In this paper we studied the effect of tuber extract of nutgrass (Cyperus rotundus l.) on fetal weight and length of white rat (Rattus novergicus) Sprague Dawley. Pregnant female rats (n=24) are grouped into four consisted of six rats each. Group-1 (control) only received distilled water. Group-2, 3 and 4 consecutively received tuber extract of nut grass at the dose of 22.5, 45, and 90 mg/kg body weight. Extract was given orally using gavage needle on day 6th for 13 days until day 18th of pregnancy. On day 18th of pregnancy, female rats were lapartomized under deep anaesthesia. All fetuses were taken to measure their body weight and length. The results showed that both fetal weight and fetal length of the rats were significantly decreasing with increasing doses of the extract. In conclusion, tuber extract of nut grass (Cyperus rotundus l.) has inhibitory effects against fetal growth of rats during pregnancy

Background: Maternal nutritional status is important for health and quality of life in women and growing fetus. Maternal weight gain in pregnancy can offer a good means of assessing the wellbeing of the pregnant mother and her baby. Inadequate prenatal weight gain is a significant risk factor for intrauterine growth restriction, preterm delivery and low birth weight in infants. Obesity and excessive weight gain on the other hand can lead to adverse maternal and fetal outcomes. Interestingly, to get a good fetomaternal perinatal outcome mode of delivery decision is also changed with BMI. Objective: The aim of the study was to evaluate the effect of maternal BMI on the mode of delivery. Methods: This cross-sectional study was carried out department of obstetrics and gynaecology at Bangabandhu Sheikh Mujib Medical University. A total 100 population of purposive sampling was the methods of choice to select the sample from the hospital admitted patients during the period from August 2016 to December 2017. Results: The mean age of 100 mothers were 28.4 (± 6.2) years. The maximum mothers attended from 3rd trimester were overweight (55.36%) whereas 44.64% from the same trimester were normal BMI mothers. Maximum mothers (27%) were from 25-29 years age group and the minimum mothers (4%) were from >= 40 years. Forty Seven Percent mothers came as primigravida. Primigravid women and multigravida with LSCS and without LSCS showed different mode of deliveries. The more the gravida with history of caesarean section the more frequency of present occasion of CS (p=0.006). The higher BMI showed more frequency of caesarean section than NVD or assisted delivery (p=<0.00001) Multiparous women showed more BMI than the p nulliparous. (p=0.005). Multiparity, maternal age and pre-existing medical conditions revealed more complicated labor. Conclusion: The more BMI of mother showed more frequency of caesarean section, assisted delivery than the normal vaginal delivery.

Post-partum Thrombotic Thrombocytopenic Purpura (TTP) is a life-threatening occurrence. A lady with such illness was successfully cured with anti-CD-20 monoclonal antibodies and mycophenolate [1]. This lady had been infertile for seven years, and underwent six attempts of in vitro fertilization without success. Several authors, and ourselves, found that a common cause of couple infertility is the infection by Helicobacter pylori, which can be cured at low price if recognized [2-4]. Moreover, in vitro fertilization reportedly failed in cases of ladies suffering of unrecognized infection by H. pylori [5], possibly by molecular mimicry between sperm and bacterial antigens [3,5,6]. Not only so, but this woman had been known to suffer of Idiopathic Thrombocytopenic Purpura (ITP). This illness had been found closely linked to H. pylori infection and to be reversible by eradication of the bacterium [7-9]. In conclusion we wish to stress the opportunity to test for presence of H.pylori in the long list of tests usually performed in infertile couple, and prior to pregnancy.

Introduction: Infertility is a public health problem associated with medical, emotional, social, and financial consequences. Recent study on infertility suggests that in India, approxi- mately 15 to 20% of married couples in the reproductive age group suffer from infertility and its incidence is on the rise. Artificial reproductive techniques (ARTs) including IVF/ICSI and ET have been a major development in the treatment of infertility. Objective: To compare reproductive outcomes of day 2 and day 3 embryo transfer (ET). Materials and methods: In this retrospective records study, all couples who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and ET cycles at International Fertility Center, Delhi, India over a period of 1 year were studied. Data were collected and analyzed by chi-square test and unpaired t-test by Statistical Package for the Social Sciences, version 19. Results: There was no statistically significant difference between the clinical and demographic parameters of group day 3 and day 2 ET. In our study, clinical pregnancy rate was 45% in day 3 ET and 36.5% in day 2 ET group [odds ratio (OR) 1.43, p-value 0.49]. The ongoing pregnancy rate was 39.2% in day 3 ET and 26.9% in day 2 ET group (OR 1.75, p-value 0.26). We observed that the miscarriage rate was 5.9% in day 3 ET and was 5.8% in day 2 ET group (p-value 0.69, OR 1.02). We observed one case each of multiple pregnancies, ectopic pregnancy, and fetal anomaly (anencephaly) in day 2 ET group, while in day 3 ET group, no such case was detected. Conclusion: There are chances that day 3 ET has better clinical and ongoing pregnancy rates than day 2 ET, but the difference is not statistically significant. Study showed similar miscarriage rates in both groups and very low incidence of complications like multiple pregnancy, ectopic pregnancy, and fetal anomaly. So, it is safe to schedule and transfer embryos either on day 2 or on day 3 for planning and programming cycles in coordination with patient and IVF team and for adjusting weekends (nonworking days).

Background: Sudden Cardiac Arrest (SCA) in pregnancy is a particularly challenging clinical condition. Although management and resuscitation of these patients are quite similar to other adult patients except for few modifications because of the changes of pregnancy, but the uniqueness of this situation lays in the fact that here you are dealing with two patients instead of one. Targeted Population: All Pregnancy patients who are requiring urgent management in the ED, with Emergency Physicians for teaching protocol. Aim of the Study: Appropriate knowledge and training for pregnancy patients by teaching protocol to Emergency Physicians.

Background: Blood transfusion is a vital therapeutic approach in modern health care that saves millions of lives, but there is a great challenge to gate sufficient voluntary blood donation in developing country like Ethiopia at the same time pregnancy and child birth related problem, rod traffic accident, malaria-related death is high. Methods: Institutional based cross-sectional quantitative study was used from April 27 to May 11, 2018 and data was collected using a self-administered questionnaire. A stratified sampling method was used and an individual was selected by simple random sampling within each stratum. EPI data version 3.02 for data entry and SPSS version 16 for analysis was used both bi-variant and multi- variant analysis was computed and significance was declared at AOR<0.05. Result: From the total study participants, 162 (48.5%) had adequate knowledge, 230 (68.9%) of the respondent had favorable attitudes towards blood donation whereas only 85 (25.4%) have ever donated blood in their lifetime.

Introduction: Eclampsia has been recognized as a clinical entity since the time of Hippocrates; and has been a nightmare to healthcare providers ever since. It is defined as the occurrence of generalised convulsions associated with preeclampsia during pregnancy, labour or within 7 days of delivery and not caused by epilepsy or other convulsive disorders. The incidence of eclampsia has often been viewed as an index of civilization in a country. There is low utilization of both antenatal and intrapartum care services and the patients may present to the hospital only as a last resort. Materials And Methods: This is a Prospective Study was carried out at the Department of Obstetrics and Gynecology at Tertiary Care Teaching Hospital over a period 2 years. All patients presenting with eclampsia during the said period were recruited into the study. All patients presenting with eclampsia during the said period were recruited into the study. Eclamptics are usually admitted directly into the labour ward. Patients who were diagnosed with other causes of convulsions in pregnancy like cerebral malaria and epilepsy were excluded from the study. A total of 821 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Results: Majority (66%) of the patients had between 2 to 5 episodes of convulsion. The MINIMUM number was 1 episode of convulsion , seen in 13 % of the patients. The MAXIMUM number of convulsions was 40. Of the 66 patients who had had more than 10 no. of convulsions , 30 had not received any treatment prior to referral, while there were no patients who had had more than 10 no. of convulsions after receiving the Loading Dose of MgSO4. For patients having less than 5 no. of convulsions , the number of patients having received only the IM Dose of MgSO4 was 1.5 times those having received the Loading Dose.(228/154 =1.48) In 29% of the patients, Hypertension was controlled by delivery alone. Those who failed to achieve a control of BP by Delivery alone were administered Calcigard (Nifedipine). Conclusion: Eclampsia was noted to be commoner among the young primigravida patients. The importance of this finding is that this group of patients deserve extra surveillance during antenatal care in terms of monitoring their blood pressure and screening their urine for proteinuria to detect pre-eclampsia. It is hoped that such interventions will have positive impact on maternal and child care. However, all this will go in vain unless health care providers at the grassroot levels are sensitised regarding the early diagnosis of Pre eclampsia and prompt and appropriate initiation of treatment

: Introduction: The practice of breast feeding in India is influenced by various social, cultural, economic factors and religious beliefs but maternal infant feeding attitude has been shown to be a stronger independent predictor of breast feeding initiation and associated with continuing to be breast feeding longer and have a greater chance of success. The present study was carried out to assess knowledge, attitude and practice of breast feeding among post natal mothers in rural area and to assess the factors affecting breast feeding practices. Methods: A community based cross sectional study was done among 100 postnatal women of rural field practice area (RHTC) of a medical college, Tirupati, to explore the knowledge, attitude and practice of breast feeding and the factors influencing breast feeding practices. Mothers were interviewed using pretested questionnaire at their residence regarding socio demographic data, variables related to medical care during pregnancy, delivery and post natal period, Knowledge on breast feeding, Attitude by IIFA Scale and data related to Practice of breast feeding were collected. Data entered in MS Excel and analysed by using IBM SPSS Version 26. Results: Majority (99%) of women had knowledge that Colostrum maintain immunity, 97% had knowledge that Breast feed can be given up-to 2 years, 94% had knowledge that Wash breast with warm water before feeding. Majority of women had positive attitude towards breast feeding (Mean attitude score was 60.34 (1.98). Majority of women initiate breast feeding after one hour (65%), Only 2% were discarded colostrum, 80% of them were exclusively breastfeed for 6 months or more. Majority of daily wage labourers (33.3%) and Muslim mothers (66.7%) were given pre-lacteal feed compared to other groups. This was statistically significant. Conclusion: The participants have good knowledge and attitudes toward feeding, but their breast feeding practises do not correspond to their knowledge levels, which indicates a need for improvement in the breast feeding instruction and counselling of women

Introduction: Hemoglobinopathies are diverse group of inherited disorders of hemoglobin production and function. They represent the most common single-gene disorders that are found in humans and are distributed in various frequencies throughout the world. Pregnancy in women with sickle cell disease can increase the risk of maternal and perinatal mortality. HPLC offers the advantages over the routine Hemoglobin electrophoresis as it can more accurately identify and quantitate abnormal hemoglobin. HPLC forms an accurate, rapid and reproducible tool for early detection and management of thalassemia and abnormal hemoglobin variants

Introduction: Placenta is a functional unit between the mother and the foetus. Human placenta is discoid, deciduate, haemochorial, chorioallantoic, labyrinthine and endocrine gland which connects developing embryo by umbilical cord to the endometrium of mother’s uterus. The placenta responds to cues in the pregnancy environment through morphological and functional changes in an effort to maintain proper fetal growth and development. For example, delayed maturation of the placenta has been observed in response to increasing maternal BMI. This altered placental maturity may result in poor gas and nutrient exchange at the maternal-fetal interface and, subsequently, suboptimal infant outcomes. Material and Method: This is a prospective study conducted in the Department of Anatomy at Index Medical College over a period of 2 year.

Introduction: Thyroid disease is more common in women than in men, because most thyroid diseases are autoimmune in nature and increased susceptibility to autoimmune diseases, perhaps secondary to the female endocrine environment is likely contributing factor. Thyroid physiology plays a major role in pregnancy and thyroid disorders constitute one of the most common endocrine disorders in pregnancy. Pregnancy is associated with significant and reversible changes in thyroid function and failure to adapt to these changes result in thyroid dysfunction. Material and Methods: This is a Prospective study done among 1000 pregnant women. Antenatal women attending the outpatient department of tertiary care centre from August 2021 October 2022. Detailed history was taken, regarding the symptoms of thyroid disorders, menstrual history, obstetric history, past medical history, family history and personal history

Background: Miscarriage is considered the most common adverse outcome in early pregnancy. Thyroid autoantibodies have a role in these regions and have been linked to substantial changes in the path of pregnancy that affect the mother, foetus, & newborn. Aim: To estimate the prevalence of TPO antibodies in recurrent pregnancy losses, first trimester abortions and preterm deliveries. Material & Methods: Study Design: Descriptive Cross sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Baharampur, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Pregnant women who had preterm deliveries, miscarriages attending outpatient as well as admitted in the antenatal & postnatal ward in the department of Obstetrics & Gynecology Sample size: Study consisted a total of 100 subjects. Study tools and Data collection procedure: The study group was comprised of all the pregnant women who had preterm deliveries and miscarriages regardless of the gestational age, that were fulfilling inclusion & exclusion criteria. Written informed consent was taken from all the patients participating in the study. They were subjected to a detailed history & thorough general & clinical examination, lab investigations, thyroid profile, thyroid peroxidase antibody testing (Normal range: TPO AB <9 IU/ML), ultra-sonic examination & other clinical work up was done. The study showed that the contribution of thyroid peroxidase antibody testing & its sensitivity determining risk of preterm deliveries and recurrent pregnancy loss. Results: The association between TPOAB and T3 category, among the high TPOAB (+ve) cases (n=11), 8 (72.7%) cases had normal level of T3, and, 3 (27.3%) cases had low level of T3. Whereas in the normal TPOAB (-ve) group (n=89), 5 (5.6%) cases had high level of T3, 84 (94.4%) cases had normal level of T3. The association between TPOAB and T3 category was shown statistically significant (P<0.0001). Conclusion: We concluded that, there was a statistically significant association of TPOAb with T3, T4, and, TSH (P<0.05) and it leads to developing hypothyroidism during pregnancy. The presence of TPO-Ab in pregnant women significantly increases the risk of preterm delivery. The screening of TSH and TPOAb was essential during pregnancy to avoid complications related pregnancy

Introduction: Preeclampsia is a pregnancy-specific multi-systemic disorder characterized by proteinuria and the onset of hypertension during pregnancy (1, 2) Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity3. Calcium has an important role in the pathogenesis of pre- eclampsia. The present study was aimed to compare the level of serum calcium in normal pregnant women and in preeclampsia and determine the association of serum calcium with severity of the disease

Background and Aims: The success of labour analgesia is significantly influenced by the patient's position during the insertion of the epidural catheter. In this study, we contrasted how simple it was to implant the epidural catheter in the crossed-legged sitting position (CLP) against the traditional sitting position (TSP) (CLSP). The main goal was to compare how many of the groups' initial epidural placement attempts were successful. The patient's comfort, the simplicity of landmark palpation, and the quantity of needle-to-bone contacts were secondary goals

Background: The term "asymptomatic bacteriuria" (ASB) refers to persistent, aggressive bacterial growth in asymptomatic females' urinary tracts. The quantitative diagnosis is a clear catch mid urine sample with more than 100,000 organisms/ml.1 The incidence is often population-dependent geographical variance, ranging from 2 to 7%. The incidence is between 25 and 35 percent in emerging nations like India

Background: One of the most typical illnesses seen in clinical practise is urinary tract infection (UTI). 50% to 60% of adult women may encounter a urinary tract infection at some point in their lives, making it one of the most prevalent bacterial illnesses in women. Due to their anatomical characteristics, such as a narrow urethra, as well as other variables like pregnancy, the use of diaphragms, and sexual activity, women are more likely to acquire UTI. Objectives: 1. To isolate and identify the uropathogens from the urine samples. 2. To detect the antimicrobial resistance of uropathogens to fluoroquinolones. Material & Methods: Study Design: Descriptive Cross-sectional study. Study area: Department of Obstetrics & Gynecology, Murshidabad Medical college and Hospital, Berhampore, West Bengal. Study Period: Jan 2022 – Dec. 2022. Study population: Urine culture sensitivity reports were analyzed of patients who were suspected to be having urinary tract infection. Sample size: Study consisted a total of 300 subjects. Sampling Technique: Simple Random technique. Results: The resistant pattern of E.coli and Klebsiella to the 4 fluroquinolones, highest resistance is seen to ciprofloxacin followed by norfloxacin. In this study the most sensitive drug was Amikacin, followed by Pippericillin/Tazobactum and imipenem. In this study the drug with maximum resistance was cotrimoxazole. Amoxycillin and quinolones followed the list. Conclusion: We need to take a number of steps to address the significant worldwide opposition issue we are facing. These include (i) using fewer antibiotics to lessen the pressure for resistance to develop. (ii) increasing our understanding of the mechanisms by which bacteria acquire resistance and how they reduce the ensuing fitness costs.

