Background: Caesarean Section is a commonly performed surgical procedure in obstetric practice, with its incidence rising every year. This increase has led to higher bed occupancy and cost burdens. Conventional Caesarean Sections have several drawbacks, including patients being kept nil per oral overnight before surgery and for 12-24 hours after surgery, immobilization for up to 24 hours or more, continuation of catheter use for 24 hours or more, and the use of opioid-based anesthetics. To address these issues, Enhanced Recovery after Surgery (ERAS) has been introduced. ERAS consists of multimodal pathways during the pre-, intra-, and post-operative periods. Numerous clinical trials, systematic reviews, and meta-analyses have shown that applying ERAS in Caesarean delivery reduces the length of hospital stay, decreases the use of opioid-based anesthetics, improves patient satisfaction, reduces post-operative pain scores, and increases compliance with breastfeeding. Objectives: To determine the outcome of Enhanced Recovery after Surgery (ERAS) pathway in Caesarean Delivery. Methodology: This was a prospective observational study conducted at Paropakar Maternity and Women’s Hospital. Total duration of study period was 3 months from July 2024 to September 2024. A total of 106 patients meeting the inclusion criteria were included in the study. Those receiving care as per the ERAS protocols and standard conventional protocols were observed throughout pre, intra and post-operative period. The two groups were compared in terms of demographic characteristics, intravenous fluid requirement, duration of surgery, length of hospital stay, post-operative pain scores and other post-operative characteristics such as nausea, vomiting, headache, urinary retention, hospital readmission and neonatal outcome. Results: Total of 106 patients were included in the study with 53 in each of ERAS and SC group. In this study, there was no statistical difference in age group, Body Mass Index (BMI), co morbid conditions, gravidity, duration of gestation, indication of CS, duration of surgery and estimated blood loss. The average amount of intravenous fluid required intra operatively in ERAS group was 1350 ml and in SC group was 1650 ml with difference of 300 which was statistically significant, p < .001. The mean length of post-operative hospital stay was 54 hrs. in ERAS group and 71 hrs. in SC group with difference of 17 hrs. which was statistically significant with p = 0.023. The mean post-operative score in ERAS group on Day 0, Day 1 and Day 2 were lower than in SC group with p value < .001. There was no significant difference in post-operative complications between two groups. Conclusion: This study showed that implementation of ERAS protocol is associated with decrease in intra operative fluid requirement, decrease in post-operative length of hospital stay and is associated with significant difference in post-operative pain with use of multi modal analgesia. ERAS can be implemented in Caesarean delivery for addressing the issues of prolonged immobilization, delayed discharge, increased bed occupancy and many more issues associated with it.

Background: In Placenta Previa the placenta is implanted in the lower uterine segment in pregnancy with previous Caesarian Section there is risk of placenta being adherent with the scar, leading to devastating hemorrhage. The aim of this study was to find out the risk of association of placenta praevia with history of uterine scar. Methods: It was a hospital based observational cross-sectional study and was carried out in Department of Obstetrics and Gynecology. Dhaka Medical College and Hospital, Dhaka from May 2013 to October 2013. Total 50 patients were enrolled as diagnosed case of placental praevia. Patients clinical condition and course of management, perinatal outcome were observed, recorded & categorized Data were analyzed using computer with Statistical Package for Social Sciences (SPSS) software for Windows version 20. Results: This study shows commonest age group was 26-30 years, which included 46%, 36% belonged to 31-35 years age group. The average age was 29.80 years. Most (94%) of the patients were multigravida Maximum (54%) number of cases were admitted during the gestational period of 35-38 weeks. Common clinical presentations were anaemia (80%) and per vaginal bleeding (84%). Regarding management, 76% patients were managed actively and 24% patients were managed expectantly. It was observed that placenta praevia with uterine scar is seen more frequently (66%) in cases of previous caesarean sections. Among 30 patients, 84% were live births, 10% were still births and 6% were neonatal deaths. No maternal death was observed in this study. Conclusion: This study shows strong association between previous caesarean section, uterine curettage and hysterotomy and placenta praevia. Most of the patients were provided with active modality of management. Hence the study advocates the use of contraceptive, advanced antenatal care & early referral to hospital and expectant management of patients after proper selection to reduce the premature birth.

