Indian Journal of Obstetrics and Gynecology

Aim: To study the incidence of eclampsia and determine associated maternal and perinatal outcome at tertiary care hospital. Methodology: A retrospective clinical study of 70 cases of eclampsia was done at Government Medical College, Latur, over period of of 1 year . The events of mother and perinatal outcome were recorded and analyzed. Result: In our study, incidence of eclampsia was 0.9%, Majority of cases, 70% were seen in the young age group of 2125 years. Primipara were at higher risk, around 71% cases. About 74% patients were from rural area and unbooked cases (60%) were more than booked cases. Antepartum eclampsia was seen in maximum cases (91%). Csection was the mode of delivery in 70% cases while vaginal delivery was seen in 30% cases. Maternal complication were found in 24 (34%) cases, out of which 10 (14%) mothers died, causes were mainly cardiopulmonary compromise, hepatic faliure or sepsis. Perinatal mortality came out to be 18.5%. Prematurity was the leading cause followed by RDS and IUGR. Conclusion: Eclampsia still remains a major contributor to maternal mortality and morbidity in developing countries like India.Improvement in health care facility, adequate antenatal supervision, early diagnosis and timely referral will reduce the maternal and fetal complication.

Keywords: Eclampsia; Maternal Outcome; Perinatal Outcome. 

 Background: Our objective was to identify potentially modifiable risk factors for preeclampsia in a Teenage Pregnancy. Materials and Methods: A longitudinal study was conducted in department of gynecology and obstetrics GSL Medical College and General hospital. The Universal sampling method was employed and every antenatal woman with age above 15 years were registered was included as the study subjects. Results: There was significant association between mother’s age, parity, complications of mother and complications of fetus in all hypertensive subjects (P<0.05). It was found there was insignificant association was found with gestational age and mother in hypertensive subjects (P>0.05). Conclusion: PIH cases delivered, with raised diastolic blood pressure & neonate with low birth weight were found risk factors for prenatal death. Fetal morbidity & mortality can be reduced by early recognition & institutional management.

Keywords: PIH; Preeclampsia; Fetal Complications and Mother Complications.

True CPD is a tenuous diagnosis because twothird or more women diagnose as having this disorder and deliver d by caesarian section, subsequently deliver even larger new born vaginally, leading to necrotic trauma to the bladder, leading to stress incontinence and fistulas. All women admitted to the labor room with obstructed labor and its sequelae. On admission detailed history was noted. General examination on admission was made, like stature, anemia, shock, dehydration, jaundice, pedal edema, and bladder – bowel distention. Vital signs like respiratory rate, pulse rate, temperature and blood pressures were noted.In our study, 4% delivered vaginally of which 2% delivered by forceps and 56% by cesarean section and 40% underwent laprotomy. A study by Konje et al shows 82% emergency caesarian section, 12% of the mothers had normal fetal cardiac activity, 44% had non-recurring pattern and in 44% fetal cardiac activity was absent.

Keywords: Obstructed Labour; CPD; Complications. 

Introduction: Fetal distress contributes to increased caesarean section rate.Predicting adverse outcome in early perinatal period is important in severe fetal distress. Aim of the Study: To study the risk factors for foetal distress and evaluate the incidence of meconium stained liquor, respiratory distress, morbidity and mortality in foetal distress. Material and Methods: This was a prospective study done in in the department of Obstetrics and Gynaecology, Dr.V.M. Government Medical College, Solapur. A total of 150 newborns delivered via Caesarean section with a diagnosis of clinical foetal distress were compared with another group of 150 newborns delivered similarly, but without clinical foetal distress. The risk factors for foetal distress were noted. The meconium quality, postnatal NICU admission rate, morbidity and mortality were looked at. Results and Observations: Majority of the patients were 2125 years in both study and control groups and majority were (53.33%) primigravida. Maximum patients in both groups (29.23%) were of 40 weeks gestational age. Incidence of post maturity (41 weeks and above) in study group was higher (25.38%) when compared to control group (7.33%). Anemia and postmaturity were the most common antenatal complications in study group. Most common indication for induction of labour in study group was postdate pregnancy. Incidence of thick meconium (52.66%) was higher in study group followed by thin meconium (40.66%). Incidence of low 1 min and 5 min Apgar score was higher in thick meconium cases. Incidence of admission to NICU (30.66%), mortality (11.33%) was higher in the study group. Conclusion: Foetal distress is associated with many antenatal risk factors necessitating LSCS. It is commonly associated with thick meconium which can lead to increased incidence of low Apgar scores at 1 and 5 minutes. It also increases the rate of NICU admission in first 48 hours and has increased perinatal mortality.