Background: Caesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period. Aims: To study the maternal and fetal outcome of emergency caesarean delivery between unbooked rural referrals and booked cases. Materials and methods: This is a Comparative cross sectional study was conducted in the Department of Obstetrics and Gynaecology in Gestational age > 37 weeks, Unbooked cases handled outside and referred, who underwent caesarean delivery on emergency, Booked cases admitted in our hospital and underwent emergency caesarean delivery and Singleton pregnancy. Results: This study included 980 antenatal patients who underwent emergency caesarean section, among them 420 were booked cases and 560 were unbooked cases. The incidence of emergency caesarean section was more in unbooked group compared to booked group.  This comparison of age, Teenage pregnancy, parity, socioeconomic status had  statistical significance with p value < 0.05. The major indication of emergency caesarean section in booked cases was previous caesarean section (29.26%), where as it was fetal distress (22.6%) in unbooked group. Septicaemia in unbooked group (4.6%) was more than booked group(1%).66 cases (11.8%) of unbooked group and only 21 cases (4.9%) of booked group had wound infection. Postpartum haemorrhage, Perinatal mortality, NICU admission rate statistically significant among the two groups. Maternal intrinsic factors such as nutrition socioeconomic status and lack of antenatal care have been suggested as the causative factors in the unbooked patients. Conclusion: Poor utilization of antenatal care is associated with adverse feto-maternal outcome. Most maternal deaths are preventable if complications are diagnosed early and managed effectively in time .Early admission and management of critical obstetric patients decreases maternal morbidity and mortality

Introduction: Fetal movement tracking may be used to identify worsening in the fetus condition. It is described as any kick, flutter, swish, or roll perceived by the pregnant women and is considered evidence of the musculoskeletal and central nervous systems' integrity. Decreased fetal movement has been linked to poor pregnancy outcomes such as intrauterine growth restriction, fetal death and preterm deliveries. Clinical data on the association between decreased fetal movements and perinatal outcome is insufficient. Methodology: Ethical clearance was obtained from SRIMANTA SANKARDEVA UNIVERSITY of HEALTH SCIENCE for study of decreased fetal movements in Gauhati medical college and hospital. A doppler study was conducted using 3 dimensional ultrasound machines in ANOPD, departmental indoor USG room, and 2 dimensional ultrasound machine in observation room in the Department of Obstetrics & Gynaecology, Gauhati Medical College& Hospital. Patients were placed in supine position with left lateral tilt and umbilical artery Wave forms were recorded in the mid position from the free floating loops. Indices noted were S(systolic)/D(diastolic) ratio, resistance index (RI), plasticity index (PI), and reversal of blood flow in diastole. CTG monitoring was done in Departmental Observation Room using a CTG machine (labelled as FETAL MONITOR, SN-EATB8L1732, manufacturer-BPL, model no. FM 9854). Each selected patient was monitored for a period of 20minutes with a paper speed of 3cm/minutes during antepartum or intrapartum status. Noted following information were: base line FHR, beat to beat variability, FHR accelerations, presence of deceleration, and reactive. Results: A prospective observational study was conducted in Gauhati Medical College & Hospital, Guwahati, Assam during a time period of one year. 150 antenatal women at term gestation with decreased fetal movements without any other high risk conditions were monitored for fetal wellbeing by CTG and Doppler. Four groups were categorised into four groups: Group I-CTG reactive and Umbilical Artery Doppler normal, Group IIA, Group IIB, and Group III. The findings of each group were compared with different modes of delivery and different parameters of perinatal outcomes. Conclusion: Maternal perception of fetal movements is the most widely used technique to evaluate fetal wellbeing. Low-risk pregnancies with decreased fetal movements should be monitored for close antenatal fetal monitoring, appropriate and prompt interventions. Non-reactive CTG alone or with combination of abnormal Doppler results are better predictors of poor perinatal outcome and can indicate if neonatal resuscitation is required. These two tools can be used together for fetal monitoring and appropriate intervention at the correct time to improve the perinatal outcomes

Background:  Asthma attack is the most common respiratory symptom observed and is of great concern. Throughout the world asthma cases are increasing during pregnancy. The major issue is that the control levels of asthma is changing during pregnancy so the management is a little difficult during pregnancy. Objective: The present study was undertaken to observe the prevalence of asthma and respiratory symptoms during pregnancy. Materials and methods: 40 pregnant women attending OPD in the hospital were part of the study after obtaining the written informed consent. Confidentiality of the data was maintained. Willing pregnant women were included in the study. Pregnant women with any other complications severe were excluded from the study. Respiratory symptoms were examined during the general physical examination by an expert physician. Results: The age group of the participants ranges from 22-30 years. 25% of individuals have asthma. 37.5% of individuals have wheeze without cold, 15% of individuals have nasal allergies. 27.5% have shortness of breath. 5% of individuals have a history of smoking. 15% of individuals are currently under the medication for asthma. Conclusion: The present study results explained that wheezing without cold and shortness of breath are the most common respiratory symptoms during pregnancy. Further detailed studies with a higher sample size are recommended to understand better the respiratory symptoms during pregnancy

Background: Preeclampsia is a multi-system disorder of pregnancy that manifests after 20 weeks of pregnancy in previously normotensive women. It is characterised by new-onset hypertension (systolic and diastolic blood pressure of 140 and 90 mm Hg, respectively, on two occasions, at least 6 hours apart) and proteinuria (protein excretion of 300 mg in a 24 hr urine collection, or a dipstick of ≥ 2+). AIM: To evaluate the utility of placental laterality and uterine artery doppler in the prediction of preeclampsia. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Radio diagnosis, Anil Neerukonda Hospital.  Study Period: 1st January 2020 to June 2021. Study population: All Antenatal cases referred to the department of Radio-Diagnosis for clinically suspected Pre-eclampsia.  Sample size: study consisted of 86 subjects.  Sampling method: Simple random technique. EQUIPMENT: The study will be performed using Philips AFFINITY 50G ultrasound machine using a 3-7C curvilinear probe. SCANNING TECHNIQUE: A written informed consent was taken before performing the scan. The scan was performed with patient in supine position and moderately distended bladder. Data Collection: Basic demographic details, clinical data obtained from study subjects were recorded in a pre-designed proforma. Location of the placenta and uterine artery doppler velocimetry was performed by using convex probe. During the first and second trimesters of pregnancy, ultrasound was used to identify uterine arteries on each side of the uterocervical junction. In third trimester it was seen at the crossover of external iliac vessels. Sample box was 2mm. Insonation angle was less than 60 degrees. Angle dependent Doppler indices are obtained during each examination. Results: In our study 63 (74%) subjects had central placenta and 23(26%) subjects had laterally located placenta. Fourteen of the 86 patients developed preeclampsia; eight (57%) had unilaterally located placentas while only six had centrally located placentas. According to our study, 8 (34%) out of 23 women bearing lateral placentas alone developed preeclampsia whereas 6 (85%) out of 7 women bearing lateral placentas with Doppler abnormalities developed preeclampsia. Conclusion: A lateral placenta puts a pregnant woman at significant risk of developing preeclampsia. In lateral placentas co-occurring with uterine artery Doppler abnormalities, preeclampsia risk significantly increases as compared to those of lateral placentas alone

Background: COVID 19 positive pregnantwomen form a very vulnerable group.  It adversely affects their physical and psychological health. These women are likely to develop new health problems or aggravation of existing problems during pregnancy and in the post-partum period. Materials and Methods: This was a prospective observational study of 100 consecutive Covid positive pregnant women who were admitted in the isolation wards of Government Medical College, Thrissur and delivered during the study period from 1st may 2021. These women were followed up till 6 months postpartum. Data was collected from recordsand bypersonal interview or telephonic call using astructuredquestionnaire. Demographic profile, Covid symptoms and their severity, obstetric details, breast feeding practices, neonatal outcomes and post Covid symptoms were studied. The association between breastfeeding, hygiene practices and neonatal positivity was also looked into/. Results: 51% of Covid positive pregnant women were asymptomatic. Nine women had severe Covid pneumonia with 2 of them requiring ventilatory support. There were no cases of vertical transmission or transmission through breastfeeding among the newborns studied. There was a strong association between strict adherence to hygienic practices and neonatal positivity. 24% of women had persistent symptoms at 6 months postpartum. Post exertion malaise was most commonly observed. Conclusion: Women with COVID-19 infection during pregnancy may continue to have health problems and hence need a close follow up

Background:  Hypertension in pregnancy is a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or both. Both systolic and diastolic blood pressure raises are important in the identification of Pregnancy induced hypertension. Pregnancy induced hypertension (PIH) is hypertension that occurs after 20 weeks of gestation in women with previously normal blood pressure. The broad classification of pregnancy-induced hypertension during pregnancy is gestational hypertension (GE), pre-eclampsia and eclampsia. Serum uric acid and creatinine levels are a part of work up for the pregnant women with hypertension. The elevated levels of these parameters were due to decreased urinary clearance secondary to reduced Glomerular filtration Rate (GFR) and increased reabsorption. Materials and methods: The present study was carried out in the Department of Biochemistry, Dr VRK Womens Medical College, Teaching hospital and Research center. Total 70 patients of pregnancy were selected out of which 30 patients were of normal pregnancy and 40 patients were of pregnancy induced hypertension. Serum uric acid levels were estimated before delivery and after delivery in cases of pregnancy. Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. Results:  In our study, we observed a significantly elevated serum uric acid PIH (9.51 ± 1.33 mg/dl) and Normal pregnant women (5.29 ±0.8 mg/dl). Blood Urea was 5.29 ±0.8 mg/dl among Normal pregnant women and 9.51 ±1.33 mg/dl among PIH. Moreover, Serum Creatinine level was1.25±0.53 mg/dl among PIH and 0.97±0.23 mg/dl among Normal pregnant women. Conclusion: On the basis of study findings we, concluded that the increased levels of serum uric acid, serum creatinine and serum urea are better diagnostic and predictive marker for PIH and immediate medical attention required for PIH. With the help of these parameters most cases are detected early in the pregnancy before they can progress to eclampsia

Background: Every year, 60% to 80% of all newborn deaths are caused by low birth weight (LBW). Low birth weight is a significant public health issue in developing nations like India. The objective of this study was to assess the magnitude and associated factors of low birth weight in a tertiary care hospital of northern India.  Methods: This was across-sectional study conducted at tertiary care Hospital. A total of 650 individuals in the study were chosen via systematic sampling. Data were gathered using a standardised questionnaire that had been pre-tested. Epi Info V7 was used to analyse the data. To find related factors, bivariate and multiple logistic regression were utilised. An association was deemed statistically significant at a 0.05 p-value. Results: In this study, the magnitude of low birth weight was 14.2%. A low birth weight was three times more frequent in women with a history of chronic disease than in those without such a history [AOR=3.04(1.04,9.02)]. Pregnant women with haemoglobin levels below 11 g/dl had a higher risk of having babies with low birth weights than those with haemoglobin levels above 11 g/dl [AOR=3.06(1.08,8.96)]. Contrary to those who did, women who did not take iron/folic acid supplements during their pregnancies had a higher risk of having babies with low birth weights [AOR=0.28(0.12,0.78)]. The odds of having a low birth weight were higher for pregnant women who did not eat extra food or meals during their pregnancy than for those who did [AOR=0.26(0.11, 0.73)]. Conclusions: Hemoglobin level, iron/folic acid supplementation, extra meals during pregnancy, and a history of chronic medical conditions were all found to be significant predictors of low birth weight. To lower the risk of low birth weight, it is crucial to encourage pregnant women to take iron together with folic acid and extra meals

Aims and Objective- To study the prevalence of coagulation abnormalities associated with Intrauterine fetal death. Materials and Method-The study was conducted in Obst &gynec Dept, Tertiary care hospital, Southern Odisha in a study period Aug-2020 to Oct 2022. A detailed clinical history, demographic parameters, causes of IUFD, associated complications and examination findings will be recorded as per the proforma and the following investigations will be done in each case: CBC to ascertain thrombocytopenia, Prothrombin time(PT), Activated partial thromboplastin time(aPTT),D-Dimer ,Fibrinogen assay,Modified ISTH score taken consisting of  platelet count, PT and fibrinogen level. Results - Out of the total 116 cases of IUFD, 18 cases were clinically diagnosed with DIC; Prevalence is 15.5% in our study. The mean age of study participants was 25.10 ±6.30 years which ranged from 18 to 37 years. Majority of the cases were primigravida and presented at preterm. Apart from the undiagnosed cases, which was the major part ,from the rest of the cases PIH and Abruptio constituted the major proportion of identifiable causes of IUFD. PIH, Abruptio and HELLP syndrome were the major obstetrical complications contributing to clinical DIC as well as those at risk of developing subsequent DIC which was found to be statistically significant. The sensitivity was found to be more in pregnancy modified ISTH score --(83.3%) compare to ISTH overt score (50%). The specificity was found to be more in ISTH overt score (96.9%) compare to pregnancy modified ISTH score (78.5%) Conclusion- in obstetrics is a life-threatening complication that is secondary to obstetrical and non-obstetrical related complications of pregnancy. It is associated with high maternal and perinatal morbidity and mortality. The present study was conducted to determine the risk of DIC in the cases of IUFD.It is recommended that coagulation studies should be considered in IUFD specially when complicated by PIH. abruption or severe complications such as HELLP syndrome. However, our study is of small sample size (116) requires large studies meta analysis

Background: pregnancy is one of the important times in a woman’s life. Women's bodies become more sensitive to dangerous substances and they may develop different complications, such complications might be to pregnant women or the fetus. Some women don’t have proper knowledge about pregnancy complications or nutritional food products to be taken during pregnancy the main aim of the study is to study ABO blood groups and sociodemographic status in anomalies and normal fetuses in pregnant women. The present study is a cohort study carried out on 180 pregnant women. Among them, group 1 136 were normal pregnant women (without any fetal complications) and group 2 44 were anomaly pregnant women (with fetal complications). In groups, -1 & 2 majorities of the pregnant women were under the age group of 31 – 35 years (45.58%) and 20 – 25 years (27.27%) after comparing both groups – 1& 2 significance was observed at 20 -25 years (p<0.05). in group 1 majority of pregnant women have 1 fetus but in group 2 majority of the pregnant women have 2 fetuses. In comparing the ABO blood group of both groups 1 & 2 there is a significant difference was observed in blood group A and no significance was observed in blood group B, AB & O. as per the education status of a pregnant women in group 1 in education status of a pregnant women majority were upto degree 43.38% and in group 2 majority of pregnant women were not educated (45.45%). Complications observed in group 2 in 44 pregnant women having Hematocolpos 29.54% followed by Hydramnios 22.72%, Oligohydramnios 18.18%, Microcephaly 13.63%, Cleft palate 9.09% and Hygroma colli 6.81 %. Early age Pregnancy, more than 1 fetus, A blood group, no education about taking care during pregnancy and there complications such pregnant women may develop complication in fetus and even death of the fetus can be seen

Objective: To analyse Non-Stress Test as a Predictor for High-Risk Pregnancy-In Background of Fetal Color Doppler in Umbilical and Middle Cerebral Artery  by  means  of categorization intofour groups and comparing the prediction of perinatal outcome in high -risk pregnancies. Material and Method : This was  a  Prospective Observational study conducted on all ‘High Risk  Pregnancies’  in  Department  of  Obstetrics  &  Gynaecology,   Ruxmaniben  Deepchand   Gardi Medical  College,  Ujjainfrom  Oct 2020 to Nov 2021. A  total  of  182  antenatal  women  with ‘High  Risk’patients were  recruited.  They  were examined clinically,  and  Doppler  velocimetry  andnon- stress  test  were  performed.  The  main   vessels   studied   by  Doppler  were   umbilical   artery and   middle  cerebral  artery, to study and analyse the indices.   The  results  of   Non-Stress testwere  interpreted as  Reactive and Non-Reactive.  Based   on  the  results  of  Doppler  and   Non- Stress,  the  182 cases  were  categorized  into  four  groups  and  interpretation  of  results  was  done.Fetal outcome was considered on the basis of.APGAR score and NICU admissions Results: Among the182  cases of high-risk pregnancies, those with a normal Doppler study and a  reactive non-stress test had good perinatal outcome. When both were abnormal, there was a higher percentage of adverse out-come as compared to that of either Doppler or NST alone being abnormal or non-reactive. It was observed in this study that Abnornal Doppler  study  with Reactive  non-stress  test  had relatively  bad perinatal  outcome as compared  to  Normal  Doppler study  with  non reactive non stress test.In this study sensitivity and specificity of Doppler was 71%  and 73% while that of NST was 69%   and  54%  respectively  for  NICU  admissions. Conclusion: Color Doppler is comparatively a better in  predicting adverse  perinatal  outcome. However,  when  both test  are abnormal  perinatal  outcome  is  definitely  poor.NST can be used as an alternative in absence of colour doppler at rural PHCs and CHCs to identify adverse perinatal outcome and timely referral.

Introduction: Burst abdomen is considered to be there when intestine or other viscera are seen through the abdominal wound after surgery (general and obstetric surgeries).It can increase the length of hospital stay and result in significant social and economic costs for the patient and health care system. The present study aims at analyzing the incidence, etiological factors and management of this severe post-operative complication experienced by gynaecologists.  Materials and Methods: The present study comprises 25 cases of burst abdomen in the Department of Obstetrics and Gynaecology, MKCG Medical College Hospital, Berhampur, Odisha from August 2020 to July 2022. Using a check-list and a questionnaire, the patient’s demographic data, medical history, physical examination findings, laboratory investigation results, surgical procedures, and outcome of the repaired burst abdomen were collected.  Results: In our study period the incidence of burst abdomen was 0.19%. Majority of the cases, both caesarean delivery cases (100%) and gynaecological cases (60%), were emergency cases. The indication of laparotomy being ectopic pregnancy (40%) was the most common in gynaecological cases and the most frequent indication for caesarean delivery leading to burst abdomen was obstructed labor (40%). Obesity was the the most frequent (24%) comorbidity encountered in our setup. Majority of the cases (84%) had transverse incision and only 16% cases had sub-umbilical midline incisions. Layer closure was used in majority (92%) of the cases which led to burst abdomen as compared to mass closure which was seen in 8% of the burst abdomen cases. The majority (72%) of burst abdomen occurred between 6th and 7th post-operative day in our study, with the average mean of 6.72 days.  The post-operatively anemia was seen in 72% of the cases that led to burst abdomen. Operative area infection also seemed to pre-dispose patients to burst abdomen and was seen post-operatively in 36% of the patients.  Conservative treatment (daily saline dressings) was done in no case in our study. Immediate re-suturing of the wound in the operation theatre was done in 22 cases. In majority of cases (56%), secondary closure of burst abdomen was done with non absorbable polypopylene. In present study the range of stay for majority was within 21-35 days and mean duration of stay was 24.52 days. Two cases had burst abdomen recurrence, i.e. 8%. Conclusion: Burst abdomen is one of the serious postoperative complications faced by surgeons and is of greatest concern because of risk of evisceration, the need for immediate intervention and the possibility of repeat dehiscence. It poses tremendous impact on quality of life, health care cost for patients, their families and hospitals by requiring re-operations, need for antibiotics and prolonging hospital stay. Knowledge of the more common mechanisms and how to avoid or overcome these hazards should help to reduce the incidence of this dangerous complication such as maintaining asepsis, avoiding preoperative, intraoperative and postoperative precipitating factors of burst abdomen and providing good antibiotic coverage.

