Indian Journal of Obstetrics and Gynecology

Objective: To test the hypothesis that women with high serum beta HCG levels in early second trimester (13-20 weeks) are at higher risk of developing hypertensive disorder of pregnancy and to compare beta HCG levels between normotensive and hypertensive pregnant women. Method: This prospective study was carried out in Department of Obstetrics & Gynaecology, GMCH, Udaipur from January 2017 to January 2018. Estimation of serum beta HCG level was done by enzyme linked fluorescence immunoassay. Followed up in antenatal clinic examined 4 weekly till delivery to note the development of hypertension and its complication. At every visit, blood pressure was recorded and urine was examined for albumin. PIH (pregnancy induced hypertension) included gestational hypertension and preeclampsia. Results: Incidence of PIH was 14% (28 out of 200 patients). Age, parity & socioeconomic status has no relation to development of PIH. There is significant difference in SBP & DBP between normotensive and PIH at the time of delivery (mean difference in SBP was 37.00 mmHg & DBP was 22.4 mmHg). Mean beta HCG in normotensive patients was 27500.10 mIU/ml and 45027.43 mIU/ml in PIH patients. 6.5% patients had beta HCG between 60,000 mIU/ml to 90,000 mIU/ml & among this 84.61% patients developed PIH. 92.50% patient had MOM of beta HCG <2. Among these 9.18% patients developed PIH. 7.50% patients had MOM of beta HCG >2, out of these 73.33% patients developed PIH. Sensitivity of beta HCG as predictor of PIH is 73.33% and specificity is 90.81%. Conclusion: Thus we can say that serum beta HCG level can be used as predictor of PIH as beta HCG is also already done as triple marker test in routine ANC. So it can be used without any extra burden on patient.

Abstract
Background: Caesarean section (CS) wound infections represent a substantial burdento the health system and the prevention of such infections should be a healthcare priority indeveloping countries [3]. The global estimates of surgicalsite infections (SSI) are from 0.5–15% [4]. SSI can beattributed to a perioperative bacterial load in the tissueat the site of surgery and the diminished  integrity ofthe host’s defenses [5]. Hence the present study was done at our tertiary care centre to assess wound infection
after caesarean delivery. Materials and methods: A hospital based case control study was conducted with 300 patients to assess the incidence of caesarean wound infections. The patients were prospectively randomized into following twogroups of 150 patients each. Results: 32 (21.3%) patients in Cases Group had hypertension / pre eclampsia while 29 (19.3%) and 23 (15.3%) patients had anemia and diabetes mellitus respectively. 10 (6.7%) patients in Cases Group had hypertension/pre eclampsia while 15 (10%) and 7 (4.7%) patients had anemia and diabetes mellitus respectively. The difference was statistically significant as per Chi-Square test (p<0.05). Conclusions: Obesity, diabetes, prolonged labour with PROM and wound haematoma are the main
contributory risk factors responsible for PCS wound infections. The need to reduce SSI is currently receiving considerable attention and requires more research.

Background: Leydig cell tumors of the ovary a rare benign neoplasms, usually occur in postmenopausal women associated with symptoms of virilization. Only five cases of benign Leydig cell tumor have been reported in literature [1]. Case Report: Here is a case of Leydig cell tumor of ovary. A 58 yr old female referred from Endocrinology department due to a biochemical diagnosis of hyperandrogenism. Serum Testosterone levels were 5.36 ng/ml. The patient presented with alopecia and hirsutism since 12 yrs. Ultrasonography showed right ovary measuring 2.8x1.8 cm with isoechoic lesion, left ovary measuring 3.8x2.6 cm. CT scan showed subserosal fibroid measuring 3x3.6 cm in fundus of uterus both ovaries were in postmenopausal status. Hysterectomy with bilateral salpingo-oophorectomy was performed. Results: Histopathological finding revealed bilateral Leydig cell tumor, measuring 2.0x1.5 cm in the right and left ovary. After surgery serum testosterone level were in normal limits and there was regression of signs of virilization. Conclusion: Bilateral Leydig cell tumor are rare, usually benign, they require surgical treatment and followup.

Genital trauma presents a diagnostic and management issue to the treating clinician in view of varied clinical presentation and often non reliable and misleading history in view of the nature of the disease. These injuries can have serious short and long term physical and psychological consequences. This article discusses such a case to stress upon the need of thorough clinical examination and if required, surgical intervention in such cases.

Extrauterine migration of like Copper T is an well reported complication of intrauterine contraceptive device, most of the times occurring at the time of insertion. Migration of Copper T into the peritoneal cavity can present as acute abdomen. Common sites of migration of IUCD are bladder, rectosigmoid. However migration of Copper T in the ovary is an extremely rare event. Here is a case of a 23 year old pregnant lady with intrauterine gestation of 11+2 weeks associated with migration of IUCD into the ovary. The approach was exploratory laparotomy, on which Copper T was seen completely embedded with right ovary, followed by safe removal of the IUCD while conserving the ovary. Hence, to conclude careful insertion of Copper T by trained hand and patient education regarding missing thread is of utmost importance to reduce untoward complications of IUCD.

Keyword: Contraceptive; Peritoneal; Bladder; Rectosigmoid; Gestation; Laparotomy; Ovary; IUCD; Cu-T.