Keywords: Fetal Distress; Perinatal Outcome; Apgar score. 

Background: The partogram is a preprinted paper on which labour observations are recorded.The aim of the partogram is to provide a pictorial overview of labour, to alert midwives or obstetricians to deviations in maternal or fetal wellbeing and labour progress. Objective: To compare the efficacy of WHO and paperless partograph in the management of labour and to determine which is more user friendly. Materials and Methods: Thestudy was conducted in PESIMSR, Kuppam over 200 uncomplicated pregnant women. WHO partograph was used in 100 and paperless partograph was used in another 100 women. In WHO partograph group conventionally P/V examination was performed every two hours, where as in paperless partograph, alert ETD (Expected Time of Delivery) and action ETD were noted. Per vaginal examination was done only at alert and action ETD. We tried to determine which partograph was more user friendly. We also noted the duration of labour, number of P/V examinations, usage of syntocinon and infectious morbidity in both mother and fetus. Results: In the present study the labour was augmented in 11% in Paperless partograph group and 41% in WHO partograph group (<0.001). The success rate in terms of spontaneous vaginal delivery was 74 and 44% in Paperless partograph and WHO partograph groups which was stastically significant. The Paperless partograph has the advantage of promoting normal course of labour with less interventions. Conclusions: Paperless partograph is very simple to understand and implement even in rural setup and by midwives with minimal training. As the sample size in this study was small and the time period over which it was conducted was less we are including only low risk pregnancies further study is required to its applicility for larger group of patients and in high risk pregnancies.

Keywords: WHO Partograph; Paperless Partograph; User Friendly. 

 Objectives: To study postoperative recovery of modified extra peritoneal cesarean section technique (group, A) and its comparison with standard transperitoneal cesarean section (group, B) Methods: Observational study with sample size of 93 and 105 for group A and B respectively, at Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India, with rate of over 10,000 deliveries per year. Two important parameters were studied. Results: Postoperative febrile morbidity was significantly lower in group A than B (6.5% Vs 21%, p=0.004). Gastrointestinal function recovery was earlier in group A than B (6h Vs 18.5h, p<0). Conclusion: Modified extraperitoneal cesarean section is associated with less febrile morbidity and early postoperative recovery than transperitoneal cesarean section.

Keywords: Early Postoperative Recovery; Transperitoneal Cesarean Section; Modified Extraperitoneal Cesarean Section.

Background: In order for individual health institutions to improve maternal health in India, there is need for research on the local causes of and factors influencing adverse maternal outcomes in booked and unbooked cases. This study would enable care providers and policy makers appreciate the burden of the problem and know where to focus as they distribute resources. Objectives: To study and compare sociodemographic profile, maternal risks, factors and fetomaternal outcomes in booked and unbooked cases. Design: A hospital based retrospective study. Setting: Department of obstetrics and gynaecology,Tertiary care teaching hospital, India. Methods: The present study is a prospective study and will be conducted at Department of obstetrics and gynaecology,tertiary care teaching hospital, India. All patients will be subjected to detailed history and systemic examination. Their sociodemographic profile, maternal risks, factors and fetomaternal outcomes in booked and unbooked cases. The data will be analysed and compared. Conclusion: If the study demonstrated the positive correlation between lack of proper antenatal care and adverse pregnancy outcome with poorer outcomes inunbooked than booked patients then improving the availability and accessibility of quality antenatal and delivery care services in our environment will improve pregnancy outcome. This study will be needed in present day situation.

Keywords: Antenatal Care; Booked Cases; Fetal Outcome; Maternal Outcome; Pregnancy. 

