European Journal of Cardiovascular Medicine

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

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.

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: 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.

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.

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: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality globally. This study aimed to determine the prevalence, associated risk factors, severity, and management outcomes of PPH in a tertiary care hospital. Methods: An observational analysis was conducted on 100 postpartum cases. Data on demographics, obstetric history, labor characteristics, and management approaches were collected. The prevalence and risk factors of PPH were analyzed, and the severity of cases was categorized based on blood loss volume. Management strategies were evaluated for their effectiveness. Results: The prevalence of PPH was 23%. Significant risk factors included maternal age ≥35 years (65%), grand multiparity (48%), cesarean delivery (56%), prolonged labor (>12 hours, 60%), antepartum anemia (67%), placenta previa/placental abruption (30%), macrosomia (5%), and pre-eclampsia (70%). Mild PPH (500–1000 mL) accounted for 65% of cases, moderate PPH (1001–1500 mL) for 26%, and severe PPH (>1500 mL) for 9%. Management was primarily medical, effectively controlling 83% of cases, while surgical interventions were required in 17%. Conclusion: PPH remains a significant obstetric challenge, with multiple risk factors contributing to its occurrence and severity. Effective management, predominantly through medical interventions, is critical in reducing complications. Preventive measures focusing on high-risk groups, such as those with antepartum anemia or pre-eclampsia, may mitigate PPH prevalence and severity.

Background: Cesarean section (CS) is a widely performed obstetric procedure, with variations in surgical technique aimed at improving maternal and fetal outcomes. This study compares exteriorization of the uterus versus in situ repair during CS in terms of surgical and postoperative outcomes. Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynecology, Konaseema Institute of Medical Sciences, Amalapuram, involving 200 patients undergoing CS. Participants were randomized into two groups: exteriorization (n=100) and in situ repair (n=100). Demographic data, intraoperative parameters, postoperative recovery, and neonatal outcomes were compared using statistical analysis. Results: The exteriorization group had a significantly shorter surgical duration (59.09 ± 10.46 min vs. 66.15 ± 11.72 min, p < 0.0001) and less blood loss (postoperative hemoglobin: 10.28 ± 1.28 g/dl vs. 9.76 ± 0.89 g/dl, p = 0.001). However, postoperative pain scores were higher on day 1 (6.69 ± 0.84 vs. 5.43 ± 0.74, p < 0.0001), with increased analgesic use. Hospital stay, febrile morbidity, and infection rates were similar between groups. Neonatal outcomes were comparable, with no difference in 1-minute APGAR scores, though the 5-minute APGAR score was slightly higher in the in situ group (p = 0.005). Conclusion: Exteriorization of the uterus offers reduced surgery time and blood loss but is associated with higher immediate postoperative pain. Given the similar maternal and neonatal outcomes between techniques, the choice of approach should be tailored to individual patient conditions and surgeon preference.

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: Ectopic pregnancy remains a significant obstetric challenge, contributing to maternal morbidity and mortality. Despite advancements in diagnostic modalities, the condition continues to pose a serious threat due to its unpredictable nature and potential for life-threatening complications. This study aimed to assess the risk factors, clinical presentations, and outcomes of ectopic pregnancies in a tertiary care hospital in Kashmir. Methods: A retrospective observational study was conducted over a 20-month period (January 2022–August 2023) at the Department of Obstetrics and Gynecology, GMC Srinagar, Jammu & Kashmir. A total of 153 cases of ectopic pregnancies were identified through a records review. Data on sociodemographic characteristics, clinical presentations, risk factors, management modalities, and outcomes were collected. Statistical analysis was performed using SPSS v.22, with Chi-square and t-tests applied to assess associations. Results: The highest incidence of ectopic pregnancy was observed in women aged 25–30 years (52.9%), with a majority being multiparous (56.2%). The most common risk factors included previous lower segment cesarean section (39.2%), prior abortions (14.4%), and prior ectopic pregnancy (9.2%). Abdominal tenderness (89.5%) and vaginal bleeding (57.5%) were the most frequent clinical presentations. Surgical management was required in 61.5% of cases, while 11.8% were managed medically. Rupture was observed in 39.2% of cases, with significant associations found with adnexal mass (p < 0.001), cervical motion tenderness (p < 0.001), and bleeding per vaginum (p = 0.004). Conclusion: Ectopic pregnancy continues to present significant diagnostic and therapeutic challenges. Previous cesarean section and abortions emerged as major risk factors. The findings highlight the importance of early diagnosis and tailored management strategies to reduce morbidity and improve patient outcomes.