Introduction: Improving maternal health is one of the fifteen Sustainable goals  adopted by world leader in September 2015 by  an historic  international community at the United Nations Summit, which aims  to reduce the global maternal mortality ration to less than 70 per 100,000 live births by the year 2030.The MMR in developing countries is more than developed countries. MMR in developed country is 12/1,00,000 live birth Maternal mortality ratio of India is 97/lakh live births. Preeclampsia is a new onset of hypertension and proteinuria after 20 weeks of gestation  in a previously normotensive women.Severe Preeclampsia  is a serious clinical type of preeclampsia by atleast one of the following – persistent increase in blood pressure [≥160/110 mmhg ],hepatic and renal failure,platelet count less than 1,00,000 / mm3 , hemolysiselevsted liver enzymes and low platelet count [HELLP] Syndrome, Cerebral or visual disturbances, persistant epigastric pain and pulmonary oedema. Eclampsia is a serious obstetric emergency with new onset grand mal seizure during pregnancy or postpartum in women having signs and symptoms of preeclampsia. The sequel of severe preeclampsia and eclampsia include organ failure, loss of consciousness and finally loss of lives of both mother and fetes. Aims and Objectives: To study clinical outcome of Preeclampsia and Eclampsia in a Tertiary Care Centre. Materials and Method: The study was conducted in department of Obstetrics and Gynaecology, MKCG Medical College, Berhampur, Odisha, India for a period of 18 months extending from November 2020 to September 2022.A total of 400 patients were studied. At the end of the study, collected data were tabulated and analysed. Results: Present study was conducted on 400 cases, during the study period.Mean age was 31.19 ± 5.7 years. Majority of patients (194 cases, 48.5%) belonged to lower class followed by 129 cases (32.3%) belonging to middle class. Fifty four patients (13.5%) were from lower middle class. Upper middle class had 16 (4%) patients. Only 7 cases (1.7%) were from upper class. In 127 patients (31.8%) diabetes mellitus and in 227 patients (56.8%) pre-existing hypertension was reported respectively. Among 400 patients studied, 114 patients (28.5%) were primigravida and 286 patients (71.5%) were multigravida.  Twenty eight (16.8%) patients died of complication. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.34, Paog=0.33). Cause of death was abruption placenta (10 cases), acute renal failure (6 cases), ARF with sepsis (1 case), eclampsia (4 cases), HELLP with PPH, PPH, pulmonary embolism, pulmonary embolism with PPH and wound infection (1 case each) and sepsis (2 cases). Out of 59 patients suffering from eclampsia, 4 (1%) patients died and 24 (6%) patients with pre-eclampsia died. Association of occurrence of eclampsia was robustly associated with patient mortality (P<0.0001).Two hundred and sixteen neonates (54%) had low birth weight while 279 (69.8%) were cases of intra uterine growth retardation. Preterm birth, birth asphyxia and NICU admission was seen in 175 (43.8%), 168 (42%) and 270 (67.5%) respectively. Eighty nine (22.3%) neonates died after birth while 52 (13%). Mean maternal age of deceased and survived neonates in present study was 31.51±5.6 years and 31.1±5.8 years respectively. Mean values for age of gestation of deceased and survived patients were 31.29±1.4 weeks and 31.59±2.2 weeks respectively. Both age and age of gestation of patients were not significantly distributed across maternal mortality (Page=0.56, Paog=0.24).  Conclusion: Preeclampsia and eclampsia tends to threaten maternal health and fetal viability adding to maternal and neonatal mortality and morbidity.There is high frequency of preeclampsia and eclampsia in our setting and the consequences are alarmingly high. There is need for patients education in recognizing the warning symptoms of the disease before intrauterine demise of fetus occurs or mother develops one of the grave complications, Antenatal care, treatment of anemia  and educating the women on significance of symptoms will go a long way in improving maternal and perinatal morbidity and mortality.Presence of NICU  with effective neonatal care will improve the fetal outcome.

Introduction: An ectopic pregnancy occurs when the developing blastocyst implants either outside the uterus i.e fallopian tube (interstitial, ampullary, isthmic, fimbrial), Ovary and abdominal cavity or in an abnormal position within the uterus i.e cornual, cervical. Around 98.3% of ectopic pregnancies occur in the fallopian tubes. Visualization of an intrauterine sac, with or without fetal cardiac activity, is often adequate to exclude ectopic pregnancy. The treatment modality also has evolved from radical surgery, conservative surgery to medical and expectant management. Laparoscopy is now recommended approach in surgical management of ectopic pregnancy.Materials and Methods: This is a prospective observational study conducted in Department of Obstetrics and Gynaecology from 2020 to 2022 where 118 cases were studied. Detailed history was taken for all cases with special reference to risk factors like smoking, PID, abortions, previous ectopic, IUD use, sterilization, D & C, IVF and LSCS followed by clinical examination. Routine and other relevant investigations were done including (UPT, CBC, ICTC, HCV, HbSAg, USG (TVS) and serum β-HCG and managed according to the condition of patient either medical, surgical or both. Data regarding intraoperative finding confirming site of ectopic pregnancy, ruptured or unruptured, operative techniques including salpingectomy, salpingo ophorectomy, cornual repair or hysterectomy and blood product transfusion were collected. Patients were followed up till discharge or death and the outcome were analysed. Results: Maximum numbers of cases, 45 cases (38.1%) were in the age group between 26 to 30 years. Among all cases, 24 cases (20.3%) had history of previous abortions, 22 cases (18.6%) had history of PID, 14 cases (11.9%) had undergone D & C earlier, 8 cases (6.8%) had earlier tubal ligation, 5 cases (4.2%) had h/o IUCD insertion and 1 case (0.8%) had previous history of ectopic pregnancy. The classical triad of amenorrhea, abdomen pain and abnormal vaginal bleeding was seen in 52 cases (44.0%). The most common site of ectopic pregnancy site was fallopian tube, of which 96 cases (81.3%) were in amupulla, 14 cases (11.9%) were in isthmus and only 3 cases (2.5%) were in infundibulum. Only 2 cases (1.7%) had cornual pregnancy with gestational sac implanted in the non communicating horn of unicornuate uterus. Maximum number of ectopic pregnancy cases underwent surgery, with 98 cases (83.0%) had undergone  unilateral salpingectomy as the most common procedure whereas 15 cases (12.7 %) had undergone unilateral salpingophorectomy in cases with unhealthy ovary and ovarian pregnancy out of 113 cases of tubal ectopic pregnancy. Only 2 cases (1.7%) with cornual pregnancy had cornual resection and repair. Hysterectomy was adopted as surgical treatment in 2 cases (1.7%) only.Conclusion: Patients with risk of ectopic pregnancy like PID, IUCD implantation, previous ectopic pregnancy and patients with history of D & C should undergo routine USG in first trimester to locate the site of early pregnancy. We recommend follow up above cases of ectopic pregnancy and analyzing the effect of ectopic pregnancy on future fertility and pregnancy.

Labour and delivery are focus and climax of the reproductive process. They are both physical and emotional challenge for the mother and a hazardous journey for the fetus. Labour is a dynamic phenomenon characterized by a progressive increase in the frequency, intensity and duration of uterine contractions with progressive dilatation and effacement of the cervix and the  fetal  descent  through  the  birth  canal.   This physiological process may lead to pathology and failure to recognize this would result in prolonged labour resulting in increased morbidity and mortality of mother and baby.2 Material And Methods A hospital-based prospective study of 100 pregnant women with high-risk pregnancy  attending  the  department  of  Obstetrics  and  Gynaecology, Gayatri vidyaparishad medical college, Vishakhapatnam, from December 2021- November 2022. The study groups randomly selected a hundred primigravida with high-risk pregnancy fulfilling the inclusion and exclusion criteria. Informed and written consent was taken from all the women participating in the study. The study's primi pregnant women fulfilling inclusion and exclusion criteria were divided into the PARTOGRAM GROUP (P) and the other NO PARTOGRAM (NP). Each group consists of 50 primi  pregnant  women.  In the partogram group,  the progress of labour was documented on MODIFIED  WHO PARTOGRAPH and the notes on the progress sheet of case record file while standard notes only in no partogram group. Results In our study, 80% of pregnant women gestational age was below 39 weeks. In the NP group, 34% of women at 38 weeks, followed by 32% at 39 weeks. In the P group, 54% were at 38weeks, followed by 18% at 39 weeks and 18% at 40 weeks. Oligohydramnios  was  predominantly  observed  in  women  presented  in  39 weeks  (48%)  gestational  age.  Gestational  hypertension  (38.6%)  and  gestational diabetes mellitus(18.1%) was commonly observed in women in 38 weeks of gestation as both conditions are delivered at 38 weeks. Hypothyroidism was predominantly observed in women at 37 weeks(36.3%) and 39 weeks(24%) of gestation.  In individuals' groups, among the NP group, most pregnant women were delivered by FTNVD (60%) followed by 30% cases by LSCS. In P group out of 50 deliveries, 78% of cases delivered by FTNVD, followed by 14% undergone LSCS.  Conclusion: Partogram is an excellent tool for reflecting quick and consistent review of labour events, handing over the patient in changing shift duties, especially in low resource settings. It leads to earlier decision making in labour management and shown to reduce cesarean section rates.

Background: Acute appendicitis is one of the commonest general surgical problems seen in pregnant females. Prompt evaluation and management is of utmost importance to avert maternal and fetal morbidity and mortality. The aims and objectives of this study were to study the presentation and management of acute appendicitis in pregnancy. Methods: This was a prospective cohort study of 50 pregnant patients presenting with acute appendicitis over a period of 4 years in a tertiary care hospital of a developing area.Results: The mean age of the patients was 29.31 ± 4.83 years with most of them being in the age group of 25 - 30 years. Thirty-one (62%) patients hailed from the rural areas. Twenty-eight (56%) patients were primigravida. Majority of patients presented in the 2ndtrimester [28 (56%) patients]. Ultrasonography was used as the diagnostic modality of choice in 48 (96%) patients. Majority of the patients [47(94%)] were managed conservatively on intravenous antibiotics, analgesics and fluids. The mean hospital stay was 4.26 ± 1.29 days. Simple open appendectomy was needed in two (4%) patients whereas one (2%) patient required laparotomy because of generalized peritonitis. No maternal or fetal loss was seen in our study.Conclusion:Acute appendicitis is a common surgical emergency encountered in the pregnant females and usually responds well to conservative therapy. However early surgical intervention is warranted in case of peritonitis to circumvent maternal and fetal complications.

Background: Foetal growth restriction (FGR) is a significant cause of morbidity and mortality. Clinical methods for identifying women whose pregnancies are affected by FGR do not perform well. Despite this, the current approach to screening includes the clinical assessment of risk and thetargeted use of ultrasound. Objectives: To analyse the uteroplacental and fetoplacental blood flow using doppler ultrasound in FGR fetuses regarding UA and MCA flow velocity and waveform indices and compare the mode of delivery and perinatal outcomes in FGR pregnancy to normal and abnormal Doppler waveforms with those of pregnant women without FGR normal dopplers. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Radiology at Shadan Institute of Medical Sciences, Teaching Hospital and research centre, Hyderabad, from January 2019 to September 2019. A group of 100 cases were studied. Half of them (50 cases) comprised the study group, i.e., cases with FGR, 25 cases of which had abnormal doppler, and the remaining 25 cases of these 50 cases had FGR with normal doppler. The results in this study group were compared with 50 cases of normal pregnancies without FGR with normal doppler. Results: The operative delivery was 88% in abnormal doppler FGR, and 36% in normal doppler FGR, in contrast to 24% in the normal doppler non-FGR group. The mode of delivery was statistically significant among the groups with a p-value (<0.001). 64% of the abnormal doppler group had oligohydramnios compared to 36% in normal doppler with FGR versus 10% in the control group with a significant p-value (<0.001). The mean birth weight in FGR with abnormal doppler was 1.96±0.25kg compared to 1.94±0.16 kg in FGR with normal doppler and 3.06±0.31 kilograms in the control group, which had a significant p-value (<0.001). Conclusion: Abnormal UA and MCA indices are notably associated with operative abdominal deliveries, oligohydramnios, and low birth weight babies.

Background: Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory disease of unknown etiology characterized by symmetric polyarthritis. It is the most common form of chronic inflammatory arthritis. It can also cause a variety of extra-articular manifestations, such as vasculitis, nodules, and accelerated atherosclerosis. RA affects 0.5–1% of the adult population worldwide. Females are more commonly affected than males, which can be attributed to the role of estrogen in enhancing immune response. Genetic and environmental factors play an important role in the pathogenesis of RA. Materials and Methods: This is a prospective study conducted in the Department of OBGY and Orthopaedics. Data about RA pregnancies were collected before conception and during each trimester and post- partum period. All the patients were prospectively followed at the multidisciplinary Pregnancy Clinic for Rheumatic Diseases. Data collection was performed at five time points: preconception visit (3–6 months before conception), during each trimester of pregnancy (first: 8–12 weeks of gestation, second: 18–24 weeks, third: 30–36 weeks), and up to 6 months after delivery. Results: Flare rates during pregnancy in patients with RA are associated with active disease in early pregnancy. A total of 65 pregnant patients were identified. No patient with RA experienced more than one episode of flare during pregnancy. Comparing patients with flares with those without them, the discontinuation of TNFi in early pregnancy correlated with the risk of flares. Conclusion: Elevated disease activity and TNFi discontinuation in early pregnancy may cause a relapse of disease activity in patients with RA. Restart of medication controls disease activity in pregnant patients with RA but shows insufficient effect in pregnant patients. The data indicate that tailored medication should be considered beyond conception to stabilize low disease activity and to prevent a flare during pregnancy.

Material & Methods: Study Design: Hospital based prospective observational study.Study area:Department of Obstetrics & Gynecology, Mayo institute of Medical Sciences,Barabanki, Uttar Pradesh.Study Period:April 2022 toMarch 2023. Study population:All patients presenting with jaundice to Department of Obstetrics & Gynecologyin antepartum or intrapartum period.Sample size: Study consisted a total of 55 subjects.Sampling Technique:  Simple Random technique. Results: In 29% (n=16) of cases, jaundice is due to obstetric cholestasis, who are mostly presented with pruritis and abnormal LFT’s in their third trimester, In 27% (n=15)it is due to HELLP syndrome which is associated with preeclampsia in 14%, In 12.7%(n=7) cases jaundice is due to sickle cell anemia and Hepatitis B each, haemolytic anemia due to blood transfusion is seen in 5.45% (3), in 3.6%(n=2) cases cause is AFLP who presented with hepatic encephalopathy and hypoglycemia , cirrhosis is the cause of jaundice in 3.6%(n=2) who presented in their first and second trimester,1.8%(n=1) cases are due to malaria, cholelithiasis and autoimmune hepatitis each. So in nearly half of the cases the cause of jaundice is pregnancy specific causes. Conclusion:Jaundice in pregnancy is a dreadful condition resulting in high maternal and fetal mortality. Even though the blood bank facilities has increased, due to their advanced disease state at admission few patients could not be survived. So early referrals are helpful.Team effort is needed in the management of jaundice , team should constitute obstetrician , physician, gastroenterologist, anaesthetist and neonatologist, so that identification and treatment throughout antepartum, intrapartum and postpartum period prevent and reduce maternal and perinatal morbidity and mortality.

Background: Identifying the women who are likely to miss receiving complete ANC care during their pregnancy and understanding the causal factors is essential towards the development of effective and targeted public health interventions. Objectives: To assess the sociodemographic profile and the factors influencing the utilisation of antenatal services among pregnant women in rural Coimbatore. Methods: A community based cross-sectional study was conducted among antenatal women residing in the field practice area of Rural Health Training Centre using multi-stage sampling method from June 2021 to May 2022 (one year) in the Rural Field Practice Area of a Medical College in Coimbatore district using pre-tested, validated, semi-structured questionnaire. Results: Majority (55.2%) of the participants were aged between 18-25 years. Only 10% of the women were currently employed. Tests of association showed that sociodemographic factors were significantly associated with ANC utilization (p<0.05). Among the study participants, 80.4% utilized the services completely (ANC visit to healthcare facility, consumption of IFA tablets, Td vaccination, basic blood, and urine investigations and ultrasonogram); 19.6% had incomplete ANC care and none had “No ANC”. Conclusion: The overall high ANC utilisation in the study area could be attributed to the favourable knowledge, attitude, and practice of the antenatal women towards maternal and child health as a result of high literacy rate, ongoing IEC and health promotional activities. Attention should be given to regular and sustained contact between healthcare workers and antenatal mothers especially through home visits to develop mutual confidence in preparing them for pregnancy, childbirth, and care beyond.

Background: One form of hypertension in pregnancy is preeclampsia, which is characterized by blood pressure ≥ 140/90 mm of Hg and protein in urine at gestational age after 20 weeks. Preeclampsia is a global problem affecting 2-8% of pregnancies, and an estimated 8.3 million pregnant women experience preeclampsia every year.  In this review we will look at potential biomarkers and its correlation with uterine artery Doppler for early prediction and diagnosis of preeclampsia. Aim: To investigate the role of placental growth factor, and uterine artery diastolic notch to predict the early onset of preeclampsia. Materials And Methods: A hospital based prospective study conducted on 100 normotensive, non- proteinuric antenatal women less than 20 weeks of gestation were recruited. At 12-16 weeks, PLGF level was estimated from stored serum samples of all cases ad Doppler assessment of uterine circulation for uterine artery indices were done. These women were again rescanned at 24 weeks of gestation by transabdominal USG and further followed up clinically for development of preeclampsia. Methods used for the detection of PLGF is ELISA kit ad Uterine artery Doppler velocimetry was done by transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer Results: In this study,the median PLGF levels being significantly lower in pre-eclampsia cases (15 pg/ml) compared to normal (20.0pg/ml) with sensitivity being 90% and specificity being 23.4%, positive predictive value of 15.5% and negative predictive value of 93.8%. When Uterine arteries notch and RI >0.65 taken together increases sensitivity by 85.71%, 84.62% specificity and negative predictive value by 98.25%.  We found 52.3% sensitivity rate and 84.62% specificity with  70.51% of Negative predictive value regarding Uterine arteries PI  at >0.9573 with Optimal Cut off.  Conclusion: The combined measurement of maternal serum PlGF concentrations and The uterine artery notching, high Resistance Index and Pulsatility Index in uterine artery Doppler waveform at <20 weeks has shown as best screening test for early prediction of preeclampsia.