 Hypertensive disorders of pregnancy (HDP) are a group of commonest medical complication in pregnancy and it is also a major cause of maternal mortality and morbidity. This study aims to determine the prevalence of fetomaternal complication and correlation with severity of HDP. Material and Method: This was a retrospective study from January 2016 to December 2016 of antepartum, intrapartum and postpartum cases of HDP with associated complication admitted at GMCH. Result: Fetomaternal complications increases with severity of HDP. Early onset of HDP was also associated with increasing complication and poor fetal outcome. Conclusion: HDP leads to progressive deterioration of fetal and maternal health which is only relieved by termination of pregnancy. Early detection and treatment can improve the fetomaternal outcome.

Keywords: PIH; PreEclampsia; Eclampsia.

Aim: To make a comparative estimation of fetal weight in both normal and high risk term pregnancy by clinical and ultrasound examination. Materials and Methods: This is a prospective hoapital based study on 100 antenatal women attending Department of Obstetrics and Gynaecology admitted for planned delivery for various reasons either by elective caesarean section or by induction of labour. Results: Using Johnson’s method 36% were within 5%, 67% were within 10% of the predicted fetal weight and in 67% of cases the birth weight was ±200 gms of the predicted weight. In 92% of cases the birth weight was within ± 500 gms of actual birth weight as an acceptable limit to predict the fetal weight clinically. Johnson’s method was least accurate when the birth weight is below 2500 gms and increased accuracy was found in the weight range of 2500 gms and above. Using Insler’s (AG X SFH) method 49% of the cases birth weight was within 5% of the of the predicted weight. By using AG X SFH, birth weight was over estimated than under estimated. 71% cases were within ± 200 gms and 97% were within ± 500 gms of the predicted weight. Insler’s method (AG X SFH) was found to be more accurate in weight range 2.501 to 3.5 kg. By Hadlock’s formula 55% were within 5% of predicted fetal weight. 88% were within 15% of predicted fetal weight. 76% gave error of ± 200 gms. It is most accurate between weight range of 2.5 to 3.5 kg weight group. While comparing all the three methods over estimation was almost equal with Ultrasonography and Insler’s (AG X SFH) method. Conclusion: Insler’s (AG X SFH) method which is simple, easy and less cumbersome method to predict the fetal weight in a developing country like India where sophisticated gadgets are not easily available.

Keywords: Johnson’s Method; Insler’s Method; Hadlock’s Formula. 

Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. Hence there is need to gain knowledge about fetomaternal outcome. The fetomaternal outcome in pregnant women with a history of previous caesarean section will be studied by this prospective observational study. Factors such as mode of delivery, incidence of vaginal delivery following LSCS, incidence of scar dehiscence/scar rupture and maternal mortality and morbidity will be observed and studied.

Keywords: Caesarean Section; VBAC (Vaginal Birth after Caesarian); Scar Dehiscence; Foetal Monitoring; Fetomaternal Outcome. 

Maternal mortality is a worldwide problem affecting millions of women, often unnecessarily. Maternal mortality rates are higher in developing countries and affect the rural and poor population most [1]. India has the highest maternal mortality rate for any single country in the world, with about one fourth of all pregnancy and delivery related deaths woridwide [2]. Haemorrhage during pregnancy, sepsis, unsafe abortion, obstructed labor and hypertension are estimated to cause 81% of the worlds maternal deaths [3]. Objective: To analyze the MMR at our institute over last 8 years and to evaluate the etiological factors contributing to maternal mortality. Method: This retrospective analytical study was conducted in department of obstetrics & gynecology, SMIMER, Surat from Jan 2010 to Aug 2017. All patients, registered & unregistered , who delivered at our institute during this tenure and total maternal deaths that occurred during the same time period were included in the study. Obsvertation: Total 52,803 deliveries occurred during last 8 years at our institute out of which 51,824 were total no of live births and total number of maternal deaths during this time period was 136. Thus MMR calculated is 262.42.Out of 136 mothers, 93 (68.38%) died due to direct obstetric causes and 43 (31.62%) died of indirect causes. PPH was found to be the main cause leading to death of 32 (23.52%) out of 93 and eclampsia was second killer contributing to 11. 02% of mortality (15 out of 93). Conclusion: Maternal mortality is an indicator of the quality of obstetric care in a community reflecting the utilization of health care services available in a community. To improve maternal health and to reduce maternal morbidity and mortality, proper ANC, emergency obstetrics and routine audits for maternal deaths are needed which will help to develop subsequent policies and protocols to tackle life threatening obstetrics emergencies.

