Abstract: Despite achievements in antenatal health care, the incidence of maternal mortality and morbidity remains high in India. Lack of efficient obstetric services at primary level lead to more referrals. This study addresses scenario of obstetric care in women referred to a Rural Medical College Hospital located in Central India. This was a prospective observational study conducted in a tertiary care Institute in Ujjain, Madhya Pradesh over a period of 1 year from July 2016 to June 2017. Various parameters studied include distance of referral center, time from referral decision to hospital admission, causes for referral, mode of delivery; and maternal and perinatal outcome. Total number of referred cases in study period was 100 which were 6.68% of total deliveries in the hospital. Fifty percent cases were referred from the city District hospital and travelled less than 10 kilometers reaching within 6 hours of referral. Most common cause of referral was preeclampsia (16%) followed by previous cesarean delivery and fetal distress (13%). Fifty two underwent emergency cesarean delivery, 43 had a vaginal delivery and 4 cases were managed conservatively. Perinatal mortality was 13 and 24 required NICU admission. Inspite of financial aids provided by Government of India majority of referrals were from city District hospital indicating lack of efficient operative facilities and emergency obstetric care. Strengthening of infrastructure, qualified medical and paramedical staff of Civil Hospital may help in improving maternal care. Triage at primary centers might help in lessening burden on tertiary centers and also facilitate specific referral.

Abstract: Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm. We report a case of 45yeras old female patient who consulted for a mastalgia. Clinical examination showed limited painful breast nodules. On ultrasound and mammography it was a well-limited mass without malignant signs. Core needle biopsy of the breast was done. Diagnosis was based on histopathological exam completed by immune-histochemistry. It’s a triple negative phenotype. The patient was treated by mastectomy plus radiotherapy and remains alive in remission.

Abstract: Caesarean scar Pregnancy (CSP) implanted in the caesarean section scar is a rare location among ectopic pregnancies that can be life-threatening. It can be classified at the same level of gravity as the placenta accreta. Hysterectomy is the gold standard treatment for massive bleeding. The diagnosis of pregnancy implanted in the caesarean section scar is a difficult diagnosis of the first trimester. It must be done as early as possible. Clinical manifestations are not specific, bleeding and pain is the most common symptoms. Endovaginal and pelvic ultrasound associated with Doppler is the first-line examination, provides optimal and panoramic vision, and studies reports of the gestational sac and its vasculature. Recent studies report the value of MRI in diagnosis because of its affinity for the study of pelvic tissue and the relationship of structures. The treatment remains non-consensual but it appears that the injection of methotrexate in situ by preferring the vaginal route is effective and not very morbid. We present here the case of a patient with CSP whose diagnosis was initially unknown.

Abstract: The objectives of the study were: a) To identify the different risk factors in Early onset Preeclampsia. b) To study the Fetomaternal outcomes in that group. This was a one year cross-sectional study conducted in the Department of Obstetrics and Gynaecology at Gauhati Medical College and Hospital.100 mothers with Early onset Preeclampsia (EO-PE) (<34 weeks of gestation) were taken. Data about maternal risk factors, maternal complications, foetal and neonatal outcome were analysed and statistical significance determined. Primiparity, increasing BMI, family history of preeclampsia and male sex of the foetus were found to be important risk factors in development of EO-PE. All the maternal complications like eclampsia, sepsis, systemic disorders, ICU admissions and maternal deaths were higher in EO-PE. Greater number of patients with EO-PE progressed to develop severe preeclampsia. The rate of neonatal complications like abnormal umbilical artery Doppler, low birth weight, reduced APGAR score was higher in EO-PE. Incidence of NICU admissions and neonatal/perinatal deaths was also noted to be higher in EO-PE. Classification of preeclampsia into early and late onset has both etiological and prognostic value. Early detection, close monitoring, timely intervention by the obstetrician and good neonatal care by the paediatrician is the key for successful outcome in Early onset preeclampsia.

