Objectives: To assess maternal and fetal morbidity associated with placenta previa and morbidly adherent placenta (MAP). Methods: All patients with placenta previa who delivered in services hospital from April 1, 2017 to March 31, 2019 were included. Maternal and fetal outcomes were compared amongst patients with placenta previa and MAP. Results: Total of 8002 patients delivered with 152 (1.9%)diagnosed as placenta previa and 56 (36.8%) amongst them had MAP. One hundred thirty-one out of One hundred fifty-two (86.1%) of our patients were booked. Increased number of caesarean section, multi parity and anterior placenta had significant association with MAP (p2000ml, caesarean hysterectomy, number of blood transfusions, bladder injury, need for ICU admission was significantly more in patients with MAP (p6 APGAR score (p<0.05). Two neonatal deaths occurred in MAP and one in placenta previa owing to prematurity. Conclusion: MAP is a dreadful complication of placenta previa with increased maternal morbidity. Regular antenatal care with adequate arrangement of blood transfusion and multidisciplinary approach can reduce maternal mortality. doi: https://doi.org/10.12669/pjms.36.5.1647 How to cite this:Wasim T, Bushra N, Riaz S, Iqbal HI. Fetomaternal outcome in patients with placenta previa. Pak J Med Sci. 2020;36(5):952-957. doi: https://doi.org/10.12669/pjms.36.5.1647 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background & Objective: Gynecological malignancies are important cause of female morbidity and mortality. They pose significant burden on health resources in low middle-income countries. Data on presentation and risk factors can help in early identification and reduce this burden. Our objective was to evaluate frequency, stage of presentation and risk factors of gynecological malignancies in a tertiary care setting. Methods: It was cross sectional study done in Gynecology Department, Services Institute of Medical Sciences, Services Hospital, Lahore from January 2015- December 2019. The records of the patients were retrospectively reviewed to include all cases of gynecologic malignancies. Demographic information, frequency, risk factors, symptoms, grade and stage of tumor was collected. Results: There were 122 patients diagnosed with gynecological malignancy during the study period. Ovarian cancer was seen in 60 (49.18%) patients followed by cervical cancer in 29(23.7%), endometrial cancer 27(22.1%) and vulva 06(4.9%). Mean age for all cancers was 51±12.7 to 55±9.3 except cervical cancer which was seen in 43±8.9 years. Patients with ovarian cancer had significantly more hypertension and diabetes (p<0.05). Heavy menstrual bleeding and postmenopausal bleeding was significantly seen in patients of endometrial and cervical cancer (p<0.05). Abdominal symptoms of pain, mass and distension were seen in patients with ovarian cancer (p<0.05). Majority patients presented in advanced stage. Among ovarian cancer, 52/60(86.6%) were epithelial in origin while 25(86.2%) cervical cancer and all vulva cancers were squamous cell carcinoma. Conclusion: Ovarian cancer was commonest gynecological malignancy followed by cervical cancer. Late presentation with advanced stage was seen in majority of all cancers. doi: https://doi.org/10.12669/pjms.37.3.3596 How to cite this:Wasim T, Mushtaq J, Wasim AZ, Gul-e-Raana. Gynecological malignancies at tertiary care hospital, Pakistan: A five-year review. Pak J Med Sci. 2021;37(3):621-627. doi: https://doi.org/10.12669/pjms.37.3.3596 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To compare the efficacy of letrozole vs Clomiphene citrate for ovulation induction in PCOS women. Methods: This double blind randomized controlled trial was conducted at Services Hospital, Lahore, from January 2016 to December 2020. Total 220 patients, diagnosed with PCOS according to Rotterdam criteria were randomly assigned into two groups after taking informed consent. The women were followed for ovulation, pregnancy and live birth rates in the next five consecutive menstrual cycles with either clomiphene citrate or letrozole. Results: Letrozole had significantly better pregnancy rate (29.0% vs 15.4% p-value 0.015), monofollicular development (77.2% vs 52.7% p-value 0.000) and live birth rate (25.4% vs 10.9% p-value 0.005) as compared to clomiphene citrate. There was no difference between the two groups in ovulation rate (68.1% vs 63.6%, p-value 0.477), early pregnancy loss (3.6% vs 4.5% p-value 0.734), and twin pregnancy (0.0% vs 1.81% p-value 0.155). There was no ectopic pregnancy and no congenital anomalies in both groups. Hot flushes were higher in clomiphene group (31.8% vs 12.7% p-value 0.001) while fatigue (30.9% vs 8.1% p-value 0.000) and dizziness (21.8% vs 10.0% p-value 0.029) was higher with letrozole but these were well tolerated. Conclusion: Letrozole is better treatment choice than clomiphene citrate in PCOS women with infertility in terms of pregnancy and live birth rate. ClinicalTrials.gov Identifier: NCT05702957. doi: https://doi.org/10.12669/pjms.40.1.7971 How to cite this: Wasim T, Nasrin T, Zunair J, Irshad S. Efficacy of Letrozole vs Clomiphene Citrate for induction of ovulation in women with polycystic ovarian syndrome. Pak J Med Sci. 2024;40(1):78-83. doi: https://doi.org/10.12669/pjms.40.1.7971 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To compare oral Nifidepine and IV labetalol in terms of rapidity of BP control in severe preeclampsia. Methods: All patients coming to Services Hospital from March 2017 to February 2019 with diagnosis of severe preeclampsia ≥ 24 weeks gestation were randomized to either receive Nifidepine or Labetalol. Primary outcome measure was time taken to control BP and number of doses required. Secondary outcome measures were side effects of drugs, APGAR score, NICU admission and perinatal mortality. Results: Two hundred four patients were included in trial with 102 patients in each group. Labetalol took 22.6± 13.5minutes and Nifidepine took 22.09± 11.7 minutes to achieve target BP (p>0.05). Labetalol required 2.3± 1.58 doses and Nifidepine 2.2± 1.58 doses to control BP ( p>0.05). No maternal side effects were seen in 86 (84.31%) and 92(90.19%) patients in both groups (p>0.05). Mean gestational age at birth was 34.8 ±2.73weeks in Labetalol and 35.2±2.48 weeks in Nifidepine group (p>0.05). In labetalol group, 43 (42.15%) babies had APGAR Score < 7/10 and 23(22.54%) babies required admission to NICU while in Nifidepine group 42 (41.17%) babies had Apgar score < 7/10 & 30(29.4%) babies were admitted to NICU(p>0.05). There were 21(20.5%) perinatal deaths in labetalol Group-And 19(18.6%) in Nifidepine group (p>0.05) Conclusion: Oral Nifidepine and IV labetalol are equally efficacious in controlling BP in patients with severe pre eclampsia without any significant side effects. doi: https://doi.org/10.12669/pjms.36.6.2591 How to cite this:Wasim T, Agha S, Saeed K, Riaz A. Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial. Pak J Med Sci. 2020;36(6):1147-1152. doi: https://doi.org/10.12669/pjms.36.6.2591 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.