ovarian Malignancies

2025-11-09T10:34:39+00:00

Objective: To assess the frequency and distribution of Ki-67 immunoexpression across different histological subtypes and tumor grades of surface epithelial serous ovarian carcinomas.

Methodology: This descriptive cross-sectional study was conducted at the Department of Pathology, SZABMU (PIMS), Islamabad, Pakistan, from January 15, 2022, to July 14, 2022. All patients fulfilling the inclusion criteria and visiting SZABMU, Islamabad, during the study period were included. All specimens were fixed in 10% formalin, followed by gross examination, sectioning, embedding in paraffin blocks, and preparation of hematoxylin and eosin (H&E)–stained slides. The slides were examined under a light microscope, and the diagnosis was recorded. Immunohistochemistry for Ki-67 was performed and evaluated accordingly.

Results: The mean age of the study cohort was 52.4 years (SD ± 12.7). High-grade serous carcinoma constituted the majority of cases (62.9%), while low-grade serous carcinoma accounted for 37.1%. Evaluation of Ki-67 immunoexpression revealed low proliferative activity (1–30% staining) in 34.3% of cases, intermediate activity (31–50%) in 15.0%, and high proliferative activity (>50%) in 50.7%.

Conclusion: High-grade serous carcinoma was identified as the predominant tumor grade, with Ki-67 immunoexpression >50% being the most consistent proliferative marker. These findings highlight the need for larger, multicenter studies in Pakistan to validate the observed trends and strengthen their clinical and prognostic significance.

Aetiology-Specific Impact of Thrombocytopenia on Maternal and Neonatal Outcomes in Pregnancy: A Prospective Cohort Study from a Resource-Limited Setting

2025-11-09T14:15:28+00:00

Objective: This study aimed to evaluate the impact of thrombocytopenia on maternal and neonatal outcomes stratified by etiology (gestational thrombocytopenia, immune thrombocytopenic purpura [ITP], hypertensive disorders, and secondary causes) and identify predictors of adverse events.

Methodology: This was a prospective observational study conducted in the Department of Gynecology and Obstetrics, Hayatabad Medical Complex (HMC), Peshawar, from January 2021 to December 2022. Pregnant women with thrombocytopenia (platelet count <150,000/μL) who received antenatal and delivery care at our institution were consecutively enrolled after informed consent. Participants were stratified according to the etiology of thrombocytopenia and followed through delivery to assess maternal and neonatal outcomes. Inclusion criteria included singleton pregnancies of ≥20 weeks gestation with documented thrombocytopenia.

Results: A total of 250 pregnant women diagnosed with thrombocytopenia were included. The mean maternal age was 28.4 ± 5.2 years, and the majority (62%) were multiparous. Thrombocytopenia was diagnosed at a mean gestational age of 28.6 ± 6.4 weeks. The mean gestational age at delivery was 37.1 ± 2.7 weeks. The average platelet count at diagnosis was 96,200/μL (range: 28,000–149,000/μL). Based on etiology, 58% of cases were classified as gestational thrombocytopenia, 34% were associated with hypertensive disorders of pregnancy (including preeclampsia and HELLP syndrome), 6% were due to immune thrombocytopenic purpura (ITP), and 2% were attributed to other secondary causes (e.g., infections, drug-induced). Comorbidities were present in 38% of patients, with hypertensive disorders being the most common (34%), followed by gestational diabetes (6%) and hypothyroidism (2%).

Conclusion: Thrombocytopenia in pregnancy impacts maternal and neonatal outcomes in an etiology-dependent manner. Hypertensive-related thrombocytopenia was associated with higher maternal morbidity, while ITP posed greater neonatal risks. In contrast, gestational thrombocytopenia had a benign course with favorable outcomes. Early identification and etiology-specific management are essential to improve maternal and neonatal outcomes.

