Comparison of PAP smear and liquid based cytology as a screening method for cervical carcinoma.

Objectives: To compare conventional PAP smear (CPS) and liquid-based cytology (LBC) for cervical carcinoma screening at a tertiary care hospital of South Punjab, Pakistan. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan from January 2021 to June 2021. We included a total of 265 women aged between 20 to 65 years who, presented with complaints related to cervical lesion and unhealthy cervix. The CPS and LBC methods were applied for screening of cervical carcinoma. Findings of both CPS and LBC were compared with histopathological findings to find out sensitivity, specificity, positive predictive value and negative predictive value for both techniques. Results: In a total of 265 women, mean age was noted to be 45.4±6.8 years. White discharge per vagina was the commonest presenting complaint noted in 12 (46.8%) patients. Satisfactory smears were found in significantly more cases with LBC in comparison to CPS (p<0.001). Sensitivity CPS and LBC for the detection of low-grade squamous intraepithelial lesion (LSIL) were found to be 71.8% and 87.2% while for high-grade squamous intraepithelial lesion (HSIL), sensitivity of CPS and LBC were 61.9% and 76.2% respectively. Specificity of CPS and LBC for the detection of LSIL was found to be 97.9% and 98.7% while for HSIL, specificity of CPS and LBC was 98.7% and 99.2% respectively. Conclusion: In comparison to conventional CPS, LBC was found to be better in terms of adequacy of smear and identification of LSIL and HSIL.

Treatment success with two doses of methotrexate vs single dose of methotrexate in Ectopic Tubal Pregnancy.

Objectives: To compare the success rates and safety of two-doses of methotrexate versus single dose of methotrexate in ectopic tubal pregnancy. Methods: This was an open-label, randomized controlled trial done at "The Department of Obstetrics & Gynecology, Nishtar University Hospital, Multan" from January 2020 to July 2021. A total of 100 women (50 in each group), aged 20 to 35 years with a tubal ectopic pregnancy were enrolled. All patients were randomly allocated to either single-dose or two-dose methotrexate protocol. Cases were evaluated for treatment success, side effects, beta-human chorionic gonadotrophin (ß-hCG) resolution time and treatment satisfaction. Results: In a total of 100 cases, mean age was 29.6±4.5 years. Mean serum ß -hCG levels at baseline was 1212±78 mIU/ml. Treatment success was noted among 43 (86.0%) cases of single-dose group versus 45 (90.0%) cases (p=0.5382). Duration of ß -hCG resolution time was significantly shorter in two-dose group (23.0±12.1 days versus 28.2±12.8 days, p=0.0394). No significant difference was noted in methotrexate associated side effects in both study groups (p=0.9996). Overall, mean satisfaction score was 4.0±1.3 (out of 5). Conclusion: Although, ß -hCG resolution time was significantly low in two-dose protocol but single-dose methotrexate offered comparable success rates versus two-dose protocol. Side effects were mild and comparable in both methotrexate treatment protocols. Methotrexate was found to be effective in the medical management of ectopic pregnancy.

Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with polycystic ovarian syndrome.

Objectives: To compare the efficacy of letrozole (LTZ) vs clomiphene citrate (CC) for ovulation induction in patients having polycystic ovarian syndrome (PCOS). Methods: This randomized controlled trial was conducted at The Department of Obstetrics & Gynecology, Nishtar Medical University Hospital, Multan, Pakistan from January 2021 to June 2021. A total of 78 women aged 18 to 30 years, diagnosed having PCOS were enrolled. In Group-A, 39 women were given LTZ, 5mg for five days of menstrual cycle. In Group-B, 39 women were given CC, 100mg for five days of menstrual cycle. All patients underwent transvaginal scan (TVS) for the evaluation of efficacy in terms of ovulation induction. Results: Overall mean age was noted to be 25.41±2.84 years. Most of the patients, 51 (65.4%) belonged to rural area of residence. There were 52 (66.7%) patients with BMI less than 25 kg/m2. Overall, mean duration of infertility was found to be 2.62±0.74 years. Among 70 patients who completed the follow ups and analyzed regarding efficacy, in Group-A, efficacy was noted in 23 (59.0%) patients in comparison to 14 (35.9%) in Group-B (p=0.0413). Mean endometrial thickness was significantly better in Group-A versus Group-B (8.1±1.5 mm vs. 6.8±1.9 mm, p=0.0022). Conclusion: Aiming ovulation induction, letrozole in comparison to clomiphene citrate was found to have significantly better efficacy among women having anovulatory PCOS.

