Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Comparison of the Effectiveness of Rectal Misoprostol with I/V Oxytocin in Prevention of Postpartum Hemorrhage

2026-08-18T14:44:04+00:00

Objective: Prevention of Postpartum Hemorrhage (PPH) was evaluated by comparing the efficacy of rectal misoprostol with intravenous oxytocin in a tertiary-care obstetric setting.

Methods: This prospective, randomized controlled trial (RCT) was conducted at Obstetrics and Gynecology Department of Jinnah Postgraduate Medical Center, Karachi, from June 2025 to December 2025. Pregnant women aged 15 to 40 years, gestational age > 37 weeks, with singleton live pregnancy and duration of labour of 24 hours, parity of less than 5 kids, who were scheduled for normal vaginal deliveries with induced labour, spontaneous labour or augmented labour, without clinical evidence of active antepartum hemorrhage and preoperative hemoglobin level of ≥10 g/dL were included. Patients were subsequently allocated equally into the two treatment groups (A& B). Patients of group A received rectal misoprostol 600 µg and the patients of group B received intravenous oxytocin 10 IU only. Total blood loss was assessed immediately after delivery using a calibrated collection container and by weighing blood-soaked pads/gauze. Subsequently women were monitored for 24 hours for further evidence of postpartum bleeding, and a volume of >500 mL of blood loss was considered as PPH. SPSS version 26 was used for data analysis.

Results: All the enrolled patients (50 misoprostol, 41 oxytocin) showed comparable baseline demographic and obstetric characteristics between groups (p>0.05). The misoprostol group found with significantly reduced PPH incidence (2.0% vs. 14.6%) and mean blood loss (299.9 ± 80.4 mL vs. 408.6 ± 125.4 mL) compared to oxytocin group (p<0.05), with less mechanical procedures need and transfusions rate (2.0% and 9.8%). Conversely the misoprostol administration was linked to a higher rate of non-significant side effects including fever, shivering and the gastrointestinal side effects (p>0.05). The mean blood loss was differed significantly according to age groups (p=0.038), being highest in the 25–35 years, while incidence of PPH incidence and hemoglobin levels showed insignificant age-related association (p>0.05).

Conclusion: Rectal administration of misoprostol showed more hemostatic efficacy in the prevention of postpartum bleeding, whereas oxytocin appears to carry a more favorable short-term tolerability profile.

Keywords: Misoprostol; Oxytocin; PPH; Vaginal delivery, Prevention

Acute Kidney Injury and Abruptio Placentae: An Avoidable Association

2026-08-18T15:25:55+00:00

Objective: To determine the frequency of acute kidney injury (AKI) and its associated risk factors among patients with abruptio placentae at Liaquat University Hospital, Hyderabad.

Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Liaquat University Hospital, Hyderabad. Pregnant women diagnosed with abruptio placentae, irrespective of age or parity, were included. The enrolled women were managed according to institutional standard obstetric protocols for placental abruption. Serum creatinine levels and urine output were monitored serially throughout the hospital stay to assess the development of AKI. All data were entered and analysed using SPSS version 20.

Results: The mean age of the participants was 27.73 ± 4.59 years, the mean gestational age was 32.86 ± 4.41 weeks, and the mean body mass index (BMI) was 21.97 ± 3.21 kg/m². Most patients (81.2%) were from rural areas. Overall, AKI was observed in 13.0% of patients with abruptio placentae. It was more frequent among women of advanced age, those from lower socioeconomic backgrounds, those residing in rural areas, and unbooked patients; however, these associations were not statistically significant (p>0.05). In contrast, higher BMI and the presence of hypertensive disorders were significantly associated with AKI (p<0.05).

Conclusion: AKI was a relatively frequent and clinically significant complication of abruptio placentae. Its occurrence was associated with higher BMI and hypertensive disorders, while rural residence, unbooked status, and lower socioeconomic status were also observed more frequently among women who developed AKI.

