Introduction: Cervical cancer is the most common form of cancer in women in developing countries and the second most common form of cancer in the world as a whole. An estimated 468,000 new cases of cervical cancer and 233,000 deaths occurred in the year 2000. Cervical cancer constitutes about 26 % of female cancer in different areas of Bangladesh. Objective: To find out the role of VIA for the detection of precancerous and early cancerous lesions of the cervix with co-relation of Colposcopic findings and ultimate. Methods: A prospective study was conducted from January, 2010 to June 2010 on 100 women attending at the "Colposcopy Clinic" of Gynae Oncology Division of Department of Obstetrics and Gynaecology of BSMMU, Dhaka. Only VIA positive cases were taken into consideration for the study. Results: The mean age of the participants were 33.39 years (range 18-60) with 41.0 % in the age group between 36-45 years. Among all the subjects, the majority (75%) was housewives and 70.0% the patients hailed from urban area. The yearly incomes of 46% families were between 50,000 to 60,000 Tk. The mean parity of the respondents was 1.75 and 4. More than 4 children were found in 14% cases. Up to 35.0% had 2 children only. About 46.0 % had experienced menarche at the age 13 years and the range was 12-14 years. In regard to risk factors, 64% used hormonal methods. Among the participants 80% experienced first coitus of age between 13-20 years. Excessive vaginal discharge and backache were the principal complaints. Colposcopy evaluated 65 cases as CIN (CIN I 34 %, CIN 11-17%, CIN-III 14%) and 3.0% as invasive lesions. Biopsy evaluated 45% as CIN (CIN I-20% CIN-15%, CIN-III 10%) and 1% as invasive lesions. The sensitivity and specificity of colposcopy were 82.14 % and 50.00% respectively. This suggests the role of colposcopy in the evaluation of CIN and cervical cancer. Conclusion: The study concludes that the VIA and colposcopy are the important methods of diagnostic tools for the diagnosis of cervical pre-malignancy. VIA may be used as a tool for screening in underdeveloped countries and may be associated with a referral procedure for further methods like colposcopy and biopsy. Colposcopy is an indispensable procedure in the evaluation of unhealthy cervix through it requires considerable training and experience.

Purpose of current study is to investigate the different trends of breastfeeding in Pakistani culture. Pakistani culture has been divided into three types, rural culture, semi-rural and urban culture. Natures and habits of breastfeeding are changing in these cultures. Author has used quantitative data in this study. Questionnaire has been developed from previous approved studies and conducted a survey in Pakistani culture. Sample size is 90 mothers who are breastfeeding or well aware about the breastfeeding in Pakistan. This is a quantitative study that has found that mothers are trying to breast feed in urban, rural and semi-rural areas. Mothers are facing many issues regarding breastfeeding. These issues are linked with the social problems and most of the mothers have less knowledge about the benefits of breastfeeding. It has found that general public is not feeling good to breastfeed at working place or public places. Current study has recommended some suggestion to the health organizations and Government to increase the breastfeeding trends in Pakistan. Current study will help the government and other health organizations to launch a campaign relevant to the breastfeeding that will increase this trend in Pakistan.

Pseudoangiomatous stromal hyperplasia (PASH) is a lesion that is often discovered incidentally in breast biopsies performed for benign or malignant lesions of the breast. More rarely, it may present as a palpable lesion. The term "Pseudoangiomatous" has been proposed to underline its particular histological aspect simulating a vascular proliferation. We report a case of PASH in a 42-year-old female patient presenting as a recurrent lesion that resulted in a considerable and rapid increase in breast volume (135 x 100 x 97mm) requiring a large lumpectomy with muscular-fat remodeling. Angiosarcoma and fibroadenoma remain the main differential diagnoses. Anatomopathological examination allows us to eliminate them, in particular through immunohistochemistry.

