Indian Journal of Maternal-Fetal & Neonatal Medicine

In developing countries like india, chromosomal anomalies are still the major cause of birth defects accounting for around 34% risk. Cell free nucleic acids are currently being studied as a noninvasive method of prenatal diagnosis of monogenic diseases with dominant paternal inheritance, chromosomal disorders, fetal RhD status and sex linked disorders.

Keywords: Cell Free Nucleic Acid; Non Invasive Method; Fetus. 

Joubert syndrome is a autosomal recessive disorder (ciliopathy) with significant genetic heterogenicity that is associated with cerebellar vermis hypoplasia and the pontomesencephalic molar tooth sign (a deepening of the interpeduncular fossa with thick and straight superior cerebellar peduncles). Clinically there is hypotonia, ataxia (as toddler), characterized by breathing abnormalities including episodic apnea and hyperpnoea (which improves with age), global developmental delay, nystagmus, strabismus, ptosis and oculomotor apraxia. Here we report a case of a 45 day female child brought by parents with complaints of: Feeding difficulty and poor sucking since birth and abnormal movements of upper and lower limbs since day 6 of life. On MRI Brain, there is seen caudal Vermian agenesis, thickening and elongation of the superior cerebellar peduncle with deepening of interpenduncular fossa giving a batwing appearance of the fourth ventricle – ‘molar tooth appearance’ typically seen in Joubert Syndrome.

Keywords: Hypotonia; Apraxia; Seizures; Joubert’s Syndrome. 

Alkaptonuria is a rare metabolic autosomal recessive disorder caused by deficiency of homogentisic acid oxidase [1]. A three old female child presented with history of staining of diaper since birth and during treatment underwent battery of scanning and investigations. Diagnosis was suspected when urine turned black when kept in a sterile container. Her urine examination showed homogentisic acid. Patient was diagnosed alkaptonuria.

Keywords: Genetic Disorder; Alkaptonuria. 

Introduction: Advanced abdominal pregnancy is a rare condition with high maternal & fetal morbidity as well as mortality. Inadequate placentation, unusual implantation &associated anomalies increase maternal &fetal morbidity and mortality. Diagnosis & management of advance abdominal pregnancy is always a challenge for obstetricians. Aims & Objectives: Management of rare case of advanced secondary abdominal pregnancy. Material & Methods: A 20yr young second gravida with full term gestation with history of previous L.S.C.S. with transverse lie & low lying placenta refered to our institute for emergency LSCS. Her last USG at 34wks showing single live intrauterine fetus in transverse lie with placenta previa. We avoided per vaginal examination in v/o central placenta previa. Decision of emergency L.S.C.S. was taken. After opening abdomen we got many surprises, after all obstacles we came out with successful outcome. Happily closed the abdomen with expression of victory. Results: With skillful and patient handling we were able to manage such a rare case with successful outcome in terms of mother as well as fetus even with complete removal of placenta. Conclusion: Advanced secondary abdominal pregnancy are rarely diagnosed clinically. Use of timely ultra sonography, intraoperative recognition, surgical skill, ready access to blood products, patiently taking decision about status of placenta are the cornerstone of successful management. Dreadful surprises can change in a remarkable unforgettable victory.

Keywords: Advanced Abdominal Pregnancy(AAP); Secondary Abdominal Pregnancy.

Background: Rudimentary horn pregnancy carries grave consequences for the mother. Though sonography and magnetic resonance imaging can clinch the diagnosis in early stages, majority of the cases are diagnosed only after rupture of rudimentary horn with intraperitoneal hemorrhage. Case: A 27 years old gravid 3 para 1 abortion 1 presented at 8 weeks of pregnancy with pain abdomen. Per vaginal examination and sonography revealed healthy intrauterine pregnancy. The same lady was referred at 20 weeks pregnancy with the sonographic diagnosis of abdominal pregnancy. Surprisingly, laparotomy revealed right sided rudimentary horn pregnancy with impending rupture. Excision of rudimentary horn alongwith right salpingectomy was done. Conclusion: As rudimentary horn pregnancy is always associated with catastrophic outcome, every effort should be made to diagnose it at an early stage. High index of clinical suspicion and carefully done ultrasonography can make the diagnosis in prerupture stage. Secondly, accurate preoperative diagnosis is must to plan exact surgical management.

