Background: An Intrauterine Fetal Demise (IUFD) is a major obstetrical catastrophe at any gestational age but the emotional pain and distress caused by this event increases in direct relation to the duration of pregnancy. The objective of the present study was to determine the incidence and possible causes of Intrauterine Fetal Demise (IUFD), and to determine preventive measures.Methods: Retrospective observational study was done from Jan 2015 to Dec 2017 at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune. Inclusion criteria were all the pregnant women with IUFD delivered at the centre, at or above 24 weeks of gestation. The methodology followed were parameters of assessment for analysis were maternal age, parity, probable causes for IUFD, booked or unbooked cases, mode of delivery, maternal complications, and placental histopathology. Statistical data were analyzed using SPSS version 25.Results: The incidence of IUFD at authors’ hospital was 27/1000 live births. The IUFD rate was similar in maternal age <20years and >30years (p value 0.26). The incidence of IUFD increased with decreasing gestational age which was statistically significant (p value 0.001). IUFD incidence was higher in multiparous women compared to primiparous women (p value 0.036 with OR of 1.6 and 95% CI 1.02 to 2.54). The rate of IUFD was similar when sex of the baby was analyzed. 49.4% of fetuses had signs of maceration. The major cause of IUFD was severe preeclampsia (48.1%) which included HELLP syndrome, IUGR, Abruption. Maternal anemia (20.4%), GDM (3.8%), SLE (2.5%), APLA positive (2.5%), anhydramnios (6.3%) were some of the other important causes of IUFD.Conclusions: This study was conducted to determine the incidence of IUFD and associated maternal risk factors. By understanding the contributing factors, we can seek ways of avoiding recurrence of IUFD by proper antenatal care and early diagnosis of obstetric complications and its appropriate management.

Background: Preterm birth is defined as birth between the age of viability and 37 completed weeks of gestation. The aim of this study is to evaluate the safety and efficacy of nifedipine, a calcium channel blocker, as a tocolytic in prolonging duration of pregnancy in case of preterm labor.Methods: This is a retrospective analytical study conducted in Department of Obstetrics and Gynaecology, SKNMC and GH, Pune, India conducted over a period of one year from June 2014 to May 2015. All uncomplicated, singleton preterm labor cases were given Cap. Nifedipine as tocolytic and Inj. Betamethasone for enhancing fetal lung maturity. Maternal parameters studied were Gravida and Parity, previous history of preterm labor, gestational age at delivery, mode of delivery, side effects. Neonatal parameters studied were weight at birth, APGAR score at birth, complications at birth, NICU admissions, mortality.Results: Out of total 4478 deliveries from June 2014 to May 2015, 252 women with preterm labor were treated with nifedipine. 214 out of 252 delivered at term with overall success rate of 84.92%. Out of remaining 38 cases, 36 cases delivered as preterm normal deliveries and 2 required Caesarean section. No major side effects observed in mothers receiving nifedipine. As regards neonatal outcome, 12 babies required NICU admission and mortality was of 2.Conclusions: Nifedipine is safe and effective in prolonging preterm labor and has minimal maternal and neonatal side effects. It eliminates the need for intensive maternal monitoring as required in case of betamimetics.

Aim and objective: To estimate the outcomes of enhanced recovery after surgery (ERAS) protocol implementation in perioperative elective cesarean patients. Study design: Cross-sectional study was conducted from January 2020 to December 2021 at a tertiary healthcare center. During the study period, ERAS protocol was implemented on elective cesarean deliveries at the study institution to find out the time to first ambulate, incidence of urinary retention, total intravenous (IV) fluids in the postoperative period, tolerability of early oral intake, hospital stay, readmissions for maternal cause, and the complications up to 30 days postpartum. Results: In total, 150 cases were enrolled in the study. Six hours 23 minutes was the mean ambulation time, and all patients started ambulation within 10 hours of surgery. There were no cases of urinary retention. About 132 patients needed 1500 mL of IV fluids in the postopertive period. About 146 postoperative patients tolerated a 2-hour liquid diet. The postoperative length of stay was 3 days 3 hours with 11 cases of postoperative complications with 3 cases requiring readmission. Conclusion:The implementation of ERAS protocols in elective cesarean delivery has shown favorable outcomes with minimal complications and readmission. Early resumption of oral feed was well-tolerated and led to a reduced need for IV fluids. Early removal of the catheter aided in early ambulation and without undue retention of urine. Early discharge is beneficial for the patient to reduce hospital-acquired infections and bed turnover in limited-bedded hospitals. Enhanced recovery after surgery protocol can be implemented in low-risk elective cases posted for cesarean delivery in Government hospitals.