Introduction: Oligohydramnios or decreased amniotic fluid volume (AFI<5cm) is associated with adverse maternal & Pregnancy outcome. Amniotic fluid is a very complicated yellowish fluid located between the amniotic sac and the fetus. Oligohydramnios is associated with adverse Pregnancy outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission. Objective: To evaluate the pregnancy outcome of oligohydramnios and borderline amniotic fluid index. Methods: This was a prospective study was carried out at Department of Obstetrics & Gynaecology, Rangpur Medical College & Hospital, Rangpur, Bangladesh from January 2022 to June 2022. Total number of sample size will be taken 100. Among them 50 patient of oligohydramnios and 50 patients with borderline amniotic fluid index will be taken as group-A & group-B respectively. 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI ≤ 5 cm and borderline AFI of 5.1 to 8 cm. Pregnancy outcome was studied in the form of onset of labor, mode of delivery, fetal heart rate variations, meconium staining and lower segment caesarean section (LSCS) for fetal distress, Apgar score, birth weight, NICU admission and neonatal mortality. Results: Amongst the study group, 50% of cases had oligohydramnios (AFI ≤5 cm) as against 50% with marginal or borderline AFI. There was no statistical difference in age, parity and gestational age in both the groups. The mean amniotic fluid index in the first group with AFI ≤5 cm was 3.48±1.10 and that of second group with AFI of 5.1 to 8 cm was 6.69±0.75. On comparison of mode of delivery in between both the groups, a statistically significant difference was observed for caesarean section in oligohydramnios with AFI ≤ 5 cm group compared to AFI of 5.1 to 8 cm group. Patients with oligohydramnios with AFI ≤5 cm were significantly associated with IUGR and presence of abnormal umbilical artery Doppler velocimetry (p <0.05). Adverse Pregnancy outcome was seen in higher percentage of patients having AFI ≤5 cm than with borderline AFI. The difference was statistically significant for overall caesarean delivery rate and LSCS for fetal distress (p <0.05). Conclusion: An amniotic fluid index of ≤5 cm is commonly associated with intrauterine growth restriction and abnormal umbilical artery Doppler velocimetry studies. Adverse Pregnancy outcome is seen in higher percentage of patients having oligohydramnios than that of borderline AFI. Statistically significant difference for overall caesarean delivery rate as well as LSCS for fetal distress mandates the need for close antepartum and intrapartum monitoring.

Introduction: The placenta is an organ that is attached to the uterine wall and connects the fetus with the mother through the umbilical cord. The placenta is said to be retained when it is not expelled out even half an hour after the birth of the baby. The study aimed to evaluate the retention of the placenta. Methods: This was a cross-sectional study was conducted at the Department of Obstetrics & Gynecology , Faridpur Medical College Hospital, Faridpur from June 2016 to November 2016. The sample was taken purposively and the sample size was 110. Patients were diagnosed with a case of 'retained placenta' through proper history, and clinical examination. Written informed consent was taken from every patient or their relatives. The information was collected in a preformed data collection sheet. Observation and results of the study and statistical analysis were presented in tables. Data were analyzed by using the computer-based program Statistical Package for Social Science (SPSS) software for windows. Result: Out of 110 study subjects about 58.18% were found in the age group of 21-30 years and 20% were found in the age group of 20 years. The age of the patients ranges from 18 to 40 years. Among 110 study subjects, 64.55% were from lower socioeconomic status, 27.27% were from middle socioeconomic status and only 8.18% belonged to affluent socioeconomic status. The majority (74.54%) of cases were delivered at home and 25.46% of cases were delivered at different levels of hospitals (among them 1.82% of cases occurred in the institute where the study was done). Among them 20% were para- 1, 54.54% were para-2-4 and 25.46% of respondents were para ≥ 5. The majority (60%) of study subjects were admitted between 3 to 8 hours after developing retained placenta, followed by 18.19% who came within 2 hours. Regarding the clinical presentation, 69.09% of study subjects presented with anemia of varying degrees, 24.53% presented with shock, 5.45% presented with sepsis, and only 0.93% (one patient) presented with acute renal failure. Concerning predisposing factors of retained placenta, 25.46% of study subjects were grand multipara, 11.82% had H/O MR or D & C, 10.90% with prolonged labor, 10.90% respondents had IUD, 10% with past H/O retained placenta, 8.20% had preterm labor, 2.72% had H/O LUCS/ other uterine surgery and 20% were without any predisposing factors. Among the respondents, 27.27% of study subjects presented with genital tract trauma, 5.45% with sepsis, 5.45% with acute renal failure, 0.91% with DIC, 0.91% with uterine prolapse 64.55% with no associated conditions/complications. Among the total study population, 58.18% of retained placenta cases required manual removal under G/A, and 41.82% were managed by manual removal of the placenta under deep sedation. Out of 110 respondents, 21.82% of cases of retained placenta did not require any blood transfusion, 58.18% received 1-2 units and 20% received 3 or more units of blood transfusion. During management, 13.63% of study subjects developed uterine atony, 0.91% developed uterine inversion, 2.73% were complicated by uterine perforation, 0.91% were complicated by anesthetic hazard; 81.82% had no complication during management. Out of 110, 18.18% of study subjects experienced various complications. Among them 9.10% were managed by intrauterine balloon tamponade,2.73% required hysterectomy, and 6.37% were managed by other measures. 70% of respondents stayed in the hospital for 1-3 days, 26.36% for 4 to 7 days, and 3.64% stayed more than 7 days before discharge. Regarding the outcome of retained placenta among study subjects, 80.91% improved and discharged, 10% had severe anemia and required subsequent blood transfusion, 6.36% developed an infection, 0.91% developed acute renal failure and 2 patients died (one due to DIC and another patient due to irreversible shock). Conclusion: The retained placenta is an obstetric emergency. Rapid recognition and treatments are essential because heavy blood loss with coagulation problems remains the lethal factor in this disease. Rapid control of hemorrhage should be the first initiative. Active management of the third stage of labor lowers the danger by a significant percentage.