Background: This prospective observational study delves into the intricate realm of Doppler indices in intrauterine growth restriction (IUGR) fetuses, aiming to illuminate their clinical relevance and predictive potential. Fetal growth restriction, a critical concern in maternalfetal medicine, is explored through the lens of Doppler ultrasound, which enables assessment of uteroplacental and fetoplacental blood flow dynamics. By evaluating umbilical arterial (Umb A) Doppler Velocimetry, this study establishes correlations between hypoxemia in IUGR-affected fetuses and abnormal Middle Cerebral Artery (MCA) pulsatility indices. The investigation comprehensively analyzes Doppler indices' performance in predicting perinatal outcomes, utilizing sensitivity, specificity, and diagnostic accuracy assessments. With a focus on both symmetrical and asymmetrical IUGR, this study demonstrates the importance of Doppler imaging in diagnosing growth retardation and predicting adverse outcomes. Findings underscore the significance of combined uteroplacental and fetoplacental assessments and the potential of umbilical artery Doppler in outcome prediction. The implications of abnormal Cerebro umbilical ratio and absent diastolic flow further underscore the utility of Doppler imaging in enhancing high-risk pregnancy surveillance and outcomes.

Introduction: Gestational diabetes affects a significant proportion of pregnant women and can have adverse health effects for both the mother and the baby. Monitoring blood glucose levels and lipid profiles is crucial in managing this condition. This comparative study examines how glycosylated hemoglobin (HbA1c) and lipid profile parameters change in women with gestational diabetes compared to normoglycemic pregnant women, with the goal of improving diagnostic and management strategies for this condition. The aim of this study was to determine that HbA1c is an independent marker of dyslipidaemia among GDM cases and emphasize the link between the aforementioned parameters among pregnant women in Bihar. Materials and Methods: In this comparative study, we included fifty patients who were diagnosed with gestational diabetes during pregnancy. All of the antenatal women were in their third trimester. We also included another fifty pregnant women as controls, who did not have gestational diabetes or any other pregnancy complications in their third trimester. Both the cases and controls were randomly selected from the age group of 20 to 45 years. In this study, we measured the serum lipid profile parameters, oral glucose tolerance test blood glucose levels, and glycosylated haemoglobin levels in patients with gestational diabetes, and compared them with those of healthy pregnant women. Results: In this study, 50 pregnant women with GDM had a mean age of 31.2 years, while 50 pregnant women in the healthy control group had a mean age of 29.3 years. In the present study, serum triglycerides were observed at 193.12±10.12 mg/dL in GDM cases and 150.76±8.54 mg/dL in the control group, while serum total cholesterol was observed at 211.43±14.34 mg/dL in GDM cases and 168.83±18.19 mg/dL in the control group. The levels of serum triglycerides and serum cholesterol in GDM cases were statistically significantly higher as compared to the controls. The serum HDL cholesterol was observed at 57.98±5.78 mg/dL in GDM cases and 55.12±6.67 mg/dL in the control group, while serum LDL cholesterol was observed at 92.13±13.45 mg/dL in GDM cases and 82.03±10.16 mg/dL in the control group. There was no statistically significant difference in their HDL and LDL Cholesterol in the cases and control group. The fasting blood glucose was recorded at 116±9.65 mg/dL in GDM cases and 89±5.89 mg/dL in the control group, the blood glucose level after 1 hour of 75grams oral glucose administration in oral glucose tolerance test was observed at 198.13±12.74 mg/dL in GDM cases and 158.33±9.34 mg/dL in the control group while blood glucose level after 2 hours was observed at 174.38±11.48 mg/dL in GDM cases and 140.11±7.87 mg/dL in the control group. The differences between cases and controls were statistically significant. The mean value of the HbA1c of cases and control groups was 8.15±1.12 mg/dL and 6.02±0.18 mg/dL respectively. This difference between healthy pregnant women and women with GDM was statistically significant. Conclusion: The study's findings have conclusively demonstrated that triglyceride, high-density lipoprotein, glycated haemoglobin, and glucose levels in the blood all play a significant role in the development of dyslipidemia in gestational diabetes mellitus (GDM). Although it is well known that lipid parameters increase during a healthy pregnancy, the way they increase in GDM is different.

Conclusion: The study concluded that there is a strong positive strength of association between the gestational age and placental thickness. The thickness of placenta increased with increase in the gestational age and hence could be used as a predictor and a parameter of gestational age prediction when the last menstruation is uncertain or is unknown. The study also found there is strong strength of association between the estimated gestational age by FL, BPD and AC with the placental thickness. Also study documented the positive strength of association of placental thickness with other fetal biometry like FL, BPD and AC.

Background: Gestational Diabetes Mellitus (GDM) is a prevalent metabolic disorder during pregnancy, carrying significant health risks for both mothers and infants. Early detection and risk assessment are crucial for effective management. This study investigates the potential of first-trimester serum uric acid levels as an early predictor of GDM in pregnant women attending a tertiary care hospital in Uttar Pradesh, India. Material and Methods: A prospective cohort study was conducted, enrolling 500 pregnant women in their first trimester. Clinical data, including demographic information, medical history, and anthropometric measurements, were collected. Laboratory measurements of uric acid, fasting glucose, and insulin resistance indices were performed. Participants were followed throughout pregnancy, and GDM diagnosis was established using the standard oral glucose tolerance test (OGTT) during the second trimester. Statistical analysis included logistic regression, ROC curve analysis, and calculation of sensitivity, specificity, and predictive values. Results: Elevated first-trimester serum uric acid levels exhibited a significant association with GDM development. Participants with uric acid levels between 4.0 - 4.5 mg/dL had an odds ratio of 1.82 (95% CI: 1.51-2.21) compared to those with levels below 4.0 mg/dL, indicating increased GDM risk. Uric acid levels > 4.5 mg/dL showed a sensitivity of 85% but a specificity of 68%. Combining uric acid with traditional risk factors, such as maternal age and BMI, may enhance predictive accuracy. Conclusion: First-trimester serum uric acid levels are a potential early predictor of GDM. Elevated uric acid levels were associated with increased GDM risk, though specificity may benefit from a multi-factorial predictive model. This study underscores the clinical significance of uric acid in GDM risk assessment and highlights the potential for improved screening strategies.

Background: Eclampsia is a serious medical condition that affects women during pregnancy. Symptoms of eclampsia appear in pregnancy as a condition known as pre-eclampsia, (condition follows a high blood pressure), the condition can go undetected until it develops into eclampsia. This can create additional complications during pregnancy. Each case of eclampsia is unique, and the pregnant woman may share few or no characteristics with other women who develop the condition. Pregnancy histories, Patient age, Family history, Obesity, High blood pressure are major high risk factors for preeclampsia and eclampsia will vary from patient to patient. Materials and methods:The present study was carried out in the Department of Biochemistry, Rama Medical College and Research centre over a period of 1 year. Total 70 patients of pregnancy were selected out of which 30 patients were of normal pregnancy and 40 patients were of pregnancy induced hypertension. Serum uric acid levels were estimated before delivery and after delivery in cases of pregnancy. Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. Result:The result showed significantly high blood pressure (SBP-165.81±20.9 VS 125.69±7.24, DBP 109.74±10.41 VS 80.8±5.15) and Blood urea (31.48±2.33mg/dl VS 6.28+/-1.9mg/dl), serum creatinine (0.67±0.52mg/dl VS 0.67±0.03mg/dl), serum uric acid level (6.28±1.9 mg/dl VS 9.48±2.33mg/dl) in pregnancy induced hypertensive women compares to normal pregnant women. In the present study, in PIH, there is elevation of serum uric acid and serum creatinine elevated values are statistically significant. Conclusion:This study concluded that PIH showed significant elevation in the urea, uric acid, and Creatinine levels compared to normal pregnant women, although all parameters’ values for both groups were in the reference values for non-pregnancy.

Purpose: To study the fundus changes in Pregnancy Induced Hypertension (PIH). Methods: It is a hospital based prospective observational study of 100 women with diagnosed PIH. Fundus was examined by direct and indirect ophthalmoscope at bedside. Result: PIH was more common in primigravida (58%); maximum in below 25 years (54%) and in >36 weeks of gestational age (59%). Retinal changes were noted in 45 patients (45%) in which grade I hypertensive retinopathy was 37.7% and grade IV was 24.44%.  Retinal changes were significantly associated with BP (systolic and diastolic), proteinuria and severity of preeclampsia and eclampsia. Most of the changes in the fundus resolved within one week of delivery. Conclusion: All the patients of PIH should be examined by an ophthalmologist for proper management.

Background: The placenta is arguably one of the most important organs in the body. It influences not just the health of a woman and her foetus during pregnancy, but also the lifelong health of both mother and child. Despite its importance, we know little about this critical but temporary organ. The placenta has evolved to support the development of the embryo and foetus during the different intrauterine periods of life. By necessity, its development must precede that of the embryo. There is now evidence that during embryogenesis and organogenesis, the development of the human placenta is supported by histotrophic nutrition secreted from endometrial glands rather than maternal blood. These secretions provide a plentiful supply of glucose, lipids, glycoproteins, and growth factors that stimulate rapid proliferation and differentiation of the villous trophoblast. The present study conducted to observe any gross morphological change in placenta of normal individuals in North Karnataka region. Materials & Methods: 50 placentas were carried in multiple medical institutions in Karnataka, which were collected from labor room and operation theaters of connected Hospitals, washed under tap water and blot dried. Weight of placenta was recorded by weighing machine. Maximum diameter was measured, radius of placenta was obtained, and surface area was calculated using the formula. Cord attachments were also observed. Results: Out of 50 placentas 86% of placenta were circular and 14% were oval. Diameter was <15cms in 12%, 16- 20 cms in 68%, > 21cms in 20%. Surface area was 100- 200 cms2 in 16%, 201- 300 cms2 in 60%, 301- 400 cms2 in 20%, > 401 cms2 in 4%. Placental weight was between 300- 400gms in 14%, 401- 500gms in 58% and > 501gms in 28%. Umbilical cord insertion on fetal surface was found to be central - 60%, Paracentral -18% and Peripheral- 22%. The average diameter was 22.86+4.2, the average surface 316.52+76.42 and the average placental weight was 512.86+42.36. Conclusion: The present study parameters and an adequate knowledge of the morphometric analysis of the placenta with its clinical relevance proves to be useful in the early assessment of placental sufficiency and also the state of the fetal wellbeing. In mothers who have had no previous antenatal checkup, a thorough examination of the placenta helps in the early diagnosis of the fetal complications, soon after parturition and thus helps in the early treatment of the baby by neonatologists.

Hypertensive disorders in pregnancy, encompassing conditions like gestational hypertension and preeclampsia, significantly impact maternal and fetal health. Understanding their incidence and associated risk factors is vital for improving prenatal care. Objectives: This study aims to determine the incidence of hypertensive disorders among pregnant women and identify key demographic and health-related factors associated with these conditions. Methods: Design: Cross-sectional study. Setting: Obstetric outpatient Department. Participants: 250 pregnant women, ranging from 18 to 45 years, at various stages of gestation. Data Collection: Medical histories, blood pressure measurements, and relevant biochemical markers were collected. Statistical Analysis: Descriptive statistics, chi-square tests, and logistic regression were used to analyze the data. Results: Incidence: The incidence of hypertensive disorders was found in a specific percentage of the participants. Risk Factors: Key risk factors such as age, BMI, and medical history were significantly associated with the development of hypertensive disorders. Demographics: The study also revealed demographic trends, such as a higher incidence in certain age groups or pre-existing conditions. Conclusion: This study highlights a significant incidence of hypertensive disorders in pregnant women, underscoring the need for targeted prenatal screening and management strategies. The identification of key risk factors can aid healthcare providers in developing personalized care plans.

Near miss maternal mortality cases generally occur more frequently than maternal deaths and therefore a more reliable quantitative analysis can be carried out, which can provide a more comprehensive profile of health system functioning. Present study was aimed to study clinical profile of maternal near miss cases at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women who were pregnant or in labor or delivered or aborted; up to 42 days from termination of pregnancy, admitted and labelled as Maternal Near Miss. Results: In present hospital-based study, 220 near-missed cases were studied. Most of the patients are from the age group of 20-24 years (45.9 %), followed by 25-29 years (29.09 %) & 30-34 years (9.54 %). Majority of near-miss cases belonged to rural area (59.09%), were housewives (41.81 %), belonged to class III of socioeconomic class (29.09 %), were illiterate (55.90 %). Of 220 cases, 197 were registered (89.54 %), 95% of patients were immunized. Majority cases were referred from other hospitals (53.63 %) & were admitted in the antepartum period (87%). Majority cases were primigravida (40.9 %) followed by gravida two (20.45 %) & gravida three cases (19.09 %). 202 cases (91%) were delivered at a tertiary centre of which many were referred in antenatal period for high-risk management. 128 cases (58.18%) underwent LSCS, 88 cases (40%) delivered vaginally. Hypertensive disorders of pregnancy (53.18 %) contributed to the majority of near-miss cases, followed by anemia (19.09 %), heart disease (9.09 %), abruptio placentae (6.36 %) & respiratory disease (5.45 %). In 52% of near-miss cases, vascular and hematological dysfunction. Conclusion: Present study noted pregnant women from rural area, from lower socioeconomic class, low literacy were common among near miss cases.

Background: This study explores the landscape of maternal health and its impact on neonatal outcomes, focusing on the prevalence of diverse pregnancy-related complications. Recognizing the significance of understanding these complexities, the study investigates conditions such as abruption, gestational diabetes mellitus (GDM), hypertension, and other factors influencing birth weight categories. Objective: To contribute nuanced insights to maternal and neonatal healthcare practices. Materials and Methods: A retrospective analysis was conducted on a cohort of subjects, extracting data from medical records. The study encompassed various pregnancy-related complications, including abruption, GDM, hypertensive disorders, fetal growth restrictions, and other maternal conditions. Statistical analyses, including percentages and prevalence rates, were employed to elucidate the distribution of these complications within the studied population. Results: The findings reveal a diverse spectrum of maternal health conditions. Notable observations include the prevalence of GDM (8.2%), hypertensive disorders (6.6%), and post-term pregnancies (11.5%). Additionally, conditions such as abruption, fetal growth restriction, and preterm births exhibited varying frequencies. Rh-negative pregnancies accounted for 9.8%, emphasizing the multifaceted nature of maternal health complexities within the studied population. Conclusion: This study provides a comprehensive overview of pregnancy-related complications and their prevalence within the studied cohort. The findings underscore the need for personalized antenatal care strategies, early anomaly detection, and focused interventions to optimize maternal and neonatal outcomes. Recognizing the intricate relationships between maternal health conditions and birth outcomes is crucial for informing clinical decision-making and enhancing public health initiatives.

Background: Gestational diabetes mellitus is a condition in pregnancy where adverseperinatal outcomes in mother occurs.Effect of longstanding diabetesmellitus on adult heart might lead to dysfunction and diabeticcardiomyopathy. Microvascular processes and subcellular disturbancescause structural and functional damage to the diabetic heart, even without overt coronary artery disease.GDM patients might have impaired cardiacfunctions compared to healthy pregnant women. Objective: In view of this, this study was undertaken to assess the Maternal cardiac adaptation of women at term with and without GDM. Methods: A prospective study was conducted among 60 pregnant women, 30 with GDM and 30 without GDMduring2022 to2023admitted inthe department of obstetrics and gynaecology at Adichunchanagiri Institute of Medical Sciences, B.G Nagara, Karnataka. Results: There was no statistically significant difference in echocardiogenic findings of both groups. Results revealed that echocardiogenic parameters, including normal heart rate, left ventricular relative wall thickness, LV late diastolic transmitral valve velocity, Ejection fraction >60%,Pulmonary artery systolic pressure,IVC findings,regionalwall motion abnormality are normal.These findings suggest that diabetesdonot appear to have impact on echocardiac measures compared to normalANC women. Conclusion: These results suggest that during pregnancy the presence ofgestational diabetes maynot impact cardiac function compared to normalantenatal women. 

Introduction: Some congenital defects can be prevented in the pregestational stage. However, many health professionals are not prepared to provide counselling to couples regarding the same. Aims: To assess the awareness of health care professionals about congenital anomalies and pre-conception car. Materials and Methods: It is a cross-sectional study that was conducted online for a duration of 6 months. Data was collected using a pretested and structured questionnaire on basics of congenital anomalies & pre-conception care, which was shared through google forms in social media. Purposive sampling was adopted. Results: Our studied group included 246 participants. The mean score for awareness of congenital anomalies was 9.7±1.6, with median score of 10 (9-11). The mean score for awareness score of pre-conception care was 8.3±1.6, with median of 9 (7-10). About 90% knew exactly what constitutes congenital anomalies but only 22.3% knew that >70% of these congenital anomalies are preventable. Only 50% of participants knew that causes are not known, only risk factors are identified. 90% believe that consanguineous marriages are one of the causes of congenital anomalies which is false. 50% knew the timing of different screening tests done during pregnancy to detect congenital/fetal anomalies. 80 - 90% knew that Periconceptional care is needed for both men & women irrespective of their health status and <50% knew that it should be considered not only before conception, but also in planning for family, contraception. Even though more than 90% knew about few components of PCC, more than 50% are not aware of the dosage of Folic acid. Conclusions: Awareness among doctors (irrespective of gender, education qualification or profession) about congenital anomalies and PCC is good in some important respects (like all antenatally detected anomalies need not be terminated) and poor in basic aspects like aetiology, prevention and detection of congenital anomalies, indications of PCC.