Keywords: Maternal Mortality; MMR; Maternal Death Audits. 

Objective: The objective of this study was to review the indications for admission, demographics, clinical characteristics, course, interventions and outcome of obstetric patients admitted in intensive care unit of a tertiary care hospital and medical college in India. Methods: It is a retrospective study done on obstetric patients admitted to the ICU in the intensive care unit of VMMC & Safdarjung hospital, New Delhi from Jan 2015 to Dec 2015 over a period of one year. Patients included were critically ill women requiring ventilatory support or major organ supportive therapy admitted during pregnancy as well as in first 6 weeks of the postpartum period. Results: In the study period, Total obstetrics admissions were 33809. 129 obstetric patients were admitted in ICU. Amongst the total ICU admissions 36 (28%) were maternal deaths. Maternal mortality ratio in the present study was 1.4/1000 deliveries. The most common indication was obstetric haemorrhage (31, 24%) followed by pregnancy induced hypertension (30, 23.2%). Mostly women stayed in ICU for 25 days. Conclusion: Early recognition of high risk cases and appropriate referral may improve the clinical outcome.

Keywords: Intensive Care Unit; Maternal Mortality; High Risk Pregnancy. 

Introduction: Incidence of infertility in our country is between 10 to 15%. The cause of infertility attributable to female partner in about third of all cases. Hysteroscopy and laparoscopy has emerged as a very important tool in evaluation and management of female infertility factors. Objective: This study aims to understand the role of minimal access surgeries like hysteroscopy and laparoscopy in cases of primary and secondary infertility. Materials and Methods: A prospective study conducted in 116 female infertility patients. Patients were subjected to clinical examination and diagnostic tests. Hysteroscopy & Laparoscopy were carried out in the proliferative phase of the menstrual cycle. Results: Out of 116 cases, 74 (63.7%) patients had a primary infertility and the rest 42 (36.2%) patients had a secondary infertility. Significant laparoscopy findings detected in 82 (70.6%) cases while hysteroscopy detected abnormalities in 46 (39.6%) cases in both the groups. Laparoscopic findings were more common than hysteroscopy in primary and secondary infertility. On laparoscopy tubal pathology was the most common abnormality seen in the pelvis while uterine polyps were the most common hysteroscopic findings observed in both the groups. Fertility enhancing endoscopic procedures carried out in the same sitting. Conclusion: Hysteroscopy & laparoscopy was found to be very useful in cases of primary and secondary infertility. It helps in the evaluation ofsignificant and correctible pelvic pathology in female infertility patients.

Keywords: Hysteroscopy; Infertility; Laparoscopy. 

Background: In girls adolescence has been recognized as a special period marked with the onset of menarche. Even though menstruation is a natural process, it is associated with misconceptions, malpractices and challenges among girls in developing countries. Many adolescent girls having lack of appropriate and sufficient information regarding menstruation and menstrual hygiene. This may result in incorrect and unhealthy behaviour during their menstrual period So, educating the adolescent girls on menstruation is essential during menstruation. Methods: A cross sectional study conducted among undergraduate medical students of GMERS Medical College, Valsad. A total 203 girls of first, second and third MBBS medical students between age group of 16–22 years were participated in this study. Data was collected by using predesigned, pretested Questionnaire. The data was entered and analyzed by using Microsoft excel 2010 and appropriate statistical test were applied. Results: Out of 203 Girls 84.24% girls had knowledge about menstruation before they experienced menarche and mother was found to be the main source of information. Mean age of menarche was 14.5 years. 59.61% of girls were experience mood disturbance during menstruation in addition to this most of the girls experience one or more kind of associated symptom during their menstruation. 86.70% girls use sanitary napkins where as 13.3% girls use clothes and reuse them. 73.40% said that religious activities were restricted for them during menstrual periods Most of the girls said that sanitary napkin is an expensive and not being easily available at all places. Conclusions: Education on menstruation is vital aspect of health education for all adolescent girls as it related with health consequences and also strongly related with misconceptions and cultural restrictions. Significantly more number of girls in the urban area was using commercially available sanitary pads as compare to the rural girls. To improve the menstrual hygiene, adolescent girls should be educated regarding menstrual hygiene as well as sanitary napkins should be made universally available at affordable price.