Introduction: Peripartum hysterectomy has to be done repeatedly as the last resort in saving a woman's existence. Currently, several drugs and surgical techniques have been established for the management of postpartum haemorrhages. The foremost indication for peripartum hysterectomy is severe uterine haemorrhage that cannot be controlled by conservative methods. Objectives: This study intended to find out the indication and frequency of peripartum hysterectomy in MAG Osmani Medical College Hospital, Sylhet. Methods: This prospective cross-sectional study on 100 cases of peripartum hysterectomy was carried out at the Department of Obstetrics & Gynaecology at Sylhet M.A.G Osmani Medical College Hospital, Sylhet from January 2004 to June 2005. Verbal consent was taken before recruiting the study population. Data was compiled and analysed manually. Result: The commonest age group involved in peripartum hysterectomy was 31-35 years (38,38.0%). The incidence of peripartum hysterectomy was 0.70%. Rupture uterus (76%) was the most common cause. Other causes are uterine atony (12%), Placenta praevia (2%), placenta accreta (2%) & sepsis in 6% of cases. Maximum patients (82,82.0%) did not get any antenatal care. Of those who got antenatal care, eighteen patients (18,18.0%) were irregularly booked. Conclusion: Emergency peripartum hysterectomy is a vital lifesaving technique and remains to have a high incidence in our community. The choice to implement an emergency peripartum hysterectomy is usually obscure as the obstetrician's paramount wish is to preserve the uterus for future childbearing.

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Molar pregnancy is one of the causes of maternal morbidity and mortality among women in the reproductive age group. However the magnitude, clinical features and risk factors are not well documented in our country .This study was conducted to describe these aspects of the disease entity in one tertiary level hospital. Objective: to determine the frequency and evaluate the current clinical characteristics of patients with molar pregnancy in Bangladesh. Study design: this was a cross sectional observational study. Study place and period: Department of Obstetrics and Gynaecology in BSMMU, Dhaka. Study period from January 2015 to June 2015. Study population: Patients with molar pregnancy admitted in the department of Obstetrics and Gynaecology in BSMMU during the study period. Outcome variables: Varieties of clinical presentation, diagnosis and treatment modalities. Results: The incidence of molar pregnancy was 7.3 per thousand pregnancies in BSMMU hospital during the study period. The age of the patient ranged from 18-47 years, with maximum 65% between 21-40 years age group. Only 5% patients were above the age of 40. Majority 65% of patients were multigravida while 35% were primigravida. Maximum 85% of all were from low socio-economic group. In 40% patient's blood group was B+ve and A+ve in 25% patients. Abnormal vaginal bleeding was the commonest presenting symptoms in 60% patients. Other than that 15% patients came with vaginal bleeding and passage of vesicles, 12.5% with lower abdominal pain, 7.5% patients had no symptom except amenorrhea diagnosed incidentally and other 5% had amenorrhea with exaggerated sign symptom of pregnancy. More than two third (80%) of the patients had uterus more than the period of gestation. USG, serum ß-hCG and CBC was done in all the cases. Chest X- ray was done in 60% cases. Serum ß- hCG level was found above the level of 50000 in 80% cases. Different modalities of treatment such as suction evacuation, D&C and hysterectomy were used for the patients with molar pregnancy. Suction evacuation was the first line treatment in 87.5% patients of molar pregnancy & follow up should be done at least for 6 months. Conclusion: Molar pregnancy is the disease of women in their reproductive years. It was commonly found in young multipara women of below average income group. Most common clinical manifestation was vaginal bleeding. Diagnosis was confirmed by ultrasonography and serum ß-hCG. Patients with molar pregnancy have the risks of developing persistent gestational trophoblastic disease (GTD) and should be followed up. It is now indispensible to set up a nationwide accepted protocol for the early detection and management of patient with molar pregnancy as well as to initiate a structured follow up programme to observe the prognosis of the disease.