Background- Effective pain relief and minimum motor block are the necessary constituents of an ideal epidural block. Fentanyl is a lipophilic opioid most commonly used as an adjuvant to local anaesthetic. Ropivacaine is an alternative to bupivacaine, with greater sensitivity for sensory fibres than motor fibres, thus producing less motor blockade than bupivacaine. This study assessed the analgesic effect of very low dose fentanyl (1mcg/ml) as an adjuvant to either ropivacaine or bupivacaine. without compromising its beneficial effects and avoiding the undesired side effects. AIM- To study the effect of fentanyl as an adjuvant to bupivacaine and ropivacaine in epidural analgesia for laboringparturient. Method- 44 nulliparous labouring parturients of ASA I & II at term with singleton pregnancy of vertex presentation without any obstetric complication were randomly allocated into two groups of 22 each. Group B received bupivacaine 0.125% with fentanyl 1 mcg/ml bolus dose till VAS<3. Similarly, Group R received ropivacaine 0.125% with fentanyl 1 mcg/ml. Analgesia was maintained with intermittent bolus of study solution. Analgesic efficacy was measured in terms of duration of analgesia, onset of analgesia, highest level of sensory block, motor block, side effects if any; obstetric and neonatal outcomes were also recorded. Results- There was no significant difference between the two groups in terms of duration of analgesia, level of sensory block achieved, time required to achieve level of sensory block, motor block or side effect profile. There were minimal side effects and neonatal outcomes were good. Obstetric outcomes and maternal satisfaction level was also comparable between the two groups. Conclusion- Fentanyl when used in a low dose of 1 mcg/ml with equal concentration of two local anaesthetic bupivacaine and ropivacaine provides good analgesia in all stages of labour avoiding the side effects of opioids.

Background: Acute kidney injury (AKI) is a common complication following coronary artery bypass grafting (CABG) surgery, particularly in older patients. The use of cardiopulmonary bypass (CPB) during CABG has been associated with an increased risk of AKI. Additionally, the type and volume of intravenous fluids administered during surgery may influence the occurrence of AKI. However, the impact of these factors on AKI in older patients undergoing CABG remains unclear. Method: This observational study conducted at a tertiary care center focused on patients undergoing coronary artery bypass grafting (CABG) surgery over an 18-month period. Included were adult patients aged 41 to 70, of any gender, diagnosed with triple vessel, double vessel, or single vessel illness, scheduled for on-pump CABG surgery, and classified as American Society of Anesthesiologists (ASA) II and III physical status. Exclusions comprised patients with specific preoperative serum creatinine levels, those below 40 or above 70 years, pre-existing kidney conditions, pregnancy, and unwillingness to participate. Result: The study included 58 participants with a mean age of 62.18 ± 8.01 years, predominantly male (76.7%). Among them, 42.2% experienced AKI postoperatively, with the majority classified as Stage 1 (37.1%). Serum creatinine levels showed a slight increase at 24 hours post-operation and a subsequent decrease at 48 hours. There was no significant association between AKI and age, gender, comorbidities, or intraoperative parameters including CPB duration and fluid administration. Conclusion: The study findings suggest that older patients undergoing on-pump CABG are at increased risk of AKI, with chloride-rich fluids being an independent predictor. However, AKI was not associated with negative outcomes or mortality in this population. Further research is needed to explore strategies for mitigating AKI in older CABG patients, including optimizing fluid management and considering alternative surgical techniques.

Background: Thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and child. This study aimed to investigate the prevalence of thyroid dysfunction among pregnant women and its correlation with obstetric outcomes and risk factors.Methods: A prospective observational study was conducted on 500 pregnant women. Thyroid function tests were performed at enrollment and during each trimester. Data on obstetric outcomes and compliance with treatment were collected. Results: The prevalence of thyroid dysfunction was 5.0%, with hypothyroidism (2.0%), hyperthyroidism (1.0%), subclinical hypothyroidism (1.6%), and subclinical hyperthyroidism (0.4%). No significant association was found between thyroid dysfunction and adverse obstetric outcomes such as preterm birth (20% vs. 9%, OR 2.5, p=0.08) and low birth weight (16% vs. 8%, OR 2.1, p=0.18). Age over 30 years (OR 2.0, p=0.02) and a family history of thyroid disease (OR 3.5, p=0.001) were significant risk factors. Followup results showed a progressive worsening of thyroid function during pregnancy. High compliance with levothyroxine treatment was observed (80%). Conclusion: While the prevalence of thyroid dysfunction in this cohort is in line with global rates, the study highlights the critical need for routine monitoring and management of thyroid function in pregnancy. The findings also emphasize the role of specific risk factors in identifying women at higher risk for thyroid dysfunction.

Background: The escalating global rates of cesarean sections (CS) have raised concerns regarding maternal and neonatal outcomes. While CS can be life-saving, their overuse poses significant risks, necessitating a careful balance between benefits and risks. In India, regional disparities and socioeconomic factors contribute to varying CS rates, highlighting the need for context-specific interventions. Objective: This study aimed to investigate the patterns of CS utilization and associated factors in the Central Vindhya region, with a focus on identifying clinically relevant groups contributing most to CS deliveries.Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, S.S. Medical College, Rewa, Madhya Pradesh, India. Data were collected retrospectively from hospital records of 7,484 women who underwent CS over a specified 3-year period. Robson's classification system was used to categorize CS cases into ten groups based on pregnancy characteristics, obstetric history, labor progression, and gestational age. Results: The overall CS rate was 28.18%, with multiparous women with prior cesarean sections (Robson's group 5) constituting the largest proportion of CS cases (32.58%). Nulliparous women in spontaneous labor (group 1) and those with induced labor or cesarean before labor (group 2) also contributed significantly to CS rates. Indications for CS included previous cesarean section (32.57%), fetal distress (16.56%), and meconium-stained liquor (19.2%). Conclusion: This study provides valuable insights into CS utilization patterns and associated factors in the Central Vindhya region. The findings underscore the importance of context-specific interventions to optimize CS utilization while ensuring maternal and neonatal safety. Further research is warranted to explore effective strategies for reducing CS rates and improving maternal health outcomes in resource-limited settings.

Objective: To determine association of cervical dialatation rate with body mass index (BMI). Introduction: The prevalence of overweight and obesity is increasing among women of childbearing age. Observational studies show that obese women have up to a 2-fold increased risk for a cesarean delivery compared with normal-weight women. The purpose of this study was to examine the effect of maternal overweight and obesity on the pattern of labor progression in pregnant women with a singleton, term pregnancy with spontaneous onset labour. Methods: We analyzed data from 1531 pregnant women with a term pregnancy those were admitted in SSMC ,Rewa from August 2017- July 2018 with spontaneous onset labour pain at term. The median duration of labor by each centimeter of cervical dilation was computed for under weight(Body mass index BMI<18.5 kg/m2), normal-weight (BMI_ 18.5 –24.9 kg/m2), overweight (BMI >24.9-29.9 kg/m2), and obese (BMI>30 kg/m2) women and used as a measurement of labor progression. Results: After considering inclusion and exclusion criteria all laboring females were allowed to progress naturally and four hourly partogram was recorded. All females who required augmentation ,caesarean or instrumental delivery were excluded from the study. On the basis of individual labour progress chart which were obtained ,a final composite labour graph was derived and appropriate statistical tests were applied. We have found that BMI is directly related to rate of cervical dilatation . Mean rate of cervical dilatation was 1.46 cm/hr in group with BMI <18.5 kg/m2 .The rate of cervical dilatation was less in group with BMI >30 i.e 0.9 cm/hr. Conclusion: . Labor progression in overweight and obese women was significantly slower than that of normal-weight and under- weight women. Given that NFHS (National family health survey -5)¹ has shown that obesity is increasing in India in all states from 21% to 24% among women, it is critical to consider differences in labor progression by maternal pre pregnancy BMI before additional interventions are performed.

Background:   Tertiary healthcare centres play a pivotal role in managing high-risk pregnancies, with referred cases presenting unique challenges and outcomes. Methods: This prospective observational study analyzed 275 referred cases among 4972 deliveries over 18 months, examining demographics, reasons for referral, delivery, and neonatal outcomes.  Results:   Most referrals involved women aged 21-30 (62.2%) from lower socioeconomic statuses. Common referral reasons included PROM (20.4%) and gestational hypertension (17.5%). Delivery outcomes were predominantly normal vaginal deliveries (53.5%) and caesarean sections (44.3%). Neonatal outcomes highlighted a 23.6% NICU admission rate, with respiratory distress and low birth weight being the leading causes. The study also noted stillbirths (2.2%) and neonatal mortality (1.8%). Conclusion:   The study reaffirms the essential role of tertiary centers in handling complex referrals, highlighting the influence of socioeconomic status on maternal health and the challenges in improving neonatal outcomes. It emphasizes the need for targeted prenatal care and streamlined referral systems.

Introduction: Foetal growth restriction (FGR), is a condition that occurs due to various reasons.It is an important cause of foetal and neonatal morbidity and mortality. It has been defined as a rate of foetal growth that is less than the growth potential of that specific infantor as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age.  It has been found to be associated with a variety of adverse perinatal outcomes.These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemiaetc. The likely long-term complications that are prone to develop when FGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps etc. Methods: This cross-sectional study included all growth restricted babies born in the department of Obstetrics and Gynecology at Government Medical College, IMCH Kozhikodeduring the study period and their mothers.   Multiple pregnancy with growth restriction were excluded from the study. Babies born outside IMCH but being referred to IMCH were also excluded. Socio –demographic and fetomaternal characteristics were collected after getting consent. Maternal data regarding socio-demographic variables including age, domicile (rural/ urban), socio-economic status, data regarding gestational age, nature of ANC, past obstetric history including parity. Results: Perinatal mortality rate was 64.2/1000 in growth restricted babies born to normotensive mother group.  The stillbirth rate was 36.6/1000 in growth restricted babies born to normotensive mother group. Fetal growthrestriction occurred more in rural womencompared to urban women. Women below poverty line had more fetal growth restriction compared to the women above poverty line and the difference was statistically significant. Early neonatal mortality rate was 28/1000 live IUGR babies in normotensive group. Conclusion: Mothers belonging to low socio-economic status have high risk of delivering babies with growth restriction. This is because of inadequate dietary intake, increased physical activity, passive smoking, increased rate of infections and low educational levels leading to decreased awareness regarding health care facilities. 

Background: Cardiac disease in pregnancy is considered to be an important cause of maternal morbidity and mortality. Cardiac disease complicates 1-3% of all pregnancies and considered as leading cause of indirect maternal deaths. Cardiac disease in pregnancy is considered to be high risk and management of it in pregnancy is challenging. Aim: To evaluate fetomaternal outcome in cardiac disease complicating pregnancy. Objectives: To evaluate fetal and maternal outcome in pregnancy with cardiac disease. To measure the prevalence of cardiac disease in pregnancy. Materials & Methods: A retrospective observational study of all women who delivered at a tertiary care centre from 2011 to 2018 with heart disease complicating pregnancy were included in the study. Their details were collected from the case record and registers, using data collection proforma. The outcomes were studied. Results: The prevalence of cardiac disease was found to be 0.66%. Most common heart disease in pregnancy was found to Rhematic heart disease (72%). Among them the most common heart disease was found to be mitral stenosis (35%). Conclusion: Cardiac disease is a high risk pregnancy and has major effect on fetal and maternal outcome morbidity and mortality in pregnancy. Hence proper antenatal monitoring, involvement of multidisciplinary team and delivery in a tertiary care setup with ICU and Cardiac care facilities will definitely improve the fetal and maternal outcomes in cardiac disease complicating pregnancy.

Background:  Aim: To study the perinatal morbidity & mortality in twin gestations  according to chorionicity. Methodology: A prospective study was carried out in all twin pregnancy women of second and third trimesters in department of Obstetrics and Gynaecology in Government maternity hospital from date of approval of scientific and ethical committee to one year. Every patient is asked about history regarding age, parity, gravida, family history of twinning, regarding conception whether conceived spontaneously or used any ART. Results: Among 200 twin pregnancies, Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The most common age being 25 to 29 years in both mono and dichorionic pregnancies. Most of the cases 83% belong to spontaneous conception,15% were induced by drugs and 2% of cases were induced by IUI. Positive family history was present in 13% of twin pregnancies compared to no family history in 87% of twins. 124 cases were (62%) were dichorionic diamniotic where as 68cases (34%) were monochorionic diamniotic where as 8 cases (4%) were monochorionic and monoamniotic. Gestational hypertension was one of the important maternal risk factor noted in my case which was present in 8% of cases where as preeclampsia was the most commonest maternal risk factor which was present in 25% of cases. Pre term complicating twin pregnancies was present in 44% where as preterm PPROM was present in 17% of cases. There was a stastical significance of preterm and preterm PPROM between monochorionic and dichorionic pregnancies. The maximum deliveries were conducted during 34 – 36 weeks and gestational age more than 37 weeks. Among the monochorionic pregnancies, 47% delivered at a gestational age of 31 -33 weeks where as in dichorionic pregnancies 54% of delivery was at more than 37 weeks. The most common causes for neonatal morbidity was RDS which was present in 80% of MC and 20% of DC where as hypoglycemia was present in 1.6 % of DC pregnancies. Neonatal mortality was found in 15cases(19.73%) in MCDA and MCMA where as 9 cases (8%) of DC. The significance in difference between the two groups was found significant. Conclusion: The present study concluded that Monochorionic-Monoamniotic twins should always be delivered by cesarean section to avoid umbilical cord complications for the non- presenting twin at the time of the first twin's delivery. A woman carrying Dichorionic-Diamniotic or Monochorionic- Diamniotic twins is a good candidate for a vaginal birth.

Background: To assess MEOWS Score (parameters &triggering factors) in pregnant & postpartum women. To measure outcome in terms of morbidity in MEOWS charted pregnant and postpartum women. Materials & Methods : A prospective study was conducted from May 2021- May 2022 .The study comprised of 300 pregnant women greater than 28 weeks upto 6 weeks post partum admitted to labor ward. After taking informed consent from pregnant women and postpartum mothers admitted to labour room, their name, age, occupation residence was recorded, clinical examination was done, vitals were recorded, general and specific investigations were done. MEOWS parameters were measured and an individual score was given and each parameter added to obtain a combined MEOWS score and patients were assigned to triggered and non-triggered groups. These triggered and the non-triggered women were followed and evaluated for obstetric morbidity and fetal outcome. Statistical software SPSS (version 22.0) was used for data presentation and statistical analysis. Continuous Data was presented as mean +/- standard deviation, categorical data was displayed in the form of percentage and analysed by Chi-square test. Performance of MEOWS chart as a screening tool was evaluated by calculating its sensitivity, specificity and predictive values. A p-value of<0.05 was considered as significant. Results: Hypertensive disorder of pregnancy was the most common (21.9%) obstetric morbidity followed by anemia (16.35%). The MEOWS score in this study had a sensitivity of 0.8806 and a specificity of 0.8069. The positive and negative predictive values of the MEOWS tool to predict obstetric morbidity were 0.5673 and 0.9592 respectively. Conclusion: The MEOWS is a sensitive and specific tool to predict obstetric morbidity with a high positive predictive value

Conclusion: The present study stated that, vaginal mode of delivery is not always a completely safe option but may be considered as a safe mode for babies in breech as long as the selection criteria is fulfilled and delivery is done by a skilled and trained   obstetrician with continuous fetal monitoring. Therefore, it is concluded that a balanced decision to be taken about the mode of delivery on a case by case basis as it differs from case to case and gestational age as well as training of assisted breech delivery will go on a long term basis to optimise the outcome of breech presentation.

ntroduction: Women seek abortions for a number of reasons, including birth control. An unintended pregnancy puts a woman at danger; if she wants an abortion, safe services are not readily available to her. In India, septic abortion is largely caused by a lack 
of knowledge about the MTP Act and contraception, as well as a shortage of medical professionals with the necessary training. The purpose of the current study was to assess  people's knowledge, attitudes, and behaviours about septic abortion and the factors that are related to it. Materials and Methods:Through straightforward randomization, a total of 100 individuals who had septic abortions were chosen to be a part of the research. Interviews were used to learn more about these cases' knowledge, attitudes, and behaviours about septic abortion as well as other relevant aspects. The findings were examined and statistically examined. Result: Of the 100 instances examined, 46% of the participants lacked awareness regarding contraceptive devices. Compared to women living in towns, rural women knew less about contraception. The majority of cases learned about contraception from the media and medical professionals, such as radio (22.22%), PHC (22.22%), television (18.52%), and ASHA/ANM (18.52%). Women in urban areas were more knowledgeable with the MPT Act than those in rural areas, and 52% of abortions were performed by dais. Of the 100 instances that were examined, 60 cases (or 60%) involved the use of instruments to achieve a septic abortion.Conclusion:The current study demonstrates that a major contributing factor to the high rate of septic abortion in India is the lack of awareness among rural women 
on contraception and the MTP Act, as well as the abortions performed by unskilled individuals such as dais, quacks, and local practitioners. Therefore, in order to provide comprehensive and safe abortion services as well as higher quality abortion services, the health system must be strengthened.

Background : Recurrent pregnancy loss (RPL) affects about 5%ofwomen. Hyper homo cysteinemia, have been implicated in several pathologic processes in the venous and arterial vascular systems. Hyper homo cysteinemia is associated with many pregnancy related complication like with deep venous thrombosis, recurrent miscarriage, abruptio placenta, preeclampsia, neural tubede fects, and fetal grow threstriction. The objective of this study to assess the prevalence of Hyper homo cysteinemia in patients with unexplained recurrent pregnancy loss. Objective: To study the levels of maternal serum homocysteine in pregnant women with2 or more consecutive miscarriages and compare with control group. Methods:100 Patients of unexplained recurrent pregnancy loss were selected as cases and 100 patients with at least one successful pregnancy were taken as controls. Serum homocysteine levels were assessed in both the study groups. Results: Out of the 100 patients who were assessed, 17% of RPL patients had hyperhomocysteinemia.17 patients out of the 100 cases had hyper homo cysteinemia. Hyper homo cysteinemia was thrice more commonin Primary aborters when compared to secondary aborters. Conclusions: Hyper homo cysteinemia is associated with recurrent pregnancy loss 

Objective: - To study CP ratio & its correlation with feto -maternal outcome. Methods: - This was a prospective observational study done in Department of Obstetrics and Gynaecology, MGM Medical college, Indore, over a period of one year. Women > 37-week singleton pregnancy with no known risk factor who had Doppler USG done at the time of labor were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. Results: - Out of 150 low risk term pregnancy who went for USG colour doppler Scan, 14 (9%) patients were having CPR <1 and 136 (90.6%) were having CPR >1. Among 14 patient with CPR <1 , 10 (71%) were delivered by caesarean section as compared to only 6 (4.41%) patients with CPR >1.  Among 14 patient with CPR <1 , 13 (92.86%) had adverse outcome as compared to only 11.76% patients with CPR >1. Conclusion: - Our study found CPR measure to be a very promising tool for optimising the identifcation of at-risk foetus in low-risk AGA pregnancies.

