Indian Journal of Obstetrics and Gynecology

Introduction: Doppler ultrasound would be a useful in antenatal fetal well-being and timely intervention. On the basis of abnormal Doppler results, obstetrical decision makingmay improve and prevent intrauterine death because hypoxic cerebral damage may begin before labor and intrapartum asphyxia is probably more damaging when superimposed on underlying hypoxia. Aims: To evaluate the role of Foetal Doppler in high risk pregnancy with relation to perinatal outcome. Materials and methods: A total of 50 patients over a period of 16 month were screened with Doppler scans at late second and third trimester. The patients with high-risk pregnancies were volunteers recruited from women undergoing routine ultrasound examination in the late second and third trimesters. Results: intrauterine growth restriction (IUGR) (n=39); preeclampsia; preeclampsia with IUGR, obesity; and others. Most of the patients were primigravida and constituted 62% of total in each group. MCA PSV increased and PI decreased with advanced gestational age. The mean PI ratios were 0.75 ± 0.15 respectively. The values in high risk group were statistically significantly reduced from the mean in values in normal pregnancy. Of 50 patients 39 (78%) had normal flow, 4 (85) had pulsation and 7 (14%) had reversal of flow. Reversal of flow was significantly related to fetal morbidity and mortality. PV IV of Ductus Venosus in high risk group was (0.78 ± 0.54). The values were statistically significant increased as compared to pregnant women with no high risk factors. None of the patients had reversal of “A” wave. For adverse fetal outcome abnormality, fetal venous parameters were more sensitive and specific as compared to the arterial parameters. Conclusion: Fetal Doppler velocimetry studies of the foetal circulation play a crucial role in the monitoring of high risk pregnancies and henceforth, help to evaluate the optional time for delivery

Fibroid is the commonest benign tumor of the uterus and extrauterine sites are rare of it. Broad ligament fibroid is most common extrauterine site. We are presenting a case of 43 year old female Multipara, sterilized who presented in guru hospital, Madurai with complaints of abdominal distention with abdominal pain. CA 125 was borderline 37.5. On evaluation it was look like ovarian malignancy/ broad ligament fibroid. Intraoperatively, uterus was pushed to side and a broad ligament fibroid of 30 × 25 × 18 cm noted which is densly adhered to bowel posteriorly and ureter is passing lower and medial to mass. Exploratory laprotomy with total hysterectomy with excision of broad ligament fibroid done which was weighing 8.5 kg. Histopathology came as broad ligament fibroid with hyline and cystic degeneration. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor, benign fibroid with cystic degeneration and surgical oriantation for its removal.

Background: Fever is the most common way of presenting any type of infections, which when left without appropriate treatment can result in adverse foetal as well as maternal outcomes. Fever can easily be presented during pregnancy time because of low immunity levels, so proper guidelines have to be given about the management of fever. It is therefore important to assess the levels of awareness in our communities. Methods: A cross sectional questionnaire-based interview was conducted among 100 pregnant women in early pregnancy who attended outpatient department of obstetric and gynecologydepartment of saveetha medical college, chennai. The study was conducted after ethical clearance and after informed consentto assess the awareness about fever during early pregnancy. Result: Overall results showed insufficient knowledge and awareness about the complications of fever in early trimester. Most of the antenatal mothers 16% had satisfactory awareness, 80% had poor awareness, and 4% had good awareness about fever during pregnancy. Out of the 80% of the antenatal women who had poor awareness about complications of fever during pregnancy, 75% belonged to lower socioeconomic class and the remaining 5% belonged to middle class. Out of the 16% of the antenatal women who had Satisfactory awareness about complications of fever during pregnancy, 15% belonged to middle class and the remaining 1% belonged to upper socioeconomic class. Out of 4% of the antenatal women who had good awareness about complications of fever during pregnancy, 4% belonged to upper socioeconomic class. Out of 80% of the antenatal women who had poor awareness about complications of fever during pregnancy, 25% had no formal education, 30% had completed their primary school education and the remaining 25% had completed their high school educatIon. Out of 16% of the antenatal women who had satisfactory awareness about complications of fever during pregnancy, 10% had completed their high school education and the remaining 6% were graduates. Out of 4% of the antenatal women who had good awareness about fever during pregnancy, 3% professionals and the remaining 1% were degree holders. Conclusion: Our participants did not have ample knowledge and awareness about the complications. Hence awareness programmes need to be implemented in the low socio-economic. This will decrease complications of fever during pregnancy.