Keywords: Rudimentary Horn; Pregnancy. 

Preconceptional, conception, antenatal period and intrapartum period are in continuum. For successful obstetric outcome, prepregnancy weight and proper antenatal care are important factors. Newborn whose birthweight exceeds 40004500gms is labled as macrosomia. Prolong labour, arrest of labour, foetal distress, shoulder dystocia, instrumental delivery and increased incidence of cesarean section are associated with macrosomic fetuses. Early detection, watchfull expectancy active interventions are key factors for safe delivery of macrosomic fetuses

Keywords: Macrosomia; Diabetes; Cesarean Section; Shoulder Dystocia.

Congenital anomalies are one of the major causes of morbidity and mortality during perinatal and early neonatal period. The overall fetal outcome depends upon the extent, severity, onset and number of organs affected by anomalies. Early detection with ultrasonography helps in establishing prognostic impact of fetus if pregnancy is continued versus timely termination of pregnancy if fetal late viability is questionable or permanent irreversible anomalies detected have high propensity for lifelong physical or mental disability. However, the sensitivity and specificity of ultrasonography for fetal anomaly detection is varied depending upon gestational age, operator training, and definition of malformations and risk of anomalies prevalent in target population. Recent advancements in screening by ultrasonography and maternal serum biochemistry have posed a serious challenge to invasive prenatal testing methods, which still is considered gold standard. End of life decision by parents for detected fetal anomalies by premature termination of pregnancy is emotionally challenging event mixed with moral, legal and ethical dilemma.

Keywords: Congenital Anomalies; Ultrasonography; Fetal Malformations. 

Thyroid disorders are common for the Obstetrician as well as neonatologist and paediatrician in their day to day practice. While there are universal consensus, clear guidelines and treatment protocols for treating overt hypothyroidism with pregnancy, and infancy, subclinical hypothyroidism has remained a cause for concern to the general physician, paediatrician and the Obstetrician equally. Poor obstetric outcomewith subclinical hypothyroidism has been reported (recurrent abortions, low birth weight etc) but the long term neonatal neurodevelopment outcome does not seem to be altered much. Altered physiological status and different lower cutoff values during pregnancy for treating hypothyroidism has led to increased complexity of this scenario. Though many treatment options are available for nonpregnant women, levothyroxine (LT4) is considered standard of care for the pregnant women and neonates with subclinical hypothyroidism. In view of all this newer updates there is a need to have a relook at the present scenario and plan the best treatment with evidence based medicine for these pregnant females.

Keywords: Subclinical Hypothyroidism; Pregnancy; Neonatal; Thyroid Dysfunction. 

Newborn screening (NBS) is a public health program designed and developed to screen infants shortly after birth. The principle of NBS Program is to detect potentially harmful disorders that are not clinically evident at birth. Newborn screening is a success story in USA and European countries despite different approaches to timing ofscreening, followup testing and intervention. In India, the concept of NBS is in the nascent stages. Screening and surveillance should go hand in hand. Newborn screening model should comprise screening, followup, diagnosis, management, and education. For this review, PubMed & Google Scholar were searched for review articles. Of these, those related to Indian scenario were reviewed & appropriately used to prepare a final review.

Keywords: NBS; Heel Stick; Cord Blood. 

