Background: Placenta previa is a disorder which happens during pregnancy when the placenta is abnormally placed in the ‘lower uterine segment’, covers the cervix. The increasing trends of cesarean delivery rate causes a marked increase in abnormally invasive placenta over the past decades. We are in need of more research-based data regarding possible complications of placenta previa in Bangladesh. Aim of the study: The aim of the present study was to assess the neonatal and maternal complications of placenta previa. Methods: This prospective observational study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital of Dhaka, Bangladesh during the period from April 2020 to March 2021. In total 87 placenta previa cases whose singleton deliveries took place at the mentioned hospital during the first year of the study were selected as the study subjects for analysis. For data cleaning, the coded-data were entered into EPI Info version 3.5. The cleaned data were exported to SPSS version 25 and analyzed. P value < 0.05 was considered as statistically significant. Results: In this study, in analyzing the maternal complications we observed, ‘hospital stay ≥14 days, ‘anemia’, ‘blood transfusion ≥2 and ‘PPH (Post-partum hemorrhage)’ were the most frequent maternal complications. Those 4 major complications were found in 36.78%, 29.89%, 24.14% and 21.84% cases respectively. On the other hand, ‘admission to NICU’, ‘dead babies’, ‘APGAR score at 1 min <7, and ‘low birth weight’ were found as the 4 most frequent neonatal complications in this study. Those 4 major complications were found in 22.99%, 21.84%, 13.79% and 12.64% cases respectively. Conclusion: Women with placenta previa should be considered as caring high risk and compatible blood should always be ready for such cases before considering caesarian section. Family planning should also be emphasized as a strategy to reduce of parity, caesarean section rate and possibilities of placenta previa. Strategies and protocols should be settled to reduce the rate of CS (caesarean section) and senior staffs and proper instruments have to be involved in the management of cases of placenta previa.

Introduction: Teenage pregnancy is the problem of both developed and developing countries. In developed country modernization may contribute to unwanted pregnancy as a result of relaxation of traditional, cultural norms prohibiting premarital sexual activity. But in our country early marriage, ignorance, illiteracy, lack of adequate healthcare facilities, failure to seek family planning advice due to social taboos and shyness are the cause of this problem. Objective: To evaluate perinatal outcome of adolescent pregnancy and labour. Methods: This is a prospective case control study was carried out in the Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital, Dhaka Bangladesh from 1st January 2008 to 1st July 2008.A total number of 100 adolescent pregnant women who satisfied the inclusion and exclusion criteria. Purposive consecutive sampling from admitted patients. One hundred pregnant women of 15 to 19 years case group and One hundred pregnant women of 20 to 35 years control group who were admitted into the hospital during the same period. Results: The overall percentage of adolescent mother during this study period among total 4592 obstetric cases admitted in Dhaka Medical College Hospital (DMCH) is 5.75% (264 cases were teenagers and 4202 were between 20-35 years old control group). Statistics significant test for difference in proportions were conducted in some of the events of both groups. Above table shows majority of adolescent mothers were between more than 17 years up to 19 years (88%). In control group majority from age 20-30 years (76%). Above tables shows 38% adolescent mothers were illiterate, 32% had primary education, 8% had secondary education and 22% could sign only. In control 20% illiterate, 24% could sign only, 38% had primary education and 18% had secondary education.54% of adolescent mothers has normal vaginal delivery,4% had assisted breech delivery, 2% had forcep delivery, 4% had ventouse delivery and 36% had caesarean section. Whereas in control group caesarean section was 38% and normal vaginal delivery 59%.foetal conditions were noted. 60% of neonates of adolescent mothers were healthy and 76% of neonates of older mothers were healthy. The differentiation was statistically significant between two groups (P<0.05). Conclusion: From our study we can say that, in order to improve the teenage health periodic information, education, community activities, ANC camps to be held at primary health care centers. Further study is needed for better outcome.