Background: Postpartum intrauterine contraceptive device (PPIUCD) is easily applicable and available postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Aim: To analyse the relation of various factors associated with removal of PPIUCD. Method: It is a retrospective observational study. A Cohort of 770 vaginal and caesarean deliveries with PPIUCD insertions, over a three-year period, was studied. Results: Amongst the various reasons abdominal pain is found the most confounding factor for removal at any time. Literacy does not seem to have any concern with continuation rate. In fact, higher the education lower the continuation rates. With increasing number of male child removal rate is higher. Intra caesarean insertions have showed higher continuation rates with preference of removal at NCH. Conclusion: PPIUCD is a promising method for immediate postpartum family planning. Early and frequent follow ups with counseling plays a very important role in acceptance as well as continuation of use.

Background: Ensuring safe pregnancy and motherhood occupies a pivotal role and is considered as one of the key issues in the framework of Reproductive and Child Health program. Cesarean section continues to be one of the most important surgical interventions performed in obstetric practice. Implementation of Robson’s 10 group classification system in various institute, corporate hospitals, tertiary care centers and in various hospital settings will help in knowing exact number of caesarean section rate and limiting the rate of caesarean section in various groups and focus on those group in reducing the caesarean section rate. This classification system will provide the backbone for yearly audits of hospitals. It will help to set up new protocol for hospital settings. Materials and methods: All pregnant patients coming in the maternity ward for admission were examined. After taking thorough history, examinations of patients were done. Patients were followed during course of labor. Patients who underwent caesarean sections were classified according to Robson’s 10 group of classification Results: Analysis based on Robsons classification showed that Group 5 made the greatest contribution in C sections rate. Group 1 and Group 2 made second and third highest contribution in C section rate as per nulliparous patients Further more we analysed Group 5 almost 85% of women undergone C sections for previous C sections Group 9 has 100% C section rate Conclusions: Group 1 and Group 2 which consists of nulliparous patents with either spontaneous or induced labour is having more caesarean section rate. More focus should be on these groups to reduce primary caesarean section rate.

Background: Instead of gonadotropins, laparoscopic ovarian drilling is considered an alternative method to induce ovulation in polycystic ovary syndrome. Aim: This study is a prospective study to compare the efficacy of ULOD versus BLOD in clomiphene citrate resistant patients in terms of ovulation and pregnancy rates. Materials and Methods: This study was a prospective, parallel randomised clinical trial which was conducted between May 2010 to June 2011. 110 PCOS patients with CC resistance were allocated randomly into ULOD (Group I) and BLOD (Group II) Results: A total of 110 patients with PCOS who underwent LOD were included. These patients were divided equally in two groups of ULOD and BLOD. Between two groups, baseline characteristics difference of patients prior to laparoscopy were not significant (p>0.05). No significant differences were observed in clinical and biochemical responses also. In both groups, after drilling, LH and testosterone levels mean serum concentrations were decreased. Between two groups, the mean decrease in serum LH and testosterone concentrations levels were not statistically significant. Conclusion: In ovulation and pregnancy rates, ULOD seems to be equally efficient as BLOD.

