Journal of The Society of Obstetricians and Gynaecologists of Pakistan

Correlation of Anti-Müllerian Hormone (AMH) with Antral Follicular Count

Nadia Ayoub Bosan — 2026-02-02

Objective: To determine the correlation between serum Anti-Müllerian Hormone levels and antral follicular count in infertile women.

Methodology: The study was a cross-sectional analytical research done in the Department of Gynaecology and obstetrics, PAEC general hospital, Islamabad between June and August 2020. Non-probability consecutive sampling was used to sample 103 infertile women aged 20-40 years. The level of serum AMH, FSH, LH, and estradiol was measured in the early follicular phase (Day 23). To evaluate bilateral AFC and ovarian volume, transvaginal ultrasound was done. The SPSS version 26 was used when analysing data. The KolmogorovSmirnov test was used to test whether there is normalcy and Pearson correlation coefficient. The p-value of 0.05 was taken as significant.

Results: The mean serum AMH level was 4.04 ± 1.95 ng/mL, and the mean total AFC was 19.69 ± 6.68. No statistically significant correlation was observed between serum AMH and total AFC (r = 0.044, p = 0.658). Serum AMH also showed no significant association with ovarian volume or age.

Conclusion: Serum AMH did not show a significant correlation with antral follicular count in this cohort. Assessment of ovarian reserve should therefore incorporate both hormonal and ultrasonographic parameters.

Text Neck Syndrome and Its Association with Smartphone Use Among Medical Students

Uzma Kausar — 2026-02-11

Background & objective: The excessive use of smartphones among medical students has been causing inimical effects on mental and physical health. Poorcan cause musculoskeletal disorders. Therefore, it is necessary to evaluate the association between the use of mobile phones and musculoskeletal pathologies among medical students.

Methodology: A cross-sectional study was conducted using the simple random sampling technique among the medical students of Abwa Medical College, Khurrianwala, Faisalabad, from March 2024 to August 2024. The sample size was 364, calculated using the WHO Sample Size Calculator after obtaining informed consent. Medical students from the 1st year MBBS to the 5^th year MBBS were included in the study. Faculty members and students of the Allied Health Sciences were excluded from the study. A pilot study was conducted to validate the questionnaire, which was subsequently distributed among medical students. The collected data were then analyzed using SPSS 22, employing the Chi-Square test.

Results. Out of 364 participants, 192 (53%) were male and 172 (47%) were female, with a mean age of 22 years. The most commonly used gadget was the smartphone, with 42% of participants reporting excessive smartphone use for more than 4 hours. A statistically significant value was reported among the medical students who used laptops for educational purposes. The pain assessment score revealed that the majority of students who hold their smartphones or laptops below eye and neck level report neck pain.

Conclusion: Neck pain has emerged as a leading cause of musculoskeletal pain among medical students. With advancements in social media and technology, students are increasingly prone to developing text neck syndrome due to excessive use of smartphones and laptops. Managing poor posture and bodily ergonomics can significantly reduce this issue. Text neck syndrome is significantly associated with the use of mobile phones. Measures should be implemented to raise awareness about mobile phone use, with a focus on postural education.

Keywords: smartphones, text neck syndrome, neck pain, medical students, poor posture

The psychoeducational analysis of Peer-Assisted learning in achieving effective educational outcomes

Aisha Akbar — 2026-02-11

Background: Peer-assisted learning (PAL) is gaining popularity as a teaching strategy where students serve as peer teachers, helping others learn while enhancing their own understanding through teaching. PAL fosters cognitive and psychomotor growth but also enhances knowledge and skills, leading to better exam performance. The aim of this study is to conduct a psychoeducational analysis of Peer-Assisted Learning (PAL) and evaluate its effectiveness in achieving desired educational outcomes.