Biochemical Markers and Their Correlation with Fetal Outcomes in Preeclamptic Mothers

2025-11-09T16:39:27+00:00

Objective: To assess the impact of serum uric acid, creatinine, and blood urea nitrogen (BUN) levels on fetal outcomes in preeclamptic mothers. It also examined correlations between uric acid and creatinine, and uric acid and BUN

Methodology: A cross-sectional comparative study was conducted at Liaquat University of Medical and Health Sciences (LUMHS) involving 86 pregnant women. Participants were divided into normotensive and preeclamptic groups. After obtaining verbal consent, blood samples were collected in a sitting position to measure serum uric acid, creatinine, BUN, and blood pressure.

Results: The mean age was 31.8±2.0 years in the normotensive group and 35.3±2.1 years in the preeclamptic group. Gestational age averaged 34.6 ± 2 weeks in normotensive women and 37.2 ± 1.3 weeks in preeclamptic women. Systolic and diastolic blood pressures were significantly higher in the hypertensive group. Serum levels of uric acid, creatinine, and BUN were also elevated in preeclamptic women, showing strong correlations with each other. These elevated markers were linked to poor fetal outcomes.

Conclusion: The study concluded that elevated serum uric acid, creatinine, and BUN levels, along with the uric acid-to-creatinine ratio, are significant predictors of hypertension and adverse fetal outcomes in pre-clamptic pregnancies.

Frequency of Structural and Hormonal Causes of Abnormal Uterine Bleeding (AUB) in Perimenopausal Women

2025-11-10T07:43:06+00:00

Objective: To evaluate the frequency of structural and hormonal causes of abnormal uterine bleeding (AUB) in perimenopausal women to support timely diagnosis, management, and prevention.

Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology at Foundation University Islamabad, Fauji Foundation Hospital, from January to August 2024. It included all perimenopausal women aged 40–55 years presenting with AUB who had not yet attained menopause. A 5ml blood sample was collected from each case for laboratory investigations, including thyroid function tests (TSH and free T4), serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels, where clinically indicated, to assess hormonal abnormalities. Transvaginal ultrasonography (TVUS) was performed to evaluate the uterus, endometrium, and adnexal structures. Data were entered and analyzed using SPSS version 26.0.

Results: Leiomyoma 93(26.4%) was the most frequent abnormality, followed by cervical polyps (9.3%), endometrial hyperplasia without atypia (9.1%), adenomyosis (3.5%), endometrial polyps (3.2%), and malignant lesions including endometrioid carcinoma (0.3%) and cervical squamous cell carcinoma (0.3%). Hormonal and endometrial dysfunction-related abnormalities included disordered proliferative endometrium (24.6%) and chronic nonspecific endometritis (22.6%), with premalignant changes such as endometrial hyperplasia with atypia (0.8%). These findings varied significantly with age (p < 0.05).

Conclusion: Leiomyomas were the predominant structural pathology, while hormonal and endometrial abnormalities were also prevalent, especially in younger perimenopausal women.

Intra-Operative Uterine Scar Dehiscence and Its Relation to Feto-maternal Outcome in Patients of Previous Lower Segment Cesarean Section with Scar Tenderness

2025-11-10T07:50:41+00:00

Objective: To determine frequency of scar dehiscence and its association with feto-maternal outcomes among patients undergoing repeat lower segment cesarean section (LSCS) with scar tenderness.

Methodology: A descriptive case series study was done at Obstetrics and Gynae department, Amna Inayat Medical College (AIMC) Lahore from December 2024 to May 2025. Women aged 20 to 40 years, >37 weeks with history of previous cesarean section delivery undergoing repeat LSCS due to scar tenderness were included. Patients were evaluated intraoperatively for scar dehiscence. Additionally, fetal and maternal outcomes were observed and compared based on the presence or absence of scar dehiscence. Data was analyzed by SPSS version 22.

Results: Overall mean age and mean gestational age of the patients was 30.0 ± 6.196 years and 38.97 ± 1.287 weeks respectively. Average BMI was 26.43 ± 2.551 kg/m². Overall, scar dehiscence was observed in 22 (19.1%) patients and was significantly associated with pulmonary complications, urinary complications, blood transfusion requirements, and meconium-stained liquor (p < 0.05), while no statistically significant association was found with Apgar score (p > 0.05).

