Validation of a Predictive Model of Vaginal Birth after Caesarean Section in Pakistani Women.

OBJECTIVE: To determine the frequency of successful trials of vaginal birth after Caesarean section (VBAC) using the Flamm and Geiger model. STUDY DESIGN: Observational study. Place and Duration of the Study: Obstetrics and Gynaecology Unit II of Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. METHODOLOGY: Women with singleton pregnancy having cephalic presentation, previous one lower segment caesarean section (LSCS), and without any contraindication for vaginal delivery were included. Women bearing foetus having estimated weight >3.5kg, morbid obesity, multiple pregnancies, non-cephalic presentation, placenta praevia, abruptio placentae, uncontrolled maternal comorbidities, or had previous two or more Caesarean sections were excluded. Flamm and Geiger score was applied to record observations of successful and unsuccessful trials. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the score were calculated by ROC curve, along with its area under the curve (AUC) and Youden's index curve, with 95% confidence interval. RESULTS: This study included 258 participants. Successful vaginal delivery was possible in 125 (48.4%) participants, whereas 133 (51.6%) underwent emergency Caesarean section. Cervical dilatation and effacement were the main factors assessing the success. The Flamm and Geiger score of >5 had an area under the curve of 0.813 (0.762-0.864). The score's sensitivity was 75% (67-82%), specificity 76% (68-82%), and PPV of 75% with an accuracy of 76%. CONCLUSION: The Flamm and Geiger score of >5 demonstrated high sensitivity, specificity, PPV, and accuracy in predicting later successful vaginal birth. It is recommended as a promising and valuable tool for assessing VBAC's success in low-resource countries. KEY WORDS: Vaginal birth after caesarean, Flamm and Geiger Model, Indication of caesarean, trial of labour after caesarean, VBAC risk scoring criteria.

Reconsidering a Lower Level of Follicle-Stimulating Hormone as Abnormal in Sub-Fertile Males of Pakistan.

OBJECTIVE: To assess the association between Follicle-Stimulating Hormone (FSH) and semen parameters in order to evaluate whether the current laboratory reference for abnormal FSH levels should be readjusted. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Infertility Clinic of Gynecology Unit 1, Civil Hospital, Karachi, from May 2015 to April 2016. METHODOLOGY: The study included 100 sub-fertile males inducted from the clinic. Those above 45 years of age, with hypo gonadotrophic hypogonadism, and those on anabolic steroids were excluded. After history and examination, semen parameters and FSH levels were tested. Abnormal semen values were based on WHO 1999 criteria. Data was analyzed by SPSS 17 and mean, frequencies and percentages were calculated. Chi-square test was applied to check association between variables. RESULTS: The FSH levels had a significant association with abnormal semen sperm concentration, motility and morphology but not with semen volume (p=0.246). The mean FSH level was 5.8 ±1.80 IU/Lwith two-thirds of individuals having value >4.5 IU/L. Frequency of semen abnormalities increased as the level of FSH increased. CONCLUSION: There is significantly an increased possibility of abnormal semen characteristics at FSH levels >4.5, so the current reference level should be lowered down and adjusted again.

Foam: a multiphase system with many facets.

Liquid foams are an extreme case of multiphase flow systems: capable of flow despite a very high dispersed phase volume fraction, yet exhibiting many characteristics of not only viscoelastic materials but also elastic solids. The non-trivial, well-defined geometry of foam bubbles is at the heart of a plethora of dynamical processes on widely varying length and time scales. We highlight recent developments in foam drainage (liquid dynamics) and foam rheology (flow of the entire gas-liquid system), emphasizing that many poorly understood features of other materials have precisely defined and quantifiable analogues in aqueous foams, where the only ingredients are well-known material parameters of Newtonian fluids and bubble geometry, together with subtle but important information on the surface mobility of the foam. Not only does this make foams an ideal model system for the theorist, but also an exciting object for experimental studies, in which dynamical processes span length scales from nanometres (thin films) to metres (foam continuum flows) and time scales from microseconds (film rupture) to minutes (foam rheology).