Background: Caesarean section when indicated is a life saving procedure but when performed without appropriate indications can add risk to both the mother and baby. However over the past 15 years it has been noted that the incidence of caesarean section has doubled all over the world, different regions having different caesarean rates which has become a serious public health issue as morbidity and mortality from an unindicated caesarean section is more than from a vaginal delivery. The present study was done as there are no studies conducted in Northeast, India and in the tribal population to know the rate of primary caesarean section in primigravida & multigravida and to know the aspects which need due attention in either group (primigravida or multigravida) which can be differentiated for better obstetric management. Aim & Objectives: 1) The primary objective is to compare the rate of primary caesarean section in primigravida and multigravida. 2).The secondary objective is to compare the indications, maternal complications, early neonatal outcome in primigravida and multigravida. Material and Method: Study population- This study consisted of two groups, group A consist of 160 primigravida who fulfil the inclusion and exclusion criteria. Similarly, group B consist of 160 multigravida who fulfil the inclusion and exclusion criteria. Inclusion criteria: 1) All primigravida (booked and unbooked) with gestational age more than 37 weeks and above who have come for delivery. 2) Multigravida upto gravida 5 with gestational age of more than 37 weeks and above who has had one previous viable vaginal delivery. Exclusion criteria: 1).Patient with nonviable pregnancy 2) Patient not willing to participate in this study. 3) Patient having previous history of myomectomy or hysterotomy. 4) Gravida 6 and above as they are prone to complications. Results: The overall incidence rate of primary caesarean section rate in this study is 58.75% in primigravida and 31.87% in multigravida. Maximum patients who underwent primary caesarean section were in the age group 20-25years and 25-30 years for both groups. Maximum of the patients were posted for emergency caesarean section 96.8% in primigravida and 94.1% in multigravida. Foetal distress was the commonest indication 54.95% in primigravida and cephalopelvic disproportion 47.92% in multigravida. Intra-operative complications were common in both groups. In multigravida PPH 77.3% was more common. However uterine wound extension 80% was more common in primigravida. The overall post-operative complications were more common in multigravida (25.49%) compared to 13.82% in primigravida. Early neonatal outcome was good in both the groups. There was only 1 neonatal death during the study period in group B. Conclusion: As we have witnessed an increased rise in the rate of caesarean section over the past few years it is our responsibility to bring out the change and modifications and note that the indications indicated for caesarean section should be genuine. From this study, we can also see many females having no antenatal check-up which we can help by creating awareness and importance of antenatal check-up and should train doctors for timely referral of patients to avoid unnecessary complications. The need to better improve skills of obstetricians and staff to read CTG, perform ECV, perform instrumental deliveries especially in second stage of labour, proper counselling of patients and availability of labour analgesia to decrease the rate of caesarean on request. The overall reduction in caesarean rate can only be reduced if the indications of primary caesarean sections can be analyzed.

Background: Cervical cancer ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. Almost 70% of the global burden of cervical cancer falls in areas with lower levels development, and more than one-fifth of all new cases are diagnosed in India. Cancer cervix has been considered preventable because it has a long pre-invasive state and availability of screening programs and treatment of pre- invasive lesion is effective. No form of cancer documents the remarkable effects of screening, early diagnosis and curative therapy on mortality rate in a better way than does cancer cervix. Aim: To compare the diagnostic value of Visual Inspection of Cervix with Acetic Acid with Papsmear for screening of Cervical intraepithelial lesions keeping Histopathology as gold standard. Material and Method: It is a cross sectional and comparative study of 522 women who fulfilled inclusion criteria attending outpatient Department of Obstetrics and Gynaecology at St Philomena’s Hospital for a period of 2 years (December 2016 to November 2018). Both pap smear and VIA are done in these cases. In positive cases, colposcopy guided cervical biopsy done and sent for histopathological studies. All results compiled and analyzed. Sensitivity, specificity, positive predictive value and negative predictive value are calculated and compared for pap smear, visual inspection with acetic acid by taking colposcopy guided cervical biopsy (histopathology) results as gold standard. Result and observations: In the present study , diagnostic values of VIA are comparable with papsmear with sensitivity of 86.6% and 80.6% respectively, specificity of 97.8% and 98.9% respectively, PPV of 85.3% and 91.5 % respectively and NPV of 98% and 97.2% respectively with histopathology as the gold standard. Conclusion: VIA has comparable results to Pap smear regarding its sensitivity, specificity, positive predictive value and negative predictive value and can be used as good alternative to pap smear in mass screening of large population. VIA can be combined with Pap smear to improve the efficacy of screening procedures in detection of pre-cancerous and cancerous lesions of cervix.

