Background: Vaginal vault prolapse is a common condition following abdominal or vaginal hysterectomy causing negative impact on women’s quality of life. The study compares the efficacy of abdominal and vaginal route surgery in correcting post-hysterectomy vault prolapse by postoperative assessment and at least twelve months follow up.Methods: A prospective comparative study among post-hysterectomy patients attending the GOPD of Midnapore Medical College diagnosed as vaginal vault prolapse at least stage2 between January 2013 to December 2019. The study population included 31 women divided into two groups-group A included 16 women underwent unilateral sacrospinous ligament fixation (SSF) and group B included 15 women underwent abdominal sacrocolpopexy (ASC).Results: There was no significant difference between the two groups in terms of mean age, mean weight, mean parity and BMI, hence both groups are comparable. The mean operating time was 117±19.68 min in ASC group and 83.25±11.28 min in SSF group (p<0.005); significant mean blood loss was reported in ASC group (373±97.79 ml in ASC group versus 193.125±98.97 ml in SSF group, p<0.005), more hospital stays in ASC group (p<0.005) and more post operative complications in ASC group than SSF group. At follow up, the mean vaginal length showed significantly longer for ASC group than that of SSF group (p<0.005).Conclusions: ASC and SSF, both techniques are effective in management of vault prolapse in hands of an expert though recovery time is much quicker in SSF group.

Intact amniotic fluid membranes may serve to protect the extremely fragile preterm infant from some of the mechanical shearing forces caused by strong uterine contraction. A “caul” delivery occurs when part of the amniotic sac is still stuck to the neonate at the time of delivery, usually attached to the cephalic end or podalic end. An “en caul” delivery is a subtype of caul delivery, which occurs when the entire intact amnion (amniotic fluid sac) is delivered with the neonate inside.1,2 This article introduces the technique of “en caul” Caesarean delivery and reviews our experience. Abdominal (or Caesarean) en caul deliveries can be performed intentionally with surgical technique, on contrary to vaginal en caul deliveries, which occur spontaneously; as a result, vaginal en caul deliveries are considered to be rarer though exact statistics are difficult to determine. According to some estimates, caul deliveries would be 1 - 2 %, or roughly 1 in 80,000, of all vaginal deliveries if no membranes were artificially ruptured (ARM / Amniotomy).2,3 Most en caul births are low gravida, premature and low birth weight (LBW). Prematurity is a significant risk factor for various postpartum complications and is hazards. Previous case reports have poorly described pertinent maternal information beyond gestational age at birth (e.g., past medical history, past surgical history, familial history, and demographic data) which could be used to analyse additional risk factors for en caul birth.

Background: The estimates of maternal mortality can only be used as a rough indicator of maternal health situation in any given country. High maternal mortality reflects not only in inadequacy of health care services for mothers, but also a low standard of living and socio economic status of the community. Objective was to assess the maternal mortality ratio (MMR), its probable causes and changing trends.Methods: The present study conducted at Midnapore Medical College (MMC), West Bengal. Data for analysis were collected from medical college record section and maternal death registrar book after having permission from higher authority of the college during the period from January 2009 to 2018 December. Total sample size for this period was 249. Statistical analysis was done through SPSS software.Results: Ten years data analysis of 249 subjects showed that total live births from January 2009 to December 2018 was 1,39,126 with MMR 178.97%. Hypertensive disorder of pregnancy (40.56%) was the leading direct cause of maternal death followed by hemorrhage (24.49%) and septicemia (10.84%). Heart disease (6.42%) was the major indirect cause of death followed by anemia (3.6%). Maternal death rate found high among primi gravida (59.43%) mothers and within 20 years age group (46.18%).Conclusions: Most maternal deaths are preventable by proper antenatal care, early diagnosis of high risk factors, timely referral to tertiary care centre along with community upliftment especially in rural and tribal based population.

Background: Ectopic pregnancy (EP) is the single most important cause of maternal morbidity and mortality in the first trimester and its rising trend throws a great challenge to the obstetrician and gynecologist due to its varied presentation. Aim: To study the incidence, clinical trends, risk factors and surgical management of ectopic pregnancy in a tertiary care hospital. Materials and methods: Retrospective study conducted among the diagnosed cases of ectopic pregnancies admitted during a period of 3 years and a total of 474 cases were studied. Data collected from BHT, Labor ward registers, Gynae ward registrars, Operation Theatre registers, Intensive care unit (ICU) and high dependency units (HDU) records. All the parameters were tabulated and analyzed after data entry. Results: Peak age of incidence were among 26-30 years (32.27%), more common in multigravida (74.69%), commonly presented at gestational age between 6-8 weeks (50.42%) risk factors associated with 73.18% of cases. Most commonly presented with lower abdominal pain (75.31%) followed by short h/o amenorrhea (68.35%). Classical triad presents in 37.97% of cases. Clinically extreme pallor and hemodynamically shock stage presented in 26.58% and 33.33% cases respectively. The commonest site of affection was Ampulla of the tube (50.84%) and most common operation done was Salpingectomy (83.54%). There was no mortality. Conclusions: Early diagnosis and proper management becomes the key of success. High degree of suspicion, identification of risk factors, availability of modern investigations and timely intervention will definitely help to reduce the morbidity and mortality associated with EP.

BACKGROUND Post caesarean section pain requires effective analgesia. Effective analgesia is integral to improvement of quality and patient care among lower segment caesarean section (LSCS) patients. Magnesium, an N-methyl-D-aspartate receptor antagonist along with calcium-channel blocker, has previously been investigated for its analgesic properties. But there is scanty previous literature available for intramuscular magnesium sulphate in the analgesic role in post caesarean mothers. The purpose of this study was to evaluate the effect of existing MgSO4 regimens (among severe pregnancy induced hypertension patients, excluding eclampsia) during early 1st 24 hours’ postoperative analgesic requirements in caesarean section patients comparing to only analgesic group. METHODS It is a retrospective observational study, conducted from January 2019 to June 2020. Patients were randomly selected, normal patients as control = 50 who got post-operative inj. diclofenac 75 mg IM twice a day and rescue analgesia inj. diclofenac 75 mg IM. Test sample comprised of 50 randomly selected severe pregnancy induced hypertension (PIH) patients who got prophylactic inj. magnesium sulphate by Pritchard regimen for 24 hrs. post delivery with 4 gm 20 % inj. magnesium sulphate intravenous with 10 gm 50 % intramuscular in both buttocks as loading dose followed by 5 gm 50 % inj. magnesium sulphate intramuscular 4th hourly for 24 hrs. along with inj. diclofenac 75 mg IM twice a day. Visual analogue scale for pain was noted among both the groups, and were compared for the effect of analgesics in the study groups. RESULTS There was a decrease in analgesic consumption and immediate post-operative pain in the group receiving MgSO4 with analgesic (inj. diclofenac 75 mg), in comparison to control group of inj. diclofenac 75 mg. (P < 0.0001). CONCLUSIONS There was a decrease in analgesic consumption in the group receiving MgSO4 plus analgesic, in comparison to control group (analgesic group). Pain severity assessment 2, 6, 12 and 24 hours post operatively showed that there was a statistically significant decrease in pain scores between the study and the control groups (P < 0.0001). It established the role of magnesium sulphate as an adjuvant analgesic along with diclofenac or other traditionally used pain medications among the post caesarean mothers in early post-operative period. KEYWORDS Analgesia, Pregnancy, Post-Operative Analgesia, Magnesium Sulphate, Lower Segment Caesarean Section (LSCS), Pain Relief, Obstetrics