Background: Lower segment placental insertion is called placenta previa. The aim was to study fetal and maternal outcome of placenta previa in pregnancy. Methods: A prospective study of all the placenta previa cases delivered at the Guru Gobind Singh Hospital done from April 2017 to September 2018 was done These women were analyzed for their parity, age, gestational age, history of bleeding, duration of hospitalization, need for blood transfusion, period of gestation at delivery, mode of delivery and ICU admissions. For the infants APGAR score, weight of infants, NICU admission, SBR, NMR are noted down. Conclusions: As the maternal morbidity and perinatal mortality due to placenta previa is preventable, efforts should be made to bring down these rates. This can be achieved by spacing pregnancies, limitation of family size, antenatal registration of all pregnant women, routine use of USG in pregnancy and early referral of high risk pregnant women to tertiary care centres. Awareness should be brought in the rural public to avail the facilities provided by the government. These measures will definitely help in a better outcome for both mother and fetus in all high risk pregnancies. ean delivery, Adherent placenta, Postpartum haemorrhage, Maternal morbidity and mortality due to increased incidence of hemorrhagic shock, increased operative interventions and sepsis. There is higher incidence of perinatal mortality and morbidity due to preterm delivery and its related complications like low birth weight, birth asphyxia and neonatal sepsis.

Objective: To evaluate the relationship between umbilical cord coiling index with perinatal out come. Method: Total of 500 pregnant ladies with singleton term gestation were included in the study done over a period of one year. UCI was caliculated and perinatal outcome was analysed. Results: Out of the 500 subjects, 390 were normocoiled, 58 were hypocoiled, 52 were hypercoiled. 89% of hypo coiled cord was associated MSAF. IUGR was observed in 80% of hypercoiled cords. NICU admission was high with hypocoiled cords. Conclusion: Abnormal umbilical coiling index either hyper or hypo coiled is associated with adverse perinatal outcome.

Introduction: Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality. Aim: To know the variation in platelet count between normal pregnancy and pregnancy induced hypertension (PIH) and correlate – fetomaternal outcome. Materials and Methods: It is prospective study done in 100 pregnant women attending the gyneacology ward. Among these 50 were normal pregnant women, 15 were eclampsia, 20 were preeclampsia (sever PIH) 15 were mild pregnancy induced hypertension from the antenatal clinic and inpatient ward. Results: More number of cases in eclampsia group came from rural area, from lower socio economic group and were unbooked for antenatal care. Both diastolic and systolic pressures are significantly correlating platelet count. Platelet count is significantly lower in cases of pre-eclampsia and eclampsia when compared to normal. Mean gestational period delivery was shorter in pre-eclampsia and eclampsia when compared to normal. Mean birth weight was reduced as the severity of the disease increased. Conclusions: Thrombocytopenia is directly proportional to the severity of the pre-eclampsia. Reduction of platelet count below 1 lac per ml. increases the risk of developing DIC and HELLp syndrome significantly, thus an early prediction suggesting prompt management.

Gestational diabetes mellitus affects up to 14% of all pregnancy with results of many maternal and fetal problems. Material and Methods: Study was carried out in the GSL general hospital in Andhra pradesh, south India. Pregnant women with gestational period with 24-28 weeks were included in the study. SPSS statistical package version 20.0 was used for the statistical analysis. Results were expressed in numbers and percentage. Chi square test were used to know association between various parameters. Results: The association between GDM, gravid, age and BMI was statistically insignificant (p>0.05). Conclusion: GDM testing and management mandatory during pregnancy.

Keywords: Gestational diabetes; Age; Body mass index; Gravida.

Context: Uterine leiomyomas is the most common benign tumor of the uterus and one of the most frequent indications for operative procedures. High dose of mifepristone used to treat leiomyomas have resulted in side effects. Hence this study was done to evaluate effects of low dose mifepristone. Aims: To evaluate the effectiveness of low dose Mifepristone in the treatment of Uterine Leiomyoma. Settings and Design: A prospective observational study was conducted among 60 women diagnosed with uterine leiomyoma in a tertiary hospital at Karaikal. Methods and Material: Data was collected using standardized questionnaire. Blood investigation and ultrasound pelvis was done to evaluate the effects on uterine leiomyoma before and after treatment with 10 mg of mifepristone for three months. Statistical analysis used: Mean and standard deviations were used to present quantitative data. Association was tested using Chi square, McNemar test, Paired t test and Wilcoxin test. Results: Maximum participants were between 40-49 years. More than half of the study participants were relieved of dysmenorrhea after the treatment. The Mean PBAC values reduced from 124.6 ± 51.85 to 34.72 ± 17.87 which was highly significant. There was significant reduction in the uterine volume from 331.69 ± 216.05 to 239.68 ± 157.23 cm3 and the Leiomyoma volume from 68.62 ± 38.94 to 46.71 ± 27.96 cm3. About 78% of the study population experienced amenorrhea after the therapy. Conclusions: Low dose of Mifepristone was effective in reducing the size of uterine leiomyoma and also decreasing symptoms of dysmenorrhoea and menorrhagia thus improving the general health status and quality of life of the study population.

Introduction: It has been proved that a successful pregnancy outcome depends on the development and maintenance of adequate uteroplacental circulation and that the hypercoagulability associated with thrombophilia might result in recurrent miscarriages. Due to the potential involvement of thrombophilia in recurrent miscarriage, the use of antithrombotic agents has been suggested as a potential means of increasing the live birth rates in subsequent pregnancies in women with either inherited thrombophilia or unexplained recurrent miscarriages. Thus, the main purpose of this work is to evaluate the effectiveness of LMWH and Aspirin to improve live birth rate in patients with recurrent pregnancy loss by seeing the outcome of the foetus in; Foetal weight, Mode of delivery, and Perinatal outcome. Methodology: A prospective observational study conducted on 100 pregnant women with a history of recurrent pregnancy loss admitted to Department of Obstetrics and Gynecology at Panna Dhai Mahila Chikitsalaya, Udaipur during the period January 2017 to February 2018. Administration of LMWH (inj. enoxaparin 40 mg s.c. OD) & tab aspirin 75 mg OD from USG confirmation of early intrauterine pregnancy till 34 weeks. Results: Patients between age 21 and 40 years were included with the mean age of 29.28 years. The mean BMI with relation to birth weight was 23.11 kg/m2. Twenty-two per cent of patients were found to be H/O IUD positive. Mode of delivery for 52% of the patients was LSCS, while for 44% of the patients it was vaginal. Two per cent of the births resulted in neonatal deaths, 4% of the pregnancies resulted in spontaneous abortion, 1% of the deliveries resulted in fresh still birth and the remaining 93% of the births resulted in survival to hospital discharge. Conclusion: Use of LMWH and tab aspirin daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates. Combination treatment with aspirin and LMWH leads to improve live birth rate among women with recurrent abortion and antiphospholipid antibodies.

