To study the drug utilization pattern and risk factor assessment on abnormal uterine bleeding in reproductive-aged women in a tertiary care hospital at Salem district, Tamil Nadu, India. This retrospective study was carried out for a period of 6 months from November 2017 to April 2018 in which 150 prescriptions were selected for study by considering the inclusion and exclusion criteria. A total of 150 prescriptions were analyzed in reproductive-aged women. Patients of age group between 41-50 years were mostly diagnosed 75 (50%) of abnormal uterine bleeding. Considering the types of AUB, most of the patients (39.33%) which has been diagnosed as adenomyosis while 59 (32.67%) of the patient has been diagnosed leiomyoma 49 (32.67%). Anaemia 102 (68%) are the most seen co-morbid condition in our survey, along with Hypertension 28 (18.6%), Infective disorders 28 (18.6%). Our findings showed that among the drugs prescribed, that antifibrinolytics were the most often prescribed drug class for AUB, and the most prescribed drug is tranexamic acid. Perimenopause 57 (38%) is the main risk factor in abnormal uterine bleeding, along with dysfunctional uterine bleeding 47 (32.6%). From we concluded that The mostly used class of drug for abnormal uterine bleeding in our tertiary care hospital is antifibrinolytics and mostly used drug agent is tranexamic acid during the period of data collection. It is found to be that perimenopause is the main risk factor in abnormal uterine bleeding along with dysfunctional uterine bleeding.

Background: Twins carry significant risks to both mothers and babies. The purpose of this study was to evaluate chorionicity and its impact on perinatal outcomes in twins.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Government T. D. Medical College, Alappuzha, Kerala. A total of 106 cases of twin pregnancies were included in the prospective descriptive study. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the cases were divided into the twin group with monochorionic diamniotic (MCDA) and twin group with dichorionic diamniotic (DCDA group). The relationships of different chorionic properties and fetal outcomes were determined by comparing various fetal outcomes.Results: Among 106 twin pregnancies, 61.3% were DCDA twins, 38.7% were MCDA. Average maternal age of monochorionic twin was 25 and that of dichorionic twin was 27. Perinatal mortality of monochorionic twin was 14.7% when compared to 8.6% for dichorionic twin. The mean gestational age for monochorionic twin pregnancy was 34.78 weeks whereas it was 35.91 weeks for dichorionic pregnancy. Elective and emergency LSCS was done more for dichorionic twin pregnancies compared to monochorionic twin pregnancies. Low Apgar scores were seen in monochorionic twins compared to dichorionic twins.Conclusions: The incidence of fetal outcomes in the monochorionic group was inferior to those in the dichorionic group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention.

Background: Induction of labour is defined as initiation of uterine contractions before spontaneous onset of labour. This observational study compares the effect of prostaglandin E2 (PGE2) and extra amniotic saline infusion (EASI) for pre-labour ripening of unfavourable uterine cervix.Methods: This was a prospective study conducted on 100 pregnant women with gestational age ≥37 weeks during a year period in the department of obstetrics and gynaecology of government TD medical college, Alappuzha, Kerala. The period of study was for one year from June 2002 to July 2003. All patients were divided into two groups. Group-1 contains 47 patients who received intracervical PGE2, (Dinoprostone gel, 0.5 mg). Group-2 contains 53 patients who were induced with EASI. The main outcome variables were the number of subjects with favourable Bishop's score, mode of delivery, maternal complications and neonatal outcomes.Results: Majority of the patients in both the groups were in the age of 21-30 years. There was significant difference in age, parity and gestational age of both groups. In this study it was found significant difference in the occurrence of hyper stimulation among PGE2 and EASI; whereas, there was no significant difference in the occurrence of maternal pyrexia among two groups. High incidence of caesarean section was found in EASI. APGAR score of new born babies was high in labour induced with PGE2.Conclusions: PGE2 and EASI have similar efficacy in induction of labour, but EASI is associated with more side effects. Cost wise EASI is more cost effective than PGE2.

BACKGROUND Twin pregnancy is associated with a high risk of maternal morbidity and mortality. Gestational hypertension, preterm labour, preterm premature rupture of the membranes (PPROM), and postpartum haemorrhage (PPH) are higher in twins. However, little is known about the differences in maternal risks in monochorionic and dichorionic twins. We wanted to study the effect of chorionicity on maternal complications. METHODS A prospective, descriptive study was conducted in the Department of Obstetrics and Gynaecology, TDMC, Alappuzha for eighteen months. All patients with twin pregnancies admitted to TDMC, Alappuzha with gestational age of more than 24 weeks were included in the study. RESULTS The incidence of twin pregnancy was 1.5 %. The incidence of monochorionic twins was 38.7 % and dichorionic twins was 61.3 %. Preterm labour was the commonest complication in both monochorionic and dichorionic twins and the incidences were comparable. Maternal pyrexia, UTI, PPH and postpartum depression were the common maternal morbidities encountered in both groups. The incidence of PPH was 10 % in monochorionic twin pregnancies and 5 % in dichorionic twin pregnancies. Maternal bed days for dichorionic twins were higher than monochorionic twins. CONCLUSIONS Preterm labour was the commonest complication in both types of twins with comparable incidence. Gestational hypertension was the second common complication in both. Caesarean section rate was higher in dichorionic twins than monochorionic twins i.e., 63 vs. 41.5. Maternal pyrexia was found in 12 % of cases, the most common postpartum morbidity. Mean maternal bed days for dichorionic twins were found to be higher than monochorionic twins.13.4 vs. 8.85. KEY WORDS Twins, Monochorionic, Dichorionic, Maternal Morbidity.

Background: Gestational trophoblastic disease encompass a spectrum of neoplastic disorders that arise from placental trophoblastic tissue after abnormal fertilisation. Most molar pregnancies spontaneously resolve after uterine evacuation with no further sequelae. However, at any time during or after gestation malignant transformation may occur in approximately 10% to 20% of molar pregnancies. Quantification of βHCG is considered as the ideal method of post molar surveillance. The regression of the disease could be reliably assessed by observing the changes in low resistance flow which paralleled the gradual decrements in serial βHCG levels. To correlate uterine artery blood flow characteristics to serum βHCG levels in the follow up of patients with gestational trophoblastic disease after molar evacuation.Methods: 50 patients with gestational trophoblastic disease after evacuation were followed up by serum βHCG titres and Doppler ultrasonography of uterine arteries. The relationship between the Doppler indices and the serum βHCG titres were evaluated by paired –t test and Pearsons correlation analysis.Results: Significant negative correlations were observed between Systolic/Diastolic (S/D) ratios, Resistance Indices(RI) and Pulsatility indices (PI) and the absolute values of serum βHCG levels, with correlation coefficients of -0.5, -0.46 and -0.40 (p<0.01). The mean values of βHCG showed a decreasing trend from 1st week to 4th week. The mean value of RI, PI and S/D Ratio showed an increasing trend from 1st week to 4th week. However, the difference in mean values of βHCG and Doppler indices at 1st week and 4th week were analysed by paired t test and found to be statistically insignificant(p>0.05) in patients with spontaneous remission.Conclusion: Uterine artery Doppler indices can be used as an adjunct to βHCG for the surveillance of patients with gestational trophoblastic disease after molar evacuation to predict remission of the disease.