Background: Evaluation of AUB in perimenopausal women is important because, during this period the endocrinological, biological and clinical features approaching menopause commences. The present Study was conducted with the aim to study and analyze clinic-pathological evaulation with clinical findings of cases wherever applicable. Method: It is a hospital based study conducted during the period of 2015 to 2017 in every consecutive Patient attending, Department of obstetrics and gynecology, GSL medical college. Patients were selected according to the inclusion criteria. Informed and written consent was taken from all the cases enrolled in the study. Ethical clearance was obtained from the ethical committee Base line information and clinical history of a patient was obtained in a pre designed proforma. Result: Majority of Patients about 45% were having Heavy Menstrual bleeding, 32.5% of them with intermenstrual bleeding followed by Irregular Bleeding with 10%. Scanty bleeding and Postmenopausal bleeding accounted for 7.5% and 5% respectively. As per clinical, radiological and histopathological diagnosis leiomyoma accounted for major aetiological factor that is 41.3%, 36.3% and 37.5% clinically, radologically and histologically respectively, followed by Ovulatory dysfunction with 33.8% clinically, 32.3% radiologically and 31.3% histologically. Conclusion: Clinical impression should be placed in to proper perspective of structural and non structural classification so that accurate diagnosis based on proper work up can help in optimizing the treatment protocol. Histopathology proved to be of little help in diagnosing adenomyosis, malignancy and endometrial hyperplasia as it is impossible to diagnose them clinically.

Tuberculosis (TB) caused by the bacterial pathogen mycobacterium tuberculosis (MTB) is one of the oldest and hardiest diseases known to mankind. The primary site of infection is the lung, spread to other organs can be haematogenous or through lymphatics. 15–20% of all TB cases are extra-pulmonary TB (EPTB). In females, genital TB infection (FGTB) first strikes the fallopian tubes, followed by the endometrium and ovaries with devastating effects. Symptomatology is varied and vague with the commonest presentation being infertility and menstrual irregularity. Diagnosis is difficult due to the pauci-bacillary status and requirement for tissue biopsy. Increase in empirical treatment has contributed to the increase in drug resistance. The aim of these good clinical practice guidelines is to encourage a uniform, evidencebased practice for suspecting, diagnosing and managing female genital tuberculosis in an Indian setting.

Introduction: One of the most important and under appreciated reproductive health problems in developing countries is the high rate of infertility and childlessness. The inability to procreate is frequently considered a personal tragedy and a curse for the couple, impacting on the entire family and even the local community. Negative psychosocial consequences of childlessness are common and often severe. About 20% of all patients diagnosed with polycystic ovarian syndrome (PCOS) and infertility, will not ovulate after ovulation induction treatment with clomiphene citrate. Even today, the effective treatment of clomiphene resistant PCOS remains a challenge for the medical profession. Aim & Objective: Study of laparoscopic evaluation in infertility cases at Panna Dhai Mahila Chikitsalaya, Udaipur. Material and Methods: Total 100 cases randomly selected attending OBG OPD with both primary and secondary infertility were studied. After taking detailed history, thorough clinical examination, investigations and informed consent diagnostic laparoscopy was done between 7th to 11th day of menses under GA. Patient was discharged on the 2th postoperative day according to her general condition and was followed on 5th postoperative day for stitches removal. Results: 62 cases were primary infertility and 38 cases were of secondary infertility. Pelvic ultrasonography was normal in 54 women. 77% of the women reproductive pathology was noted on laparoscopy. 23% women had normal study. In 25% of the women reproductive pathology was freshly detected by laparoscopy, which was missed by other modalities like clinical examination and ultrasound. 20 women conceived during the period of study. Among these 13 (22.14%) women had undergone concurrent therapeutic interventions at laparoscopy conceived during follow-up. 8 conceived spontaneously, 4 women who had polycystic ovaries had undergone ovarian drilling conceived after ovulation induction. One woman conceived with GnRH agonist. 6 women conceived with ovulation induction in subsequent cycles and one woman with unilateral tubal block conceived after hydrotubation in subsequent cycles. Conclusion: Most effective treatment decisions and interventions can be made in the light of laparoscopic findings in managing infertility. Though laparoscopy is invasive the complications associated with the procedure can be minimized with proper training.