Introduction: WHO defines Adolescence is the age group between 10 to 19 years [1]. It is a transitional stage from appearance of secondary sexual characters to sexual maturity. Today every fifth person in India is an adolescent [3]. Adolescent health is important as they are demographic force, economic force, future heath of nation and they have right to participate. Aims and Objectives: 1 To study the magnitude of different gynaecological morbidities in adolescent girls attending out patient department of obstetrics and gynaecology in new civil hospital, Surat. 2 To study the socio-demographic determinants and nutritional status. Methods: A observational study conducted including total 197 consenting subjects between age 11-19 years attending out patient department of our tertiary care hospital Surat. After detailed history taking, general and gynaecological examination was done followed by if needed investigations include hemogram, coagulograms, hormonal survey, sonography and other radiological investigations done. Data analysis done by Microsoft excel and open EPI software. Results: Menstrual disorders found to be the commonest gynaecological problems (76.14%) includes irregular menses, amenorrhoea, dysmenorrhoea. DUB was the commonest among irregular menses. Statistical significance found between PCOD and high BMI and socioeconomic class, puberty menorrhagia and dysmenorrhoea found statistically significant with age of 14-16 years, genital infections with married adolescents. Conclusion: In Adolescents menstrual disorders are more common but other problems also significant so scared resources should be directed for their health so future generation health can be improved. Correlated factors can be used in their prevention strategies.

Aims and Objectives: The objective of this study was to find out the incidence and indications of primary caesarean section in parous women and evaluate the maternal and perinatal outcomes there from. Methods: Prospective study of primary caesarean sections in parous women was done at our institute, VikhePatil Memorial Hospital, a tertiary referral center from July 2016 to June 2017. Age, indications and the maternal as well as perinatal outcomes were analyzed. Data was expressed as number and percentage. Results: Out of 974 caesarean deliveries, 154 (15.8%) primary caesareans in parous women were done. The most common age group was 20-25 (50%) years. The majority of parous women who underwent primary caesarean section, were primipara. Booked cases constituted around 55.19% of total study population. Among all, 142 (92.21%) patients were operated in emergency. The most common indication for caesarean section in this group of patients was fetal distress (35.06%). There was no maternal mortality seen, but 2 cases of neonatal mortality occurred in study population. Conclusions: Fetal distress was the most common indication for primary caesarean section in the parous woman, although malpresentation also contributed significant numbers. Our study shows that Primary caesarean section in parouswomen is not uncommon. Though to a small extent, they are contributing to rise in total caesarean section rates. Good obstetric care is required in parous women to improve maternal and neonatal outcome and it will also help to keep caesarean section to a lower rate.

Background: Perinatal mortality is an important indicator of maternal care, health and nutrition, it also reflect the quality of obstetric and the pediatric care available. The majority of global perinatal death occurs in the low and middle socioeconomic countries. Our hospital being a tertiary level facility receiving complicated cases from urban as well as remotes areas so this study was carried out here. The present study was conducted to study obstetric factors leading to perinatal mortality at a tertiary centre. Materials and Methods: The present prospective observational study was undertaken in a tertiary centre from October 2016 to March 2018. All perinatal deaths including stillbirths (SBs) and early neonatal deaths within 0-7 days of birth after 28 weeks of gestation were analyzed. Results: Out total 163, 10 cases had congenital malformation. 153 cases i.e. 93.86% had no obvious congenital abnormality. Out of 10 congenital anomalies 2 cases had congenital heart disease. 2 cases had anencephaly. 1 case congenital Diaphragmatic hernia, 3 cases had cleft lip, cleft palate, 2 cases had hydrocephalous. Conclusion: Majority of perinatal deaths are preventable by regular ANC check up and early detection of high obstetric factors before pregnancy and during gestation.

Introduction: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome. Isolated oligohydramnios at term is defined as AFI <5 cm without any maternal or fetal cause. Incidence of isolated oligohydramnios is 0.5-1% at term. It can be used as an adjunct to other fetal surveillance method to identify those infants at risk of poor perinatal outcome. The number of studies dealing with isolated oligohydramnios at term and its outcome in Indian setup is limited. Therefore this study is conducted to determine the perinatal outcome in cases of isolated oligohydramnios coming to R.L. Jalappa Hospital, Kolar. Method: Consisted of analysis of pregnancy outcome in 50 cases diagnosed as oligohydramnios by ultrasound after 37 completed weeks of gestation (Cohort 1) compared with 50 controls (Cohort 2) and matched for other variables like age, parity, gestational age. Various outcomes were recorded, tabulated and analyzed. Results: In our study occurrence of non reassuring NST, lower neonatal birth weight, low normal value of cord blood pH was higher in the study group when compared to control group. There was no statistically significant difference in the occurrence of adverse neonatal outcomes except for lower birth weight among neonates born to oligohydramnios mothers. Conclusion: The presence of isolated oligohydramnios in the absence of other complicating maternal and fetal causes does not conclusively predict adverse perinatal outcomes.