Background: Though the most common reasons for medical termination of pregnancy (MTP) is unwanted pregnancy due to nonuse of contraceptives by the women of reproductive age group and other are pregnancy before marriage or due to rape. Several studies indicate that most abortions are sought to limit family size or space the next pregnancy. There is need to study relation of MTP with contraceptive practices.Methods: The present cross-sectional study was conducted at Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, to study socio-demographic factors associated with medical termination of pregnancy and its relation with contraceptive practices. Total 1840 women seeking care for medical termination of pregnancy were interviewed after their informed consent during period of January 2015 to December 2017. A detailed history regarding age, religion, income, marital status, parity, history of previous MTP, indications for MTP, use of contraception, gestational age was taken.Results: Statistical analysis-chi square test of significance for qualitative data using SPSS software version 24.0. The proportion of women coming for MTP due to nonuse of contraceptives was 86% the other indications for MTP were medical condition (9%) and contraceptive failure (5%). The factors like age, religion, education and socioeconomic status were significantly associated with MTP.Conclusions: There is need to counsel women of reproductive age group that MTP is not a way to control unwanted birth.

Background: Instrumental or assisted vaginal birth is commonly used to expedite birth, for the benefit of either mother, baby or both. Objective of present study was to evaluate risk factors for unsuccessful vacuum delivery when variability between individual accoucheurs is taken into account.Methods: We conducted a retrospective cohort study of attempted 687 vacuum deliveries over a 10-year period (2008–2017 inclusive) in a tertiary care center at Smt. Kashibai Navale Medical College and General Hospital, Narhe to account for inter-accoucheur variability, we matched unsuccessful deliveries (cases) with successful deliveries (controls) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful vacuum deliveries.Results: During the study period of 10 years, there were 29861 deliveries, of which 19831 (66.4%) were vaginal deliveries. 8802 (29.47%) were cesarean deliveries and 1228 (4.1%) were instrumental deliveries. Among instrumental deliveries, 687 (56%) were vacuum deliveries and 541 (44%) were forceps deliveries. Six hundred and eighty-seven ventouse deliveries of vertex presenting, single, term infants were attempted, of which 38 were unsuccessful (5.5%). Increased birth weight (OR=1.11 p<0.001), second-stage duration (OR=1.01 p<0.001), rotational delivery (OR=1.52 p<0.05) and use of ventouse versus forceps (OR=1.33 p<0.05) were associated with unsuccessful outcome. When inter-accoucheur variability was controlled for, instrument selection and decision to rotate were no longer associated with vacuum delivery success. More senior accoucheurs had higher rates of unsuccessful deliveries (12% v. 5%, p<0.05), but undertook more complicated cases. Cesarean delivery in the second stage without prior attempt at ventouse delivery was associated with higher birth weight (OR=1.07 p<0.001), increased maternal age (OR=1.03 p<0.01), and epidural analgesia (OR=1.46 p<0.001).Conclusions: Careful selection of cases and adequate training of post graduate students during residency under direct supervision of senior experienced obstetrician can reduce the rate of failed vacuum delivery and related complications Results suggest that birth weight and head position are the most important factors in successful vacuum delivery, whereas the influence of patient selection and rotational delivery appear to be operator-dependent. Risk factors for lack of vacuum delivery success are distinct from risk factors for requiring vacuum delivery, and these should not be conflated in clinical practice.