Background: Continuous monitoring of fetal well-being through cardiotocography (CTG) is a standard practice in antenatal care, aiming to detect and manage potential complications. However, interpreting CTG patterns requires expertise and understanding, especially in diverse clinical settings such as those in Bangladesh. Objective: To assess normal and abnormal CTG patterns and their implications for perinatal outcomes in a tertiary level hospital in Bangladesh. Methods: A cross sectional study was conducted on CTG recordings of pregnant women admitted to the antenatal unit of a tertiary level hospital in Bangladesh from January 2024 to June 2024. CTG pattern was abnormal based on established criteria. Perinatal outcomes including fetal distress, neonatal outcomes, and obstetric interventions were recorded and analyzed in relation to CTG findings. The aims of the study were to evaluate the abnormal cardiotocography (CTG) patterns during the antenatal period and their impact on perinatal outcomes at a tertiary level hospital in Bangladesh. Results: The incidence of fetal distress was significantly higher in cases with abnormal CTG patterns compared to normal patterns (p<0.05). Furthermore, neonatal outcomes such as Apgar scores <7 at 1 minute and 5 minutes were more prevalent in pregnancies with abnormal CTG patterns. Among the abnormal CTGs groups, who had more risk factors abnormal outcomes were more. Most of the patients in both the normal and abnormal CTGs groups were associated with DM. In abnormal CTGs groups pre-eclampsia, PROM Many pregnant women had other risk factors associated with DM. Conclusion: This study highlights the importance of accurately assessing CTG patterns in the antenatal period for predicting perinatal outcomes. The identification of abnormal CTG patterns can aid in timely interventions to prevent adverse outcomes for both the mother and the newborn.

Background: Combined effects of pregnancy induced hypercoagulability and SARS-CoV-2 infection place pregnant women with COVID-19 disease at high risk of severe outcome. COVID-19 severity has also been associated with serum D-dimer, a biomarker reflecting coagulation and fibrin degradation, in general populations. Despite its prognostic value in pregnant women, the prognostic value of this finding particularly in maternal outcomes remains less understood. The aim of this study was to determine whether elevated serum D-dimer levels in pregnant COVID-19 positive women are of prognostic significance for severe maternal outcomes. Methods: This retrospective observational study included 62 third trimester COVID 19 positive pregnant women admitted to the Department of Obstetrics and Gynecology, BSMMU, Dhaka from March 2019 to February 2020. Serum D-dimer were measured at admission and day 7, 14. D-dimer levels were related to clinical outcomes and statistically evaluated using chi square tests and logistic regression at p < 0.05. Results: Significantly associated with higher risk of severe outcomes, all of which included ICU admission, respiratory complications and adverse pregnancy events is elevated D-dimer levels (≥1.5 mg/L). In logistic regression analysis, patients with D-dimer levels of ≥1.5 mg/L had 3.5-fold greater odds of severe outcomes (OR 3.486; 95% CI, 1.184 to 10.263; p = 0.023). D-dimer had a sensitivity of 64.29%, 67.55% specificity in predicting severe outcomes. Conclusion: Serum D-dimer is valuable prognostic marker of disease severity in pregnant COVID-19 positive women and may be used for early risk assessment and clinical decision making. Routine measurement may help identify early high risk cases in order to improve maternal outcomes.

Background: Chronic pain following cesarean delivery (CD) is a recognized postoperative complication affecting a notable proportion of women. The incidence and risk factors for chronic post-surgical pain in CD are influenced by physical, psychological, and procedural variables. Aim of the study: The aim of this study was to evaluate the incidence and risk factors of chronic pain after cesarean delivery. Methods: This cross-sectional observational study was conducted in Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from March 2023 to February 2024. Total 100 women undergoing cesarean delivery were included in this study. Result: In our study, majority (46%) were in the age group of 18-24 years. About 53% participants with chronic pain reported preoperative anxiety (p = 0.015), and 47% reported depression compared to 9% in the non-chronic pain group (p < 0.0001). Chronic pain was present in 50% of anemic and 83% of malnourished participants (p < 0.0001 for both). Spinal anesthesia was associated with higher chronic pain (83%) than epidural (p < 0.0001). Surgery duration, intraoperative excessive bleeding (OR = 4.9, p < 0.0001) and wound infection (OR = 3.8, p < 0.0001) as well as postoperative wound infection (OR = 3.8; p < 0.0001) and excessive physical activity (OR = 4.2; p < 0.0001) also significantly increased chronic pain risk. Conclusion: This study highlights a significant incidence of chronic pain after cesarean delivery, with socioeconomic status, psychological factors, anemia, malnutrition, intraoperative complications, postoperative wound infection and excessive physical activity as strong predictors.

Background: Management of IUFD has immense significance in today’s obstetric practice. To summarize, dinoprostone gel, misoprostol and intra cervical catheter can be used for induction of labour in second and third trimester IUFD. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Objective: To observed the complications of induction of labor with Foley's catheter in patients with a previous cesarean section. Materials and Methods: The observational study was carried out in the Department of Obstetrics & Gynecology, Dhaka Medical College Hospital. Dhaka, Bangladesh. Total 52 patients with singleton pregnancy with IUFD, at ≥28 weeks of gestation was attending in the Department of Obstetrics & Gynae were included in this study. Details of history, general physical and systemic examination, ultrasonography, basic laboratory investigations like haemoglobin level, and DIC profile were recorded. Results: Forty three (82.7%) received augmentation with oxytocin, 3(5.8%) developed scar tenderness and 8(15.4%) had failed induction. Failed ICC was found 8 cases, among them 5(62.5%) had dinoprostone gel used followed by vaginal birth, 2(25.0%) had LUCS and 1(12.5%) had laparotomy. Induction delivery interval was found 16.3±5.5 hours. Regarding maternal outcome 49(94.2%) patients had normal vaginal delivery, 4(7.7%) had PPH, 3(5.8%) had fever, 2(3.8%) were ICU admission, 1(1.9%) had laparotomy and 1(1.9%) had rupture uterus. Conclusion: Common maternal complications were PPH, fever, ICU admission, laparotomy and rupture uterus. Induction can be done safely in carefully selected cases of previous LSCS with Foley’s Balloon.