Heterotopic pregnancy (HP) is defined as the coexistence of an intrauterine pregnancy and an ectopic pregnancy i.e. the presence of simultaneous gestations at two or more implantation sites [1]. Incendence of heterotopic preganancy is around in infertility treated patients 33/10,000, but it is very rare among women who conceive spontaneously amounting to 1:30,000 pregnancies [2]. Both diagnosis and management of the disease is difficult and can be sometimes even life threatening. We are reporting a rare case of multiparous woman with a spontaneous conception resulting in a triplet heterotopic pregnancy : a twin intrauterine pregnancy and a single left tubal ectopic pregnancy, that presented with tubal rupture which was successfully surgically treated with preservation of the intrauterine pregnancy.

Keywords: Heterotopic pregnancy; Triplet; Spontaneous conception.

Carcinoma of cervix is most common genital tract malignancy in India. It has two bimodal age pattern one at 35 year and another at 65 year. Incidence of carcinoma of cervix at young age is very rare. Here we present an advanced case of cancer cervix in a 24 year old woman. A 24 yrs old, nullipara woman presented to gynecology OPD with complaints of foul smell discharge per vaginum and post coital bledding pervaginum since 2 months. On examination a large ulceroproliferative growth was present which involved whole cerxix, vagina, fornices and extended up to lateral pelvic wall. Histopathological came out as large cell non-keratinizing squamous cell carcinoma. As clinical diagnosis was Carcinoma cervix stage 3B, patient managed on chemoradiation. Along with implenentation of public health programme, targeting young People to avoid high risk sexual behavior, avoid tobacco, the most important measure to prevent invasive cancer in young women is inclusion of HPV vaccine in national vaccination schedule

Keywords: Carcinoma of cervix; Young woman; Human pailloma virus vaccine.

Background and Objectives: In spite of increasing awareness, controversies prevail among Obstetrics and Gynaecology healthcare practitioners (HCPs) regarding use of hormone therapy in the management of menopause. This study aimed to assess the current understanding and practices among HCPs in menopause hormonal therapy (MHT) in Tier I and II cities in North and West India. Methods: An MHT certification training course was conducted for HCPs by Pfizer Ltd. in partnership with Indian Menopause Society (IMS), and a subsequent clinic-based cross-sectional interviewer-administered survey was carried out. A section of questions was devoted to obtain feedback on the course. A total of 140 HCPs volunteered to complete the survey and data was reported using descriptive statistics. Results: Eighty nine out of 140 (64%) HCPs believed that hormone therapy should be routinely prescribed to symptomatic menopausal women. The two most common factors influencing initiation of MHT were severity of symptoms (76%) and age at presentation (53%). Conjugated estrogens were the first choice for 44% of HCPs in their prescribing practice and 43% preferred prescribing MHT for 6–12 months. All HCPs reported that the course helped them improve their understanding about menopause and most important learning point was that hormone therapy should be started early. Additionally, 96% of HCPs felt that refresher training in MHT would be beneficial for their practice. Conclusions: Menopause hormonal therapy is gaining acceptance as a preferred treatment in menopause management. However, reservations exist regarding the duration of therapy. Regular training may reinforce confidence of HCPs in prescribing MHT.

Objective: Objective of this study was to assess the impact of deranged renal function and severity of disease in terms of number of fits and mean arterial pressure on incidence of toxicity of MgSO4 and to compare the standard regimes of Magnesium sulfate by IM and IV routes. Method: A prospective study was performed on patients of eclampsia and severe preeclampsia. Result: Subjects with creatinine levels > 0.80 mg/dl, mean arterial pressure ≥ 130 mmHg and No. of fits >3 have significantly higher percentage of patients with loss of DTR (p value = 0.002; 0.05; 0.04 respectively). At higher creatinine levels >0.80 mg/dl significantly less percentage of patients with loss of DTR were found (p value = 0.009) with IV route compared to IM route. At mean arterial pressure ≥ 130 mmHg and No. of fits >3 results were comparable with IM and IV routes of MgSO4. Conclusion: IV route was found safer in patients with higher creatinine values. But with further increase in severity as evident by mean arterial pressure ≥ 130 mmHg and No. of fits >3 route of MgSO4 did not matter.