Background: Placenta Accreta Spectrum (PAS) represents a range of severe obstetric complications characterized by abnormal placental adherence, leading to significant maternal morbidity. Early and accurate prenatal detection is crucial for optimal management. A low-lying placenta (LLP) is a known risk factor for PAS. This study aimed to investigate the correlation between maternal serum alpha-fetoprotein (MS-AFP) levels and the presence of PAS in pregnant women with LLP, and to evaluate its potential as a predictive marker. Methods: This was conducted at Lalla Ded hospital, a tertiary care centre in Srinagar, J&K, between August 2023 and January 2025. Pregnant women with gestation >=28 weeks, diagnosed with LLP via ultrasound , who underwent MS-AFP screening were included. MS-AFP levels were measured using and expressed as Multiples of the Median (MoM). An MS-AFP level of >=2.5 MoM was considered elevated. The diagnosis of PAS was confirmed by intraoperative findings and/or histopathological examination. Statistical analysis included descriptive statistics,, correlation analysis, and calculation of diagnostic accuracy metrics. Results: A total of 250 women with LLP were included. PAS was confirmed in 38 (15.2%) participants. The mean MS-AFP level was significantly higher in women with PAS (>=2.5 MoM) compared to those without PAS ( <2.5 MoM) (P<0.05). A significant positive correlation was observed between MS-AFP levels and the presence of PAS (P<[0.05]). Elevated MS-AFP (>=[2.5] MoM) demonstrated a sensitivity of [86.8]%, specificity of [72.1]% for the detection of PAS in this observational study.  Conclusion: Elevated second-trimester MS-AFP levels are significantly correlated with an increased risk of PAS in women with LLP. While not a standalone diagnostic tool, MS-AFP may serve as a valuable, non-invasive adjunct for risk stratification, prompting enhanced surveillance and timely referral for specialized management in this high-risk population.

Context/Background: The reproductive health of women is a crucial aspect of overall health and plays a key role in human development with services utilization playing a key role in reducing maternal morbidity and mortality. Despite global efforts to improve maternal health outcomes, the utilization of maternal health services remains suboptimal in many regions. Aims/Objectives: To assess the utilization of maternal and child health services and their children and factor influencing in the Chargawan block of Gorakhpur district. Methodology: A community based cross-sectional multistage study was conducted among recently delivered women in the Chargawan block of Gorakhpur district. The study participants were 400 recently delivered women and their children up to 24 months who reside in Chargawan block A pre-tested and pre-designed questionnaire was used to collect data on sociodemographic characteristics, and utilization of maternal and child health (MCH) services, including ANC, delivery, postnatal care (PNC), family planning, immunization, and childcare and factors influencing access utilization of MCH services. Statistical package for social sciences, version‑26 (SPSS‑26, IBM, Chicago, USA) was used for data analysis. P <0.05 was considered statistically significant. Results: The overall registration for ANC services in the study area was 96.50%. Most women who avail ANC services primarily visit the nearest Primary Health Center (36.50%), and 19.00% of RDWs prefer private clinics or hospitals for receiving ANC services. the majority (41.00%) had more than four ANC visits. The majority (95.75%) of RDWs opted for institutional deliveries. The family services availed by RDWs was 60.25%. the complete immunization by their children was 76.2%. The findings highlight the significant role of education, spouse’s occupation, and socio-economic status in shaping maternal health service utilization. Conclusions: To improve utilization addressing socio-economic disparities, enhancing awareness of maternal health, and improving healthcare access.