Introduction: Pregnancy is an incredibly stressful period due to outcome of delivery, anxious about the well-being of the unborn child, added responsibilities once the child is born, financial obligations, adapting to her postpartum body, interpersonal relationships with her spouse and other family members. Aim & Objectives: 1. To determine whether higher anxiety levels in term patients has significant effects on the duration, progress and complications of labour, 2.To assess whether significant maternal anxiety can lead to an increase in caesarean sections or instrumental deliveries, 3.To assess the difference in anxiety levels between term primigravida and term multigravida. Methodology: The study was a descriptive cross-sectional study conducted in the Department of Obstetrics and Gynecology in IGMC&RI.  Antenatal women in the low-risk group with gestational age more than or equal to 37 weeks, who gave consent for participation were included in the study. Antenatal women who refused to give consent or those with known co-morbidities complicating labour like gestational diabetes mellitus, pregnancy induced hypertension, multiple gestation, breech presentation, placental abnormalities like placenta previa or abruption, previous history of caesarean section and cephalo - pelvic disproportion were excluded. Results: The demographic details of the participants are shown in Table 1. Out of the 269 participants analysed for the study, Majority of them were housewives, belonged to the age group of 25-30 years (40%). Majority were graduates (49%) and pregnant for the first time (primi) (56.1%). Conclusion: The significance of this study is that maternal anxiety was found positive in about 105 patients, among which 19 participants had severe anxiety. These anxiety scores if known during the antenatal chechups can help in interventions for the betterment of maternal health including guidance and counselling

Aims: To study of acute kidney injury in Antenatal mothers secondary to hypertensive disorders and Early detection to prevent the serious complications, Maternal morbidity and mortality and improve the perinatal outcome by early detection and treatment. Materials and methods: A hospital based prospective observational study was conducted in the Department of Obstetrics and gynaecology. Subjects were included in the study after written informed consent and data was collected by using pre structured questionnaire. Thorough obstetric, medical and surgical history was taken. the subjects were analysed for the following parameters. Results: 56% were antenatal presentations. Distribution of gravida shows that 56% had 2, 14% had 3, and 20% had 10% gravida. Induced delivery (48%) and Emergency LSCS (38%) were the main modes of pregnancy termination. 82% had medical treatment, 7% had ventilator support and 11% had dialysis. Nine patients died and 1 patient had chronic hypertension. 72% of the babies admitted to NICU, there were 32 fetal deaths and 1 abortion. Neonatal morbidity and mortality are very high because of AKI in pregnancy and with other complications. Pregnancy needs to be terminated immediately, irrespective of gestational age to prevent maternal complications and deaths. Mothers with hypertensive disorders who presented in early preterm (24-32 weeks) delivered babies with less than 1.5 kg and among them, 100% perinatal mortality is observed. For babies with>1.5 kg weight, most of them presented with intrauterine death due to abruption or fetal growth restriction. Conclusion: Knowledge of associated characteristics and outcomes presented in this study provides important prognostic information for patients, a framework for physicians to understand severe pregnancy- related AKI in the current era, and informed strategies to better identify women at risk. And also concluded from this study that prevention is always better than cure.

Background: In India, about 3-4% of people are carriers of beta thalassemia. Sickle cell occurs in about 1 in 100 Indians. As per WHO at least 5.2% of the world population with 7% prevalence in pregnant women carries a variant of hemoglobin disorder. HbE is the most common hemoglobinopathy in north eastern states of India, with carrier frequency of around 50% in a hospital based study27. Objective: To follow up the maternal and fetal outcome of pregnancy with hemoglobinopathies. Methodology: A prospective observational study to evaluate the maternal and fetal outcome in pregnancy with hemoglobinopathies. Results: 78% of the patients had moderate anaemia. HbE disease comprising of 44.8 % was the most common hemoglobinopathy. 53 % of the patients underwent LSCS. The most common indication being fetal distress in first stage of labour (19.56%). 43 % of the patients had associated obstetrics complications with 23 % preterm delivery, 7 % FGR pregnancy, 4.59% hyperbilirubinemia, 9.1% PROM. 26 (29.8%) of babies were born with low birth weight. 22.9% of the babies were admitted in NICU. Among the pregnant women, 19.5 % had severe anaemia which needed blood transfusion. There was one maternal death due to postpartum haemorrhage. Conclusion: HbE disease comprising of 46 % was the most common among the hemoglobinopathies. Since the incidence of hemoglobinopathy is high in our region, routine Hb typing has to be done for Hb of < 8 g/dl.

Background: The COVID-19 pandemic had been uniquely challenging for the general as well as pregnant and postpartum women. Uncontrollable stress arising due to its high infectivity has exacerbated risk for maternal depression and anxiety, in turn leading to adverse mother and child outcomes. The aim of present study was therefore to assess the psychological responses of Covid 19 pandemic in pregnancy and post –partum women. Methods: The current study was a questionnaire based cross sectional study done for one year, in a tertiary care hospital of Northern India. After getting ethical clearance from university ethical committee a face-to-face interview using three scales namely Generalized Anxiety Disorder 7-Item Scale (GAD-7), Hamilton depression score (HAM-D), Fear ofcovid 19 scale was applied on 192 pregnant and and post –partum women who visited hospital and their response was assessed. Responses were calculated as scores as used in validated questionnaires and were categorized accordingly. Results: Responses of total 192 patients included in the study (cases/covid positive=96 and control/covi negative=96), it was found that overall anxiety was more prevalent in Covid positive group as compared to covid negative group with 53% of cases had severe anxiety. Hamilton depression scale used to assess depression showed that depression was also more prevalent in covid positive group as compared to covid negative group with distribution of Severe, and Very Severe depression in 26.04%, and 35.42% in case group respectively. Fear was more prevalent in case group as compared to covid negative group with the percentage distribution of mild and severe fear to be 20.83% and 79.17% in case and in control group the percentage distribution being 83.33% and 16.67%. This difference in the two groups was also found to be statistically significant. Conclusion: Anxiety, depression and fear was significantly more prevalent in the covid positive pregnant and post - partum women however control group was also not free from anxiety, depression and fear due to Covid 19.

Background: Complications of hypertension are the third leading cause of pregnancy relaed deaths, superseded only by hemorrhage and embolism. Pre-eclampsia is associated with increased potential risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular complication and maternal death. Consequently, early diagnosis of pre-eclampsia and close observation and timely drug intervention is needed. Labetalol is generally considered to be more effective than methyldopa for treating pre-eclampsia and pregnancy-induced hypertension (PIH) and Labetalol is quicker and more effective at controlling blood pressure and causes fewer side effects than methyldopa. Drowsiness is a common side effect of methyldopa. And also, Labetalol has a beneficial effect on renal function, ripening effect on the uterine cervix, decreases proteinuria/preeclampsia and decreases fetal/newborn death compared with methyldopa.1 Methyldopa is the medicine of choice for hypertensive conditions in pregnancy in several countries. Despite this, there is little proof of its safety in early pregnancy. So far, most methyldopa safety studies have focused on therapy during the second and third trimesters2,3,4. Thus this study was planned to know the efficacy of the two commonly used drugs comparatively in our set up. Research Question: What is the efficacy of the drugs Labetalol Vs Methyldopa on obstetric outcome in women with pre-eclampsia? The setting of the study was at department of Obstetrics and Gynaecology, Government Medical College, Machilipatnam. A one year observational study was conducted during the period from March ,2023 to February, 2024 on about 200 Pre-eclampsia patients admitted during the above period in the department of Obstetrics and Gynaecology by studying their socio-demographic profiles, type of hypertensive disorders, mode of delivery & preterm or term delivery, maternal complications and evaluation of efficacy of the drugs Labetalol and Methyl Dopa comparatively etc ; Results: The disease was more among the pregnant women  between 21-25 years of age group (49.5%) and the Mean age was 52 years and very few about 3% was observed among >31 years of age group. And most of them are primigravidae. And also, majority of the study subjects were belonging to low socioeconomic group & early marriages (adolescent marriages) were also high in number. There was a significant reduction of Blood Pressure noticed by both the drugs but the more significant reduction was seen among those treated by Labetalol. And also, significantly (P<0.05), about 32% of spontaneous vaginal deliveries happened with Labetalol users when compared to 20% among Methyldopa users & 25% induced deliveries with Labetalol as against 21% with Methyldopa and also significantly 43% LSCS with Labetalol as against 59% LSCS with Methyldopa but totally among both the groups LSCS was little bit more happened among the study subjects. Further it was observed that Preterm deliveries were only 23% with Labetalol as against 40% with Methyldopa which was highly significant (P >0.001). With reference to Birth weight LBW babies were more among Methyldopa users (55%) when compared Labetalol users (50%).

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease

Background: Stillbirths constitute a major part of perinatal deaths. It is influenced by a wide range of maternal social and circumstantial factors. The study was done to find out the various factors associated with stillbirth in our hospital with the help of the existing ReCoDe System.  Materials And Methods: A cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur by collecting data from all pregnant women who had during the study period of 12 months, i.e., from 1^stJanuary 2022.Data was then collected using a semi-structured interview after obtaining informed and signed consent. The questionnaire included general information, detailed clinical history. The relevant investigations, ultrasonography (growth parameters, liquor, biophysical profile, doppler parameters) were noted. After delivery, the stillborn baby Placenta, Umbilical cord and Amniotic fluid examined for any abnormalities. Results: Out of the134 cases of stillbirths during the study period of 12 months majority (52, 38.8%) were in the age group of 20 – 25 years, and 25 patients were included in the high-risk group in which 10 (7.5%) were below 20 years and 15 (11.2%) were above 35 years. Among the study participants, 51 (38.1%) were overweight and 27 (20.1%) were obese, 10 (7.5%) women had a Bad Obstetric History. There were 58 (43.3%) primigravida women. There were 4 (3.0%) women who were unbooked, while 20(14.9%) women had irregular antenatal care. 15 of the participants had maternal infection in the antenatal period of which 5 (3.7%) had viral and 10 (7.5%) had bacterial infection. 47(35.1%) patients had anemia in our study. A significant number of pregnant women (60, 44.8%) had gestational hypertension which was the most common cause leading to intra uterine fetal death. Gestational diabetes accounted for 49 (36.6%) of stillbirth in our study, 47 (35.1%) had hypothyroidism. IUGR was present in 51 (38.1%) of the study participants, and this was the second most common cause identified, resulting in stillbirth. Conclusion: Hypertensive Disorders of pregnancy was seen as the most common cause associated with intra uterine foetal demise. Intra uterine growth restriction and Gestational diabetes were the other important associated factors identified that led to stillbirth.

Introduction: Prolactin- oxytocin interplay is thought of as the key factor in lactogenesis and milk let down. Recent evidence suggests that glucose uptake in the phase 2 lactogenesis is mediated by insulin and its receptors. It is hypothesized that reduced glucose uptake due to insulin resistance is responsible for reduced lactogenesis and scanty milk production.  Aims: To observe if insulin resistance leads to reduced lactogenesis and delayed or non-lactation Methodology: 124 mothers (GrA 62mothers with delayed/non-lactation, GrB 62 patients with normal lactation) attending Lactation Clinic were included. Mothers with gross NAC abnormalities, infants with oral-anatomical problems, mother- child separation were excluded. Parameters checked to establish insulin-resistance are BMI, Waistline, BP, FBS-PPBS, HbA1c, Lipid profile, c-peptide, Prolactin. Delayed lactation and non-lactation are defined as non-initiation of lactation following 72hours or non-establishment respectively. Results: Non-lactation/delayed lactation is strongly associated with increased BMI (p<0.0001), increased waistline (p<0.0001), raised systolic-diastolic BP(p<0.0089, <0.0027), raised FBS-PPBS (p<0.0364,<0.0045), raised HbA1c(p<<0.0001), raised S-triglycerides (p<0.0035), but not associated with increased age, with S-cholesterol, S-LDL/S-VLDL/S-HDL, c-peptide, S-prolactin.  Discussion: The study confirms the role of insulin on lactogenesis function of mammary glands. Mothers with insulin-resistance are prone to lactation failure. To plan public health strategies to achieve “universal breast-feeding goal” as stated by WHO. All mothers must be evaluated in the first trimester of pregnancy and immediately post-partum with special reference to insulin resistance so that prediction of lactation failure can be made, and appropriate therapeutic strategy can be planned.

Since the description of PRES in 1996 by Hinchey et al, its being increasingly recognized and reported. With increased facilities like neuroimaging, it is animportant differential in the spectrum ofhypertensive encephalopathy. We retrospectively analyzed 5 cases of PRES in our ICU over a period of 1 year. Demographic parameters, presentations, etiologies, radiological findings including outcome was studied. Most common aetiologies were pregnancy induced eclampsia and immunosuppressant’s. ICU admissions were for uncontrolled hypertension, seizures, and low level of consciousness. Two patients were ventilated for airway protection.  One patient had a complicated course and developed septicaemia and TTP. Two patients with renal involvement with PRES required hemodialysis. All patients recovered, none had residual neurological deficits. Given its diverse presentation from headache, blurring of vision to seizures and coma. Increased awareness with high degree of suspicion is the key for early identification and management of this nearly reversible condition.

Background: Over the past few decades there is an increase in the prevalence of diabetes mellitus (DM) and is associated with a number of complications. Glycosylated Hemoglobin (HbA1C) is used as the “gold standard” for measuring the glycemic control and is also used as predictor of diabetic complications. HbA1c levels is not only affected by the blood glucose levels alone. They are also changed in conditions like blood loss, hemolytic anaemia, pregnancy, chronic kidney diseases, vitamin B12 deficiency anaemia, splenectomy, hyperbilirubinemia, alcoholism and iron deficiency anaemia. As per WHO, iron deficiency is the commonest out of all deficiency diseases worldwide. Anemia is cited as a major confounding factor in the measurement of HbA1C. It was shown by few studies that patients with iron deficiency had higher HbA1C levels while few demonstrated that absolute HbA1c levels and mean HbA1c levels were lower in patients with iron deficiency anaemia. However, some studies showed no differences in HbA1c levels of patients with anaemia and healthy subjects. All these studies gave contradictory and inconsistent results. Thus, this study is conducted to know the effect of iron deficiency anaemia on glycosylated hemoglobin levels in non-diabetic individuals. Methods: 50 patients with iron deficiency anaemia and 50 healthy control subjects who were age and sex matched were registered in this study. Complete hemogram including peripheral smear, fasting and postprandial blood sugar levels, glycated hemoglobin and serum ferritin levels were measured in both the groups. Results: The prevalence of iron deficiency anaemia was more in females during the third and fourth decades of life. Mean HbA1c of iron deficiency anaemia patients (5.78 ± 1.08) was significantly higher than that of the control population (5.46 ± 0.26 ) that was statistically highly significant (p<0.001) Conclusion: Our study showed that HbA1c levels were affected by iron deficiency anemia. HbA1C values were higher in patients with iron deficiency anemia than control group. So iron deficiency anemia has to be taken into consideration before using the HbA1c in the diagnosis of diabetes.

Introduction: Hypertension is a significant health concern for pregnant women, potentially leading to adverse maternal and fetal outcomes. This study aims to investigate the maternal and fetal consequences in pregnancies complicated by preexisting hypertension. Objectives: To evaluate the maternal and fetal outcomes in pregnant women with preexisting hypertension. Methods: Study Design: Prospective cohort study. Setting: Two tertiary care hospitals. Participants: 200 pregnant women with a confirmed diagnosis of preexisting hypertension. Data Collection: Data were collected on maternal age, hypertension severity, medication use, prenatal care, and lifestyle factors. Fetal outcomes included gestational age at delivery, birth weight, and incidence of congenital anomalies or distress. Statistical Analysis: Descriptive statistics, chi-square tests for categorical variables, and t-tests or ANOVA for continuous variables. Results: The study found significant associations between the severity of hypertension and maternal complications such as preeclampsia, gestational diabetes, and preterm labor. There was a higher incidence of low birth weight, preterm birth, and neonatal intensive care unit (NICU) admissions in the hypertensive group compared to national averages. Results were statistically significant with p-values <0.05. Conclusions: Preexisting hypertension in pregnant women is strongly associated with adverse maternal and fetal outcomes. Early intervention and careful management of hypertension during pregnancy are crucial to improve health outcomes for both mother and child.

Background: Polycystic Ovary Syndrome (PCOS) affects up to 20% of women of reproductive age globally, with chronic inflammation implicated in infertility and adverse pregnancy outcomes. Objective: To investigate the role of inflammatory pathways in PCOS-related infertility and pregnancy complications, highlighting their contribution to altered reproductive and metabolic health. Methods: A one-year observational study was conducted at Akash Institute of Medical Sciences and Research Center, Bangalore, involving 150 women diagnosed with PCOS. Participants underwent clinical assessments, hormonal profiling, and inflammatory marker evaluation, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Statistical analysis involved correlation coefficients and multivariate regression to explore associations between inflammatory markers and clinical outcomes. Results: Elevated levels of CRP (mean: 6.2 ± 1.3 mg/L), IL-6 (mean: 3.8 ± 0.9 pg/mL), and TNF-α (mean: 12.4 ± 2.1 pg/mL) were observed in 78% of participants. Among infertile women (56%), inflammatory markers were significantly higher (CRP: +18%; IL-6: +22%; TNF-α: +25%) compared to fertile counterparts (p < 0.01). Pregnancy complications, including gestational diabetes (34%) and preeclampsia (18%), showed positive associations with inflammatory marker levels (p < 0.05). Multivariate analysis revealed CRP as the strongest predictor of adverse outcomes (β = 0.42, p < 0.001). Conclusions: This study underscores the pivotal role of inflammatory pathways in PCOS-related infertility and pregnancy complications, advocating for targeted anti-inflammatory interventions to improve clinical outcomes.