Background: The common perinatal complications associated with eclampsia are intrauterine death, intrapartum death, neonatal death, neonatal seizures, and prematurity. Aim: To study the factors affecting perinatal outcome in eclampsia of the south Indian population. Materials and Methods: 50 eclampsia patients (>32 weeks of gestational age) utilized, and the patients with medical complications like anaemia, diabetes mellitus, hypertension, vascular or renal disease, multiple gestations, and polyhydramnios excluded from the study. The patient history followed by physical examination and systemic examination recorded. Results: In 50 cases of eclampsia, 12 perinatal deaths occurred, of which five neonatal deaths (41.6%) and the most common cause for the death are prematurity (60%) in the present study. The majority of perinatal deaths observed in the middle socio-economic group population. The perinatal deaths were significantly higher in unbooked cases. Perinatal mortality increases with parity and found statistically significant. Perinatal mortality was significantly higher in < 36 weeks of gestational ages. Perinatal mortality was considerably higher in patients with the blood pressure of more than 160/100 mm of Hg. Perinatal mortality increases with the number of convulsions and found statistically significant. The perinatal mortality was very high in convulsion delivery interval in more than 24 hours, with an incidence of 30%. Perinatal mortality increases with the duration of labour. The perinatal mortality was more in vaginal delivery (34.4%) in the present study. Conclusion: The better health care facilities, improving socioeconomic status, adequate antenatal supervision will improve perinatal outcome in eclampsia.

Objective: In this study was designed to see the risk factors of UTI in pregnant women and the maternal and perinatal outcome. Methods: In this case control study, women enrolled in antenatal OPD of North East Medical College and Hospital, Sylhet, during July 2020 to December 2020, were randomly allocated into case and control group. The inclusion criteria for pregnant women during the 13th - 26th weeks of pregnancy in the case group was the positive urine cultures of bacteria (more than 10 5 colonies growth in a standard positive urine culture). The same with negative culture was control group. Then parameters such as parity, sexual activity, type of delivery, and infants' birth weight were recorded in questionnaire. Results: Incidence of UTI in mid trimester pregnancy during study period was 26%. Risk factors like previous history of UTI, sexual activity and multipara were higher in case group. Highest age incidence was between 20-30 years. Predominantly patients were asymptomatic. Lower abdominal pain was a common symptom. Eshcherichia coli was commonest organism. Prevalence of bacteriuria was more in women with history of UTI earlier in pregnancy. Premature rupture of membrane was significantly higher in case group. Caesarean section was higher in the case group. According to this study, the average weight of newborns whose mothers had UTI was 2.83 kg and it was 0.44 kg lower than the newborns of healthy mothers. Conclusion: According to the conducted study, UTI in mothers is the major reason for comparatively lower birth weight of infants. Routine urine check during pregnancy is helpful in diagnosing this early and fast care. For better results, more analysis is required.

The triad of uterine didelphys, obstructed hemivagina and ipsilateral renal anomaly known as OHVIRA syndrome, formerly known as Herlyn-Werner-Wunderlich syndrome, is a rare congenital urogenital malformation. It represents a diagnostic dilemma because of the regular menstruation and nonspecific abdominal pain. We present the case of a 13 year old pubertal girl presenting with severe dysmenorrhea. After evaluation with history and investigations she was diagnosed to have bicornuate uterus with hematometrocolpos, left sided hematosalpinx and left renal agenesis. After laparotomy she was diagnosed to have uterine didelphys with left sided hematometra, hematocolpos and ahematosalpinx due to left sided obstructed hemivagina and left renal agenesis (OHVIRA Syndrome). Surgery was done by abdominoperineal route. She had drainage of hematometra, hematocolpos and hematosalpinx and repair of obstructed hemivagina through perineal route. In conclusion, awareness of such anomaly is a prerequisite to early and prompt diagnosis. Surgery should not to be delayed after diagnosis of OHVIRA syndrome, so that complications can be avoided and reproductive function can be preserved.

The aim was to assess women's knowledge and attitudes towards cervical cancer. Materials and methods: This was a descriptive study of transversal type from March to October 2018, i.e. a period of eight months at the reference health center of commune VI. Results: During the study period from March to October 2018, we registered 100 women who agreed to participate in the study as part of cervical cancer screening. The 18-30 age group was the most represented (64%) with extremes of 18 years and 65 years. The average age was 37.90 ± 0.66 years with extremes of 18 years and 65 years. Multiparous people were the most represented with a rate of 37% of cases. Women in school were the most represented with a rate of 67% of cases. Attitudes aspects: Women were in favour of systematic research into cervical cancer with a rate of 68%. Cervical cancer is known as a serious disease by 53% of women. Practical aspects: Cervical cancer screening was not carried out with a rate of 63% and the most cited reason for this non-practice was the lack of information. Thus, the practice of screening depended on information. Cervical cancer screening was more common in the 18-30 age group. The attitude depended on practice as 52% of women who considered cervical cancer a serious disease were in favour of routine screening. Practice depended on knowledge with a statically significant test. Conclusion: Visual inspection methods are simple, inexpensive tests that are easily acceptable to women and the result is systematic at the end of the examination; allowing for effective detection of precancerous lesions of the cervix. However, more than the majority of the women surveyed had no information on screening.