Background: Primary amenorrhea, defined as the absence of menarche by age 15 in the presence of secondary sexual characteristics or by age 13 without them, arises from various etiologic factors. Timely diagnosis and targeted interventions, including genetic counseling and reconstructive surgeries, are essential for effective management. Aim of the study: The aim of this study was to prevalence of etiologic causes of primary amenorrhea among women in a tertiary care center. Methods: This cross-sectional study was conducted in Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, during the period from June 2023 to May 2024. Total 120 women presenting with primary amenorrhea during the study period were included. Result: The study involved participants with a mean age of 17.8 ± 3.2 years, with 58.3% aged 15-20. Most were from low-income backgrounds (62.5%), and 33.3% reported parental consanguinity. Hormonal causes (41.7%) predominated, followed by structural (33.3%) and genetic causes (16.7%). Hypogonadotropic hypogonadism (60.0%) and Müllerian agenesis (62.5%) were leading subtypes, while Turner syndrome accounted for 60.0% of genetic cases. Diagnostic findings included pelvic ultrasound abnormalities (45.8%, p <0.001) and karyotype abnormalities (16.7%). Hormonal imbalances were most common (58.3%), reflecting the diversity of etiologies and the importance of advanced diagnostics in identifying underlying causes. Socioeconomic status and parental consanguinity significantly influenced etiological patterns. Conclusion: This study highlights significant associations between socio-demographic factors, such as age, consanguinity, socioeconomic status, and etiological categories were observed. Diagnostic findings underscored the importance of pelvic ultrasound, karyotyping, and hormonal evaluation in accurate classification.

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal complications, including preterm delivery, macrosomia, and neonatal hypoglycemia. Elevated serum ferritin levels, a marker of inflammation and oxidative stress, may exacerbate these risks. This study was aims to determine if serum ferritin elevation is a marker of adverse maternal and fetal outcome in pregnancies complicated by GDM. Method: A case control study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College, Dhaka from September 2020 to August 2021. 42 pregnant women at 2nd 3rd trimester attended for antenatal care diagnosed as GDM was selected as cases and 42 non-diabetic pregnant women matching with cases by age and gestational age was selected as control are included this study. GDM was diagnosed by oral glucose tolerance test (OGTT). The serum ferritin level of these patients was measured. Results: Elevated serum ferritin was significantly associated with GDM (p<0.05). GDM women had higher rates of obesity (p=0.005), preterm delivery (30.9% vs. 16.6%) and term delivery was less in case group (69.05%) than controls (83.33%) . In neonates of GDM mothers macrosomia rates were 26.19% in case group and 14.3% in control group. Hypoglycemia was 16.6%, respiratory distress 11.9% and NICU admissions 21.4% (p<0.05 vs controls). Conclusion: Elevated serum ferritin is a strong predictor of adverse maternal and neonatal outcomes in GDM pregnancies. These findings suggest that ferritin could serve as a biomarker for identifying high-risk pregnancies. Incorporating ferritin screening into antenatal care may facilitate early risk stratification and targeted interventions.

Background: Antenatal care (ANC) engagement is essential for ensuring healthy pregnancy outcomes by providing timely medical interventions and education to expectant mothers. In Bangladesh, various factors such as socioeconomic status, education level, and access to healthcare services significantly influence antenatal care (ANC) utilization. This study aimed to explore the trends in antenatal care engagement among women in Bangladesh. Methods: This observational cross-sectional study took place over six months at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. During this period, 100 women admitted to the Obstetrics and Gynaecology Ward for delivery were purposively selected as participants. Thorough clinical examinations and pertinent investigations were conducted. Data analysis was performed using MS Office tools. Results: In Bangladesh, educated women are more likely to have regular antenatal care (ANC) and make at least four visits. Women over 25 years old tend to attend ANC less frequently, whereas regular attendance is seen in 91.1% of women aged 20-25. Primiparous women had a higher ANC attendance rate at 95.7%, but women with higher parity (≥4) also showed an increased usage of ANC services at 71.4%. Cesarean sections were more prevalent in rural areas at 56.4% compared to 71.0% in urban areas. Regarding neonatal outcomes, 15% of babies were born with low birth weight, and prematurity was observed in 15% of cases. Conclusion: In Bangladesh, a rich tapestry of cultural, educational, and socioeconomic elements plays a pivotal role in shaping the way maternal healthcare is sought. There is a notable disparity in access across urban and rural areas, differences in education levels, preferred treatment facilities, economic standing, and pregnancy experiences.