Keywords: Menstruation; Menarche; Sanitary Napkin; Medical Student. 

Aims and Objectives: Elderly patients of carcinoma cervix uteri are increasing in number. Outcome of cervical cancer with relation to age is controversial. We conducted a retrospective analysis in treated patients of carcinoma cervix uteri to investigate characteristics and outcome of patients older than 60 years in comparison to patients younger than 60 years. Materials and Methods: Medical records of 92 patients of carcinoma cervix uteri who had been treated with radiotherapy or radiotherapy combined with chemotherapy from May’2013 to December’2015 were retrospectively analyzed. The patients were divided in to the two age groups: Group I patients older than 60 years and in group II patients younger than 60 years, there were 37 patients in group I and 55 patients in group II. Patient characteristics, treatment and toxicities were evaluated. Results: With a median followup time of 28 months (range 449 months), disease free survival was 51.35% and 40% in group I and II respectively (p value0.565) whereas overall survival was 62.16% and 45.45% in two groups respectively (p value0.414), hence DFS and OS are not statistically significant. However in incidence of anemia and neutropenia there was statistically significant difference between the two groups (p value 0.0222, 0.0096 for anemia and neutropenia respectively). Conclusions: There is no statistically significant difference in outcome of cervical cancer patients older and younger than 60 years is in our study with respect to DFS and OS. Haematological toxicities were found more in patients more than 60 years in comparison to patients younger than 60 years.

Keywords: Cervical Cancer; Women Older than 60 Years; Haematological Toxicity. 

Aim of the Study: To study the incidence, age at presentation, sites of involvement of various gynaecological cancers, treatment aspects of gynaecological malignancies in a tertiary care hospital. Methodology: Retrospective analysis of gynaecological cancer patients from Department of Gynaecology, Radiotherapy, Medical Oncology at Government Rajaji Hospital, Madurai from January 2017–June 2017. Cases were stratified based on age, stage, histological type and clinical presentation. Results: The total number of cases registered during this study period were 141. Among them cervical malignancy was the commonest at our centre as compared to other gynaecological malignancy. Number of cases of cancer cervix were 86, constituting 61% of the total cases. This is followed by cancer ovary 29.7%, cancer endometrium 4.2%, cancer vulva 3.5%, vault cancer 1.4%, metastatic carcinoma of ovary 2%. Most of the cases were between 45 to 60 years. Advanced stage predominated in all malignancies. Conclusion: Cervical cancer is still the most common gynaecological cancer in the developing world. Targeting younger women for cancer survey is a necessity. Vaccination is the primary prevention. Secondary prevention is by conducting health education and creating awareness about the importance of screening programmes . Early diagnosis and treatment may help to preserve the fertility.

Keywords: Malignancy; Cancer Cervix; Ovarian Cancer. 

Background: Cancer of the cervix is the third most common cancer in women. In India and other developing countries cervical cancer is the leading cause of morbidity and mortality. Cancer cervix is readily preventable, and can be diagnosed at the preinvasive stage with adequate and repetitive cytological screening with Papanicolaou (Pap) smears. Objectives: This is a retrospective study aimed toevaluate all previously conducted cervical smears examined at a teaching tertiary hospital during a 6 months period. Methods: Detailed clinical data and Pap smear cytology reports were obtained and data noted in a structured proforma. All the smears were reported as per the 2001 Bethesda system. Results: A total of 556 Pap smears were examined. Maximum number of patients was in the age group of 2534years (28.1%). A total of 142 smears (25.5%) were reported to have normal cytological findings , 148 (26.6%) showed superficial squamous cells, 259 (46.6%) were inflammatory, 6 (1.1%) smears showed LSIL and 1(0.18%) showed HSIL. Conclusion: Premalignant and malignant lesions of cervix can be diagnosed easily by Pap smears. The epithelial cell abnormality rate in our study was 1.26%.

Keywords: Cervical Cytology; Pap Smear; Screening; Squamous Intraepithelial Lesion (SIL). 