Abstract: Management of heart disease complicating pregnancy in a tertiary care centre is a great challenge to obstetricians and cardiologists. To know the maternal perinatal outcome of heart disease complicating pregnancies so that the quality of treatment in a tertiary care centre can be improved. Cardiac disease in pregnant women most commonly due to RHD, CHD, less commonly due to ischemic heart disease or cardiomyopathy. Though the frequency of RHD has decreased worldwide but still in developing countries like India, RHD is predominant. Admission of heart disease in pregnant women is approximately 30 of 2278 total deliveries from the month of june2018 to august2018 in MGMGH. The purpose of this study is to analyse all heart diseases in pregnancy and to characterize the clinical course, treatment and perinatal outcome in antenatal and postnatal women. Details of all antenatal or women less than 6 weeks postpartum admitted to MGMGH in the month of june to august 2018 were reviewed. Obstetric data included gestational age at the time of delivery, type, indication , location of delivery, congenital , rheumatic heart disease, operated , newly diagnosed were categorised depending on the major system involved. Out of 2278 deliveries from june2018 to august2018 in MGMGH, Trichy, 30 were heart disease complicating pregnancy. Rheumatic heart disease and congenital heart disease were more common. Operated congenital heart disease was also more common. Postnatally most of them required ICU monitoring and management. Incidence of Postpartum cardiomyopathy was very less in this study. Early anticipation of complications and close monitoring in the antenatal and perinatal period decreased maternal morbidity and mortality.

Abstract: Pre-eclampsia, is an obstetric disorder characterized by hypertension and proteinuria that prevails all over the world. It presents as a pressing peril for fetal and maternal lives. Though inflammation, increased levels of TXA2, ischemic placenta, dysfunction of endothelium are discerned, the exact pathophysiology yet remains a mystery. The absolute treatment is still to be discovered, however its prevention by low dose aspirin and calcium supplementation present as promising preventative measures for pre-eclampsia. To observe the effect of aspirin and calcium in prevention of preeclampsia. This was a prospective clinical trial study for evaluation of role of aspirin and calcium in prevention of pre-eclampsia in primigravidas. It was carried out at department of Obstetrics and Gynecology at AL-Wahda hospital Derna from Jan 2016 to Dec 2016. Three hundred and forty four primigravidae were included in the study. Their age ranged from 16 to 45 years with a mean 26.32 ± 4.88 years. Out of the 344 healthy primigravidae, 63 (18.3 %) developed preeclampsia. Both (aspirin and calcium) supplementations were associated with a reduction preeclampsia. There was significant difference between the group taken both (aspirin & calcium) group and prevent pre-eclampsia (X2= 6.07, P= 0.014). In Conclusion, It was noted in the present study that low dose aspirin and calcium might have beneficial effect in the prevention of preeclampsia.

Abstract: Ciliated epithelial cells are fairly common in gynecologic lesions; however malignant growth showing these elements and occurring in the ovary are very rare. In the case under discussion, the ovarian tumour coexisted with an endocervical growth with different morphology. 90% of ovarian endometroid tumour showed ciliary processes in our patient and these findings are discussed with a comparison to the available literature on this subject.

Abstract: Due to active involvement of fetal system in regulation of amniotic fluid volume it has been identified as an indicator of intrauterine fetal status. USG has revolutionized the process of assessment of amniotic fluid thus becoming an integral part of fetal surveillance. Polyhydramnios is an obstetrical condition associated with significant perinatal morbidity and mortality. In a low resource health facility as India with poor coverage of antenatal care and malnutrition it still becomes more important to screen pregnancies for such high risk factors. The objectives of the present study were: 1. To determine the incidence of polyhydramnios by ultrasonography. 2. To evaluate its relationship with neonatal outcome. A hospital based prospective study for duration of one year. All the patients identified as having polyhydramnios according to Largest pocket diameter method. The incidence of polyhydramnios in singleton pregnancy during the study period was 1.04 %. Majority of cases (76.61%) were mild, 14.03% moderate and 9.36 % severe polyhydramnios. Congenital anomalies were present in 34 (19.88%) fetus. The commonest malformations were central nervous system 17 cases (9.94%), gastrointestinal system anomalies 9 (5.3%) and musculoskeletal 7 cases (4.1%). Anencephaly was the commonest CNS malformations. Significant association existed between severity of polyhydramnios and chances of fetus having congenital anomaly. Other fetal complications include VLBW 4.09%, macrosomia 1.75%, SGA babies 8.77%, LGA babies 9.94%, still birth 7.59%, NICU admission 20.47% , Perinatal death 16.96% and early neonatal death 9.36%. The study gives us the understanding of the impact of polyhydramnios on the fetal outcome. Our study demonstrates that careful fetal examination has to be performed when polyhydramnios is diagnosed, as congenital malformations are often associated with this condition. These anomalies if detected early timely termination of pregnancy can be done hence less physical and psychological trauma to mother.