Aims: Aim of this study is to determine the incidence, clinical features, associated risk factors, treatment undertaken along with, morbidity and mortality associated with ectopic pregnancy. Methods: This retrospective study was done in Guru Gobind Singh General Government Hospital, attached to Shri M.P. Shah Medical college, Jamnagar, Gujarat, India. July 2017 to June 2018 for the period of 1 year. The following parameters: age of patient, parity at presentation, gestational age at presentation, associated risk factors, clinical features, site of ectopic gestation, diagnostic methods utilized, mode of treatment, morbidity and mortality were noted. Results: Out of 7700 deliveries, 64 were ectopic pregnancies (0.83%). Ectopic gestation was common in multiparous women (76.56%) and within age group of 20-25 years (40.6%). Common symptoms were abdominal pain (85.93%), amenorrhea (82.8%), bleeding per vaginum (53.12%), asymptomatic (14%) patients. Urine pregnancy test was positive in96.8%. Right sided ectopic was more common. In fallopian tubes ampulla (68.75%), cornua (10.93%), isthmus (9.37%), fimbria (7.81%), followed by ovarian ectopic (3.12%). About 64% of ectopic were ruptured at presentation. Tubal abortions were noted in 18.75% of ectopic pregnancies. Salpingectomy in 92.2% cases and salpingo-oopherectomy in 3.12% cases were performed in ruptured ectopic. Conclusions: Early diagnosis and identification of underlying risk factors coupled with timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality due to ectopic pregnancy.

Aims and Objective: The objective of this study was to analyze the maternal and perinatal outcomes in low risk early, full and late term pregnancies. Study design: A retrospective cohort study of low risk women at term pregnancies were categorized in to early, full and late term. Statistical comparison was done using Cramer’s V test. Results: Out of 1500 women with low risk term pregnancies, 26.4% were early term, 64% were full term, and 9.1% were late term. Spontaneous progress was seen in 46%, acceleration with syntocinon was required in 41.7%, gel induction in 12.3% among which 88.1% delivered vaginally with 20 instrumental deliveries and cesarean section required in 11.9%. Statistically significant variation was seen when early term compared with full and late term. Neonatal outcomes showed more number of LBW, NICU admissions, and neonatal deaths in early term group compared to full term with significant P value. Conclusion: Mothers who deliver at or after 39 weeks of pregnancy have better perinatal outcomes than do mothers who deliver before 39 weeks.

Objective: To assess the Feto-Maternal outcome in subjects of Eclampsia. Method: This prospective descriptive study (case series) was carried out in department of Obstetrics & Gynaecology, Govt. Medical College, New Civil Hospital Surat, enrolling 61 subjects with Eclampsia admitted in Labour Room at New Civil Hospital, Surat over a period of two years from August 2010 to July-2012 & followed till discharge. Summary: This study was conducted at New Civil Hospital, Surat enrolling subjects admitted with Eclampsia (n=61). The incidence of Eclampsia amongst our labour room admissions was 1.2%. All patient were given inj. Mgso4 for control of convulsions, and Adverse maternal outcome was noted in 33.4% subjects, Abruptio Placenta was the commonest complication noted in 13.1% subjects and maternal mortality in 2.4% subjects. Adverse Fetal outcome was seen in 67.2% subjects – prematurity accounting for 92.7% of the adverse Fetaloutcomes. Conclusion: Maternal mortality and morbidity increases in subjects with eclampsia. So it is important for clinicians to educate women about the early warning sign of Pre-eclampsiaand to identify women with severe PET to prevent Eclampsia. MgSO4 is very effective to prevent convulsion in severe PET and to treat Eclampsia.

Objectives:To find out associated risk factors, maternal outcome of pregnancies with polyhydramnios. Methods: This is retrospective study carried out at ACPMMC Dhule. 100 pregnant women who were diagnosed with polyhydramnios by USG from 24 weeks onwards till 40 weeks, were followed for associated risk factors, complications, severity of polyhydramnios, mode of delivery. Result: Study showed that the incidence was higher in 20-30 years of age group. 83% were multi and 17% were primi. It was mild in 78%, moderate in 16% and severe in 6% cases. 14% were associated with diabetes, 12% with PIH, 7% with multiple gestation, 2% with Rh negative pregnancy. 65% were delivered at term, 35% were preterm labour, 25% by PROM, 10% by fetal malposition and malpresentation, 4% by PPH and 2% by cord prolapse. 63% patients delivered vaginally and 37% by c-section. Conclusion: The study gives the understanding of impact of polyhydramnios on the maternal outcome. Careful maternal assessment must be performed when polyhydramnios is diagnosed, as it is associated with various maternal and perinatal complications and congenital anomalies. Early diagnosis of polyhydramnios and intervation will improve the outcome.

Aim: To observe the effect of Amniotic fluid index (AFI)<5 cms in predicting subsequent fetal outcome in low risk pregnancy with regards to mode of delivery, fetal complications, intrapartum and early neonatal mortality and need for NICU admissions. Method: Oligohydramnios is defined as AFI ≤5 cm. This study consists of an analysis of pregnancy outcome in cases with diagnosis of oligohydramnios (AFI <5) in 42 patients, by ultrasound after 37 completed weeks of gestation and those who fit the inclusion and exclusion criterias. This was a observational study done over a period of 28 months (August 2016 to December 2018). Low risk, at term women with 37 completed weeks of gestation was studied. For all the women, ultrasound examination was done, and AFI was calculated by four quadrant amniotic fluid volume measurement technique. For all women baseline investigations like hemoglobin%, blood group and Rh typing, urine examination, Non-stress test (NST) is done. It was have a regular charting of pulse, BP, weight, pedal edema, daily fetal movement count, fetal heart sound, amniotic fluid index and estimated fetal weight according to the latest sonography. Results: A total of 42 patients were included in the study. Most of the study population was between 20-24 years (61%) of age group, were multigravida (69%) and gestational age was between 37-38 weeks (79%). Fetal movement counting (FMC) was less than 10 in 52%. LSCS (62%) was the most common mode of delivery. Live births seen in 98%. Birth weight was less than 2.5 kg in 67% and APGAR score at 1 minute was less than 7 in 61% of study population. Number of NICU admission was found to be 14.3%. Meconium aspiration syndrome (MAS) was found in 26.2% of study population. Intrauterine growth retardation (IUGR) was found in 31%. Conclusion: We need to increase the awareness about effects of oligohydramnios. Oligohydramnios increases the chances of cesarean delivery and with vaginal delivery strict vigilance in labor is mandatory. So timely detection, early intervention by an obstetrician may help in improving the perinatal outcome.