Background: Ectopic pregnancy is a potentially life-threatening condition in which a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tubes. It remains a major cause of maternal morbidity and mortality in the first trimester, particularly in resource-limited settings. Despite advancements in diagnostic imaging and laboratory support, delays in diagnosis are still common due to the variable and non-specific nature of its clinical presentation. Ectopic pregnancy accounts for 1–2% of all pregnancies globally, but the incidence may be higher in populations with limited access to early antenatal care or with high rates of risk factors such as pelvic inflammatory disease, tubal surgery, infertility treatments, or previous ectopic pregnancies.  In many cases, the classic triad of amenorrhea, abdominal pain, and vaginal bleeding may not be evident, making clinical suspicion essential. Without timely intervention, ectopic pregnancy can lead to tubal rupture, massive intra-abdominal bleeding, and maternal death. In low- and middle-income countries, the burden is further amplified due to late presentation, inadequate diagnostic facilities, and restricted access to emergency obstetric care. Understanding the clinical features and demographic patterns of ectopic pregnancy in a tertiary care setting is crucial to improve early diagnosis and outcomes. A hospital-based analysis provides valuable insight into real-world presentations and helps identify gaps in care that can be addressed through targeted interventions. Objective: To determine the clinical features of ectopic pregnancy among women presenting to a tertiary general hospital. During the study period, 50 subjects were chosen for the study. Conclusion: Strengthening clinical acumen and timely diagnostic protocols in emergency and obstetric care settings can significantly improve maternal outcomes in cases of ectopic pregnancy.

Background: A Caesarean Section (CS) is a significant procedure commonly performed in obstetric practice ⁽¹⁾. It serves as a life-saving intervention when warranted and helps to avert complications for both mothers and newborns, including the risk of neonatal death. The frequency of CS is escalating due to various factors such as maternal traits (age extremes, obesity, etc.), requests from mothers, labor induction, and the use of epidural anaesthesia ^(2-4).

Objectives:

1. To assess the various risk factors in mothers requiring re-laparotomy after caesarean section in our hospital during the given period.
2. To evaluate maternal outcomes in this study in terms of mortality and morbidity.

Material & Methods: Study Design: A prospective observational study. Study area: Department of Obstetrics and Gynecology, R.G.KAR Medical College and Hospital, Kolkata. Study Period: December, 2022 to May, 2024 (18 months). Study population: All women undergoing re-laparotomy after caesarean section deliveries in the stipulated time frame in R.G.KAR Medical College and Hospital, Kolkata.   Results: Among the booked cases most of the re-laparotomies were performed due to PPH (atonic uterus) (45.45%) followed by rectus sheath hematoma and broad ligament hematoma. Among the referred cases, most of the re-laparotomies were performed due to rectus sheath hematoma (27.59%) followed by PPH (24.14%0 and hemoperitoneum (13.79%). Conclusion: Finally, it can be concluded that exposure to CS is itself a definitive risk factor with complications such as need of re-laparotomy which is done as a procedure in cases of near miss fatality of mother. Every effort must be made to make the procedure safe. If the personnel and adequate blood products are available, re-laparotomy should not be delayed for the management of intractable hemorrhage and unstable vital signs after CS. Strict post -operative vigilance and timely intervention can reduce both maternal morbidity and mortality

Background: Heart disease in pregnancy is a major contributor to maternal and perinatal morbidity and mortality, especially in low- and middle-income countries. Pregnancy-related cardiovascular changes can precipitate decompensation in women with pre-existing heart disease. Methods: This retrospective observational study was conducted at Lalla Ded Hospital, Srinagar, Jammu and Kashmir, India, over a 2-year period. Sixty-one pregnant women with known or newly diagnosed heart disease were included. Maternal outcomes assessed included ICU admission, mechanical ventilation, cardiovascular complications, and delivery mode. Perinatal outcomes included preterm birth, NICU admission, and mortality. Data were analysed descriptively. Results: The majority of women were aged 25–29 years (49.18%). Rheumatic heart disease was the most common lesion (32.78%). ICU admission was required in 36.06% and mechanical ventilation in 14.75%. Cardiovascular complications occurred in 18%. Preterm birth rate was 16.4%, NICU admissions 16.4%, stillbirths 3.3%, and no congenital heart defects were detected. Conclusions: Pregnancies complicated by heart disease are associated with significant maternal morbidity and moderate perinatal risk. Early diagnosis, mWHO-based risk stratification, vigilant antenatal surveillance, and multidisciplinary care at tertiary centres can improve outcomes. (95% CI for ICU admission: 24.2%–48.6%).