Introduction: Progress of quality improvement in health services is expected to reduce perinatal mortality rate. Various studies from all over India have quoted perinatal mortality rate of 60120/ 1000 births which is alarmingly high as compared to 1020/ 1000 births in developed countries. Aims & Objectives: To determine theincidence of perinatal mortality of this hospital, the various causative factors and their impact on perinatal mortality. Material and Methods: The present prospective study was carried out from 01102008 to 30092010 in the Department of OBGY in a tertiary care hospital.Complete general and systemic examination to look for any medical or surgical disorder in mother was conducted. Results: In this study the perinatal mortality rate was 77.04 per 1000 live births. The PMR was double in unbooked cases as compared to booked cases (Table 3) which reflect importance of antenatal care. PMR was high in para 4 and above as compared to para 2 and least in para 3. PMR was higher in advanced maternal age and teenage pregnancies. PMR per 1000 births is very high in preterm babies than term babies, which is comparable to the findings of all other studies. In the present study (Table 8) perinatal ortality rate in vaginal deliveries was 84.69 per 1000 births. Conclusions: Importance should be given on increasing female literacy as it is closely linked to high parity, poor nutrition, dietary deficiencies, lack of awareness and underutilization of health services. Efforts should be made to reduce the incidence of prematurity and LBW babies as these were the leading causes of perinatal deaths. Periodic composite perinatal audit involving obstetricians, neonatologists and pathologists can improve performance of clinicians by avoiding repetition of clinical mistakes.

Keywords: Perinatal Mortality; Vaginal Deliveries; Hypertensive Disorders of Pregnancy; APH; Intrapartum Asphyxia. 

 Background: Prevalence of vitamin D deficiency among pregnant women is commonly seen in many populations across the world. Vitamin D deficiency is a preventable and treatable health problem. Recent studies on vitamin D deficiency in pregnant women reported the adverse effects on maternal health and fetal wellbeing. Recent research on vitamin D deficiency on maternal health outcomes during pregnancy reported associated risk factors such as anemia, gestational hypertension, preeclampsia, gestational diabetes mellitus and caesarean section. Therefore, utmost attention is required in prevention of vitamin D deficiency among pregnant women. Objectives: Aim of the present study is to identify the prevalence of vitamin D deficiency and other related risk factors associated with it. Also to determine screening for vitamin D deficiency amongst our population is warranted. Setting and Study Design: This is a comparative prospective study. Conducted during the period of December 2016 to October 2017. Materials and Methods: Comparison of serum vitamin D levels was studied in 75 nulliparous women and 100 pregnant women. Pregnant females were randomly selected who attended the antenatal clinic. Women with serum 25hydroxy vitamin D level lower than 10ng/ml were diagnosed as vitamin D deficient. SPSS version 16.0 is used for statistical analysis. Results: In the present study, the mean serum 25(OH) vitamin D concentration in nulliparous women was 21.4±8.9 ng/ml and that of parous women is 12.5±10.8 ng/ml at 1530 weeks of gestation. The difference in vitamin D levels between the two groups is statistically significant. Conclusion: The high prevalence of vitamin D deficiency in pregnancy calls for unanimous approach to tackle this grave situation by implementing a national strategy for screening, prevention, and treatment of this deficiency.

Keywords: Vitamin D Deficiency; Prevalence; 25 – OH Vitamin D; Antenatal Women; Nulliparous Women; Maternal Risk Factors.

Background: Labour Admission test (LAT) is a non invasive Cardiotocographic (CTG) recording of foetal heart rate and uterine contractions simultaneously for twenty minutes. This is commonly used to evaluate the foetal well being at the time of admission in labour ward. In a low resource setting where continuous CTG monitoring for all patients in labour is not possible, an abnormal tracing in LAT will help the treating Obstetrician to identify antenatal women who require continuous monitoring and appropriate timely intervention prevent perinatal mortality. Material and Methods: This is a retrospective study done on 300 antenatal women who met the inclusion criteria. The CTG tracing was categorised based on FIGO 2015 guidelines into Normal, Suspicious and pathological. Mode of delivery and specific foetal and neonatal outcome measures were studied and correlated with admission CTG testing. Results: The incidence of operative delivery was phenomenally high in Pathological group (70%) and low in Normal group (5.5%). Foetal distress during labour developed in 8.5% of patients with Normal tracing and 70% of patients with pathological tracing. LAT has a sensitivity of 64.7% and specificity of 94.37% and Positive predictive value (PPV) of 40.4% in predicting an Apgar score of <7 at 5 minutes of birth. NICU admission was required in 1.03% of patients with Normal tracing and 50% of patients with Pathological tracing (Pvalue < 0.001). Conclusion: The result of the study showed high specificity indicating that normal tracing appears to be predictive of foetal well being in low risk and hish risk cases. However, Suspicious and Pathological pattern required intense monitoring and if possible early intervention in the absence of diagnostic modalities like foetal blood gas evaluation.