Xanthogranulomatous inflammation of female genital tract is extremely rare entity. Very few cases have been documented in literature. It is an uncommon cause of chronic destructive process of the normal tissue of the affected organ. We presented 3 cases of xanthogranulomatous affection of tube and ovary in 27 years, 30 years and 74 years postmenopausal woman with unilateral hydronephrosis without having history of all known predisposing factors like pelvic inflammatory disease (PID), endometriosis, intrauterine contraceptive devices (IUCD). Their clinical examination, radiological evaluation, tumor markers, were likely to get confused with neoplasm in first case and large uterine fibroid mass in second case. Peroperatively It was found tubo-ovarian mass. On histopathological examination it came out with xanthogranulomatous inflammation of tube and ovary. So in this clinical scenario we should keep xanthogranuloma as one of differential diagnosis. It is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils.

Background & Aim: • To evaluate the outcome of births in last one year. • To evaluate the occurrence, indications, complications, interventions and outcomes of obstetric patients admitted in the Labor room. • To gather baseline data for expansion of the Obstetrics High Dependency Unit. Methods and Materials: A retrospective record based study was done for one year from 1st January 2018 to 31st December 2018 in a tertiary care referral hospital attached to a teaching medical institute. Institutional ethics committee approval was obtained for this observational study. The labor room record log was used to study the selected parameters. Results: There were total 1658 births in the study period of 1 year in 2018. 52 (3.1%) women were unregistered during their antenatal period and 298 (17.9%) women were referred for deliveries from other hospital. There were total 639 caesarean section performed and the section rate was 38.5% of all deliveries. The incidence of instrumental deliveries was 5.9%. Labor was induced in 97 (35.8%) women and post-dated pregnancy was the commonest indication for induction of labor. There were total 47 (2.8%) vaginal births after caesarean section. The incidence of still births was 103 (6.2%). Conclusion: The study depicts a summary of the births and deliveries occurring in a teaching hospital based on selected parameters. These findings can be utilized for refining the current quality of care, to help formulate the logistics of high risk pregnancy workload and provide a framework for establishment of Obstetrics High Dependency Unit.

Background: There has been an increase in rate of cesarean section over last few decades. There are various factors involved in the rise of rate of cesarean section. There has been an increase in primary cesarean section rate, a decrease in VBAC (Vaginal birth after cesarean section) trial, decrease in operative vaginal deliveries (Forceps/Ventouse), increase in litigations, increasing facility of electronic monitoring, and decreasing threshold of patients for bearing labor pains. Methods: A retrospective study was carried out in 2846 patients in the tertiary care hospital). The data were collected in a pre-designed proforma. Data were analysed & We have done a retrospective study of different indications of cesarean section amongst 2846 patients who underwent cesarean section from May 2017 to May 2018. Results: In our study, we found out that the most common indication was Previous cesarean section (46.2%), followed by Fetal Distress (13.4%) and malpresentations (11.4%). Non progress of labour (10.2%) and toxaemia of pregnancy (6.6%) were amongst the other indications. Conclusions: Reduction of number of primary cesarean sections and successful VBAC trials are recommended to keep the rate of cesarean sections to the possible minimum level.

Background and Aim: An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. Present reroseptive study was performed to determine the clinical features, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy in a tertiary care hospital. Material and Methods: A Retrospective study was conducted in the gynaecology and Obstetrics (G & O) ward of the hospital from July 2006 to May 2010. Two researchers of this study were from same unit of G & O department of the study hospital. All the cases diagnosed intra operatively as ectopic pregnancy (EP) were considered as final study population and included in the study. After the patient became stable, history taken post-operatively as per pre designed and semi structured proforma. Results: Out of 103 women, 45 (69%) from urban area, 14 (13.59%) from rural area and 44 (42.72%) data was not available. Out of 104 women, 46 (44.66%) in 19-25 age group. Out of 103 women 11 (10.68%) women tested for VDRL and reported negative and 7 (80%) women tested for HIV and reported negative. Per operatively 4 women (3.88%) had omental adhesions, 3 (2.91%) had intestinal adhesion and 2 (1.94%) had tuboperional adhesions and 1 (0.897%) had chocalate cyst. Paracentesis 2 (1.94%) cases and culdocentesis in 1 (0.97%) noted. Conclusion: In our study, there is higher chances of occurrence of ectopic pregnancy in case of Lap TL (11 cases) abdominal TL (7 cases) 17.48%) and with past H/o Cu-T usage are 11 cases (10.68%). More mode of treatment was salpingectomy. Total mortality 1 case (0.97%) occurred during the study ruptured due to of ectopic.