Background: Non-communicable diseases (NCDs) such as hypertension, diabetes, thyroid disorders, and obesity are emerging as significant contributors to maternal morbidity and adverse fetal outcomes in low- and middle-income countries. In pregnancy, the burden of these conditions is increasing due to lifestyle changes, delayed childbearing, and rising prevalence of metabolic disorders . Understanding their impact on maternal and neonatal outcomes is critical for optimizing obstetric care. Aim: To study the prevalence of non-communicable diseases in pregnancy and their association with maternal and fetal outcomes in a hospital-based population. Methods: A cross-sectional study was conducted at Government Medical College Kathua from September  2023 to August  2024 on 100 pregnant women diagnosed with non-communicable diseases. Data regarding demographic profile, type of NCD, obstetric complications, and neonatal outcomes were collected and analyzed using descriptive statistics. Results: Among 100 women, hypertensive disorders in pregnancy were most common (42%), followed by gestational diabetes (28%), thyroid disorders (18%), and obesity (12%). Maternal complications included preeclampsia (24%), cesarean section (46%), and postpartum hemorrhage (6%). Fetal complications included low birth weight (22%), preterm birth (18%), intrauterine growth restriction (12%), and perinatal mortality (4%). Conclusion: Non-communicable diseases in pregnancy contribute substantially to adverse maternal and perinatal outcomes. Early screening, preconception counseling, and multidisciplinary management are essential to reduce morbidity and mortality associated with these conditions.

Background The placenta accreta spectrum represents the abnormal adherence of the placenta to the uterine wall, leading to severe maternal morbidity and mortality. Early antenatal diagnosis using imaging is crucial for planning delivery, reducing hemorrhagic complications, and improving maternal outcomes. USG (Ultrasonography) remains the first-line modality, while MRI (Magnetic Resonance Imaging) is often employed in inconclusive or complex cases. This study aimed to evaluate and compare the diagnostic accuracy of USG and MRI in detecting abnormal placental invasion, using histopathology as the gold standard. Methods This cross-sectional study was conducted over a period of 24 months in the Department of Radiology, Kurnool Medical College & Hospital, Kurnool. Fifty pregnant women with a history of previous cesarean section and suspected placental invasion were included. All patients underwent USG followed by MRI, and findings were compared with intraoperative and histopathological results. Statistical analysis included sensitivity, specificity, predictive values, and diagnostic accuracy. Results Among the study population, 60% had type IV placenta previa and 28% had type III. USG findings showed 82% with no invasion, 6% suspicious, 8% accreta, and 4% percreta. MRI detected 76% with no invasion, 20% accreta, and 4% percreta. Histopathology confirmed 80% normal placentation, 16% accreta, and 4% percreta. USG demonstrated 100% sensitivity, 90% specificity, 97.5% PPV (Positive Predictive Value), and 100% NPV (Negative Predictive Value), with an overall diagnostic accuracy of 98%. MRI showed 83% sensitivity, 100% specificity, 100% PPV, 95% NPV, and 96% diagnostic accuracy. Conclusion Both USG and MRI are reliable for antenatal detection of PAS. USG, with its high sensitivity and cost-effectiveness, should be the first-line tool, while MRI serves as an excellent adjunct in complex or equivocal cases for precise surgical planning.

Background: Labor induction is an obstetric procedure performed routinely across the globe including in India and it initiate labor before its onset spontaneously. Labor induction is advisable when benefits of termination of pregnancy are higher compared to the risks of pregnancy continuation. Concerning Indian context, incidence of labor induction are in the range of 5-22%. Aim: The present study was aimed to assess the impact of Induction Indications on Delivery Outcomes and modes. The study also assessed the degree of perinatal, fetal, and maternal morbidity with each indication for labor induction. Methods: The present study assessed 200 pregnant females that underwent induction of labor at the Institute within the defined study period for delivery modes and indications. The data gathered were assessed statistically for results formulation. Results: Among 200 subjects assessed, operative vaginal delivery, cesarean section, and vaginal delivery was done in 22% (n=44), 41% (n=82), and 37% (n=74) subjects respectively. Highest rate of induction was seen with PROM with 27%. Other conditions with high induction rate were hypertension, diabetes, and past dates with 10%, 14%, and 2% respectively. Normal vaginal delivery rates were high in hypertension, polyhydramnios, and PROM and were lowest with IUGR and diabetes. Highest cesarean rate was seen with IUGR and diabetes. High maternal morbidity was seen with operative vaginal delivery highest NICU admission was seen with cesarean section. Conclusion: The present study concludes that indications for induction of labor are affected greatly with the mode of delivery and also decrease the rate of emergency cesarean section and morbidity linked with it. The study outcomes were inefficient owing to a smaller sample size. Further, large randomized trials are needed to assess the impact of labor induction indication on the mode of delivery