Background: Severe acute maternal morbidity (SAMM) also known as maternal near miss (MNM) is defined as “Any woman who nearly died but survived as a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. For adequate evaluation of maternal health, all these cases should be included in analysis. Aims and objectives of this study were to analyze the cases of severe acute maternal morbidities with regards to aetiology and management. Methods: This prospective analytical study was conducted from March 2017 to August 2018. Cases of SAMM according to WHO criteria were included in the study. The data were analysed using Microsoft excel spreadsheet and SPSS software. Descriptive statistics had been used in the analysis and data had been presented as frequencies, ratios and percentages. Results: There were 14070 Obstetric admissions, 11560 live births, 248 cases of SAMM/MNM and 38 maternal deaths (MD) during the study period. MNM ratio (MNMR) was 21.45 per 1000 live births (MNMR/LB). Obstetric hemorrhage was the leading cause (37.9%) followed by hypertensive disorders of pregnancy (34.27%). Most common intervention was transfusion of blood components (63.30% cases). Majority of cases (69.35%) required 7-14 days of hospital stay. Neonatal outcome was poor-stillbirth occurred in 13.76% cases and 32.08% babies required NICU admission. Conclusion: Severe Obstetric morbidities can be prevented if they are diagnosed and managed at early stage. Review of MNM cases can greatly help to improve maternal health and to reduce maternal mortality.

Aim: The aim of this study is to Study on Severe Acute Maternal Morbidity in patients attending Sultania Zanana Hospital, Bhopal. Study Design: Observational Study. Result: Among all the cases of SAMM maximum 66.2% were in the age group 20–30 yrs. This is due to the fact that 20–30 yrs is the most fertile period of a woman’s life. Maximum cases i.e. 95.96% were unbooked emergencies. The strong positive association between level antenatal care obtained during pregnancy and degree of severe acute maternal morbidity. Primigravidas were 25.8%, 61.29% were multiparas, and 21.9% were grandmultiparas. Hemorrhage was the leading cause of severe acute maternal morbidity in our setting accounting for 62.9% of the cases, followed by hypertensive disorders of pregnancy representing 20.16% of total cases. Conclusion: The most common reason for SAMM was Hemorrhage of which ruptured ectopic pregnancy emerged out to be the commonest obstetric factor followed by eclampsia among hypertensive disorders of pregnancy. Reduction of maternal deaths in this centre therefore requires channeling of resources towards the prevention of hemorrahage & hypertensive disorders at the lower level of health care system while strengthening the resources for their treatment in the tertiary care hospital. This implies maintaining & improving the existing preventive measures & treatment strategies for early identification of ectopic pregnancy, for eg use of transvaginal sonography & improving the protocols & resources for managing it. Necessary facilities should be made available and training of doctors in both basic and emergency obstetric care should be frequently conducted to combat the identified disease processes that received suboptimal care during pregnancy.

Introduction: Intrauterine Contraceptive device is an effective, safe and convenient method of contraception used worldwide. It may have complications like missing threads, abnormal uterine bleeding, perforation and migration to neighbouring structures. The device has nylon thread attached to its lower end and this thread protrudes through cervical canal into vagina. Missing strings of IUCD is a common complaint, among IUCD Users with, possibilities of spontaneous expulsion or it could be intrauterine, Partially embedded in the myometrium or trans migration to extra uterine structure. With the invent of hysterolaparoscopy missing strings of IUCD can we managed easily. Objectives: To analyze the factors associated with the missing strings of IUCDs’. To review the management of missing strings of IUCD Materials and Methods: This is a Prospective observational study conducted in the department of OBG at Oxford Medical College, Hospital and Research Centre, Yadavanahalli, Bangalore, from Jan 2017–2018. Results: In our study there were 46 cases of missing strings of IUCD found over a period of 1 year, with a common type being Cu T 380A and multi load. Out of 46 cases 78% of cases IUCD was Inserted by lady health worker/PHC doctor. Majority of the patients had a time interval of 2-5 years between the insertion and removal of IUCD. 80% of the cases (37 patients) IUCD was intrauterine, 10% of cases (5 patients) it was partially embedded in the myometrium and only 6.5% cases (3 patients) IUCD was situated extra uterine sites. Missing IUCD was removed easily with simple artery forceps/IUCD hook in 28 cases (60%), 14 cases required hysteroscopy and 3 cases laparoscopy was needed for the retrieval. Conclusion: Hence, IUCDs is a safe and cost effective method of contraception in the developing countries. Proper education and counseling of the beneficiaries regarding the regular follow up is required for early removal of misplaced IUCD. Institutional training of the family planning personnel is necessary for proper insertion to avoid complications. Hysteroscopy guided retrieval of the misplaced IUCD is the Gold Standard.