Medulloblastoma is a primary central nervous tumour with malignant potential which begins in brain or spinal cord. It is the second most common brain tumour in Children accounting for 20% of cases. It can occur in any age, but most often occur in young children. It is found rare in adult group. It is primarily a cerebellar tumour and as cerebellum is mainly involved in muscle co-ordination, balance and movement hence this tumour symptoms include–headache, nausea, vomiting, dizziness, tiredness, Double Vision, Poor Co-Ordination and unsteady Walk. Treatment Includes Surgery, Chemotherapy And Radiotherapy.

Background: Excess aromatase activity is common in males with severely impaired sperm production, as shown by low Semen testosterone and somewhat increased estradiol levels. Elevated estrogen levels cause inhibitory effects of the hypothalamic-pituitary-gonadal axis, resulting in a reduction in LH required for testosterone production and FSH to maximize sperm motility. The main objective of this study was to see how an aromatase inhibitor to Improve Semen Quality in Case of Eugonadotropic Hypogonadism. Methods: This Prospective study was conducted in the Department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from June 2020 to May 2021. The sample size was 40 subfertile men with oligospermia. (≤ 10 million/ml), low semen testosterone level (<300 ng/dl) and low testosterone to estradiol ratio (<10). All patients were treated with Aromatase Inhibitor 2.5 mg daily for 4 months. At the end of the 4 months the semen analysis was performed. Statistical analysis was carried out by using IBM Statistical Package for Social Sciences version 25 for windows (SPSS version 25.0). Results: The sperm concentration, sperm motility and total motile sperm count significantly increased after Aromatase Inhibitor treatment. The side effects were mild and well tolerated. Conclusions: According to the findings of this study, some men with oligospermia, low Semen testosterone levels, and normal gonadotropin levels may have curable endocrinopathy. In infertile males with a low Semen testosterone to estradiol ratio, Aromatase Inhibitor may be administered to enhance sperm parameters.

Background: Hypertensive disorder is the most common medical problem encountered in pregnancy with a high perinatal and maternal mortality & morbidity. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. Objective: To assess the relation between labetalol and methyldopa in treatment of pregnancy induced hypertension. Methods: This study was hospital based comparative prospective study was conducted at Dept. of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2021. The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total patients were taken for the study and divided into 2 groups of 50 patients in each group. Results: A total 100 patients were included. The mean age in Group I was 24.4±4.55 years and in Group-II, 23.95±4.28 years. Maximum number of patients was between 19- 24 years in both the groups. In Group-I, 26 (52%) patients and in Group-II, 25 (50%) patients were in this age group. The maximum age in the Group I was 34 years and 35 years in the Group-II. The minimum age was 17 years in both the groups. The inter group difference was not statistically significant (p>0.05) thus the two groups were comparable by age. At baseline no significant difference was seen in SBP in both treatment groups. However after 8 days post testament SBP of women was significantly lower in Group-I patients as that of Group-II patients. i.e. Group-I: 123.41 vs. Group-II: 126.62, p- value=0.009. At baseline no significant difference was seen in DBP in both treatment groups. However at 8th day post treatment DBP of patients was significantly lower in Group-I patients. i.e. 77.18 vs. Group-II 79.64, p-value=0.005. For SBP more effective control was seen in women whose parity was 3-4 and for DBP notable difference was seen in women whose parity was 1-2. The control of systolic blood pressure was more effective in patients with normal body mass index and for Diastolic blood pressure (DBP) more effective control was seen in patients who were obese. On comparison methyldopa significantly causes more drowsiness, headache and nasal congestion and the incidence of Postural hypotension and dysponea in both groups were not significantly different. The patient who required additional drugs to control the uncontrolled hypertension. In Group I, 2 (4%) patients and in Group II, 3 (6%) patients did not respond with starting drug. The inter group difference was not statistically significant (p>0.05). Conclusion: Labetalol had less maternal adverse effect compared to methyldopa but fetal outcome was not observed in this study. Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy. This study is just a step in this long way. Therefore, labetalol can be considered positively in the treatment of pregnancy induced hypertension.