Conclusion: Scar dehiscence was observed in 19.1% of patients undergoing repeat lower segment cesarean section with scar tenderness and was significantly associated with adverse feto-maternal outcomes.

Assessment of Fetomaternal Outcome in Females Presenting with Morbidly Adherent Placenta in a Large Tertiary Care Facility

2025-11-10T10:25:53+00:00

Objective: To assess fetomaternal outcome in females presenting with morbidly adherent placenta

Methodology: This descriptive study was conducted at Department of Obstetrics & Gynecology, Shifa International Hospital, Islamabad. A total of 50 females were recruited in 6-month period (5th November 2022 to 5th May 2023). Both booked and non-booked females were followed-up till delivery. Maternal outcome included hemorrhage, hysterectomy, preterm delivery and need of massive blood transfusion and ICU admission. Fetal outcome included birth weight, Apgar scores and NICU admissions. A structured proforma was used for data collection. Data analysis was performed in SPSS version 21.0.

Results: Mean age was 29.92 ± 6.59 years. There were 8 (16%) females with placenta increta, 4 (8%) had placenta percreta while 38 (76%) had placenta accreta. Antepartum hemorrhage was noted in 29 (58%) cases, hysterectomy was done in 25 (50%), preterm delivery in 28 (56%) cases, massive blood transfusion in 24 (48%), need for ICU care in 23 (46%) cases and need for neonatal care in 19 (38%) cases. Further analysis revealed that antepartum hemorrhage, need of ICU admission, low birth weight, and need of NICU admissions were more frequent in women with increta/percreta placental abruption, however, not statistically significant (p-value, 0.71).

Conclusion: The maternal complications rate was very high in women with morbidly adherent placenta . Prematurity and need for neonatal intensive care unit were the most frequent fetal complications in this study.

Optimizing Maternal Care: The Imperative Analysis of Rational Blood Transfusion Uses in Obstetrics

2025-11-14T06:50:14+00:00

Objective: To determine the frequency and indications of red cell transfusions in obstetrics and to evaluate their rational use according to established transfusion guidelines.

Methodology: This is a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology at Akbar Niazi Teaching Hospital, Islamabad, Pakistan, over a period of two years, from January 2022 to January 2024. A total of 300 transfusions were administered in obstetric patients included in the study. All obstetric patients who required blood transfusion during pregnancy (including cases of miscarriage, ruptured ectopic pregnancy, molar pregnancy, antepartum hemorrhage), at the time of delivery, or within 7 days postpartum for obstetric causes such as postpartum hemorrhage or obstetric hysterectomy were included in the study.

Results: The mean age of transfused patients was 28.4±4.6 years (range: 19–40 years). Among them, 72 (24%) were primigravida and 228 (76%) were multigravida. The majority, 129 (43%), were at ≥36 weeks of gestation. The proportion of obstetric patients who required blood transfusion was 300 (11%), some patients received more than one component. Packed red blood cells (PRBCs) were the most commonly used, accounting for 192 transfusions (64%), followed by whole blood 144 (48%), random donor platelets 45 (15%), and fresh frozen plasma (FFP) 33 (11%). The leading indications were postpartum hemorrhage (PPH) in 43 cases (30%) and anemia during pregnancy in 37 cases (25.7%). Platelet transfusions were most often required for gestational thrombocytopenia (11 cases, 24.5%) and other medical disorders (22 cases, 48.9%).

Conclusion: Red cell transfusions were predominantly required for hemorrhagic and anemic conditions, while platelet and FFP use was linked to pregnancy-related complications. These findings highlight the need for improved antenatal care and adherence to rational transfusion practices.

Effectiveness of Prophylactic Intravenous Tranexamic Acid in Preventing Postpartum Hemorrhage After Vaginal Delivery: A Quasi-Experimental Study

2025-11-03T08:49:13+00:00

Objective: To evaluate the effectiveness of prophylactic TXA in reducing PPH among women undergoing vaginal delivery

Methodology: This quasi-experimental research included 192 women undergoing vaginal delivery from Sir Ganga Ram Hospital, Lahore, during 6^th March 2023 to 28^th February 2024. Women in TXA group (n=96) received intravenous TXA 100 mg/mL, and women in SOC group (n=96) received only standard of care (SOC). Gravimetric method was used to estimate blood loss. Independent sample t-test employed to compare blood loss between groups.