Introduction: Asymptomatic bacteriuria has been reported to be associated with adverse pregnancy outcome. This study sought to determine the fetomaternal outcome in patients with urinary tract infection during pregnancy in a tertiary level teaching hospital in Southern part of Rajasthan, India. Material & Methods: The study was a hospital based prospective study involving 126 eligible antenatal attendees coming or referred to Department of Obstetrics and Gynecology at a tertiary level teaching hospital in Southern Rajasthan. Urine culture was conducted for each participant and the fetomaternal outcome between symptomatic and asymptomatic bacteriuria was observed. Results: Regarding pregnancy complications in UTI cases of pregnant women, anemia was found in 35.71%, Preterm labour in 18.25%, PPROM in 14.29%, IUGR in 13.49% and only 4.76% had preeclampsia and 3.18 had suffered from Pyelonephritis. Regarding fetal outcome in UTI cases of pregnant women, NICU admission was maximum i.e. 36 (28.57%), followed by low birth weight (19.84%), low APGAR score (n=24; 19.05%) and preterm delivery (17.46%). Conclusion: UTI in pregnancy is associated with significant morbidity for both mother and baby. All pregnant mothers should be screened for UTI.

Introduction: Preeclampsia is a multisystem disorder that associated with significant maternal and neonatal morbidity and mortality. Hyperuricemia has been linked with preeclampsia hemce having a predictive role in perinatal outcome. Objectives: Objective was intended to study uric acid as an important biomarker in early identification and measurement of severity of preeclampsia and prediction of maternal and perinatal complication. Material and Methods: A prospective observational antenatal control study was done at GMCH Udaipur, Rajasthan from January 2018 to July 2018. Total no. of 191 patients with PIH were included in our study. Maternal outcome noted in the terms of the mode of delivery, maternal complications and maternal end result. Fetal outcome assessed by perinatal morbidity and mortality, need for admission in NICU and neonatal end result. Patients were divided into two groups according to the level of uric acid. Patients with uric acid <5.0 mg/dl and >5.0 mg/dl. Results: Out of 191 patients, 39 (20.52%) patients with mild preeclampsia, 24 (12.56%) with moderate preeclampsia and 6 (3.14%) with severe preeclampsia while 3 (1.57%) patients had eclampsia. All the patients with Severe pre eclampsia and eclampsia and majority of moderate preeclampsia had uric acid >5 mg/dl (p value <001). In which higher level of mean of uric acid level in severe preeclampsia (8.67 ± 2.32) and eclampsia (10.37 ± 4.85) have been noted in our study. Majority of maternal as well as fetal complicatios have been noticed in patients with uric acid levels >5 mg/dl. Majority of low birth weight and NICU admissions were also seen in uric acid levels >5 mg/dl. Conclusion: The presence of hyperuricemia, especially >5 mg/dl levels identifies PIH patients at increased risk of maternal and fetal complications. By serum uric acid laboratory test, the severity of the disease can be predicted with more accuracy timely intervention gives us better perinatal outcome.