Background: Hysterectomy is most common gynaecological surgery done for various indications varying from AUB, fibroid uterus to malignancies. It can be done by abdominal or vaginal route and with the help of laparoscopy. Laparoscopic assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) although gaining more popularity now a days, though it is associated with higher cost, longer duration of operation, and need general anaesthesia moreover ureteric injury, bladder injury, and anesthetic complications were more in laparoscopic assisted hysterectomy (LAVH) group when compared to abdominal and vaginal hysterectomies. In addition LAVH was accomplished in twice the time required for vaginal hysterectomy. Most common indication for hysterectomy being excessive menstrual blood loss due to hormonal reasons or fibroids (size more often not exceeding 12 weeks). The need for safer and less expensive route of surgery would be a better option for these kind of patients. The aim of the study was to analyse the safety, feasibility and to study the indication and the complications of non-descent vaginal hysterectomy. Methodology: This is a retrospective cohort study. 120 women who underwent non-descent vaginal hysterectomy in the department of OBGY, Smt. Kashibai Navale Medical college and General Hospital, Pune, India were included in the study. Patient’s records were retrieved. Data regarding patient’s age, parity, indications for hysterectomy, and uterine size in weeks, previous surgeries in the past, duration of surgery and complications were recorded. Data collected on a semi structured proforma and the same was analysed using suitable statistical analysis. Results: A total of 120 cases were operated for different indications. Among the study participants majority were in the age group of 41-45 years (56 i.e 46.7%). Most common indication for hysterectomies were Abnormal uterine bleeding (AUB) (54 i. e 45%), followed by fibroid uterus (30 i.e 25%). The mean duration of surgery time taken was 60+10 minutes. Majority of the women who underwent hysterectomies had bulky uterus (70%). Complications were very few. Fever, UTI (urinary tract infection) and headache were seen in 5% cases. There were two cases of vault sepsis and one case of upper respiratory tract infection (URTI). In one patient vaginal hysterectomy could not be completed and abdominal hysterectomy was carried out. Mean hospital duration was 4 days. Conclusion: Vaginal hysterectomy appears to be safe and feasible in most of the women requiring hysterectomy for benign conditions with minimum complications and shorter hospital stay.

Corona-virus pandemic has become a major health problem worldwide. It evokes mental health disorders affecting population globally especially the pregnant women and associated with adverse maternal and fetal outcomes. Therefore, we aimed to assess anxiety and depression among pregnant women during this lethal outbreak of corona-virus. We conducted a cross-sectional study at Hamdard University Hospital, Karachi from October 2020 to February 2021. A total of 120 pregnant women were included in this study. Psychological Impact was assessed using questions from DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure for Adults and data was analysed using the software IBM SPSS Statistics 26. We found that more than half (67.5%) of pregnant women had developed mental health disorders during this pandemic and there is a need to reform policies for the care and counselling of pregnant women as they are particularly susceptible.

The most cost effective, essential component for the growth and development as well as to reduce the infant mortality, is breastfeeding, which is often disrupted due to lack of confidence, improper positioning for latching, breast pain, perception of insufficient milk supply etc. The present study aims to assess the effectiveness of lecture cum demonstration versus video assisted teaching on knowledge and practice of breast feeding technique among primipara. Methodology: 60 primipara were selected through purposive sampling and divided into group I and group II among which lecture cum demonstration and video assisted teaching regarding breastfeeding technique were applied consecutively. The data were collected by using structured questions and observational checklist. The data were analyzed by using descriptive and inferential statistics. The effectiveness of lecture cum demonstration versus video assisted teaching on knowledge and practice of breast feeding technique among primipara was computed by paired‘t’ test. Comparison between the lecture cum demonstration and video assisted teaching was not significant.