Keywords: Acute kidney injury, frequency, risk factors, abruptio placentae.

Comparison of mean D-dimer levels in preeclampsia versus normal pregnancy

2026-08-18T14:43:44+00:00

Objective: To compare prevalence of high D-dimer levels between pregnant women with or without preeclampsia.

Design: Comparative Cross-sectional Study

Place and Duration of Study: Department of Obstetrics and Gynecology CMH Multan, from 1^st April 2025 to 30^th September 2025.

Methodology: Seventy (70) 3^rd trimester pregnant women aged 20-40 years were enrolled, including 35 women with preeclampsia and 35 normotensive women in comparative group. Demographic and clinical variables were recorded. D-dimer estimation was performed on platelet-poor plasma using MISPA-i2 reagent, and levels >0.5 µg/ml were considered high. Data were analyzed through SPSS version 27. Descriptive statistics were calculated. Quantitative and categorical variables were contrasted using independent sample t-test and chi-square test, respectively, with p-value <0.05 taken substantially significant.

Results: Mean age was 30.5±5.2 years and 54% of women were obese. Women with preeclampsia were older than normotensive pregnant women (31.8±5.3 vs. 29.2±4.8 years, p=0.039). Mean D-dimer levels were significantly higher among women with preeclampsia compared to without preeclampsia (0.76±0.78 vs. 0.23±0.44 µg/ml, p<0.001). High D-dimer levels were more frequent in preeclampsia (42.9% vs. 8.6%, p=0.002). Stratified analysis showed significantly higher D-dimer levels in younger, urban, and obese women with preeclampsia. Among women aged below 30-years, prevalence of high D-dimer levels remained significantly greater in pregnant females with pre-eclampsia than without preeclampsia (38.5% versus 4.3%, p=0.016). Obese women with preeclampsia also demonstrated substantially higher D-dimer positivity during stratified subgroup analysis.

Conclusion: Pre-eclampsia was associated with elevated D-dimer levels and higher prevalence of abnormal D-dimer positivity during third trimester of pregnancy.

Effect of myo-inositol and D-chiro-inositol combination therapy on improvement in menstrual irregularities and biochemical characteristics in patients with polycystic ovarian syndrome

2026-08-18T14:43:36+00:00

Objective: To compare improvement in menstrual irregularity and hormone levels in females with polycystic ovarian syndrome (PCOS) treated with myo-inositol (MI) and D-chiro-inositol (DCI) combination therapy versus placebo.

Design: Randomized Controlled Trial

Place and Duration of Study: Obstetrics and Gynecology department, Nishtar Hospital Multan. Over 06 months (1st June 2025 to 30th November 2025).

Methodology: Sixty women aged 18-45 years with PCOS were enrolled and allocated to combination therapy or placebo for three months. Menstrual irregularity was defined as amenorrhea, oligomenorrhea, or menorrhagia. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were obtained at baseline and after three months. Monthly follow up assessed improvement in menstrual regularity. Data analysis was performed through SPSS version 27. Quantitative variables are reported as mean ± SD and qualitative as number and proportion. Between group comparison was done through t-test for quantitative variables and chi-square test for categorical variables. P-value below 0.05 was considered substantial.

Results: Mean age was 32.2±6.2 years, 65% married, 51.7% obese and oligomenorrhea was commonest (51.7%) irregularity. Baseline age, marital status, obesity and menstrual irregularities were comparable between groups. Improvement in menstrual irregularities was higher with combination therapy than placebo (70% vs. 20%, p<0.001). After three months, serum FSH (6.3±1.1 vs. 8.6±1.6 mIU/ml, p<0.001), LH (12.3±12.3 vs. 24.5±13.2 mIU/ml, p<0.001), and testosterone levels (24.5±13.2 vs. 31.8±20.4, p=0.012), were substantially lower in the combination therapy group in contrast to placebo.