Background: To evaluate the efficacy and safety of COCPs v/s Norethisterone treatment in cases of heavy menstrual bleeding (HMB) by estimating the decrease in amount of blood loss during menses and improvement in quality of life of patients. Methods: This is an observational study conducted at PDMC attached to RNT Medical College, Udaipur in 2018. The women who fulfill the inclusion criteria were studied with respect to reproductive age group females with Heavy Menstrual Bleeding. Administration of OCPs (Mala-N) for 21 days starting from day 5 of cycle for 3 consecutive cycles and administration of oral progesterone (norethisterone) 5 mg TDS from D5 to D26 of menstrual cycle for 3 cycles was done. Results: Out of the total patients of heavy menstrual bleeding, majority were in the age group of 19-45 years i.e. 81.25%. Reduction in menstrual blood loss (MBL) is maximum with COCPs (70%). 55-60% patents improved haemoglobin with COCPs after 3 cycles of treatment. 71.4% of patients were relieved of dysmenorrhea, and 42.8% case of norethisterone. The side-effects reported were mainly epigastric pain, nausea, vomiting, headache and giddiness. COCPs improved QOL i.e. 75% and norethisterone (60%) which was almost equally effective. Reduction in menstrual blood loss was observed to be 36.7% (p<0.001) with norethisterone and 37.3% (p<0.001) with COCPs. There was improvement in mean haemoglobin levels after 3 treatment cycles with norethisterone (p=0.022) and COCPs (p=0.001). Conclusion: Both COCPs and norethisterone, are effective in reducing the PBAC score with COCPs being the most effective drug. COCPs was the most effective drug in improving the quality of life parameters and in improving the mean haemoglobin. It improved efficacy and safety in the treatment of heavy menstrual bleeding.

Background: Labour has been termed the most dangerous journey a human ever under takes Any failure to recognize such, would result in prolonged labour which may result in morbidity or mortality of both the mother & fetus [2]. Objective: To assess the progress of labour and to identify if intervention is needed using modified WHO Partograph. Methodology: This is a cross sectional study which was conducted in a VIMS (Vijayanagar Institute of Medical Sciences) Bellary, over a period of 12 months. All primigravida with full term pregnancy with vertex presentation without any risk factors and those suitable for vaginal delivery on initial examination were included in the study. Results: Out of the 200 patients who were admitted in labour room 124 (62%) belonged to group A, 47 (23.5%) to group B and 29 (14.5%) to group C. Of the patients who belonged to Group A majority had a vaginal delivery 118 (95.1%) and the rest 6 (4.9%) underwent LSCS. None had any assisted (forceps or vacuum) delivery. Those in group B most of them had vaginal delivery 33 (70.2%) followed by LSCS 10 (21.2%). The rest 4 patients had assisted delivery with 3 (6.3%) vacuum and 1 (2.1%) forceps assisted delivery. Of the patients in Group C majority underwent LSCS 25 (86.2%) followed by vaginal delivery 2 (6.8%). Only 2 had assisted delivery with 1 (3.4%) vacuum and 1 (3.4%) forceps assisted delivery.

Background: The relation between menstrual irregularities and thyroid disorders are attributed to multiple mechanisms. Menstrual disturbances may accompany and even may precede thyroid dysfunction. In the present study thyroid status of patients presenting with abnormal uterine bleeding was assessed by TSH, T3, and T4 assay. Materials and methods: The present study was a hospital based prospective study, conducted in the Department of Obstetrics and Gynecology department of Tertiary care center during 1st June 2016 to 31st June 2018. The study group was comprised of women attending Obstetrics and Gynecology department, presenting with menstrual disorder. Results: Patients with age less than or equal to 20 years, most common bleeding pattern was oligomenorrhoea (50%). Followed by Hypomenorrhoea (25%) and menorrhagia (9%) Oligomenorrhoea was present in 40 (32%) of the cases in age group 21- ≤ 30 years. Conclusion: Abnormal uterine bleeding is frequently seen to be associated with thyroid dysfunction and in majority of the patients, menstrual abnormality may even precede the occurrence of other clinical signs and symptoms of thyroid dysfunction.