OBJECTIVE:The aim of the study was to see the fetomaternal outcome of pregnancy with previous cesarean section. METHODS: This study was conducted in the department of OBGYN, BARC Hospital, Mumbai from October 2011 to September 2012, a period of one year. All the pregnant women with previous one cesarean section attending ANC clinic for confinement were included in the study group after giving consent. RESULTS: Out of total75 cases, a total of 23 patients (30.67%) were given trial of labor. Out of 23 patients given trial of labor, 12 patients (52.17%) had successful VBAC. Commonest indication for unsuccessful trial of labor undergoing repeat cesarean section was nonprogress of labor (54.55%) and failed IOL (36.67%). Out of 12 patients who had successful VBAC, 3 patients (25%) had complication like episiotomy hematoma, perineal tear and cervical tear. No patients had major complications. In present study no baby had apgar score <7 at 1min and 5 min in VBAC group and elective LSCS group. CONCLUSION: The current study concludes that women with a prior cesarean are at increased risk for repeat cesarean section. Vigilance with respect to indication at primary cesarean delivery, proper counseling for trial of labor and proper antepartum and intrapartum monitoring of patients, are key to reducing the cesarean section rates. The antepartum, intrapartum and postpartum complications are more in repeat cesarean section cases. There is no doubt that a trial of labor is a relatively safe procedure, but it is not risk free. Therefore, patient evaluation prior to TOLAC, careful observation throughout labor in a well-equipped unit with around the clock services for emergency surgery and availability of expertise is the backbone for successful VBAC.

OBJECTIVE:To confirm the clinical diagnosis in patient with first trimester bleeding. To evaluate the role of pelvic ultrasound, in management of first trimester bleeding. To correlate the outcome of pregnancy, with fetal activity seen on pelvic ultrasound. METHODS: Study includes all Obstetric cases attending Bhabha Atomic Research Centre and Hospital with history of bleeding per vaginum in first trimester of pregnancy during the study period October 2011 to September 2013. RESULT: In our study we have evaluated 100 cases of bleeding in the first trimester of pregnancy to know the role of ultrasound examination. On mere clinical examination, it was not possible to diagnose many cases correctly. There was a disparity of 72% between clinical and sonological diagnosis. Out of 86 cases clinically diagnosed as threatened abortion only 50 cases were confirmed as threatened abortion by ultrasonography. Rest 36 cases were misdiagnosed clinically. Sonographically diagnosed 50 cases were followed and all 50cases continued as normal pregnancy. 8 cases of these 50 threatened abortions had chorionic hemorrhage in ultrasonography findings, but all 8 cases also continued as normal pregnancy. These 36 clinically misdiagnosed cases were diagnosed correctly on ultrasonography as 12 cases of complete abortion, 4 cases of incomplete abortion, 1 case of inevitable abortion, 11 cases of missed abortion, 1 case of complete mole and 7 cases of blighted ovum. 1 cases of complete abortion was diagnosed by sonography only. 3 cases were clinically diagnosed as incomplete abortion, but only 1 was confirmed on sonography, rest 2 cases were case of missed abortion and blighted ovum. All 8 cases of blighted ovum was ultrasonography diagnosis only. None of them could be diagnosed clinically. 3 cases of ectopic pregnancy were diagnosed clinically and also confirmed on ultrasonography. 1 case of complete mole was an ultrasonography diagnosis only. CONCLUSION: Bleeding per vaginum in the first trimester is one of the most common causes for the majority of emergency admissions to the obstetrics department and also vaginal bleeding is most frequent indication of first trimester ultrasonography. The common causes of bleeding during first trimester include abortions, ectopic pregnancy and molar pregnancy. Ultrasound is a non-invasive, non-ionizing and easily available method of investigation to assess the patients with first trimester bleeding which is highly accurate in diagnosing the actual causes of bleeding and guides the clinician in choosing the appropriate line of management and prevents mismanagement of the cases. Ultrasound can assess some findings which are helpful in predicting the prognosis of the pregnancy. Life threatening emergency like ectopic when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status.

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