Background Twin pregnancies are associated with increased maternal and perinatal risks compared to singleton gestations. They contribute significantly to maternal morbidity, obstetric complications, and adverse neonatal outcomes. This study aimed to evaluate the maternal and perinatal outcomes of twin pregnancies at a tertiary care hospital in Tezpur, Assam. Objectives To determine the incidence of twin pregnancies and analyse maternal complications, maternal morbidity and mortality, as well as neonatal morbidity and mortality. Methods This study was conducted over one year at Tezpur Medical College and Hospital. A total of 100 women with twin pregnancies beyond 28 weeks of gestation were included, fulfilling inclusion and exclusion criteria. Data were collected through structured proformas, clinical examinations, ultrasonography, and perinatal monitoring. Maternal and neonatal outcomes were analysed using descriptive statistics. Results The incidence of twin pregnancy was 0.7% among 13,737 deliveries. Most women were aged 20–29 years (73%), with nearly equal distribution between primigravida (49%) and multigravida (51%). Preterm delivery occurred in 84% of cases, and anemia (72%) was the most common maternal risk factor. Premature labour (76%) was the leading complication, with maternal mortality recorded in 2%. Caesarean delivery was slightly more common (54%) than vaginal birth (46%). Perinatal outcomes were marked by low birth weights (s (<2.5 kg in 80–90% of twins), intrauterine deaths (3–5%), and a high NICU admission rate (52–56%). Conclusion Twin pregnancies are high-risk with significant maternal and perinatal complications. Strengthening antenatal care, early risk identification, and skilled intrapartum management are essential to improve outcomes.

Placenta Accreta Spectrum (PAS) is a condition associated with high maternal morbidity and mortality rate with unique challenges in its diagnosis and management. The main complication of PAS is due to its massive obstetric hemorrhage that requires prompt intervention to save the patient’s life. We report here a series of three cases of placenta accrete spectrum managed by subtotal caesarean hysterectomy at our tertiary care hospital within a span of three hours, each operation lasting for around 45 minutes reflecting the importance of a shorter time interval in the intra operative management of PAS

Background: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Understanding the clinical profile and determinants of PPH is essential for early identification and timely intervention to reduce adverse outcomes. Objectives: To assess the clinical characteristics, risk factors, management practices, and maternal outcomes among women with postpartum hemorrhage in a tertiary health-care institute. Methods: A cross-sectional study was conducted among 53 women diagnosed with PPH between January and December 2024 at a tertiary care hospital. Data were collected using a structured proforma from case records, labour room registers, and operative notes. Maternal demographic details, obstetric risk factors, clinical characteristics, management interventions, and outcomes were analyzed. Associations between major determinants and severity of PPH were assessed using chi-square or Fisher’s exact test, with p < 0.05 considered statistically significant. Results: Most women were aged 25–29 years (37.7%), multiparous (54.7%), and from rural areas (60.4%). Anemia (64.2%), induction/augmentation of labour (39.6%), and prolonged labour (28.3%) were the most common risk factors. Uterine atony was the leading cause of PPH (71.7%). All women received oxytocin and IV fluids, while 84.9% received tranexamic acid and 54.7% required blood transfusion. Balloon tamponade and compression sutures were required in 17% and 11.3% of cases, respectively. Severe morbidity included hemodynamic instability (35.8%), ICU admission (15.1%), and prolonged hospital stay (26.4%). One maternal death (1.9%) occurred. Anemia, prolonged labour, and induction/augmentation were significantly associated with increased blood loss (p < 0.05). Conclusion: PPH continues to be a major obstetric emergency with significant morbidity despite active management. Anemia, labour-related factors, and uterine atony were key determinants. Strengthening antenatal correction of anemia, optimizing labour management, and ensuring readiness of PPH interventions may substantially reduce complications