Introduction: Embryo culture allows us to culture embryos to the blastocyst stage. Prolonging the duration of culture to day 5 allows chromosomally competent embryos to develop to the blastocyst stage and permits selection of embryos that have the potential for continued development under embryonic genomic control. Objective: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer. Methods: A randomized, prospective study was conducted in International Fertility Center, Delhi, India on 300 patients aged 25‑40 years undergoing in‑vitro fertilization (IVF)/ intra‑cytoplasmic sperm injection (ICSI) cycle from March 2019 and February 2020. When three or more Grade‑I embryos were observed on day 2 of culture, patients were divided randomly into two study groups, cleavage stage transfer and blastocyst transfer group having 150 patients each. Primary outcomes evaluated were, Clinical pregnancy rate and Implantation rate. The results were analyzed using proportions, standard deviation and Chi‑square test. Results: Both the groups were similar for age, indication and number of embryos transferred. Clinical pregnancies after blastocyst transfer were significantly higher 66 (44.0%) compared to cleavage stage embryo transfer 44 (29.33%) (p< 0.01). Implantation rate for blastocyst transfer group was also significantly higher (p< 0.001). Conclusion: Blastocyst transfer having higher implantation rate and clinical pregnancy rate lead to reduction in multiple pregnancies.

Background: Ovary is a very common site for tumors, both benign and malignant which causes great morbidity and mortality. Ovarian tumors most commonly occur in women of childbearing age. The ovarian tumors manifest a wide spectrum of clinical, morphological, and histological features. The proper management of the patients with ovarian tumor directly depends on the clinical profile the respective patients. Aim of the study: The aim of this study was to evaluate the clinical status of ovarian tumor patients attended a tertiary care hospital in Bangladesh. Methods: This cross-sectional observational study was done at Rajshahi Medical College and Hospital, Rajshahi, Bangladesh during the period from December 2017 to November 2019. In total 240 women with ovarian tumor from several age groups were enrolled as the study people. In each case, information about the patient was collected in a prescribed questionnaire after getting written consent from the patients in a preformed consent form. Results: In analyzing the previous family history of cancer, we observed among total participants only 18% (n=43) had the positive family history of cancer. As the habit of using contraceptive methods we found, the highest number of patients were used to Barrier method (20%). Besides this, 15%, 5%, 11% and 2% participant were using injectables (Irregularly), Natural method, OCP irregularly and Calender method as contraceptive methods respectively. In this study, two third of participants were multipara and the rest one third were nullipara. In analyzing the histopathology reports of participants, as some most potential and/or frequent characteristics we observed mucinous cyst, endometrioma, serous cyst adenoma and dermoid cyst were found among 26.67%, 18%, 16.67% and 13.33% participants respectively. Conclusion: From our study we can conclude that, ovarian tumors are most commonly occurred in middle aged women in the middle-income group. Parous women are most vulnerable in condition for affecting ovarian tumor. Clinical profiling of patients may be helpful in treating and preventing ovarian tumor as well as in awareness building on ovarian tumor to mass people.

Background: A molar pregnancy is also known as hydatidiform mole which is a benign tumour that develops in the uterus. It begins when an egg is fertilized but normal viable pregnancy not occurs, rather than the placenta develops into an abnormal mass of cyst. In all cases of molar pregnancy observation is essential to detect the reawakening of chorionic activity. Objectives: The aim of the study was to explore the incidence, clinical presentation, management and outcome of the molar pregnancy in our hospital. Materials & Methods: This prospective study was conducted in Faridpur Medical College Hospital, Faridpur, Bangladesh and Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka, Bangladesh. Over a period of one year from August 2005 to July 2006. 50 consecutive patients attended the out-patient’s department (OPDD) of obstetrics & gynaecology and were admitted in the department of obstetrics and gynaecology of these two hospitals during this period, were taken as the study population. All pregnant women who were diagnosed as molar pregnancy were included in the study. Other necessary investigations were done if clinically indicated and to prepare the patient for anesthesia. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: During this period total 6550 pregnant patients and 420 patients with abortion and 85 ectopic pregnancy were admitted in both of the hospitals 50 of them were suffering from gestational trophoblastic diseases. So, incidence of gestrational trophoblastic disease was 7.08 per thousand pregnancies. Conclusion: Results from this study showed that a small portion of patient of molar pregnancy came for routine follow up. To achieve high cure rate and low chemotherapy rate an effective registration programme and treatment protocol should be established.