Aim: To study the role of color Doppler ultrasonography in high risk pregnancy in predicting maternal outcome depending on gestational age at the time of delivery and mode of delivery. Material and Methods: 50 women with high risk pregnancies were diagnosed and recruited for the study. Doppler indices carried out to predict perinatal outcome like birth weight and comparison of the accuracy of various Doppler parameters were also done for maternal and perinatal outcome. APGAR score at 5 minutes calculated. Perinatal morbidity and mortality were recorded. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy weredetermined for all Doppler measurements were also done. Results: In the present study group, 28(56%) of women were in the age group of 21 – 25 years. 20(40%) of women had PIH and 32(64%) had abnormal Doppler. In 32 women with abnormal Doppler, 28 (87.5%) had caesarean section and 4 (12.5%) had vaginal delivery. In abnormal doppler group out of 28 caesarean sections, 18 (64.2%) women had caesarean section for fetal distress. The mean birth weight of the babies born to women in the study group was 2.3kg. Out of 32 newborns in abnormal doppler group 12 (37.5%) newborns had APGAR <7 and 20 (62.5%) newborns had APGAR 7. Umbilical artery Doppler was found to have sensitivity 46.6%, specificity – 94%, PPV 93%, NPV 54%. Middle cerebral artery Doppler was found to have sensitivity 73.3%, specificity – 90%, PPV – 91.6%, NPV69.3%. CPR abnormality was found to have sensitivity 86.6%, specificity – 95%, PPV – 96.2%, NPV – 82.6%. Conclusion: The results of the present study supports the use of doppler study of both umbilical, middle cerebral arteries wave forms as a primary tool for antenatal surveillance in high risk pregnancies.

Keywords: APGAR Score; Maternal Outcome; Doppler Ultrasonography; High Risk Pregnancies.

Aims and Objectives: (1) To study prevalence of various etiological factors involved in early pregnancy haemorrhage. (2) To find out relative frequency of various causes of bleeding during early pregnancy. Materials and Methods: (1) This is observational retrospective study performed within span of 2 years (August 2014 to july 2016) in Department of Obstetrics and Gynaecology in ACPM Medical college, Dhule. (2) Total number of 200 women with bleeding per vaginum during pregnancy were enrolled in the study. The patients who presented with vaginal bleeding were divided into: 1. Early pregnancy bleeding < 20 weeks. 2. Late pregnancy bleeding > 20 weeks. Since the demographic profile, etiology, risk factors involved, maternal & perinatal morbidities and mortalities associated with early and late pregnancy group are drastically different, so the cases in this study are divided into two groupsEARLY (< 20 weeks) & LATE (>20 weeks). In this first article, early pregnancy group studied separately in terms of all variables. Results: In this study, 66% patients presented with early pregnancy bleeding and 34% with late pregnancy bleeding. Early pregnancy bleeding due to abortion was 72.7%, 4.54% was due to molar pregnancy, 10.6% was due to ectopic pregnancy and rest 6.81% constitutes causes due to cervical factors. Conclusion: Preventable maternal death is greatest tragedy in obstetrics. Vaginal bleeding at any stage of pregnancy is an alarming event and can be potentially life threatening situation. Efforts to improve geographical access, referral services and quality of comprehensive emergency obstetric care are required to improve maternal outcome.

Keywords: Early Antenatal Bleeding; Miscarriage; Preterm delivery; Etiological Factors. 