Results: Baseline means of age (p-value 0.822), BMI (p-value 0.757), age categories (p-value 0.826), BMI classes (p-value 0.626) and parity (p-value 0.688) were similar in both groups. PPH immediately after delivery of placenta (323.59 ± 49.91 vs. 424.88 ± 41.28 ml; p-value <0.001), and up to 6-hours (70.14±6.54 ml vs. 104.68±8.53 ml; p-value <0.001) in TXA group was significantly lesser than SOC group. Requirement of blood transfusion (3.1% vs. 10.4%; p-value 0.04) in TXA group was significantly lower than SOC group. However, allergic reactions (8.3% vs. 0.0%; p-value 0.007) were only observed in TXA group. Other side effects including nausea, vomiting and diarrhoea were also higher in TXA group, but the difference remained statistically insignificant.

Conclusion: Prophylactic administration of intravenous tranexamic acid significantly reduced postpartum blood loss both immediately after placental delivery and within the first six hours following vaginal delivery.

Keywords: Pregnancy, Postpartum Hemorrhage, Postpartum Period, Placenta, Tranexamic Acid

Factors Affecting Intensity of Post-Operative Pain After Caesarean Section Under Spinal Anaesthesia

2025-11-02T08:48:27+00:00

Objective: To investigate the factors influencing the intensity of post-operative pain following caesarean section under spinal anesthesia.

Methodology: This prospective observational study included 270 patients who underwent elective or emergency C-section under spinal anesthesia. After obtaining ethical approval, a questionnaire was used to collect demographic, clinical, and surgical data. The Visual Analogue Scale (VAS) was used to describe intensity of pain at 2, 12, and 48 hours after surgery. Data was analyzed using SPSS version 23. A p-value < 0.05 was considered significant.

Results: Among all the variables, significant difference was observed in the pain intensity based on parity (P=0.034), type of surgery (P=0.073), labour phase (P=0.04), indication of surgery ie failure to progress (P=0.032), duration of surgery (P=0.034) and incision length (P=0.023). This study invites us to think about broader perioperative assessments of patients submitted for caesarean section and development of clinical tool for appropriate guidelines for satisfactory postoperative pain management, which is one the contributing factor for postoperative quality care.

Conclusion: This study demonstrates higher score of postoperative pain associated with the factors like higher parity, active phase of labour, emergency C-section, longer duration of surgery and incision length of more than 10 cm. There is a need to evaluate other factors contributing intensity of postoperative pain for the provision of better health care.

Psychosocial Morbidity of Patients Before and After Surgical Correction of Vesicovaginal Fistula

2025-11-04T08:48:04+00:00

Objective: To compare mean preoperative and postoperative quality of life scores using the World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire following successful repair of genitourinary fistula.

Methodology: A comparative cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Isra University Hospital, Hyderabad, from December 30, 2020, to June 30, 2021. Women aged 20 to 60 years who presented with complaints of continuous leakage of urine per vagina following obstetric or gynecological procedures and underwent surgical repair were included. The WHOQOL-BREF questionnaire was used to assess quality of life before surgery. Surgical repair was performed in all participants, and quality of life was reassessed six weeks postoperatively. Data were recorded on a specially designed proforma and analyzed using SPSS version 22.

Results: A total of 101 women with vesicovaginal fistula (VVF) were included. The mean age of the patients was 37.70 ± 10.96 years. The majority of women (55.4%) had poor preoperative physical domain scores according to the WHOQOL-BREF. Successful surgical repair was achieved in 98.0% of cases. Overall, 30.7% of women had poor quality of life (WHOQOL score < 40), 67.3% had moderate quality of life (WHOQOL score 41–60), and only two women had good quality of life (WHOQOL score > 60), likely because these women had mild disease and strong social and family support. Psychosocial and overall quality of life scores significantly improved after treatment (p = 0.001). The mean preoperative QOL score was 33.56 ± 9.33 (indicating a poor environmental domain), which improved to 80.07 ± 9.55 after treatment (indicating good quality of life) (p = 0.001).