Background: Cesarean sections have been a part of human history from the beginning of time. There are legends from both western and eastern civilizations of this technique leading to live mothers and children. In today's obstetrics practice, pregnant women who have had cesarean sections in the past are becoming more commonplace. There are proven hazards to the mother's health following a cesarean section in subsequent pregnancies, such as placenta praevia or rupture of the uterine scar. Premature birth, low birth weight, and perinatal mortality have also been linked to it. Because of the risk of harm to the surrounding structures, repeat cesarean sections are extremely difficult to perform. Aim: To evaluate the outcome of vaginal birth after cesarean section (VBAC) of patients admitted into a tertiary level hospital. Methods: It was prospective, non-randomized, and observational, which involved interviewing all pregnant patients admitted in Gynae and Obstetric Department of RMCH with a history of one or more cesarean sections were included in this study. Results: Out of 50 cases mean age of the study population was 26.92±4.67. Eighty-four percent of study subjects received a regular antenatal check-up during their present pregnancy. A maximum number of 29 patients (58%) had BMI < 20. Before VBAC 40% of subjects had previous vaginal delivery followed by cesarean section, 4% of subjects had previous cesarean section followed by vaginal delivery, and 56% of subjects had only one delivery by caesarean section. All the caesarean sections were done due to nonrecurrent causes. Bishop's scoring during admission for present pregnancy was the highest number i.e., 30(60%) had dilatation ≥4 cm, 60% of the subjects had ≥80% effacement. Women presenting with established labor had a greater chance of successful VBAC. Most of the patients 39 had spontaneous onset of labor while in 11 cases were induced. Eighty-six percent underwent VBAC successfully, and 14% of cases failed to undergo VBAC. Six subjects (12%) had undergone caesarean section. During caesarean section, peritoneal adhesion (83.33%), bladder adhesion with lower segment (66.67%), liquor-stained amniotic fluid (66.67%), cord around the neck (33.33%) were found. It was observed that the majority (76%) of the neonates were born with a birth weight between 2.5 to 3 kg, and 92% of the neonates had an APGAR score 7 at 1 min and 10 at 5 min. Only 2 neonates died after VBAC, but they died a few hours after admission in the Neonatal ward. The mother of these two neonates was in a prolonged 2nd stage of labor on admission. Peripartum hysterectomy was done in one case due to extension of cervical tear up to the body of the uterus following precipitate labor. The average length of hospital stay was about 24 hours. after delivery for most (86%) of the mothers (after VBAC), whereas only 2% stayed for more than 5 days (who underwent peripartum hysterectomy). Conclusion: From the Study, it could be concluded that if a mother fulfilled the criteria, VBAC could be attempted as it has a few maternal and fetal complications. If risk factors are identified and proper antenatal care is given, VBAC could be successfully undertaken without any grave maternal and fetal outcomes.

Introduction: Cervical cancer is one of the most common causes of cancer death in the world. It constitutes about one fourth of the total number of female cancers patient in our country. Cervical cancer is the second leading cause of cancer in females in developing countries and first in developed countries. Objective: To assess the level of awareness among the women attending the OPD of DMCH regarding cervical cancer. Materials and Methods: The cross sectional study was conducted among the outdoor patients of Obstetrics & Gynecology wards of Dhaka Medical College Hospital, Dhaka, Bangladesh from 1st July 2015 to 30th December, 2015. The study period was only 6 months. 95 patients included in your study. The aim of the study is to assess the level of awareness among the women attending the OPD of DMCH regarding cervical cancer. The sample was collected from the women attending GOPD of DMCH by random sampling. The sampling was done to select the patient according to the eligibility criteria. Results: This study age of maximum women was within below 30 years and the minimum numbers of women were from above 30 years out of 100 women. The numbers of women in these two categories were 84% and 16% respectively. The mean age and standard deviation of total study population was 24.184 ±6.63years.Maximum respondents of our study received education up to primary level (43%)followed by illiteracy (31%). Risk factors were mentioned as genital infection (15.79%), OCP (21.93%), multiple sexual partners (10.53%), white discharge (21.93%), repeated MR (12.28%), many children in early age (8.77%), smoking (8.77%). They heard of cancer from various sources such as Uthan boithok (28%), electronic & Print media (27%), Miking of VIA camp (25%). A greater percentage of the sample 91% reported having information on cervical cancer. However, when asked to describe cervical cancer 50% of the respondents could not. Of those who had some information about cervical cancer, a greater percentage (32%) of respondents gave a general description of a bad disease or fatal disease of the uterus which is curable when diagnosed early. Conclusion: Cervical cancer is a common female cancer but apt knowledge regarding the risk factors and prevention way of this disease may show excellent response. Keeping that in mind, the country policy maker took many projects to campaign against cervical cancer to improve the awareness of community people. As female of reproductive age are one of the principle group of sufferer of the disease so the research work was operated on the married, unmarried, widow and divorced women of this age group. This study proved that the awareness regarding the disease just now is almost unsatisfactory.