Keywords: Labour Admission Test (LAT); Cardiotocogram (CTG); Normal; Suspicious; Patholgical. 

Aim of the Study: The uterine artery Doppler has potentials for screening for complications of impaired placentation like preeclampsia and adverse fetaloutcomes.The purpose of this study was to determine the role of uterine artery Doppler flow velocimetry at 2nd trimester of pregnancy in the early prediction of complications of impaired placentation and elucidate it’s role in stratifying antenatal care. Methods: This prospective study was carried out in the department of obstetrics and gynaecology and radiodiagnosis in Government Rajaji Hospital, Madurai. This study includes 183 pregnant women from January 2016 to January 2017 whose uterine artery resistive index and presence of notching was noted between 2024 weeks of pregnancy. R.I>0.6 and presence of diastolic notch in the uterine artery was considered abnormal. Results: out of 183 recruited cases 141 were lowrisk and 42 cases were high risk for developing preeclampsia, IUGR, SGA, preterm. Out of 141 low risk cases, 130 had normal doppler and 11 had abnormal doppler. Out of 42 high risk cases 27 had normal Doppler and 15 had abnormal doppler. dmong the patients having abnormal doppler study (including high risk and lowrisk patients) developedpreeclampsia and 8 developed adverse fetal outcome. Conclusion: Doppler velocimetry of uterine artery in 2nd trimester of pregnancy can be used as a screening test for complication of abnormal placentation in high risk patients when compared to low risk patients.

Caesarean section is one of the commonest surgery in obstetrics which is done to facilitate delivery in cases where vaginal delivery is either not feasible or poses undue risk to mother, baby or both [1]. Surgical site infections (SSI) following caesarean delivery is a major cause of maternal morbidity & mortality, increasing both the duration of patient hospitalization and hospital cost [1114]. Objective: To assess the incidence of caesarean wound complications and to study the risk factors/comorbid factors. Method: This prospective study was conducted in Obstetrics and Gynec department, SMIMER from April 2015 to September 2016 with follow up of patient for subsequent 1 month. Total 2377 patients of both elective & emergency LSCS were included in the study. Observation: During the study period, total 10407 deliveries were conducted out of which 8070 (77.16%) were vaginal deliveries and 2377(22.84%) were caesarean sections. Out of 2377 patients, 75(3.16%) patients developed wound complications which were categorized as induration, serous discharge, superficial wound infection (skin gape), deep wound infection (subcutaneous gape) and hematoma. Prolonged operative time, multiple vaginal examinations, anemia, PIH & DM were some of the associated risk factors. Conclusion: Caesarean section is one of the commonest surgeries performed in obstetrics, both as emergency as well as elective. Wound complications in LSCS increases post operative maternal morbidity, thus leading to prolonged hospital stay thus imposing financial burden on both patient and society in general. Protocols need to be designed & followed to reduce these post operative wound complications.

Keywords: LSCS; Wound Complications; SSI. 