Objective: To assess the fetomaternal outcome in subjects of severe PET. Method: This prospective descriptive study (case series) was carried out in department of obstetrics & gynecology, Govt. Medical College, New Civil Hospital Surat, enrolling 142 subjects with severe Preeclampsia (Severe PET) admitted in labour room at new civil hospital, surat over a period of two years from august 2010 to july-2012 & followed till discharge. Summary: This study was conducted at new civil hospital, surat enrolling subjects admitted with severe PET (n=142). The incidence of severe PET amongst our labour room admissions was 1.2%. All patient were given labetalol for control of hypertension, but labetalol alone was sufficient in 74.49% subjects and other anti-hypertensive were needed in 25% subjects. MgSO4 sulphate prophylaxis was administered in 72 out of 142 subjects with severe PET- none of whom developed subsequent eclampsia. 66.9% delivered vaginally, 6.9% had assisted vaginal delivery while 26.1% had CS. Adverse maternal outcome was noted in 34% subjects, abruptio placenta was the commonest complication noted in 10.3% subjects and maternal mortality in 3.9% subjects. Adverse fetal outcome was seen in 11.8% subjects – prematurity accounting for 85.2% of the adverse fetal outcomes. Conclusion: Maternal mortality and morbidity increases in subjects with severe pre-eclampsia so it is important for clinicians to educate women about the early warning sign of pre-eclampsia and to identify women with severe PET. Labetalol is an effective drug to control the severe hypertension noted in pre-eclampsiaand MgSO4 is very effective to prevent convulsion in severe PET.

Background: Today, laparoscopy is one of the most common surgical procedures performed by gynaecologists because of being safe and minimally invasive. Short hospital stay, reduced morbidity, quick mobilization and comfortable postoperative period are main advantages of the laparoscopic technique. Aim: 1. to study incidence of laparoscopic surgeries out of total major Gynaec surgeries in rural india. 2. To study varieties of laparoscopic surgeries in rural setup. 3. To study various indications of Laparoscopic surgeries. Material and Methods: The present Retrospective Observational study was conducted in the OBGYN Dept, CCM MC, Kachandur, Durg (Chhattisgarh) in 810 women between January 2014 to June 2018 (54 months). After inserting camera through primary port, quick evaluation of whole abdominal cavity was undertaken by rotating 300 camera through 360 degrees to rule out any adherence of bowel and decision made for inserting secondary 5 mm ports through small incisions under direct vision. Results: Out of total 4128 major gynaecological surgeries 810 patients underwent gynaec laparoscopic surgeries i.e. 19.62%. Out of total 810 surgeries, maximum 570 (70.37%) cases were of Operative & 240 (29.63%) cases were of Diagnostic Laparoscopy. Out of total 58 cases of Diagnostic Laparoscopic only maximum 48 (82.75%) cases were of Chronic Pelvic Pain & Chronic PID. Out of total 570 cases of Operative Laparoscopy maximum 247 (43.33%) cases were of TLH followed by Lap Cystectomy (16.67%), LTT (08.42%), Lap Myomectomy (06.31%), Ectopic Pregnancy (06.14%), Lap Adhesiolysis (05.09%), Lap TO Mass Removal (03.68%), LAVH (3.51%), Lap Sacrocolpopexy (02.46%) Lap Resection of Adenomyoma (01.75%), Lap Wertheims Hysterectomy (00.88%) & minimum both of 3 cases (00.53%) were of Embedded CuT Removaol and Vaginoplasty by Davydov’s Technique. Conclusion: It is very important to understand that in our rural set-up minimal access laparoscopic surgeries are not only feasible but very safe, effective, short hospital stay & not so costly as a both diagnostic and operative tool.

Aims: To review the causes, indications, age groups, maternal and fatal outcomes in case of peripartum hysterectomies taken place in tertiary health care set up like G.G.G. Hospital, Jamnagar. Methods: All women who had undergone hysterectomy during pregnancy, labor and puerperium were included. It also contained women who had undergone hysterectomy due to sepsis or perforation due to curettage. Results: Out of total 19072 deliveries, in a duration of 2 years, there were total 32 Obstetric Hysterectomies. A rate of 1.67 per 1000 deliveries. With maternal age between 31-35 years, parity of >2 and uterus atonicity being the most common indication of all. Conclusion: Obstetric hysterectomy is a lifesaving procedure. Decision should be prompt and treated by an experienced surgeon. Every obstetrician should be trained to perform this procedure. Even so, by good obstetric practices, we should be able to bring down the number of obstetric hysterectomy.

Objective: • To compare fetomaternal outcome of pregnancy in booked versus unbooked patients. • To study the effectiveness of hospital based antenatal monitoring and care. Material and method: This was a prospective analytical study carried out at tertiary health centre, Surat from July 2017 to February 2018. This study was carried out to assess and compare the impact of fetal and obstetrical outcome in booked and unbooked mothers. Booked patients were those who had at least three antenatal care visits while unbooked patients encompassed those who had no antenatal care throughout the index pregnancy or those who had less than three antenatal visits in the current pregnancy. Result: Total 1000 patients were recruited in study out of which 500 were booked mothers while 500 were unbooked mothers. It was observed that maximum booked and unbooked mothers belonged to the age group of 26-35 years. Besides having a lower education level (48.6% primary education), the majority of unbooked mothers belonged to lower socio economic class (46.2%) as compared to booked mothers (30%) [p value <0.001]. It was observed that unbooked mothers (56.8%) belonged to rural area as compared to booked mothers (27.2 %) [p value <0.001]. It was observed that there was an increased prevalence of anemia, antepartum haemorrhage, obstructed labour, preeclampsia, eclampsia, postdatism, preterm labour, liquor abnormalities, medical conditions in unbooked mothers as compared to booked mothers. Maternal and perinatal morbidity and mortality rate was found to be significantly higher in unbooked group as compared to booked group. Conclusion: The pregnancy outcomes in booked mothers are far more successful in unbooked mothers. Thus it can be concluded that provision of antenatal care improved the maternal morbidity and prevented maternal mortality.