Background: Placenta praevia is one of the leading causes of antepartum haemorrhage usually responsible for significant maternal & fetal morbidity & mortality. Now a day, there is rising trend of caesarean section with parallel rise in placenta praevia specially the major variety where placenta lies in the lower uterine segment partially or completely covering the cervical os. Objective: To see the maternal and perinatal outcome of ultrasonographically diagnosed cases of major variety of placenta praevia with previous caesarean section. Methods: It was a cross sectional descriptive type of observational study conducted in the Obs & Gynae Department of Mymensingh Medical College, Mymensingh over the period of six months from July, 2017 to December, 2017. Total 50 patients were selected for this study after fulfilling the inclusion criteria and diagnosed as major types of placenta praevia by ultrasonography. A purposive sampling technique was applied for selecting the patient with previous caesarean section. Data analysis was implemented using SPSS version 22. Results: The study result shows that 36% cases were Type III placenta praevia and 52% were central placenta praevia. Among 50 patients 54% patients were presented with history of previous one caesarean section & 32% had previous two caesarean section. 50.0% cases of type III & 80.8% cases of central placenta praevia with previous caesarean section needed peripartum hysterectomy. Out of 50 patients, 11 patients were complicated with urinary bladder injury, PPH occurred in 4 patients & 2 patients needed ICU support. That patient who needed hysterectomy massive blood transfusion was required. In this study no maternal mortality was observed. Regarding fetal outcome, 88% babies were alive & 12% were stillborn. Almost two third (66%) neonates were deliverd before term & 08 neonates were transferred to NICU. Conclusion: Placenta praevia is a matter of concern for the obstetrician due to devastating haemorrhage & adverse maternal & fetal outcome. Patients with major variety of placenta praevia with history of caesarean section are regarded as high risk pregnancy & these patients should be managed in the tertiary level hospital by multidisciplinary approach in presence of skilled obstetrician, expert anaesthesiologist, neonatologist, urologist along with all logistical support.

Introduction: Induction of labor is an artificial initiation of uterine activity before the spontaneous onset of labor with the aim of achieving vaginal delivery. To assess the effectiveness of extra amniotic saline infusion and prostaglandin E2 gel for induction of labour. Methods: A randomized, comparative study was conducted in the Department of Obstetrics and Gynaecology, Ayaan Institute of Medical Sciences over a period of 6 month. 260 patients at term with a Bishop's score ≤5 with various indications for induction were randomly allocated to group E (extra amniotic normal saline) and group P (PGE2 gel) with 130 women included in each group. Results: 61.5% of Primi delivered within 12 hrs in the extra amniotic saline infusion group compared to only 44.4% in the PGE2 gel group. 96% of Multi delivered within 12 hrs in extra amniotic saline infusion group compared to only 55.6% in the PGE2 gel. The mean Induction delivery interval in Primi with Extra amniotic saline infusion was 12.34 hrs. The mean Induction to delivery interval in Primi with PGE2 gel was 14.43 hrs. The mean Induction to delivery interval in Multi with Extra amniotic saline infusion was 10.54 hrs. The mean Induction to delivery interval in Multi with PGE2 gel was 13.64 hrs. The difference between the two group is statistically significant. Conclusions: Cervical ripening was more effective in the Extra amniotic saline infusion group when compared to PGE2 group. Oxytocin usage was lower in the Extra amniotic saline infusion group when compared to PGE2 gel group.

Background: Genital Tuberculosis is one of the leading causes of infertility in Bangladesh which is a high tuberculosis burden country. As the patients are mostly asymptomatic and diagnostic tests have low sensitivity and specificity, diagnosis of genital tuberculosis is very much challenging. The aim of this study is to evaluate the patients of genital tuberculosis diagnosed at laparoscopy. Methods: A retrospective study was performed on 12 patients who underwent laparoscopy and hysteroscopy. Cases were analyzed according to history, relevant pre surgery investigation findings, laparoscopic and hysteroscopic findings, histopathology, MTB PCR and Acid-Fast Bacillus (AFB) tests reports. Results: Mean age 25 years, range (22 -33), ten (83.3%) with primary subfertility and two (16.6%) with secondary subfertility. Two had secondary amenorrhea, two women presented with scanty menstrual flow and seven women with regular cycle with average flow and duration. Two (16.6%) had previously completed treatment for pulmonary tuberculosis, 4(33.3%) had history of exposure to tuberculosis patient. Hysterosalpingography showed eleven (91.6%) cases with bilateral tubal block, one (8.3%) with only left tubal block. At laparoscopy all women had tubal involvement, ovarian involvement in 6(50%), frozen pelvis or dense pelvic adhesion in one. At hysteroscopy 11 (91.6%) cases had intrauterine adhesion. Histopathology of endometrial tissue revealed tubercular granuloma in two (16.6%) cases; MTB PCR was detected in 6(50%) cases and acid-fast bacillus was negative in all cases. Conclusions: Laparoscopic and hysteroscopic findings are more suggestive than history, microscopic, histopathological and molecular examination of endometrial tissue in diagnosing genital tuberculosis in infertile women.