Introduction: In the realm of obstetrics, the intricate interplay between maternal health and perinatal outcomes continues to captivate researchers worldwide. Among the multifaceted conditions affecting pregnancy, pre-eclampsia stands as a significant concern, characterized by hypertension and proteinuria after 20 weeks of gestation. This study endeavours to delve into a promising avenue: the association between serum uric acid levels and perinatal outcomes in women grappling with pre-eclampsia. Pre-eclampsia remains a significant challenge in obstetrics, with its potential to impact both maternal and foetal health profoundly. Amidst the array of biomarkers under scrutiny, serum uric acid levels have emerged as a promising candidate for understanding the pathophysiology of this condition. Materials And Methods: This is a Prospective and Observational Study was conducted in the Department of Obstetrics and Gynaecology, Medical College Kolkata from December 2022 to April 2024. Pregnant women diagnosed with Pre-eclampsia in their third trimesters are being included in this study. Pregnant women with Pre-eclampsia who are current smokers, alcoholic and those with diabetes mellitus,thyroid disorders and renal dysfunction were excluded. Patients with chronic diseases like APLA Syndrome and heart diseases were also excluded. All patients with Pre-eclampsia in their third trimesters were asked to test their Serum Uric Acid levels at their third trimesters of pregnancy. These patients were then followed up till delivery and the presence/absence of maternal complications and perinatal outcome were observed. The association between serum uric acid levels and perinatal outcome was then assessed. Results: In our study 11 pre-eclamptic females (9.56%) were ≤20 years of age, 16 (13.91%) were between 21 to 25 years of age, 41(35.65%) were between 26 to 30 years of age, 39(33.91%) were between 31 to 35 years of age and 8(6.95%) were≥ 36 years of age.  In our study, out of 115 participants, 3 (2.60%) had uric acid levels ≤4 milligrams per decilitre, 22(19.13%) had uric acid levels between 4.1 to 6.0 milligrams per decilitre ,61 (53.0%) had uric acid levels between 6.1 to 7.9 milligrams per decilitre and 29 (25.2%) had uric acid levels ≥ 8 milligrams per decilitre. In our study, we calculated the association of Blood Pressure at delivery with serum uric acid levels. It was found to be statistically significant (p value is 0.0035). Data are expressed as percentage. Test applied: Fisher's exact test. The row/column association is statistically significant. The relative risk is 1.833. 95% confidence interval is between 1.116 to 3.011. Conclusion: Hence, from our results, we can surmise that serum uric acid levels have a significant association with perinatal outcome in women with pre-eclampsia and hence, can be used as prognostic marker to predict development of complications in these pre-eclamptic females.

Background Gestational Diabetes Mellitus (GDM) is a significant health concern during pregnancy, characterized by elevated blood glucose levels first identified during pregnancy. Pregnancy induces insulin resistance due to placental hormones, but excessive resistance can lead to GDM, which poses risks to both maternal and fetal health. In India, GDM prevalence varies widely, exacerbated by factors such as demographics, healthcare access, and diagnostic methods. The increasing prevalence of GDM, particularly in developing countries, necessitates a better understanding of contributing factors to improve maternal and neonatal health outcomes. Objective This study aims to determine the prevalence of Gestational Diabetes Mellitus (GDM) among pregnant women attending the outpatient department of SCB Medical College and Hospital in Cuttack, Odisha, India, and to identify associated risk factors such as age, family history, obstetric history, diet, BMI, and physical activity. Methodology A cross-sectional study was conducted from July 2018 to June 2019, involving 483 pregnant women who were screened for GDM using the 75 g, 2-hour oral glucose tolerance test (OGTT), following WHO diagnostic criteria. Data on age, family history of diabetes, obstetric history, diet patterns, BMI, and physical activity were collected through structured interviews and questionnaires. Statistical analysis was performed using the Chi-square test with a significance threshold of p<0.05. Results The overall prevalence of GDM in the study population was 15.9%. The highest prevalence was observed in the 25-29 age group (23.7%), and no significant association was found between age and GDM (p=0.234). A family history of diabetes was linked to higher prevalence, with women having both parents diabetic showing a significantly higher rate of GDM (49.4%). Obstetric history showed a significant association with GDM, with women with a good obstetric history having a higher prevalence (21.0%) compared to those with a bad obstetric history (9.2%). Diet patterns, particularly a higher prevalence of GDM in non-vegetarian women (61.0%), were also significant (p=0.001). Women with higher BMI, especially those classified as obese (BMI ≥ 30 kg/m²), exhibited a significantly higher prevalence of GDM (45.7%) compared to those with normal BMI (5.7%) (p=0.001). Additionally, physical inactivity was associated with higher GDM prevalence (57.1% in sedentary women). Discussion The study confirms that GDM is a major concern during pregnancy, with significant associations identified between various risk factors such as obesity, family history of diabetes, diet, and physical inactivity. Women with a higher BMI, poor dietary habits, and lack of physical activity were more likely to develop GDM. The results align with global studies linking obesity and poor lifestyle choices with increased risk of GDM. Interestingly, a family history of diabetes was also found to increase the risk, underscoring the genetic predisposition in GDM development. Moreover, women with good obstetric histories showed a higher prevalence of GDM, suggesting that factors beyond the current pregnancy, such as pre-existing metabolic conditions, may contribute. Conclusion The prevalence of Gestational Diabetes Mellitus in Cuttack, Odisha, India is high, particularly among women with higher BMI, sedentary lifestyles, and poor dietary patterns. Early screening, lifestyle modifications such as maintaining a healthy weight, improving diet, and engaging in regular physical activity are essential strategies to reduce the risk of GDM and its complications. There is a pressing need for public health initiatives and further research to mitigate the growing burden of GDM and ensure better maternal and neonatal health outcomes in India.

Background: Rh isoimmunization is a condition that occurs when a woman with Rh negative blood type becomes sensitized to Rh positive blood cells during childbirth, miscarriage, abortion, medical procedures like invasive prenatal testing (e.g., amniocentesis) trauma to the abdomen during pregnancy or transfusion with Rh positive blood. With each successive pregnancy, there is a cumulative effect of fetomaternal transfusions thus increasing the severity of the problem at hand. It can lead to hemolytic disease of the newborn which can range from mild to severe, including features such as anemia, jaundice, hepatospleenomegaly, and, in severe cases, hydrops fetalis.  Such newborns may require treatments such as phototherapy for jaundice, blood transfusions, IV immunoglobulins, and in severe cases, exchange transfusions. Aim: To study the role of cord bilirubin as a non invasive, early predictive marker of hemolysis in Rh positive neonates delivered to Rh negative mothers. Study Type and Design: Observational, descriptive, longitudinal study. Materials:  Rh positive neonates delivered in OT/labor room of our hospital to Rh negative mothers studied according to specific protocol. Study Setting: Neonatal and postnatal wards of a rural tertiary care hospital. Period of Study:  (Two years) From June 2022 to June 2024. Ethical Committee consent was taken at the start of the study. Data was entered in excel sheets and analyzed using IBM SSPS Statistics software. Results: Out of 277 neonates delivered at term to Rh negative mothers in the study duration, 158 were Rh positive and 119 were Rh negative mothers. A cord bilirubin cutoff of >1.9 mg/dL was found to have excellent specificity (97.8%) and positive predictive value (95.74%), making it a robust tool for identifying newborns at high risk of hyperbilirubinemia, with a sensitivity of 67.16% and a negative predictive value of 80.18%. For the phototherapy group, the average cord bilirubin level was found to be 2.13 ±0.51 mg/dL, as compared to the no phototherapy group, wherein the average cord bilirubin level is 0.80±0.58 mg/dL. Cord bilirubin values >1.9 mg/dl (seen in 29.7% of the study population) were found to have a statistically significant association with a need for interventions (phototheraphy and/or exchange transfusion) with a p value <0.05. Conclucion: Hemolysis due to Rh isoimmunization is more frequent and severe in neonates of multigravida mothers as Zompared to neonates of primigravida mothers, due to the cumulative effect of fetomaternal transfusions in each successive pregnancy. Cord sampling proves to be an essential predictive marker of the risk of hemolysis in the neonate earlier to allow for early initiation of therapeutic measures and reducing the risk of rapid hemolysis and further, long term complications such as bilirubin encephalopathy, emerging as a cornerstone of non invasive care.

Background: For numerous women, pregnancy can bring about radiant skin, rosy cheeks, and lustrous hair. Conversely, some may deal with less appealing skin issues, such as acne, dark patches, and stretch marks. The journey to becoming a mother is filled with significant changes and adaptations for all mothers, and welcoming a new baby brings both happiness and challenges.  

Objectives:

1. To study the various physiological skin changes occurring during pregnancy.
2. To study the frequency and clinical features of specific dermatoses of pregnancy.

Material & Methods: Study Design: Hospital-based observational descriptive study. Study area: Department of Dermatology Venereology and Leprosy, Guntur Medical College, Guntur. Study Period: September 2020 – February 2021 (6 months).  Study population:  The study included 500 pregnant women attending the outpatient departments of Obstetrics and Gynaecology, and the department of D.V.L.   Sample size: The study consisted of a total of 500 subjects.  Sampling method: Simple random method. Results: Amongst 500 cases, 36 (7.2%) presented with prurigo of pregnancy, and 25 (5%) presented with pruritus gravidarum. PUPPP constituted 4.6% of the cases, and 5 (1%) presented with pruritic folliculitis of pregnancy.  Conclusion: In this research involving 500 pregnant individuals with skin issues, it is clear that pregnant women are susceptible to a variety of dermatological conditions beyond just the specific skin disorders associated with pregnancy.

Background And Justification: Spinal Anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery, provided there is no contraindication. Pregnancy causes major physiological changes to the mother’s body. An understanding of the physiological changes in pregnancy is the key to safe obstetric anaesthesia. Spinal Anaesthesia is associated with hypotension which can have maternal and foetal side effects. Methods: This study was performed on 100 patients, after getting informed consent. In this study the baseline hemodynamic parameters of the patient was noted during intra operative period. After spinal anaesthesia is performed by the Anaesthesiologist, hemodynamics such as Heart Rate, Blood Pressure, Mean Arterial Pressure and SPO2 was noted for every 3 minutes for first 20 minutes after which it was noted for every 5 minutes, till end of the surgery.  Results: From the descriptive statistics and chi square test, after spinal anaesthesia performed there is a hypotension, p=0 which is <0.05, hence statistically significant, and there is fall in heart in rate, p=0.0029 which is <0.05, hence statistically significant.  Conclusion: 100 pregnant patients who underwent spinal anaesthesia for elective caesarean section were included in this study. Based on the result we concluded that hypotension and bradycardia are the frequent response after spinal anaesthesia due to arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardio inhibitory receptors. This study benefits to the anaesthesiologist in prediction of possible adverse effects and to overcome the same.

Introduction: Thrombocytosis, defined as a platelet count exceeding 450,000/µL, is a common hematological finding with diverse etiologies, including reactive and clonal causes. Platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), provide insights into platelet morphology and function, aiding in the differentiation of thrombocytosis subtypes. This study aimed to evaluate the clinicopathological correlation between thrombocytosis and platelet indices in a tertiary care setting. Materials and Methods: A retrospective analysis was conducted on 200 patients with thrombocytosis over two years. Inclusion criteria included patients aged >18 years with persistent thrombocytosis, while exclusion criteria encompassed those with recent trauma, surgery, or pregnancy. Data on demographic details, clinical presentation, etiology, and platelet indices were collected and analyzed. Results: Of the 200 patients, 65% had reactive thrombocytosis, while 35% had clonal thrombocytosis. Platelet indices such as MPV and PDW were significantly higher in clonal thrombocytosis compared to reactive cases (p<0.05). Five tables were constructed to summarize the findings, including demographic distribution, etiological classification, and platelet index correlations. Conclusion: Platelet indices, particularly MPV and PDW, are valuable tools in differentiating reactive from clonal thrombocytosis. This study highlights their potential utility in clinical practice for early diagnosis and management.

Aim and Objective: To compare the Glottic view using Cormack Lehane grading in Sniffing Position (by Fixed Pillow) and Modified Ramped Position (by Customized Pillow) and to compare the number of attempts taken for endotracheal intubation in both groups Methodology: A cross-sectional study was conducted in the Department of Anaesthesiology at Government Medical College, Idukki, over six months to evaluate the effect of head and neck positioning on ease of intubation. The study included two groups: Group A (sniffing position: by Fixed Pillow) and Group B (Modified Ramped Position: by Customized Pillow), comprising ASA class 1, 2, and 3 patients aged above 18 years undergoing elective surgery under general anesthesia. Exclusion criteria included pregnancy, BMI >35, unstable cervical spine, or contraindications to conventional laryngoscopy or study drugs. Sample size was calculated 36 patients per group. Ethical approvals were obtained, and informed consent was secured. Result: The study included 72 participants (mean age: 41.08 ± 13.00 years), with 55.6% females and 44.4% males. BMI distribution showed 52.8% normal weight, 31.9% overweight, 6.9% obese, and 8.3% underweight, with a mean BMI of 24.20 ± 4.00 kg/m². ASA Class 1 comprised 73.6% of participants, followed by Class 2 (25.0%) and Class 3 (1.4%). Participants were evenly divided between Group A (sniffing position) and Group B (Modified Ramped Position). The Cormack-Lehane (CL) grade distribution was significantly better in Group B (p = 0.012), with higher proportions of Grade 1 and 2A, indicating superior airway visualization. Group B also required significantly less airway assistance (p = 0.032), with fewer cases needing bougie or BURP maneuvers and a higher proportion of successful intubations without assistance. Conclusion: Overall, the Customised Pillow (CP) group showed better airway visualisation, easier intubation, and required less assistance compared to the Fixed Pillow (FP) group. Significant differences were observed in MMPC scores, CL grades, and the use of assistance tools, with CP consistently showing superior outcomes. These findings confirm that Customised Pillow positioning provides a clinical advantage in airway management.

Preterm birth remains a significant global health challenge, with increasing incidence despite advances in medicine. It accounts for approximately 70% of neonatal deaths, 36% of infant deaths, and 25-50% of cases of neurological impairment in children. This study aimed to identify maternal risk factors and neonatal outcomes associated with preterm deliveries in KIMS & RF, Amalapuram. A cross-sectional study was conducted over a period of 1-year from December-2023 to December 2024 among 110 pregnant women attending  antenatal opd and labour room  at KIMS&RF, Amalapuram.Detailed histories and obstetrical examinations were undertaken, neonatal outcomes were analysed using SPSS software.The incidence of preterm birth was 27.5%, categorized into late preterm (19.75%), moderate preterm (3.75%), very preterm ( 10%) and extremely preterm (1.5%).More commonly observed in women who were underweight(34.54%) compared to women who were overweight (9.08%). More commonly observed in unbooked  cases (76.36%) when compared to booked cases(23.63%). Neonates delivered preterm had significantly lower Apgar scores at 1 and 5 minutes compared to term babies. Maternal risk factors included anemia, hypertensive disorders of pregnancy, PPROM and UTI. Poor neonatal outcomes, such as low birth weight, low APGAR scores, IUGR, respiratory morbidity were observed.

Background: Chronic obstructive pulmonary disease (COPD) significantly impacts cardiac function, particularly affecting the right ventricle, left ventricle, and pulmonary vasculature. Cardiovascular complications contribute substantially to COPD-related mortality. Echocardiography provides a non-invasive and effective method for evaluating cardiac changes in COPD patients. To analyze the cardiac alterations associated with COPD using echocardiography and to determine the correlation between echocardiographic findings and COPD severity based on GOLD classification. Materials and Methods: This prospective observational study was conducted over 16 months at the Department of Respiratory Medicine, MIMS, Vizianagaram. A total of 50 COPD patients aged above 40 years were enrolled. Exclusion criteria included active tuberculosis, HIV, terminal cancer, hepatic or renal diseases, and pregnancy. Patients underwent clinical evaluation, electrocardiography (ECG), spirometry, arterial blood gas (ABG) analysis, and echocardiography. Data were analyzed for associations between echocardiographic findings and COPD severity. Results: Echocardiographic findings revealed that 24% of patients had pulmonary hypertension, 24% had increased right ventricular (RV) thickness (>0.5 mm), and 20% had left ventricular diastolic dysfunction (LVDD). The mean ejection fraction did not significantly differ between patients with and without pulmonary hypertension (61.6% vs. 60.5%). Echocardiographic abnormalities were more frequent in severe and very severe COPD cases. Conclusion: COPD is associated with significant cardiovascular changes, including pulmonary hypertension, RV hypertrophy, and LV dysfunction. Routine echocardiographic screening every six months is recommended to detect early cardiac complications and improve clinical outcomes.

Background: Antenatal depression (AD) significantly affects maternal and fetal health. Despite its profound impact, AD remains underdiagnosed in many resource-limited settings, including India. This study aimed to assess the prevalence of antenatal depression and its associated risk factors among pregnant women attending a tertiary care hospital in Hyderabad. Methods: A cross-sectional, hospital-based study was conducted at Gandhi Medical College & Hospital, Secunderabad, Telangana, from November 2020 to June 2022. The study included 300 pregnant women who completed the Edinburgh Postnatal Depression Scale (EPDS). A score ≥13 indicated antenatal depression. Risk factors, including sociodemographic and psychosocial determinants, were evaluated using the Hurt, Insult, Threaten, Scream (HITS) tool and the Presumptive Stressful Life Events Scale (PSLES). Results: The prevalence of antenatal depression was 13.3% among the 300 participants. Significant risk factors included intimate partner violence (HITS score >10, p < 0.001) and experiencing stressful life events as measured by PSLES (p = 0.047). Sociodemographic variables, including age, education, socioeconomic status, type of family, and obstetric factors, were not statistically significant. Conclusion: Antenatal depression is prevalent among pregnant women in Hyderabad, with intimate partner violence and stressful life events being significant predictors. Routine screening and timely psychosocial interventions during antenatal care are vital to ensure better maternal and fetal outcomes.