Background: Immediate postpartum intrauterine contraceptive device (PPIUCD) insertion is approved by WHO as one of the safe and effective method of temporary contraception. Aims and Objectives: To evaluate and compare the safety and efficacy of post placental versus intra caesarean insertion of intrauterine contraceptive device (CuT 380A). Material and Methods: This prospective study was carried out on 210 patients. The patients were divided in two groups: Group I: 105 patients in whom post placental intrauterine contraceptive device was inserted within 10 minutes of delivery of placenta after vaginal delivery. Group II: 105 patients in whom intra caesarean intrauterine contraceptive device was inserted. Results: Mean age of women in group I was 24.94 ± 2.67 years & 24.81 ± 3.15 years in group II. Majority of women in group I, 40 (38.09%) women and 47 (44.76%) in group II were primigravida. In group I, 56 (53.33%) women & 51 (48.57%) in group II had PPIUCD insertion for long acting reversible contraception (LARC). In group I, 49 (46.66%) women & 54 women (51.42%) in group II had PPIUCD insertion only to space the next pregnancy. The most common complication seen at 6 weeks was missing thread in both the groups, 7.61% in group I & 28.57% in group II (p value 0.001 significant). At 6 weeks, 21 women (20%) in group not statistically significant. The incidence of missing thread of PPIUCD was more in intracesarean insertion than post placental insertion, but proper counselling and awareness motivated majority of the women for continuation of PPIUCD. The continuation rate & removal rates were same in both the groups. There was no case of pregnancy or perforation in either of the groups. Hence, PPIUCD is highly effective and safe long acting contraceptive method both in vaginal as well as cesarean deliveries with no major complications.

Background: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre– existing disease. Those patients with critical illness require close monitoring and intensive care.To determine the current spectrum of diseases requiring admissions in High dependency unit (HDU)/ intensive care unit (ICU) at a tertiary care hospital. Methods: A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. Results: A total of 102 (1.6%) of patients among admitted to the hospital required ICU admissions. Among them 14% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis and 9.8% of maternal deaths were seen in this group. Conclusion: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive carespecialist for the optimal care of these patients.

Introduction: The present study aimed to assess whether changes in platelet indices, during pregnancy could be used as markers for prediction of development of hypertensive disorders of pregnancy. Methods: A total of 255 antenatal patients matching the inclusion and exclusion criteria was taken up for this study. Platelet count and its indices (MPV & PDW) were done at 10-12 weeks and repeated again at 28-30 weeks. Clinical manifestation of development of hypertensive disease and its relation with platelet indices in respective patients were analyzed. Results: Mean platelet count at 10-12 weeks was 2.53 lakhs in normotensives as compared to 2.21 lakhs in cases who developed HDP (p<0.05). Mean platelet volume (MPV) at 10-12 weeks was 9.74 fl in normotensives as compared to 10.81 fl in cases who developed HDP (p<0.05). Mean platelet distribution width (PDW) at 10-12 weeks was 11.89% in normotensives as compared to 14.15% in cases who developed HDP (p<0.05). Derangement of platelet indices was seen in 33 cases out of total 255 cases at 10-12 weeks. Out of these 33 cases, 6 (18.2%) developed HDP while out of the remaining 222 cases of normal platelet indices, 14 (6.3%) developed HDP. Conclusion: Platelet indices provide an effective tool to monitor HDP. The increase in PDW provides a tool in the early diagnostic assessment of HDP. Currently, the platelet count is only used as one of the criteria for the diagnosis of preeclampsia. However, assessing the PDW and MPV may be beneficial as an indicator of preeclampsia and eclampsia.

Background: Mother and newborn SSC is a low-cost intervention that would be accessible, simple, and feasible for most mothers in developing countries. Keeping the newborns in their natural habitat immediately after their birth initiates successful adaptation to extrauterine life. Skin – skin contact at birth is a profound intervention which increases the physical, mental, social stability and well being of the baby. The early mother newborn contact will help to initiate breast feeding at an early time, foster the newborn attachments process at the earliest and there by enhancing the bond between mother and her newborn. The present study was conducted in order to assess the effects of post birth mother newborn skin to skin contact on maternal satisfaction & success of first breastfeeding. Methods: A quazi experimental two group post test only design was used for the study. Conceptual framework was based on Ramona. T. Mercer’s Maternal Role Attainment theory. Study was conducted in the Labor room of District Hospital, Thrissur from March - May 2102. 60 samples were selected using purposive sampling. (30 mother newborn dyads in the intervention group who received skin to skin contact immediately after birth and 30 mother newborn dyads in the routine care (RC) group) After delivery, immediate skinskin contact (SSC) was given to the intervention group. Success of First Breast Feeding was observed in both the groups by using First Breast Feeding Assessment tool. Maternal satisfaction on first Breast Feeding was assessed by using a Maternal Breast Feeding Satisfaction Assessment Scale. The data was compared by using t-test. Significant p-value was taken as < 0.05. Results: Twenty one (70%) infants in SSC group had score of 11-20 (successful first breast feeding) on First Breast Feeding Assessment tool compared to sixteen infants (53%) in RC Group during the first breastfeed. Maternal levels of satisfaction were high as 90% in SSC group as compared to 60% in RC Group. Newborns who experienced SSC initiated breastfeeding 10.41 ± 3.38 minutes after delivery, while newborns in the routine care group started breastfeeding 16.48 ± 2.70 minutes following their birth (p < 0. 05). Duration of the first breastfeed in mothers with SSC versus RC Group was 17.22 ± 3.04 minutes and 15.98 ± 3.66 respectively (p < 0.05). Conclusion: Maternal-infant early skin-to-skin contact significantly enhanced the success of first breastfeeding. It reduced the time to initiate first breast feeding and improved the time span of first feeding.

