Objective (1) To determine the incidence of near-miss, maternal death and mortality index; (2) to compare nearmiss cases as per WHO criteria with that of maternal mortality; and (3) to study the causes of near-miss and maternal deaths. (2002) 123Methodology A cohort of emergency obstetric admission in the study setting during the study period was followed till 42 days after delivery, and cases fulfilled WHO set of severity markers for near-miss cases for severe acute maternal morbidity (SAMM) and mortality. All maternal deaths during the same period were analysed and compared with near-miss ones. Results During the study period, there were 29,754 emergency obstetric admissions, 21,992 (73.91 %) total deliveries with 18,630 (84.71 %) vaginal deliveries and 3360 (15.28 %) caesarean deliveries. There were 161 nearmiss cases and 66 maternal deaths occurred. The maternal near-miss incidence ratio was 7.56/1000 live births, while maternal mortality ratio was 2.99/1000 live births. Mortality index was 29.07, lower index indicative of better quality of health care. Maternal near-miss-to-mortality ratio was 3.43:1. Amongst near-miss cases, haemorrhage n = 43 (26.70 %), anaemia n = 40 (24.84 %), hepatitis n = 27 (16.77 %) and PIH n = 19 (11.80 %) were leading causes, while causes for maternal mortality were PIH n = 18 (27.27 %), haemorrhage n = 13 (19.79 %), sepsis n = 12 (18.18 %), anaemia n = 11 (16.16 %) and hepatitis n = 11 (16.66 %). Conclusion Despite improvements in health care, haemorrhage, PIH, sepsis and anaemia remain the leading obstetric causes of near-miss and maternal mortality. All of them are preventable. The identification of maternal nearmiss cases using new WHO set of severity markers of SAMM was concurrently associated with maternal death. Definite protocols and standards of management of SAMM should be established, especially in rural Indian settings.

BACKGROUNDInfertility is best defined as the inability to conceive after one year of unprotected regular intercourse. An accurate diagnosis is the key to successful treatment. Laparoscopy is considered the clinical reference test for diagnosing tubal pathology. Laparoscopy allows visualization of periadnexal adhesions and the presence of endometriosis, which cannot be done with HSG. It provides information regarding tubal and ovarian status, uterine normality and standard means of diagnosing various pelvic pathology.

Uterine rupture in pregnancy is rare and often catastrophic obstetric event with a high maternal and perinatal complication rate.1Numerous risk factors are known to increase the risk of rupture, but even in high risk groups, overall incidence of uterine rupture is low around 0.07 %.2 Rupture of unscarred uterus may be caused by trauma or congenital or acquired weakness of the myometrium. Contributing factors include exposure to uterotonic drugs, high parity, uterine anomalies, advancing maternal age, dystocia, marosomia, multiple gestation, abnormal placentation, short pregnancy interval. Most ruptures occur in women who had a previous transmyometrial incision, typically for cesarean delivery.Spontaneous rupture in an unscarred uterus is extremely rare. We present a case of spontaneous third trimester uterine rupture in unscarred uterus with Mullerian anomaly. This is extremely rare case of its own we encountered for the first time in our department.

INTRODUCTIONPregnancy and child birth involve significant health risks, even for women with no pre-existing health problems. Near about one quarter of all maternal deaths are due to haemorrhage: the proportion range from less than 10% to nearly 60% in various countries. 1It has been observed that near about 11% of women having live births have severe PPH (Globally 14 million women per year). About 3.9% of vaginal deliveries and 6.4% of Cesarean section get PPH. Near about 1.4 million women die of PPH every year. Studies have showed that 15-25% of maternal deaths in India are due to PPH.2 About 10% of obstetric hysterectomies are due to PPH. In developing countries PPH is an important cause of maternal mortality and morbidity where about 28% are attributed due to this cause. Methods: The present study was carried out in tertiary care teaching hospital for a period of three years from June 2007-May 2010. A total of 364 study participants who reported to labour ward with labour pains in latent phase and subsequently went in spontaneous labour were enrolled and randomly distributed to two groups and given oral misoprostol and i.v. ergometrine.

Thrombocytopenia is defined as a platelet count below the lower limit of normal range (typically < 150,000/ microL). It is second only to anemia as the most common hematological abnormality encountered during pregnancy. Thrombocytopenia complicates about 7-8% of all pregnancies, especially in third trimester; it most frequently represents a complication not requiring treatment. Evaluation and management of thrombocytopenia during pregnancy and postpartum may be challenging because there are many potential causes, some directly related to pregnancy and some unrelated. For many causes there are no diagnostic laboratory tests. This topic reviews our approaches to determining causes of thrombocytopenia in a pregnant women and its impact on newborns while looking to stratify the risk according to etiology and severity of parturient's hematological condition. In our study Gestational thrombocytopenia was the commonest cause of thrombocytopenia with incidence of 70%, followed by Preeclampsia (22%), HELLP (4%), ITP (2%) and Dengue (2%). Gestational thrombocytopenia is the commonest cause of thrombocytopenia and may not be related to adverse pregnancy outcome, thus can be treated as benign condition. Clinical assessment is most important factor for evaluating a patient with thrombocytopenia. Monitoring of platelet count of pregnant women should be a routine at antenatal visits for timely diagnosis and to achieve favorable feto-maternal outcome in all types of thrombocytopenia. Neonatal platelet count should be done in all mothers diagnosed with thrombocytopenia. After detailed evaluation of the data, we came to the conclusion that with proper care and precautions, readiness to deal with complications, thrombocytopenia does not pose significant impact on maternal and fetal morbidity and mortality when compared to normal population.