Background: Abnormal uterine bleeding (AUB) means any bleeding that is not normal in amount, duration, frequency, and cyclicity. It is a common disorder occurring in reproductive age group females. It can be understood as bleeding that occurs from the uterus outside the normal parameters and there are no structural defects in the genital tract. One of the most common associations with AUB is thyroid dysfunctions. Hence, this study aimed to see the incidence of thyroid-related disorders in AUB and also to assess the menstrual pattern. Methods: A total 145 women suffering from AUB who presented to OPD of the gynecology department of Enam Medical College & Hospital (EMCH), Dhaka, Bangladesh were recruited in the study. All females in 19 to 45 years of age group with abnormal uterine bleeding were included excluding those with a previously known thyroid disorder, abortion history within 3 months, etc. Thyroid function tests were done in all along with ultrasonography of the pelvis region. Data were analyzed using SPSS software v.23.0. and Microsoft office 2007. Results: The bleeding abnormality that was found in most of the women was heavy menstrual bleeding. Out of the 145 patients taken into study 21(14.48%) had thyroid disorders, out of which subclinical hypothyroidism was most prevalent accounting for 16(11.03%) cases, 5(3.45%) cases were found to have hypothyroidism and 2(1.38%) case of hyperthyroidism was detected. Conclusions: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction.

Background: Over last decade progressive increase in the rate of deliveries by cesarean section, is a cause of major public health concern due to potential maternal and perinatal morbidity. The driving factor leading to steady increase in cesarean delivery is not completely understood and there is lack of consensus on the appropriate cesarean section rate. This study will present the cesarean section rate in primigravida at our institute, indications of cesarean section and associated maternal and fetal morbidity. Methods: This was a retrospective study done on primigravida who delivered by cesarean section in the department of Obstetrics and Gynecology, SMBT institute of medical sciences & research center during one-year period. Result: The incidence of cesarean section in primigravida in our study was 29.09%. Most common indication of cesarean section in primigravida was fetal distress 39.81%. Amongst 41 cases of cesarean sections done for fetal distress, 33 cases had spontaneous onset of labor, 5 cases were induced with pgE1. Other common indication of cesarean section was cephalopelvic disproportion in 12.62% of cases, oligohydramnios in 11.65% of cases and breech presentation in 9.71% of cases. Most common antenatal high-risk factor was hypertensive disorder of pregnancy in 18.44% of cases. Blood transfusion and postpartum hemorrhage were the maternal morbidities noted in our study. Common cause for NICU admission was respiratory distress syndrome. Conclusion: Standardization of indications of primary cesarean section at tertiary center level is required. So that sequential annual audit of cesarean sections can help to strategize improvement of antenatal care for the reduction of primary cesarean section rate.

Introduction: Vaginal discharge is one of the most common problems faced by women in reproductive ages. Most of the time it caused by bacteria, fungi or parasites and many times these infections are sexually transmitted. Aim of the study: The aim of this study is to observe the responses of improvement symptoms and to reduce the risk of complication. Methods: This randomized study was conducted in Department of Obstetrics and Gynaecology OPD in Shaheed M. Monsur Ali Medical College and Hospital. Two hundred and nineteen patients were selected with the complaints of vaginal discharge with or without urinary symptoms, pruritus vulvae and lower abdominal pain. Couple were given one day combination kit therapy, containing (Fluconazole 150 mg, Azithromycin 1 gm, Secnidazole 2 gm). They were called after two weeks to know about their outcome of treatment or persisting symptoms. Result: In the study population, 55% women had excellent response for vaginal discharge, 46.8% women had excellent response for urinary symptoms and 62.3% women had excellent response for pruritus vulvae. Most common adverse effects of kit therapy were anorexia 44.54%, metallic taste 32.77% and nausea 38.66%. Conclusion: This strategy has had a considerable impact in decreasing the burden of STD in society with high cure rate for vaginal discharge.