Objective: This systematic review is aimed to review the role of uterine artery Doppler in first trimester of pregnancy along with use of maternal characteristics as a predictor of early and late on set pre-eclampsia (PE). Selection Criteria: The search was limited by selecting; only original articles, prospective & retrospective study designs, role of uterine artery Doppler done at 11 to 14 weeks, done on singleton pregnancy and written in English language were included. Data Collection and Analysis: The data extracted for author name, year of publication, place of study, duration of study, study design, outcomes and study variables including maternal factors, uterine artery Doppler and serum markers. Then detailed analysis of uterine artery Doppler performance as predictor in the form of Area under curve, Sensitivity, Specificity, Positive predictive value, Negative Predictive Value and its relation to preeclampsia, Early PE and Late PE. Results: Following the search strategy of PRISMA, 148 full articles reviewed, and 21 articles were included from 2010 to 2021. Out of 21 articles, 19 articles had “prospective study design” whereas two had “retrospective. Out of 21 researches, 15 assessed early preeclampsia, 4 assessed late preeclampsia, 4 assessed both, however 7 articles studies only preeclampsia as an outcome. The extracted estimate show value of first trimester uterine Doppler as a predictor of early and late preeclampsia. Conclusions: The uterine artery Doppler with maternal characteristics is a valuable, noninvasive tool to be used at 11 to 14 weeks as predictor of preeclampsia in the low resource settings where serum markers cannot be available to general population.

Background: Magnesium plays an import role in the physiology of parturition. Decrease of Magnesium in plasma may be responsible for a decrease of the same in myometrium and this might have a considerable influence on the preterm labour. A Hypomagnesaemia leads to neuromuscular irritability leading to uterine hyperactivity which leads to cervical dilation. Objective: To find out the association between serum magnesium and preterm level. Methods: This was a cross sectional study, conducted in 100 women in labour, of them 50 were diagnosed case of preterm labour and 50 women were in labour at term attended in Gynaecology and Obstetrics department of Dhaka Medical College, Dhaka, from January 2015 to December 2015.5ml fasting blood sample was collected and was analyzed for serum magnesium using a standard enzymatic method. The mean value of serum magnesium was compared between two groups by student unpaired t-test and serum magnesium level was correlated with BMI, Gravita and gestational age in preterm labour patients by Pearson’s correlation coefficient test. A p-value was considered to be statistically significant at 0.05 at a 95% confidence interval. Results: The mean age was found 28.2±4.5 years in group I and 26.7±4.1 years in group II. The mean age difference was not statistically significant (p>0.05) between two groups. A majority (80.0%) of the patients came from a middle-class family in group I and 29(58.0%) in group II. The mean BMI was found 23.0±3.8 kg/m2 in group I and 26.4±2.4 kg/m2 in group II. The socioeconomic status and BMI were statistically significant (p<0.05) between two groups. The mean serum magnesium was found 1.64±0.13 mg/dl in group I and 2.05±0.11 mg/dl in group II. The mean serum magnesium level was significantly (p<0.05) lesser in group I. Serum magnesium had an area under curve 0.974, which gave a cut-off value < 1.8 mg/dl, with 98.0% sensitivity and 88.0% specificity for prediction of preterm labour. Conclusion: Most of the patients were belonged to age 21-30 years in both groups are not associated. A negligible correlation was found with BMI, gravid, through serum magnesium in preterm labour. Low serum magnesium level was significantly higher in preterm labour.