Conclusion: Myo-inositol with D-chiro-inositol combination therapy improved menstrual irregularity and hormonal profile than folic acid alone in women with PCOS.

Frequency of Microbial Colonization of the Maternal Vagina in Preterm Premature rupture of Membranes

2026-08-25T14:46:52+00:00

Objective: To determine the frequency of microbial colonization of the maternal vagina in preterm premature rupture of membranes (PPROM).

Methodology: This cross-sectional study commenced at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan, from March 2025 to August 2025. A total of 111 pregnant women between 20 to 45 years, who presented with PPROM within 12 hours and had a live fetus with a gestational age between 28-36 weeks were studied. The frequency of commonly isolated pathogens were documented. Culture confirmed vaginal microbial colonization was defined as growth of any predefined organism on high vaginal swab culture. Participants were not selected on the basis of positive culture or suspected vaginal infection. Data analysis was performed using IBM-SPSS 26.0, taking p<0.05 as signficiant for inferential statistics.

Results: In a total of 111 women, the median age, and gestational age were 29.0 (27.0-32.0) years, and 33.0 (30.0-35.0) weeks, respectively. There were 23 (20.7%) women who were primparous, while 88 (79.3%) were multiparous. Evaluation of socio-economic status revealed that 45 (30.5%) women belonged to low socio-economic status. Residential affiliation was rural among 69 (62.8%) women. Vaginal swab cultures yielded identifiable microorganisms in all 111 (100%) women. Escherichia coli (E. coli) was isolated in 32 (28.8%) women, Enterococcus faecalis in 22 (19.8%), Group B streptococcus in 18 (16.2%), Staphylococcus aureus in 19 (17.1%), and Staphylococcus haemolyticus in 20 (8.0%) women. Gestational age was observed to have significant association with microbial distribution (p=0.011).

Conclusion: The frequency of culture confirmed microbial colonization of the maternal vagina was universal among women with PPROM. The culture profile in PPROM in this study supports a mixed aerobic colonisation pattern with substantial contributions from E. coli, enterococci, GBS, and staphylococci, and demonstrates gestational age-related differences in organism distribution.

Outcome of postpartum hemorrhage in patients managed with the Modified Emotive bundle at a tertiary care center

2026-08-25T14:46:43+00:00

Background: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, especially in low- and middle-income countries. The Modified Emotive bundle offers a structured management approach, but local evidence from Pakistan is
limited.
Methods: This prospective cohort study was conducted at the Department of Gynaecology and Obstetrics, CMH Malir, Karachi, from April to September 2025. A total of 68 women aged 18–55 years, with gestational age ≥34 weeks and diagnosed with PPH, were included using consecutive sampling. All were managed with the Modified Emotive bundle, and blood loss was measured using calibrated drapes. The
outcomes included incidence of severe PPH, need for blood transfusion, surgical intervention, and intensive care unit (ICU) admission.
Results: The mean maternal age was 35.36 ± 11.10 years, gestational age 37.38 ± 1.93
weeks, and BMI 27.26 ± 5.81. Severe PPH occurred in 5 patients (7.4%). Blood transfusion was required in 9 patients (13.2%), surgical intervention in 3 (4.4%), and ICU admission in 2(2.9%). No significant associations were found between outcomes and maternal or obstetric characteristics.
Conclusion: The Modified Emotive bundle was effective in controlling PPH with low rates of transfusion, surgery, and ICU admission. Larger multicenter studies are needed to confirm these findings and support their adoption in national protocols.