Introduction: Pregnancy associated with any medical illness becomes a challenge for an obstetrician. Cardiac disease is one such medical illness which complicates 0.1 – 4% of pregnancies. Aims and objectives: 1) to study incidence of heart disease associated with pregnancy at a Dr.V.M.G.H. Solapur. 2)To study the baseline characteristics of patients and associated complications of heart disease in pregnancy. Materials and Method: In the present cross sectional study all the cases of heart disease in pregnancy admitted in obstetrics and gynaecology department of Dr. V.M.G.H. Solapur during the study period were enrolled. All the selected patients underwent detailed antenatal evaluation. Detailed medical history along with routine obstetric history was elicited regarding duration of disease, medication. All these cases were analyzed with regard to their age, education, socioeconomic class, locality (urban or rural), parity, type of cardiac lesion, NYHA status. Results: Out of total 16362 deliveries; 39 pregnant patients were diagnosed with heart disease. Thus the incidence of heart disease in pregnant patients in the study was 0.24%. The mean age of patients, was 24.6 ± 5.2 years. 89.7% belonged to lower socioeconomic class. Rheumatic heart disease was the most common heart disease (74.4%) followed by Congenital heart disease was found in 20.5%. In 38.46% patients heart disease was diagnosed during the present pregnancy, whereas in 61.54% patients heart disease was diagnosed in previous pregnancy or before. Dyspnoea (61.5%) was the most common presenting complaint followed by palpitation (23.1%). 66.7% patients were from NYHA Class I, followed by 23.1% from NYHA Class II. Pulmonary hypertension was seen in 17.9% cases. Congestive heart failure was developed in 7.7% cases. Anaemia was noted in 10.3% cases, whereas Hypertensive disorders of pregnancy (12.8%), postpartum haemorrhage (5.1%), Oligohydramnios 2.6% (n = 1) were predominant obstetrical complications. Conclusion: Thus we conclude that the incidence of heart disease in pregnant patients in the study was 0.24%. Rheumatic heart disease was the predominant cause of heart disease in pregnancy and was seen mainly in the age group of 2029 years of age among the lower socioeconomic class women. Dyspnoea and palpitations were the most common presenting symptoms with NYHA class I. Pulmonary hypertension and congestive heart failure were the common cardiac and noncardiac hypertensive disorders of pregnancy and anaemia were common non cardiac complications.

Keywords: Pregnancy; Heart Disease; Symptoms; Complications. 

Context: Assessment of breast feeding efficiency and impact of drugs used during labor is essential to increase success of breast feeding. Aims: To study impact of Oxytocin on LATCH scores, prediction of exclusive breast feeding at 6 weeks using LATCH scores and find out correlation between LATCH score and breastfeeding self efficacy scale (BSESSF). Settings and Design: Prospective cohort study conducted at Mehta multispecialty hospitals, Chennai. Methods and Material: 50 mother infant dyads receiving Oxytocin compared to 50 mother infant dyads who did not receive. LATCH scores assessed at birth, 48hrs/discharge and 6 weeks along with BSESSF print outs given to all mothers. Statistical analysis used: LATCH and BSESSF expressed as Mean. ChiSquare test and comparison of means used. Pearson correlation coefficient used to correlate LATCH and BSESSF. Sensitivity and specificity along with a cutoff of LATCH score that predicts exclusive breastfeeding at 6 weeks calculated. Results: Mean LATCH scores at birth and 48hrs/discharge significantly low in Oxytocin group (p = 0.0003 and 0.0035 respectively). LATCH score8 at birth and 9 at 48hrs/discharge had highest sensitivity and specificity in NVD group. LATCH score 7 at birth and 8 at 48hrs/discharge had highest sensitivity and specificity in Oxytocin group. Positive linear correlation between LATCH and BSESSF at 48 hrs and 6 weeks (NVD – r value 0.77, 0.77 and Oxytocin r value 0.76, 0.76). Conclusions: Use of Oxytocin during labor is associated with poor LATCH scores. LATCH tool assessed in the first days of life can predict exclusive breastfeeding at 6 weeks postpartum. There is a positive linear correlation between LATCH score and BSESSF.

Keywords: Breast Feeding Prediction; Breastfeeding Self Efficacy; LATCH Score and Oxytocin. 

Aims and Objectives: 1. Study the incidence of eclampsia. 2. Study the maternal and perinatal outcome. Materials and Methods: It is a prospective study of Maternal and Perinatal outcome in 50 cases of eclampsia above 32 weeks of gestation from July 2015 to july 2016 in M.R. Medical College Gulbarga. Patients were examined in labour ward to know the pregnancy outcome and neonates in neonatal intensive care unit. On admission detailed history is taken from the attendant, general physical examination and systemic examination of patient was done. Management includes – General line of management, management of convulsions by pritchard regimen, anti hypertensives, obstetric management – delivery by either vaginal route or cesarean section. All the babies delivered are followed up during early neonatal period for complications. Result: The most common cause of perinatal mortality is prematurity. Incidence of eclampsia is 0.64%, with 2 maternal deaths and 12 perinatal deaths. 36% of patients developed complications. Maternal mortality was significantly high in patients with 6 or more episode of convulsions. Antepartum eclampsia with gestational age less than 36 weeks, BP >160/100, preterm birth, low birth weight babies, low apgar scores influenced adverse perinatal outcome. Conclusion: Eclampsia still remains a major problem in developing countries. It is one of the important cause of maternal and perinatal morbidity and mortality due to lack of proper ANC, low socioeconomic status and lack of education.