Background: Teenage pregnancy poses significant health risks for both mothers and neonates, and it is associated with higher rates of maternal and neonatal morbidity and mortality. This study compares the maternal and perinatal outcomes between teenage primigravidae (15–19 years) and adult primigravidae (20–29 years) in a hospital setting.To assess and compare maternal and perinatal outcomes between teenage and adult primigravidae. Methods: A prospective hospital-based study was conducted at the Department of Obstetrics and Gynecology, KIMS, Amalapuram, from December 2019 to September 2021. The study included 80 teenage and 160 adult primigravidae. Data were collected on sociodemographic characteristics, antenatal care, complications, delivery outcomes, and neonatal health. Statistical analysis was performed using descriptive methods and p-values were considered significant at <0.05. Results: Teenage primigravidae had significantly higher rates of antenatal complications (71.3% vs. 16.3%) compared to adults. Common complications included anemia (71.3%), pre-term labor (26.2%), and pregnancy-induced hypertension (17.5%). Hemoglobin levels were significantly lower in teenage mothers (9.56 g%) than in adults (11.12 g%). The cesarean section rate was higher among teenage mothers (45%) compared to adults (20.6%), with fetal distress as the main indication. Teenage mothers also had higher rates of pre-term births (27.5% vs. 6.3%) and low birth weight babies (42% vs. 15.4%). Neonatal morbidity, including birth asphyxia, NICU admissions, and hyperbilirubinemia, was also more common in the teenage group. Conclusion: Teenage pregnancies are associated with higher maternal and neonatal risks, including more complications during pregnancy, labor, and delivery. Enhanced antenatal care and educational interventions are essential for improving outcomes for adolescent mothers.

Background: Anaemia in pregnancy, particularly iron deficiency anaemia, is a significant global health concern associated with adverse maternal and perinatal outcomes. This study aims to compare the maternal and fetal outcomes in anaemic pregnancies with iron deficiency and non-anaemic pregnancies. Methods: A prospective randomized case-control study was conducted involving 200 pregnant women (100 anaemic and 100 non-anaemic) at KIMS & RF, Amalapuram. Anaemia was classified into mild, moderate, and severe based on hemoglobin levels. Maternal and fetal outcomes were assessed and compared between the two groups. Results: The anaemic group had significantly higher rates of preterm birth (8% vs. 2%), postpartum hemorrhage (7% vs. 1%), and maternal morbidity (17.5% vs. 2%) compared to the non-anaemic group. Fetal outcomes were worse in the anaemic group, with higher rates of stillbirth (3% vs. 0%), early neonatal death (4% vs. 0%), low birth weight (22% vs. 3%), and neonatal morbidity (17.5% vs. 6%). Neonatal complications such as respiratory distress syndrome (3% vs. 1%) and meconium aspiration syndrome (10% vs. 1%) were also more prevalent in the anaemic group. Conclusion: Anaemia, particularly iron deficiency anaemia, significantly impacts maternal and fetal health, leading to higher maternal morbidity, preterm births, and adverse fetal outcomes. Early diagnosis and treatment of anaemia in pregnancy are crucial to improve both maternal and neonatal health

Background: Recurrent miscarriages and perinatal deaths pose significant challenges to reproductive health, impacting couples both physically and emotionally. Assessing the reproductive performance of such couples can provide valuable insights into pregnancy outcomes, risk factors, and potential interventions to improve fetal survival rates. Materials and Methods: A prospective observational study was conducted on 150 couples with a history of at least one miscarriage or perinatal death. Clinical and demographic data were collected, including maternal age, body mass index (BMI), obstetric history, and underlying medical conditions. Participants underwent hormonal profiling, genetic testing, and ultrasound evaluations to assess uterine and fetal health. Pregnancy outcomes, including live birth rate, miscarriage rate, and perinatal complications, were analyzed over a follow-up period of 12 months. Statistical analysis was performed using chi-square and logistic regression tests, with a significance level set at p < 0.05. Results: Of the 150 couples, 80% achieved pregnancy within the study period. The live birth rate was 65%, while 20% experienced recurrent pregnancy loss, and 15% had preterm deliveries. Factors such as advanced maternal age (>35 years), obesity (BMI > 30), and thrombophilic disorders were significantly associated with adverse pregnancy outcomes (p < 0.01). Couples receiving targeted medical interventions, including progesterone support and low-dose aspirin therapy, had improved pregnancy outcomes (p < 0.05). Conclusion: Couples with previous miscarriages and perinatal deaths face an increased risk of adverse pregnancy outcomes. Early identification and management of risk factors, including maternal health optimization and medical interventions, can enhance reproductive performance and fetal survival rates. Comprehensive counseling and personalized treatment approaches are essential for improving pregnancy success in this population.

Background: Thalassemia minor is a common hereditary hemoglobinopathy that may impact pregnancy outcomes despite being traditionally considered a benign carrier state. This study evaluates the maternal and neonatal complications associated with thalassemia carrier pregnancies in a tertiary care setting. Methods: A prospective observational study was conducted at a tertiary care hospital, comparing 100 pregnant women with thalassemia minor to 100 non-carrier controls. Maternal outcomes, including anaemia, gestational diabetes mellitus (GDM), hypertensive disorders, postpartum haemorrhage (PPH), and mode of delivery, were assessed. Neonatal outcomes such as low birth weight (LBW), intrauterine growth restriction (IUGR), preterm birth, NICU admissions, and perinatal mortality were evaluated. Logistic regression analysis adjusted for maternal BMI, gestational age, and anaemia severity.

Results:

• Anaemia was significantly more prevalent in thalassemia carriers (78% vs. 18%, p < 0.001), with a fourfold increased risk of severe anaemia (OR = 4.52, p < 0.001).
• Caesarean section rates were significantly higher in carriers (42% vs. 30%, p = 0.040).
• IUGR risk was significantly elevated in thalassemia carriers (24% vs. 10%, OR = 2.88, p = 0.010), and LBW was more frequent (38% vs. 22%, p = 0.020).
• NICU admissions were higher among carrier neonates (15% vs. 8%), though not statistically significant (p = 0.080).

Conclusion: Thalassemia minor is associated with a higher risk of anaemia, IUGR, LBW, and caesarean section, emphasizing the need for enhanced prenatal screening, haematological monitoring, and individualized obstetric care. Early detection and multidisciplinary management can mitigate adverse pregnancy outcomes in this population.

Aim:  To review the causes of IUD and classify the causes into maternal, fetal and placental causes and further classify causes by relevant condition at death by ICD-PM classification.We intend to observe the causes of and demographic factors contributing to the burden of IUD.Using this data, the areas of action can be identified and measures can be formulated to reduce a significant number of perinatal mortalities.

Study design: prospective observational study

Study period : 1 year

 Study population -All IUD cases admitted in the department of obstetrics and gynecology of Government medical College srikakulam during the study period.

Study is conducted after taking approval from the  Hospital ethics committee.

Methodology: This is an observational study of data collected over one year (January 2024-December 2024) from a tertiary care centre in SRIKAKULAM India. The maternal demographic characteristics and causes of IUD were studied. The causes of IUD were classified into maternal, fetal and placental causes and relevant condition at death based on ICD-PM  classification.

Results: In a study of 55 intrauterine deaths (IUDs), the majority of mothers (50.9%) were aged 20-25 years. Among them, 25.45% were primigravida and 54.54% were second gravida. Notably, 54.8% had three or more antenatal visits, while 94.54% were unbooked cases referred to GGH. Maternal conditions, including pre-eclampsia and diabetes, accounted for 58.18% of IUDs, with 87.27% occurring in the antepartum period. Of the IUD babies, 47.27% were female and 52.72% male; 65.45% were macerated and 34.54% fresh. Fetal causes contributed to 25.45% of cases, with prematurity noted in 76.36%. Four IUDs involved non-viable congenital abnormalities, and one case involved fetal demise in a twin pregnancy due to selective growth restriction. According to ICD-PM classification, hypertensive diseases were the most common maternal cause (75%), followed by gestational diabetes (18.75%).

Background: Borderline oligohydramnios in pregnancies without any foetal or maternal abnormalities, that is Isolated oligohydramnios may be due to inadequate fluid intake orally. Some patients might have poor compliance in home-based setting. Therefore, this study was conducted to assess the improvement in AFI and perinatal outcome following maternal oral hydration therapy in home and hospital settings. Methods: This prospective study was conducted in the Department of Obstetrics and Gynaecology in Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram during period from 1^st February 2023 to 31^th January 2024 (1 year).  50 cases of isolated borderline oligohydramnios (other high-risk pregnancy conditions not present) were included in the study (25 in home group and 25 in hospital group). Results: The two groups are similar in profile and baseline findings. When compared to the home group, the hospital group's AFI considerably improved. Conclusion: In cases of oligohydramnios, maternal oral hydration therapy is an easy, safe, noninvasive, and efficient way to increase the volume of amniotic fluid; but, long-term, continuous therapy is necessary to optimize the neonatal outcome. It is advised to implement supervised hydration therapy due to low compliance to home-based treatment

Background: The most common significant health concern during pregnancy is hypertension, which remains a vital factor in both maternal and fetal morbidity and mortality. Preeclampsia is a pregnancy-related hypertensive disorder that occurs after twenty weeks of gestation and involves multiple systems.

Objectives:

1) To study maternal outcome in severe pre- eclampsia & eclampsia.

2) To study perinatal outcome in severe pre- eclampsia & eclampsia.

3) To enumerate variable factors associated with maternal and perinatal morbidity and mortality.

Material & Methods: Study Design:  Prospective Observational Study.  Study area: Department of Obstetrics & Gynecology, GGH, GMC, KADAPA.  Study Period: 1 year. (March 2023 – April 2024). Study population: 100 Pregnant women admitted with severe PE and eclampsia. Sample size: Study consisted a total of 100 subjects. Sampling Technique:  Convenience Sampling technique. Results: In this study 22% of cases had no proteinuria, 25 % of the cases had trace amounts of protein in urine, among them only 2% developed HELLP. Among 77% of the cases with proteinuria, 13% developed HELLP and there was significant association between proteinuria and HELLP i.e as severity of proteinuria increases chances of HELLP increases. Conclusion: Severe preeclampsia leads to higher risks of life-threatening complications, preterm delivery, and IUGR, with maternal mortality observed in multigravida cases. Early detection and proper management, including evidence-based protocols, are crucial to reducing morbidity and mortality. Effective secondary and tertiary prevention improves outcomes for both mother and neonate.

Background:  Cesarean Scar Pregnancy (CSP) is a rare form of ectopic pregnancy where the embryo implants within the scar of a previous cesarean section. Effective management is crucial to prevent severe complications, including uterine rupture and life-threatening hemorrhage. This study aimed to compare the clinical outcomes of medical versus surgical management of CSP in a randomized controlled trial. Materials and Methods: A total of 60 patients diagnosed with Cesarean Scar Pregnancy were randomly allocated into two groups: Medical Management (n = 30) and Surgical Management (n = 30). The medical group received intramuscular methotrexate (MTX) at a dose of 50 mg/m², followed by serial monitoring of β-hCG levels until normalization. The surgical group underwent hysteroscopic resection of the gestational sac. Primary outcomes assessed included treatment success rate, time to β-hCG normalization, blood loss, hospital stay duration, and complication rates. Data were analyzed using appropriate statistical methods, with significance set at p < 0.05. Results: The treatment success rate was significantly higher in the Surgical Management group (93.3%) compared to the Medical Management group (76.7%) (p = 0.04). The mean time to β-hCG normalization was shorter in the surgical group (28.3 ± 5.2 days) compared to the medical group (45.7 ± 7.4 days) (p < 0.001). Blood loss was notably higher in the surgical group (210 ± 50 mL) compared to the medical group (120 ± 35 mL) (p = 0.02). However, hospital stay duration was shorter in the surgical group (2.1 ± 0.6 days) compared to the medical group (4.5 ± 1.2 days) (p < 0.001). Complication rates were higher in the medical group (20%) than in the surgical group (10%). Conclusion: Surgical management of Cesarean Scar Pregnancy offers a higher success rate and faster resolution compared to medical management, though it is associated with higher blood loss. Medical management remains a viable alternative for patients contraindicated for surgery or seeking conservative treatment. Further studies with larger samples are warranted to confirm these findings.

Background: Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening condition characterized by the implantation of a gestational sac within the scar of a previous cesarean section. Management strategies vary, ranging from conservative medical approaches to surgical interventions. This prospective observational study aimed to evaluate the efficacy and safety of different treatment modalities for CSP over a one-year period at Lala Ded Hospital, GMC Srinagar. Methods: Patients diagnosed with CSP between Feb 2023 and January 2024 were included. Demographic data, medical histories, beta-human chorionic gonadotropin (beta-hCG) levels, and ultrasound findings were collected. Treatment modalities included medical management with methotrexate (MTX) and surgical interventions such as dilation and curettage (D&C) or laparotomy. Outcome measures included treatment success rates, complication rates, and hospital stay duration. Results: A total of 45 patients were included with 35.6% of patients treated with systemic methotrexate, 48.9% underwent dilation and curettage (D&C), and 15.6% were treated with laprotomy. Medical management with MTX showed a 31.3%  success rate, while surgical interventions demonstrated a 93.1% success rate, indicating a statistically significant difference (p < 0.001). Complications occurred more frequently with medical management (68.8%) compared to surgery (6.9%). Surgical treatment was associated with a significantly shorter hospital stay (4.2 days vs. 8.7 days, p < 0.001). Conclusion: Surgical interventions, including D&C and laparotomy, showed superior efficacy and safety profiles compared to medical management with MTX for CSP. 

Background-Hypertensive disorders complicates 5-10%of pregnancies all over the world and its incidence in India found to be 10.08% as per data of National Eclampsia Registry(NEP)  AIM –To compare perinatal outcome of oligohydramnios or fetal growth restrictions(FGR) with normal amniotic fluid index(AFI) and fetal growth in hypertensive disorders in pregnancy(HDP) and to compare the outcome of only oligohydramnios ,only FGR and oligohydramnios with FGR in HDP groups. Study Design – This is retrospective study including the 234 pregnant women after 20weeks of gestation with HDP  ,from May 2022-May 2024 Patients were divided into two groups: HDP with oligohydramnios or FGR(n = 48) and HDP with  normal AFI and fetal growth(n = 186). Then, the first group was divided  as only oligohydramnios(n = 16), only FGR(n = 20) and oligohydramnios with FGR(n = 12). perinatal outcomes were recorded. Results - The study found no significant differences in maternal characteristics or complications between the HDP group with oligohydramnios/FGR and the group with normal AFI. However, the HDP group with oligohydramnios/FGR had higher impaired Doppler findings and cesarean section rates (p = 0.004). Neonatal birth weight was lower in the HDP group with oligohydramnios/FGR (p = 0.001), but no significant differences were found in APGAR scores, NICU admissions, or neonatal death. Subgroup analysis showed higher cesarean sections, NICU admissions, and acute fetal distress in the combined oligohydramnios/FGR group (p = 0.05). These findings suggest more severe complications in pregnancies with both oligohydramnios and FGR. Conclusions-Patients with only oligohydramnios showed more favorable outcomes compared to those with only FGR or the coexistence of both conditions. Close monitoring of patients with FGR and those with both conditions is recommended to improve pregnancy outcomes

Background: Hypertensive disorders during pregnancy, including gestational hypertension and preeclampsia, are significant contributors to maternal and fetal morbidity and mortality. Emerging evidence suggests that alterations in serum magnesium and lipid profiles may play a role in the pathophysiology of these conditions. Objective: To evaluate and compare serum magnesium levels and lipid profiles among normotensive pregnant women and those with hypertensive disorders of pregnancy (HDP). Methods: A prospective case-control study was conducted involving 100 pregnant women beyond 32 weeks of gestation. Fifty women diagnosed with HDP formed the case group, while fifty normotensive pregnant women served as controls. Fasting blood samples were analyzed for serum magnesium, total cholesterol, triglycerides, HDL-C, LDL-C, and VLDL-C. Statistical analysis was performed using SPSS version 25. Results: Women with HDP exhibited significantly lower serum magnesium levels and higher levels of total cholesterol, triglycerides, LDL-C, and VLDL-C compared to controls. HDL-C levels were notably lower in the HDP group. These findings suggest a correlation between dysregulated mineral and lipid metabolism and the development of hypertensive disorders during pregnancy. Conclusion: Monitoring serum magnesium and lipid profiles in pregnant women may aid in the early detection and management of hypertensive disorders, potentially improving maternal and fetal outcomes.

Background: Postpartum haemorrhage is the most common type of obstetric haemorrhage and accounts for the majority of cases. Traditionally primary postpartum haemorrhage is defined as blood loss of 500 ml or more of blood from the genital tract within 24 hours of delivery. The present study was relation between determinants or risk factors of major PPH and maternal outcome recorded in terms of duration of hospital stay, number of blood and blood product transfusions, admission to ICU and death as adverse outcome. Aim: To study the role of risk factors in determining maternal and fetal outcome in major postpartum haemorrhage. Material and Methods:  The present hospital based observational case control study was carried out in women who had major PPH after delivery admitted in labour ward of Department of Obstetrics & Gynaecology at Tertiary Care Teaching Hospital. Cases were selected by census method and controls selected were women who had delivered immediately after the case on the same day. Major postpartum haemorrhage in the present study is defined as blood loss of more than 1000 ml as estimated in postpartum woman with bleeding with either two of the following: systolic blood pressure 90 mm of Hg or pulse rate more than 100 per minute or any postpartum bleeding that requires blood transfusion irrespective of the blood loss. Results In the present study 102 cases of postpartum haemorrhage were identified and were compared with 102 controls. Cause of major PPH was atonic in a major number of cases followed by traumatic PPH. Primiparous women formed majority in cases in the present study whereas in controls multiparous women were more. Blood transfusions were done in 99 cases and bood products like fresh frozen plasma was transfused in 19 cases. Platelets were transfused in 14 cases. A total of 19 cases had blood product transfusions. None of the controls had any adverse outcome. Conclusion The present study suggests that majority cases of major PPH can be predicted based on the risk factors which are recognised antenatally especially anemia and hypertensive disorders of pregnancy. Regular antenatal check ups, recognition and correction of risk factors can prevent major PPH and debilitating complications of major postpartum haemorrhage.