Assessing the Utilization of Preoperative Ultrasound Guided Skin Marking for Tumor Localization in Post-Neoadjuvant Breast Cancer - A Single-Centre Study

2026-08-25T14:46:34+00:00

Objective: This study compares the cost-effective use of ultrasound-guided skin surface marking (USGSSM) with wire-guided localization (WGL) for tumor localization in breast cancer surgery at Shalamar Hospital.
Materials and Methods: A retrospective study was conducted at Shalamar Hospital, Lahore, between July 2023 and December 2023. The records of breast cancer patients including age, localization technique, sonographic and pathological tumor size, histologic type/grade, margin status, chemotherapy, and axillary dissection were included for analysis (27 WGL, 38 USGSSM). USGSSM involved preoperative surface marking in surgical position using ultrasound; WGL used ultrasound-guided wire insertion, confirmed with post-wire mammography. The data were entered and analyzed using SPSS version 25.
Results: The mean age of patients was 49 years, with invasive ductal carcinoma being most common. Mean ultrasound tumor size: WGL 13mm, USGSSM 17.7mm; mean pathological size: WGL 15.7mm, USGSSM 27.7mm. A significant correlation noted between ultrasound and pathological tumor sizes was noted (p < 0.001). Margins were involved in 6 cases (WGL: 2, USGSSM: 4), with no significant difference (p > 0.05).
Conclusion: USGSSM offers comparable efficacy to WGL for tumor margin clearance, making it a cost-effective option in breast-conserving surgery following neoadjuvant chemotherapy.

The diagnostic accuracy of MRI pelvis in parametrial invasion in patients with cervical cancer keeping histopathology as gold standard

2026-08-25T14:46:25+00:00

OBJECTIVE: To determine the diagnostic accuracy of MRI pelvis in parametrial
invasion in patients with cervical cancer keeping histopathology as gold standard.
STUDY DESIGN: Cross-sectional study
SETTING: Department of Radiology, Liaquat University of Medical and Health Sciences,
Hyderabad.
STUDY DURATION: 23 rd April 2022 till 23 rd October 2022
METHODS: Women aged 30-70 years having suspicion of cervical cancer clinically
were included. Pregnant patients and patients with already diagnosed with other pelvic
malignancy were excluded. Diagnostic accuracy including sensitivity, specificity, positive
predictive value (PPV) and negative predictive value (NPV) of MRI was calculated using
2 x 2 tables keeping histopathological findings as gold standard.
RESULTS: Mean age of the patients was 44.67 ± 11.99 years. Majority of patients were
pre-menopausal. Diagnostic accuracy of MRI in diagnosing parametrial invasion in
cervical cancer showed sensitivity, specificity, positive predicted value (PPV), negative
predicted value (NPV) and overall diagnostic accuracy as 86.44%, 62.50%, 94.44%,
38.46% and 83.58% taking histopathology as gold standard.
CONCLUSION: MRI has sensitivity of 86.44%, specificity of 62.50%, positive predictive
value of 94.44%, negative predictive value of 38.46% and diagnostic accuracy of
83.58% in diagnosing parametria invasion in cases of cervical cancer.
KEY WORDS: Cervical cancer; Magnetic Resonance Imaging; Sensitivity; Specificity;
Diagnostic accuracy

Effects of Pregnancy Specific Anxiety on Pregnancy outcome and Serum Cortisol levels during Third Trimester of Pregnancy