Introduction: The use of Ambulatory blood pressure monitoring may help in accurate assessment of blood pressure patterns throughout pregnancy and early detection of pre eclampsia. Objective: To determine whether Ambulatory BP monitoring is comparable to conventional BP measurements in pregnancy. Methods: A prospective study was conducted in Department of OBG at JSS Hospital from July 2016- June 2017. 40 women, 18–35 years of age with no risk factors like multiple pregnancy, molar pregnancy, chronic hypertension, renal, cardiac, connective tissue disorders, diabetes and thyroid disorders were recruited. Office BP monitoring and 24 hour Ambulatory BP measurement using Welch Allyn 6100P Ambulatory BP monitor was done. The BP was recorded at 8–14 weeks, 16–20 weeks, 22–28 weeks and 32–36 weeks. Results: The SPSS 21 software was used for statistical analysis. The mean ambulatory systolic and diastolic pressures did not show significant difference when compared to office BP. The night time ambulatory pressures when compared to office recordings also did not show significant changes. There was no night time dip in BP in majority of women. Conclusion: Ambulatory BP monitoring is an effective method, which may be used in high risk women, for early detection of hypertensive disorders in pregnancy.

This study aimed to evaluate outcome of various malpresentations at the teritary care centre. There are various causes of maternal and perinatal morbidity and mortality with neglected and mismanaged malpresentation being one. This prospective study was carried out at tertiary care center and teaching institute in the Department of Obstetrics and Gynecology over a period of 18 months. During this period 384 cases of malpresentations were delivered. Out of which 134 delivered vaginally and 246 by caesarean section. Majority of cases i.e. 86% were breech presentation, 8.2% were transverse lie,. 4.2% face presentation. Of the 328 cases of breech 49% were complete breech. 89.4% cases were in full term group which had good fetal outcome. 97% of cases out of 65.6% cases that were delivered by caesarean section had good fetal outcome. Our study states that breech presentation is the commonest type of malpresentation and though caesarean section yields better perinatal outcome, we can conclude that vaginal breech delivery is also safe with good maternal and fetal outcomes. Transverse lie and brow presentation are conditions that poses significant clinical challenge, both in terms of perinatal and maternal survival. Thus early diagnosis followed by caesarean delivery are likely to give better clinical outcome. The corner stone of proper management of malpresentations lies in provision of good antenatal care and maternal and fetal outcome can be improved by early diagnosis. Delivery in cases of breech and face presentation should be conducted in hospital with well equipped caesarean facilities and skilled obstetrician because once it becomes neglected then the maternal and fetal outcome is poor.

Background & Aim: • To compare the efficacy of Ropivacaine Versus Bupivacaine for post-operative analgesia during surgical TAP block during caesarean section. • To correlate the advantages and side effects of the drugs during the surgical TAP block. Methods and Materials: A randomized control study (double blind) including 100 women who required caesarean section and fulfilled the inclusion criteria. Institutional ethics committee approval was obtained for this prospective study Patients were randomized as Group A: received surgical TAP block with Bupivacaine. Group B: received TAP block with Ropivacaine. Surgical TAP block was administered to the patients via the trans-peritoneal route with dose of the drug adjusted with weight of patient and visual analogue score (VAS) was assessed by an observer blind to the group allocation. Time required for rescue analgesia was and the ‘Mann-Whitney U test’ was used for statistical analysis. Results: The duration of postoperative analgesia in hours was comparable in both groups [Group A: Bupivacaine 5.24 ± 1.53 hrs, Group B Ropivacaine 4.96 ± 1.58 hrs]. There were no reported complications during the surgical technique or any adverse effects to bupivacaine and ropivacaine administered for the TAP block. Conclusion: Surgical TAP block with Bupivacaine and Ropivacaine is equally effective with no significant difference in the duration of post-operative analgesia. Surgical TAP block is a safe, effective and easy technique to provide post-operative analgesia and should establish as a routine during caesarean section delivery.

Keywords: Transversus Abdominis Plane Block; Bupivacaine; Ropivacaine; Surgical TAP block.

Aim: To compare and evaluate the effectiveness of different types of conservative surgical suture in the management of PPH (postpartum haemorrhage) after failed medical treatment. Settings and Design: Retrospective study at tertiary care hospital in Chandigarh and New Delhi. Methods and Material: Total of 62 women were included in the study, encountered over period from December 2004 to December 2016, in whom different types of conservative surgical sutures were used in combination with or without devascularisation technique for the management of PPH not responding to medical treatment. Statistical analysis used: Categorical variables are presented in number and percentage (%) and continuous variables are presented as mean ± SD. Results: Different conservative surgical sutures used in the management of PPH were effective in 80.64% of cases (50/62). The success rate of conservative compression sutures with devascularisation techniques was 91.93% ( 57/62). The most common cause of PPH encountered during caesarean delivery was uterine atony (51/62, 82.25%) followed by placenta praevia (11/62, 17.74%) in our study. The success rate for U shaped compression suture in cases of uterine atony was (19/22) 86.36% and B-Lynch was 10/12 (83.33%). Conclusions: Conservative surgical sutures with or without devascularisation technique are an effective method for the management of postpartum haemorrhage not responding to medical treatment.

Introduction: Rupture uterus is a rare but potentially catastrophic obstetric complication with serious maternal morbidity and fetal mortality. This is a three year (2014-17) retrospective clinical study of cases of uterine rupture in labour room in a tertiary care institute. Aim: Aim of study was to evaluate the incidence of uterine rupture, associated risk factors, diagnosis (clinical features), complications, different surgical modalities of management and maternal n fetal outcome. Material & Methods: Retrospective analytical study of 14 cases of rupture of uterus in SMIMER, surat was collected from case records of 16221 deliveries during a three year span of (July, 2014-July 2017). Parameters like age, gravida, cause of rupture, type, site of rupture, surgical management and maternal n fetal outcome were recorded. The collected data was analysed by SPSS software v19. Results: Out of 16221 deliveries during the 3 year period there were 14 cases of uterine rupture with incidence of 0.86 in 1000 deliveries. Mean age of rupture was