Methodology: An 8-week prospective quantitative study was conducted on 45 undergraduate students learning Pathology at a Dental college in Islamabad, following ethical approval. The students were divided into 5 groups of 8, each led by a tutor who conducted PAL sessions based on provided learning objectives and instructions. A pretest and posttest were used to evaluate the effectiveness of PAL. Tutees’ perceptions were gathered through structured questionnaires on a 5-point Likert scale. Quantitative data were analyzed using SPSS 22.

Result: Learners, including both tutors and tutees, reported high satisfaction with PAL. About 62.5% of students felt that it provided a safe learning environment, while 82.5% agreed that peer learning helped clarify the subject matter. Additionally, 82.5% of students mentioned that the sessions motivated them to actively participate (1.92 ± 0.730). A comparison of pre- and post-intervention test scores showed a significant improvement, with the mean score rising from 22.1 ± 6.9 to 68.5 ± 11.7, a statistically significant difference (p < 0.001).

Conclusion: Students found Peer-Assisted Learning valuable, recognizing its role in enhancing communication and leadership skills. The relaxed environment facilitated the achievement of learning objectives effectively, leading to noticeable improvements in their scores.

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

Irfana ali — 2026-02-02

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

Reliability of C-Reactive Protein in the Diagnosis of Neonatal Sepsis in Combined Military Hospital, Malir

Ayesha Asif — 2026-02-11

Objective: To determine the reliability of C-reactive protein (CRP) as an early diagnostic biomarker for neonatal sepsis by assessing its correlation with clinical features, and potential perinatal risk factors, in order to support its use as a rapid and accessible tool for early diagnosis and management.

Methodology: A descriptive cross-sectional study was conducted at the Neonatology Unit of Combined Military Hospital (CMH), Malir, over a period of six months, from July 2021 to November 2021. All neonates aged ≤28 days, of either gender, presenting with signs and symptoms suggestive of sepsis such as lethargy, poor feeding, temperature instability, respiratory distress, or convulsions were included. A total of 2 to 3 mL of venous blood was drawn aseptically from each neonate for CRP testing. A CRP level greater than 10 mg/L was considered positive and indicative of infection, serving as a key marker in assessing the likelihood of neonatal sepsis. All data were entered and analyzed using SPSS version 25.

Results: A total of 101 neonates were assessed, with 51.5% being male and 48.5% female. Among them, 96% had a positive CRP level. The most common clinical features observed were lethargy (72.3%), reluctance to feed (51.5%), and persistent vomiting (46.5%). CRP levels were predominantly in the range of 6–30 mg/L (51.5%) and 31–50 mg/L (40.6%). There was a statistically significant association between CRP status and both mode of delivery (p = 0.020) and type of feeding (p = 0.042), while no significant association was found with age, gender, PROM, meconium-stained liquor, or maternal fever (p=>0.05).

Conclusion: C-reactive protein observed to be a reliable and accessible biomarker for the early diagnosis of neonatal sepsis, with its positivity rate of 96% among clinically suspected cases and strong alignment with key clinical features such as lethargy and feeding difficulties, CRP proves to be a valuable diagnostic aid in neonatal care.

Fetomaternal Outcome with Active versus Expectant Management of Pre Labour-Rupture of Membranes at Term; A randomized controlled trial

Aisha Ishtiaq — 2026-02-02

Background: Prelabour Rupture of Membranes (PROM) at term complicates 10% of all pregnancies, leading to a number of possible fetomaternal complications. No set management plan has yet been devised whether to deliver such women immediately or to wait for spontaneous labour.