Conclusion: Preoperative quality of life was observed to be poor among women with vesicovaginal fistula; however, it significantly improved to a good level following successful surgical repair, as measured by the WHOQOL-BREF scoring system.

Precision of Ultrasound Guided Wire Localization for Residual Breast Cancer during Breast Conservation Surgery: A Prospective Cohort Study

2025-11-03T08:48:44+00:00

Objective: This study aims to evaluate the efficacy of ultrasound-guided wire localization (USGWL) by achieving a negative surgical margin rate of at least 90% and a re-excision rate below 15% in 185 patients. It also seeks to assess the safety of the procedure by limiting complication rates to less than 5% and to identify patient and lesion characteristics that influence these outcomes.
Methodology: This study retrospectively analyzed data from 185 patients who underwent ultrasound-guided wire localization (USGWL) for breast lesions after receiving Institutional Review Board (IRB) approval. The primary goal was to evaluate the procedure's efficacy by assessing localization success, negative margin rates, and re-excision rates. Secondary outcomes provided a broader view of the procedure's impact, including operative time, resected tissue volume, complication rates, local recurrence, and patient-centric measures like cosmetic outcomes and patient-reported satisfaction. An exploratory analysis was also performed to examine the influence of variables such as the use of intraoperative ultrasound (IOUS), the surgeon's experience, prior neoadjuvant therapy, and the proximity of the wire to the lesion.
Results: Localization using USGWL was successful in 96.2% of cases, leading to a negative margin rate of 89.2%. The use of intraoperative ultrasound (IOUS) showed a positive but non-significant trend toward improving outcomes, with a higher negative margin rate (92.3% vs. 87.5%) and a lower re-excision rate (4.6% vs. 10.0%). On an average, the procedure took 60.9 minutes with a resected tissue volume of 45.3 cm³. The safety profile was excellent, with a low complication rate of 2.7% and a local recurrence rate of just 1.1% after 12 months. Patients reported high satisfaction, with an average score of 8.2 out of 10, and 88% reported good to excellent cosmetic results. Crucially, the study found that surgeon experience (over 50 procedures) and a close wire proximity to the lesion (less than 2 mm) were significant factors in achieving clear margins, with negative margin rates of 92.1% and 94%, respectively, in these groups. Neoadjuvant therapy, however, had no significant effect on the outcomes.

Conclusion: This study confirms that ultrasound-guided wire localization (USGWL) is a highly effective and safe technique for breast conservation surgery, demonstrating high success rates and low complication rates. The data also highlights that outcomes are significantly improved by increased surgeon experience and precise wire placement. Therefore, focusing on surgeontraining and meticulous technique can further enhance the already reliable clinical performance
of USGWL.
Keywords: Breast Neoplasms, Ultrasonography, Margins of Excision, Surgical Procedures,
Operative, Treatment Outcome

Caesarean Scar Ectopic Pregnancy: A Rare Form of Ectopic Pregnancy; Case Report

2025-11-07T08:48:25+00:00

Cesarean scar ectopic pregnancy (CSEP) is a rare but potentially life-threatening condition in which the embryo implants in scar tissues of a previous cesarean section rather than in endometrial cavity. Cesarean scar ectopic pregnancy is often considered as asymptomatic and is primarily diagnosed by ultrasound. Management of Cesarean scar ectopic pregnancy remains a challenge clinically due to lack of standardized treatment protocol globally. Society for Maternal Fetal Medicine strongly advises against continuing pregnancy in this condition due to high risk of different complications, such as maternal morbidity and mortality. Thus, early diagnosis, mainly in women with a history of cesarean section is essential to prevent severe complications such as uterine rupture and massive hemorrhage. The current case report describes the case of 38 years old women diagnosed with Cesarean scar ectopic pregnancy. The patient was initially treated for three weeks conservatively before undergoing surgical procedure successfully.