BACKGROUND Most commonly done obstetric procedure globally is caesarean section. The incidence of C-section is continuously increasing because risk associated with vaginal delivery after caesarean, previous caesarean section is an important indication for Csection. The purpose of this study was to assess the difficulties during intra-operative period in women who undergo caesarean section repeatedly and also to study the comparison between difficulties with women with previous one caesarean section and women with previous 2 or more C-sections. METHODS It is a prospective observational study conducted on 150 women in the Department of Obstetrics & Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar in women with history of previous caesarean sections (one or more). The women were divided into two groups - Group 1 - Those with previous one caesarean section and Group 2 - Those with previous two or more caesarean sections. RESULTS Out of 150 cases randomly selected and studied who had repeated caesarean section,90 had 1 previous lower segment caesarean section (LSCS), 60 had two or more caesarean sections, the highest number of caesarean sections were performed on women between the age group of 20 - 29 years. Out of these, some cases did not show intra-operative complications, some showed variety of intra-operative complications. Most common type of complications that they came across were adhesions (44 %) in 1 previous LSCS, 65 % in 2 or more LSCS. There were no cases of scar rupture, uterine rupture, bowel injury, caesarean hysterectomy in the study population, probable reason could be that cases were taken elective or taken with a short trial of labour with high level of intrapartum monitoring. CONCLUSIONS Higher incidence of intra-operative complication is seen in women with previous caesarean sections. KEY WORDS Repeat C - Section, Adhesions, Intra-operative Complications

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Objective: To study the risk of adverse pregnancy outcomes in women with polycystic ovary syndrome Design: Population based cohort study. Participants: patient attending OPD in ChalmedaAnand Rao institute of medical sciences 100 births among women with a diagnosis of polycystic ovary syndrome and 100 births among women without such a diagnosis. Main outcome measures: Risk of adverse pregnancy outcomes (gestational diabetes, pre-eclampsia, preterm birth, stillbirth, neonatal death, low Apgar score (<7 at five minutes), meconium aspiration, large for gestational age, macrosomia, small for gestational age), adjusted for maternal characteristics (body mass index, age), socioeconomic factors Results: Women with polycystic ovary syndrome were more often obese. Polycystic ovary syndrome was strongly associated with pre-eclampsia and very preterm birth and the risk of gestational diabetes was more than doubled . Infants born to mothers with polycystic ovary syndrome were more prone to be large for gestational age and were at increased risk of meconium aspiration and having a low Apgar score (<7) at five minutes Conclusions: Women with polycystic ovary syndrome are at increased risk of adverse pregnancy and birth outcomes These women may need increased surveillance during pregnancy and parturition.

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