Objective: To study the efficacy, safety, cost effectiveness, intrapartumcomplications, mode of delivery and neonatal outcome with intravaginal misoprostol and intracervicaldinoprostone for induction of labor. Methods: 200 antenatal women who were decided for induction of labor were randomly divided into two groups, one group (PGE1) received misoprostol 25mcg intravaginally and another group (PGE2) received dinoprostone 0.5mg intracervically. The efficacy and safety of these methods were analysed and compared in the following parameters: induction delivery interval, mode of delivery, neonataloutcome, fetomaternal complications and cost of the drug. Results: Among 200 antenatal women of different age groups and different indications for induction of labor, 100 women of one group receiving PGE1, of which 82% had vaginal delivery compared to 69% of PGE2 group which is statistically significant (p = 0.032). Csection rate was 31% in PGE2 group compared to 18% in PGE1 group, which is statistically significant. 64% of PGE1 group had vaginal delivery within 12hrs compared to 37% of PGE2 group which is statistically significant (p = 0.0007). PGE1 group had less need for acceleration of labor with oxytocin i.e 42% compared to 81% in PGE2 group. Failed induction with PGE2 is more statistically significant (p = 0.037). Maternal and fetal complications are not significant statistically. Conclusion: PGE1 is more efficacious for cervical ripening and labor induction than PGE2 as PGE1 has lesser requirement of oxytocin for laboraugmentation, shorter induction delivery interval, more number of vaginal deliveries, lesscsection rate, stable at room temperature and cost effective, however uterine contraction abnormalities, fetal heart rate irregularities and MSL should be carefully assessed by close monitoring of labor by intapartum CTG and partogram.

Keywords: PGE1; PGE2. 

Background: The current maternal mortality ratio in India is 212 100000 live births. India is behind the target of 103 deaths per live births to be achieved by 2015 under the united nations mandated millennium development goals. Maternal mortality is one of the area in Indian obstetrics where strong concern and consequences is seen. Aims and Objectives: To calculate the maternal mortality rate in our hospital, assess the demographic data, assess the causes of maternal mortality and suggest steps to reduce the MMR. Materials and Methods: A retrospective analysis of maternal deaths from hospital records and death summaries over a period of seven years from January 2009 to December 2015. Data will be collected and grouped. Standard statistical software will be used for analysis of data. Observation In our institute, MMR was 362 in 2009 which declined to 242 in 2015. (mean mortality rate of study was 309.28 year). Most of deaths occurred in women belonging to 3rd decade of their life (73.8%). Most belong to lower class families (62.09%), Majority of the females in our study had vaginal delivery (61.43%), most of deaths occurred within 24 hours of admission to hospital (48.36%), eclampsia was the most common direct cause of maternal mortality (24.1% of total maternal deaths), anemia was the most common indirect cause of maternal mortality (15.68% of total maternal deaths). Conclusion: Reviewing the maternal deaths that occurred in our hospital there is an urgent need of early intervention in PIH, sepsis and anaemia. Analysis of every maternal death through maternal death audit should be carried out to identify the actual cause of maternal deaths and deficiencies in health care delivery system that might help to formulate preventive measures to reduce pregnancy related deaths

Keywords: Maternal Mortality. 

Background and Aim: Abortion or miscarriage is the term to denote vaginal bleeding with or without abdominal cramps in early stages of pregnancy, usually 20 to 24 weeks of gestation, which may lead to expulsion of the fetus before it is capable ofexutero survival. It is of utmost importance to diagnose the condition at the earliest and prevent it from progressing to imminent or complete miscarriage so the purpose of the study was to study the maternal outcome of patients affected by threatened miscarriage in first trimester. Materials and Methods: Present Study was Performed at Department of Gynaecology, Gujarat Adani Institute of Medical Science, Bhuj , Kutch, Gujarat. 150 patients who came to the hospital in OPD or in emergency casualty with complaints of bleeding per vaginum before 20 weeks and documentation of fetal viability by ultrasound was done were selected for the study. Any incidence of preeclampsia, intrauterine fetal growth restriction, intrauterine fetal death, low birth weight, low lying placenta, placenta praevia or low lying placenta, birth weight was recorded. Results: Of the 154 patients in the study group, 12 had gestational hypertension and 20 had preeclampsia. In the control group, only 5 had gestational hypertension and 6 had preeclampsia. There is a significant difference in gestational age, baby weight, APGAR scores, incidence of preeclampsia in control group and study group. Conclusion: The various maternal complications like gestational hypertension, preeclampsia, antepartum hemorrhage due to placenta previa have a high incidence in patients with threatened miscarriage. Risk of preterm labour is also significantly increased in these cases with threatened miscarriage. Hence if timely diagnosed & adequately treated, the maternal outcome would improve in cases of threatened miscarriage.

Keywords: Bhuj; Hypertension; Miscarriage; PreEclampsia.