Abstract: Polyhydramnios is an important obstetric complication with increased maternal morbidity. Undoubtedly, ultrasound is the best means to diagnose polyhydramnios USG has revolutionized the process of assessment of amniotic fluid thus becoming an integral part of fetal surveillance. In a low resource health facility as India with poor coverage of antenatal care and malnutrition it still becomes more important to screen pregnancies for such high risk factors. To determine the incidence and to assess the maternal outcome in patients diagnosed to have polyhydramnios in singleton pregnancies. The present study was conducted in Guahati Medical College for a period of one year from July 2017 to June 2018. All the patients were identified as having polyhydramnios using Largest pocket diameter method. The incidence of polyhydramnios in singleton pregnancy during the study period was 1.04 %. Majority of cases (76.61%) were mild, 14.03% moderate and 9.36 % severe polyhydramnios. Most common etiology was found to be idiopathic 69% followed by congenital anomalies19.8% and Diabetes Mellitus 10.52% Out of 171cases, 9 case was an abortion out of which 8 was induced due to fetal anomaly, 37 cases had preterm vaginal deliveries, 59 cases had full term vaginal deliveries, 66 cases had cesarean section. The most common maternal complication encountered was preterm labour and the most common malpresentations was breech. The study gives us the understanding of the impact of polyhydramnios on maternal outcome.

Abstract: The objective of the study was to compare computed tomography (CT) imaging of patients with respect to neurological signs. This is a hospital based prospective observational study. 50 patients of eclampsia (both antepartum and postpartum) were studied. CT scan was performed within 48 hours of admission. Statistical analysis was done chi square test and unpaired student’s t test. In this study, of the 42 cases with CT scan abnormality, 39 women had neurological signs and symptoms and 3 cases did not have neurological signs and symptoms (p=0.000005). The sensitivity, specificity, positive predictive value and negative predictive value were found to be 92.85%, 75%, 95.12% and 66.66 % and the diagnostic accuracy was found to be 90%. CT scan of brain in eclampsia can provide useful intra cerebral information and should be done in cases with severe neurologic manifestations, if possible for every eclamptic mother. Further studies including diagnosis of specific neurological manifestations would emphasize the precise clinical presentations in women with eclampsia. Neuroimaging therefore, will help in modifying management protocol in eclampsia.

Abstract: Sepsis is a clinical syndrome that complicates severe infection and is characterized by inflammation and widespread tissue injury. The clinical process usually begins with infection, which potentially leads to sepsis and organ dysfunction [1]. It is estimated that puerperal sepsis causes at least 75,000 maternal deaths every year, mostly in low-income countries [2]. To assess specific management of maternal sepsis in High Dependency unit (HDU) and its impact on maternal outcome. Prospective study carried out at HDU in Gauhati Medical College (GMCH) and Hospital from 1st June 2017- 30th July 2018.All patients with sepsis admitted to HDU during the period of study were studied for their response to management and outcome is evaluated. Out 74 patients with sepsis admitted to HDU, 42 expired due to severe sepsis, septic shock or MODS. The total number of maternal deaths during the study period was 148 due to various causes and the total number of live births was 15802. So maternal sepsis was responsible for 28 % of maternal deaths. The calculated MMR for the period of study was 936/ lakh live births and calculated MMR for maternal sepsis was 265 / lakh live births. From this study it can be concluded that sepsis is an important cause of maternal morbidity and mortality. A positive blood culture and the antibiotic susceptibility testing of the isolates are the best guide in choosing the appropriate antimicrobial therapy in treating sepsis. Blood and blood products, vasopressors also plays important role as adjunctive treatment of sepsis.