Keywords: Eclampsia; Hypertension; Maternal Death; Perinatal Death. 

Introduction: Heart disease during pregnancy increases maternal morbidity and mortality, it should be managed very meticulously by team of experts from various specialties viz. obstetricians, cardiologists and cardiovascular surgeons, anaesthetist, and neonatologist. The evaluation of patients with cardiovascular disease should ideally begin prior to conception so that appropriate evaluations can be made without putting the foetus or mother at risk. Aims and objectives: 1) To study the foetal outcome and perinatal mortality in patients of pregnancy with heart disease. 2)To study the maternal mortality in patients of pregnancy with heart disease. Materials and Method: In the present prospective study all the cases of heart disease in pregnancy admitted in obstetrics and gynaecology department of Dr. V.M.G.H. Solapur during the study period were enrolled. All the selected patients underwent detailed antenatal evaluation. Detailed medical history along with routine obstetric history was elicited regarding duration of disease, medication. All the enrolled cases were followed up to the delivery. All these cases were analyzed with regard to their age, type of cardiac lesion, NYHA status and mode of delivery, obstetric and medical complication, and maternal death if any. Foetal outcome was recorded by parameters namely gestational age (term or preterm), birth weight, admission to neonatal intensive care unit (NICU), and neonatal death if any. Results: Majority of the patients were in the age group of 2029yrs. Rheumatic heart disease was the most common heart disease with NYHA Class I. Spontaneous vaginal delivery was conducted in 70% (n=21) cases. Ventouse was applied to cut short second stage of labour in 3.3% (n=1) cases. Caesarean section was done in 26.6% (n=8) cases, of which 3.3% (n=1) were elective and 23.3% (n=7) were emergency. Out of total 30 live birth babies, 43.3% (n=13) babies were low birth weight and 56.7% (n=17) were having birth weight  2.5 kg. Among 30 babies, 23.3% (n= 7) were admitted to NICU. Perinatal mortality was 64.5 per 1000 live births in pregnancy with heart disease. There were no maternal deaths among enrolled pregnant patients with heart disease during study period. Conclusion: Thus we conclude that the most common mode of delivery among the pregnant women with heart disease was spontaneous vaginal delivery followed by emergency caesarean section with foetal distress as the common indication. For NICU admission foetal distress, mothers in intensive care unit and IUGR were the common indication. The perinatal mortality was 64.5 per 1000 live births in pregnancy with heart disease where as no maternal deaths among the study patients noted.

Key words: Heart Disease in Pregnancy; Outcome; Perinatal Mortality Rate. 

Objectives: To correlate nucleated RBC count per 100 WBC (nRBC/ 100WBC) within first 24 hours of birth in term and near term neonates with perinatal hypoxic events and to correlate increased nRBC/100WBC with adverse prognostic outcome in neonates. Design: Prospective comparative study. Setting: Level III neonatal intensive care unit (NICU) of tertiary care hospital in southern India. Participants: 128 neonates e— 34 weeks of gestation admitted in NICU over 10 months period. Methods: Neonates were grouped into twoperinatal hypoxic and controls. Details regarding birth weight, gestational age, maternal age, relevant antenatal history and mode of delivery was obtained. Examination included Apgar score at birth and assessment for need for any respiratory support. Blood gas estimation from umbilical cord blood at birth and peripheral smear examination for nRBC/100WBC within first 24 hours of birth was done. Morbidity in form of duration of NICU stay was evaluated. Result: Among 128 babies, 46 had perinatal hypoxia while 82 acted as control. Mean nRBCs/100WBC among the cases was 15.54±63.66 whereas that in control was 3.74±5.21. Among the term babies, mean nRBC/100 WBC was significantly higher in those with perinatal hypoxia (17.28±69.09) as compared to controls (3.15±4.418). Statistically significant association was observed between mean nRBC/100WBC and gestational age at birth, requirement of resuscitation at birth and duration of NICU stay. On constructing receiver operating characteristics curve, among term babies for nRBC/100 WBC of >2, sensitivity and specificity was 66.67% and 64.15% respectively, with a positive and negative predictive value of 57.77% and 72.34% respectively. The specificity increased to 95% when a cut off > 13 nRBC/100 WBC was used. Conclusion: Among term babies, mean nRBC/100WBC was significantly higher in those with perinatal hypoxia as compared to controls. Hence raised nRBC/100WBC at Day 1 of life in term babies can be taken as surrogate marker of perinatal hypoxic event provided confounding factors have been eliminated. Higher mean nRBC/100WBC on Day 1 of life can be used as a predictor of morbidity and hence longer duration of NICU stay.