Objective: To compare fetomaternal outcome with immediate/active versus expectant management in pregnancies complicated with pre labour rupture of membranes at term. Methodology: A randomized prospective controlled trial conducted in Obstertics & Gynaecology department of Benazir Bhutto Hospital, Rawalpindi. All women presenting with PROM at term and fulfilling the defined inclusion criteria were recruited and randomized equally to Group-A and Group-B for Active versus Expectant management. The latency period for onset of labour, mode of delivery, maternal and fetal complications were compared in two groups.
Results: During study period, 190 women were recruited. The mean maternal age was 26.16 years. Out of total, 45% were primigravidas, 40% multigravidas and 15% were grand multiparas. There was no statistically significant difference in mode of delivery between two groups (p-value The latency period was significantly prolonged (>24 hours) in 57.9 % of the patients with expectant management (p-value <0.05). The rate of PPH (p-value 0.004) and chorioamnionitis (p-value 0.005) was higher in expectant group and while neonatal complications were comparable in both groups (p-value >0.05).
Conclusion: The active management of PROM is the preferred management option due to a shorter latency period, lesser maternal complications, without any significant increase in the rate of operative delivery.

Key words: Active management, Expectant management, Latency period, Premature rupture of membranes, PROM.

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

Zeeshan Ahmed Rehman — 2026-02-12

INTRODUCTION:

A well-designed curriculum is a backbone of medical education as it aligns learning outcomes, teaching/learning strategies, and assessment to ensure attainment of knowledge, clinical skills, professional behaviors and attitudes within the learners. The aim of the current study is to evaluate and redesign the curriculum of one of the leading medical institutes of Pakistan by identifying its strengths and gaps and designing a more robust plan for corrective measures.

METHODOLOGY:

The current study employed the CIPP framework as the main evaluation model incorporating Harden’s SPICES and 11 steps Integration model as well. The current study identified gaps in 5 year MBBS UHS curriculum and further artificial intelligence based quality enhancements tool proposed to bridge this gap.

RESULT:

The current study emphasizes use of AI assistance for evaluation of curriculum and quality enhancement. The study found UHS curriculum at 6-7 level at Harden’s 11 steps integration model and proposed for employment of AI synchronization model for vigorous improvement in integration throughout the curriculum.

CONCLUSION:

A comprehensive curriculum evaluation should be performed for incorporation of latest hi-tech advances in medical education. Artificial Intelligence based AI synchronization model proposed in the current study could efficiently and effectively improve teaching, learning and assessment.

Keyword: Artificial Intelligence (AI),Curriculum Evaluation,Context,Input,Process & Product(CIPP model),Level of Integration

Assessing Maternal Health Efficiency and Predicting Mortality: An Empirical Analysis of Clinical determinants and Health system efficiency.

Sehr Nasrullah — 2026-02-02

Objectives:

Purpose: The paper explores the complicated relationships among the fundamental determinants of maternal health and their impacts on the maternal mortality rate (MMR) and the Neonatal mortality rate (NMR) in 2000-2024 in Pakistan. The study is appropriate in filling in key knowledge gaps about the synergistic interaction of skilled birth attendance, health expenditure, adolescent fertility, anemia prevalence, and lifetime risk of maternal death to determine the outcome of reproductive health in a low-resource context.

Methodology: The paper has used advanced econometric modeling as multivariate linear regression with interaction terms and longitudinal time-trend analysis. Two predictive models were constructed on the basis of 25 years (annual data 2000-2024) of analysis including direct effects, interaction modifiers (SBAxCHE and AFRxAnemia), and the trend of secular improvement. Heteroscedasticity, autocorrelation, multicollinearity, and normality tests were all performed in comprehensive diagnostic tests and proved model assumptions.

Results: Pakistan demonstrated substantial improvements with MMR declining 51% (from 305 to 150 deaths per 100,000 live births) and NMR decreasing from 50.3 to 32.7 deaths per 1,000 live births. Skilled birth attendance increased dramatically from 37% to 70%, while adolescent fertility declined from 78.6 to 40.5 births per 1,000 women aged 15-19. Both models achieved strong explanatory power (R² = 0.975 for MMR model) with all coefficients significant at the 5% level. Key interactions revealed synergistic benefits when skilled attendance and health expenditure increased together, while combined adolescent fertility and anemia showed compounded adverse effects.

Risk of Incidence of Breast Cancer in Relationship to Age and BMI

Hoor Fatima — 2026-02-11

Objective: To evaluate the association between different age groups and body mass index (BMI) and the incidence of breast cancer (BC) among clinically suspected women.