Role of Mentzer index for differentiating iron deficiency anemia and beta thalassemia trait in pregnant women.

Objective: To observe the role of Mentzer index for differentiating iron deficiency anemia (IDA) and beta thalassemia trait (ß TT) in pregnant women. Methods: This cross-sectional study was conducted in Gynaecology & Obstetrics Department of Nishtar Medical University from October 2020 to March 2021. Non-consecutive sampling was applied. A total of 100 antenatal ladies with hemoglobin <11 gm/dl were included. Their complete blood counts were checked and Mentzer Index was calculated. Mentzer Index <13 points to diagnosis of ß TT and >13 indicates IDA. The diagnoses were confirmed by serum iron studies and Hb electrophoresis. The sensitivity and specificity of Mentzer Index for both causes of microcytic hypochromic anemia was calculated. Results: Out of total 100 patients with microcytic hypochromic anemia, 87 had Mentzer Index >13 and IDA was confirmed in 86 out of 87 cases. Thirteen cases had Mentzer Index <13 and ß TT was confirmed in eight of them. Thus, Mentzer Index has a sensitivity and specificity of 91% & 83% for IDA and 83% & 91% for ß TT. Conclusion: In this study, it was found that Mentzer Index can be used as a discriminatory test to differentiate between iron deficiency anemia and beta thalassemia trait. The high risk group can then be subjected to definitive diagnostic tests. This can result in better patient compliance and cost effectiveness.

Oral versus Vaginal Micronized Progesterone for the Treatment of Threatened Miscarriage.

OBJECTIVES: This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage. METHODS: This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation. RESULTS: In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164). CONCLUSION: The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage.

Analysis of Cesarean Sections using Robson's Ten Group Classification System.

OBJECTIVE: To analyze trends of CSs and evaluating them according to Robson's Ten Groups Classification System (TGCS) at a leading government tertiary care hospital of South Punjab, Pakistan. METHODS: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Nishtar Medical University Hospital, Multan Pakistan, from October 2019 to March 2020.The study population included a total of 167 women who underwent CS in the hospital during the specified study period. For each case, we collected data regarding maternal characteristics and pregnancy-related information. The dependent variable was Robson classification group. RESULTS: Overall, mean age was 26.53+5.1 years. Majority of the women, 116 (69.5%) belonged to urban areas of residence, 74 (44.3%) gestational aged between 37-42 years while 108 (64.7%) had history of cesarean section. Most of the patients, 85 (50.9%) turned out to be from TGCS Group-10. Group-5 and Group-1 were the 2nd and 3rd most common group, accounted for 24 (14.4%) and 19 (11.4%) cases respectively. Previous cesarean section (20.4%) and fetal distress (19.8%) were found to be most common indications leading to cesarean section. CONCLUSION: As per Robson's Ten-Group Classification, Group-10 and Group-5 were found to be the most contributing among deliveries done. Previous cesarean section and fetal distress were the most common indications of cesarean section.

Maternal and Perinatal outcome after Ramadan Fasting.

OBJECTIVE: To determine maternal and perinatal outcome after Ramadan fasting during pregnancy. METHODS: This cross sectional study was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital, Multan from May to October 2019. A total of 226 women attending labour room, aged 18-35 years, having gestational amenorrhoea 15 - 40 weeks of gestation were included. Women who fasted for more than 15 days were compared with those who did not fast or fasted for less than 15 days in the month of Ramadan. Demographical profile along with maternal and perinatal outcomes were compared between the study groups considering p value less than 0.05 as significant. RESULTS: Out of 226 women, 58 (25.7%) fulfilled the criteria to be included in the fasting group while remaining 168 (74.3%) were slotted in the non-fasting group. There was no difference (p value > 0.05) in between the both group with respect to demographical characteristics except significantly less women were employed in the fasting group (p value=0.0246). No statistical difference was found in terms of maternal or perinatal outcomes between both the study groups. CONCLUSION: Fasting women were not found to have poor maternal and fetal outcomes when compared to non-fasting women.

Replacement of dilation and curettage/evacuation by manual vacuum aspiration and medical abortion, and the introduction of postabortion contraception in Pakistan.

Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.