Background:The study of intraoperative difculties in extraction of baby in previous cesarean section Method:This is a tertiary centre based prospective observational study conducted in the department of Obstetrics and Gynaecology, at our tertiary health Care hospital between the study period October 2018-september 2020.A total 1200 cases of patients with previous cesarean section were studied . They are divided into number of previous scar and the intraoperative surgical difculty encountered by the surgeon in delivering the baby based on the consequences of scar from previous cesarean section. Results: The incidence of repeat cesarean section being 9.4%, among which only of 38% cases were encountered with difculties in cesarean section by the surgeons in the institute. Among which 26.3% cases were encountered with Adhesions,4.2% with difculty in delivery of baby, 1.5% cases needed assistance by senior surgeon in delivering baby and 6% among that had poor perinatal outcome. Conclusions: The common clinical entity of “previous cesarean section” in subsequent pregnancies, giving a high risk pregnancy status to the reference pregnancy. The risks associated with repeat cesarean section can be reduced by many measures including-vigorous ANC surveillance to reduce the risk of primary CS, intervention by operative vaginal delivery whenever needed, giving trial of labor in cesarean section(TOLAC) with skilled monitoring, counselling of patients regarding perineal exercises in pregnancy. Most complications will be recognized at the time of operation and easily corrected either by the operating surgeon or by seeking assistance from other specialties

Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified or untrained person. CASE: A 20 year old primigravida with 6 months ANC was referred to our hospital with the USG of uterine rupture and with a history of Dilation and curettage i/v/o anomalous baby, was in septic shock. There was also evidence of Sigmoid colon perforation. As a life saving measure Obstetric hysterectomy with colostomy done. Unsafe CONCLUSION: abortions are still in practice which has led to increased rate of mortality and morbidity. surgical intervention on a uterus of more than 20 weeks can be hazardous and should be terminated wisely.

Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: This was a tertiary care based Observational Prospective Study design conducted between October 2018 to September 2020 to nd magnitude, morbidity associated with Obstetric haemorrhage. To study various Maternal outcomes and intervention for management of maternal near miss cases. Total 350 samples were selected by using concurrent sampling method for maternal near miss cases at tertiary care centre and who met the designed set of criteria. Result: Most common cause of MNM observed was Atonic PPH 224 (64%). 242 (69.14%) cases required blood transfusion and mean and SD of blood transfused was 10.98 ± 1.04. In our study, hemodynamic compromise was common cause of Systemic dysfunction, most common system involve in MNM observed was haematological 185 (52.86%). Overall, 218 (62.28%) cases required ICU monitoring. 166 (47.42%) cases needed emergency LSCS, Obstetric hysterectomy was performed on 56 (16%) of cases whereas 47 (13.43%) cases undergone Exploratory Laparotomy. The most common problem encountered by patients prior to hospital admissions was the unavailability of treatment at lower-level health facilities, affecting 248 out of 350 of study participants. Conclusion: Concluded from this study that Post-Partum Haemorrhage were the most common cause maternal morbidity in the study group. “Near-Miss” morbidity in PPH reect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.