Methodology: A retrospective cross-sectional study was conducted at the Department of Radiology, Liaquat National Hospital, Karachi, based primarily on hospital records, with a few cases assessed cross-sectionally from May to October 2024. The study included all female patients aged 18 years or older who were clinically diagnosed with breast cancer and had histopathological confirmation, along with complete clinical records, including age, height, weight (for BMI calculation), menopausal status, and cancer stage. All patients and their medical records were assessed according to the inclusion criteria. Data were entered and analyzed using SPSS version 26.

Results: The overall mean age of the patients was 44.3 ± 14.8 years, and the mean BMI was 25.9 ± 4.7 kg/m². The most common breast condition was fibrocystic changes (30.0%), followed by breast cancer (25.6%), benign lumps (20.0%), mastitis (15.6%), and intraductal papilloma (8.9%). Analysis revealed a significant association between breast cancer and women aged >40 years, with an odds ratio (OR) of 0.26 (95% CI: 0.08–0.85; p = 0.019). Similarly, BMI showed a significant association, with an odds ratio of 0.12 for overweight/obese women (95% CI: 0.03–0.45; p = 0.001).

Conclusion: This study revealed that older age and higher BMI are significantly associated with an increased risk of breast cancer among women presenting with different breast conditions.

Uterine Rupture: A Tertiary Care Dilemma - The Case Series

Sara Usman — 2026-02-04

This case series presents the successful management of three complex uterine rupture cases with high morbidity at a tertiary care center, emphasizing the challenges and outcomes. Patients who consented were analyzed for clinical presentation, intraoperative findings, and postoperative outcomes. Case 1 involved a 32-year-old woman (G11, P7+3) with spontaneous uterine rupture at 35 weeks gestation, extending to a broad ligament hematoma, necessitating total abdominal hysterectomy, internal iliac ligation, broad ligament exploration. Case 2 described a 35-year-old woman (P3+1) with a history of three cesarean sections, who experienced uterine rupture following dilation and curettage for a cesarean scar ectopic pregnancy, requiring cesarean hysterectomy and bladder repair. Case 3 involved a 28-year-old woman (G5, P4) with uterine rupture and hand prolapse, successfully managed with uterine repair and conservation. These cases underscore the critical importance of prompt recognition, timely surgical intervention, and a multidisciplinary approach in managing uterine rupture. Individualized strategies tailored to patient conditions are essential for optimizing outcomes, particularly in high-risk obstetric patients.

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

Rida Asghar — 2026-02-02

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.

Management of Women with Endometriosis in Pakistan: Good Clinical Practice Recommendations

Shams-un-Nisa Sadia — 2026-02-16

Executive summary

Diagnosis: A careful history is the cornerstone. Imaging supports diagnosis. Laparoscopy is not mandatory for diagnosis; empirical medical treatment is a valid first step.

Medical Treatment: First-line: NSAIDs + Combined Oral Contraceptives or Progestogens. Second-line: GnRH agonists/antagonists with add-back therapy.

Third line: Aromatase inhibitors (used with caution).

Evaluate every 6–12 months for efficacy and side effects.

Lifestyle & Psychosocial: Mental Health: Integrate Cognitive Behavioural Therapy (CBT), mindfulness, and psychosocial support.

Surgery: Excision is preferred over ablation. Laparoscopic cystectomy is standard for endometriomas >3-4cm. Drainage with sclerotherapy is option in selected patients. Avoid repeated surgeries.

Fertility: Do not use hormonal suppression to improve fertility. Determination of ovarian reserve before treatment is prognostically important. Surgery may improve natural conception (ASRM I–II); IVF preferred for advanced disease (ASRM III–IV); pre-treatment with GnRH agonists for 3+ months is beneficial.

Special Populations: Adolescents: Have a high index of suspicion. Postmenopausal Women: Menopausal Hormone Therapy (MHT) can be used but requires careful counselling.