Keywords: Erythroblasts; Hypoxia; Intensive Care Units; Neonatal; Gestational Age. 

Objectives: Evaluation and prevelance of hypospadiasis in north maharastra. Materials and Methods: The study was conducted in January 2000 to december 2017 in department of general surgery, ACPM Medical College, Dhule. In OPD and emergency total of 415 patients presented and were admitted and treated. Results: Here we compare the prevelance in varying age group and its association with various factors like congenital anomalies, socioeconomic status, its surgeries and related complications, etc. Conclusion: This study underlines the epidemiology of hypospadias in rural set up in india , no such study of epidemiology of hypospadias is available in india.

Keywords: Epidemiology; Hypospadias. 

Context: The improvement in perinatal care has led to increase in survival as well as morbidity in sick newborns. Babies discharged from NICU need to neurodevelopmental (ND) follow ups and rehabilitation. Aims: To assess the neurodevelopmental outcome of NICU discharged babies in follow up clinic. Settings and Design: A Retrospective Observational Study at High Risk Follow up clinic of a Tertiary Care Hospital. Methods and Material: Data was collected from follow up clinic of level III NICU of tertiary care hospital running since 6 years. Risk categorization at enrollment and neurodevelopmental assessment were done till 6 month age. The AmielTison Method and Denver Development Screening Test were used. Assessments were done according to the follow up protocol. Various neonatal morbidities like Hypoglycemia, Acute Bacterial Meningitis, Asphyxia, RDS, ventilation more than 7 days, IVH Grade 2 etc were considered for analysis. Statistical Analysis Used: MS EXCEL & IBM SPSS (version 2015). Results: Out of 1704 infants enrolled, 345 (19.9%) were having a High risk of neurodevelopmental delay. Only 644 (37.7%) followed up at 3 months, numbers reduced to 366 (21.4%) at 6 months. Babies with risk factors of Prematurity, Hypoglycemia, ventilation more than 7 days & IVH Grade 2 were more likely to have the neurodevelopmental delay. Conclusions: Attrition in follow up percentage warrants active follow up interventions. Early developmental screening necessary for all NICU discharged babies irrespective of risk category.

Keywords: Follow up; NICU Discharged Babies; Neonatal Morbidities; Neurodevelopmental Outcome. 

Despite its discovery a 100 year ago, vitamin D has emerged as one of the most controvertial nutrient and prohormone of the 21st century. Its role in calcium metabolism and bone health is undisputed yet has non classical action on glucose metabolism, immune function, bacterial infections etc. During pregnancy Vitamin D deficiency induces maternal and neonatal complications. Objective: The aim of our study was to determine the prevelence of Vitamin D deficiency during pregnancy and its consequential effect and complication in mothers and their newborn. Design: A sample size of 50 preganant mothers attending antenatal clinic with suspicion of vitamin D deficiency was picked up for the evaluation that included detailed history, physical examination and Vitamin D level estimation. The extent and severity of Vitaamin D deficiency were analysed, maternal and neonatal outcome were recorded. Result: Majority of womens (60%) had Vitamin D level < 10ng/dl and 28% have insufficiency and 8% had sufficient levels of Vitamin D. Main symptoms were fatigue, bone and muscle pain etc and complications during pregnancy with Vitamin D deficiency were,PIH, oligohydroamnios and GDM. There was a six fold increase in the incidence of caessarean section and significant perinatal complications that were highlighted like asphysia, low birth weight resulting in NICU admission. Conclusion: High prevelence of Vitamin D deficiency during pregancy is increasingly recorganized lead to maternal and perinatal complication. A concious knowledge about in and its adverse impact on mother and the newborn requirs close scrutiny. Universal screening is highly recommended looking to the very high prevelence of Vitamin D deficiency.