2026-08-25T14:46:16+00:00

Objectives: To evaluate the effects of Pregnancy Specific Anxiety on Pregnancy outcome and
serum Cortisol levels.
Methods: This study was conducted during February to July 2022 at the “Department of
Gynecology” (Opd/ward) of LUMHS Jamshoro/Hyderabad. This was a “Cross-sectional,
observational Study”. 227 women in their 3rd trimester with singleton pregnancy age 25-38
years were included in this study. Pregnant women with the condition of essential hypertension,
women already on anti-hypertensive therapy, not attended regular antenatal care follow-ups, anti
-depression / anti-psychotic, and those who had endocrinological disorders were excluded.
Serum Cortisol level (nmol/L) was assessed early morning level between 8 to 11am in fasting
state. Anxiety was assessed with “The Hamilton Anxiety Scale (HAMA)”. Pregnancy outcomes
i.e. pre-eclampsia, low birth weight and head-circumference of infant were reported.
Results: Average age of the pregnant women was 27.83+/-5.43 years. Mean serum Cortisol level
(nmol/L) was 369.36+/-175 (nmol/L). Hamilton anxiety scale score was 23.04+/-8.6. Mean birth
weight was 2.76+/-0.74 Kgs. Head circumferences (cm) was 33.61+/-1.05 cm of infants.
Majority of them were Multiparous 131(57.7%). Majority of women 70% diagnosed with
pregnancy related anxiety in their 3rd trimester. Correlation between Cortisol level and anxiety
score showed significant and positive correlation (r=0.58; P= 0.000).
Conclusion: The results demonstrated the prevalence of pregnancy specific anxiety and its
effects of on cortisol levels in pregnant women during 3rd trimester. Additionally, we discovered
evidence of long-term effects of psychological indicators of anxiety or cortisol on pregnancy
outcomes i.e. lower birth weight. 70% of the study participants reported having anxiety. In order
to avoid associated negative pregnancy outcomes, it is essential to investigate and manage
pregnancy-specific anxiety during routine prenatal care.
Keywords: Maternal anxiety, Cortisol level, third trimester, pregnancy, birth weight, adverse
outcomes, neonates, Hamilton anxiety scale.

Surgical Site Infection after Emergency versus Elective Cesarean Section: A Comparison in Low-Risk Pregnant Women

2026-08-25T14:46:07+00:00

Objectives: To compare the frequency of surgical site infection (SSI) in emergency versus elective caesarean section.
Methodology: This case series study was conducted at department of Obstetrics and Gynaecology, Sheikh Zayed Medical Complex, DHQ Hospital, Rahim Yar Khan, from January 2025 to June 2025. Women undergoing caesarean section aged 20-40 years,
gestational age >37 weeks and with singleton pregnancy were included. Total three doses of same 3 rd generation cephlosporins were given to all the patients. Patients were followed up 48 hours after caesarean section for surgical site infection. Data collection was done by study proforma and analysis was done by using SPSS version 26.
Results: Mean age of the patients was 27.27±3.28 years with 20-30 years aged group being most common. Mean gestational age was 38.28±0.91 weeks. Emergency C-sections were performed in 139 patients (65.3%) while elective C-sections in 74 patients (34.7%). Overall SSI was developed in 21 patients (9.9%). The SSI was significantly more common after emergency C-sections (18/139, 12.9%) compared to elective C-sections (3/74, 4.1%), (p=0.038).
Conclusion: SSI remains a notable complication of C-section, with more frequent in emergency procedures compared to elective procedures, signifying the influence of surgical urgency and linked risk factors on wound healing and postoperative recovery.
Key words: C- section, Elective, Emergency, SSI.

Knowledge, Attitude and Practice of Cervical Screening among Females of the Local Community

2026-08-25T14:45:58+00:00

Objective: To determine the frequency of knowledge, attitude and practice of cervical
screening among females of the local community attending Gynecology OPD.
Method: This cross-sectional study was carried out at Department of Obstetrics &
Gynecology, Shifa International hospital, Islamabad, from July 2021 to January 2022.
Females of age 20-60 years, any parity presenting the history of any complaint
including abnormal uterine bleeding, post-coital bleeding, infertility, lower abdominal
pain in Gyane OPD. Then females undergo a face-to-face discussion with the
researcher. Their feedback against each question was recorded and knowledge, attitude
and practice were noted. All this information was recorded through pre-designed
proforma.
Results: Patients' mean age was 34.67+10.01 years ranged from 20 to 60 years. Out
of all, 24(13%) cases had good knowledge, positive attitude in 167(90.3%) and
45(24.3%) cases were practicing it.
Conclusion: Cervical cancer is a manageable condition. Educating healthcare
personnel in addition to general public about cervical cancer screening and prevention
can help prevent its spread in our country.
Keywords: Cervical cancer, knowledge, attitude, practice, screening