Keyword: Vitamin D; PIH; GDM; IUGR; Maternal and Perinatal Outcome. 

Introduction: Increase incidence of caesarean section is a major concern in todays era. Ceaser may be performed in one of the three way, by classic technique, by lower segment or by some form of extraperitoneal cesarean section. The earliest extraperitoneal technique used was Latzko’s as introduced by Dr Henry Burns. Extraperitoneal cesarean section is a useful method of preventing postoperative morbidity in form of infections & adhesions. Early ambulation , Start oral fluids immediately and get the patient out of bed as soon as the anesthesia worn off are supposed to be advantages of this new study of old technique. Objective: To evaluate advantages or disadvantages of extra peritoneal caesarean section over trans peritoneal caesarean section. Study Design: Single blinded Randomized prospective control triel were performed over 66 patients in our tertiary care institute. Intra operative complications morbidity and outcome compaired by scaling signs, symptoms & examination findings by single consultant. Results: Patients of ECS had better score for postoperative pain, ambulation & oral intake there were less requirement of analgesic in ECS group. Postoperative nausea, shoulder pain febril episodes peritonitis genitourinary tract infection & bowel discomfort were very minimal in ECS group compaire to TCS group. Conclusion: An extra peritoneal csection is definitely advantageous over transperitoneal approach of lower segment caesarean section. There is no need for postoperative starvation, and ileus after this method is rare. Early mobilization reduces the risk of thrombosis and shortens postoperative pain. Less pain makes early commencement of breastfeeding easier within the first hours after the operation. This will also help contraction and involution of the uterus. Early removal of stitches reduces the risk of infection and keloids.

Keywords: Extraperitoneal Caesarean Section (ECS); Transperitoneal Caesarean Section (TCS). 

Introduction: ”Successful motherhood is the unique achievement in woman’s life” Advanced maternal age is defined as age 35 years or more for the mother at the time of delivery. Across the world, there is a rising trend among women towards delaying pregnancy and child birth. In obstetric practice, maternal age is an important determinant of the outcome of pregnancy. Pregnancy after the age of 35 years can present a challenge because it is associated with the maternal and fetal risk factors. Aims & Objectives: To evaluate the Maternal outcome of labour & perinatal outcome with advanced maternal age. To study age and parity distribution. Material & Methods: Total 100 Patients of Pregnancy with advanced maternal age who met all the parameters in inclusion and exclusion criteria were taken. This is Hospital based retrospective study in ACPM Medical College over a period of 2 years from June 2014 to May 2016. Data collected from the patient’s medical records and hospital database. Results: The mean age of the patients was 37.4yrs, in which 58% were multigravida. 42% were primigravida. The rate of LSCS was 41% which was significantly higher. There was increased incidence of hypertensive disorder, gestational diabetes mallitus, preeclampsia & malpresentations. Conclusions: Advanced maternal age is high risk pregnancy with adverse maternal & perinatal outcomes. It is a vital time to screen for congenital and chromosomal abnormalities. There was significantly increased rate of instrumental delivery and caesarean section. There is a need for individualising antenatal obstetric care based on age group in older to attempt to improve maternal and perinatal outcomes.

Keywords: Advanced Maternal Age; PreEclampsia; Multiple Pregnancy; Caesarean Section; Antepartum Haemorrhage.